Flávia Branco Cerqueira Serra Neves

Uso de substâncias psicoativas entre estudantes de Medicina de Salvador (BA)

Background: Studies have shown that medical students consume psychoactive substances at the same rates as the same age youth on general population, despite their predictable knowledge about drugs effects. Objective: To analyze the local pattern of psychoactive substances use among medical students and contribute for the formulation of preventive activities. Methods: The frequency of psychoactive substances use was evaluated by a self-administered anonymous questionnaire that also asked the main reasons for that use. Four hundred and four students in the first to sixth year from the two biggest medical schools in Salvador answered the questionnaire. Results: The lifetime use was bigger for alcohol (92.8%) and inhalant (46.2%). Alcohol use was constant for the students from first to sixth year of course, but it was not statistically significant (p > 0.05). However, tobacco, inhalants and tranquilizers use had a significant increase at the last two years of course students (p < 0.05). It was verified a bigger drugs use by the male gender. “Fun” was shown as the first main reason for psychoactive substances (58.7% of the valid answers). Conclusion: Psychoactive substances consume rates by medical students from Salvador are as high as the ones shown on other scientific researches about this subject.

Trabalho e síndrome da estafa profissional (Síndrome de Burnout) em médicos intensivistas de Salvador

OBJETIVO: Descrever a prevalencia da Sindrome de Burnout em medicos intensivistas de Salvador, associando-a a dados demograficos e aspectos da situacao de trabalho (demanda) psicologica e controle sobre o trabalho. METODOS: Um estudo de corte transversal investigou a associacao entre aspectos psicossocias do trabalho e a sindrome da estafa profissional em uma populacao de 297 medicos intensivistas de Salvador, Bahia. Um questionario individual autoaplicavel avaliou aspectos psicossociais do trabalho, utilizando o modelo demanda-controle (Job Content Questionnaire) e a saude mental dos medicos, usando Inventario de Burnout de Maslach (MBI). RESULTADOS: Constatou-se elevada sobrecarga de trabalho e de trabalho em regime de plantao. A prevalencia da Sindrome da Estafa Profissional (Burnout) foi de 7,4% e estava mais fortemente associada com aspectos da demanda psicologica do trabalho do que com o controle deste por parte dos medicos intensivistas. CONCLUSAO: Medicos com trabalho de alta exigencia (alta demanda e baixo controle) apresentaram 10,2 vezes mais burnout que aqueles com trabalho de baixa exigencia (baixa demanda e alto controle).

Médicos plantonistas de unidade de terapia intensiva: perfil sócio-demográfico, condições de trabalho e fatores associados à síndrome de burnout

OBJECTIVES: Burnout syndrome is a response to prolonged occupational stress that involves three main dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. The aim of this study was to describe socio-demographic characteristics of intensive care unit physicians and evaluate factors associated to the presence of Burnout syndrome in this population. METHODS: A cross-sectional study was performed to evaluate physicians who have worked in intensive care units from the city of Salvador (Bahia - Brazil) with a minimum weekly workload of 12-hour. An anonymous self-reported questionnaire was used and it was divided into two parts: socio-demographic characteristics and evaluation of Burnout syndrome through Maslach Burnout Inventory. RESULTS: We studied 297 physicians and most of them were male (70%). The mean age and time of graduation were, respectively, 34.2 and 9 years. High levels of emotional exhaustion, depersonalization, and reduced personal accomplishment were found in respectively, 47.5%, 24.6% and 28.3%. The prevalence of Burnout syndrome, considered as high level in at least one dimension, was of 63.3%. This prevalence was statistically lower in physicians specialized on intensive care, those with more than nine years of graduation and those who intend to continue working in intensive care units for more than 10 years. The prevalence was higher in the doctors with more than 24-hours of uninterrupted intensive care work per week. CONCLUSIONS: Burnout syndrome was common among intensive care physicians and it was more frequent in the youngest doctors, with higher workload and without specialization on intensive care.

