Posttraumatic stress disorder: prevalences, comorbidities and quality of life in a community sample of young adults

Objectives To verify the prevalence of current posttraumatic stress disorder (PTSD) in young adults, the occurrence of comorbidities and its association with quality of life. Methods This is a cross-sectional population-based study. The targeted population consisted on individuals aged 18 to 24 years old, who lived in the urban area of Pelotas-RS, Brazil. Cluster sampling was applied. PTSD and its comorbidities were assessed using the Mini International Neuropsychiatric Interview (MINI 5.0), whereas quality of life was evaluated with the eight domains of the Medical Outcomes Survey Short-form General Health Survey (SF-36). Results A total of 1,762 young adults were selected. The prevalence of PTSD was 2.1% and current episode of depression was the most prevalent comorbidity (71.9%). The individuals with PTSD had lower scores in all domains of quality of life. Conclusion These findings indicate that PTSD is associated with other psychopathologies, especially depression, and it has a substantial impact over quality of life in a sample of young adults.

Associated factors to empyema in post-traumatic hemotorax

ABSTRACTObjective:to analyze the associated factors with empyema in patients with post-traumatic retained hemothorax.Methods:prospective observational study. Data were collected in patients undergoing PD during emergency duty. Variables analyzed were age, sex, mechanism of injury, side of the chest injury, intrathoracic complications of RH, laparotomy, specific injuries, rib fractures, trauma scores, days to diagnosis, diagnostic method of RH, primary indication of PD, initial volume drained, length of the first tube removal, surgical procedure. Cumulative incidence of empyema, pneumonia and pulmonary contusion and the proportion of patients with empyema or without empyema in each category of each variable analyzed were obtained.Results: the cumulative incidence of PD among trauma patients was 1.83% and the RH among those with PD was 10.63%. There were 20 cases of empyema (32.8%). Most were male in the age from 20 to 29, victims of injury by firearm on the left side of the thorax. The incidence of empyema in patients with injury by firearms was lower compared to those with stab wound or blunt trauma; higher among those with drained volume between 300 and 599 ml. The median hospital lenght of stay was higher among those with empyema.Conclusion:the incidence of PD was 1.83% and RH was 10.63%, these results are consistent with the low severity of the patients involved in this study and consistent with the literature. The incidence of empyema proved to be negatively associated with the occurrence of injury by firearms and positively associated with a drained volume between 300 and 599 ml, compared with lower or higher volumes.

A Brazilian version of the "Children's Interview for Psychiatric Syndromes" (ChIPS)

OBJETIVE: The advance of research in child and adolescent psychiatry in Brazil heavily depends on the existence of instruments for the investigation of psychiatric syndromes adapted to Brazilian Portuguese. METHODS: This article describes a careful process of translation of the Children's Interview for Psychiatric Syndromes for the purpose of use in research in Brazil. The Children's Interview for Psychiatric Syndromes has a version for parents (P-ChIPs) and a version for children (ChIPS). In this article, the sections of P-ChIPS referring to attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, mania/hypomania, anorexia nervosa, bulimia nervosa and psychotic disorders were translated to Brazilian Portuguese. The sections of the ChIPS referring to substance use disorders, social anxiety disorder, specific phobias, obsessive-compulsive disorder, generalized anxiety disoder, separation anxiety disorder, post-traumatic disorders and depression/dysthimia were also adapted. Each section was translated by two independent translators and later discussed in a committee composed of experts in the field of Psychiatry and a professional of the field of linguistics. RESULT: A final version containing an interview for the main psychiatric syndromes was defined. CONCLUSION: The translated P-ChIPS is a helpful instrument in children and adolescent clinical evaluation.

