Sleep loss causes emotional dysregulations increasing depression and anxiety: a reciprocal relationship

Introduction: Good quality sleep is essential for good neurocognitive performance, mental and physical health. However, changes in society have led to a worsening of sleep quality, which is associated with the development of anxiety and depression. Objective: ​​Discuss and contribute for a better understanding of the association between sleep loss and anxiety and depression. Methodology: This article presents a narrative review of the literature based on the analysis of scientific articles published from 2014 to 2022, in PubMed, about sleep deprivation and its association with anxiety and depression. Two criterias were applied, titles that did not mention the thematic association between sleep deprivation and depression and anxiety and abstracts that did not address that theme. After the exclusion criterias, was obtained in total, 45 articles originally in English (including book chapters, guidelines and case reports) remained. Discussion: Sleep deprivation is associated with an increase in cortisol levels, a reduction in testosterone and serotonin levels, and an increase in inflammatory markers. In this context, this condition is related to symptoms of depression and anxiety. Due changes in the pattern of society, such as increased use of the internet and a greater workload, have led a large part of the population to develop problems in sleep quality. Addictionaly, it is known that good quality sleep is essential for good neurocognitive performance, mental and physical health. Conclusion: This study discussed the relation between sleep deprivation, depression and anxiety. It is added to its effect on good neurocognitive performance, mental and physical health. Overall, it was evidenced that there is an association of mechanisms between these disorders. In this context, there is an urgent need for more specific research and dissemination of data on the association of sleep deprivation and depression and anxiety

Tuberculose pulmonar: adesão e vulnerabilidade dos pacientes em situação de rua / Pulmonary tuberculosis: adherence to the vulnerability of homeless patients

INTRODUÇÃO: A tuberculose (TB) é uma doença infecciosa cujo tratamento é longo e possui, além da duração, fatores que reduzem sua adesão. Tais fatores evidenciam-se fortemente na população em situação de rua (PSR), mais vulnerável à infecção por TB. METODOLOGIA: Revisão narrativa de literatura, em inglês e português nas bases da PubMED/MEDLINE, SciELO, BVS e OPAS/PAHO utilizando os descritores “Tuberculosis”, “Pulmonary”, ”Homeless” e ”Medication Adherence”. Ana?lise de estudos pre?-existentes, buscando a síntese de informac?o?es da tema?tica. RESULTADOS: Seleção de 48 artigos, dentre os quais 27 preenchiam os critérios de inclusão e exclusão, cujas informações compuseram o artigo. DISCUSSÃO: O tempo de tratamento e seus efeitos colaterais afetam a adesão à terapêutica da TB na PSR. O uso de drogas e álcool, infecção por HIV, baixa escolaridade, falta de apoio familiar, fatores socioeconômicos e outras condições relacionadas à PSR, influenciam nessa problemática, tornando tal grupo mais vulnerável e com maiores taxas de abandono do tratamento. Almeja-se melhorar tal questão mediante políticas públicas que ainda demonstram-se insuficientes. CONCLUSÃO: Apesar da existência de políticas públicas que visem a resolução da problemática, a PSR possui maior vulnerabilidade à infecção por TB, menor adesão ao tratamento e pior prognóstico comparado a população em geral.

Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units

ObjectiveTo validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2.MethodsObservational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve – AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013–2015, 2015–2017, and 2017–2019.Results41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2–5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94–1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83–0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%–3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%–46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%–100% mortality risk).ConclusionsBoth scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Neoliberalismo Escolar: A Educação de Jovens na Atualidade e seus Efeitos Subjetivos

Na atualidade, presenciamos um nítido esfacelamento dos fundamentos e finalidades da educação, o que vem deixando incerta sua atual função social. Se, um dia, seu papel se centrou numa formação intelectual e cidadã, a partir da transmissão dos valores da cultura e dos referenciais simbólicos da sociedade, tal propósito vem sofrendo profundas transformações com o advento do neoliberalismo escolar, que consiste na migração dos valores econômicos para o campo educacional. Nesse contexto, a escola passa a ser convocada a responder a interesses econômicos, o que se torna evidente ao analisarmos, sobretudo, as propostas pedagógicas voltadas à juventude. Diante desse cenário, o presente trabalho busca discutir as consequências da entrada dos valores econômicos na educação de jovens, atentando para os seus efeitos no sujeito/aluno. Sugerimos, aqui, duas modalidades distintas de sintomas escolares que se presentificam na relação com o saber: as inibições intelectuais e a melancolização. Tais sintomas dão testemunho de um preocupante declínio do sentido do conhecimento, que representa uma das principais mazelas com que a escola precisa lidar na atualidade. Partindo da concepção psicanalítica de que o sentido só se constrói na referência a outro, tal problemática não se resolveria com tentativas de conferir sentidos individuais ao conhecimento, como temos observado nas práticas educativas contemporâneas. Progressivamente, o aspecto coletivizante do conhecimento vem perdendo seu lugar em detrimento de uma compreensão mais individualizada, segundo a qual a educação funciona como instrumento de “modelagem” de competências exigidas pelo mercado de trabalho. Assim, concluímos que a necessidade de se resgatar o caráter coletivizante do conhecimento é urgente; há que se levar em consideração as condições de possibilidade de uma real transmissão no contexto escolar, pois o triunfo de um modelo educacional que se propõe a responder a demandas de eficácia e de inovação encontra seus limites na própria natureza do ato pedagógico