Confidencialidade em medicina ocupacional: protegendo informações / Confidentiality in occupational medicine: protecting information / Confidencialidad en medicina del trabajo: protección de información

Resumo A confidencialidade é elemento central da relação médico-paciente e está associada à boa qualidade do atendimento. Contudo, pode ser rompida em conformidade com as normas éticas e legais estabelecidas no país. Este estudo objetiva mostrar os principais aspectos da confidencialidade em medicina ocupacional. Para isso, realizou-se revisão narrativa de literatura sobre o tema, utilizando bases de dados de livre acesso e embasando-se nos códigos de ética médica. A atuação do médico do trabalho envolve o trabalhador, outros profissionais não médicos e o empregador, situação capaz de desencadear conflitos, requerendo que o médico conheça suas obrigações e limites ético-legais. A proteção da confidencialidade respeita os direitos humanos, mas dilemas podem surgir, não bastando obedecer aos ditames éticos, mas sendo necessário essencialmente seguir as normas legais. Este estudo busca mostrar os principais aspectos éticos e legais atualizados referentes à saúde ocupacional.

Abstract Confidentiality is a central element of the physician-patient relationship and is associated with good quality of care. However, it may be broken in accordance with the ethical and legal standards established in the country. This study aims to show the main aspects of confidentiality in occupational medicine. For this, a narrative review of the literature on the subject was carried out, using free access databases and based on the codes of medical ethics. The occupational physician's performance involves the worker, other non-medical professionals and the employer, a situation that may trigger conflicts, requiring physicians to know their obligations and ethical-legal limits. The protection of confidentiality respects human rights, but dilemmas may arise, not only to obey ethical precepts, but to follow legal norms. This study seeks to show the main and updated ethical and legal aspects regarding occupational health.

Resumen La confidencialidad es clave en la relación médico-paciente y está asociada a buena calidad de la atención. Sin embargo, está sujeta a una quiebra de conformidad a lo establecido en las normas éticas y legales en el país. Este estudio pretende mostrar los principales aspectos de confidencialidad en la medicina del trabajo. Para ello, se realizó una revisión narrativa de la literatura en las bases de datos de acceso abierto basándose en códigos de ética médica. El actuar del médico del trabajo involucra al trabajador, a profesionales no médicos y al empleador, lo que puede desencadenar conflictos requiriendo que el médico conozca sus obligaciones y límites ético-legales. La protección de la confidencialidad respeta los derechos humanos, pero pueden surgir dilemas y no solo bastará atenerse a los dictámenes éticos, sino seguir fundamentalmente las normas legales. Los resultados mostraron los principales aspectos éticos y legales actualizados relacionados con la salud laboral.

Management of hereditary angioedema type I and homozygous MTHFR mutation during pregnancy.

Hereditary angioedema (HAE) is an autosomal dominant disease, characterized by edema attacks resulting from quantitative and/or functional deficiency of the C1 inhibitor (C1-INH), which acts in controlling the complement, coagulation, fibrinolysis, and contact systems. The exacerbation of these systems results in decreased circulating levels of kallikrein and conversion of bradykinin. In addition, thrombophilia is related to the deficiency of methylenetetrahydrofolate reductase (MTHFR) enzyme, causing an increase in homocysteine, accumulation of atheromatous plaques, and arterial and venous thrombosis. The association of these conditions in related systems brings greater clinical risks to the patient. We report a female patient, aged 23 years, with HAE and homozygous MTHFR mutation, G2A1, carrier of HAE with crises since early childhood. The first pregnancy terminated with abortion due to gestational sac detachment. In the second pregnancy, at 5.1 weeks, she had bleeding and partial detachment of gestational sac. Thrombophilia tests confirmed homozygosity for the MTHFR enzyme. At the beginning of gestation, she had attacks of angioedema treated with fresh plasma, and at one occasion, she received treatment with a plasma-derived C1-INH esterase. During breastfeeding, she received prophylaxis with plasma-derived C1-INHdp. The course of HAE during pregnancy worsened. There are studies that discuss the occurrence of abortion due to attacks of angioedema. The patient's disease was associated with a homozygous MTHFR mutation, which probably caused the miscarriage. The control of both clinical situations is important for the success of pregnancy, so a combined action plan between obstetricians and HAE treatment specialists is essential.

Management of hereditary angioedema type I and homozygous MTHFR mutation during pregnancy

Hereditary angioedema (HAE) is an autosomal dominant disease, characterized by edema attacks resulting from quantitative and/or functional deficiency of the C1 inhibitor (C1-INH), which acts in controlling the complement, coagulation, fibrinolysis, and contact systems. The exacerbation of these systems results in decreased circulating levels of kallikrein and conversion of bradykinin. In addition, thrombophilia is related to the deficiency of methylenetetrahydrofolate reductase (MTHFR) enzyme, causing an increase in homocysteine, accumulation of atheromatous plaques, and arterial and venous thrombosis. The association of these conditions in related systems brings greater clinical risks to the patient. We report a female patient, aged 23 years, with HAE and homozygous MTHFR mutation, G2A1, carrier of HAE with crises since early childhood. The first pregnancy terminated with abortion due to gestational sac detachment. In the second pregnancy, at 5.1 weeks, she had bleeding and partial detachment of gestational sac. Thrombophilia tests confirmed homozygosity for the MTHFR enzyme. At the beginning of gestation, she had attacks of angioedema treated with fresh plasma, and at one occasion, she received treatment with a plasma-derived C1-INH esterase. During breastfeeding, she received prophylaxis with plasma-derived C1-INHdp. The course of HAE during pregnancy worsened. There are studies that discuss the occurrence of abortion due to attacks of angioedema. The patient’s disease was associated with a homozygous MTHFR mutation, which probably caused the miscarriage. The control of both clinical situations is important for the success of pregnancy, so a combined action plan between obstetricians and HAE treatment specialists is essential (AU)

