Resumo Introdução: A trombocitemia essencial (TE) é uma condição pouco comum e assintomática na maioria dos casos. No entanto, podem surgir sintomas como cefaleias, síncope, vertigem, dor torácica, eritromelalgia e distúrbios visuais transitórios. Os eventos hemorrágicos e tromboembólicos são os grandes riscos desta patologia. O objetivo da partilha deste caso clínico é alertar para uma patologia rara que pode passar despercebida e causar eventos potencialmente graves. Descrição do caso: Sexo feminino, 43 anos, raça caucasiana, antecedentes de hepatite B crónica, sem antecedentes cirúrgicos nem medicação habitual, incluindo método contracetivo hormonal. Recorreu a consulta com queixas de enfartamento precoce, dispepsia e epigastralgia com três dias de evolução, negando alterações do trânsito intestinal, características das fezes, náuseas ou vómitos. Exame físico e endoscopia digestiva alta recente sem alterações de relevo. Foi consultado o estudo analítico que a utente realizava regularmente no hospital, verificando-se que o valor do número de plaquetas se encontrava consistentemente a rondar os 500.000/uL desde há três anos. Pediu-se ecografia abdominal que descrevia trombose parcial da veia porta e do seu ramo esquerdo. A doente foi medicada com enoxaparina 60 mg 12h/12 h. Foi realizado angio-TC abdominal, estudo pró-trombótico e estudo genético e iniciou varfarina 5 mg 1x/dia, inicialmente sobreposta com enoxaparina 60 mg 12/12h. O angio-TC viria a confirmar a trombose da veia porta e confirmou-se positiva a mutação JAK2 V617F. Assumido o diagnóstico de TE e iniciado tratamento citorredutor com hidroxiureia 500 mg em dias alternados. Comentário: Este caso chama a atenção pelo excesso de plaquetas secundário à TE, ainda que ligeiramente acima do valor de referência, ter originado uma trombose da veia porta. Pretende-se alertar os médicos de família para a importância de realizar um estudo atento, valorizando pequenas variações sustentadas fora dos intervalos da normalidade e fazer uma referenciação correta e atempada quando necessário.

Abstract Introduction: Essential thrombocythemia (ET) is an asymptomatic rare condition in most cases. Nonetheless, symptoms like headache, syncope, vertigo, thoracic pain, erythromelalgia, and transient visual disturbances may surge. The major concerns of this pathology are hemorrhagic and thromboembolic events. The aim of sharing this case report is to alert for the existence of this rare pathology that can go unnoticed and cause potentially serious events. Case description: Female, 43-year-old, Caucasian. Background of chronic B hepatitis, without surgical background nor usual medication, including the contraceptive pill. She appealed to a medical appointment with an early feeling of fullness when eating, dyspepsia, and epigastric pain in the last three days. She denied changes in intestinal habits, feces characteristics, nausea, or vomiting. Physical examination and recent upper endoscopic study were normal. The hospital medical record was examined, verifying that platelet levels were consistently rounding 500,000/uL for the past three years. An abdominal ultrasonography was requested, and it described a partial portal vein and left branch thrombosis. The patient started enoxaparin 60 mg every 12 hours. It was conducted an abdominal angiotomography, prothrombotic, and genetic study, including the JAK2 V617F mutation. The patient started warfarin 5 mg one time daily, initially overlaid with enoxaparin 60 mg 12h/12h. The abdominal angiotomography would confirm the portal vein thrombosis and the JAK2 V617F mutation study was positive. It was assumed the diagnosis of ET and was initiated cytoreductive therapy with hydroxyurea 500 mg on alternated days. Comment: This case report shows that the excessive platelet count, secondary to ET, even if slightly above the reference value, caused a portal vein thrombosis. We aim to alert family physicians to the importance of doing a careful study, valuing little sustained variations out of the normal intervals, and referring correctly and promptly when necessary.

