The current worldwide outbreak of COVID-19 has changed the modus operandi of all segments of society. While some pandemic-related stressors affect nearly everyone, many especially affect women. ...Purpose: To review what is known about the pandemic’s effect on women’s mental health, what makes them more predisposed to vulnerabilities and adverse impacts, and strategies for preventing and treating these mental health consequences in the female population during specific stages across the lifespan. Methods: The authors performed a narrative review in combination with their observations from clinical experience in the field of women’s mental health and reproductive psychiatry. Articles on women’s mental health and COVID-19 up to May 30, 2020, were searched using the electronic PubMed and PsychInfo databases, as well as publications by major health entities (e.g., World Health Organization, Centers for Disease Control and Prevention, the United Nations) and press releases from prime communication outlets (e.g., National Public Radio). Results and conclusions: Women who are pregnant, postpartum, miscarrying, or experiencing intimate partner violence are at especially high risk for developing mental health problems during the pandemic. Proactive outreach to these groups of women and enhancement of social supports could lead to prevention, early detection, and prompt treatment. Social support is a key protective factor. Similarly, parenting may be substantially more stressful during a pandemic. Gender disparities may be accentuated, particularly for employed women or single parents, as women are disproportionately responsible for the bulk of domestic tasks, including childcare and eldercare.
BACKGROUND:The prevalence of burnout and depression in anesthesiology residents has not been determined. It is also unknown whether anesthesiology resident burnout/depression may affect patient care ...and safety. The primary objective of this study was to determine the prevalence of burnout and depression in anesthesiology residents in the United States. We hypothesized that residents at high risk of burnout and/or depression would report more medical errors as well as a lower rate of following principles identified as the best practice of anesthesiology.
METHODS:A cross-sectional survey was sent to 2773 anesthesiology residents in the United States. The questionnaire was divided into 5 parts examining trainees’ demographic factors, burnout (Maslach Burnout Inventory), depression (Harvard depression scale), 10 questions designed to evaluate best practice of anesthesiology, and 7 questions evaluating self-reported errors. Best practices and self-reported error rates were compared among subjects with a high risk of burnout only, high risk of depression only, high risk of burnout and depression, and low risk of burnout and depression. Pairwise comparisons were considered significant at P < 0.004 and confidence intervals (CIs) reported at 99.6%.
RESULTS:There were 1508 (54%) resident responds. High burnout risk was found in 41% (575 of 1417) of respondents. Working >70 hours per week, having >5 drinks per week, and female gender were associated with increased burnout risk. Twenty-two percent (298 of 1384) screened positive for depression. Working >70 hours of work per week, smoking, female gender, and having >5 drinks per week were associated with increased depression risk. Two hundred forty (17%) respondents scored at high risk of burnout and depression, 321 (23%) at high risk of burnout, 58 (4%) at high risk of depression only, and 764 (56%) at low risk of burnout or depression. Median best practice scores (maximum = 30) for residents at high risk of burnout (difference −2; 99.6% CI, −1 to −2; P < 0.001) or high risk of burnout and depression (difference −4; 99.6% CI, −3 to −6; P < 0.001) were lower than scores of residents at low risk for burnout or depression. Thirty-three percent of respondents with high burnout and depression risk reported multiple medication errors in the last year compared with 0.7% of the lower-risk responders (P < 0.001).
CONCLUSION:Burnout, depression, and suicidal ideation are very prevalent in anesthesiology residents. In addition to effects on the health of anesthesiology trainees, burnout and depression may also affect patient care and safety.
Dexamethasone is frequently administered in the perioperative period to reduce postoperative nausea and vomiting. In contrast, the analgesic effects of dexamethasone are not well defined. The authors ...performed a meta-analysis to evaluate the dose-dependent analgesic effects of perioperative dexamethasone.
