Relationship between length of exposure to trauma and mental illness in the police

Introduction: The activities of the police are considered high risk, because they are exposed to high levels of physical and emotional stress. These work activities can contribute to the emergence of psychiatric disorders that affect their readiness in responding to threats and safety of their actions. Our aim was to conduct a systematic literature review to identify studies that evaluated the time that police officers may be deployed without developing a mental illness. Materials and Methods: Articles published until May 2016 in The MEDLINE (PubMed), Cochrane Library, PsycINFO, and Lilacs databases were searched. In addition, a manual search in the gray literature (theses and dissertations) was also conducted. Several combinations of indexed terms were used in the search of electronic databases, including terms referring to trauma exposure, intervention, and population. There were no restrictions on date and language of the publications. Two reviewers independently assessed studies for eligibility and quality. Disagreements were resolved after consultations with a third reviewer. Results: Of 905 selected studies, 13 studies evaluated deployment duration and the incidence of mental illness. Studies were excluded because they addressed the prevalence of mental illness but did not relate it to deployment duration or because the studied sample was not the target population of the present study. Studies have shown that a longer deployment time is associated with increased incidence of mental illness. Our analysis of the 13 identified studies indicated the existence of an association between exposure to deployment and mental illness onset. Conclusion: These findings will be useful to inform and guide future studies conducted in Brazil and worldwide

A cross-sectional study of the quality of life of patients living with type 1 diabetes treated with insulin glargine and neutral protamine hagedorn insulin and the implications

Objectives: The study aim was to identify key factors associated with the health-related quality of life (HRQOL) of patients with type 1 diabetes mellitus (T1DM) treated with neutral protamine Hagedorn (NPH) insulin or human insulin analog glargine (IGLA). Methods: We conducted two cross-sectional studies in Minas Gerais State, Brazil. One with 401 patients treated with IGLA, and the other with 179 T1DM patients treated with NPH. HRQOL was measured by Euroqol (EQ-5D-3L). Key findings: Most participants were male (51%), aged between 18 and 40 years (47%), non-black (58%) and from the highest economic strata (A1-B2) (74%). Participants perceived their health as good/very good (51%), had one to three medical consultations in the previous year (51%), were not hospitalized in the previous year (74%), did not report angina (96%), diabetic neuropathy (90%), hearing loss (94%) or kidney disease (89%). Non-severe hypoglycaemia episodes in the last 30 days were reported by 17% of participants. Conclusions: Higher HRQOL was associated with younger age (18-40 years), good/very good health self-perception, having had up to three medical consultations in the last year, not being hospitalized in the last year, having none to three comorbidities, not reporting angina, diabetic neuropathy, hearing loss or kidney disease and having had episodes of non-severe hypoglycaemia. In addition, the findings of our study demonstrated inequalities in access to treatment, which will be the subject of future research projects

Avaliação da qualidade dos serviços de saúde: notas bibliográficas

No momento em que se discute a reorganização dos serviços de saúde no Brasil, a avaliação da qualidade destes serviços ganha importância. Nesta revisão, buscamos os antecedentes históricos da avaliação dos serviços de saúde e apresentamos as propostas contemporâneas de sistematização da avaliação de qualidade. Através da análise dos trabalhos revisados, identificamos duas grandes linhas metodológicas de acordo com seu objeto de estudo: Estudos Corporativos Racionalizadores e Estudos Antropossociais. A maioria destes se referenciam nos trabalhos desenvolvidos por Avedis Donabedian, autor que, nos últimos vinte anos, vem desenvolvendo estudos de avaliação dos serviços de saúde.Quality assessment and evaluation becomes an issue of raising concern as the re-organization of health services in Brazil has been discussed. In this review, we search for the historical background of health services evaluation and present the contemporary proposals for a systematic quality evaluation. The analyses of the studies reviewed show two major methodological trends in this area: the Rationalizing-Corporative and the Antropological-Social Studies. Most of both types of studies derive from the work on health services evaluation developed during the last twenty years by Avedis Donabedian