Work and Common Mental Disorders in Private Education Teachers: Theoretical Model / Trabalho e Transtornos Mentais Comuns em Professores do Ensino Privado: Modelo Teórico / Trabajo y Trastornos Mentales Comunes en Docentes de Educación Privada: Modelo Teórico

Abstract The teaching category is among the professions that most fall ill. The objective was to propose a theoretical model that explains the relationship between work context, experiences of pleasure and suffering, and common mental disorders. Data collection was online in a sample of 740 private education teachers from all levels of education in the state of Rio Grande do Sul/Brazil. The cross-sectional and explanatory research used a Self-Reported Questionnaire, the Work Context Assessment Scale and the Scale of Indicators of Pleasure and Suffering at Work as instruments. As a result, the structural equation model presented the variables of work organization, socio-professional relationships, professional achievement, and emotional exhaustion as predictors of common mental disorders. Social-professional relationships, although they present a risk of illness and emotional exhaustion, are at the same time protective and generate professional fulfillment, when evaluated positively. Work organization is an important predictor of emotional exhaustion and mental disorders.

Resumo A categoria docente está entre as profissões que mais adoecem. Este estudo teve por objetivo propor um modelo teórico que explicasse a relação entre o contexto do trabalho, vivências de prazer e sofrimento e transtornos mentais comuns em docentes. Uma coleta online em uma amostra de 740 professores do ensino privado, de todos os níveis de ensino do Estado do Rio Grande do Sul/Brasil, foi realizada. A pesquisa, transversal e explicativa, utilizou o Self Report Questionnaire, Escala de Avaliação de Contexto de Trabalho e Escala de Indicadores de Prazer e Sofrimento no Trabalho como instrumentos. Como resultado o modelo de equações estruturais apresentou as variáveis organização do trabalho, relações socioprofissionais, realização profissional e esgotamento emocional como preditoras de transtornos mentais comuns. As relações socioprofissionais, embora apresentem risco de adoecimento e esgotamento emocional, também são protetivas e geradoras de realização profissional, quando avaliadas positivamente. A organização do trabalho é preditora de esgotamento emocional e transtornos mentais.

Resumen La categoría docente se encuentra entre las profesiones que más se enferman. El objetivo fue proponer un modelo teórico que explique la relación entre contexto laboral, experiencias de placer y sufrimiento y trastornos mentales comunes en profesores. La recopilación de datos se realizó mediante una muestra de 740 docentes de educación privada de todos los niveles en el estado de Rio Grande do Sul/Brasil. La investigación transversal y explicativa utilizó el Cuestionario de Autoinforme, la Escala de Evaluación del Contexto Laboral y la Escala de Indicadores de Placer y Sufrimiento en el Trabajo como instrumentos. Como resultado, el modelo de ecuaciones estructurales presentó las variables de organización del trabajo, relaciones socioprofesionales, logros profesionales y agotamiento emocional como predictores de trastornos mentales comunes. Las relaciones socioprofesionales presentan un riesgo de enfermedad y agotamiento; además, son protectoras y generan satisfacción profesional, cuando son evaluadas positivamente. La organización del trabajo es predictora de agotamiento emocional y trastornos mentales.

Preditores de Depressão em Docentes do Ensino Privado: a study in the private sector / Depression and teaching

Professores são acometidos por depressão acima da média populacional. Este estudo buscou identificar quais fatores do contexto trabalho e vivências de prazer e sofrimento no trabalho são preditivos de depressão em professores do ensino privado do Rio Grande do Sul. Realizou-se uma pesquisa quantitativa explicativa com uma amostra de 197 professores com sintomas de depressão de todos os níveis de ensino privado. Os instrumentos utilizados foram a Escala de Indicadores de Prazer e Sofrimento no Trabalho, a Escala de Avaliação do Contexto de Trabalho e o Inventário Beck de Depressão. A coleta de dados foi realizada, inicialmente, online e depois por Correio. Foi realizada análise de regressão linear por método stepwise. Como resultados, identificou-se que as variáveis preditoras de depressão foram: esgotamento emocional e realização socioprofissional. Considerou-se que as vivências de frustração, insegurança e estresse contribuem diretamente para a falta de identificação e de orgulho pelo trabalho docente.

Teachers are affected by depression above the population average. This study sought to identify which factors of the work context and experiences of pleasure and suffering at work are predictive of depression in private school teachers in Rio Grande do Sul. An explanatory quantitative research was carried out with a sample of 197 teachers with symptoms of depression. all levels of private education. The instruments used were the Scale of Indicators of Pleasure and Suffering at Work, the Scale of Assessment of the Work Context and the Beck Depression Inventory. Data collection was carried out, initially, online and then by post. Linear regression analysis was performed using the stepwise method. As a result, it was identified that the variables predictive of depression were emotional exhaustion and socio-professional achievement. It was considered that the experiences of frustration, insecurity and stress directly contribute to the lack of identification and pride in the teaching work.