We followed the PRISMA statement guidelines. A wide search was performed to identify randomized controlled trials that evaluated the effects of a single dose systemic dexamethasone on postoperative pain and opioid consumption. Meta-analysis was performed using a random-effect model. Effects of dexamethasone dose were evaluated by pooling studies into three dosage groups: low (less than 0.1 mg/kg), intermediate (0.11-0.2 mg/kg) and high (≥ 0.21 mg/kg).
Twenty-four randomized clinical trials with 2,751 subjects were included. The mean (95% CI) combined effects favored dexamethasone over placebo for pain at rest (≤ 4 h, -0.32 0.47 to -0.18, 24 h, -0.49 -0.67 to -0.31) and with movement (≤ 4 h, -0.64 -0.86 to -0.41, 24 h, -0.47 -0.71 to -0.24). Opioid consumption was decreased to a similar extent with moderate -0.82 (-1.30 to -0.42) and high -0.85 (-1.24 to -0.46) dexamethasone, but not decreased with low-dose dexamethasone -0.18 (-0.39-0.03). No increase in analgesic effectiveness or reduction in opioid use could be demonstrated between the high- and intermediate-dose dexamethasone. Preoperative administration of dexamethasone appears to produce a more consistent analgesic effect compared with intraoperative administration.
Dexamethasone at doses more than 0.1 mg/kg is an effective adjunct in multimodal strategies to reduce postoperative pain and opioid consumption after surgery. The preoperative administration of the drug produces less variation of effects on pain outcomes.
Children with cerebral palsy have a higher prevalence of sleep disorders, with numerous factors associated with a negative impact on the quality of life of caregivers.
To identify factors related to ...sleep disorders, nonpharmacological treatment, and the impact on the lives of caregivers.
The present literature review was carried out in the Latin American and Caribbean Center on Health Sciences Information (BIREME), the Cochrane Library, Scopus, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, WorldCat, Web of Science, Latin American Literature on Health Sciences (LILACS), and Excerpta Medica Database (EMBASE), with the descriptors
, and
. Studies available in Portuguese, English, or Spanish, published between 2010 and 2020, were our inclusion criteria. A total of 29 articles were included in the present review.
We considered nonpharmacological interventions effective support measures to drug-based treatments. The main sleep disorders in children with cerebral palsy are insomnia, parasomnias, nightmares, sleep bruxism, sleepwalking, sleep talking, disorders of initiation and maintenance of sleep, and sleep hyperhidrosis. Most studies point to a reduction in the quality of life of caregivers whose children have sleep disorders.
Our review suggests the effectiveness of nonpharmacological treatments combined with the use of medications. Measures such as changes in sleep environment and routine are favorable strategies to improve sleep quality. In addition, children with sleep disorders negatively impact the quality of life of their caregivers.
The use of external prestressed tendons in steel-concrete composite beams can improve the performance of beams by strengthening their structure, increasing the ultimate moment resistance, and ...reducing deflections. The present research aims to investigate the behavior of simply supported steel-concrete composite beams, prestressed with external tendons and under positive bending moment through the development of a parametric study. Firstly, for the beam strength determination, an analytical model is discussed. To predict the ultimate increment in tendon stress Chen and Gu method is used. Additionally, a numerical model that can adequately simulate the behavior of prestressed composite beams is developed using the Abaqus software. The accuracy of this model is validated through comparisons between the obtained results and existing experimental tests. Then, a parametric study is carried out to identify the influence of the following variables: positioning and shape of the tendons, initial prestressing force, and tendon and span lengths. The effect of prestressing at the steel-concrete interface is also investigated. The results of the ultimate moment from the finite element models, are compared by applying the analytical procedure. It can be concluded that all the different tendon configurations considered in the parametric study improved the ultimate moment resistance in the composite beams, but some designs are more efficient than others, increasing the resistance even more, and significantly reducing the deflections and cracking in the concrete under service loads. Regarding the analytical procedure, it was found that the method can adequately estimate the strength capacity of the beams.
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•An analytical method for externally prestressed steel-concrete composite beams is discussed.•A numerical parametric analysis is developed.•Divergences between the numerical analyses and analytical procedures were verified.•Tendon configuration influences the beam's resistance, deflections, slab cracking and the steel-concrete interface.•The analytical procedure can adequately estimate the ultimate resistance of the beams.
