Vanessa de Albuquerque Citero

The mental health of graduate students at the Federal University of São Paulo: a preliminary report

We present data regarding the care provided to graduate level health professionals at the mental health center of the Federal University of São Paulo. From September 1996 to September 2003, 146 graduate students (99 in the Masters degree program and 47 in the Doctoral program) were attended. This population was predominantly female (68.5%), with a mean (+/- SD) age of 28.6 +/- 4.42 years, not married (71.9%). Most of the subjects were professionals who had not graduated from the Federal University (78.1%). The students who sought help for psychological and/or psychiatric problems were classified into two categories: situational-adaptive crises and psychopathological crises. The main diagnoses were depression and anxiety disorders (44%) causing 4.5% of the subjects to be temporarily suspended from their graduate studies; 19.2% reported that they had used psychotropic drugs within the previous month, and 47.9% referred to sleep disturbances. Suicidal tendencies were mentioned by 18% of those interviewed. Students with emotional disturbances and academic dysfunctions should be recognized at an early stage, and it is fundamental for them to have access to mental health programs that provide formal, structured and confidential care. Thus, it is important that professors and advisors in graduate programs build a warm and affective learning environment. If we consider the expressive growth in Brazilian scientific production resulting from the implementation of an extensive national system of graduate education, it is important to focus efforts on enhancing and upgrading the mental health care system.

O impacto do trabalho em saúde mental: transtornos psiquiátricos menores, qualidade de vida e satisfação profissional

OBJETIVO: Avaliar o impacto da carga de trabalho sobre a satisfacao profissional, a qualidade de vida e a prevalencia de transtornos psiquiatricos menores em profissionais de saude mental. METODO: Estudo transversal com amostra de 203 profissionais de saude mental. Foram aplicados os instrumentos: IMPACTO-BR, SATIS-BR, SRQ-20 e um questionario sociodemografico ocupacional. RESULTADOS: 75,4% dos participantes eram do sexo feminino, com idade media de 33,7 anos (DP = 9); 15,8% dos participantes apresentaram transtornos psiquiatricos menores. Em relacao ao trabalho, obteve-se nivel de satisfacao global mediano (escore 3,59; DP = 0,485). O impacto global foi avaliado como pequeno (escore 1,85; DP = 0,536). Sobre a qualidade de vida, houve prejuizo nos subitens dor, estado geral de saude e vitalidade. CONCLUSAO: Os dados obtidos com esta pesquisa demonstram que os profissionais que atuam na area da saude mental sentem-se mais satisfeitos em relacao a qualidade dos servicos oferecidos e ao trabalho realizado em equipe. O fator que gerou menor satisfacao esta relacionado as condicoes de trabalho oferecidas. Foram observados escores mais elevados na subescala referente ao impacto emocional, assim como maior presenca de transtornos psiquiatricos menores nos profissionais de terapia ocupacional e servico social. Profissionais que trabalham mais de 20 horas semanais apresentam prejuizos na qualidade de vida.

Fatores que tornam estressante o trabalho de médicos e enfermeiros em terapia intensiva pediátrica e neonatal: estudo de revisão bibliográfica

OBJETIVOS: Revisao de literatura sobre estresse ocupacional e sindrome de burnout em medicos e enfermeiros que trabalham em unidade de terapia intensiva pediatrica e neonatal. METODOS: Os artigos foram identificados a partir das bases de dados MedLine, LILACS e SciElo, usando as palavras-chave estresse, burnout, medicos, enfermagem, unidade de terapia intensiva, unidade de cuidados intensivos pediatricos e unidades de cuidados intensivos neonatais. O periodo pesquisado foi de 1990 a 2007. RESULTADOS: Medicos e enfermeiros que trabalham em unidade de terapia intensiva pediatrica e neonatal sao candidatos a apresentarem estresse, alteracoes psicologicas e sindrome de Burnout. Pesquisas sobre o tema identificaram alteracoes importantes que acometem medicos e enfermeiros intensivistas: sobrecarga de trabalho, burnout, desejo de abandonar o trabalho e niveis elevados de cortisol entre outros fatores. CONCLUSOES: Os profissionais que trabalham em unidade de terapia intensiva pediatrica e neonatal , pela especificidade do seu trabalho, estao expostos ao risco do estresse ocupacional e, consequentemente ao Burnout. Estes dados sugerem a necessidade de serem feitas pesquisas, com o objetivo de desenvolver medidas preventivas e modelos de intervencao.

Qualidade de vida e adesão ao tratamento anti-retroviral de pacientes portadores de HIV

Foi realizada uma revisao da literatura cientifica sobre adesao terapeutica a highly active antiretroviral therapy e sobre a qualidade de vida dos pacientes portadores do HIV, indexada no MEDLINE no periodo entre 1998 e 2008. Foram incluidos estudos em pacientes maiores de 18 anos, publicados em portugues, espanhol ou ingles. Foram excluidos estudos de revisao, relatos de caso e cartas. Dos 21 estudos encontrados, 12 foram incluidos (tres ensaios clinicos, tres coortes prospectivos, seis transversais). A relacao entre qualidade de vida e adesao terapeutica permanece controversa, embora estudos descritivos apontem a possibilidade de uma relacao positiva. Os resultados podem ter sido influenciados por caracteristicas especificas dos ensaios clinicos descritos e mostram nao haver consenso sobre o impacto da adesao terapeutica sobre a qualidade de vida dos pacientes.

Clinical and demographic profile of users of a mental health system for medical residents and other health professionals undergoing training at the Universidade Federal de São Paulo

CONTEXT A postgraduate and resident trainee mental health assistance center was created in September 1996 within our university. OBJECTIVE To describe the clinical and demographic profile of its users. TYPE OF STUDY Retrospective. SETTING Universidade Federal de São Paulo--Escola Paulista de Medicina (Unifesp-EPM). METHODS The study was carried between September 1996 and November 2002, when 233 semi-structured registration forms were filled out either by the psychologist or the psychiatrist during their first contact with the trainees, who were medical and nursing residents, and postgraduate students at specialization, master or doctoral levels. The registration forms included demographic, occupational and clinical data. RESULTS The trainees were predominantly young (mean of 27 years old), single (82.0% of cases), women (79.4%), seeking help especially during the first year of training (63.1%). In 70.8% of the cases, they came to the service spontaneously. Such individuals showed greater adherence to the treatment than those who were referred by supervisors (p < 0.05). In 30% of the cases, the trainee sought psychological guidance or support at the service due to specific situational conflicts. Depression and anxiety disorders were the most frequent diagnoses; 22.3% of the trainees followed up mentioned a tendency towards suicidal thoughts. In comparison with other trainees, there was a higher prevalence of males among the medical residents (p < 0.01), with more cases of sleep disorders (p < 0.05), a smaller number of individuals refraining from the use of alcohol (p < 0.05) and a higher number of trainees requiring leave of absence (p < 0.001). DISCUSSION The first year of training in health sciences is the most stressful, especially for women. Depression and anxiety symptoms are common, reflecting transitory self-limited deadaptation. However, the severity of the cases can also be evaluated in view of the large number of trainees who mentioned suicidal tendencies. CONCLUSIONS This study emphasizes the need and importance of providing formal, structured and confidential mental health services for medical residents and postgraduate students from other health professions, in the training programs of academic institutions.

Quality of life and adherence to HAART in HIV-infected patients

Foi realizada uma revisao da literatura cientifica sobre adesao terapeutica a highly active antiretroviral therapy e sobre a qualidade de vida dos pacientes portadores do HIV, indexada no MEDLINE no periodo entre 1998 e 2008. Foram incluidos estudos em pacientes maiores de 18 anos, publicados em portugues, espanhol ou ingles. Foram excluidos estudos de revisao, relatos de caso e cartas. Dos 21 estudos encontrados, 12 foram incluidos (tres ensaios clinicos, tres coortes prospectivos, seis transversais). A relacao entre qualidade de vida e adesao terapeutica permanece controversa, embora estudos descritivos apontem a possibilidade de uma relacao positiva. Os resultados podem ter sido influenciados por caracteristicas especificas dos ensaios clinicos descritos e mostram nao haver consenso sobre o impacto da adesao terapeutica sobre a qualidade de vida dos pacientes.

Adaptação cultural do Chronic Liver Disease Questionnaire (CLDQ) para população brasileira

The aims of this study were the English-to-Portuguese translation and cross-cultural adaptation of the Chronic Liver Disease Questionnaire (CLDQ) for use in Brazil. The instrument was translated from the original language, English, to Portuguese by the authors, and was subsequently reviewed and evaluated as to the degree of difficulty of the translation and equivalence, by bilingual translators. The questionnaire was then applied to 20 randomly selected patients with chronic liver disease. Patients had no difficulty understanding the questionnaire and considered all the questions applicable. The cultural equivalence of the CLDQ was demonstrated, without requiring changes in the original translation. The translation into Portuguese and cross-cultural adaptation of the CLDQ successfully completed this important stage for its validation and use in Brazil.