Abstract Introduction: Endovascular aortic repair (EVAR) has become the technique of choice in most vascular centres for abdominal aortic aneurysms (AAA). However, due to its low incidence, literature regarding secondary aortoenteric fistula (AEF) as an EVAR complication is still scarce. We aim to summarise the latest evidence on the topic through a narrative review. Methods: We conducted a MEDLINE literature search and included studies on secondary aortoenteric fistula, abdominal aortic aneurysms and endovascular aneurysm repair. Relevant studies were selected by reading of the titles and abstracts. Only English literature was considered. Results: Despite secondary AEF after EVAR first being reported in 1998, its incidence is hard to calculate, but is recognized to be lower (<0.5%) when compared to open aortic repairs (up to 1.6%). Aetiology may be categorised into local infection factors (pre-existent or associated with the procedure), mechanical factors associated with the aneurysm (such as anatomical shape and size) or mechanical factors associated with the stent graft (such as kinking, endoleak or endotension). Most common symptoms include abdominal or back pain, nausea, fever and gastrointestinal bleeding. Haemodynamic instability and shock at presentation is only present in less than a fifth of patients. Patients should be thoroughly submitted to a laboratory work-up, cultures and imaging tests, particularly CT scan and upper endoscopy. There are no guidelines regarding management, but it should include total graft excision along with arterial reconstruction (either in-situ or extra-anatomical), bowel repair and prolonged antibiotic therapy. Nonetheless, AEF is associated with a high mortality rate, even if adequate treatment is performed. Conclusion: Secondary AEF is an uncommon life-threatening complication after EVAR. Clinical presentation is non-specific, so a high level of suspicion is necessary to rapidly reach diagnosis. Treatment requires infection source control and prolonged antibiotic therapy. Considering the increasing use of endovascular devices, there is a need for future studies providing more insight on the most adequate treatment for this complication.

Abstract This paper aims to evaluate the applicability of the carbonation front prediction model recommended by CEB Bulletin 34 (2006) in Brazilian territory. For this, data from concrete mixtures produced in laboratory and exposed to natural carbonation for 10 years were used as benchmarks. Time of exposure, water/binder ration, different types of mineral admixtures and curing were considered as independent variables, while carbonation depth and coefficient as dependent ones. Analysis of variance and linear regression were performed between the actual and estimated data in order to establish criteria that allowed verifying the applicability of the model. It was considered the environmental and climatic conditions of the city of Goiânia/GO located in the tropical zone of Brazil Central with a hot semi-humid climate. As a result, based on the correlation and determination coefficients - equal to 0.83 and 0.68 respectively - it is concluded that the model needs to be revised before being applied in Brazil. More specifically, the inverse effective normal carbonation resistance factor, which associates the water/binder ration and the type of mineral admixture, should be readjusted so that it represents the effects in orders of magnitude similar to the real ones.

Resumo Este artigo tem como objetivo avaliar a aplicabilidade do modelo de predição de frentes de carbonatação preconizado pelo CEB Bulletin 34 (2006) em território brasileiro. Para isso, dados de concretos produzidos em laboratório e expostos à carbonatação natural por 10 anos foram utilizados como balizadores. Tempo de exposição, relação água/ligante, adição mineral e cura foram consideradas variáveis independentes, ao passo que a profundidade e o coeficiente de carbonatação como dependentes. Foram realizadas análises de variância e regressão linear entre os dados reais e os estimados, de maneira a estabelecer critériosque permitiram constatar a aplicabilidade do modelo. Consideraram-se condições ambientais e climáticas da cidade de Goiânia, GO, localizada na zona tropical Brasil Central, com clima quente semiúmido. Como resultado, com base nos coeficientes de correlação e determinação - iguais a 0,83 e 0,68 respectivamente - conclui-se que o modelo precisa ser revisto antes de ser aplicado no Brasil. Mais especificamente, o fator de resistência inversa efetiva à carbonatação natural, que associa a relaçãoágua/ligante e o tipo de adição, deve ser reajustado de maneira que represente os efeitos em ordem de grandeza semelhantes às reais.

Abstract Background: meeting the needs of families with a member who has a Neuromuscular Disorder (ND), enables an improvement in their quality of life, minimizing the possibility of illness and allowing greater family contribution to their functions. Objectives: characterize the needs of families with a member who has a ND in the functional dimension. Methodology: a quantitative, descriptive, cross-sectional study was carried out with an intentional sample of 30 families. The operative matrix of the Dynamic Model of Family Assessment and Intervention (MDAIF) was used as a data collection instrument. Data processing and analysis were performed by descriptive statistics. Results: most members who have a ND are dependent on self-care, clothing, hygiene and using the bathroom; families have saturation of home care role and caregiver role. Conclusion: family nurses will be able to help families by creating programs that allow: -the readjustment of family roles where there is saturation; -the possibility of working and supporting caregivers; -specific training regarding the people who have a ND.

