Enaldo Vieira de Melo

Burnout Syndrome and associated factors among medical students: a cross-sectional study

OBJECTIVES: To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. METHODS: A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. RESULTS: The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio–OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68). CONCLUSION: There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.

Sintomas depressivos entre internos de medicina em uma universidade pública brasileira

OBJECTIVE: To estimate, among Medical School intern students, the prevalence of depressive symptoms and their severity, as well as associated factors. METHODS: Cross-sectional study in May 2008, with a representative sample of medical intern students (n = 84) from Universidade Federal de Sergipe (UFS). Beck Depression Inventory (BDI) and a structured questionnaire containing informationon sociodemographic variables, teaching-learning process, and personal aspects were used. The exploratory data analysis was performed by descriptive and inferential statistics. Finally, the analysis of multiple variables by logistic regression and the calculation of simple and adjusted OR swith their respective 95% confidence intervals were performed. RESULTS: The general prevalence was 40.5%, with 1.2% (95% CI: 0.0-6.5) of severe depressive symptoms; 4.8% (95% CI: 1.3-11.7) of moderate depressive symptoms; and 34.5% (95% CI: 24.5-45.7) of mild depressive symptoms. The logistic regression revealed the variables with a major impact associated with the emergence of depressive symptoms: thoughts of dropping out (OR 6.24; p = 0.002); emotional stress (OR 7.43;p = 0.0004); and average academic performance (OR 4.74; p = 0.0001). CONCLUSION: The high prevalence of depressive symptoms in the study population was associated with variables related to the teaching-learning process and personal aspects, suggesting immediate preemptive measures regarding Medical School graduation and student care are required.

Common mental disorders among medical students at Universidade Federal de Sergipe: a cross-sectional study

OBJECTIVE Estimate the prevalence of common mental disorder and its associated factors among medical students of the Universidade Federal de Sergipe. METHOD A cross-sectional study was carried out, applying Self Reporting Questionnaire-20 to 473 students from the 512 medical students enrolled in 2006 and compared with compared with a structured questionnaire by the authors containing information on the socio-demographic characteristics, the teaching-learning process and the psycho-emotional experiences of the students. Freshmen were excluded after initial comparison with the students already exposed to the medical course. Statistical analysis by multiple logistic regression after calculating simple and adjusted odds ratio (OR). RESULTS The general prevalence of common mental disorder was 40% (n = 473); after exclusion of the freshmen it increased to 42.5% among students from the 2nd to the 12th semester. It was higher among those who did not have faith in their acquisition of the skills needed to become a good doctor (OR = 2.82), who felt less comfortable about course activities (OR = 3.75), who considered themselves emotionally stressed (OR = 2.14), among those who did not consider themselves happy (OR = 2.85), who believed that the course did not match their expectations (OR = 1.64) and those who had a prior diagnosis of mental disorder by a psychiatrist (OR = 3.78). CONCLUSION The results suggest the necessity of changes to the teaching-learning process and the establishment of a preventive mental health program for medical students.

Preterm newborns at Kangaroo Mother Care: a cohort follow-up from birth to six months

