Brazilian Physicians Mental Health: A Cross-Sectional Nationwide Study exploring factors associated with prevalence of suicide planning and attempts.

OBJECTIVES: To report suicide planning and attempts' in a lifetime among Brazilian physicians and to explore associated risk factors. METHODS: A nation-wide, online survey based on the Tool for the Assessment of Suicide Risk and Satisfaction with Life Scale was conducted among Brazilian physicians (January 2018 - January 2019). Multivariate explored associations of demographics, psychological, and work-related factors on suicide planning and attempts reports. RESULTS: Among 4,148 respondents, 1,946 (53.5%) were male, 2,527 (60.9%) were 30-60 years old, 2,675 (64.5%) had 2-4 work-contracts and 1,725 (41.6%) reported a weekly workload of 40-60 hours. Overall prevalence of suicide plans was 8.8% (n=364) and suicide attempts were reported by 3.2% (n=133) of respondents. Daily (AdjOR=7.857;95%CI 2.282-27.051, p=0.002) or weekly emotional exhaustion (AdjOR=7.953; 95%CI 2.403-26.324, p=0.001), daily frustration with work (AdjOR=3.093;95%CI 1.711-5.588, p<0.001), and being bisexual (AdjOR=5.083;95%CI 2.544-10.158, p<0.001) were significantly associated with higher odds of reports. Among extremely dissatisfied professionals 38.3% reported having made suicide planning and attempts, while among extremely satisfied only 2.8% reported it (p<0.001). CONCLUSIONS: Brazilian physicians with a lifetime history of suicide planning and attempts presented a higher association with emotional exhaustion and frustration with work. Urgent actions are needed to promote professional protection policies and resilience.

There is no shortage, but inequality: demographic evolution of neurologists in Brazil (2010-2020).

BACKGROUND: Neurology is a medical specialty that deals with prevalent diseases such as stroke, headache, epilepsy, and neurodegenerative diseases. Many countries, such as Brazil, struggle to provide neurological care for their populations, but the inadequacy and unequal distribution of the neurologist workforce are real challenges. OBJECTIVE: To analyze the demographic evolution of neurologists and the first-year Neurology residency positions in Brazil during the last decade (2010-2020) and the distribution imbalance between regions. METHODS: The demographic and geographic distribution of neurologists was calculated based on data extracted from the Brazilian Federal Medical Council reports, and the number of Neurology residency positions was based on the Brazilian National Commission of Medical Residency reports. Indicators of wealth were associated with demographic data. RESULTS: The number of neurologists per 100,000 population has increased since 2011, with a similar increase in the geographic distribution of neurologists. However, there was a marked inequality of distribution of neurologists through regions, with a gap between the Northern (lowest) and Southeastern (highest) regions. Furthermore, the imbalance of distribution of neurologists strongly correlated with social inequality. The number of Neurology residency positions increased, but with an imbalance between North and Southeast regions. CONCLUSIONS: Brazil has advanced in providing neurologists. However, instead of a shortage, inequality between regions is the greatest challenge regarding the neurological workforce. The training of new neurologists is unequal between regions and occurs at a slower rate than needed. Neurologists, public health authorities, and patients should discuss solutions for these issues.

ANTECEDENTES: A Neurologia é uma especialidade médica que lida com doenças prevalentes, como acidente vascular cerebral, cefaleia, epilepsia e doenças neurodegenerativas. Muitos países, como o Brasil, se esforçam para oferecer assistência neurológica à população, mas a distribuição insuficiente e desigual da força de trabalho de neurologistas são desafios. OBJETIVO: Analisar a evolução demográfica dos médicos neurologistas e das vagas de Programas de Residência Médica em Neurologia no Brasil durante a última década (2010-2020) e o desequilíbrio de distribuição entre as regiões. MéTODOS: A distribuição demográfica e geográfica de neurologistas foi calculada com base nos dados extraídos de relatórios do Conselho Federal do Medicina do Brasil, e o número de vagas em Programas de Residência Médica em Neurologia foi extraído de dados da Comissão Nacional de Residência Médica. Os indicadores de riqueza foram associados aos dados demográficos. RESULTADOS: O número de neurologistas por 100.000 habitantes aumentou desde 2011, com um aumento similar na distribuição geográfica de neurologistas. Entretanto, houve uma nítida desigualdade na distribuição de neurologistas entre as regiões, com um hiato entre as regiões Norte e a Sudeste. Além disso, a desigualdade da distribuição de neurologistas se correlacionou fortemente com a desigualdade social. O número de vagas em Programas de Residência Médica aumentou, porém com desigualdade entre as regiões Norte e Sudeste. CONCLUSõES: O Brasil tem avançado na geração de neurologistas. Porém, ao invés de uma escassez, a desigualdade entre regiões é o maior desafio em relação à força de trabalho neurológica. O treino de novos neurologistas é desigual entre regiões e ocorre em um ritmo mais lento do que o necessário. Neurologistas, autoridades em saúde pública e pacientes devem discutir soluções para estes problemas.