Sintomas da síndrome de apnéia-hipopnéia obstrutiva do sono em crianças

OBJETIVOS: Investigar os sintomas mais frequentes encontrados em criancas com diagnostico polissonografico de sindrome da apneia-hipopneia obstrutiva do sono (SAHOS). METODOS: Foram avaliadas 38 criancas consecutivamente encaminhadas ao laboratorio do sono com suspeita de SAHOS no periodo de junho de 2003 a dezembro de 2004. Os pacientes foram submetidos a um questionario pre-sono e a polissonografia. RESULTADOS: A idade media foi de 7,8 ± 4 anos (variacao, 2-15 anos), sendo 50% das criancas do sexo masculino. Nao apneicos corresponderam a 7,9% dos pesquisados, disturbio leve obstrutivo do sono ocorreu em 42,1%, moderado em 28,9% e severo em 22,1%. Observou-se maior frequencia de casos severos de apneia entre criancas menores de seis anos (idade pre-escolar). Dentre as criancas com SAHOS, os sintomas mais citados foram ronco e obstrucao nasal, presentes em 74,3 e 72,7% das criancas, respectivamente. Sonolencia excessiva e bruxismo ocorreram em, respectivamente, 29,4 e 34,3% dos casos e doenca do refluxo em apenas 3,1%. Agitacao das pernas e dificuldade para iniciar o sono foram encontradas em, respectivamente, 65 e 33% dos avaliados. Todas as criancas que apresentaram SAHOS de grau severo tinham queixa de ronco e bruxismo. CONCLUSOES: Nossos resultados mostraram que os sintomas mais frequentes em criancas e adolescentes com SAHOS sao ronco e obstrucao nasal. Alem disso, quadros mais graves da SAHOS estao associados a menor faixa etaria.

Conhecimento e interesse em ética médica e bioética na graduação médica

OBJECTIVES: To evaluate the interest and knowledge about Medical Ethics and Bioethics in medical graduation. METHODS: Transversal and descriptive study. Two different questionnaires were applied with questions about the interest in Medical Ethics and Bioethics and the knowledge about the Brazilian Code of Medical Ethics (CME), one to professors and the other to students. RESULTS: One hundred and one professors and 331 students answered the questionnaires. The Brazilian CME had been read by 86.2% of the teachers and by 100% of the students. The importance given to the discipline Medical Ethics, on a scale from 1 to 5, was similar among teachers and students (4.7 ± 0.7 vs. 4.5 ± 0.8; p = 0.086); however the self-evaluation on knowledge about this subject was higher in the first group (3.4 ± 0.9 vs. 3.2 ± 0.7; p = 0.017). In a block with 9 questions, the right answer was given by 5,0 ± 1.9 of teachers and 5.9 ± 1.5 of students (p < 0,001); the mean of correct answers were related to the reading of the CME. CONCLUSIONS: The present study presents unpublished data about the perception of medical teachers and students about medical ethics and bioethics and can be useful for improving the teaching of these disciplines in our medical schools.

Análise de estressores para o paciente em Unidade de Terapia Intensiva

JUSTIFICATIVA E OBJETIVOS: O ambiente hospitalar, especialmente o de uma Unidade de Terapia Intensiva (UTI), devido a complexidade do atendimento prestado, bem como a estrutura fisica, o barulho, os equipamentos e a movimentacao das pessoas, e tido como gerador de estresse para os pacientes. O objetivo deste estudo foi identificar e estratificar os estressores para pacientes internados em UTI, na perspectiva do proprio paciente, familiares e profissionais de saude. METODO: Estudo de corte transversal realizado entre junho e novembro de 2004, na UTI geral de hospital privado. A amostra foi composta por tres grupos: pacientes (G1), familiares (G2) e um membro da equipe da UTI responsavel pelo atendimento do paciente incluido (G3). Para identificacao e estratificacao dos fatores estressantes, utilizou-se a Escala de Estressores em UTI (Intensive Care Unit Environmental Stressor Scale - ICUESS). Para cada paciente e participante, foi calculado um escore total de estresse (ETE) pela soma de todas as respostas da escala. RESULTADOS: Foram incluidos 30 pacientes e participantes em cada grupo. A media de idade foi de: 57,30 ± 17,61 anos para o G1; 41,43 ± 12,19 anos para o G2; e 40,82 ± 20,20 anos para o G3. A media do ETS foi: 62,63 ± 14,01 para os pacientes; 91,10 ± 30,91 para os familiares; e 99,30 ± 21,60 para os profissionais. A media do ETS dos pacientes foi estatisticamente inferior a encontrada nos familiares e nos profissionais de saude (p < 0,01). Os principais estressores para os pacientes foram: ver a familia e amigos por apenas alguns minutos do dia; tubos no nariz e/ou boca; e nao ter controle de si mesmo. CONCLUSOES: A percepcao sobre os principais estressores foi diferente entre os tres grupos. A identificacao destes fatores e importante para a implementacao de medidas que possam facilitar a humanizacao do ambiente da UTI.