Microvascular dysfunction plays a central role in organ dysfunction during septic shock. Endothelial glycocalyx (eGC) damage could contribute to impaired microcirculation. The aim was to assess ...whether several eGC-damaged biomarkers are associated with microvascular dysfunction in resuscitated septic shock patients.
This cross-sectional study included resuscitated septic shock patients (N = 31), and a group of healthy individuals (N = 20). The eGC damage biomarkers measured were syndecan-1 (SDC-1), soluble CD44 (CD44s), hyaluronic acid (HYAL) in blood sample; sulfated glycosaminoglycans (GAGs) in urine sample; and thrombomodulin (TBML) in blood sample as biomarker of endothelial cell damage. Microcirculation was assessed through sublingual videocapillaroscopy using the GlycoCheck™, which estimated the perfused vascular density (PVD); the perfused boundary region (PBR), an inverse parameter of the eGC thickness; and the microvascular health score (MVHS). We defined a low MVHS (<50th percentile in septic patients) as a surrogate for more impaired microvascular function.
The SDC-1, CD44s, TBML and GAGs levels were correlated with impaired microvascular parameters (PVD of vessels with diameter < 10 μm, MVHS and flow-adjusted PBR); p < 0.05 for all comparisons, except for GAGs and flow-adjusted PBR. The SDC-1 78 ng/mL (interquartile range (IQR) 45–336) vs. 48 ng/mL (IQR 9–85); p = 0.052, CD44s 796ρg/mL (IQR 512–1995) vs. 526ρg/mL (IQR 287–750); p = 0.036, TBML 734ρg/mL (IQR 237–2396) vs. 95ρg/mL (IQR 63–475); p = 0.012 and GAGs levels 0.42 ρg/mg (IQR 0.04–1.40) vs. 0.07 ρg/mg (IQR 0.02–0.20); p = 0.024; were higher in septic patients with more impaired sublingual microvascular function (low MVHS vs. high MVHS).
SDC-1, CD44s, TBML and GAGs levels were associated with impaired microvascular function in resuscitated septic shock patients.
•Endothelial glycocalyx (eGC) damage could contribute to sepsis microvascular dysfunction.•eGC-damage biomarkers correlated with microvascular dysfunction in septic shock.•These biomarkers were higher in patients with more pronounced microvascular dysfunction.
In aquatic ecosystems, phytoplankton is an important component of biodiversity. Although much is already known about the main climate change agents impacting phytoplankton, it is necessary to ...systematize this knowledge in order to identify the main trends, gaps, and perspectives for future research in this field. Thus, we conducted a systematic review of the global scientific literature on phytoplankton and climate change. We found 660 articles published between 1991 and 2020 using the Web of Science platform. The studies were mostly conducted in marine and freshwater environments using an observational approach. The main variables studied were temperature and nutrient concentrations. The main phytoplankton response variables are linked to metrics of species composition/diversity or physiological/biochemical traits of organisms. We found that over the last 30 years, a large number of climatic predictors and phytoplankton response variables have been studied. However, the number of studies evaluating interactions of multiple variables (climate and phytoplankton response) is small in comparison to the total amount of research. Thus, the combination of methodological approaches, as well as the simultaneous study of multiple climate predictors and response variables, can help in the production of new information to understanding of the effects of climate change on phytoplankton.
Steel-concrete composite beams with concrete slab cast on profiled steel decking are widely used in bridges and building construction. Prestressed tendons can be added to the beams to increase their ...structural performance in new structures or in retrofitting. However, no experimental data was found in the literature that investigated prestressing associated with profiled steel decking in composite beams. This paper presents an experimental study that investigates the behavior of simply supported prestressed steel-concrete composite beams with profiled steel decking under positive bending moment. Tests were carried out both on a beam with straight tendon profile placed at the beam's full length and on a conventional non-prestressed composite beam, and deflections and strains were measured. The beams were mounted in a four-point bending test configuration and then loaded. The tests terminated due to excessive deformations of the models and safety concerns, and no particular failure mode was observed. Then, a numerical model to simulate the behavior of the composite beams was developed and validated with the test data. The numerical models indicated that the failure mechanism in both beams consisted in yielding of the tensioned steel beam. It was found that adding prestressing can increase the ultimate moment by up to 19% and significantly reduce deflections under service loads.
