Murilo Duarte da Costa Lima

Headache precipitated by Valsalva maneuvers in patients with congenital Chiari I malformation

The objective of this study was to characterize the headache precipitated by Valsalva maneuvers associated with Chiari type I malformation (CM-1). Nineteen patients were evaluated, with ages ranging from 30 to 75 years. Ten of them presented headache. Pain was more prevalent in the occipital (80%) and frontal region (60%). The headaches were of significantly shorter duration in the women compared with the men. The frequency of headache crises was relatively high. All patients with Valsalva-related headache suffered from at least one episode per month. The most prevalent precipitating factors were coughing, which is well described in the literature, and sexual activity, which only now is recognized as an event associated with CM-1.

Air traffic control activity increases attention capacity in air traffic controllers

Air traffic controllers simultaneously develop complex and multiple tasks in the course of their activities. In this context, concern is raised over the high level of attention needed by these professionals which can ultimately be affected by stress and fatigue. Objectives The objective of this study was to assess attention level in air traffic controllers (ATCo). Methods 45 flight protection professionals were evaluated, comprising 30 ATCo, subdivided into ATCo with ten or more years in the profession (ATCo≥10, n=15) and ATCo with less than ten years in the profession (ATCo <10, n=15) and 15 aeronautical information services operators (AIS), subdivided into AIS with ten years or more in the profession (AIS≥10, n=8) and AIS with less than ten years in the profession (AIS <10, n=7), who were included as the control group. The digit symbol, d2 (the individual marks the letter d on a specific form containing 14 lines with 47 letters in each, maintaining focus on letter d followed by two dashes), forward digit span, backward digit span and PASAT (paced auditory serial addition test) attention tests were used. Kruskal-Wallis was used and data expressed as Median (Minimum and Maximum) with p<0.05. Results The ATCo≥10 presented greater focus of attention, sustained attention, mental manipulation and resistance to interference capacity compared to the AIS≥10. Comparison of ATCo≥10 to the AIS<10 showed they presented only greater resistance to interference, and when compared to the ATCo<10 presented lower focus. Conclusions The air traffic control activity after ten years may be associated with a high level of attention.

Mephentermine dependence without psychosis: a Brazilian case report

BACKGROUND Substance abuse is a serious health concern. This report presents the case of a 22-year-old Brazilian man with a history of mephentermine use who fulfils all the criteria for chemical dependence listed by ICD-10. Mephentermine is a sympathomimetic agent derived from methamphetamine which, in Brazil, is restricted to veterinary use. CASE DESCRIPTION The subject used the substance at a high dose (120 mg) to improve his physical performance while working out at a gym. His symptoms included anorexia and insomnia. After days of intense activity, he felt fatigue and soreness. A physical examination revealed scars on both forearms from the injections and a psychological examination revealed moderate speech and motor agitation. CONCLUSIONS Cases such as this may be common among the general public. They should have some bearing upon medical practice and public health policies involving drugs.

Presence of dual diagnosis between users and non-users of licit and illicit drugs in Brazil

Objective Investigate the occurrence of dual diagnosis in users of legal and illegal drugs. Methods It is an analytical, cross-sectional study with a quantitative approach, non-probabilistic intentional sampling, carried out in two centers for drug addiction treatment, by means of individual interviews. A sociodemographic questionnaire, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the Mini-International Neuropsychiatric Interview (MINI) were used. Results One hundred and ten volunteers divided into abstinent users (group 1), alcoholics (group 2) and users of alcohol and illicit drugs (group 3). The substances were alcohol, tobacco, crack and marijuana. A higher presence of dual diagnosis in group 3 (71.8%) was observed, which decreased in group 2 (60%) and 37.1% of drug abstinent users had psychiatric disorder. Dual diagnosis was associated with the risk of suicide, suicide attempts and the practice of infractions. The crack consumption was associated with the occurrence of major depressive episode and antisocial personality disorder. Conclusion It was concluded that the illicit drug users had a higher presence of dual diagnosis showing the severity of this clinical condition. It is considered essential that this clinical reality is included in intervention strategies in order to decrease the negative effects of consumption of these substances and provide better quality of life for these people.

