Burnout syndrome and common mental disorders among community-based health agents

Experiential Avoidance in Primary Care Providers: Psychometric Properties of the Brazilian "Acceptance and Action Questionnaire" (AAQ-II) and Its Criterion Validity on Mood Disorder-Related Psychological Distress

BACKGROUND

A sizeable proportion of Brazilian Primary Care (PC) providers suffer from common mental disorders, such as anxiety and depression. In an effort to cope with job-related distress, PC workers are likely to implement maladaptive strategies such as experiential avoidance (EA). The Acceptance and Action Questionnaire (AAQ-II) is a widely used instrument that evaluates EA but has shown questionable internal consistency in specific populations. This study assesses the psychometric properties of the AAQ-II among Brazilian PC providers, evaluates its convergence and divergence with self-criticism and mindfulness skills, and explores its criterion validity on anxiety and depressive symptoms.

METHODS

A cross-sectional design was conducted in Brazilian PC services, and the sample included 407 PC workers. The measures evaluated EA, self-criticism, mindfulness, depression, and anxiety.

RESULTS

The one-factor model of the AAQ-II replicated the original version structure. The AAQ-II presented good internal consistency among Brazilian PC providers. A multiple regression model demonstrated higher relationships with self-criticism than mindfulness skills. The criterion validity of the AAQ-II on anxiety and depression was stronger in the context of more severe symptoms.

CONCLUSIONS

The AAQ-II is an appropriate questionnaire to measure the lack of psychological flexibility among Brazilian PC workers in the sense of EA.

Violence against public school teachers and burnout

School expansion, changes in the educational model and funding problems have profoundly changed teaching in Brazil, intensifying demands on teachers. Health problems such as burnout are common in the profession. We investigated teacher burnout and its association with occupational factors, including violence. Data were collected using in-depth interviews and two specific instruments (the Maslach Burnout Inventory and Spanish Burnout Inventory). Statistical analysis was performed using Stata, version 13.0. Ninety-three teachers referred to psychotherapy from public schools in different regions of the city of São Paulo participated in the study. Burnout was associated with 11 school setting variables, including having suffered violence in the school (p <0.001), discomfort with interpersonal contact at work (p <0.001) and noise (p <0.001). Sixty percent of the teachers with severe burnout had suffered violence at school in the last year. Both collective and occupational issues were associated with teacher burnout. Among these, interpersonal conflict and violence, which appears as a new and common problem, adversely affect the health of these professionals.

Prevalence of common mental disorders among Brazilian workers: systematic review and meta-analysis

Abstract The aim of the present study was to summarize the prevalence of common mental disorders (CMD) among Brazilian workers through a systematic review and meta-analysis. Searches were conducted in SciELO, LILACS, PubMed, Scopus, and Web of Science. Articles were included if they had; an observational design, a sample of Brazilian workers, used a validated instrument and cut-off to assess CMD, and provided the prevalence value. A random-effect meta-analysis using professional categories as subgroups and a meta-regression were conducted. In total, 89 studies were included, with a total of 56,278 workers from 26 professional categories. The overall pooled prevalence of CMD was 0.30 (95%CI: 0.27-0.34), varying from 0.07 to 0.58. Professional categories that presented higher prevalences of CMD were: Prostitutes 0.58 (95%CI: 0.51-0.65), Social Educators 0.54 (95%CI: 0.50-0.59), Banking Workers 0.45 (95%CI: 0.44-0.47), Ragpickers 0.45 (95%CI: 0.40-0.49), and Teachers 0.40 (95%CI: 0.32-0.48). No other variable in addition to profession was associated with prevalence of CMD in the meta-regression analysis. Workers from the most affected professional categories should be monitored to prevent social, occupational, and health impairment from CMD.

Psychometric Properties of the Emotional Exhaustion Scale (ECE) in Chilean Higher Education Students

The main objective of this study was to estimate the psychometric properties of the Emotional Fatigue Scale (ECE) in a sample of 1308 Chilean university students and confirm the unifactorial structure of the scale. Exploratory and confirmatory factor analyses were carried out. The ECE assessment had an internal consistency of 0.893 (Cronbach's Alpha). An exploratory factor analysis with Varimax rotation and a confirmatory analysis were performed, obtaining the factor that explains 52.3% of the variance. The results indicated that the ECE has adequate psychometric properties for use with higher education students in Chile. The ECE scale has good psychometric properties to be applied in the Chilean university context. Its usage may be very relevant to contribute to higher education institutions to emphasize students' mental health and prevent possible severe pathologies in future professionals. It is suggested to use the ECE scale together with the EES-Int, which is the only interpretation table for this instrument.

Vulnerabilidade social e transtornos mentais

A saúde mental representa parte essencial da vida das pessoas, podendo resultar no aumento da desigualdade de renda e de vulnerabilidade social. Assim, as relações entre saúde/doença mental e vulnerabilidade social incitam uma série de reflexões e de contextualizações para sua maior compreensão. Esta scoping review apresenta como objetivo mapear as produções científicas sobre as vulnerabilidades das pessoas com transtornos mentais em suas diferentes relações sociais. Divide-se em cinco etapas, com buscas nas bases de dados: MEDLINE via Pubmed; SCOPUS e Academic Search Premier, e busca nas referências dos artigos encontrados, a fim de responder à questão de pesquisa: “Como ocorre à vulnerabilidade das pessoas com transtorno mental em suas diferentes relações sociais?”. Foram encontrados 211 artigos e após as exclusões de estudos não pertinentes, foram incluídos 31 artigos. Os artigos foram organizados em 3 (três) categorias: 1 – a vulnerabilidade das pessoas com transtornos mentais e os serviços de saúde; 2 – a vulnerabilidade das pessoas com transtornos mentais e os determinantes sociais; e 3 – a vulnerabilidade das pessoas com transtornos mentais e a violência/vitimização. Dessa forma, sugere-se o desenvolvimento de mais estudos sobre a temática, assim como a reavaliação das políticas públicas voltadas às pessoas com transtornos mentais, no intuito de se tornarem mais eficazes, tanto na garantia dos direitos desse grupo como na manutenção de sua saúde mental.

Balancing roles and blurring boundaries: Community health workers' experiences of navigating the crossroads between personal and professional life in rural South Africa

As demand for health services grows, task-shifting to lay health workers has become an attractive solution to address shortages in human resources. Community health workers (CHWs), particularly in low-resource settings, play critical roles in promoting equitable healthcare among underserved populations. However, CHWs often shoulder additional burdens as members of the same communities in which they work. We examined the experiences of a group of CHWs called Mentor Mothers (MMs) working in a maternal and child health programme, navigating the crossroads between personal and professional life in the rural Eastern Cape, South Africa. Semi-structured qualitative interviews (n = 10) were conducted by an experienced isiXhosa research assistant, asking MMs questions about their experiences working in their own communities, and documenting benefits and challenges. Interviews were transcribed and translated into English and thematically coded. Emergent themes include balancing roles (positive, affirming aspects of the role) and blurring boundaries (challenges navigating between professional and personal obligations). While many MMs described empowering clients to seek care and drawing strength from being seen as a respected health worker, others spoke about difficulties in adequately addressing clients' needs, and additional burdens they adopted in their personal lives related to the role. We discuss the implications of these findings, on an immediate level (equipping CHWs with self-care and boundary-setting skills), and an intermediate level (introducing opportunities for structured debriefings and emphasising supportive supervision). We also argue that, at a conceptual level, CHW programmes should provide avenues for professionalisation and invest more up-front in their workforce selection, training and support.