Resumo Enquadramento: dar resposta às necessidades das famílias com membro Portador de Patologia Neuromuscular (PPN), possibilita uma melhoria na qualidade de vida dos mesmos, minimizando a possibilidade de doença e permite maior contribuição familiar nas suas funções. Objetivos: este estudo tem como objetivo caracterizar as necessidades das famílias com membro PPN, na sua dimensão funcional. Metodologia: foi realizado um estudo quantitativo, descritivo, transversal, com amostra intencional de 30 famílias. Utilizámos um formulário construído com base na matriz operativa do Modelo Dinâmico de Avaliação e Intervenção Familiar (MDAIF) como instrumento de colheita de dados. Tratamento e análise de dados efetuados pela estatística descritiva. Resultados: os membros portadores de patologia neuromuscular, na sua maioria são dependentes no autocuidado vestuário, higiene e uso do sanitário; a família apresenta a saturação do papel do cuidado doméstico e a saturação do papel de prestador de cuidados. Conclusão: o enfermeiro de família poderá dar resposta às famílias com a criação de programas que permitam: -reajuste dos papeis familiares onde existe saturação; -possibilidade de trabalhar e dar apoio ao prestador de cuidados; -formação específica no que respeita aos cuidados ao membro PPN.

Resumen Marco contextual: responder a las necesidades de las familias con un miembro con Patología Neuromuscular (PPN), posibilita una mejora en su calidad de vida, minimizando la posibilidad de enfermedad y permitiendo una mayor contribución familiar a sus funciones. Objetivos: este estudio tiene como objetivo caracterizar las necesidades de las familias con un miembro con Patología Neuromuscular (PPN), en su dimensión funcional. Metodología: se realizó un estudio cuantitativo, descriptivo, transversal, con una muestra intencional de 30 familias. Se utilizó un formulario construido sobre la matriz operativa del Modelo Dinámico de Evaluación e Intervención Familiar (MDAIF) como instrumento de recolección de datos. Procesamiento y análisis de datos realizado por estadística descriptiva. Resultados: la mayoría de los afiliados con patología neuromuscular son dependientes del autocuidado, vestimenta, higiene y uso del baño; la familia presenta la saturación del rol de cuidado doméstico y la saturación del rol de cuidador. Conclusión: la enfermera de la familia podrá responder a las familias con la creación de programas que permitan: - reajuste de los roles familiares donde hay saturación; -posibilidad de trabajar y apoyar al cuidador; -formación específica respecto al cuidado de la persona con PPN.

Abstract In the community, malnutrition is manifested by the loss of muscle mass, being associated with a decrease in muscle strength, an increased risk of frailty, functional impairment and impaired healing of chronic wounds, as well as a higher incidence of infections. It is estimated that malnutrition affects one in three elderly people at home and one in three patients in elderly care institutions. Malnutrition is reversible as long as the patient has access to timely nutritional screening that identifies their nutritional risk and as long as an individualized nutritional intervention is instituted. Disease associated malnutrition continues to be perceived as a secondary problem in primary health care, so the implementation of nutritional risk screening, as a routine parameter, is the first step in improving access to nutritional care in the community. In this article, the Malnutrition Universal Screening Tool is proposed for routine nutritional screening in primary care.

Resumo Na comunidade, a malnutrição manifesta-se pela perda de massa muscular, estando associada à diminuição da força muscular, ao aumento do risco de fragilidade, ao comprometimento funcional e da cicatrização de feridas crónicas, assim como a maior incidência de infeções. Estima-se que a malnutrição afete um em cada três idosos no seu domicílio e um em cada três utentes em instituições de cuidados de idosos. A malnutrição é reversível desde que o utente tenha acesso a um atempado rastreio nutricional que identifique o seu risco nutricional e instituída uma intervenção nutricional individualizada. A malnutrição associada à doença continua a ser percecionada como um problema secundário nos cuidados de saúde primários, pelo que a implementação do rastreio do risco nutricional, como um parâmetro de rotina, é o primeiro passo na melhoria do acesso aos cuidados nutricionais na comunidade. Neste artigo, é proposta a ferramenta Malnutrition Universal Screening Tool para rastreio nutricional de rotina nos cuidados de saúde primários.

