Suffering and illness : study of shorthand workers of a public institution

Trabalho de Conclusão de Curso (especialização)—Universidade de Brasília, Instituto de Psicologia, Departamento de Psicologia Social e do Trabalho, 2013.A pesquisa em Psicodinâmica do Trabalho foi delineada para aferir risco de adoecimento patogênico no trabalho num grupo de taquígrafos parlamentares aplicando o IRIS (Inventário de Riscos de Sofrimento Patogênico no Trabalho) acompanhado de algumas questões abertas. A demanda surgiu da própria instituição que registrava oficialmente um número elevado de adoecimentos nessa categoria profissional. Participaram 70 taquígrafos. A análise das respostas do IRIS, submetidas a tratamento estatístico pelo SPSS (Statistical Package for the Social Sciences), mostraram risco ausente no grupo analisado. As respostas às perguntas abertas, submetidas a análise categorial dedutiva1 (BARDIN, 1977) revelaram a presença de indignidade, mecanismos de defesa (negação, racionalização) e mobilização subjetiva. Formulamos a hipótese de que a coexistência de adoecimento, mecanismos de defesa e mobilização subjetiva no coletivo de trabalho talvez possam explicar termos encontrado risco de sofrimento patogênico ausente pela tabulação do IRIS numa amostra com elevados índices de absenteísmo. __________________________________________________________________________ ABSTRACTThis paper presents an analysis of the psychodynamics of work of parliamentary shorthand workers using the IRIS (Pathogenic Suffer Risk Inventory) and some openended questions. The demand for this research stemmed from the organization itself, given the large number of shorthand workers with history of illness. A group of seventy shorthand workers participated in the survey. Analysis of IRIS through SPSS (Statistical Package for the Social Sciences) showed absence of risk for said group. Analysis of open-ended questions through categorical deductive analysis (BARDIN, 1977) showed different results: Besides reports of repeated sickness, the use of subjective mobilization strategies, the presence of psychological defensive strategies (rationalization and denial) and indignity feelings were also observed. By pooling the results with official absenteeism statistics, which were very high, a great discrepancy between self - reported illnesses and the official index were observed. The formulated hypothesis postulates that the coexistence of subjective mobilization, psychological defensive strategies and sickness in a working population creates a bias in IRIS questionnaires

Ultrasonography for the diagnosis of tendinitis and electromyography for the diagnosis of peripheral neuropathy and upper limb radiculopathy: rheumatologists' perspectives

OBJECTIVE: To ascertain the value ascribed by Brazilian rheumatologists to ultrasonography (US) for diagnosing tendinitis and to electromyography (EMG) for diagnosing peripheral neuropathy and upper limb radiculopathy. MATERIAL AND METHODS: In total, 165 rheumatologists answered an anonymous survey (sent via the internet) concerning the two exams, with respect to the following characteristics: reliability, diagnostic accuracy, the importance and necessity of these tests for diagnostic RESULTS: The study revealed that most of the rheumatologists recognised that these exams are operator-dependent, that clinicians do not rely entirely on the results, that these exams are not mandatory for the diagnoses listed, and that professionals who perform these exams should be better trained to provide reliable results. CONCLUSIONS: The Brazilian rheumatologists believe the following: the results of these exams should be interpreted with caution and are not definitive for diagnosis; musculoskeletal US and EMG should be performed by trained professionals; and there must be better preparation of the professionals who perform these exams.OBJETIVO: Averiguar o valor que os reumatologistas brasileiros conferem ao exame de ultrassonografia para o diagnóstico de tendinite e ao exame de eletroneuromiografia para o diagnóstico da neuropatia periférica e da radiculopatia dos membros superiores. MATERIAL E MÉTODOS: No total, 165 reumatologistas responderam a uma pesquisa de opinião anônima (enviada pela internet), sobre diversas situações relativas aos dois exames, no que diz respeito aos seguintes questionamentos: confiabilidade, precisão no diagnóstico, importância e necessidade desses exames para confirmação diagnóstica e credibilidade e treinamento dos profissionais que executam os exames. RESULTADOS: O estudo revelou que a maioria dos reumatologistas reconhece que esses exames são operador-dependentes, que não confia integralmente nos resultados observados, que tais exames não são imperativos para os diagnósticos elencados, e que os profissionais que executam esses exames deveriam ser mais bem treinados para fornecer resultados mais confiantes. CONCLUSÃO: Para os reumatologistas brasileiros, os resultados desses exames devem ser interpretados com cautela e não são definitivos para o diagnóstico; a ultrassonografia musculoesquelética e a eletroneuromiografia devem ser realizadas por profissionais capacitados; deve haver melhor preparo dos executores desses exames em nosso meio.Universidade Federal de São Paulo (UNIFESP)Hospital de Base do Distrito Federal Serviço de ReumatologiaUniversidade de BrasíliaJustiça Federal Seção Judiciária de São PauloJustiça Federal do Paraná Seção Judiciária do ParanáUNIFESPSciEL

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)