Burnout among primary health care workers in Brazil: results of a multilevel analysis

PURPOSE

Burnout among health care workers may hamper the quality of care and effectiveness of health systems. Hence, we examined the prevalence of burnout in primary care teams, including community health workers; and investigated associations between individuals' characteristics, team and primary care center factors, and burnout.

METHODS

We carried out a cross-sectional study among primary care teams in the city of São Paulo, Brazil (n = 2940). We randomly selected 66 primary care centers. The Maslach burnout inventory was used to investigate burnout. We used multilevel modelling to examine the associations between individuals' characteristics, team and primary care center variables with burnout.

RESULTS

We addressed 351 primary care teams, with 11.4% of participants presenting severe burnout. The variance in burnout among primary care workers was partially explained by individuals' characteristics, and by team and primary care center factors. Severe burnout was associated with the following: (1) individuals' characteristics: being black, being younger, a higher length of employment in primary care, and presenting a lack of feedback from supervisors; (2) team factors: working in deprived areas and not receiving the support of a multidisciplinary team; and (3) primary care center factors: inadequate infrastructure (less than one office available per team), and having a bad/very bad relationship with the community council.

CONCLUSIONS

To reduce burnout among primary care teams, stakeholders should: (1) train managers/supervisors on leadership styles that prioritize performance feedback, support, and communication skills; (2) allocate catchment areas to teams according to each community's vulnerability; (3) provide a multidisciplinary team to support primary care workers; and (4) offer suitable facilities and infra-structure.

Sociodemographic and occupational profile and quality of life of health agents responsible for combating dengue in two towns in Parana, Brazil

Background

Community health agents (CHA) and endemics combat agents (ECA) play a decisive role in the prevention and control of dengue and are in direct contact with the population.

Objective

To analyze the sociodemographic profile, activities and quality of life (QoL) of CHAs and ECAs in two towns in Parana, Brazil, in which dengue is respectively endemic (Paranavai) and epidemic (Paranagua).

Method

Cross-sectional study which analyzed sociodemographic and occupational parameters and the QoL of CHAs and ECAs in July and August 2016.

Results

Ninety-eight health agents were included, 40 from Paranagua and 58 from Paranavai. About 92.9% of the participants were female; their average age was 38.9 years old; 63.5% had completed secondary school; and 90% earned less than 3 times the equivalent of the minimum wage per month. The agents in Paranagua reported to feel they were better prepared for their job, although most considered training insufficient. Most participants reported to have already suffered verbal violence at work. Job dissatisfaction was higher among the Paranavai agents. QoL analysis showed that neither mental nor physical health was good, which might be explained by sociodemographic factors and professional exhaustion.

Conclusion

Most participants were female, younger adults, with high educational level and low income. The training currently provided to combat dengue is insufficient, as most health agents felt insecure to convey information to the population. A part of the sample had already suffered violence at work. QoL was below the expected level, mainly due to work overload and low salary.

Frenetic, under-Challenged, and Worn-out Burnout Subtypes among Brazilian Primary Care Personnel: Validation of the Brazilian "Burnout Clinical Subtype Questionnaire" (BCSQ-36/BCSQ-12)

Primary healthcare personnel show high levels of burnout. A new model of burnout has been developed to distinguish three subtypes: frenetic, under-challenged, and worn-out, which are characterized as overwhelmed, under-stimulated, and disengaged at work, respectively. The aim of this study was to assess the psychometric properties of the long/short Brazilian versions of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-36/BCSQ-12) among Brazilian primary healthcare staff and its possible associations with other psychological health-related outcomes. An online cross-sectional study conducted among 407 Brazilian primary healthcare personnel was developed. Participants answered a Brazil-specific survey including the BCSQ-36/BCSQ-12, "Maslach Burnout Inventory-General Survey", "Utrecht Work Engagement Scale", "Hospital Anxiety/Depression Scale", "Positive-Negative Affect Schedule", and a Visual Analogue Scale of guilt at work. The bifactor was the model with the best fit to the data using the BCSQ-36, which allowed a general factor for each subtype. The three-correlated factors model fit better to the BCSQ-12. Internal consistence was appropriate, and the convergence between the long-short versions was high. The pattern of relationships between the burnout subtypes and the psychological outcomes suggested a progressive deterioration from the frenetic to the under-challenged and worn-out. In sum, the Brazilian BCSQ-36/BCSQ-12 showed appropriate psychometrics to be used in primary healthcare personnel.

Challenges for implementing a global mental health agenda in Brazil: The "silencing" of culture

Since its emergence in 2007, Global Mental Health has been a growing and polemic area of study, research and practice in mental health worldwide. Despite having a significant endogenous academic production and innovative policy experiences, the Brazilian mental health field and its actors make few references to, and scarcely dialogue with, the Global Mental Health agenda. This article explores an aspect of this divergence between Global Mental Health initiatives and public mental health care in Brazil regarding the role of culture within mental health policies and practices. Our hypothesis is that part of this difficulty can be attributed to the low relevance of the cultural dimension for the Brazilian mental health field, here referred to as the "silencing of culture." We examine the possible historical roots of this process with reference to theories of "anthropophagy" and "cultural uniformity" in the context of Brazilian cultural matrices. We then describe two recent experiences in public mental health care that incorporate cultural competence through the work of community health workers and the example of community therapy. We argue that the development of cultural competence can be decisive in enabling an improved dialogue between research and practice in Brazilian mental health and global mental health initiatives.

A CULTURA EM TORNO DA SEGURANÇA DO PACIENTE NA ATENÇÃO PRIMÁRIA À SAÚDE: DISTINÇÕES ENTRE CATEGORIAS PROFISSIONAIS

Resumo O estudo que originou este artigo teve como objetivo analisar a cultura de segurança do paciente na atenção primária em saúde de um município de grande porte do estado do Paraná, segundo a categoria profissional. Foi desenvolvido um estudo transversal com trabalhadores da atenção primária, com coleta de dados realizada em 2017, por meio da aplicação de um instrumento autorrespondido denominado Pesquisa sobre Cultura de Segurança do Paciente para Atenção Primária (Medical Office Survey on Patient Safety Culture). Os resultados indicaram que o processo de trabalho no serviço de atuação e apoio dos gestores foram as dimensões da cultura de segurança com avaliação mais fragilizada. De modo geral, houve divergências na percepção da cultura de segurança pelos profissionais de saúde da atenção primária, denotando a importância do planejamento conjunto de estratégias de assistência à saúde. Os técnicos de enfermagem apresentaram maior prevalência de avaliação fragilizada da cultura de segurança do paciente. De forma contrária, os enfermeiros mostraram menor prevalência de avaliação fragilizada sobre a cultura de segurança.