Abstract Introduction: Fenestrated/branched EVAR (f/bEVAR) are associated with lower peri-operative major complications, when compared to open repair in complex aortic pathologies. However, f/bEVAR is limited by the waiting time for customized graft production and has specific anatomic limitations. Alternatively, adapting outside instructions-for-use, readily available off-the-shelf devices has been used with variable success. Among these options is the Octopus technique, which consists of parallel stent grafts originating inside a larger external stent graft. Despite being an off-label combination of devices, it can play a role when f/bEVAR is unavailable or inapplicable. Methods: Single center retrospective study, including all consecutive patients treated with the Octopus technique. Baseline characteristics, peri-procedural and follow-up data was obtained. Primary endpoint is clinical success. Secondary endpoints are complications and secondary interventions in follow-up. Results: Between 2015 and February 2022, six patients with a mean of 74±9 years were identified. Treatment indications included three type 1A endoleaks and 3 thoracoabdominal aortic aneurysms (TAAA) without prior intervention, one of which was mycotic. Four procedures were elective and the remaining two emergent. In the elective cases, the Octopus technique was chosen due to anatomical constraints and because waiting time for customization was considered excessive. Excluder and Incraft endografts were used in 5 and 1 cases, respectively. Thirteen visceral branches were revascularized (6 superior mesenteric, 4 renal and 3 celiac arteries). Gutter endoleaks were observed in 2 patients. Mean blood loss, surgery and hospitalization duration was 483 (300) mL, 288 (73) minutes and 26 (19.5) days. One perioperative death occurred, in a patient treated in the context of post-EVAR rupture due to type 1A endoleak. The most frequent postoperative complications were temporary acute renal failure (2/6), paraplegia (2/6) of which one was completely resolved, and non-graft related infection (2/6). One early reintervention, consisting of branch relining due to kinking and gutter embolization was necessary. On follow-up, there were no new endoleaks or endoleak-related interventions. Four patients died within two years, one with an aneurysm-related complication (spondylodiscitis in the context of a mycotic TAAA). The remaining deaths were not aneurysm related. Conclusion: The Octopus technique may offer a valuable off-the-shelf solution for complex aortic diseases, particularly due to anatomical constraints or in the emergent setting. Despite a high technical success rate, there is significant early morbidity and high mid-term mortality. In our series, durability was reasonable for this challenging group of patients, and our outcomes are in accordance with other reports.

SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between maternal anxiety in the third trimester and changes in fetal and maternal circulation assessed by Doppler velocimetry. METHODS: This is a prospective, cross-sectional study. The inclusion criteria were good health, a singleton pregnancy, maternal age between 18 and 40 years, and gestational age between 34 and 40 weeks. Doppler measurements included mean uterine artery pulsatility index, fetal middle cerebral artery pulsatility index, peak of systolic velocity, umbilical artery, and umbilical vein. The Beck Anxiety Inventory questionnaire, validated for the Brazilian population, with 21 self-reported items, was applied. RESULTS: The study included 34 pregnant women, and 6 (17.7%) presented a total Beck Anxiety Inventory score showing moderate or severe maternal anxiety. The mean maternal age was 28.1 years (SD 5.7 years); the mean gestational age at interview was 36.5 weeks (SD 1.8 weeks), and the mean Beck Anxiety Inventory total score was 12.3 (SD 9.8). The group with moderate or severe anxiety, compared to the group with minimal or mild anxiety, presented an association with lower maternal age (median 21.5 vs. 29.5 years, p=0.019), lower fetal umbilical vein blood flow (median 189.4 vs. 249.5 mL/min, p=0.047), and lower umbilical vein-corrected blood flow (median 68.5 vs. 84.9 mL/kg/min, p=0.038). CONCLUSION: Maternal anxiety may affect fetal circulation patterns in late pregnancy and is associated with reduced blood flow in the fetal umbilical vein. The underlying physiopathology needs further investigation.

Abstract: This study examines the prevalence of big bath accounting in an emerging market context, focusing on newly appointed CEOs of Brazilian firms. We find evidence of big bath accounting in Brazil and extends the big bath and CEO turnover literature by documenting a limit to downward earnings manipulation and by using Brazil as a source of study. Our results suggest that incumbent CEOs have incentives to manage profits downward only when the company was previously profitable, rather than risking worsening an already bad situation, in the case of unprofitable firms. We also find that they are more likely to use accrual earnings management, rather than reducing production or increasing discretionary expenditures, as tool to decrease earnings level. Overall, our study fills a gap in the literature and supports future research in understanding the big bath CEO turnover scenario in Brazilian firms.