Parto traumático e transtorno de estresse pós-traumático: revisão da literatura

OBJETIVO: Esta revisão da literatura tem como objetivo verificar a prevalência e os fatores de risco do parto traumático e do transtorno de estresse pós-traumático (TEPT) relacionado com o parto. MÉTODOS: Foi realizada uma pesquisa nos bancos de dados PubMed e BIREME, com as expressões "traumatic birth", "traumatic delivery", "postpartum posttraumatic stress disorder", "childbirth", "stress disorder" e avaliados estudos de 1994 a 2009. RESULTADOS: Três estudos qualitativos e quatro quantitativos sobre o parto traumático mostram que sua prevalência varia de 21,4% a 34% e que a mulher apresenta, durante o trabalho de parto ou o parto, medo intenso de sua morte ou do bebê, além de impotência, desamparo e horror. O parto traumático está relacionado a partos dolorosos, com procedimentos obstétricos de urgência e com assistência inadequada da equipe de saúde. Quanto ao TEPT relacionado com o parto, foram encontrados um estudo qualitativo e doze quantitativos e sua prevalência variou de 1,3% a 5,9%. Mulheres que apresentaram sintomas dissociativos ou emoções negativas no parto, que tiveram eventos traumáticos prévios, depressão na gestação e que tiveram pouco suporte social e pouco apoio da equipe de saúde são as mais vulneráveis para TEPT pós-parto. CONCLUSÃO: O parto traumático, apesar de pouco conhecido, não é um evento raro e traz consequências negativas para a vida da mulher, podendo inclusive ser sucedido de TEPT. A equipe de saúde que assiste mulheres no periparto deve estar preparada para prevenir e identificar esses casos.

Effect of different substrates in aquaponic lettuce production associated with intensive tilapia farming with water recirculation systems

ABSTRACT The integration of fish farming in intensive system and plant production, called "aquaponics" is practiced successfully in countries like the USA, Australia and Europe. In Brazil, this integration has attracted the attention of researchers and producers. In this context, the aim of this study was to evaluate the effect of two substrates (crushed stone number 3, CS III and flexible polyurethane foam, FPF) on the production of aquaponic lettuce, moreover, to show that the residual water from intensive tilapia production provides sufficient qualitative characteristics for competitive production of lettuce without adding commercial fertilizers. The treatment in which FPF was used provided higher concentrations of macro and micronutrients in the shoots, higher production of fresh matter of shoots (95.48 g plant-1) and a larger number of leaves (14.90) relative to CS III. These results were attributed to the lower post-transplanting stress and the higher water retention time provided by the FPF. The residual water from tilapia intensive farming can provide sufficient nutrients for the production of lettuce, making the supplementary fertilization with commercial products unnecessary. Thus, the FPF presents the most suitable conditions to be used as substrate in aquaponics system with recirculation of the residual water from the intensive tilapia farming.

Pneumopericárdio após traumatismo penetrante: relato de três casos

Pneumopericardium after penetrating wound represents a high suspicion for cardiac wound. Some authors recommend thoracotomy to discharge a cardiac lesion. We present three cases of post-traumatic pneumopericardium one following a gunshot wound and two following a stab wound and discuss about diagnosis and treatment. None showed clinical signs of cardiac tamponade. Diagnosis was made by chest x-ray. Pneumopericardium was identified at the initial evaluation in two patients, who had concomitant hemothorax and underwent chest drainage. The patient with penetrating thoracic wound by gunshot pneumopericardium developed 24h after trauma. Treatment was directed to the associated lesions without specific measurements for pneumopericardium. This aproach was safe in these patients.

Hérnia traumática do pulmão

Traumatic lung herniation is an unusual clinical problem. We present a case of a large left post-traumatic lung hernia on the left, anterior, second intercostal space following blunt chest trauma. An important factor in the etiology of these lesions is the relative lack of muscular support of the anterior part of the chest. This report describes the diagnosis and management of a post-traumatic lung hernia.