The Influence of Depression on the Psychometric Properties of the Maslach Burnout Inventory-Human Services Survey: A Cross-Sectional Study With Nursing Assistants

Background: The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) is the most commonly used instrument to assess burnout. Although various factors have been reported to influence its validity, the influence of major depressive disorder (MDD) has not been previously considered. We developed this study to investigate the influence of MDD on the psychometric properties of the MBI-HSS in nursing assistants. Results: From a sample of 521 nursing assistants, we found in those with MDD (n = 138, 24.56%) a degree of data misfit into the model, revealed by non-acceptable values for the root mean square error of approximation (RMSEA; 0.073; p = 0.004) and for the comparative fit index (CFI; 0.912), while in the non-MDD group these indices were acceptable and good, respectively, for RMSEA (0.048; p = 0.639) and for CFI (0.951). Also, we found higher coefficients of correlation among MBI-HSS factors and less items loading properly in their respective factors in the MDD subset, when compared to the non-MDD subset. For the total sample, while original 3-factor solution was an acceptable model, the bifactor model fitted data better. Conclusions: MDD may impair the construct validity of MBI-HSS subscales, by increasing measurement error and decreasing model fitness. Therefore, researchers and health professionals should be aware of potential changes in the psychometric properties of the MBI-HSS when applied in subjects with depression.

Equidade na cobertura dos gastos com saúde pelo Sistema Único de Saúde de pessoas com indicativos de transtornos mentais comuns no município de São Paulo

RESUMO: Introdução: O objetivo deste trabalho foi verificar a equidade na cobertura/complementação dos gastos com saúde pelo Sistema Único de Saúde (SUS) de pessoas com indicativos de transtornos mentais comuns (TMC), no ano de 2008, no município de São Paulo. Métodos: Foi realizado um estudo de corte transversal a partir dos dados do Inquérito de Saúde no Município de São Paulo de 2008 (ISA-Capital 2008). Os sujeitos incluídos na pesquisa tinham 16 anos de idade ou mais e indicativos de TMC, avaliados por meio do instrumento Self-Reporting Questionnaire (SRQ-20). Foram analisados: a procura pelo SUS, a cobertura dos gastos com saúde pelo SUS e os gastos com saúde no último mês, correlacionando-os com aspectos sociodemográficos e de condições de saúde. Resultados: A procura pelo SUS foi menor entre as pessoas de cor branca, renda per capita elevada, com união estável e Ensino Superior. A cobertura pelo SUS foi menor entre as faixas etárias de 45 a 59 anos e de 60 anos ou mais, com renda per capita elevada, Ensino Médio ou Técnico e Ensino Superior. As pessoas que gastaram mais com a saúde da família foram aquelas com idade igual ou superior a 60 anos, de cor branca, renda per capita mais elevada, com união estável e Ensino Superior. Conclusões: Foi observado que o SUS atende e cobre os gastos majoritariamente daqueles com renda per capita e escolaridade mais baixas, denotando uma cobertura desigual que favorece os mais necessitados. Porém, considerando o fator idade, ficou explícita uma situação de iniquidade, pois foi constatada maior cobertura dos gastos em saúde pelo SUS para a população mais jovem.

Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review

Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs).

Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout.

Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support.

Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.

Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review

Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.

Mental health of public health workers in Bento Gonçalves, Rio Grande do Sul, Brazil

Background

Work-related mental disorders are an acknowledged global health problem.

Objective

The aim of the present study was to investigate the prevalence of and factors associated with common mental disorders and suicidal ideation among public health workers.

Methods

We conducted a cross-sectional study with municipal healthcare workers. We collected sociodemographic and occupational data including employment relationship, job area, professional category, length of work in current job and interpersonal conflict in the workplace (ICW). The analyzed mental health indicators were common mental disorders (CMD) and suicidal ideation by means of the Self Reporting Questionnaire (SRQ-20). Statistical analysis included the χ² test and Poisson regression.

Results

The prevalence of CMD and suicidal ideation was 20.3% and 11.6%, respectively, among the 597 participants. Permanent and younger employees exhibited higher CMD rates, while suicidal ideation predominated among the participants with higher educational level and the widowed/separated/divorced. Physicians, administrative employees, cleaning personnel and community health agents exhibited the highest rates of CMD. In turn, there was no association between professional category and suicidal ideation on multivariate analysis. ICW was associated with poorer mental health indicators, the association being stronger when conflict involved supervisors and coworkers.

Conclusion

Both analyzed indicators (CMD and suicidal ideation) point to a worrisome situation as concerns the mental health of professionals charged of collective health care. The possible limitations of the questionnaire applied notwithstanding, ICW was the main factor associated with poorer mental health indicators. These findings point to the need to develop specific approaches to improve the psychosocial work environment.

Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review

Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.

SITUAÇÕES DE DESEQUILÍBRIO ENTRE ESFORÇO-RECOMPENSA E TRANSTORNOS MENTAIS COMUNS EM TRABALHADORES DA ATENÇÃO BÁSICA DE SAÚDE

Resumo Estudo da associação entre transtornos mentais comuns e situações de desequilíbrio entre esforços e recompensas em trabalhadores da atenção básica de saúde realizada em distrito sanitário de Salvador, na Bahia. Foram estudados trabalhadores que estavam em exercício profissional nas unidades de saúde do distrito, em 2012. Estudo transversal, com quatrocentos do total de 509 trabalhadores. Para avaliação de esforço e recompensa no trabalho, utilizou-se o Effort-Reward Imbalance. O Self-Reporting Questionnaire mensurou os transtornos mentais comuns. A prevalência de transtornos mentais comuns foi de 21%; 46,2% dos trabalhadores vivenciavam situações de desequilíbrio esforço-recompensa no trabalho. A prevalência de transtornos mentais comuns foi mais elevada na situação de desequilíbrio esforço-recompensa (26,9%) e no grupo dos trabalhadores operacionais (33,8%). A análise de correspondência indicou relação entre desequilíbrio esforço-recompensa e transtornos mentais comuns na primeira dimensão. O modelo de regressão logística log-binomial evidenciou associação positiva entre desequilíbrio esforço-recompensa e transtornos mentais comuns (razão de prevalência ajustada=1,91). Trabalhadores expostos a situações de desequilíbrio esforço-recompensa no trabalho apresentaram maior frequência de adoecimento mental. Os resultados reforçam a necessidade de intervir na gestão e organização do trabalho quanto às demandas dos serviços, condições precárias do trabalho e formas de recompensa ou reconhecimento.

