Actions of occupational therapy in mental health for patients hospitalized in general hospitals: impact on occupational functioning

Introdução: A Terapia Ocupacional (TO) em saúde mental favorece o cuidado ao paciente em situações de adversidade decorrentes da hospitalização. Objetivo: Avaliar o impacto da abordagem em TO sobre o funcionamento ocupacional especificamente nas dimensões de causalidade pessoal, valores, interesses, papéis, hábitos, habilidades e meio ambiente de pacientes internados em hospital geral provenientes de um serviço de interconsulta psiquiátrica. Método: Estudo longitudinal que avaliou o funcionamento ocupacional, antes e após a intervenção em TO, verificando o impacto sobre estratégias utilizadas para lidar com as dificuldades com a internação por, no mínimo, cinco sessões. Os dados foram obtidos dos registros do serviço e pela Autoavaliação do Funcionamento Ocupacional (SAOF). Resultados: As médias de todas as dimensões de funcionamento ocupacional após as intervenções foram maiores do que as médias inicias (p<0,05). Conclusão: A abordagem em TO no contexto da interconsulta psiquiátrica possibilita a ampliação das dimensões que compõem diferentes sistemas do desempenho do paciente internado em hospital geral.Introduction: Occupational Therapy (OT) in mental health favors the care for the patient in situations of adversity due to hospitalization. Objective: To evaluate the impact of the OT approach on the occupational functioning, specifically on the dimensions of personal causation, values, interests, roles, habits, skills, and environment of inpatients at general hospitals under a consultation-liaison psychiatry service. Method: This is a longitudinal study that evaluated the occupational functioning of patients who presented difficulties with the hospitalization, before and after the OT intervention and the impact on the occupational functioning. We studied patients who went to at least five OT sessions. Data were obtained from records of the service and from the Self-Assessment of Occupational Functioning (SAOF) scale. Results: Means of all the occupational functioning dimensions were higher than baseline means (p<0.05) after the intervention. Conclusion: The OT approach in consultation-liaison psychiatry allows the dimensions that compose the performance systems of the general hospital inpatient to be improved

Quality of life in patients with chronic kidney disease

AIM: To compare the dimensions of quality of life in the stages of chronic kidney disease and the influence of sociodemographic, clinical and laboratory data. INTRODUCTION: The information available on the quality of life of patients on conservative treatment and the relationship between the quality of life and glomerular filtration rate is limited. METHODS: 155 patients in stages 1-5 of chronic kidney disease and 36 in hemodialysis were studied. Quality of life was rated by the Medical Outcomes Study Short Form 36-Item (SF-36) and functional status by the Karnofsky Performance Scale. Clinical, laboratory and sociodemographic variables were investigated. RESULTS: Quality of life decreased in all stages of kidney disease. A reduction in physical functioning, physical role functioning and in the physical component summary was observed progressively in the different stages of kidney disease. Individuals with higher educational level who were professionally active displayed higher physical component summary values, whereas men and those with a higher income presented better mental component summary values. Older patients performed worse on the physical component summary and better on the mental component summary. Hemoglobin levels correlated with higher physical component summary values and the Karnofsky scale. Three or more comorbidities had an impact on the physical dimension. CONCLUSION: Quality of life is decreased in renal patients in the early stages of disease. No association was detected between the stages of the disease and the quality of life. It was possible to establish sociodemographic, clinical and laboratory risk factors for a worse quality of life in this population

Burnout in nursing residents

Enfermeiros Residentes podem experimentar desgaste físico e emocional decorrentes do cotidiano da Residência de Enfermagem. O objetivo deste estudo foi determinar a incidência do Burnout em Residentes de Enfermagem. Realizou-se um estudo exploratório, descritivo, analítico e longitudinal-prospectivo com 16 Residentes, no período de dois anos. Utilizou-se o Maslach Burnout Inventory traduzido e validado para o Brasil e um instrumento de dados sociodemográficos/ocupacionais. Dos Residentes, 17.2% mostraram valores elevados em Exaustão Emocional e Despersonalização; 18.8% comprometimento em Incompetência/falta de Realização Profissional, dos quais 75% pertenciam às especialidades de Pronto Socorro, Unidade de Terapia Intensiva Adulto e Pediátrica. Idade e especialidade correlacionaram-se positivamente com a Incompetência/falta de Realização Profissional. Identificou-se um Residente de Enfermagem com alteração nas três subescalas do Maslach Burnout Inventory, sendo caracterizado como portador da Síndrome de Burnout. Os Residentes de enfermagem possuem perfis de adoecimento. Conhecer esses fatores pode minimizar os agravos à saúde desse trabalhador.Los Enfermeros Residentes pueden experimentar desgaste físico y emocional derivado del trabajo cotidiano de la Residencia de Enfermería. El objetivo de este estudio fue determinar la incidencia del Burnout en residentes de enfermería. Se realizó un estudio exploratorio, descriptivo, analítico y longitudinal-prospectivo con 16 Residentes, en el período de dos años. Se utilizó el Maslach Burnout Inventory traducido y validado para Brasil y un instrumento de datos socio-demográficos/ocupacionales. 17,2% de los Residentes mostraron valores elevados en Agotamiento Emocional y Despersonalización, respectivamente; 18,8% compromiso en Incompetencia/falta de Realización Profesional, entre estos, 75% pertenecían a las especialidades de Emergencias, Unidad de Terapia Intensiva de Adultos y Pediátrica. Edad y especialidad se correlacionaron positivamente con Incompetencia/falta de Realización Profesional. Se identificó a un Residente de Enfermería con alteración en las tres sub-escalas del Maslach Burnout Inventory, caracterizándoselo como portador de Síndrome de Burnout. Los Residentes de Enfermería poseen perfiles de sufrimiento. Conocer tales factores puede minimizar los transtornos de salud de dichos trabajadores.Nursing residents may experience physical and emotional exhaustion from the daily life of attending the Program. The aim of this study was to determine the Burnout incidence among Nursing Residents. An investigative, descriptive, analytical, longitudinal-prospective study was conducted with 16 Residents over two years. The Maslach Burnout Inventory was used, translated and validated for Brazil, as well as a sociodemographic/occupational data tool. Of all residents, 17.2% showed high rates in Emotional Exhaustion and Depersonalization; 18.8% showed impaired commitment in Personal Accomplishment, 75% of which belonged to specialty areas, such as Emergency Nursing, Adult and Pediatric Intensive Care. Age and specialty area were positively correlated with Personal Accomplishment. One of the Residents was identified with changes in three subscales of the Maslach Burnout Inventory, thus characterized as a Burnout Syndrome patient. Nursing Residents have profiles of disease. Knowing these factors can minimize health risks of these workers