F110. THE BRIEF NEGATIVE SYMPTOM SCALE (BNSS): VALIDATION IN A MULTICENTER BRAZILIAN STUDY

Abstract Background Negative symptoms are a core feature of schizophrenia. The Brief Negative Symptom Scale (BNSS) is a new scale developed to assess negative symptoms in schizophrenia. Methods The present study aimed to examine the construct validity of BNSS, by using convergent and divergent validities as well as factor analysis, in a Brazilian sample of 111 outpatients diagnosed with schizophrenia by DSM-5. Patients were evaluated by the Brazilian version of the BNSS and positive and negative subscales of the Positive and Negative Syndrome Scale (PANSS) Results Assessment of patients by both instruments revealed an either an excellent internal consistency (Cronbach’s alpha = 0.938) or inter-rater reliability (ICC = 0.92), as well as a strong correlation between BNSS and negative PANSS (r = 0.866) and a weak correlation of the instrument with the positive PANSS (r = 0.292) thus characterizing adequate convergent and discriminant validities, respectively. The exploratory factor analysis identified two distinct factors, namely, motivation/pleasure and emotional expressivity, accounting for 68.63% of the total variance. Discussion The study shows that the Brazilian version of the BNSS has adequate psychometric properties and it is a reliable instrument for the assessment of negative symptoms in schizophrenia, either for clinical practice or research.

The Brief Negative Symptom Scale: Validation in a multicenter Brazilian study

BACKGROUND Negative symptoms are a core feature of schizophrenia. The Brief Negative Symptom Scale (BNSS) is a scale developed to measure negative symptoms in schizophrenia. METHODS The present study aimed to examine the construct validity of BNSS, by using convergent and divergent validities as well as factor analysis, in a Brazilian sample of 111 outpatients diagnosed with schizophrenia by DSM-5. Patients were evaluated by the Brazilian version of the BNSS and positive and negative subscales of the Positive and Negative Syndrome Scale (PANSS). RESULTS Assessment of patients by both instruments revealed an excellent internal consistency (Cronbachs alpha = 0.938) or inter-rater reliability (ICC = 0.92), as well as a strong correlation between BNSS and Marder negative PANSS (r = 0.866) and a weak correlation of the instrument with the positive PANSS (r = 0.292), thus characterizing convergent and discriminant validities, respectively. The exploratory factor analysis identified two distinct factors, namely, motivation/pleasure and emotional expressivity, accounting for 68.63% of the total variance. CONCLUSION The study shows that the Brazilian version of the BNSS has adequate psychometric properties and is a reliable instrument for the assessment of negative symptoms in schizophrenia, either for clinical practice or research.

Assessment tools for the measurement of the self-efficacy of drug users: protocol for a systematic review

Introduction The abuse of alcohol and other drugs is a worldwide problem, the treatment of which poses a challenge to healthcare workers. Objective This study presents a proposal for a systematic review to analyse the psychometric properties of assessment tools developed to measure the self-efficacy of drug users with regard to resisting the urge to take drugs in high-risk situations. Methods and Analysis The guiding question was based on PICOS (Population Intervention Comparator Outcome Setting), and the report of the methods of review protocol was written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Searches will be performed in the PsycINFO, Cochrane, Pubmed, Web of Science, SCOPUS and CINAHL databases, followed by the use of the ‘snowball’ strategy. The inclusion criteria for the articles will be (1) assessment tool validation studies; (2) assessment tools developed to measure self-efficacy; (3) quantitative measures; (4) measures designed for use on adults; (5) data from self-reports of the participants; (6) studies involving a description of psychometric properties of the measures; and (7) studies that explain how the level of self-efficacy is scored. The search, selection and analysis will be performed by two independent reviewers. In cases of a divergence of opinion, a third reviewer will be consulted. The COSMIN checklist will be used for the appraisal of the methodological quality of the assessment tools and the certainty of the evidence in the articles (risk of bias) will be analysed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Ethics and dissemination This protocol does not require ethical approval. However, this protocol is part of the thesis entitled Drug-Taking Confidence Questionnaire for use in Brazil, presented for obtaining a doctorate in neuropsychiatry and behavioural sciences from the Federal University of Pernambuco, and has received approval from the human research ethics committee of the Federal University of Pernambuco (reference number: 1.179.162). The results will be disseminated to clinicians and researchers through peer-reviewed publications and conferences. PROSPERO registration number CRD42017068555.

