Profile of workers receiving disability benefits for depressive conditions in south Santa Catarina, Brazil.

Introduction: In recent years, mental disorders have remained the third leading cause of sick-pay benefits due to incapacity for work in Brazil. Objectives: To assess the profile and outcomes of workers receiving sick pay for depression through the Criciúma unit of the Brazilian National Social Security Institute (Instituto Nacional do Seguro Social, INSS). Methods: The study was carried out using data obtained from the Electronic System Portal of the INSS Citizen Information Service of Criciúma, state of Santa Catarina. A total of 343 individuals were selected over a 1-year period. We then analyzed all new benefits granted over a 6-year period. Results: Mild depressive episode was the disorder that prompted the most disability benefits. The mean age was 42 years, with a predominance of female beneficiaries. Overall, 56% of beneficiaries were granted at least one new disability benefit. Mental health disorders were among the leading causes. The duration of new benefits was significantly longer. Conclusions: The typical profile is that of a 42-year-old woman, gainfully employed, earning one to two times the minimum wage, with low educational attainment, who is deemed unfit for work due to a mild depressive episode. Older age was a risk factor for being awarded a new benefit. Benefits classified as due to a more serious condition and those awarded subsequent to the first benefit had a longer duration. Given the relevance of depression to occupational health, we hope that the findings of the present study will contribute to the literature and encourage new research in the field.

Contraindicações ao uso de trombolítico em pacientes acometidos por acidente vascular cerebral isquêmico num hospital de alta complexidade do sul catarinense no período de 2012 a 2014 / Contraindications to the use of thrombolytic agents in patients with ischemic stroke in a hospital of high complexity in southern santa catarina from 2012 to 2014

Este estudo visa analisar as contraindicações mais prevalentes ao uso de trombolítico nos pacientes acometidos por acidente vascular cerebral isquêmico (AVCi). Foram analisados 743 prontuários, sendo que os indevidamente preenchidos foram excluídos (64%), restando 255 pacientes viáveis para o estudo internados em um hospital de alta complexidade em Criciúma, no período de janeiro de 2012 a dezembro de 2014, através de dados coletados em prontuários eletrônicos. Os dados foram analisados através do software IBM Statistical Package for the Social Sciences verão 22.0, utilizando-se os testes de Kolmogorov-Smirnov, razão vero semelhança, teste de H Kruskal-Wallis como também Fisher e QuiQuadrado. A média e desvio padrão de idade foi 67,6 ± 12,8, com predomínio do sexo masculino (59,6%). A principal comorbidade encontrada foi hipertensão arterial sistêmica (78,8%), seguida por dislipidemia (29,8%), diabetes mellitus (29,4%), cardiopatia (22,7%). A contraindicação mais frequente para o uso de trombolítico foi Delta T acima de 4,5 horas (43,9%), seguida por pressão sistólica maior do que 185 mmHg e/ou diastólica maior do que 110 mmHg (12,9%). Dado relevante da amostra foi que 24,7% dos pacientes não apresentavam contraindicação documentada ao uso de trombolítico. Dos 743 pacientes, apenas 2 (0,3%) foram submetidos à terapia trombolítica ao longo dos três anos. Levando em conta esses dados, se faz necessário implantação de protocolos para a instituição do tratamento, conscientização da população quanto ao reconhecimento dos sintomas de AVCi, assim como melhor preenchimento dos prontuários por parte dos profissionais de saúde.

This study aimed to analyze the most prevalent contraindications to the use of thrombolytic agents in patients with ischemic stroke (AIS). A total of 743 medical records were analyzed, and those that were unduly filled were excluded (64%), remaining 255 patients suitable hospitalized in a highly complex hospital in Criciúma, from January 2012 to December 2014, through data collected in electronic medical records. The material was analyzed using the IBM Statistical Package for the Social Sciences Summer 22.0, using the Kolmogorov-Smirnov tests, the likelihood ratio test, the Kruskal-Wallis H test as well as Fisher and Qui-Square. The average and standard deviation of age was 67.6 ± 12.8, with the predominance of males (59.6%). The main comorbidity found was systemic arterial hypertension, followed by dyslipidemia, diabetes mellitus, heart disease. The most frequent contraindication was Delta T over 4.5 hours (43.9%), followed by SBP> 185mmHg and / or DBP> 110mmHg (12.9%). A relevant fact from the sample was that 24.7% of the patients did not present a documented contraindication to thrombolytic use. Only 2 (0.3%) out of 743 patients were submitted to thrombolytic therapy over the three years. Taking into account these data, it is necessary to implement protocols for institution of the treatment and to require a better completion of medical records by health professionals. Also, population awareness regarding the recognition of all stroke symptoms is essential.