ANÁLISE DA PREVALÊNCIA DA SÍNDROME DE BURNOUT EM PROFISSIONAIS DA ATENÇÃO PRIMÁRIA EM SAÚDE

Resumo A síndrome de burnout resulta de um processo crônico de exposição a estressores laborais. Caracteriza-se pelas dimensões exaustão emocional, despersonalização e baixa realização profissional. Profissionais de saúde são propensos a ela por lidarem diretamente com pessoas e sofrimento, o que prejudica sua saúde e o cuidado ofertado à sociedade. A atenção primária à saúde é o nível assistencial mais adjacente à comunidade, expondo os profissionais às realidades desta. Este estudo objetiva identificar a prevalência de burnout nos profissionais da atenção primária e fatores associados. Estudo transversal, realizado com 153 profissionais de saúde da atenção básica do município de Juiz de Fora, entre 2013 e 2014. Utilizou-se o Maslach Burnout Inventory para mensurar o desfecho. A prevalência da síndrome foi de 51%, destacando-se que ela foi maior entre os profissionais de enfermagem. As variáveis associadas ao desfecho após análise multivariada foram: autoavaliação do estado de saúde ruim e insatisfação no trabalho. O trabalho no nível primário de atenção é complexo e exigente, o que torna relevante atentar para a saúde e satisfação destes profissionais, visando resguardar seu bem-estar e a produção do cuidado de qualidade à sociedade.

Mental disorders among health workers in Brazil

The scope of this article is to deter mine the prevalence of common mental disorders (CMD) and Depression among Community Health Agents (CHA) and employees of Psychosocial Care Centers (CAPS). It is a cross-sectional descriptive study involving the target population of Community Health Workers and Psychosocial Care Center workers, linked to the Municipal Health Department of Pelotas in the Brazilian State of Rio Grande do Sul. The presence of common mental disorders was considered when the Self Report Questionnaire (SRQ) was > 7 and the occurrence of depression when BDI > 12. In total, 257 professionals participated in the study. Among mental health professionals (n = 119), the prevalence of CMDs was 25.2% and depression was 23.5%, while the prevalence of CMDs was 48.6% and depression was 29% among CHA (n = 138). The ratio of CMDs between the two groups of professionals was statistically different (p < 0.001). In this study, it was observed that the CAPS professionals are more adapted to work issues, with less perceived health problems arising from work and with a lower prevalence of mental disorders compared to CHA.

Common mental disorders related to incidents and behaviour in physicians

BACKGROUND

Common mental disorders (CMD-burnout, stress, depression and anxiety disorders) are prevalent in physicians.

AIMS

To investigate the relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians.

METHODS

PubMed was searched for all articles published between 2003 and 2013 that study a relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians. The strength of evidence was assessed through five levels of evidence.

RESULTS

We included 15 studies. We found strong evidence for a significant association between burnout and the occurrence of medical incidents, based on two longitudinal and seven cross-sectional studies with a positive association [odds ratio (OR) 1.07-5.5]; one longitudinal study found a non-significant association (strong evidence). For the association between depression and medical incidents, four longitudinal studies and three cross-sectional studies found a significant positive association (strong evidence; OR 2.21-3.29). For the association between fatigue and medical incidents, one longitudinal study and one cross-sectional study showed a significant positive association, but one cross-sectional study showed a non-significant association (strong evidence; OR 1.37). For the association between sleepiness and medical incidents, one longitudinal study and two cross-sectional studies showed a significant positive association (strong evidence; OR 1.10-1.37). No significant association was found between burnout and unprofessional behaviour (inconsistent evidence). Nor was any evidence found for the association between unprofessional behaviour and depression, fatigue or sleepiness.

CONCLUSIONS

CMD in hospital physicians were associated with the occurrence of self-reported medical incidents, but there was inconsistent evidence for unprofessional behaviour.

Community health workers lensed through a South African backdrop of two peri-urban communities in KwaZulu-Natal

Background

As the South African government re-engineers primary healthcare (PHC), the need for additional information on stakeholders involved in the process has emerged. Of these are community health workers (CHWs), who have been identified as central to PHC success.

Objectives

To profile the current CHWs within KwaDabeka and Clermont in KwaZulu-Natal, to describe their roles and to explore the barriers and enablers influencing their service delivery.

Method

A convergent mixed methods design was employed with a sample of CHWs with the use of a survey (n = 53) and two focus groups (n = 10) and semi-structured interviews with four ward councillors (n = 4). Data were analysed statistically and thematically.

Results

The profile of CHWs reflected only women with a mixed age range and a majority of 59% who had not completed formal schooling. General work experience as a CHW varied. There were diverse opinions expressed towards the CHW role which related to their job title and identity, supervision, remuneration, growth pathways and psychological and emotional issues. Whilst the National Community Health Worker Profile Framework was established for the CHW programme, there are several factors lacking in the current CHW programme such as a formal growth pathway or formal training to align the CHWs with the National Qualifications Framework.

Conclusion

The study findings are essential for the monitoring and evaluation as well as development and refinement of policies that will assist in ensuring adequate rollout of PHC with CHWs.

Common mental disorder and its association with academic performance among Debre Berhan University students, Ethiopia

Background

Common mental disorder (CMD) is prevalent in industrialized and non-industrialized countries. The prevalence of CMD among university students was 28.8–44.7% and attributed to several risk factors, such as schooling. The aim of this study was to assess the prevalence and risk factors of CMD. In addition, the association between CMD and academic performance was tested.

Methods

Institution based cross-sectional study was conducted with 422 students at Debre Berhan university from March to April 2015. CMD was the primary outcome variable whereas academic performance was the secondary outcome variable. Kessler psychological distress (K10) scale was used to assess CMD. Bivariate and multiple logistic regression analysis were performed for modeling the primary outcome variable; independent samples T test and linear regression analysis were carried out for modeling the secondary outcome variable. The strength of association was interpreted using odds ratio and regression coefficient (β) and decision on statistical significance was made at a p value of 0.05. Data were entered using EPI-data version 3.1 software and analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.01 software.

Results

The prevalence of CMD was 63.1%. Field of study (p = 0.008, OR = 0.2, 95% CI 0.04–0.61), worshiping (p = 0.04, OR = 1.8, 95% CI 1.02–3.35), insomnia (p < 0.001, OR = 3.8, 95% CI 2.21–6.57), alcohol drinking (p = 0.006, OR = 2.7, 95% CI 1.33–5.66), and headache (p = 0.02, OR = 2.1, 95% CI 1.10–3.86) were identified risk factors for CMD. The mean cumulative grade point average of students with CMD was lower by 0.02 compared to those without CMD, but not statistically significant (p = 0.70, β = −0.02, 95% CI −0.15 to 0.10). CMD explained only 0.8% (r² = 0.008) of the difference in academic performance between students.

