Carlos Teles

The impact of comorbid posttraumatic stress disorder on bipolar disorder patients

BACKGROUND Available data regarding posttraumatic stress disorder (PTSD) in bipolar disorder (BD) are scarce and usually from a limited sample size. The present report was carried out using the Brazilian Research Consortium for Bipolar Disorders and aimed to examine whether patients with BD and comorbid PTSD are at an increased risk for worse clinical outcomes. METHODS A consecutive sample of bipolar I outpatients from two teaching hospitals in Brazil was recruited. Patients were assessed using the Structured Clinical Interview for DSM-IV, Young Mania Rating Scale, 17-item Hamilton Rating Scale for Depression, and quality of life instrument WHOQOL-BREF. Participants were divided into three groups: a. bipolar patients with PTSD, b. bipolar patients exposed to trauma without PTSD, and c. bipolar patients with no trauma exposure. RESULTS Of the 405 patients who consented to participate, 87.7% completed the survey. All three groups were similar in terms of demographic parameters. The group with comorbid PTSD reported worse quality of life, more rapid cycling, higher rates of suicide attempts, and a lower likelihood of staying recovered. LIMITATIONS The cross-sectional design excludes the opportunity to examine causal relationships among trauma, PTSD, and BD. CONCLUSIONS The findings indicate that PTSD causes bipolar patients to have a worse outcome, as assessed by their lower likelihood to recover, elevated proportion of rapid cycling periods, increased risk of suicide attempts, and worse quality of life.

Behavior problems and prevalence of asthma symptoms among Brazilian children.

Objective Asthma is the most common chronic disease in childhood and has been designated a public health problem due to the increase in its prevalence in recent decades, the amount of health service expenditure it absorbs and an absence of consensus about its etiology. The relationships among psychosocial factors and the occurrence, symptomatology, and severity of asthma have recently been considered. There is still controversy about the association between asthma and a childs mental health, since the pathways through which this relationship is established are complex and not well researched. This study aims to investigate whether behavior problems are associated with the prevalence of asthma symptoms in a large urban center in Latin America. Methods It is a cross-section study of 869 children between 6 and 12 years old, residents of Salvador, Brazil. The International Study of Allergy and Asthma in Childhood (ISAAC) instrument was used to evaluate prevalence of asthma symptoms. The Child Behavior Checklist (CBCL) was employed to evaluate behavioral problems. Results 19.26% (n = 212) of the children presented symptoms of asthma. 35% were classified as having clinical behavioral problems. Poissons robust regression model demonstrated a statistically significant association between the presence of behavioral problems and asthma symptoms occurrence (PR: 1.43; 95% CI: 1.10–1.85). Conclusion These results suggest an association between behavioral problems and pediatric asthma, and support the inclusion of mental health care in the provision of services for asthma morbidity.

Clinical and Socio-Demographic Characteristics of College Students Exposed to Traumatic Experiences: A Census of Seven College Institutions in Northeastern Brazil

Background Epidemiological studies show that most of the adult population will be exposed to at least one potentially traumatic event in the course of his/her life; adolescence and early adulthood are the most vulnerable periods of life for exposure to traumatic experiences (70% of their deaths are due to external causes). Posttraumatic Stress Disorder is characterized by the development of dysfunctional symptoms that cause distress or social, academic, or occupational impairment, as result of exposure to a traumatic event. The aim of this multicentric study is to establish the proportion of college students, within seven institutions in Northeastern Brazil, who were exposed to traumatic experience and met PTSD criteria. Methods/Design A one-phase census protocol of seven college institutions in three metropolitan regions in Northeastern Brazil was performed (April to July 2011). All students aged 18 years or older, matriculated and attending their first or final semester were eligible. The self-applied protocol consisted of a socio-demographic questionnaire and the following scales adjusted to Brazilian Portuguese standards Trauma History Questionnaire (THQ), PTSD Checklist-Civilian (PCL-C), Impulsivity Scale (BIS-11). Data were entered into SPSS 17.0. Results 2213 (85.5%) students consented to participate, and completely filled in the protocols. Of these, 66.1% were woman, mean age 23.9 (SD 6.3), 82.7% were single, and 57.3% attended university outside their native cities. The total PTSD prevalence was 14%, and the median for frequency of trauma exposure was 5 events. Conclusion A high frequency of exposure to violence, as well as a high rate of PTSD, suicide attempts, and high-risk sexual behavior was found in Brazilian college students. This highlights the importance of effective public health actions in relation to the prevention and treatment of PTSD and other dysfunctional behaviors resulting from traumatic exposure in young individuals, usually an at risk population for violence and traumatic situations.

Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort,

OBJECTIVE To verify whether the occurrence of acute viral bronchiolitis in the first year of life constitutes a risk factor for asthma at age 6 considering a parental history of asthma. METHODS Cross-sectional study in a cohort of live births. A standardized questionnaire of the International Study of Asthma and Allergies in Childhood was applied to the mothers to identify asthma in children at the age of 6 years. Acute viral bronchiolitis diagnosis was performed by maternal report of a medical diagnosis and/or presence of symptoms of coryza accompanied by cough, tachypnea, and dyspnea when participants were 3, 6, 9, and 12 months. Socioeconomic, environmental data, parental history of asthma, and data related to pregnancy were collected in the first 72h of life of the newborn and in prospective home visits by trained interviewers. The association between acute viral bronchiolitis and asthma was evaluated by logistic regression analysis and potential modifier effect of parental history was verified by introducing an interaction term into the adjusted logistic regression model. RESULTS Prevalence of acute viral bronchiolitis in the first year of life was 68.6% (461). The occurrence of acute viral bronchiolitis was a risk factor for asthma at 6 years of age in children with parental history of asthma OR: 2.66, 95% CI (1.10-6.40), modifier effect p=0.002. Parental history of asthma OR: 2.07, 95% CI (1.29-3.30) and male gender OR: 1.69, 95% CI, (1.06-2.69) were other identified risk factors for asthma. CONCLUSION Acute viral bronchiolitis in the first year of life is a risk factor for asthma in children with parental history of asthma.

Risco de suicídio em pacientes em hemodiálise: evolução e mortalidade em três anos

Risk of suicide is associated with high rates of death in chronic hemodialysis patients. In Brazil only few studies have measured your prevalence, evolution and mortality. OBJECTIVE: Study the prevalence, evolution and mortality of risk of suicide in two nephrology units for three years. METHODS: The Mini was used in three moments. Frequency and evolution of Risk of Suicide was analyzed. Kaplan-Meier Curve and Cox Regression was used to study the mortality. RESULTS: 244 patients in 1st step, 200 in 2nd and 110 in 3rd. Risk of suicide was diagnosticated in 40 in 1st, 49 in 2nd and seven in 3rd period. Between the 1st and 2nd period, nine patients death, 29 followed with the condition and 20 others patients presented risk of suicide. Between the 2nd and 3rd period thirteen death, seven followed with the condition and 29 changed the disorder. The death incidence in patients without disorder was 3.35 and in patients with risk was, 9.91 (RR = 2.87; IC de 95% [1.69-4.87]). CONCLUSIONS: The prevalence of risk of suicide was high, and this condition was associated with high rates of mortality.

Validez del constructo de la escala Experiences of Discrimination en una población brasileña

Um dos instrumentos mais utilizados na pesquisa epidemiologica sobre discriminacao e o Experiences of Discrimination (EOD), utilizada no Brasil, porem nao validado. O objetivo foi avaliar a confiabilidade e estrutura dimensional da escala EOD em uma populacao brasileira. Foi conduzido um estudo transversal com 1.380 adultos da cidade de Salvador, Bahia, Brasil. Realizou-se analise fatorial confirmatoria (AFC) testando um modelo de dois fatores: experiencia de discriminacao e preocupacao por discriminacao. Os resultados da AFC mostraram parâmetros satisfatorios de ajuste, elevadas cargas fatoriais e valores adequados de confiabilidade, confirmando a consistencia interna da escala. Identificaram-se correlacoes residuais envolvendo itens de ambos os fatores. A estrutura dimensional apresentada neste estudo destaca a importância de utilizar diferentes medidas de discriminacao - interpessoais e grupais - que permitam em estudos futuros aprofundar nos efeitos do racismo sobre a saude

Validity of the Experiences of Discrimination scale in a Brazilian population

Um dos instrumentos mais utilizados na pesquisa epidemiologica sobre discriminacao e o Experiences of Discrimination (EOD), utilizada no Brasil, porem nao validado. O objetivo foi avaliar a confiabilidade e estrutura dimensional da escala EOD em uma populacao brasileira. Foi conduzido um estudo transversal com 1.380 adultos da cidade de Salvador, Bahia, Brasil. Realizou-se analise fatorial confirmatoria (AFC) testando um modelo de dois fatores: experiencia de discriminacao e preocupacao por discriminacao. Os resultados da AFC mostraram parâmetros satisfatorios de ajuste, elevadas cargas fatoriais e valores adequados de confiabilidade, confirmando a consistencia interna da escala. Identificaram-se correlacoes residuais envolvendo itens de ambos os fatores. A estrutura dimensional apresentada neste estudo destaca a importância de utilizar diferentes medidas de discriminacao - interpessoais e grupais - que permitam em estudos futuros aprofundar nos efeitos do racismo sobre a saude

Validade de constructo da escala Experiences of Discrimination em uma população brasileira

