ERICA : prevalência de transtornos mentais comuns em adolescentes brasileiros

Objetivo: descrever a prevalência de transtornos mentais comuns em adolescentes escolares brasileiros, segundo macrorregiões, tipo de escola, sexo e idade. Métodos: foram avaliados 74.589 adolescentes participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), estudo transversal, nacional, de base escolar, realizado em 2013-2014 em municípios com mais de 100 mil habitantes. Utilizou-se questionário autopreenchível e coletor eletrônico de dados. Presença de transtornos mentais comuns foi avaliada por meio do General Health Questionnaire (GHQ-12). Estimaram-se prevalências e intervalos de confiança de 95% de transtornos mentais comuns por sexo, idade e tipo de escola, no Brasil e nas macrorregiões, considerando o desenho da amostra. Resultados: a prevalência de transtornos mentais comuns foi de 30,0% (IC95% 29,2-30,8), sendo mais elevada entre meninas (38,4%; IC95% 37,1-39,7), quando comparadas aos meninos (21,6%; IC95% 20,5-22,8) e entre os adolescentes de 15 a 17 anos (33,6%; IC95% 32,2-35,0), em relação àqueles entre 12 e 14 anos (26,7%; IC95% 25,8-27,6). As prevalências de transtornos mentais comuns aumentaram conforme a idade, para ambos os sexos, sempre maior nas meninas (variando de 28,1% aos 12 anos, até 44,1% aos 17 anos), do que nos meninos (variando de 18,5% aos 12 anos até 27,7% aos 17 anos). Não houve diferença importante por macrorregião ou tipo de escola. Análises estratificadas mostraram maior prevalência de transtornos mentais comuns entre meninas de 15 a 17 anos de escolas privadas da região Norte (53,1; IC95% 46,8-59,4). Conclusões: a elevada prevalência de transtornos mentais comuns entre os adolescentes e o fato de os sintomas serem muitas vezes vagos fazem com que esses transtornos sejam pouco identificados por gestores escolares ou mesmo serviços de saúde. Os resultados deste estudo podem ajudar na proposição de medidas de prevenção e controle mais específicas e voltadas para os subgrupos sob maior risco.Objective: to describe the prevalence of common mental disorders in Brazilian adolescent students, according to geographical macro-regions, school type, sex, and age. Methods: we evaluated 74,589 adolescents who participated in the Cardiovascular Risk Study in Adolescents (ERICA), a cross-sectional, national, school-based study conducted in 2013-2014 in cities with more than 100,000 inhabitants. A self-administered questionnaire and an electronic data collector were employed. The presence of common mental disorders was assessed using the General Health Questionnaire (GHQ-12). We estimated prevalence and 95% confidence intervals of common mental disorders by sex, age, and school type, in Brazil and in the macro-regions, considering the sample design. Results: the prevalence of common mental disorders was of 30.0% (95%CI 29.2-30.8), being higher among girls (38.4%; 95%CI 37.1-39.7) when compared to boys (21.6%; 95%CI 20.5-22.8), and among adolescents who were from 15 to 17 years old (33.6%; 95%CI 32.2-35.0) compared to those aged between 12 and 14 years (26.7%; 95%CI 25.8-27.6). The prevalence of common mental disorders increased with age for both sexes, always higher in girls (ranging from 28.1% at 12 years to 44.1% at 17 years) than in boys (ranging from 18.5% at 12 years to 27.7% at 17 years). We did not observe any significant difference by macro-region or school type. Stratified analyses showed higher prevalence of common mental disorders among girls aged from 15 to 17 years of private schools in the North region (53.1; 95%CI 46.8-59.4). Conclusions: the high prevalence of common mental disorders among adolescents and the fact that the symptoms are often vague mean these disorders are not so easily identified by school administrators or even by health services. The results of this study can help the proposition of more specific prevention and control measures, focused on highest risk subgroups

A Comprehensive Microarray-Based DNA Methylation Study of 367 Hematological Neoplasms

Background: Alterations in the DNA methylation pattern are a hallmark of leukemias and lymphomas. However, most epigenetic studies in hematologic neoplasms (HNs) have focused either on the analysis of few candidate genes or many genes and few HN entities, and comprehensive studies are required. Methodology/Principal Findings: Here, we report for the first time a microarray-based DNA methylation study of 767 genes in 367 HNs diagnosed with 16 of the most representative B-cell (n = 203), T-cell (n = 30), and myeloid (n = 134) neoplasias, as well as 37 samples from different cell types of the hematopoietic system. Using appropriate controls of B-, T-, or myeloid cellular origin, we identified a total of 220 genes hypermethylated in at least one HN entity. In general, promoter hypermethylation was more frequent in lymphoid malignancies than in myeloid malignancies, being germinal center mature B-cell lymphomas as well as B and T precursor lymphoid neoplasias those entities with highest frequency of gene-associated DNA hypermethylation. We also observed a significant correlation between the number of hypermethylated and hypomethylated genes in several mature B-cell neoplasias, but not in precursor B- and T-cell leukemias. Most of the genes becoming hypermethylated contained promoters with high CpG content, and a significant fraction of them are targets of the polycomb repressor complex. Interestingly, T-cell prolymphocytic leukemias show low levels of DNA hypermethylation and a comparatively large number of hypomethylated genes, many of them showing an increased gene expression. Conclusions/Significance: We have characterized the DNA methylation profile of a wide range of different HNs entities. As well as identifying genes showing aberrant DNA methylation in certain HN subtypes, we also detected six genes DBC1, DIO3, FZD9, HS3ST2, MOS, and MYOD1 that were significantly hypermethylated in B-cell, T-cell, and myeloid malignancies. These might therefore play an important role in the development of different HNs

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Can Participatory Institutions Promote Pluralism? Mobilizing Low-Income Citizens in Brazil

Participatory decisionmaking institutions have proliferated across the developing world during the past decade as governments and civil society organizations sought to incorporate citizens directly into policymaking arenas. This article draws from a survey (n = 833) of elected delegates in Brazil\u27s Participatory Budgeting (PB) to explain what factors most strongly influence participants\u27 attitudes and behaviors. Do citizen-participants believe that they exercise authority within these new institutions? Have they modified their basic strategies to secure public goods? The purpose of this article is to account for the significant differences in the survey respondents\u27 attitudes and behaviors by developing individual- and municipal-level models that test the significance of civil society participation, institutions, social context, and partisan political identification. Ordinary least squared (OLS) and logistic regression are used to test these models. Group-oriented behavior, more commonly known as pluralism, is replacing clientelism and personalism in the most successful cases of PB due to the extension of authority to individual citizens. This article demonstrates that participatory institutions, in conjunction with participation in a civil society organization, can alter citizens\u27 attitudes and behavior