Noradrenaline use is not associated with extubation failure in septic patients

Standard clinical practice recommends minimal doses of vasoactive drugs during weaning of patients from mechanical ventilation. However there are currently no clinical data to inform clinicians about whether the use of noradrenaline during weaning predisposes to weaning failure. The objective of this study was to evaluate whether the necessity of the vasopressor noradrenaline in mechanically ventilated patients recovering from septic shock changed the extubation outcome. A total of 656 patients recovering from septic shock on mechanical ventilation were selected from intensive care units in two university hospitals. Patients receiving noradrenaline at the time of weaning and case-controls not taking noradrenaline were matched for age, gender, haemodynamic and ventilatory parameters, aetiology of respiratory failure and APACHE II score. One hundred and forty-five patients who successfully tolerated a spontaneous breathing trial were extubated while on noradrenaline therapy and the reintubation rate was measured. In the noradrenaline group, the mean dose of noradrenaline during initial shock treatment was 0.52+/-0.29 microg/kg/min and 0.12+/-0.10 microg/kg/min during weaning. The reintubation rate was 12/63 (19%) in the noradrenaline group and 15/82 (18.3%) in the control group (P=1.00). Intensive care unit mortality was also similar in both groups (10/63, 15.9%) for noradrenaline patients and (11/82, 13.4%) for control patients (P=0.81). Arterial blood gases and ventilatory and haemodynamic parameters were similar in all patients regardless of weaning success. We did not find that the use of noradrenaline at the time of weaning was associated with extubation failure. Low doses of noradrenaline may not preclude weaning from mechanical ventilation.     

Association between psychosocial factors and self-reported overweight in Brazilian adults

The objective of this study was to investigate the association between psychosocial factors and self-reported overweight. A cross-sectional study was carried out with 1,100 adults in a Brazilian city. Structured interviews were conducted using a standard pre-tested questionnaire. Overweight was self-reported by participants and defined as body mass index (BMI) > 25kg/m2. Psychosocial factors were quality of life (WHO-8: EUROHIS) and social support (Medical Outcomes Study). Crude and adjusted prevalence ratios (PR) were obtained by modified Poisson regression. After controlling for socio-demographic and behavioral variables, prevalence of overweight among individuals reporting low quality of life and low social support was 19% (PR = 1.19; 95%CI: 1.03-1.38) and 12% (PR = 1.12; 95%CI: 0.96-1.31), respectively, and was higher in those reporting high/moderate quality of life and high/moderate social support, respectively. The findings suggest that psychosocial factors can play a role in self-assessment of overweight.     

Pathways to care,DUP, and types of interventions over 5 years following psychosis onset: findings from a naturalistic study conducted in routine generalist mental health services

Social Psychiatry and Psychiatric Epidemiology - To describe pathways to care, duration of untreated psychosis (DUP), and types of interventions provided to first-episode psychosis (FEP) patients...     

Age dependence of within-subject biological variation of nine common clinical chemistry analytes

Abstract Background: The knowledge of biological variation (BV) data is important for clinical decisions and as a basis for defining analytical quality specifications. However, in gene\xadrating reliable data of biological variation there are still some unsolved problems, such as age dependence. The aim of our work is to verify this aspect. Methods: Twenty-six subjects divided into three groups by age were studied. Blood samples were collected in lithium heparin tubes for four weeks at one week intervals, on the same day of the week (Tuesday) and at the same time of day (8-9 a.m.) by the same phlebotomist. They were analysed in duplicate for creatinine, urate, calcium, albumin, total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL)-cholesterol, triglycerides and iron. After outlier exclusion by Cochran\u2019s test, components of biological variation were calculated by ANOVA. The significance of the differences between results of the classes was also calculated with the Student\u2019s test (t-test) and the Fisher\u2019s test (F-test). Results: Excluding albumin, the group 3 results (age range from 78 to 98 years) showed significantly lower CV within subjects (CVW) than the other two groups. Conclusions: Our data seem to highlight the relevance of the age when choosing the reference subjects for biological variation studies. The level of within-subject biological variation of the elderly group may have been further reduced by the homogeneity of the group constituted by individuals living together in the same nursing home.     

Neighborhood sociodemographic and environmental contexts and self-rated health among Brazilian adults: a multilevel study

The aim of this study was to investigate the association between sociodemographic and environmental contexts on self-rated health. A population-based cross-sectional study with a random sample of 38 neighborhoods (census tracts) and 1,100 adults was carried out. Data analysis used multilevel logistic regression. Data from the Brazilian Census of 2000, mean income, years of study of the head of household and mean number of residents per tract were R$955 (SD = 586), 8 years (SD = 3), and 746 residents (SD = 358) respectively. Higher prevalences of fair/poor self-rated health were found in neighborhoods with greater populations and lower income/schooling levels. After control for individual variables, the odds for fair/poor self-rated health was twice as high in more populous (OR = 2.04; 95%CI: 1.15-3.61) and lower-income neighborhoods (OR = 2.29; 95%CI: 1.16-4.50) compared to less populous, higher-income ones. Self-rated health depends on individual characteristics and the sociodemographic context of neighborhoods.     

Shaping ability of RaCe rotary nickel-titanium instruments in simulated root canals

This study assessed the shaping ability of RaCe rotary nickel-titanium instruments in simulated root canals. Forty simulated root canals consisting of four different shapes were prepared with RaCe rotary nickel-titanium instruments in a crowndown approach. Preoperative images were taken at the outset and postoperative images at various stages of preparation including at the conclusion of the shaping procedure. The combined images enabled assessment of aberrations and resin removal at various positions along the canal length. Overall, mean preparation time to size 40, .02 taper was 1.36 min. Thirty-three canals (83%) maintained the working length, three instruments deformed and no zips, perforations, or ledges were created. Under the conditions of this study RaCe rotary nickel-titanium instruments prepared simulated canals rapidly and successfully, with little change in working length and with few aberrations or instrument deformities.     

Attitudes of Brazilian psychiatrists toward people with epilepsy

The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment, formal training, attitudes, and knowledge with respect to epilepsy (and associated mental disorders). One hundred fifty-seven Brazilian psychiatrists completed a specially developed questionnaire. Most (95%) had previously treated patients with epilepsy and mental disorders. About one-third (35%) admitted a lack of any formal training in epilepsy, and only 46% confirmed having received some formal training in mental disorders related to epilepsy. Eighty percent were dissatisfied with their knowledge. Three knowledge-based questions were answered correctly by only 10%. Almost half (48%) admitted that among psychiatrists, prejudice exists toward patients with epilepsy. Difficulties with treatment (50%) and lack of knowledge of epilepsy (50%) were considered the main causes of such prejudice. These data indicate an urgent need for improvement in education on epilepsy and associated mental disorders, as well as inclusion of formal epilepsy training in psychiatry residency programs.     

Gender and 5-years course of psychosis patients: focus on clinical and social variables

Most studies on gender and psychosis have focused on gender differences at illness onset or on the long-term outcome, whereas little is known about the impact of gender on the first years after...