There is no shortage, but inequality: demographic evolution of neurologists in Brazil (2010-2020) / Não há escassez, mas sim desigualdade: evolução demográfica de neurologistas no Brasil (2010-2020)

Abstract Background Neurology is a medical specialty that deals with prevalent diseases such as stroke, headache, epilepsy, and neurodegenerative diseases. Many countries, such as Brazil, struggle to provide neurological care for their populations, but the inadequacy and unequal distribution of the neurologist workforce are real challenges. Objective To analyze the demographic evolution of neurologists and the first-year Neurology residency positions in Brazil during the last decade (2010-2020) and the distribution imbalance between regions. Methods The demographic and geographic distribution of neurologists was calculated based on data extracted from the Brazilian Federal Medical Council reports, and the number of Neurology residency positions was based on the Brazilian National Commission of Medical Residency reports. Indicators of wealth were associated with demographic data. Results The number of neurologists per 100,000 population has increased since 2011, with a similar increase in the geographic distribution of neurologists. However, there was a marked inequality of distribution of neurologists through regions, with a gap between the Northern (lowest) and Southeastern (highest) regions. Furthermore, the imbalance of distribution of neurologists strongly correlated with social inequality. The number of Neurology residency positions increased, but with an imbalance between North and Southeast regions. Conclusions Brazil has advanced in providing neurologists. However, instead of a shortage, inequality between regions is the greatest challenge regarding the neurological workforce. The training of new neurologists is unequal between regions and occurs at a slower rate than needed. Neurologists, public health authorities, and patients should discuss solutions for these issues.

Resumo Antecedentes A Neurologia é uma especialidade médica que lida com doenças prevalentes, como acidente vascular cerebral, cefaleia, epilepsia e doenças neurodegenerativas. Muitos países, como o Brasil, se esforçam para oferecer assistência neurológica à população, mas a distribuição insuficiente e desigual da força de trabalho de neurologistas são desafios. Objetivo Analisar a evolução demográfica dos médicos neurologistas e das vagas de Programas de Residência Médica em Neurologia no Brasil durante a última década (2010-2020) e o desequilíbrio de distribuição entre as regiões. Métodos A distribuição demográfica e geográfica de neurologistas foi calculada com base nos dados extraídos de relatórios do Conselho Federal do Medicina do Brasil, e o número de vagas em Programas de Residência Médica em Neurologia foi extraído de dados da Comissão Nacional de Residência Médica. Os indicadores de riqueza foram associados aos dados demográficos. Resultados O número de neurologistas por 100.000 habitantes aumentou desde 2011, com um aumento similar na distribuição geográfica de neurologistas. Entretanto, houve uma nítida desigualdade na distribuição de neurologistas entre as regiões, com um hiato entre as regiões Norte e a Sudeste. Além disso, a desigualdade da distribuição de neurologistas se correlacionou fortemente com a desigualdade social. O número de vagas em Programas de Residência Médica aumentou, porém com desigualdade entre as regiões Norte e Sudeste. Conclusões O Brasil tem avançado na geração de neurologistas. Porém, ao invés de uma escassez, a desigualdade entre regiões é o maior desafio em relação à força de trabalho neurológica. O treino de novos neurologistas é desigual entre regiões e ocorre em um ritmo mais lento do que o necessário. Neurologistas, autoridades em saúde pública e pacientes devem discutir soluções para estes problemas.

The subtleties of cognitive decline in multiple sclerosis: an exploratory study using hierarchichal cluster analysis of CANTAB results.

BACKGROUND: It is essential to investigate cognitive deficits in multiple sclerosis (MS) to develop evidence-based cognitive rehabilitation strategies. Here we refined cognitive decline assessment using the automated tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and hierarchical cluster analysis. METHODS: We searched for groups of distinct cognitive profiles in 35 relapsing-remitting MS outpatients and 32 healthy controls. All individuals participated in an automated assessment (CANTAB) and in a pencil and paper general neuropsychological evaluation. RESULTS: Hierarchical cluster analysis of the CANTAB results revealed two distinct groups of patients based mainly on the Simple Reaction Time (RTI) and on the Mean Latency of Rapid Visual Processing (RVP). The general neuropsychological assessment did not show any statistically significant differences between the cluster groups. Compared to the healthy control group, all MS outpatients had lower scores for RTI, RVP, paired associate learning, and delayed matching to sample. We also analyzed the associations between CANTAB results and age, education, sex, pharmacological treatment, physical activity, employment status, and the Expanded Disability Status Scale (EDSS). Although limited by the small number of observations, our findings suggest a weak correlation between performance on the CANTAB and age, education, and EDSS scores. CONCLUSIONS: We suggest that the use of selected large-scale automated visuospatial tests from the CANTAB in combination with multivariate statistical analyses may reveal subtle and earlier changes in information processing speed and cognition. This may expand our ability to define the limits between normal and impaired cognition in patients with Multiple Sclerosis.

Dosage of lactate in the cerebrospinal fluid in infectious diseases of the central nervous system

This paper analyzes the diagnosis aid of the dosage of lactate in the cerebrospinal fluid (CSF) in infectious diseases of the central nervous system (CNS). We analyzed prospectively 130 samples of CSF of 116 patients with diagnoses of infectious processes in the CNS. The 130 samples of CSF were divided into five groups: 28 samples of the control group, 40 of bacterial meningitis, 22 of viral meningitis, 16 of fungal meningitis and 24 of patients presenting acquired immune deficiency syndrome (AIDS). The concentration of lactate in the CSF was elevated in the group of patients with bacterial meningitis (average = 46.2 mg/dL), fungal meningitis (average = 27.3 mg/dL) and in the AIDS group (average = 23.5 mg/dL). In the control group and viral meningitis group the lactate content in the CSF presented the reference rates according to the employed method. The lactate dosage in the CSF presented a negative correlation with glycorrhachia and positive correlation with the cellularity and total proteins of the CSF. We conclude that the lactate dosage in the CSF, although unspecific, helps to distinguish the infectious processes of the CNS