Alisson Roberto Teles

Consistency and reliability of the Brazilian Portuguese version of the Mini-Sleep Questionnaire in undergraduate students

PurposeQuestionnaires are indispensable tools in epidemiologic studies and clinical surveys. Many questionnaires focusing on sleep disorders have been described in the literature. This cross-sectional study is aimed to assess the consistency and reliability of the Brazilian Portuguese Version of the Mini-Sleep Questionnaire (MSQ-BR).MethodsSelf-administered questionnaires were given to a sample of 1,108 undergraduate students. The variables collected were age, gender, socioeconomic level, and MSQ-BR scores. A subgroup of 53 students was randomly chosen to test the test–retest reliability of the instrument. Internal consistency of total MSQ-BR and its subscales (i.e., insomnia and hypersomnia) was evaluated using Cronbach’s alpha coefficient.ResultsOur results showed good internal consistency of total MSQ-BR score, with a Cronbach’s alpha value of 0.770. The insomnia subscale had an adequate internal consistency (Cronbach’s alpha, 0.749). On the other hand, the hypersomnia subscale had moderate internal consistency (Cronbach’s alpha, 0.624). The test–retest analysis showed good reliability of the instrument using Pearson’s correlation coefficient.ConclusionsThe MSQ-BR has adequate internal consistency and test–retest reliability. The MSQ-BR insomnia has adequate internal consistency for use as a separate application. However, the MSQ-BR hypersomnia demonstrated only moderate internal consistency for use as a separate application. Our intention was not to introduce modifications to the questionnaire, but to evaluate the reliability of total MSQ-BR and its subscales. Others studies are needed to assess the consistency of MSQ compared to other instruments.

Depression Subscale of the Hospital Anxiety and Depression Scale applied preoperatively in spinal surgery

OBJECTIVE To evaluate the accuracy of the Depression Subscale of Hospital Anxiety and Depression Scale (HADS-D) in spine surgery, comparing it to Beck Depression Inventory (BDI). METHODS In a cross-sectional study, the HADS-D and the BDI were applied to patients undergoing spine surgery for lumbar (n=139) or cervical spondylosis (n=17). Spearman correlation tests for HADS-D and BDI were applied. The internal consistency of HADS-D was estimated by Cronbachs alpha coefficient. RESULTS According to the BDI, the prevalence of depression was of 28.8% (n=45). The Spearman r coefficient between HADS-D and BDI was 0.714 (p<0.001). Cronbachs alpha for HADS-D was 0.795. The area of the ROC curve was 0.845. Using a cutoff for HADS-D >10, there was a sensitivity of 71.1%, specificity of 95.4%, and positive likelihood-ratio of 15.78. CONCLUSIONS HADS-D showed a strong correlation with BDI and good reliability. HADS-D is a good alternative for screening depression and assessing its severity.

AWARENESS OF STROKE RISK FACTORS AND WARNING SIGNS IN SOUTHERN BRAZIL

OBJECTIVE To evaluate the knowledge about stroke in Caxias do Sul. METHOD A closed-ended, self-administered questionnaire was used to assess the knowledge about stroke among residents of Caxias do Sul. In order to verify variables associated to lack of knowledge we defined three main end points: (1) the inability to recognize that stroke is a disease that affects the brain; (2) insufficient knowledge of risk factors; (3) insufficient knowledge of signs and symptoms of acute stroke. RESULTS A total of 952 subjects answered the questionnaire. Lower income and lower educational level were independent factors associated to inability to recognize that stroke affects the brain. Lower income and being under 50 years old were independent risk factors to lack of knowledge concerning stroke risk factors. Lower educational level was the unique risk factor for insufficient knowledge about stroke warning signs. CONCLUSION There is a lack of knowledge about stroke in Caxias do Sul. People with lower socioeconomic status and lower education level should be the targets of educational campaigns.

Awareness, attitudes and perceptions on epilepsy in Southern Brazil

OBJECTIVE To verify awareness and attitudes toward epilepsy in Southern Brazil. METHOD A questionnaire about familiarity with the disease, awareness and attitudes toward epileptics was applied to 832 inhabitants of Caxias do Sul. The answers were analyzed in three different groups: G1, non-university students; G2, university students up to the second year; and G3, university students with more than two years education and university graduates. RESULTS University students and graduates are better informed regarding causes and treatment of epilepsy. Moreover, those interviewees present less negative attitudes toward epileptics. However, a large part of that group lacks some basic information on the disease. CONCLUSION There is lack of information on epilepsy among Brazilians. Education campaigns should be carried out in order to clarify some aspects concerning epilepsy.