Avaliação do conhecimento de intensivistas sobre morte encefálica / Evaluation of intensivists' knowledge on brain death

JUSTIFICATIVA E OBJETIVOS: A falha ou atraso no diagnóstico de morte encefálica resulta na ocupação desnecessária de um leito hospitalar, em perdas emocionais e financeiras e na indisponibilidade de órgãos para transplante. O médico intensivista tem fundamental papel nesse diagnóstico. O objetivo deste estudo foi avaliar o conhecimento sobre morte encefálica entre os intensivistas. MÉTODO: Estudo transversal em 15 unidades de terapia intensiva (UTI) em oito hospitais da cidade de Porto Alegre, Brasil. RESULTADOS: Duzentos e quarenta e seis intensivistas foram entrevistados em uma amostra consecutiva entre abril e dezembro de 2005. Encontrou-se prevalência de desconhecimento do conceito de morte encefálica de 17 por cento. Vinte por cento dos entrevistados desconheciam a necessidade legal de exame complementar para o seu diagnóstico. Quarenta e sete por cento se consideraram no nível máximo de segurança para explicar o conceito para a família de um paciente. Vinte e nove por cento desconheciam a hora do óbito legal para os pacientes em morte encefálica. Os intensivistas pediátricos tiveram menor conhecimento do conceito em relação aos intensivistas de adultos (p < 0,001). CONCLUSÕES: O atual conhecimento sobre morte encefálica é insuficiente entre os profissionais que mais freqüentemente se deparam com pacientes nessa situação. Há necessidade de educação sobre o tema a fim de evitar gastos desnecessários, diminuir o sofrimento familiar e aumentar a oferta de órgãos para transplantes.

BACKGROUND AND OBJECTIVES: Failure or delay to diagnose brain death leads to needless occupation of a hospital bed, emotional and financial losses, and unavailability of organs for transplants. The intensive care physician plays an essential role in this diagnosis. This study intended to evaluate intensivists' knowledge concerning brain death. METHODS: Cross-sectional study in 15 intensive care units (ICU) in eight hospitals in the city of Porto Alegre, Brazil. RESULTS: Two hundred forty-six intensivists were interviewed in a consecutive sample between April and December 2005. The prevalence of lack of knowledge regarding the concept was of 17 percent. Twenty per cent of the interviewees ignored the legal need for complementary confirmatory tests for their diagnosis. Forty-seven per cent considered themselves as having the highest level of assurance to explain the concept to a patient's family members. Twenty-nine per cent erroneously determined the legal time of death for brain dead patients. Pediatric intensivists had less knowledge about the concept, when compared to intensivists for adults (p < 0.001). CONCLUSIONS: Current knowledge of brain death is insufficient in Brazil, among the health care professionals who most often find patients in this situation. Education on the subject is needed to avoid unnecessary expenses, reduce family suffering and increase the offer of organs for transplant.

Evaluation of intensivists' knowledge on brain death. / Avaliação do conhecimento de intensivistas sobre morte encefálica.

BACKGROUND AND OBJECTIVES: Failure or delay to diagnose brain death leads to needless occupation of a hospital bed, emotional and financial losses, and unavailability of organs for transplants. The intensive care physician plays an essential role in this diagnosis. This study intended to evaluate intensivists' knowledge concerning brain death. METHODS: Cross-sectional study in 15 intensive care units (ICU) in eight hospitals in the city of Porto Alegre, Brazil. RESULTS: Two hundred forty-six intensivists were interviewed in a consecutive sample between April and December 2005. The prevalence of lack of knowledge regarding the concept was of 17%. Twenty per cent of the interviewees ignored the legal need for complementary confirmatory tests for their diagnosis. Forty-seven per cent considered themselves as having the highest level of assurance to explain the concept to a patient's family members. Twenty-nine per cent erroneously determined the legal time of death for brain dead patients. Pediatric intensivists had less knowledge about the concept, when compared to intensivists for adults (p < 0.001). CONCLUSIONS: Current knowledge of brain death is insufficient in Brazil, among the health care professionals who most often find patients in this situation. Education on the subject is needed to avoid unnecessary expenses, reduce family suffering and increase the offer of organs for transplant.

Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil.

OBJECTIVES: To study the possible change on mode of deaths, medical decision practices, and family participation on decisions for limiting life-sustaining treatments (L-LST) over a period of 13 yrs in three pediatric intensive care units (PICUs) located in southern Brazil. METHODS: A cross-sectional study based on a retrospective chart review (1988 and 1998) and on prospective data collection (from May 1999 to May 2000). SETTING: Three PICUs in Porto Alegre, southern Brazilian region. PATIENTS: Children who died in those PICUs during the years of 1988, 1998, and between May 1999 and May 2000. RESULTS: The 3 PICUs admitted 6,233 children during the study period with a mortality rate of 9.2% (575 deaths), and 509 (88.5%) medical charts were evaluated in this study. Full measures for life support (F-CPR) were recognized in 374 (73.5%) children before dying, brain death (BD) was diagnosed in 43 (8.4%), and 92 (18.1%) underwent some limitation of life support treatment (L-LST) There were 140 (27.5%) deaths within the first 24 hrs of admission and 128 of them (91.4%) received F-CPR, whereas just 11 (7.9%) patients underwent L-LST. The average length of stay for the death group submitted to F-CPR was lower (3 days) than the L-LST group (8.5 days; p < .05). The rate of F-CPR before death decreased significantly between 1988 (89.1%) and 1999/2000 (60.8%), whereas the L-LST rose in this period from 6.2% to 31.3%. These changes were not uniform among the three PICUs, with different rates of L-LST (p < .05). The families were involved in the decision-making process for L-LST in 35.9% of the cases, increasing from 12.5% in 1988 to 48.6% in 1999/2000. The L-LST plans were recorded in the medical charts in 76.1% of the deaths, increasing from 50.0% in 1988 to 95.9% in 1999/2000. CONCLUSION: We observed that the modes of deaths in southern Brazilian PICUs changed over the last 13 yrs, with an increment in L-LST. However, this change was not uniform among the studied PICUs and did not reach the levels described in countries of the Northern Hemisphere. Family participation in the L-LST decision-making process has increased over time, but it is still far behind what is observed in other parts of the world.