Estudo preliminar sobre o estresse ocupacional de médicos e enfermeiros em UTI pediátrica e neonatal: o equilíbrio entre esforço e recompensa

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.El objetivo del estudio fue comparar el equilibrio entre esfuerzo (E) y recompensa (R) entre médicos de unidades de terapia intensiva pediátrica (PED) y neonatal (NEO) y entre enfermeros de las mismas unidades. Este es estudio transversal descriptivo con 37 médicos y 20 enfermeros. El cuestionario Effort-Reward Imbalance fue utilizado. No se encontraron diferencias estadísticas entre médicos de la PED y de la NEO en relación al E y R (p>;0,05). De la misma forma, enfermeros de la PED y de la NEO no tuvieron diferencias estadísticas en relación al E y R (p>;0,05). Comparando médicos con enfermeros de la PED, no fueron encontradas diferencias entre las variables estudiadas. En relación a la comparación hecha entre profesionales de la NEO, se encontró un mayor súper compromiso de médicos de que de enfermeros (p=0,01). El ambiente organizacional de la NEO se mostró más exigente para los médicos, determinando mayor compromiso con el trabajo, en cuanto que, para los enfermeros de ambas unidades, la demanda pareció ser la misma.O objetivo do estudo foi comparar o equilíbrio entre esforço (E) e recompensa (R) entre médicos de unidades de terapia intensiva pediátrica (PED) e neonatal (NEO) e entre enfermeiros das mesmas unidades. Este é estudo transversal descritivo com 37 médicos e 20 enfermeiros. O questionário Effort-Reward Imbalance foi utilizado. Não se encontrou diferença estatística entre médicos da PED e da NEO em relação ao E e R (p>;0,05). Da mesma forma, enfermeiros da PED e da NEO não diferiram estatisticamente em relação ao E e R (p>;0,05). Comparando médicos com enfermeiros da PED, não foram encontradas diferenças entre as variáveis estudadas. Em relação à comparação feita entre profissionais da NEO, encontrou-se maior supercomprometimento dos médicos do que de enfermeiros (p=0,01). O ambiente organizacional da NEO mostrou-se mais exigente para os médicos, determinando maior comprometimento com o trabalho, enquanto que, para os enfermeiros de ambas as unidades, a demanda pareceu ser a mesma

Investigation of minor psychiatric symptoms in patients with chronic kidney disease on hemodialysis treatment

AIMS: To identify the sociodemographic characteristics and the presence of minor symptoms of anxiety and depression in patients on hemodialysis.METHODS: Cross-sectional study, carried out in the hemodialysis units of the Santas Casas de Misericórdia in Marília and Tupã, São Paulo state, Brazil, with 65 hemodialytic patients, ranging from 20 to 86 years. Initially, the mental state of the participants was evaluated in order to ensure they had conditions to understand the research objectives and to respond to the evaluation instruments. Following, the subjects answered to the socio-demographic and clinical questionnaire and the Hospital Anxiety and Depression Scale. The data were organized using relative and absolute frequencies for the categorical variables, and measures of central tendency and dispersion for the quantitative variables. In order to compare the mean scores according to the studied variables, unpaired Student's t test and Analysis of Variance were used in addition to Mann Whitney U-Test and Kruskal-Wallis test when the distribution did not present normality. The adopted level of significance was 5% (p<0.05).RESULTS: The Hospital Anxiety and Depression Scale for minor symptoms identified 42 patients with anxiety and 45 with depression. The anxiety mean scores were statistically higher in the female (10.23±4.51) than in the male (8.32±3.68) patients (p=0.034). Patients aged 31 to 41 years and 42 to 52 years had higher depression scores (12.20±1.48 and 11.16±2.50 respectively) when compared to patients aged over 52 years (9.23±3.63) and aged 20 to 30 years (5.50±2.12) (p=0.017). Patients who underwent psychotherapeutic treatment had lower scores of anxiety (1.00±1.41) compared to those who had already undergone psychotherapeutic treatment and those had never been under treatment (9.27±3.92 and 12.75±3.40 respectively) (p=0.020).CONCLUSIONS: According to the Hospital Anxiety and Depression Scale, women had higher anxiety mean scores than men. The lowest scores for anxiety and depression were present in the younger and older age groups of women, and those who underwent psychotherapy presented even lower scores. Clinical management in psychotherapy can be a positive contribution to ease the symptoms of anxiety and depression, improving the patients' ability to cope with hemodialysis.***Investigação de sintomas psiquiátricos menores em pacientes renais crônicos em tratamento hemodialítico***OBJETIVOS: Identificar as características sociodemográficas e a presença de sintomas menores de ansiedade e depressão em pacientes em hemodiálise. MÉTODOS: Estudo transversal, realizado nas unidades de hemodiálise das Santas Casas de Misericórdia em Marília e Tupã, estado de São Paulo, com 65 pacientes hemodialíticos, na faixa de idade entre 20 a 86 anos. Inicialmente, foi realizada avaliação do estado mental a fim de identificar se os pacientes estavam em condições de compreender os objetivos da pesquisa e de responder ao questionário sociodemográfico e clínico e a Escala de Ansiedade e Depressão Hospitalar. Os dados foram organizados utilizando frequências relativas a absolutas para as variáveis categóricas e medidas de tendência central e dispersão para as variáveis quantitativas. Para comparação dos escores médios segundo as variáveis estudadas foram utilizados teste t de Student não pareado e Análise de Variância, além do Teste U de Mann Whitney e do teste de Kruskal-Wallis quando a distribuição não apresentava normalidade. O nível de significância adotado foi de 5% (p<0,05). RESULTADOS: A Escala de Ansiedade e Depressão Hospitalar para sintomas menores identificou 42 pacientes com ansiedade e 45 com depressão. As médias dos escores de ansiedade apresentaram-se maiores nas mulheres (10,23±4,51) do que nos homens (8,32±3,68) (p=0,034). Os pacientes com idades de 31 a 41 anos e 42 a 52 anos apresentaram escores de depressão mais elevados (respectivamente 12,20±1,48 e 11,16±2,50) quando comparados aos pacientes com idades acima de 52 anos (9,23±3,63) e com idades entre 20 e 30 anos (5,50±2,12) (p=0,017). Os pacientes que realizam tratamento psicoterápico tiveram escores de ansiedade menores (1,00±1,41) em comparação aos que já haviam realizado o tratamento psicoterápico e aos que não tiveram essa intervenção (respectivamente 9,27±3,92 e 12,75±3,40) (p=0,020).  CONCLUSÕES: Conforme a Escala de Ansiedade e Depressão Hospitalar, as mulheres apresentaram, em média, escores de ansiedade maiores. Os menores escores para ansiedade e depressão estavam presentes nas faixas etárias mais jovens e mais velhas, e os que faziam ou já haviam feito psicoterapia apresentaram escores menores. O manejo clínico em psicoterapia pode ser uma contribuição positiva para amenizar os sintomas de ansiedade e depressão, melhorando a capacidade dos pacientes no enfrentamento do tratamento hemodialítico