O nascimento prematuro e uma ocorrencia frequente, mesmo em paises desenvolvidos. Os avancos tecnologicos tem proporcionado taxas de sobrevivencia cada vez maiores, mesmo para os muito prematuros. A prematuridade e um fator de risco para varias morbidades, dentre elas atraso no desenvolvimento neuropsicomotor, deficit no crescimento somatico e dificuldade de vinculacao afetiva com a familia. O Metodo Canguru (MC) surgiu como alternativa de assistencia ao recem-nascido de baixo peso como parte da politica nacional de humanizacao na saude, objetivando maior apego, incentivo ao aleitamento materno, melhor desenvolvimento e seguranca, inclusive quanto ao manuseio do bebe e ao relacionamento familiar. Esta pesquisa teve como objetivo avaliar a evolucao dos prematuros assistidos pelo MC, do nascimento aos seis meses de idade, incluindo evolucao ponderal, frequencia de aleitamento materno, tempo de hospitalizacao e desenvolvimento. Trata-se de um estudo observacional e descritivo de uma coorte de bebes prematuros assistidos pelo MC, nascidos entre julho de 2011 e janeiro de 2012 em uma maternidade publica de nivel terciario, com peso ao nascer igual ou menor que 1750 g e em condicoes clinicas necessarias para aplicacao do metodo. A amostra foi constituida por 137 recem-nascidos, com media de peso ao nascer de 1,365±283 g, idade gestacional media de 32±3 semanas, sendo 26,2% com peso ao nascer adequado a idade gestacional. Foram admitidos na Enfermaria Canguru com 19±18 dias de vida, pesando 1.430±167g em media, sendo que, nesse momento 57,7% da amostra tinham baixo peso para a idade cronologica (BP). Tiveram alta hospitalar com 36,8±21,8 dias, pesando 1.780±165g e 67,9% tinham BP. Aqueles que tiveram apneia na unidade de terapia intensiva neonatal, que usaram drogas vasoativas ou antibioticos de terceira linha e os com diagnostico de displasia broncopulmonar tiveram maior tempo de hospitalizacao (p< 0,001). Aos seis meses (n=76), tinham peso medio de 5.954±971g, sendo que 68,4% estavam com o peso entre os percentis 3 e 97. Tiveram resultado do Teste de Triagem de Desenvolvimento de Denver II considerado como suspeito 17,1% deles. As variaveis que estiveram fortemente associadas a este resultado foram: hemorragia peri-intraventricular, displasia broncopulmonar e peso abaixo do percentil 3 aos seis meses de idade. A frequencia de aleitamento materno exclusivo na alta foi 56,2% e aos 6 meses foi 14,4%. Conclusoes: Na amostra estudada as criancas assistidas pelo Metodo Canguru tiveram recuperacao ponderal adequada nos primeiros seis meses de vida, bem como baixa frequencia de alteracao no desenvolvimento. A frequencia de aleitamento exclusivo aos seis meses foi baixa.OBJECTIVE: To evaluate clinical outcomes, growth and exclusive breastfeeding rates in premature infants assisted by Kangaroo Mother Care at birth, at discharge and at six months of life. METHODS: Prospective study of a premature infants cohort assisted by Kangaroo Mother Care in a tertiary public maternity in Northeast Brazil with birth weight ≤1750g and with clinical conditions for Kangaroo care. RESULTS: The sample was composed by 137 premature infants, being 62.8% female, with average birth weight of 1365±283g, average gestational age of 32±3 weeks and 26.2% were adequate for gestational age. They have been admitted in the Kangaroo Ward with a median of 13 days of life, weighing 1430±167g and, at this time, 57.7% were classified as small for corrected gestational age. They were discharged with 36.8±21.8 days of chronological age, weighing 1780±165g and 67.9% were small for corrected gestational age. At six months of life (n=76), they had an average weight of 5954±971g, and 68.4% presented corrected weight for gestational age between percentiles 15 and 85 of the World Health Organization (WHO) weight curve. Exclusive breastfeeding rate at discharge was 56.2% and, at six months of life, 14.4%. CONCLUSIONS: In the studied sample, almost two thirds of the children assisted by Kangaroo Mother Care were, at six months of life, between percentiles 15 and 85 of the WHO weight curves. The frequency of exclusive breastfeeding at six months was low.

Malformações do sistema nervoso central e malformações associadas diagnosticadas pela ultrassonografia obstétrica