Effort-reward imbalance and overcommitment at work in medicine and nursing faculty in a public institution

Occupational stress studies with effort-reward imbalance at work in medical and nursing faculty have not been described in literature. Objectives: 1) To estimate the effort-reward imbalance and the overcommitment at work in medical and nursing faculty. 2) To verify if there is an association of those variables according to faculty groups. Method: A cross-sectional study was achieved with 232 professors of a public institution in São Paulo State from April to November in 2009. Applied instruments: a sociodemographic and occupational questionnaire and an effort-reward imbalance at work questionnaire (Effort-Reward Imbalance ”“ ERI). The chi-square test was used to verify the association of variables between faculty groups. Results: Prevalence of effort-reward imbalance was 31.3% in nursing faculty, 14.1% in medical faculty and 17.7% in overall sample, with significant difference between faculty (p = 0.006). Prevalence of overcommitment at work was similar in nursing and medical faculty as well as in overall sample (45.8%, 39.7% and 40.9% respectively), without any significant difference between faculty (p = 0.738) . Conclusions: The effort-reward imbalance in nursing faculty was 2.2 times higher compared to medical faculty. Both faculty groups presented a high prevalence of overcommitment at work, which denotes remarkable personal characteristics of better controlling needs and difficulty in relaxing after work in those professions. Further studies may contribute to preventive and interventional measures related to occupational stress in medical and nursing faculty.   Keywords: Burnout. Occupational stress. Epidemiology. Medical Faculty. Nursing Faculty

Animal performance in oat and Italian ryegrass pastures under leaf lamina biomass levels

O objetivo deste trabalho foi avaliar o efeito de biomassas de lâminas foliares no desempenho animal. Utilizou-se mistura de aveia (Avena strigosa Schreb) e azevém (Lolium multiflorum Lam.), para determinar quantidades adequadas de sua biomassa no manejo da pastagem. Foram realizados dois experimentos, na estação fria de 2002 e 2003. Na avaliação de 2002, os valores de biomassa de lâminas foliares foram de 360 kg ha-1 (baixa) e 630 kg ha-1 (alta). Em 2003, foram obtidas biomassas de 352, 422 e 507 kg ha-1, classificadas como baixa, média e alta, respectivamente. O método de pastejo foi contínuo, com taxa de lotação variada; os animais utilizados foram terneiros da raça Charolês e cruzados com Nelore, com idade inicial de nove meses. As variáveis de produção animal avaliadas, nos dois anos, foram: ganho médio diário, carga animal e ganho de peso vivo por área. As distintas biomassas de lâminas foliares mantidas não são fatores limitantes ao desempenho animal.The objective of this work was to evaluate the effect of different leaf lamina biomass over animal performance. A mixture of oat (Avena strigosa Schreb) and Italian ryegrass (Lolium multiflorum Lam.) was used to determine adequate levels of leaf lamina biomass for pasture management. Two trials were made, in 2002 and 2003 cool seasons. In 2002 evaluation, leaf lamina biomass values were of 360 kg ha-1 (low) and 630 kg ha-1 (high). In 2003, values obtained for leaf lamina biomasses were of 352, 422 and 507 kg ha-1, being classified as low, medium and high, respectively. Grazing method was continuous, with variable stocking rate; testing animals were calves of Charolais breed and its crosses with Nelore breed, with initial age of nine months. Evaluated variables in animal production, in both years, were: average daily gain, stocking rate and live weight gain per area. Leaf lamina biomasses evaluated are not limiting factors to animal performance

Erratum to: The study of cardiovascular risk in adolescents – ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

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Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp