The prevalence of burnout syndrome in medical students

Background Burnout syndrome (BS) is a set of psychological symptoms resulting from the interaction between chronic occupational stress and individual factors. These symptoms include emotional exhaustion, depersonalization and decreased professional satisfaction. BS is manifested in a variety of professions and is prevalent in contexts in which health professionals are required to interact directly with the public. Objective To determine the prevalence of BS among medical students at a university in Ceará State, Brazil. Methods Of the 517 students enrolled in their first to eighth semester in 2013, 376 (72.7%) were contacted. A socio-economic evaluation questionnaire and the Maslach Burnout Inventory – Human Services Survey (MBI-HSS) were administered. Statistical analysis was conducted using SPSS 20.0. Two groups – burnout/risk and non-burnout – were compared using the chi-square and likelihood ratio tests with a significance level of 5%. Variables with p < 0.20 were included in a multivariate analysis logistical regression model. Results Burnout was detected in 14.9% of the students, and 57.7% showed a risk of developing the syndrome. Logistic regressions showed an association between burnout and “have failed examinations” and “have considered abandoning the course”, p = 0.047 and p < 0.0001, respectively. Discussion Psychopedagogy should be implemented to address the high prevalence of burnout in medical students

Acceptance and treatment of schizophrenics under Primary Health Care as seen by managers, therapists, relatives and patients

O estudo investigou as possibilidades e impasses do acolhimento e do tratamento de pacientes esquizofrênicos na Atenção Básica. Como pressupostos, admitiu-se que a Atenção Básica emerge como locus importante para as práticas de Saúde Mental e que seus técnicos vêm incorporando novas práticas aos seus currículos. Uma revisão da literatura abrangeu os principais marcos teóricos e conceituais das políticas de saúde, da Reforma Psiquiátrica e dos modelos em atenção à Saúde Mental, bem como considerações acerca da esquizofrenia e do estigma nos transtornos mentais. O estudo adotou um desenho de metodologia quali-quantitativa e trabalhou com um universo de significados, motivos, aspirações, crenças, valores e atitudes dos sujeitos envolvidos. A amostra foi composta por gestores, terapeutas, familiares e pacientes, atores sociais identificados na Atenção Básica com significativa vinculação com o problema trabalhado. Foram realizadas 38 entrevistas com gestores e terapeutas, aplicando-se às falas a metodologia do Discurso do Sujeito Coletivo. Dados fornecidos por familiares e pacientes, coletados em três entrevistas em profundidade realizadas em seus domicílios, permitiram a compreensão, entre outros aspectos, dos vínculos parentais, aspectos sociofamiliares, educacionais, história e tratamentos da doença pregressa e atual. As informações foram analisadas, dispostas numa narrativa cronológica e receberam tratamento de relatos de casos. Resultados: dentre os discursos de maior densidade observa-se que a maneira pela qual o paciente seria tratado - compreendendo acolhimento de qualidade, humanização da atenção, promoção da reinserção, atenção integral incluindo medicamentos e atitudes sem preconceito, interessava mais que o lugar onde a atenção ao doente mental grave fosse dispensada. De maneira reiterada, não se considera que os terapeutas da 7 Atenção Básica estejam capacitados para acolher e tratar de portadores de esquizofrenia, talvez casos leves ou compensados. Dentre as razões levantadas estão a falta de capacitação, supervisão, estrutura física, medicamentos, de pessoal, retaguarda, escuta de qualidade, além da sobrecarga de trabalho e ausência de um sistema de referência operante. São realçadas potenciais contribuições para a melhoria da qualidade e resolubilidade dos tratamentos e identificam-se mecanismos para modificações de posturas estigmatizantes no trato com os doentes e a doença. Os relatos de caso mapearam o itinerário de pacientes e familiares na demanda por cuidados de saúde mental, mostrando encontros e desencontros. Os resultados da pesquisa permitem sugerir a necessidade de maior preparo dos profissionais para dar conta do desafio de tratar portador de esquizofrenia na Atenção Básica, com ênfase na realização de trabalho conjunto que envolva gestores, terapeutas, familiares e pacientesThe study investigated the possibilities and concerns regarding acceptance and treatment of schizophrenics under primary care. We assumed that Primary Health Care emerges as an important locus for the practices of mental health and their agents incorporate new practices to their curricula. A literature review encompassed the main theoretical and conceptual milestones about health politics, Psychiatric Reform and models in mental health, as well as considerations around schizophrenia and the stigma as concerned to mental illness. The study adopted a quali-quantitative design and took into account meanings, reasons, goals, beliefs, values and attitudes. The sample consisted of managers, therapists, relatives and patients, social actors identified as having some significant link with the issue. Thirty-eight managers and therapists were interviewed, and the Collective Discourse methodology was implemented. Data obtained from relatives and patients collected on 3 home interviews allowed the understanding, among other aspects the parental bonds, sociofamilial, educational, historic and treatment of past and current disease. They were chronologically analysed and were treated as case reports. Results: among the greatest density speechs it was observed that the way a patients was treated, understanding quality care, humanization of attention, reinsertion promotion, thorough attention including medications and attitudes free of discrimination, was more relevant than the place a severely ill patient was treated. Repeatedly it was considered that therapists of Primary Care were not capacitated to treat schizophrenic patients, perhaps only the mild and stable cases. Among the reasons for that are the lack of capacitation, supervision, structure, medications, staff, interview skills, in addition to the overwhelming amount of work and lack of a system of reference. Potential contributions for the improvement of quality and resolution of treatments 9 are highlighted and mechanisms for changes of stigmatizing behaviors on patient care are identified. Case reports tracked the itineraries of patients and families searching for mental health care. Our results allow us to suggest the need for better preparation of mental health workers in order to satisfy the challenge of treating schizophrenic patients on Primary Care, with emphasis on the collective work encompassing administrators, therapists, family members and patient