Risk of behaviour suggestive of opioid abuse: a protocol for a systematic review of validated assessment tools

Introduction Opioid use patterns of individuals with non-cancer pain are influenced by the behavioural dynamics of the individual in managing and properly following the prescription. The use of assessment tools for measuring the risk of behaviour suggestive of opioid abuse is important for health professionals who provide care to individuals with non-cancer pain. The aim of the proposed review is to analyse the psychometric properties of tools for measuring the risk of behaviour suggestive of opioid abuse in adults with non-cancer pain. Methods and analysis The review process will be based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The Consensus-Based Standards for the Selection of Health Measurement Instruments will be used to analyse the assessment tools. Two independent reviewers will perform the literature search and analysis procedures. Searches will be performed on PubMed, Web of Science, Cochrane, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases, and the ‘snowball’ strategy will be employed. The inclusion criteria will be (1) validation studies, (2) assessment tools designed exclusively for measuring the risk of behaviour suggestive of opioid abuse and (3) assessment tools designed for evaluation of adults with chronic non-cancer pain. The titles and abstracts of the studies retrieved from the databases will be analysed for the preselection of articles, which will be submitted to a full-text analysis to define the final sample. Divergence of opinion between two reviewers will be resolved by consulting a third reviewer. Ethics and dissemination The review will offer an overview of assessment tools available for measuring the risk of behaviour suggestive of opioid abuse, which is relevant to reducing the risk of deaths due to abusive consumption and for clinical management of adults with chronic non-cancer pain. PROSPERO registration number CRD42018081577.

Nursing Diagnoses of the Homeless Population in Light of Self-care Theory

BACKGROUND: A growing number of people find themselves in conditions of extreme poverty, which often makes living on the streets the only option. Living conditions in this setting exert a direct impact on health and self‐care. Health care for the homeless population should be planned in an interdisciplinary and intersectoral manner. In this context, nursing diagnoses constitute an essential part of the systemization of care. OBJECTIVES: The aims of the present study were to identify nursing diagnoses of a homeless population and propose nursing interventions based on the findings in light of the Nursing Outcomes Classification and Nursing Interventions Classification. DESIGN AND SETTING: A descriptive, cross‐sectional study with a quantitative approach was conducted on the streets of the city of Recife in northeastern Brazil. PARTICIPANTS: The sample consisted of 274 male and female adult homeless individuals. METHODS: Data collection involved the administration of a semi‐structured interview, the Alcohol, Smoking and Substance Involvement Screening Test and the International Neuropsychiatric Interview. RESULTS: The most prevalent diagnoses were related to risk‐prone health behaviors (78.1%), inadequate health maintenance (67.1%), along with sleep deprivation (100%), feelings of hopelessness (100%) and low self‐esteem (99%). CONCLUSIONS: The experience enabled the identification of the peculiarities of the population, bringing nursing practice closer to health promotion for the homeless. Adequate public policies and training for health teams are needed to address the health needs of the homeless population. HIGHLIGHTSMain nursing diagnoses were related to the health promotion, activity/rest and self‐perception domains.Self‐care is key strategie that can minimize risks and harm and reduce homelessness.Daily drug intake may be related to a mechanism of adjustment to unfulfilled needs.Nursing interventions should be focused on a support system and health education.

Nursing staff members mental's health and factors associated with the work process: an integrative review

Background: The mental health of nursing staff members influences the work process outcomes. Objective: Identify the work related factors that harms the nursing team’s mental health. Methods: Databases PubMed, Scopus, CINAHL and MEDLINE, by mating between the indexed descriptors in MeSH terms “mental health” and “occupational health nursing”. 783 articles were rescued to give a final sample of 18 articles. Integrative review in order to identify factors associated with the work process of the nursing staff that negatively affects mental health. Results: The main associated factors were work demands, psychological demands, violence, aggression, poor relationships with administrators, accidents involving the risk of exposure to HIV, stress and errors in the execution of labor activities. The main findings regarding the nursing staff’s mental health were post-traumatic stress disorder, depression, stress, major depressive episode and generalized anxiety disorder. Conclusion: Occupational nurses need to understand the complexities of mental health problems and substance use among nursing staff members to recognize, identify and care for workers at risk and offer adequate mental health care. Although the researches interests in this theme have increased, proving that all these factors contribute to the risk to mental health of nursing professionals, the protective measures and care are being neglected by managers in both private and public network . The health of nursing workers in question here is one more challenge for a profession that takes care of others in need, therefore, requires some caring with their own health.