Conclusions

At least three out of five students fulfilled CMD diagnostic criteria. The statistically significant risk factors were field of study, worshiping, insomnia, alcohol drinking, and headache. Moreover, there was no statistically significant association between CMD and academic performance. Undertaking integrated evidence-based intervention focusing on students with poor sleep quality, poor physical health, and who drink alcohol is essential if the present finding confirmed by a longitudinal study.

[Mental disorders and participation in the labor market: a multicenter national study in Brazil]

The objective was to explore the relationship between labor market participation and patient characteristics in a representative sample of 2,475 adults admitted to 26 Brazilian mental health institutions (15 Centers for Psychosocial Care and 11 hospitals). Socio-demographic, clinical, and behavioral characteristics were obtained with structured interviews. Multinomial regression was used. Increased likelihood of temporary absence from the work market was associated with female gender, single, divorced, or widowed conjugal status, lack of stable housing, and history of first admission or treatment before the age of 18. Increased likelihood of permanent absence from the labor market was associated with older age. Temporary or permanent leave from work was directly associated with low schooling, lifetime hospitalizations, and diagnosis of severe mental disorder and inversely associated with alcohol and drug use. The occupational vulnerabilities identified in the study raise the debate on specific policies for the mental health sector.

Work-Related Depression in Primary Care Teams in Brazil

OBJECTIVES

To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams.

METHODS

Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions.

RESULTS

Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors.

CONCLUSIONS

Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

Perfil sociodemográfico, ocupacional e avaliação das condições de saúde mental dos trabalhadores da Estratégia Saúde da Família em um município do Rio Grande do Sul, RS

Objetivo: Descrever os fatores sociodemográficos e ocupacionais e avaliar a prevalência de transtornos mentais comuns em trabalhadores das Estratégias de Saúde da Família (ESF) em Santa Cruz do Sul, RS. Métodos: Estudo com abordagem epidemiológica, de corte transversal e quantitativo, realizado no período de junho a agosto de 2013. Foram avaliados 83 trabalhadores, entre médicos, enfermeiros, técnicos/auxiliares de enfermagem e agentes comunitários de saúde, atuantes nas 11 unidades de saúde da família do município. O instrumento de pesquisa constituiu-se em um questionário autoaplicável, englobando aspectos sociodemográficos, ocupacionais e questões pertencentes ao Self-Reporting Questionnaire. Resultados: A idade média dos participantes foi de 37,1±8,9 anos, sendo a maioria agentes comunitários de saúde, do sexo feminino, casadas, com filhos, renda per capita de até 2 salários mínimos e ensino médio completo. A prevalência geral de transtorno mental comum foi de 19,7%, estando presente em todas as categorias profissionais, e mais frequente entre os enfermeiros (25%), porém sem diferenças estatísticas. Conclusão: O presente estudo, além de caracterizar a população de trabalhadores das ESF de Santa Cruz do Sul, RS, em seus aspectos sociodemográficos e ocupacionais, identificou que o sofrimento psíquico está presente, embora em graus variados, em todas as categorias profissionais avaliadas. Frente a esses achados relevantes, sugerem-se providências que visem à prevenção e promoção da saúde mental desses profissionais

Psychosocial Work Conditions and Burnout Among Brazilian Bank Employees: A Cross-Sectional Study

OBJECTIVES

Changes in the modern economy have affected the financial sector. Time pressures, excessive work demands, and job stress are frequent concerns among bank employees, which might predispose them to burnout symptoms. The objective of the present study was to investigate the association between burnout symptoms and exposure to psychosocial work conditions in bank employees.

METHODS

A cross-sectional study of 1046 bank employees was carried out in Pará and Amapá, northern Brazil. We applied a self-administered questionnaire evaluating socio-demographic characteristics, burnout (Maslach Burnout Inventory), and two job stress models (Demand-Control-Support and Effort-Reward Imbalance). Two levels of burnout symptoms were analysed: moderate level of burnout (MLB) and high level of burnout (HLB). Logistic regression models were used to estimate associations between the two levels of burnout and the two stress models, controlling for relevant covariates.

RESULTS

The overall prevalence of burnout was 71.8% (31.1% for HLB; 40.7% for MLB), regardless of gender. Exposure to adverse psychosocial conditions in the workplace, such as high strain, low social support at work, high effort/low reward, and over commitment showed strong association with HLB and MLB, and these associations were independent of age, gender, and other occupational characteristics.

CONCLUSIONS

We found that psychosocial conditions in the financial sector involving high strain, low social support at work, high effort/low reward, and over commitment represent possible risk factors for moderate and HLB symptoms in bank employees.

Transtornos mentais comuns em trabalhadores da Atenção Básica à Saúde

Resumo Introdução: os trabalhadores da saúde podem ser acometidos por doenças relacionadas ao trabalho. A literatura registra que os transtornos mentais constituem importante fator de adoecimento entre esses trabalhadores. Objetivo: avaliar a prevalência de transtornos mentais comuns (TMC) e os fatores sociodemográficos, de estilo de vida e de trabalho, associados à sua ocorrência entre trabalhadores da Atenção Básica à Saúde. Métodos: estudo exploratório, de corte transversal, com amostra estratificada proporcional de trabalhadores das Unidades Básicas de Saúde, Unidades de Saúde da Família, equipe de Vigilância Epidemiológica e Núcleo de Apoio à Saúde da Família (Nasf). Resultados: a prevalência global de TMC foi de 22,9%; entre os trabalhadores do Nasf atingiu 31,6%. Observou-se associação positiva e estatisticamente significante (p≤0,05) entre TMC e sexo feminino, qualidade de vida regular/ruim/muito ruim, estado de saúde regular/ruim/muito ruim, pressão do tempo, insatisfação com o trabalho e elevadas demandas psicológicas. Discussão: devem ser priorizadas ações sobre os aspectos relacionados ao gênero, ao estado de saúde, qualidade de vida e, especialmente, sobre os aspectos da organização do trabalho, como a pressão do tempo, satisfação no trabalho e demanda psicológica envolvida.

Stress Reduction in Chronic Patients’ Professional Carers Through Hydrotherapy

Objetivo

Cuidadoras em trabalho institucional para pessoas com deficiências profundas exercem atividades fundamentais, mas desgastantes, observadas constantemente por todos os memberos da instituição (diretores, funcionários e até voluntários), provocando altos níveis de stress. O objetivo foi realizar uma atividade que reduza o stress em cuidadoras de pacientes crónicos institucionalizados.

Método

Participaram 11 cuidadoras formais de uma instituição residencial para atendimento de pessoas com paralisia cerebral severa, que responderam ao Inventário de Sintomas de Stress para Adultos de Lipp – ISSL, antes e após sessões de hidroterapia semanais.

Resultados

Os resultados demostraram que todas as participantes apresentaram elevado grau de stress antes das sessões e houve redução dos sintomas na maioria das participantes após a hidroterapia. São discutidas as necessidades destas profissionais com formação escolar básica, sem cursos técnicos e muito exigidas pelas instituições.