Objetivo: Identificar a prevalencia de malformacoes congenitas do sistema nervoso central (SNC) e malformacoes asso-ciadas diagnosticadas pela ultrassonografia obstetrica. Materiais e Metodos: Estudo observacional, transversal, des-critivo, em instituicao de referencia para gestacoes de alto risco. Resultados: Malformacoes congenitas do SNC estive-ram presentes sem outras malformacoes associadas em 65,78%, com a distribuicao: hidrocefalia (37,5%), mielomenin-gocele (15%), encefalocele (12,5%), agenesia de corpo caloso (12,5%), anencefalia (12,5%), holoprosencefalia (7,5%),Dandy-Walker (7,5%), Arnold-Chiari (5,0%), hidranencefalia (5,0%), meningocele (5,0%), cisto aracnoideo (2,5%). Mal-formacoes congenitas de outros sistemas estiveram associadas as do SNC: craniofacial (73,9%), ortopedica (65,2%),cardiovascular (34,8%), geniturinaria (30,4%), gastrintestinal (30,4%), respiratoria (8,7%), sindromica (8,7), oftalmolo-gica (4,3%). A sensibilidade ultrassonografica no estudo de malformacoes fetais do SNC foi 79,4%. A taxa de falso-ne-gativos foi 20,5%. Dentre as limitacoes quantificaveis destaca-se o oligodrâmnio, presente em 25% dos falso-negativos.Conclusao: A ultrassonografia obstetrica possui boa sensibilidade no rastreio de malformacoes fetais do SNC, em espe-cial com o aperfeicoamento constante e dominio na utilizacao de metodos especializados, como o Doppler e a ultrasso-nografia volumetrica (3D/4D), contribuindo para firmar-se como modalidade de escolha nesta rotina. Complementar aometodo, a ressonância magnetica pode vir a fornecer subsidios para uma ainda melhor assistencia perinatal.Unitermos: Malformacoes congenitas; Malformacoes do sistema nervoso central; Malformacoes associadas; Ultrasso-nografia.Objective: To identify and evaluate the prevalence of congenital central nervous system (CNS) malformations andassociated defects diagnosed by obstetric ultrasonography. Materials and Methods: Observational, descriptive, cross-sectional study developed in an institution of reference for high-risk pregnancies. Results: Congenital CNS malformationswithout other associated defects were present in 65.78% of cases, as follows: hydrocephalus (37.5%), myelomeningocele(15%), encephalocele (12.5%), corpus callosum agenesis (12.5%), anencephaly (12.5%), holoprosencephaly (7.5%),Dandy-Walker (7.5%), Arnold-Chiari (5.0%), hydranencephaly (5.0%), meningocele (5.0%), arachnoid cyst (2.5%).Congenital malformations of other systems were associated with such malformations, as follows: craniofacial (73.9%),orthopedic (65.2%), cardiovascular (34.8%), genitourinary (30.4%), gastrointestinal (30.4%), respiratory (8.7%),syndromic (8.7%), ophthalmologic (4.3%). The sonographic sensitivity in the study of CNS malformations was 79.4%.The rate of false-negative results was 20.5%. Oligohydramnios, present in 25% of false-negative studies, stands outamong the quantifiable limitations. Conclusion: Obstetric ultrasonography presents good sensitivity in the screeningfor fetal CNS malformations, specially with the constant improvement and control of specialized methods such as Dopplerand volumetric ultrasonography (3D/4D), contributing to consolidate its role as a modality of choice in this routine.Magnetic resonance imaging may play a supplementary role, providing information for an even better perinatal care.Keywords: Congenital malformations; Central nervous system malformations; Associated malformations; Ultrasonog-raphy.ResumoAbstract

Common mental disorders and associated factors among final-year healthcare students

OBJECTIVE to assess the prevalence of common mental disorder (CMD) and to identify potential associated factors among medical, dental and nursing students. METHODS a cross-sectional study conducted in a public university in Northeast Brazil with 172 undergraduate students of the last three semesters of the medicine, dentistry and nursing courses, in February 2010, using the Self Reporting Questionnaire (SRQ-20) and a structured questionnaire developed by the authors. Logistic regression was performed for data analysis. RESULTS the prevalence of CMD was 33.7%. The courses presented no differences in CMD prevalence. The logistic regression analysis showed a strong association of the following variables with CMD: female (OR=4.34), lack of good expectations regarding the future (OR=5.83), course as not a source of pleasure (OR=7.52) and feeling emotionally tense (OR=11.23). CONCLUSION the high prevalence suggests that immediate preventive measures should be implemented, such as the setting up of psycho-pedagogic support services for students, and teacher development programs.

Clinical variables associated with leprosy reactions and persistence of physical impairment

INTRODUCTION Leprosy is a chronic disease that affects skin and peripheral nerves. Disease complications include reactional episodes and physical impairment. One World Health Organization (WHO) goal of leprosy programs is to decrease the number of grade 2 impairment diagnoses by 2015. This study aims to evaluate clinical factors associated with the occurrence of leprosy reactions and physical impairment in leprosy patients. METHODS We conducted a retrospective study of data from medical records of patients followed in two important centers for the treatment of leprosy in Aracaju, Sergipe, Brazil, from 2005 to 2011. We used the chi-square test to analyze associations between the following categorical variables: gender, age, operational classification, clinical forms, leprosy reactions, corticosteroid treatment, and physical impairment at the diagnosis and after cure. Clinical variables associated with multibacillary leprosy and/or reactional episodes and the presence of any grade of physical impairment after cure were evaluated using the logistic regression model. RESULTS We found that men were more affected by multibacillary forms, reactional episodes, and grade 2 physical impairment at diagnosis. Leprosy reactions were detected in a total of 40% of patients and all were treated with corticosteroids. However, physical impairment was observed in 29.8% of the patients analyzed at the end of the treatment and our multivariate analysis associated a low dose and short period of corticosteroid treatment with persistence of physical impairments. CONCLUSIONS Physical impairment should receive an increased attention before and after treatment, and adequate treatment should be emphasized.

