5 research outputs found
Monumental challenges : local perspectives on world heritage landscape regulation at Angkor Archaeological Park, Cambodia
Trabalho final de mestrado integrado em Medicina (Psicologia Médica), apresentado à Faculdade de Medicina da Universidade de Coimbra.Introdução: Estudos recentes demonstraram que o sono tem implicações na saúde e bem-estar, doença, desempenho e na sobrevivência. O Stresse académico e emocional afecta negativamente a Qualidade de sono nos estudantes universitários sendo frequente o auto-relato de perturbações do sono nesta população. A relação entre as variáveis Stresse, Afecto e Qualidade de sono é complexa e ainda pouco estudada nas suas diversas vertentes.
Objectivos: Pretendeu-se com este trabalho estudar se, em estudantes universitários, existia alguma relação entre as variáveis Activação pré-sono (somática e cognitiva), Predisposição para activação, Stresse académico, Reactividade do sono ao stresse, Afecto (positivo e negativo), Neuroticismo, Extroversão, Auto-estima e a Qualidade de sono (IQS).
Materiais e Métodos: Neste estudo foram analisadas as respostas de 713 estudantes de Medicina (468; 65.6% do sexo feminino), com a idade média de 19.29±1.256 (variação=17-24) que preencheram questionários que permitiram aferir os seguintes parâmetros: Activação pré-sono (somática e cognitiva), Predisposição para activação, Stresse académico, Reactividade do sono ao stresse, Afecto (positivo e negativo), Tendência para preocupação/ruminação; Neuroticismo, Extroversão, Auto-estima e Qualidade de sono. Para este último parâmetro foi utilizada uma escala multi-dimensional que incluiu os componentes: Profundidade, Qualidade subjectiva, Latência do sono (minutos) e o Número de acordares nocturnos.
Resultados e Discussão: No sexo feminino, nos modelos de regressão, demonstraram-se predictoras significativas independentes da Qualidade de sono as variáveis Activação cognitiva pré-sono (β=.340, p<.001), Activação somática pré-sono (β=.126, p=.020) e a Reactividade do sono ao stresse (β=.170, p=0,002). Na análise de mediação as variáveis activação somática (IC95% .0010-.0281) e cognitiva pré-sono (IC95% .0009-.0421) revelaram-se como mediadores parciais significativos da relação entre a Reactividade do sono ao stresse e Qualidade de sono. No sexo masculino os modelos de regressão revelaram que a Activação cognitiva pré-sono (β=.311, p<.001), Reactividade do sono ao stresse (β=.176, p=.023) e Afecto positivo (β=-.214, p=.001) foram predictores significativos independentes da Qualidade de sono. O Afecto Positivo foi mediador parcial significativo da relação entre Activação pré-sono e Qualidade do sono (IC95% .0014-.0373) e também entre a Reactividade do sono ao stresse e Qualidade do sono (IC95% .090-.0623).
Conclusões: Na amostra de estudantes analisada foi encontrada uma associação entre a Reactividade do sono ao stresse e Activação pré-sono e a variável independente deste estudo, a Qualidade de sono. Os nossos resultados sugerem, portanto, que tanto a variável Reactividade do sono ao stresse como a Activação pré-sono podem ser determinantes da qualidade geral do sono, nos jovens adultos.Introduction: Recent studies have shown that sleep has implications on health and wellness, disease, performance and survival. Academic and emotional stress adversely affects the Quality of sleep in college students with frequent self-reported sleep disturbances in this population. The relationship between Stress, Affect and Quality of sleep is complex and not well known.
Objective: The purpose of this study was to examine the relationship between Pre-sleep arousal, Arousability, coping, Academic stress, Sleep reactivity to stress, Affect, Neuroticism, Extraversion, Self-esteem, and Sleep quality, in university students.
Materials and Methods: 713 medical students (468; 65.6% females), mean age 19.29 years, (sd=1.256; range = 17-24) completed a series of questionnaires that assessed Pre-sleep cognitive and somatic arousal, Arousability predisposition, perceived Academic stress Tendency to worry/ruminate, Sleep reactivity to stress, Positive affect/ Negative affect Neuroticism, Extraversion, Self-esteem and a multi-dimensional measure of Sleep quality, including Sleep depth, Subjective sleep quality, Sleep latency (min) and Night awakenings (nr.).
Results and Discussion: In females, the regression models showed that Sleep reactivity to stress (β=.170; p=.002), Pre-sleep cognitive arousal (β=.340; p<.001) and Pre-sleep somatic arousal (β=.126; p=.020) were all independent significant predictors of Sleep quality. Mediation analysis revealed that Somatic arousal (95%CI .0010-.0281) and Cognitive arousal (95% CI .0009-.0421) both are significant partial mediators of the relationship between Sleep reactivity to stress and Sleep quality. In males the regression models revealed that Pre-sleep cognitive arousal (β=.311; p<.001), Sleep reactivity to stress (β=.176; p=.023) and Positive affect (β=-.214; p=.001) were all independent significant predictors of Sleep quality. Positive affect was a significant partial mediator of the relationship between Pre-sleep cognitive arousal and Sleep quality (95%CI .0014-.0373) and between Sleep reactivity to stress and Sleep quality (95%CI .0090-.0623).
Conclusions: Our findings suggest that Sleep reactivity to stress and Pre-sleep cognitive arousal may be key determinants of overall sleep quality, in young adults
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CureGN Study Rationale, Design, and Methods: Establishing a Large Prospective Observational Study of Glomerular Disease
Glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and immunoglobulin A (IgA) nephropathy, share clinical presentations, yet result from multiple biological mechanisms. Challenges to identifying underlying mechanisms, biomarkers, and new therapies include the rarity of each diagnosis and slow progression, often requiring decades to measure the effectiveness of interventions to prevent end-stage kidney disease (ESKD) or death.
Multicenter prospective cohort study.
Cure Glomerulonephropathy (CureGN) will enroll 2,400 children and adults with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy (including IgA vasculitis) and a first diagnostic kidney biopsy within 5 years. Patients with ESKD and those with secondary causes of glomerular disease are excluded.
Clinical data, including medical history, medications, family history, and patient-reported outcomes, are obtained, along with a digital archive of kidney biopsy images and blood and urine specimens at study visits aligned with clinical care 1 to 4 times per year.
Patients are followed up for changes in estimated glomerular filtration rate, disease activity, ESKD, and death and for nonrenal complications of disease and treatment, including infection, malignancy, cardiovascular, and thromboembolic events.
The study design supports multiple longitudinal analyses leveraging the diverse data domains of CureGN and its ancillary program. At 2,400 patients and an average of 2 years’ initial follow-up, CureGN has 80% power to detect an HR of 1.4 to 1.9 for proteinuria remission and a mean difference of 2.1 to 3.0mL/min/1.73m2 in estimated glomerular filtration rate per year.
Current follow-up can only detect large differences in ESKD and death outcomes.
Study infrastructure will support a broad range of scientific approaches to identify mechanistically distinct subgroups, identify accurate biomarkers of disease activity and progression, delineate disease-specific treatment targets, and inform future therapeutic trials. CureGN is expected to be among the largest prospective studies of children and adults with glomerular disease, with a broad goal to lessen disease burden and improve outcomes
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Age of Onset and Disease Course in Biopsy-Proven Minimal Change Disease: An Analysis From the Cure Glomerulopathy Network
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Association of COVID-19 Versus COVID-19 Vaccination With Kidney Function and Disease Activity in Primary Glomerular Disease: A Report of the Cure Glomerulonephropathy Study
Patients with glomerular disease (GN) may be at increased risk of severe COVID-19, yet concerns over vaccines causing disease relapse may lead to vaccine hesitancy. We examined the associations of COVID-19 with longitudinal kidney function and proteinuria and compared these to similar associations with COVID-19 vaccination.
Observational cohort study from July 1, 2021 to Jan. 1, 2023.
& Participants: A prospective observational study network of 71 centers from North America and Europe (CureGN) with children and adults with primary minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy.
COVID-19 and COVID-19 vaccination.
Repeated measure of estimated glomerular filtration rate (eGFR); recurrent time-to-event outcome of GN disease worsening as defined by doubling of UPCR to at least 1.5g/g or increase in dipstick urine protein by two ordinal levels to 3+ (300mg/dL) or above.
Interrupted time series analysis for eGFR. Prognostic matched sequential stratification recurrent event analysis for GN disease worsening.
Among 2,055 participants, 722 (35%) reported COVID-19; of these, 92 (13%) were hospitalized and 3 died (<1%). eGFR slope pre-COVID-19 was -1.40ml/min/1.73m2 (SD 0.29), and -4.26ml/min/1.73m2 (SD 3.02) within 6 months post-COVID-19, which were not significantly different (p=0.34). COVID-19 was associated with increased risk of worsening GN disease activity (HR 1.35, 95% CI 1.01-1.80). Vaccination was not associated with change in eGFR (-1.34ml/min/1.73m2, SD 0.15 vs -2.16ml/min/1.73m2, SD 1.74; p=0.6) or subsequent GN disease worsening (HR 1.02, 95% CI 0.79–1.33) in this cohort.
Infrequent or short follow-up.
Among patients with primary GN, COVID-19 was severe for 1 in 8 cases and was associated with subsequent worsening of GN disease activity, as defined by proteinuria. In contrast, vaccination against COVID-19 was not associated with change in disease activity or kidney function decline. These results support COVID-19 vaccination for patients with GN.
In this cohort study of 2,055 patients with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy, COVID-19 resulted in hospitalization or death for 1 in 8 cases and was associated with a 35% increase in risk for worsening proteinuria. In contrast, vaccination did not appear to adversely affect kidney function or proteinuria. Our data support vaccination for COVID-19 in patients with glomerular disease