Resumen: Este estudio examina la prevalencia del big bath accounting en un contexto de mercado emergente, centrándose en los CEOs recién nombrados de empresas brasileñas. Encontramos evidencias de big bath accounting en Brasil y ampliamos la literatura sobre big bath y rotación de CEOs, documentando un límite a la manipulación de beneficios a la baja y utilizando Brasil como fuente de estudio. Nuestros resultados sugieren que los CEOs tienen incentivos para gestionar los beneficios a la baja sólo cuando la empresa es rentable, en lugar de arriesgarse a empeorar una situación ya de por sí mala, en el caso de las empresas no rentables. También descubrimos que es más probable que utilicen la gestión de beneficios por devengo, en lugar de reducir la producción o aumentar los gastos discrecionales, como herramienta para disminuir el nivel de beneficios. En general, nuestro estudio llena un vacío en la literatura y apoya la investigación futura para entender el escenario de rotación de los CEOs en las empresas brasileñas.

Resumo O estudo tem como objetivos: cartografar a trajetória de racismo estrutural e de sofrimento psíquico de uma mulher negra acompanhada por uma enfermaria psiquiátrica em um Hospital Geral; e refletir sobre a relação entre o racismo estrutural e sofrimento psíquico. O racismo é a operacionalização tecnológica, destinada ao exercício do biopoder, que coloca negros em posições inferiores, determinando desvantagens a partir da raça. A violência racista impõe o debate para o campo da saúde mental por sua influência no sofrimento psíquico. Pesquisa qualitativa, descritiva e exploratória, com abordagem cartográfica, por meio da trajetória de uma usuária-cidadã-guia, utilizando-se da entrevista semiestruturada e do diário de campo cartográfico. A analise fez emergir as cenas: ser negra e como a sociedade nos vê; auto ódio; solidão da mulher negra, que demonstram como o sofrimento psíquico é influenciado pelo racismo estrutural que condicionam a existência do negro ao menor valor, à estigmatização e à desumanização. A subjetividade produzida internaliza sentimentos de inferioridade, de solidão, de auto-ódio e de não lugar. Torna-se urgente a problematização da questão racial na produção do cuidado em saúde mental, bem como uma reforma societária que proporcione a existência plena de direitos e de dignidade das pessoas negras.

Abstract The study aims to map the trajectory of structural racism and psychic suffering of a black woman accompanied by a psychiatric nursery in a General Hospital; and to reflect on the relationship between structural racism and psychic suffering. Racism is the technological operationalization, destined to the exercise of biopower, which places black people in inferior positions, determining disadvantages based on race. Racist violence imposes the debate on the field of mental health due to its influence on psychic suffering. Qualitative, descriptive and exploratory research, with a cartographic approach, through the trajectory of a user-citizen-guide, using a semi-structured interview and a cartographic field diary. The analysis made the scenes emerge: being black and how society sees us; self-hate; and loneliness of black women that demonstrate how psychic suffering is influenced by structural racism that condition the existence of black people to the lowest value, stigmatization and dehumanization. The subjectivity produced internalizes feelings of inferiority, loneliness, self-hatred and non-placement. It is urgent to problematize the racial issue in the production of mental health care, as well as a societal reform that provides the full existence of rights and dignity of black people.

ABSTRACT COVID-19 is commonly associated with high serum levels of pro-inflammatory cytokines, and the post-infection status can disturb self-tolerance and trigger autoimmune responses. We are reporting a 45-year-old male who was admitted with fatigue, jaundice, elevated liver enzymes (with cholestatic pattern), and acute kidney injury two weeks after recovering from a mild SARS-CoV-2 infection. Serologies for viral hepatitis and anti-mitochondrial antibody were negative, while anti-nuclear and anti-smooth muscle antibodies were positive. There were no signs of chronic liver disease, and a magnetic resonance cholangiography showed no dilatation of biliary ducts. Histologic evaluation of the liver evidenced numerous foci of lobular necrosis without ductopenia or portal biliary reaction. Considering the autoantibody profile and histologic changes, the medical team started oral prednisone, but there was a suboptimal biochemical response in the outpatient follow-up. Two months later, a second liver biopsy was performed and revealed non-suppurative destructive chronic cholangitis, extensive areas of confluent necrosis with hepatocytes regenerating into pseudorosettes, and numerous plasma cells. According to the Paris Criteria, the patient was then diagnosed with an autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC-OS). After adding azathioprine and ursodeoxycholic acid to the treatment, there was a satisfactory response. This is the second worldwide report of an AIH-PBC-OS triggered by COVID-19, but the first case with a negative anti-mitochondrial antibody. In this setting, histologic evaluation of the liver by an experienced pathologist is a hallmark of achieving the diagnosis and correctly treat the patient.