Análise do erro médico em processos ético-profissionais: implicações na educação médica

The objective of this work was to evaluate the characteristics of Professional Ethics Investigations with denouncement of a medical error and to discuss the importance of medical education for its prevention. The main article of the Brazilian Code of Medical Ethics characterizing the medical error is article 29. In this descriptive study we reviewed all investigations carried out in the Regional Council of Medicine of the State of Bahia (Cremeb) from 2000 to 2004. From the 372 doctors investigated by the Cremeb during the period, 42.7% (n = 159) were denounced according to article 29. From these, most were male (78.6%) and the medium age was of 44 years. The most frequent specialties were: Gynecology-obstetrics (24.8%), General Surgery (9.4%) and Anesthesiology (7.4%). Most of the accusations referred to medical errors occurred in public services (80.1%, n = 109) and were related to surgical interventions (66.0%, n = 97). Negligence was identified in 67.3% (n = 107) of the accusations, imprudence in 23.3% (n = 37) and inability in 8.8% (n = 14). Only 23.9% (n = 38) were considered guilty as charged while 31.4% (n = 50) were absolved due to lack of proofs and 44.0% (n = 70) for proven innocence. We conclude that medical errors, mostly due to negligence, are a frequent cause of accusations against doctors at Cremeb, a fact showing the need of this subject being more discussed and valued in the medicine course.

Prevalência de anemia e insuficiência renal em portadores de insuficiência cardíaca não-hospitalizados

BACKGROUND Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. OBJECTIVE To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. METHODS Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. RESULTS Of the 345 patients included in this study, 26.4% (n = 91) had anemia and 29.6% had moderate to severe renal failure (GFR < 60 ml/min). The association between anemia and a higher prevalence of renal failure was statistically significant (41.8% vs. 25.2%; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0% vs. 19.4%; p <0.001) and renal failure (38.2% vs. 24.8%; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. CONCLUSION The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).

Apresentação clínica de pacientes obesos com diagnóstico polissonográfico de apnéia obstrutiva do sono

AIM To evaluate the symptoms of obese patients with polysomnographic diagnosis of obstructive sleep apnea (OSA). METHODS All obese patients (BMI > or =30 kg/m(2)) that accomplished overnight polysomnography in two sleep laboratories in the city of Salvador, BA, Brazil, in the period of July to December of 2004, and had an apnea hypopnea index (AHI) > or =5. The considered symptoms were excessive daytime sleepiness, awakenings during the night and nocturnal choking or gasping. RESULTS 73 patients were included, being 57.5% male, with mean age and BMI of 45.2 years old and 38.0 kg/m(2), respectively. The majority (49.3%) was classified as having severe OSA (AHI > or =30). Data revealed that 19.2% of the patients did not have any symptoms, while 28.8% had one symptom, 30.1% had two and 21.9% had three. There was no statistically significant difference in the severity of OSA between the subjects with and without symptoms. There was a higher prevalence of asymptomatic patients in the subgroup with severe obesity--BMI > or =35 kg/m(2) (30.8% vs. 5.9%; p = 0.007). CONCLUSIONS The polysomnography seems to be a fundamental exam in the evaluation of obese patients due to the elevated prevalence of asymptomatic individuals with OSA in this group, especially the severely obese.

Reflexões sobre os juramentos utilizados nas faculdades médicas do Brasil

PURPOSE: Evaluate the graduation oaths (GO) administered in Brazilian medical schools. METHODS: Descriptive study covering graduations in Brazilian medical schools up to the year 2004. A questionnaire was sent to the dean of each university using three different attempts of contact: mail, fax and e-mail. RESULTS: From a total of 96 contacted universities, 48 (51,1%) answered to the questionnaire, 25 of which (52,1%) public institutions. All medical schools administer some oath during the course. In relation to the text used: 44 universities (91,7%) used the Hippocratic Oath or updated versions. Thirty eight answers to the questionnaire (79,2%) forwarded the entire text of the oath allowing to analyze its content. The most frequently mentioned principles were beneficence, non-maleficence (94,7%) and confidentiality (97,4%). Only one oath expressed the principle of autonomy of the patient and none of them the principle of justice. CONCLUSIONS: The use of the GO is very common in Brazilian medical schools. However, unlike to what is observed in other countries, the greater part of texts are still based on the Hippocratic Oath and do not address current relevant ethical and bioethical principles.