Depressive disorer in elderly people: screening, diagnosis and epidemiological aspects

INTRODUCTION: Depression is a health problem that is frequent among elderly people. Most of the time it is difficult to identify in clinical practice. It results in the loss of autonomy, aggravation of a preexistent pathological state and it is also associated with a bigger risk of morbid-mortality, suicide and negligence in self-care. The diagnosis and the treatment are still deficient. OBJECTIVES: To identify the selected range used, to know epidemiological data in Brazil and risk factors related to elderly people's depression. Method: Explanatory study using bibliography research from books, documents and articles that are related to the theme from the basis MEDLINE, SCIELO, LILACS published from 2006 to 2011. RESULTS: Depressive syndromes are psychiatric disturbance more prevalent among elderly people with 5% of depression and significant depressive symptoms up to 15%. The prevalence of hospitalized or institutionalized elderly people reaches 22%. The prevalence in literature varies between 6.4 to 59.3% in the community. Among the main risk factors are: female sex, widowhood, low schooling, chronic physical diseases and stressful events of life. The main methods of selection identified for diagnosis have been: the level of geriatric depression, center of epidemiological studies and DSM-IV-TR. DISCUSSION AND CONCLUSION: Depression in elderly people is a problem of public health that can't be seen as a manifestation of physiological aging. The use of routine instruments of selection helps the diagnosis in many cases that may be unnoticeable and may influence in these patients quality of life.</p

Prevention of cardiovascular disease in patients recovering from use of psychoactive substances

Objective: Assess the knowledge of people recovering from substance abuse, after performance of educational activities, about the risk factors of cardiovascular diseases. Methods: This was a quantitative study involving 36 patients receiving treatment in the detoxification unit of a public psychiatry hospital in the State of Ceará, Brazil. All subjects were consenting adults over the age of 18 years. A questionnaire was used before and after an educational activity that measured the level of knowledge and understanding of cardiovascular disease and related risk factors. Results: The results demonstrated that initially, 19 (52.8%) people confirmed that they were not aware of any cardiovascular disease but after the activity, this number dropped to 4 (11%). In addition, the reference to the risk factors for diseases of the circulatory system was evaluated, when it became evident that, before the educational activity, 22 (61%) did not know these factors, another 14 (39%) cited one or two, especially a diet rich in fat and the use of illegal drugs. After the activity only 3(8%) did not know and the other 33 (92%) were able to cite the use of legal drugs, obesity, and a sedentary lifestyle. Conclusion: Educational intervention resulted in a significant change in participants´ knowledge of cardiovascular risk factors, which may help result in improvement in the lifestyle of patients, as well as their families

Prevenção das doenças cardiovasculares nas pessoas em recuperação do uso de substâncias psicoativas - doi:10.5020/18061230.2012.s5

Objective: Assess the knowledge of people recovering from substance abuse, after performance of educational activities, about the risk factors of cardiovascular diseases. Methods: This was a quantitative study involving 36 patients receiving treatment in the detoxification unit of a public psychiatry hospital in the State of Ceará, Brazil. All subjects were consenting adults over the age of 18 years. A questionnaire was used before and after an educational activity that measured the level of knowledge and understanding of cardiovascular disease and related risk factors. Results: The results demonstrated that initially, 19 (52.8%) people confirmed that they were not aware of any cardiovascular disease but after the activity, this number dropped to 4 (11%). In addition, the reference to the risk factors for diseases of the circulatory system was evaluated, when it became evident that, before the educational activity, 22 (61%) did not know these factors, another 14 (39%) cited one or two, especially a diet rich in fat and the use of illegal drugs. After the activity only 3 (8%) did not know and the other 33 (92%) were able to cite the use of legal drugs, obesity, and a sedentary lifestyle. Conclusion: Educational intervention resulted in a significant change in participants´ knowledge of cardiovascular risk factors, which may help result in improvement in the lifestyle of patients, as well as their familiesAvaliar o conhecimento das pessoas em recuperação do uso de substâncias psicoativas sobre os fatores de risco das doenças cardiovasculares após realização de atividade educativa. Métodos: Estudo quantitativo, realizado em hospital psiquiátrico público do Ceará, com amostra de 36 pessoas internadas na unidade de desintoxicação que concordaram em participar do estudo, maiores de 18 anos, orientadas e conscientes. Utilizou-se um formulário para coleta de dados sociodemográficos e aferir o grau de conhecimento sobre as doenças cardiovasculares e seus fatores de risco, antes e após a realização de atividades de educação em saúde. Resultados: Os resultados demonstraram que inicialmente, 19 (52,8%) pessoas afirmaram não conhecer nenhuma doença cardiovascular e depois da atividade esse número caiu para 4 (11%). Foi avaliada, ainda, a referência aos fatores de risco para doenças do aparelho circulatório, quando se constatou que, antes da atividade educativa, 22 (61%) desconheciam estes fatores, outros 14 (39%) citaram de um a dois, principalmente a alimentação rica em gorduras e o uso de drogas ilícitas, após a atividade apenas 3 (8%) desconheciam e os outros 33 (92%) passaram a citar uso de drogas lícitas, obesidade, sedentarismo. Conclusão: A atividade educativa ocasionou uma mudança significativa no conhecimento dos participantes acerca do tema explorado, o que poderá gerar melhora no estilo de vida do paciente e de sua família