Abstract Introduction: Smartphone use has become a popular social communication phenomenon worldwide. Its excessive use can compromise daily routines and habits, which is associated with sleep disorders, stress, anxiety and pain. Therefore, the university student stands out, as they has a lifestyle in which it is necessary to reconcile daily activities with curriculum activities, aggravating psychosocial factors. Objective: To investigate whether smartphone addiction influences sleep quality, anxiety, depression and pain in university students. Methods: We carried out an analytical cross-sectional study. For data collection, the following self-administered questionnaires were used: Smartphone Addiction Inventory (SPAI-BR), to assess smartphone dependence; Pittsburgh Sleep Quality Index (PSQI), to evaluate sleep quality; Hospital Anxiety and Depression Scale, to assess anxiety and depression (HADS), where it was subdivided into HADS-A for anxiety and HADS-D for depression; and Numeric Rating Scale (NRS) to determine physical pain intensity. The sample consisted of 301 university students studying physiotherapy and physical education at the State University of Northern Paraná (UENP). They were divided according to the score obtained in the SPAI-BR between the “regular” group (up to 6 points) and “predisposed” to smartphone dependence (7 or more points). Results: The comparisons were statistically significant in favor of the regular group: the predisposed group obtained a higher score for the questionnaires used with an average NRS of 2.37 points, average HADS-D of 9.05 points and average HADS-A of 6.01 points. Differences between groups were statistically significant: NRS, p = 0.018; HADS-A, p = 0.001; HADS-D p = 0.001; and PSQI, p = 0.001. Conclusion: The university students analyzed in this study classified as predisposed were more prone to being addicted to their smartphone, and they were more likely to have anxiety, with a worse quality of sleep and with a greater intensity of pain.

Resumo Introdução: O uso de smartphones se tornou um fenômeno social mundialmente popular de comunicação. Seu uso excessivo pode comprometer as rotinas e hábitos diários, que estão associados aos distúrbios do sono, estresse, ansiedade, algias; logo, destaca-se o universitário, que apresenta um estilo de vida em que é preciso conciliar as atividades diárias com as curriculares, agravando fatores psicossociais. Objetivo: Investigar se a dependência do uso de smartphone influencia a qualidade de sono e os níveis de ansiedade, depressão e dor em universitários. Métodos: Trata-se de um estudo transversal analítico. Para a coleta dos dados foram utilizados os questionários autoaplicáveis Inventário de Dependências do Smartphone (SPAI-BR), Escala de Pittsburgh (PSQI), Escala Hospitalar de Ansiedade e Depressão (HADS), sendo este subdividido em HADS-A (ansiedade) e HADS-D (depressão), e Escala Numérica da Dor (END). A amostra foi composta por 301 universitários da Universidade Estadual do Norte do Paraná, dos cursos de fisioterapia e educação física. Os estudantes foram divididos de acordo com o escore obtido no SPAI-BR entre grupo regular (até 6 pontos) e pré-disposto à dependência do uso de smartphone (7 ou mais pontos). Resultados: As comparações foram estatisticamente significativas a favor do grupo regular; sendo assim, o grupo pré-disposto obteve uma pontuação pior nos questionários utilizados, sendo a média END de 2,37 pontos, a média HADS-D de 9,05 e a média HADS-A de 6,01. Os valores de intensidade de dor entre os grupos foram de p = 0,018; HADS-A: p = 0,001; HADS-D: p = 0,001; PSQI: p= 0,001. Conclusão: Os universitários classificados como pré- dispostos apresentaram uma maior propensão à dependência do smartphone, além de maior chance de terem ansiedade com uma pior qualidade de sono e maior intensidade de dor.