Quality of life of physicians in the state of Minas Gerais, Brazil.

Introduction: Studies conducted with physicians from different locations and age groups show a tendency to mental illness and low quality of life in this population. Objectives: To describe the socioeconomic and quality-of-life profile of medical doctors in the state of Minas Gerais, Brazil. Methods: Cross-sectional study. A socioeconomic and quality-of-life questionnaire (World Health Organization Quality of Life instrument-Abbreviated version) was applied in a representative sample of physicians working in the state of Minas Gerais. Non-parametric analyses were used to assess outcomes. Results: The sample was composed of 1,281 physicians, with a mean age of 43.7 years (SD, 11.46) and time since graduation of 18.9 years (SD, 12.1); 12.46% were medical residents, of which 32.7% were in the first year of training. Of the total number of physicians, 66.4% reported feeling overwhelmed and 70.7% were satisfed with their profession. The rate of diagnoses related to depression and anxiety was higher than in the general population. Mean World Health Organization Quality of Life instrument-Abbreviated version score was 60.44±21.72. The analysis of the reported quality-of-life scores showed that younger physicians, especially women, in the first year of residence, with lower income or salary ranges, high workload, and no regular time of obtained lower scores, as well as those who reported diagnoses of depression and/or anxiety. Conclusions: Some socioeconomic factors may influence the quality of life of the study population. Further studies are needed to develop effective social support and health protection actions for these workers.

Introdução: Estudos realizados entre profissionais médicos de diferentes localidades e faixas etárias demonstram uma tendência ao adoecimento mental e à baixa qualidade de vida nessa população. Objetivos: Desenhar o perfil de qualidade de vida de médicos atuantes no estado de Minas Gerais, Brasil. Métodos: Tratou-se de um estudo transversal. Foram utilizados questionários socioeconômico e de qualidade de vida (WHOQOL-Bref, do inglês World Health Organization Quality of Life Instrument-Abbreviated Version) em amostra representativa de médicos atuantes no estado de Minas Gerais, com utilização de análises não paramétricas na avaliação dos desfechos. Resultados: A amostra foi composta de 1.281 médicos, com média de idade de 43,7 anos ± desvio-padrão 11,46 e tempo de formado de 18,9 anos ± 12,1; 12,46% estavam cursando residência médica, entre os quais 32,7% no primeiro ano de treinamento. Do total dos médicos, 66,4% se sentiam sobrecarregados e 70,7% se sentiam satisfeitos com a profissão. Observou-se elevado índice de diagnósticos relacionados à depressão e ansiedade, superior ao encontrado na população geral. A média de pontuação do WHOQOL-Bref foi de 60,44 ± 21,72. A análise das pontuações de qualidade de vida mostrou que os médicos mais jovens, em especial do sexo feminino, em seu primeiro ano de residência, que apresentam renda ou faixas salariais menores, com elevada carga horária de trabalho e sem folgas regulares apresentam pontuação inferior, bem como aqueles que informaram diagnósticos de depressão e/ou ansiedade. Conclusões: Existem fatores socioeconômicos que influenciam positiva ou negativamente na qualidade de vida da população estudada. O aprofundamento nos estudos sobre essa realidade é essencial para o desenvolvimento de ações efetivas e abrangentes de suporte social e de proteção à saúde desses trabalhadores.

Sequential changes of longitudinal and radial myocardial deformation indices in the healthy neonate heart.

BACKGROUND: Significant hemodynamic changes, including preload and afterload modifications, occur during the transition from the fetal to the neonatal environment. The ductus arteriosus closes, pulmonary vascular resistance decreases, and pulmonary blood flow increases. Strain rate (SR) and strain (epsilon) have been proposed as ultrasound indices for quantifying regional wall deformation. This study was designed to determine if these indices can detect variations in regional deformation between early and late neonatal periods. METHODS: Data were obtained from 30 healthy neonates (15 male). The initial study was performed at a mean age of 20.1+/-14 hours (exam 1) and the second at 31.9+/-2.9 days (exam 2). Apical and parasternal views were used to quantify regional left ventricular (LV) and right ventricular (RV) longitudinal and radial SR and epsilon, and systolic, early, and late diastolic values were calculated from these curves. A paired-samples t test was performed comparing the two groups. RESULTS: Compared with exam 1, LV radial deformation showed significant reductions in peak systolic epsilon in the basal and mid segments (51+/-15% vs 46+/-9%, P<.01). LV longitudinal deformation behaved similarly, showing significant peak systolic epsilon reductions in all measured segments. Systolic SR showed reductions only in the basal and apical segments of the lateral wall and in the mid portion of the inferior wall (-1.9+/-0.5 vs -1.7+/-0.3 s(-1) and -1.9+/-0.4 vs -1.7+/-0.2 s(-1), respectively, P=.03). RV longitudinal free and inferior wall systolic SR and epsilon values were significantly higher in exam 2. CONCLUSIONS: LV peak systolic epsilon decreases in exam 2 were possibly due to afterload increase and preload decrease. The lower RV initial deformation indices could be attributed to increased afterload caused by physiologic pulmonary hypertension or immature RV contractile properties. SR seemed to be a more robust index than epsilon and less influenced by preload and afterload hemodynamic alteration.