Depression, anxiety and spirituality in oncology patients.

OBJECTIVE To relate anxiety and depression levels to the spirituality levels of oncology patients in the ABC region. METHODS Cross-sectional study performed at the ABC University Center oncology outpatient clinics. For the evaluation of spirituality, the Religiosity, Spirituality, and Personal Beliefs instrument of the World Health Organization (SRPB-WHO) was applied. To evaluate the levels of depression and anxiety, the Hospital Anxiety and Depression Scale (HADS) was applied. Qualitative variables were described by frequency and percentage, and quantitative variables by mean and standard deviation or median and range. Relationships were established using either the T-test or Wilcoxon-Mann-Whitney test and correlations with Pearson or Spearman tests, depending on the normality assessed by the Shapiro-Wilk test. RESULTS We included 99 patients, 68% female, with a median age of 60 years (19 to 81). A total of 24% had high or borderline levels of anxiety and 21% of depression. There was a negative correlation between levels of depression and spirituality (rho = -0.44, p <0.001), and anxiety and spirituality (rho=-0.232, p=0.02). We found no significant difference between levels of anxiety, depression, or spirituality when stratified by schooling, income, ethnicity, or marital status. There was a positive correlation between levels of anxiety and depression (cor = 0.477, p <0.001). CONCLUSION Spirituality can be a complementary tool in the treatment of patients with cancer.

Depression, anxiety and spirituality in oncology patients

SUMMARY OBJECTIVE To relate anxiety and depression levels to the spirituality levels of oncology patients in the ABC region. METHODS Cross-sectional study performed at the ABC University Center oncology outpatient clinics. For the evaluation of spirituality, the Religiosity, Spirituality, and Personal Beliefs instrument of the World Health Organization (SRPB-WHO) was applied. To evaluate the levels of depression and anxiety, the Hospital Anxiety and Depression Scale (HADS) was applied. Qualitative variables were described by frequency and percentage, and quantitative variables by mean and standard deviation or median and range. Relationships were established using either the T-test or Wilcoxon-Mann-Whitney test and correlations with Pearson or Spearman tests, depending on the normality assessed by the Shapiro-Wilk test. RESULTS We included 99 patients, 68% female, with a median age of 60 years (19 to 81). A total of 24% had high or borderline levels of anxiety and 21% of depression. There was a negative correlation between levels of depression and spirituality (rho = -0.44, p <0.001), and anxiety and spirituality (rho=-0.232, p=0.02). We found no significant difference between levels of anxiety, depression, or spirituality when stratified by schooling, income, ethnicity, or marital status. There was a positive correlation between levels of anxiety and depression (cor = 0.477, p <0.001). CONCLUSION Spirituality can be a complementary tool in the treatment of patients with cancer.

RESUMO OBJETIVO Relacionar os níveis de ansiedade e depressão com os de espiritualidade dos pacientes oncológicos da região do ABC. MÉTODO Estudo transversal realizado nos ambulatórios de oncologia do Centro Universitário ABC. Para avaliação da espiritualidade, foi aplicado o questionário Religiosidade, espiritualidade e crenças pessoais da Organização Mundial da Saúde (SRPB-WHO). Para avaliar os níveis de depressão e ansiedade foi aplicado a Hospital Anxiety and Depression Scale (Hads). Variáveis qualitativas foram descritas por frequência e porcentagem, as quantitativas por média e desvio padrão ou mediana e intervalo. Relações foram feitas por meio do teste de t ou Wilcoxon-Mann-Whitney e correlações pelo teste de Pearson ou Spearman, a depender da normalidade avaliada pelo teste de Shapiro-Wilk. RESULTADO Foram incluídos 99 pacientes; 68% do sexo feminino, mediana de idade 60 (19 a 81); 24% tiveram níveis altos ou limítrofes para ansiedade e 21% para depressão. Foi observada correlação negativa entre os níveis de depressão e espiritualidade (rho=-0,44, p<0,001) e ansiedade e espiritualidade (rho=-0,232, p=0,02). Não foi observada diferença entre os níveis de ansiedade, depressão ou espiritualidade ao estratificar por escolaridade, renda, etnia ou estado civil. Houve correlação positiva entre os níveis de ansiedade e depressão (cor=0,477, p<0,001). CONCLUSÃO A espiritualidade pode ser uma ferramenta complementar a ser utilizada no tratamento do paciente com câncer.