Prognostic value of chronotropic incompetence in elderly patients undergoing exercise echocardiography

BACKGROUND Chronotropic incompetence (CI), defined as failure to achieve less than 80% of age-expected heart rate, is a predictor of mortality and adverse cardiovascular events and may confer a worse prognosis in elderly diabetic individuals. OBJECTIVE To evaluate the prognostic value of chronotropic incompetence (CI) in elderly diabetic patients considering endpoints with acute myocardial infarction (AMI), cerebrovascular disease (CVD) and overall mortality and compare clinical and echocardiographic characteristics between patients with and without CI. METHOD A total of 298 elderly diabetic patients undergoing exercise echocardiography (EE) were studied from January 2001 to December 2010. Of these, 109 were chronotropic incompetent (group 1) and were compared with the chronotropic competent ones (group 2) regarding the occurrence of cardiovascular events, clinical and echocardiographic characteristics. RESULTS Chronotropic incompetents patients showed a higher frequency of cerebrovascular disease (9.2% vs. 3.2, p = 0.027) and higher mortality was observed in those who had cerebrovascular disease or acute myocardial infarction. The presence of typical angina and dyspnea prior to the performance of EE and male gender were more frequent in group 1. Rest and exercise left ventricular wall motion score index, rate of left ventricle mass and left atrium diameter were higher in chronotropic incompetent individuals. CONCLUSION Chronotropic incompetence was independently associated with the occurrence of cerebrovascular disease in elderly diabetic individuals.

Depressive symptoms among medical intern students in a Brazilian public university

OBJECTIVE To estimate, among Medical School intern students, the prevalence of depressive symptoms and their severity, as well as associated factors. METHODS Cross-sectional study in May 2008, with a representative sample of medical intern students (n = 84) from Universidade Federal de Sergipe (UFS). Beck Depression Inventory (BDI) and a structured questionnaire containing information on sociodemographic variables, teaching-learning process, and personal aspects were used. The exploratory data analysis was performed by descriptive and inferential statistics. Finally, the analysis of multiple variables by logistic regression and the calculation of simple and adjusted ORs with their respective 95% confidence intervals were performed. RESULTS The general prevalence was 40.5%, with 1.2% (95% CI: 0.0-6.5) of severe depressive symptoms; 4.8% (95% CI: 1.3-11.7) of moderate depressive symptoms; and 34.5% (95% CI: 24.5-45.7) of mild depressive symptoms. The logistic regression revealed the variables with a major impact associated with the emergence of depressive symptoms: thoughts of dropping out (OR 6.24; p = 0.002); emotional stress (OR 7.43;p = 0.0004); and average academic performance (OR 4.74; p = 0.0001). CONCLUSION The high prevalence of depressive symptoms in the study population was associated with variables related to the teaching-learning process and personal aspects, suggesting immediate preemptive measures regarding Medical School graduation and student care are required.

Spirometry with FEV 0.75 Increases the Sensitivity for the Diagnosis of Obstructive Disorder in Children of Asthmatic Mothers

Objective: To evaluate and compare the sensitivity of spirometry in children of asthmatic mothers by the parameters FEV1 and FEV0.75. Methods: An observational cross-sectional analytical study nested in a cohort of 4,757 pregnant women. Clinical evaluation was performed for the diagnosis of asthma, besides the realization of spirometry in the children of asthmatic mothers, evaluating the following parameters and relationships: FEV1, FVC, FEV1/FVC, FEV0.75 and FEV0.75/FVC. Results: A total of 86 children of asthmatic mothers were included in the study, with age mean of 79.8 ± 1.1 month old. Regarding the breathing pattern there was a predominance of normality. When using FEV1, changes were observed in 26 children, representing 30.3% of the sample. Of these, 17 were classified as restrictive and nine as obstructive. Using the FEV0.75 instead of the FEV1 (and its consequent FEV0.75/FVC) 29 ventilatory tests found changed, representing 33.7%. Of these, 27 were classified as obstructive and only two were restrictive. Of the 16 children diagnosed with asthma, only five had presented obstructive pattern when FEV1 customization spirometry was used. In contrast, when we used FEV0.75, 12 of these patients were considered obstructive. The sensitivity was higher in the spirometric test that used FEV0.75, with even greater negative predictive value. On the other hand the test set for the parameter FEV1 showed greater specificity and higher positive predictive value. Conclusions: Spirometry, though with recognized value in the complementary diagnosis of obstructive disturbance, classically presents limitations in the pediatric population, especially in younger children. We observed a significantly higher sensitivity and negative predictive value when we used FEV0.75 in substitution to the FEV1. As a consequence, the parameter FEV0.75 is probably more effective for the diagnosis of obstructive disorder in patients with clinical history or family history of asthma.