Conclusão

Quanto melhores forem as suas condições de trabalho, melhor será a sua relação com os assistidos, que são os motivos reais da existência das instituições.

Limites e imposições dos instrumentos de controle do trabalho de agentes comunitários de saúde da Estratégia Saúde da Família

Ser considerado elemento de união entre moradores e serviço não revela de imediato a abrangência das funções, nem oferece visibilidade das exigências a que os agentes comunitários de saúde estão expostos no cotidiano de trabalho diante das atribuições previstas pela Estratégia Saúde da Família. O objetivo desse estudo é analisar os instrumentos de controle da ação social dos agentes comunitários e suas possibilidades de emancipação, a partir da noção de agir comunicativo de Jürgen Habermas. Trata-se de pesquisa qualitativa, realizada numa Unidade Básica de Saúde da cidade de São Paulo (SP), por meio de entrevista semiestruturada com 14 agentes comunitários com experiência mínima de dois anos. Como resultado, destacamos o domínio da razão instrumental sobre a razão comunicativa nas atividades de planejamento, nos critérios técnicos de decisão e avaliação, bem como nos instrumentos de registro do trabalho. Verificamos oportunidades de emancipação nas ações comunicativas em que os agentes comunitários, por meio do diálogo, desenvolvem ações de entendimento mútuo com os pacientes que complementam as ações técnicas. É também por meio do diálogo orientado à construção de consensos que processos cooperativos de trabalho em equipe são elaborados em torno de objetivos comuns. Consideramos que os agentes comunitários resistem aos ditames das ações instrumentais através do entendimento intersubjetivo promovido pela racionalidade comunicativa que permeia o mundo da vida, efetivando situações de emancipação das tensões e conflitos inerentes ao trabalho de mediação.

Psychosocial factors and prevalence of burnout syndrome among nursing workers in intensive care units

OBJECTIVE

To evaluate the prevalence of burnout syndrome among nursing workers in intensive care units and establish associations with psychosocial factors.

METHODS

This descriptive study evaluated 130 professionals, including nurses, nursing technicians, and nursing assistants, who performed their activities in intensive care and coronary care units in 2 large hospitals in the city of Rio de Janeiro, Brazil. Data were collected in 2011 using a self-reported questionnaire. The Maslach Burnout Inventory was used to evaluate the burnout syndrome dimensions, and the Self Reporting Questionnaire was used to evaluate common mental disorders.

RESULTS

The prevalence of burnout syndrome was 55.3% (n = 72). In the quadrants of the demand-control model, low-strain workers exhibited a prevalence of 64.5% of suspected cases of burnout, whereas high-strain workers exhibited a prevalence of 72.5% of suspected cases (p = 0.006). The prevalence of suspected cases of common mental disorders was 27.7%; of these, 80.6% were associated with burnout syndrome (< 0.0001). The multivariate analysis adjusted for gender, age, educational level, weekly work duration, income, and thoughts about work during free time indicated that the categories associated with intermediate stress levels - active work (OR = 0.26; 95%CI = 0.09 - 0.69) and passive work (OR = 0.22; 95%CI = 0.07 - 0.63) - were protective factors for burnout syndrome.

CONCLUSION

Psychosocial factors were associated with the development of burnout syndrome in this group. These results underscore the need for the development of further studies aimed at intervention and the prevention of the syndrome.

Conhecimentos dos agentes comunitários de saúde sobre crack e outras drogas

Objetivo: identificar os conhecimentos dos agentes comunitários de saúde (ACS), do município de Passo Fundo sobre o crack e outras drogas e descrever os perfis sociodemográfico e de saúde. Métodos: estudo descritivo realizado com 78 ACS de Passo Fundo. A coleta de dados ocorreu por meio da aplicação de um questionário estruturado e autoaplicável sobre dados demográficos e de saúde dos ACS, e de um questionário de investigação dos conhecimentos sobre crack e demais drogas. Foram realizados análise descritiva, teste de Tukey e correlações lineares de Pearson e Spearman. Resultados: todos os ACS eram do sexo feminino, com idade média de 41,1±9,6 anos, sendo que 57,7% delas possuíam o ensino médio completo e 69,2% eram casadas. Além disso, 11,5% eram tabagistas, 93,6% negaram dependência ao álcool, e a maioria tinha dependentes químicos em sua área de abrangência. Metade delas apresentou problemas familiares. Em relação à saúde, 29,5% obtiveram SRQ com pontuação sugerindo possibilidade de Transtornos Mentais Comuns, e 51,3% afirmaram ser portadoras de doenças crônicas. A prova de conhecimentos obteve 34,5% de média de acertos, sendo o maior número de respostas corretas entre as ACS com maior escolaridade (p=0,006). Conclusão: o baixo número de acertos em teste de conhecimento evidencia uma necessidade urgente: a de reforçar a formação das ACS. O perfil específico dessas profissionais suscita a necessidade de maior atenção à sua saúde, bem como de novas pesquisas na área. 

Burnout em médicos da Atenção Primária: uma revisão sistemática

Objetivos: analisar as variáveis individuais e as características relacionadas ao trabalho que estão associadas à síndrome de burnout em médicos da Atenção Primária. Métodos: revisão sistemática utilizando as bases de dados Medline (PubMed), SciELO, Lilacs e Cochrane. Em novembro de 2013, realizamos a busca dos estudos com base nos seguintes descritores: “Esgotamento Profissional”, “Pessoal da Saúde” e “Atenção Primária”. Avaliamos 2.416 títulos, e 18 artigos foram selecionados. Resultados: a síndrome de burnout é de alta prevalência entre os médicos da Atenção Primária. Houve associação de burnout com doenças físicas, transtornos mentais, consumo de álcool e uso de substâncias psicoativas. Os médicos que apresentaram maior exaustão emocional faltaram mais ao trabalho, pensaram em mudar de emprego e foram responsáveis por maior gasto farmacêutico por paciente atendido. As principais características do trabalho associadas ao burnout foram: tempo de atuação na área, número de horas trabalhadas por semana, número de pacientes atendidos, tipo de contrato de trabalho, atividade docente, duração do período de férias e dificuldades na relação com profissionais não médicos. Conclusão: a alta prevalência de burnout em médicos da Atenção Primária suscita grande preocupação para os gestores da saúde, uma vez que a Atenção Primária é a base de sustentação dos sistemas de saúde e que a síndrome de burnout repercute na qualidade do cuidado oferecido à população, podendo comprometer a efetividade de todo o sistema. Conhecer os fatores associados ao burnout permite elaborar estratégias de intervenção e de prevenção.