Common mental disorder among family carers of demented older people in Brazil

ABSTRACT Objective: Population aging is a global phenomenon associated with a rising prevalence of chronic degenerative diseases such as dementia. Dementia poses a challenge not only for patients but also their family caregivers who, in exercising this role, are at higher risk of mental illness. The present study investigated the prevalence of common mental disorders (CMD) in family caregivers of demented elderly seen at a geriatric outpatient clinic of a Brazilian teaching hospital. Methods: A cross-sectional study was conducted in which the following assessment instruments were applied: the Self Reporting Questionnaire, Zarit Burden Interview, Hospital Anxiety and Depression Scale and Mini-Mental State Examination (caregivers aged ≥65 years) plus a sociodemographic questionnaire. Results: The sample comprised 90 caregivers; 83 (92.2%) women, 51 (56.7%) married, 60 (66.7%) son/daughter of elder and 62 (68.6%) holding another job besides caring for the demented elder. Caregivers had a mean age of 57.3 (±11.7) years and mean education of 9.5 (±4.9) years; 62.2% of caregivers were diagnosed with common mental disorder, 50% exhibited anxiety symptoms, 52.2% depression symptoms and 66.7% reported burden. Caregivers with common mental disorder had higher scores on the anxiety, depression and burden scales (p<0.01). Logistic regression showed that caregivers with anxiety symptoms were 15 times more likely to present common mental disorder (OR: 15.0; 95% CI: 3.5-71.2) and caregivers with symptoms of depression were 8 times more likely to have CMD (OR: 8.0; 95% CI: 2.1-31.1). Conclusion: Results revealed a high prevalence of common mental disorder in the population studied

Cognitive assessment in an elderly population with metabolic syndrome in Brazil

ABSTRACT Chronic degenerative conditions are very common in the elderly. According to medical literature, there is a correlation between cognitive impairment among elders and arterial hypertension/hyperglycemia which in turn are common diseases among the elderly population worldwide. Nonetheless, data on the association between cognitive impairment and Metabolic Syndrome (MetS) remains controversial. Objective: To compare the cognitive status of Brazilian elderly outpatients with and without MetS. Methods: A cross-sectional case-control study with 49 subjects (25 MetS and 24 controls) who underwent a global geriatric and neuropsychological assessment was carried out. The scores for cognitive abilities (sustained attention, alternating attention, immediate memory, working memory, memory - immediate recall, memory - delayed recall, memory - recognition, executive function, ideomotor praxis, constructive praxis, naming ability, verbal fluency) were compared with the data for the normal population and differences between case and control groups were analyzed using Student's t-test or the Mann-Whitney test. Results: Forty-five patients (91.8%) were female, with a mean age of 73.9±5.9 years, and 3.0±1.0 years of schooling. A significant difference (p<0.01) was found between case and control groups regarding the MetS components. For cognitive abilities, no statistically significant difference was detected between the groups and all subjects presented low cognitive scores. Conclusion: The results obtained in the present study showed that MetS was not associated with cognitive impairment in this population. Further prospective studies are necessary to investigate the influence of well-controlled MetS on cognitive performance among elders