Avaliação clínica e funcional no pré-operatório de doenças degenerativas da coluna vertebral

OBJETIVO: la utilizacion de instrumentos de evaluacion clinica y funcional de patologias vertebrales, ademas de determinar la evolucion despues del tratamiento, puede predecir el resultado postoperatorio. El objetivo de este estudio es describir la metodologia de evaluacion de patologias degenerativas de la columna y verificar los resultados. METODOS: luego de la indicacion del tratamiento quirurgico, los pacientes son invitados a participar del estudio mediante firma de un termino de consentimiento libre y claro. Los pacientes responden los cuestionarios en el consultorio medico y son auxiliados cuanto a dudas al completarlo por una persona no involucrada con la cirugia. Todos los instrumentos de evaluacion utilizados son auto-aplicativos. Se utilizan: escala numerica del dolor (NRS), Cuestionario SF-36, Cuestionario de Evitacion por Miedos y Creencias (FABq), Inventario de Depresion de Beck (BDI), Escala de Depresion y Ansiedad Hospitalaria (HAD), Indice de Discapacidad Oswestry (ODI), Indice de Disfuncion Relacionado al Cuello (NDI). RESULTADOS: se evaluaron 220 pacientes con patologias de la columna lumbar y 32 de la cervical. La prevalencia de depresion segun el BDI fue del 28,0 y 31,2% en pacientes con enfermedad quirurgica lumbar y cervical, y la prevalencia de ansiedad por el HAD-A del 40,1 y 46,9%, respectivamente. El promedio de ODI fue de 46,5 y del NDI de 25,4. Cuanto a la viabilidad de completar los cuestionarios, se observo que la mayoria de los pacientes, una vez instruidos cuanto a la manera de completarlos, no presenta dificultades para hacerlo. El tiempo promedio para completar todos los instrumentos es de 25 a 35 minutos. CONCLUSION: la utilizacion de instrumentos validados para evaluacion de los pacientes con enfermedades degenerativas vertebrales es viable y debe ser estimulada entre los cirujanos de columna.OBJETIVO: a utilizacao de instrumentos de avaliacao clinica e funcional nos pacientes com doencas da coluna vertebral pode determinar a evolucao e predizer o desfecho pos-operatorio. O objetivo deste estudo foi descrever a metodologia de avaliacao de doencas degenerativas espinhais e verificar os resultados. METODOS: apos a indicacao de tratamento cirurgico nos pacientes com doencas das colunas lombar e cervical, os mesmos foram informados dos objetivos do estudo e convidados a participar. Os questionarios foram respondidos no consultorio medico, onde possiveis duvidas surgidas durante o preenchimento eram esclarecidas por uma pessoa treinada nao envolvida com a cirurgia. Todos os instrumentos de avaliacao usados eram autoaplicativos. Foram utilizados a escala numerica de dor, o Questionario de Qualidade de Vida SF-36, o Questionario de Evitacao por Medos e Crencas (FABq), o Inventario de Depressao de Beck (BDI), a Escala de Depressao e Ansiedade Hospitalar (HAD), o Indice de Incapacidade Oswestry (ODI) e o Indice de Disfuncao Relacionado ao Pescoco (NDI). RESULTADOS: foram avaliados 220 pacientes com doencas da coluna lombar e 32 da cervical. A prevalencia de depressao segundo o BDI foi de 28,0% e de 31,2% em pacientes com doenca cirurgica lombar e cervical, e a prevalencia de ansiedade pelo HAD-A de 40,1% e 46,9%, respectivamente. A media do ODI foi de 46,5, e a do NDI, de 25,4. Quanto ao preenchimento dos questionarios, a maioria dos pacientes, uma vez instruidos, nao apresentou dificuldades em finaliza-los. O tempo medio de preenchimento de todos os instrumentos foi de 25 a 35 minutos. CONCLUSOES: a utilizacao de instrumentos validados para avaliacao dos pacientes com doencas degenerativas vertebrais e exequivel e deve ser estimulada entre os cirurgioes que atuam no âmbito da coluna vertebral.OBJECTIVE: the use of clinical and functional evaluation instruments for vertebral pathologies, besides determining how the situation evolves after treatment, can predict the postoperative outcome. The objective of this study was to describe the methodology to evaluate spinal degenerative pathologies and verify the results. METHODS: after the indication of surgical treatment, the patients were invited to participate in the study by signing a letter of free and informed consent. The patients completed the questionnaires at the doctors office, and were helped regarding doubts in filling them out by a person who was not involved in the surgery. All the evaluation instruments used are self-applied. The following were used: numerical rating scale of pain (NRS), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABq), Beck Depression Inventory (BDI), Hospital Anxiety and Depression (HAD) Scale, Oswestry Disability Index (ODI) and Neck Disability Index (NDI). RESULTS: 220 patients with lumbar spine pathologies and 32 with cervical pathologies were evaluated. The prevalence of depression, according to the BDI, was 28.0% and 31.2% in patients with lumbar and cervical surgical disease, and the prevalence of anxiety according to HAD-A was 40.1% and 46.9%, respectively. The mean of ODI was 46.5, and of NDI, 25.4. As to the feasibility of completing the questionnaires, it was observed that most of the patients, when they have been instructed about completing them, did not have any difficulty in finishing them. The mean time for the completion of all instruments was 25 to 35 minutes. CONCLUSION: the use of instruments validated to evaluate patients with degenerative spinal diseases is feasible and should be encouraged among the spinal surgeons.

Effect of deep wound infection following lumbar arthrodesis for degenerative disc disease on long-term outcome: a prospective study: clinical article.

OBJECT Deep wound infections are one of the most common and serious complications of spinal surgery. The impact of such infections on long-term outcomes is not well understood. The purpose of this study was to evaluate the functional status and satisfaction in patients who suffered a deep wound infection after undergoing lumbar arthrodesis for symptomatic degenerative disc disease. METHODS The authors conducted a prospective study in 13 patients with a clinical and radiological diagnosis of symptomatic degenerative lumbar stenosis and instability; after undergoing decompression and instrumentation-augmented arthrodesis, the patients suffered a deep wound infection (infection group). A 3:1 (39-patient) matched cohort was selected for comparison (control group). All surgeries were performed during the same period and by a single surgeon. The postoperative infections were all treated in a similar manner and the instrumentation was not removed. Both groups were followed up and assessed with validated outcome instruments: Numerical Rating Scale of pain, Oswestry Disability Index, 36-Item Short Form Health Survey, Beck Depression Inventory, and Hospital Anxiety and Depression Scale. Patient satisfaction was also determined. RESULTS The median follow-up duration was 22 months (range 6-108 months). The mean patient age was 62 ± 10 years, and 59.6% of the patients were female. There was no significant difference between the groups in pain, functional disability, quality of life, or depression and anxiety. However, 53.8% of the patients with infection were not satisfied with the procedure at the final evaluation, compared with 15.4% of the patients without a deep wound infection (p = 0.003). CONCLUSIONS Patients with successfully treated postoperative deep wound infections do not have a difference in functional outcome compared with patients who underwent an identical operation but did not suffer a complicating infection. Patients who suffered an infection were more likely to be unsatisfied with the procedure than patients who did not.

Sleep disorders among undergraduate students in Southern Brazil

PurposeSleep disorders are very common in the young, being a result of the typical lifestyle lived by young people or a sleep disease that requires assistance and treatment. Furthermore, according to previous findings, sleep alterations can favor the development of depressive mood disorder. This survey aimed to assess the prevalence and characteristics of sleep disorders in a young population sample and their association with depressive symptoms.MethodsWith a cross-sectional study design, self-administered questionnaires were applied to 1,180 undergraduate students. The Mini-Sleep Questionnaire (MSQ) and the Beck Depression Inventory were used to evaluate sleep disturbances and depressive symptoms, respectively. Bivariate and multivariate analyses were conducted, with the main findings being the presence of disrupted sleep (MSQ > 24), with an alpha error of 5%. The median point of the MSQ was 26 (P25–P75, 21–32 points).ResultsSleep alterations were found in 59.6%. The prevalence of depression was 9.3% (n = 110), mild depression being identified in 5.9% (n = 62), moderate in 3.4% (n = 40), and severe in 0.7% (n = 8) of the students. In logistic regression, female gender (OR, 1.48; CI 95%, 1.09–2.01; P = 0.012) and being depressed (OR, 4.42; CI 95%, 2.30–8.50; P < 0.001) were independent factors for disrupted sleep.ConclusionsSleep alterations are prevalent complaints among young people, being present in nearly 60% of the students. Female gender and being depressed are independent factors for having some form of sleep disorder.

Instrumentos de avaliação clínica e funcional em cirurgia da coluna vertebral

Alguns dos individuos submetidos a cirurgia de coluna vertebral terao desfechos pos-operatorio desfavoraveis, independente do exito tecnico. Esse insucesso gera aumento da morbidade e dos custos socioeconomicos. Sabe-se que fatores psicossociais interferem na impressao do sujeito. Com o proposito de identifica-los, tem-se estimulado a busca de preditores prognosticos por meio de instrumentos de triagem. Porem, a eleicao do mais adequado pode ser dificil, ja que existe um grande numero de questionarios. Entre os aspectos abordados por eles, podemos citar: incapacidade funcional, qualidade de vida, satisfacao, dor, depressao, disturbios do humor e atividade funcional. O trabalho objetiva revisar as particularidades, indicacoes e limitacoes dos instrumentos de avaliacao do paciente com doenca na coluna vertebral.

Concomitant dermoid cysts of conus medullaris and cauda equina

A 35-year-old woman presented with chronic low back pain and left ciatalgia. She had previous history of two abdominal surgeries to the treatment of chronic constipation with intraop-erative diagnosis of intestinal adherences. No history of spinal trauma, surgery or lumbar puncture was reported. She brought a normal lumbar radiography. Neurological examination revealed hypoesthesia in the lateral surface of the left leg, weakness on dorsiflexion of the left foot and Lasegue sign on the left leg. The magnetic resonance imaging (MRI) evidenced a large mass located at cauda equina and a smaller mass located at the co-nus medullaris (Fig 1).Surgical resection was accomplished through a posterior midline incision exposing L2 to S2. Dissection and lateral re-moval of musculature were performed followed by laminecto-my from L3 to S1. There was a decrease of the epidural fat and the dural sac was hypertense and non-pulsatil. After opening the dura mater a large brown-yellowish tumor was observed tightly adhered with cauda equina nerves (Fig 2A). Microscopically to-tal tumor removal was accomplished with normal nervous mar-gins (Figs 2B and 2C). A small fragment of the intradural conus tumor was resected and then the remaining tumor was excised by aspiration with the ultrasonic aspirator. The surgical time was 2.5 hours and the bleeding was 650 mL. The histological examination of the tumors in cauda equi-na and conus yielded a diagnosis of dermoid cysts (Fig 3). Post-operatively, the patient had urinary retention which reverted in two months. Follow-up at four years showed complete resolu-tion of preoperative symptoms, including constipation, and no evidence of local or systemic recurrence.

Perspective of Value-Based Management of Spinal Disorders in Brazil

INTRODUCTION The state of value-based management of spinal disorders and ongoing Brazilian strategies toward its implementation are highlighted in this article. METHODS The health care system, economic impact of spine surgery, use of patient-reported outcomes, ongoing studies about health economics, and current strategies toward implementation of quality assessment of spine care in Brazil are reviewed. RESULTS During the past 20 years, there has been an increase of 226% in the number and 540% in the total cost of spine surgeries in the public health system. Examples of economic regulatory mechanisms involve the process of health technology assessment and the auditing processes imposed by health insurance companies. Some barriers to implementing clinical registries were identified from a large Latin American survey. Strategies based on education and technical support have been conducted to improve the quality of comparative-effectiveness research in spine care. Only 1 cost-utility study on spine care has been published until now. CONCLUSIONS The paradigm of value-based management of spinal disorders is still incipient in Brazil. Some issues from our analysis must be emphasized: (1) Brazil presents many regional disparities and scarce resources for health care; it is crucial for the health system to allocate resources based on the value of interventions; (2) because of the high economic and social burden of developing new technologies for diagnosis and treatment, research in health economics of spine care in Brazil should be prioritized; (3) these efforts would help to provide a more accessible and effective health system for patients with spinal problems.