Capacidade para o trabalho, sintomas osteomusculares e qualidade de vida entre agentes comunitários de saúde em Uberaba, Minas Gerais

O objetivo deste estudo foi avaliar a capacidade para o trabalho (CT), aspectos socioeconômicos, qualidade de vida (QV) e sintomas osteomusculares, bem como as associações entre estes em agentes comunitários de saúde (ACS) da cidade de Uberaba, Minas Gerais. Participaram da pesquisa 47 ACS (42 mulheres e 5 homens), com idade média de 37,26 12,74 anos, que responderam um questionário sociodemográfico, o Questionário Nórdico de Sintomas Osteomusculares, o Questionário de Qualidade de Vida SF-36 e o Índice de Capacidade para o Trabalho. A análise inferencial foi realizada com a utilização do teste de Mann-Whitney, teste de Kruskall Wallis e teste de correlação de Spearmann, com significância de 5%. Dos ACS entrevistados, 82,98% apresentaram sintomas osteomusculares nos últimos 7 dias e 93,62% nos últimos 12 meses. O domínio da QV mais comprometido foi a dor, seguido pela vitalidade, aspectos sociais, saúde mental, estado geral de saúde, aspectos emocionais, aspecto físico e capacidade funcional. A média da CT foi de 36,51±7,95. A comparação entre sexo e CT indicou que maior número de mulheres apresentou capacidade inadequada. Maior incidência de sintomas implicou capacidade inadequada. Quanto mais baixos os escores da QV, menor a CT.

Avaliação da presença da Síndrome de Burnout em Agentes Comunitários de Saúde no município de Aracaju, Sergipe, Brasil

O Programa de Agentes Comunitários de Saúde nasceu em 1991 com o objetivo de contribuir para melhoria da qualidade de vida da população, tendo como protagonistas os agentes comunitários de saúde. Diante disso, este trabalho teve como objetivo avaliar a presença da Síndrome de Burnout em agentes comunitários de saúde de Aracaju (SE). A coleta de dados foi realizada com 222 agentes comunitários de saúde das 43 unidades de saúde da família de Aracaju. Os instrumentos da pesquisa foram: ficha de identificação produzida pelos autores para verificar a situação socioeconômica e ocupacional dos profissionais; questionários Job Stress Scale e Maslach Burnout Inventory. Os resultados mostraram que em relação à exposição ao estresse, 57,2% apresentam alta demanda psicológica e alto controle sobre o trabalho; 10,8% dos agentes comunitários de saúde demonstram moderada tendência à Síndrome de Burnout e 29,3% apresentam características equivalentes à doença. Essas características podem estar relacionadas à frustação relacionada à ineficácia da resolutividade dos problemas e ao grande envolvimento dos agentes comunitários de saúde com a sua comunidade. Diante disso, é necessário criar estratégias de intervenção que busquem a prevenção de problemas psicossociais presentes nesses profissionais da saúde.

Esgotamento entre profissionais da Atenção Primária à Saúde

O esgotamento profissional (EP) caracteriza-se por exaustão emocional, despersonalização, e baixa realização profissional, podendo ocorrer entre profissionais da saúde. Este artigo avalia o EP entre trabalhadores da Atenção Primária à Saúde (APS) em três municípios de pequeno porte da Zona da Mata Mineira. O estudo analisa a associação por regressão logística entre EP, aspectos socioeconômicos, demográficos e aspectos do trabalho. Um total de 149 profissionais foi selecionado, destes, 107 responderam a todos os questionários. Para mensurar o EP, foi utilizado o Maslach Burnout Inventory(MBI) e, para a caracterização dos profissionais, foi utilizado outro questionário segundo três diferentes questões: aspectos individuais, sociodemográficos e área de cobertura da equipe. Foram classificados 101 profissionais com indicação positiva para EP. As variáveis presentes no modelo de regressão logística backward stepwise, associadas positivamente com indicativo de esgotamento profissional foram: possuir idade inferior à mediana da população (> 29,5 anos) e fazer uso de medicamentos "calmantes, tranquilizantes e remédios para dormir". Os resultados contribuem para identificar fatores associados com o esgotamento profissional e apontam, neste sentido, para a necessidade de investigações mais detalhadas.

Improving treatment of children with autism spectrum disorder in low- and middle-income countries: the role of non-specialist care providers

Mashudat Bello-Mojeed and Muideen O. Bakare discuss the unmet challenges in care of children with autism spectrum disorders in low- and middle-income countries. Please see later in the article for the Editors' Summary

Condições de trabalho nos ônibus e os transtornos mentais comuns em motoristas e cobradores: Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil, 2012

A prevalência de transtornos mentais comuns (TMC) contribui para a carga mundial de doenças. O objetivo foi descrever a prevalência de TMC numa amostra de motoristas e cobradores da Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil, e verificar se as condições do trânsito e as condições internas aos ônibus estavam associadas ao desfecho. Os respondentes foram 1.607 trabalhadores. A amostra não probabilística foi estimada de acordo com as quotas do efetivo distribuído nas empresas de ônibus (n = 17.470). As entrevistas face a face utilizaram o questionário digital. Trânsito ruim perdeu significância estatística na análise multivariável; renda mais elevada e condições de trabalho e de segurança inadequadas mantiveram-se associadas ao desfecho. Comportamentos nocivos e situação vulnerável de saúde foram associados com TMC. Abordar a saúde dos trabalhadores dos ônibus urbanos é uma rara contribuição que pode amparar a elaboração de políticas públicas dirigidas às populações metropolitanas.

Quality of life of orthopedists in Mato Grosso do Sul

Objective

Evaluate QOL and its implications for health care providers specialized in orthopedics.

Methods

In this quantitative, descriptive, cross-sectional study two questionnaires, World Health Organization Quality of Life (WHOQOL-100) and sociodemographic, were sent to 117 orthopedic surgeons, with 29 doctor's response. Statistical analysis was performed using three different tests: Analysis of Variance (ANOVA), Student t-test, and Pearson's linear correlation. The tests were applied with a reliability of 95%.

Results

Twenty-nine orthopedic surgeons responded to the questionnaire. The studied variables regarding domains were age and employment duration, which have a positive relationship with the environment and social relationships domains; income, which positively influences the level of independence and environment domains; and workload, which negatively influences the psychological domain.

Conclusion

Orthopedic physicians had high scores in the WHOQOL-100 domains and, in their perception, good quality of life had higher scores compared to other professions.

Prevalência e fatores associados aos transtornos mentais comuns em residentes médicos e da área multiprofissional

OBJETIVO: Determinar a prevalência de transtornos mentais comuns (TMC) e sua associação a fatores sociodemográficos e profissionais em residentes de medicina, enfermagem, nutrição e saúde coletiva da cidade do Recife (PE). MÉTODOS: Estudo transversal foi conduzido, em 2007, envolvendo uma amostra aleatória de 178 residentes que responderam a questões sociodemográficas e sobre a formação profissional e ao Self-Reporting Questionnaire (SRQ-20). Calcularam-se as prevalências de TMC e estimaram-se as razões de prevalência (RP) e os intervalos de confiança. RESULTADOS: A prevalência total dos TMC foi de 51,1% e não se observou associação aos fatores sociodemográficos. A prevalência do evento foi 39% maior nos médicos que nos não médicos (p = 0,049) e 46% maior em residentes médicos das especialidades cirúrgicas que entre os de enfermagem, nutrição e saúde coletiva (p = 0,048). Cinco das queixas do SRQ-20 foram mais frequentes no sexo feminino (p < 0,05). CONCLUSÃO: Os dados demonstram a elevada magnitude dos TMC nessa população, principalmente nos residentes médicos, e servem para educadores e gestores de serviços de saúde no sentido de viabilizar estratégias para prevenir e recuperar a qualidade de vida dos residentes.