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•The behavior of prestressed steel-concrete composite beams with profiled steel deck under positive moments were analyzed.•Experiments on a beam with straight tendon and on a conventional non-prestressed composite beam were developed.•A numerical model to simulate the behavior of the composite beams was proposed and validated with the test data.•Adding prestressing can increase the ultimate moment by up to 19% and significantly reduce deflections under service loads.
The Environmental Stress Hypothesis (ESH) is a causal theoretical framework that provides a flexible context for understanding factors that mediate the relationship between low motor proficiency and ...internalizing problems in children. The purpose of the present study was to use the ESH framework to determine whether body mass index (BMI), physical activity levels, psychosocial health and physical health, self-efficacy, perceived social status, prosocial behavior and externalizing problems were potential mediators between motor proficiency and internalizing factors in a population of Brazilian children. 431 children aged 7- to 10 years (240 females, 191 males) participated in the study. The variables were measured with the Movement Assessment Battery for Children, 2nd ed. (MABC-2), the Pediatric Quality of Life Inventory (PedsQL), the Strengths and Difficulties Questionnaire (SDQ), the MacArthur Subjective Social Status Scale (MacArthur SSS), the Self-efficacy Sense Assessment Roadmap (RASAE), and the Physical Activity Questionnaire (PAQ). The results indicated a direct relationship between motor proficiency and internalizing problems in a population of Brazilian children, with externalizing problems being the only variable mediating that relationship. To the best of our knowledge, this is the first time that externalizing problems were tested in the context of the ESH. Understanding and evaluating potential mediators in the relationship between motor proficiency and internalizing problems using the ESH framework is essential to promote prevention policies and interventions for school-age children.
•The relationship between motor proficiency and internalizing problems is mediated by externalizing problems.•Physical activity did not mediate the relationship between low motor proficiency and internalizing problems.•This study extends the ESH by adding a mediating pathway that had not previously been addressed.
To investigate, among children and adolescents with cerebral palsy (CP), the relationship between impairment of the gross motor function and: (i) child sleep disorders; (ii) the need for nocturnal ...support; and (iii) the quality of sleep of their caregivers.
For children, we considered their scores on the gross motor function measure (GMFM-88) and on the sleep disturbance scale for children (SDSC), besides analyzing qualitative features about their sleep. For caregivers, we considered their scores in the Pittsburgh sleep quality index (PSQI).
Our sample was comprised of 87 participants with mean age of 11.4 years old (±3.4). We observed correlations between GMFM-88 and disorders of initiating and maintaining sleep (DIMS) (r = −0.22; p = 0.039), sleep–wake transition disorders (SWTD) (r = 0.26; p = 0.017) and disorders of arousal (DA) (r = 0.23; p = 0.033). Children receiving nocturnal support presented lower scores in the GMFM-88 (p = 0.001) and higher scores in the SDSC (p = 0.029). For the caregivers, we found no correlation between GMFM-88 and PSQI. Nonetheless, their PSQI scores correlated with the SDSC scores (r = 0.24; p = 0.027).
Impairment of the gross motor function correlated with DIMS and the need for nocturnal support but might not have an impact on the caregivers’ sleep, which in turn correlated with child sleep disorders.
•Higher motor impairment in children with CP increases the need for nocturnal support.•Children with CP have sleeping problems that increase the need for nocturnal support.•Disorders of initiating and maintaining sleep are related to higher motor impairment in children with CP.•Higher motor impairment in children with CP does not influence the sleep quality of their caregivers.•Sleeping problems of children with CP influence the sleep quality of their caregivers.
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