Aplication of videothoracoscopy in trauma - experience of a service

Objective: To evaluate patients with chest trauma submitted to videothoracoscopy during hospitalization. In 2007, the Trauma Surgery Group was created in the General Surgery Department of the Hospital Municipal Lourenço Jorge of Rio de Janeiro-RJ, and started following all trauma victims who were admitted to the Hospital. Methods : We conducted a retrospective analysis of patients submitted to thoracoscopy from July 2007 to May 2015, based on a database started at the beginning of this period and on data collection from patients who underwent thoracoscopy. We evaluated the following parameters: procedure effectiveness, indication of the procedure, conversion rate, complications and mortality. We included patients who presented post-traumatic pleural collections, such as retained hemothorax and pleural empyema, and penetrating injury in the thoracoabdominal transition. All patients were hemodynamic stable and signed an informed consent. Results: In the analyzed period 53 patients were submitted to videothoracoscopy; 24 had penetrating trauma (45.3%) and 29, blunt (54.7%), with a predominance of males (75.5%). The procedure was performed in 26 cases of retained hemothorax (49%), 14 cases of empyema (26.5%) and in 13 patients for evaluation of injury in the thoracoabdominal transition (24.5%). The thoracoscopy was effective in resolution of 36 cases (80%), without need for further procedure. There was a conversion rate of 15.5% and 3 procedure complications related (6.6%). Mortality was nil. Conclusion: In this series, videothoracoscopy proved that this diagnostic and therapeutic procedure is safe and effective, if performed by a surgeon with appropriate training, especially when it is indicated in cases of retained hemothorax and evaluation of penetrating thoracoabdominal trauma.

Post-Hospital Syndrome: A New Challenge in Cardiovascular Practice

AbstractThe image of the hospital representing the modern medicine and its diagnostic and therapeutic advances becomes more evident in the face of an aging population and patients with multiple comorbidities requiring highly complex care. However, recent studies have shown a growing number of hospital readmissions within 30 days after discharge. The post-hospital syndrome is a new clinical entity associated with multiple vulnerabilities that contribute to hospital readmissions. During hospitalization, the patient is exposed to different stressors of physical, environmental, and psychosocial natures that trigger pathophysiological and multisystemic responses and increase the risk of complications after hospital discharge. Patients with a cardiac disease have high rates of readmission within 30 days. Therefore, it is important for cardiologists to recognize the post-hospital syndrome since it may impact their daily practice. This review aims at discussing the current scientific evidence regarding predictors and stressors involved in the post-hospital syndrome and the measures that are currently being taken to minimize their effects.

Reduction in Post-Marathon Peak Oxygen Consumption: Sign of Cardiac Fatigue in Amateur Runners?

Abstract Background: Prolonged aerobic exercise, such as running a marathon, produces supraphysiological stress that can affect the athlete's homeostasis. Some degree of transient myocardial dysfunction ("cardiac fatigue") can be observed for several days after the race. Objective: To verify if there are changes in the cardiopulmonary capacity, and cardiac inotropy and lusitropy in amateur marathoners after running a marathon. Methods: The sample comprised 6 male amateur runners. All of them underwent cardiopulmonary exercise testing (CPET) one week before the São Paulo Marathon, and 3 to 4 days after that race. They underwent echocardiography 24 hours prior to and immediately after the marathon. All subjects were instructed not to exercise, to maintain their regular diet, ingest the same usual amount of liquids, and rest at least 8 hours a day in the period preceding the CPET. Results: The athletes completed the marathon in 221.5 (207; 250) minutes. In the post-marathon CPET, there was a significant reduction in peak oxygen consumption and peak oxygen pulse compared to the results obtained before the race (50.75 and 46.35 mL.kg-1 .min-1; 19.4 and 18.1 mL.btm, respectively). The echocardiography showed a significant reduction in the s' wave (inotropic marker), but no significant change in the E/e' ratio (lusitropic marker). Conclusions: In amateur runners, the marathon seems to promote changes in the cardiopulmonary capacity identified within 4 days after the race, with a reduction in the cardiac contractility. Such changes suggest that some degree of "cardiac fatigue" can occur.

Work-related stress according to the demand-control model and minor psychic disorders in nursing workers

This was a cross-sectional study that aimed to assess the association between work-related stress according to the Demand-Control Model, and the occurrence of Minor Psychic Disorder (MPD) in nursing workers. The participants were 335 professionals, out of which 245 were nursing technicians, aged predominantly between 20 and 40 years. Data were collected using the Job Stress Scale and the Self-Reporting Questionnaire-20. The analysis was performed using descriptive and analytical statistics. The prevalence of suspected MPD was 20.6%. Workers classified in the quadrants active job and high strain of the Demand-Control Model presented higher potential for developing MPD compared with those classified in the quadrant low strain. In conclusion, stress affects the mental health of workers and the aspects related to high psychological demands and high control still require further insight in order to understand their influence on the disease processes of nursing workers.

Pre-and post-puberty physiological plasma oxytocin concentrations in male domestic cats (Felis silvestris catus)

The hormone oxytocin is released by the neuropituitary gland through stimulation of the neurons of the supraoptic and paraventricular nuclei of the hypothalamus. In order to determine the physiological concentrations of this hormone in domestic cats, blood samples were collected from 15 male animals (Felis silvestris catus) during the pre- and post-puberty periods (at four and eight months of age, respectively). Oxytocin determination was accomplished by radioimmunoassay. The average oxytocin concentrations measured in the pre- and post-puberty periods were 2.54±0.24 (μg/dL) and 2.53±0.28 (μg/dL), respectively, and there were no statistical differences between these measurements. Because there are few literature on the analysis of this hormone, especially in the case of male Felis silvestris catus, more studies on the influence of oxytocin on the physiology and reproduction of this species should be conducted under maintenance and situations of stress (such as transportation), and other routine events.

Sexual behavior and fertility of male rats submitted to prolonged immobilization-induced stress

In order to investigate whether prolonged stress interferes with the onset of sexual behavior at puberty and with fertility at adulthood, prepubertal male Wistar rats (40 days of age) were immobilized 6 h a day for 15 days (up to early puberty) or for 60 days (until sexual maturity). Pubertal stressed rats showed a two-fold increase in the latency for the first mount (probably due to repeated aversive experience in which a change of environment was always followed by immobilization) and a 2.5-fold increase in the frequency of thrusting (indicative of enhanced sexual performance). The apparently stimulatory effect of prolonged stress on the onset of sexual behavior is discussed in terms of increased testosterone level and interference with the complex interchanges between the neurotransmitters/neuropeptides involved in the central control of male sexual activity. Adult stressed animals were mated with normal females, which became pregnant but exhibited a more than two-fold increase in both pre-implantation and post-implantation loss, probably due to a smaller rate of fertilization and/or fertilization with damaged spermatozoa.

The growing competition in Brazilian science: rites of passage, stress and burnout

Brazil's scientific community is under pressure. Each year there is an increase in its contribution to international science and in the number of students who are trained to do research and teach at an advanced level. Most of these activities are carried out in state and federal universities, but with government funding that has decreased by more than 70% since 1996. Interviews with graduate students, post-doctoral fellows and professors in one university department with a strong research tradition illustrate the level of stress engendered by the conflict between increasing competition and diminishing resources, and serve to underscore the negative effects on creativity and on the tendency to choose science as a career.

Routine post-weaning handling of rats prevents isolation rearing-induced deficit in prepulse inhibition

Rats reared under isolation conditions from weaning present a number of behavioral changes compared to animals reared under social conditions (group housing). These changes include deficits in prepulse inhibition (PPI) of the startle reflex to a loud sound. PPI refers to the reduction of the magnitude of the startle reflex when a relatively weak stimulus (the prepulse) precedes by an appropriate time interval the intense startle-elicing stimulus (the pulse). PPI is useful for studying sensorimotor integration. The present study evaluated the effect of handling on the impairment of PPI induced by isolation-rearing. Male Wistar rats (N = 11-15/group) were housed in groups (5 per cage and handled three times a week) or isolated (housed individually) since weaning (21 days) for 10 weeks when they reach approximately 150 g. The isolated rats were divided into "minimally handled" animals (handled once a week for cleaning purposes only) or "handled" animals (handled three times a week). This handling consisted of grasping the rat by the tail and moving it to a clean cage (approximately 5 s). A statistically significant reduction (52%) in the PPI test was found only in the isolated group with minimal handling while no difference was seen between grouped animals and isolated handled animals. These results indicate that isolation rearing causes disruption in the PPI at adult age, which serves as an index of attention deficit. This change in the sensory processing of information induced by post-weaning isolation can be prevented by handling during the development of the animal.