Profissionais da Estratégia Saúde da Família diante de demandas médico-sociais: dificuldades e estratégias de enfrentamento

Os profissionais da Estratégia Saúde da Família (ESF) atuam em comunidades onde a complexidade de problemáticas médico-sociais pode levá-los a sofrer psicologicamente, com prejuízos ao atendimento aos usuários e à consolidação da ESF como modelo de reorganização da atenção básica no Brasil. Esse estudo investigou as dificuldades e as formas de enfrentamento referidas por profissionais de equipes da ESF frente às demandas médico-sociais apresentadas pelos usuários em seu cotidiano de trabalho. Grupos focais e entrevistas semiestruturadas foram realizados com 68 profissionais de três Unidades de Saúde da Família da cidade de São Paulo. Tráfico e uso de drogas ilícitas, alcoolismo, depressão e violência doméstica são as demandas mais significativas para o grupo estudado. Frente a elas, os profissionais referem formação profissional e capacitação técnica insuficientes, sobrecarga e condições desfavoráveis de trabalho, com sentimentos de impotência e frustração. No enfrentamento das dificuldades, destacam-se as estratégias coletivas, especialmente as reuniões de equipe e apoio matricial, nas quais há troca de experiências, conhecimentos e apoio compartilhado. Os resultados indicam que as dificuldades referidas podem deixar os profissionais da ESF em situação de vulnerabilidade, tal como os usuários por eles atendidos. O investimento no desenvolvimento de competências, o fortalecimento de estratégias de enfrentamento coletivas, assim como maior articulação com as redes de serviços e as lideranças locais, mostram-se necessários para que os profissionais de saúde atuem com menor estresse frente às complexas demandas médico-sociais presentes em seu cotidiano de trabalho, e assim contribuam na consolidação da ESF.

The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study

Background

We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability.

Methods

A questionnaire was sent to all (n = 958) hospital physicians of one academic medical center, using validated scales to assess burnout, work-related fatigue, stress, posttraumatic stress disorder (PTSD), anxiety and depression. Furthermore, respondents were asked to rate their current work ability against the work ability in their own best period (adapted version of the first WAI item). The prevalence of each common mental disorder was calculated. In addition, odds ratios of reporting insufficient work ability for subjects with high complaint scores compared to physicians with low complaint scores were calculated for each mental disorder.

Results

The response rate was 51%, and 423 questionnaires were eligible for analysis. The mental disorder prevalence rates were as follows: work-related fatigue 42%, depression 29%, anxiety 24%, posttraumatic stress complaints 15%, stress complaints 15% and burnout 6%. The mean score for self-reported work ability was 8.1 (range 0–10), and 4% of respondents rated their own work ability as insufficient. Physicians with high mental health complaints were 3.5- for fatigue, 5.6- for PTSD, 7.1- for anxiety, 9.5- for burnout, 10.8- for depression and 13.6-fold for stress more likely to report their work ability as insufficient.

Conclusions

The prevalence of common mental disorders among hospital physicians varied from 6% for burnout to 42% for work-related fatigue. Those physicians with high complaints had significantly 4- to 14 times increased odds of reporting their own work ability as insufficient. This work suggests that to ensure future workers health and patients safety occupational health services should plan appropriate intervention strategies.

Agentes Comunitários de Saúde e as vivências de prazer - sofrimento no trabalho: estudo qualitativo

Este estudo objetivou identificar as situações geradoras de prazer - sofrimento no trabalho dos Agentes Comunitários de Saúde (ACS) de um município do Rio Grande do Sul/Brasil. Foi realizada uma pesquisa de abordagem qualitativa, com participação de 24 agentes. A coleta dos dados ocorreu em 2009, por meio do grupo focal, empregando-se a técnica da análise temática. As situações geradoras de prazer no trabalho foram: ser reconhecido, ser resolutivo, trabalhar junto aos pares e usar a criatividade. As situações geradoras de sofrimento foram: deficiências nos serviços de saúde; desconhecimento das funções; falta de reconhecimento; o sofrimento de trabalhar em equipe; a obrigatoriedade de morar e trabalhar no mesmo local; convivência e envolvimento com os problemas sociais da comunidade e a exposição à violência, resultando em medo. Evidenciou-se a necessidade de adoção de medidas interventivas com vistas a promover melhores condições de trabalho, satisfação profissional e saúde aos agentes comunitários.

Promotoras in mental health: a review of English, Spanish, and Portuguese literature

Promotoras have worked in various areas of public health; however, there is a lack of understanding about their work in mental health. This article reviews the literature in 3 different cultures/languages (English, Spanish, and Portuguese) and aims to describe promotoras' roles, training, and interventions and their outcomes related to mental health activities. Results demonstrate that in different cultures/languages, promotoras empower community members to promote mental health and prevent exacerbation of individuals' mental illness. Promotoras, when trained carefully, have the ability to increase awareness and to promote mental health in populations that would otherwise have limited or no access to care.

Síndrome de Burnout em agentes comunitários de saúde: aspectos de sua formação e prática

A síndrome de burnout tem recebido destaque em recentes pesquisas por representar não apenas um agravo à saúde do profissional, mas também um risco aos indivíduos por ele assistidos, principalmente em atividades nas quais o contato humano é um componente preponderante. O objetivo deste estudo é analisar a manifestação de burnout em agentes comunitários de saúde (ACS) a partir da literatura revisada, dando ênfase a aspectos de sua formação e prática. Procedeu-se a uma pesquisa de referencial teórico a partir de publicações encontradas na base de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Importantes fontes de estresse ocupacional levantadas nas referências foram: a função de elo entre serviço e comunidade exercida por este profissional, a proximidade emocional com a população e o contato direto com os problemas socioeconômicos do território. Foi averiguado também que a formação do agente, no que tange aos conhecimentos humano-sociais, é ainda insuficiente. Conclui-se que estas questões suscitam mudanças na formação dos agentes e nas suas condições de trabalho, sendo que os benefícios destas medidas refletir-se-ão também sobre a saúde da população assistida, e que o limitado número de pesquisas empíricas sobre ACS e burnout encontradas para este estudo prova a necessidade de pesquisas adicionais para consolidação destes conhecimentos e futuras mudanças na abordagem destes profissionais.