Preliminary study about occupational stress of physicians and nurses in pediatric and neonatal intensive care units: the balance between effort and reward

This study compared the balance between effort (E) and reward (R) among physicians and nurses working in pediatric (PED) and neonatal (NEO) Intensive Care Units. This descriptive cross-sectional study was carried out with 37 physicians and 20 nurses. The Effort-Reward Imbalance Questionnaire was used. Statistically significant differences were not found among physicians (p>0.05) or nurses from PED and NEO in relation to E and R (p>0.05). No statistically significant differences were found between physicians and nurses in PED in the several studied variables. Comparison between the professionals working in NEO revealed that physicians presented more over-commitment than nurses (p=0.01). The organizational setting of NEO proved to be more demanding for physicians, exacting a greater commitment to their work, while demands presented in both units seemed to be the same for nurses.O objetivo do estudo foi comparar o equilibrio entre esforco (E) e recompensa (R) entre medicos de unidades de terapia intensiva pediatrica (PED) e neonatal (NEO) e entre enfermeiros das mesmas unidades. Este e estudo transversal descritivo com 37 medicos e 20 enfermeiros. O questionario Effort-Reward Imbalance foi utilizado. Nao se encontrou diferenca estatistica entre medicos da PED e da NEO em relacao ao E e R (p>;0,05). Da mesma forma, enfermeiros da PED e da NEO nao diferiram estatisticamente em relacao ao E e R (p>;0,05). Comparando medicos com enfermeiros da PED, nao foram encontradas diferencas entre as variaveis estudadas. Em relacao a comparacao feita entre profissionais da NEO, encontrou-se maior supercomprometimento dos medicos do que de enfermeiros (p=0,01). O ambiente organizacional da NEO mostrou-se mais exigente para os medicos, determinando maior comprometimento com o trabalho, enquanto que, para os enfermeiros de ambas as unidades, a demanda pareceu ser a mesma.

Suggested instruments for General Practitioners in countries with low schooling to screen for cognitive impairment in the elderly.

BACKGROUND General Practitioners (GPs) from underdeveloped countries apply cognitive impairment (CI) assessment tools translated and adapted to cultural setting from other idioms, mainly English. As schooling in elderly from underdeveloped countries tends to be relatively heterogeneous, it is necessary to establish normative and cut-off scores for these CI instruments that are based on studies conducted locally. Some CI screening instruments frequently used by Brazilian specialists in dementia were analyzed to determine which could be most useful to GPs in their working sets. METHOD Two hundred forty-eight patients aged 65 years or older that had been assisted by GPs in a tertiary hospital in Brazil were evaluated. Based on the MMSE and/or Short-IQCODE scores, 52 probable cases were identified on the basis of clinical data, performances on the neuropsychological tests and questionnaires (Functional Assessment Questionnaire/FAQ, Category Verbal Fluency/CVF, Clock Drawing Test/CDT) and blood tests and brain CT. RESULTS The combination of a functional questionnaire with a cognitive instrument had higher sensitivity and specificity than using the instruments alone. A FAQ cut-off of 3 in conjunction with a CDT cut-off of 6 proved optimal (93% sensitivity and 92.5% specificity). A higher specificity (93.5%) was attained using a combination of the FAQ (cut-off of 3) with the CVF (cut-off of 10). CONCLUSIONS For low schooling elderly, the combination of the FAQ and CVF represented a very simple method of increasing the chances of correct screening. For those with higher schooling, the combination of the FAQ and CDT was more suitable.

Psychiatry career in Brazil: Regional disparities, differences and similarities in an international context

Abstract This review explores the literature related to career choice of psychiatry in Brazil through selection of scientific articles published in the period from 1999 to 2013 in the MEDLINE and SciELO databases. There are currently 145 medical schools in Brazil, the highest concentration being in the more developed areas. In 2005, there were 6,003 psychiatrists working in Brazil, a rate of 3.3 psychiatrists per 100,000 inhabitants, with unequal distribution across the geographical regions of the country: a rate of 4.5 psychiatrists/100,000 inhabitants in the southern region, and less than one psychiatrist per 100,000 inhabitants in the northern region. The south and south-east regions comprise 56% of the national population and 76% of the residency posts in psychiatry. In 2013, 27% of the residency posts in psychiatry were not filled, particularly in the north and north-east areas, where the shortage of professionals is more pronounced. The number of specialized doctors is far below what is needed to cover the burden attributed to neuropsychiatric disorders in the country. The main hypotheses to explain this imbalance in Brazil are the relatively low exposure to the speciality during undergraduate coursework, the stigma attached to mental disorders, and the poor organization of mental healthcare services.