Um dos instrumentos mais utilizados na pesquisa epidemiologica sobre discriminacao e o Experiences of Discrimination (EOD), utilizada no Brasil, porem nao validado. O objetivo foi avaliar a confiabilidade e estrutura dimensional da escala EOD em uma populacao brasileira. Foi conduzido um estudo transversal com 1.380 adultos da cidade de Salvador, Bahia, Brasil. Realizou-se analise fatorial confirmatoria (AFC) testando um modelo de dois fatores: experiencia de discriminacao e preocupacao por discriminacao. Os resultados da AFC mostraram parâmetros satisfatorios de ajuste, elevadas cargas fatoriais e valores adequados de confiabilidade, confirmando a consistencia interna da escala. Identificaram-se correlacoes residuais envolvendo itens de ambos os fatores. A estrutura dimensional apresentada neste estudo destaca a importância de utilizar diferentes medidas de discriminacao - interpessoais e grupais - que permitam em estudos futuros aprofundar nos efeitos do racismo sobre a saude

Environmental factors associated with the decision time for seeking care in myocardial infarction

The purpose was to estimate the decision time (DT) for searching for attendance for men and women suffering from acute myocardial infarction (AMI); and to analyze the influence of surrounding variables in the DT. Transversal study, involving one hundred patients interviewed in hospitals of Salvador-BA, Brazil. For data analysis, it was used the chi-squared or Fishers exact test, and the Robust Linear Regression Model. AMI at the home predominated, with family members and patients receiving mistaken actions. A high DT was observed both, for women (0.9h) and men (1.4h). Those at home during the initial symptoms had higher DT, compared to those at work; and lower in relation to those in public spaces (p=0.047). Statistically significant interaction occurred among gender and the fact of living with company; and among gender and having a companion and children, for the outcome of the DT. Nursing care focused on the specificity of surrounding factors and gender can optimize early attendance.Se objetivo estimar el tiempo de decision para buscar atendimiento (TD) para hombres y mujeres con infarto agudo de miocardio (IAM); analizar la influencia de variables ambientales en TD y la interaccion entre genero y variables ambientales para el desfecho del TD. Estudio transversal, envolviendo cien pacientes entrevistados en hospitales de Salvador-BA, Brasil. En el analisis se utilizo el chi-cuadrado o el Teste Exacto de Fisher y el Modelo de Regresion Linear Robusto. Predomino el IAM en el domicilio, familiares en el entorno y con pacientes siendo objeto de acciones equivocadas. Se observo TD elevados para mujeres (0,9h) y hombres (1,4h). Aquellos en sus casas en el inicio de los sintomas tuvieron mayor TD, comparados a los en el trabajo, y menor en relacion aquellos en via publica (p=0,047). Hubo interaccion estadisticamente significante entre genero y vivir acompanado y entre genero y tener companero e hijos en el entorno, para el desfecho del TD. El cuidar en enfermeria focalizado en especificidades de factores ambientales y de generos puede optimizar el atendimiento precoce.

Fatores ambientais associados ao tempo de decisão para procura de atendimento no infarto do miocárdio

The purpose was to estimate the decision time (DT) for searching for attendance for men and women suffering from acute myocardial infarction (AMI); and to analyze the influence of surrounding variables in the DT. Transversal study, involving one hundred patients interviewed in hospitals of Salvador-BA, Brazil. For data analysis, it was used the chi-squared or Fishers exact test, and the Robust Linear Regression Model. AMI at the home predominated, with family members and patients receiving mistaken actions. A high DT was observed both, for women (0.9h) and men (1.4h). Those at home during the initial symptoms had higher DT, compared to those at work; and lower in relation to those in public spaces (p=0.047). Statistically significant interaction occurred among gender and the fact of living with company; and among gender and having a companion and children, for the outcome of the DT. Nursing care focused on the specificity of surrounding factors and gender can optimize early attendance.Se objetivo estimar el tiempo de decision para buscar atendimiento (TD) para hombres y mujeres con infarto agudo de miocardio (IAM); analizar la influencia de variables ambientales en TD y la interaccion entre genero y variables ambientales para el desfecho del TD. Estudio transversal, envolviendo cien pacientes entrevistados en hospitales de Salvador-BA, Brasil. En el analisis se utilizo el chi-cuadrado o el Teste Exacto de Fisher y el Modelo de Regresion Linear Robusto. Predomino el IAM en el domicilio, familiares en el entorno y con pacientes siendo objeto de acciones equivocadas. Se observo TD elevados para mujeres (0,9h) y hombres (1,4h). Aquellos en sus casas en el inicio de los sintomas tuvieron mayor TD, comparados a los en el trabajo, y menor en relacion aquellos en via publica (p=0,047). Hubo interaccion estadisticamente significante entre genero y vivir acompanado y entre genero y tener companero e hijos en el entorno, para el desfecho del TD. El cuidar en enfermeria focalizado en especificidades de factores ambientales y de generos puede optimizar el atendimiento precoce.