Effect of spleen surgeries on Escherichia coli distribution on the mononuclear phagocytic system.

OBJECTIVE: To avoid asplenic state, many approaches preserving the spleen have been proposed in the literature: splenorraphy, partial splenectomy with or without preservation of hilar vessels and splenic tissue auto-implants. Subtotal splenectomy, preserving the upper spleen pole nourished only by splenogastric vessels is an alternative when the splenic pedicle must be ligated. The purpose of this study was to evaluate the influence of partial, subtotal and total splenectomies on the distribution of Escherichia coli in the mononuclear phagocytic system. METHOD: Thirty-two rats divided into four groups were studied: sham operation (total spleen preservation), partial splenectomy, subtotal splenectomy and total splenectomy. Five weeks after surgeries, an aliquot of E. coli marked with tecnetium-99m was injected intravenously. The animals were killed 20min later and the spleen, lungs and liver were removed in order to determine the distribution of labeled bacteria. RESULTS: The amount of E. coli in the splenic tissue was greater in the intact spleen group than in the partial or subtotal splenectomy groups. Phagocytosis through the spleen did not differ between the partial and subtotal splenectomy groups. The amount of bacteria in the lungs was greater in the partial than in the subtotal splenectomy group. The distribution of labeled bacteria was greater in the liver of animals submitted to subtotal splenectomy than in the other groups. CONCLUSION: The upper splenic pole, supplied only by splenogastric vessels, has the ability to remove live bacteria from the blood stream, showing that effective blood clearance occurs even without vascularization through the splenic pedicle. Thus, the distribution of E. coli through the mononuclear phagocytic system shows different behavior depending on the type of splenectomy to which the animals are submitted.

Quantification of regional left and right ventricular deformation indices in healthy neonates by using strain rate and strain imaging.

BACKGROUND: Color Doppler myocardial imaging (CDMI) allows the calculation of local longitudinal or radial strain rate (SR) and strain (epsilon). The aims of this study were to determine the feasibility and reproducibility of longitudinal and radial SR and epsilon in neonates during the first hours of life and to establish reference values. METHODS: Data were obtained from 55 healthy neonates (29 male; mean age, 20 +/- 14 hours; mean birth weight, 3,174 +/- 374 g). Apical and parasternal views quantified regional longitudinal and radial SR and epsilon in differing ventricular wall segments. Values at peak systole, early diastole, and late diastole were calculated from the extracted curves. CDMI data acquired at 300 +/- 50 frames/s were analyzed offline. Three consecutive cardiac cycles were measured during normal respiration. The timing of specific systolic or diastolic regional events was determined. Multiple comparisons between walls and segments were made. RESULTS: Left ventricular (LV) longitudinal deformation showed basal differences compared with apical segments within one specific wall. Right ventricular (RV) longitudinal deformation was not homogeneous, with significant differences between basal and apical segments. Longitudinal epsilon values were higher in the RV free basal and middle wall segments compared with the left ventricle. In the RV free wall apical segment, longitudinal SR and epsilon were maximal. LV systolic SR and epsilon values were higher radially compared with longitudinally (radial peak systolic SR midportion, 2.9 +/- 0.6 s(-1); radial peak systolic epsilon, 53.8 +/- 19%; longitudinal peak systolic SR midportion, -1.8 +/- 0.5 s(-1); longitudinal peak systolic epsilon, -24.8 +/- 3%; P < .01). Longitudinal systolic epsilon and SR interobserver variability values were 1.2% and 0.7%, respectively. CONCLUSION: Ultrasound-based SR and epsilon imaging is a practical and reproducible clinical technique in neonates, allowing the calculation of regional longitudinal and radial deformation in RV and LV segments. These regional SR and epsilon indices represent new, noninvasive parameters that can quantify normal neonate regional cardiac function. Independent from visual interpretation, they can be used as reference values for diagnosis in ill neonates.