Comparación Clínica de radioterapia de intensidad modulada vs. radioterapia 3D en tratamiento neoadyuvante del cáncer de recto localmente avanzado / Clinical comparison of intensity modulated radiotherapy vs. 3D radiotherapy in neoadjuvant treatment of locally advanced rectal cancer

El objetivo de este trabajo fue comparar ventajas potenciales de la radioterapia de intensidad modulada (IMRT) vs. la radioterapia 3D (3DRT) en el control loco-regional y la toxicidad aguda en pacientes con cáncer de recto localmente avanzado (CRLA). Se analizaron retrospectivamente 235 pacientes con adenocarcinoma de recto T2/T4 y N0/N1 sometidos a radioquimioterapia neoadyuvante entre febrero de 2010 y agosto de 2015. La modalidad radiante se correlacionó con los resultados clínicos (control local y a distancia) y las tasas de toxicidades agudas urinarias, hematológicas, gastrointestinales (GI) y dérmicas. Ciento cuarenta (59.6%) recibieron IMRT y 95 (40.4%) 3DRT. La mediana de seguimiento fue de 36 meses. Las tasas de recidiva local y metástasis a distancia fueron similares entre IMRT y 3DRT. No se encontraron diferencias estadísticamente significativas en control local (CL) ni en supervivencia global (SG) entre IMRT y 3DRT (p=0.56 y p=0.24, respectivamente), ni en colostomía libre para tumores rectales bajos (p=0.44). IMRT implicó menor toxicidad cutánea (p<0.001), hematológica (p<0.0001), urinaria (p=0.0017), y gastrointestinal (p=0.0006). La incidencia de diarrea grado ≥ 3 fue del 16% entre los pacientes del grupo 3DRT frente al 5% de del grupo IMRT. En el análisis univariado, el estadio clínico T, edad, KPS, y quimioterapia adyuvante se asociaron con mejor SG (todos p<0.05) y la dosis total de radiación se asoció con mejor período libre de enfermedad (p=0.0065) Postulamos que IMRT permitiría un aumento de dosis en forma segura con el potencial de aumentar la tasa de respuestas patológicas completas (RPC), en particular en tumores rectales bajos (AU)

The aim was to compare the advantages of IMRT vs. 3D in loco regional control and acute toxicity in patients with locally advanced rectum cancer. We analyzed retrospectively 235 patients with rectal adenocarcinoma T2/T4 and N0/N1 undergoing chemo radiation between February 2010 and August 2015. The radiant modality was correlated with clinical outcomes (local and systemic control) and rates of acute urinary, hematological, gastrointestinal and dermal toxicities. One hundred and forty patients (59.6%) received IMRT and 95 (40.4%) received 3D. The median follow-up time was 36 months. The rates of local recurrence and distant metastases were similar between IMRT vs. 3D. No statistically significant differences were found in local control or survival between IMRT and 3D (p=0.56 and p =0.24, respectively), nor in free colostomy for low rectal tumors (p= 0.44). IMRT resulted in lower dermal (p<0.001), hematological (p<0.0001), urinary (p=0.0017), and gastrointestinal toxicity (p=0.0006). The incidence of diarrhea grade ≥ 3 was 16% among 3D patients vs. 5% in IMRT. In the univariate analysis, clinical stage T, age, KPS, and adjuvant chemotherapy were associated with better overall survival (all p<0.05) and the total dose of radiation was associated with better disease-free period (p=0.0065). We postulate that IMRT would allow us to increase dose in a safe manner with the potential to increase rate of complete pathological responses, particularly in low rectal tumors (AU)

Cáncer anal: resultados clínicos, toxicidades y supervivencia libre de colostomía comparando técnicas de radioterapia conformada tridimensional versus radioterapia de intensidad modulada / Anal cancer: clinical results, toxicities and colostomy-free survival comparing three-dimensional conformal radiotherapy techniques versus intensity modulated radiotherapy

Las técnicas definitivas de quimio-radioterapia para el cáncer anal, radioterapia tridimensional conformada (3DCRT) o radioterapia de intensidad modulada (IMRT) dan excelentes resultados a largo plazo. Evaluamos resultados en centros de radiación basados en la comunidad. Se evaluaron retrospectivamente 281 pacientes tratados con quimio-radioterapia definitiva para carcinoma anal loco-regional, entre 2006 y 2014. El 95% realizó quimioterapia. Se evaluaron datos de toxicidades, progresión de la enfermedad y necesidad de colostomía durante el período de seguimiento. La supervivencia global, supervivencia libre de progresión y colostomía libre se calcularon con métodos de Kaplan-Meier. La edad media fue 63.7 años con seguimiento medio de 60 meses. Ciento sesenta y nueve pacientes recibieron IMRT y 112 recibieron 3DCRT. La dosis total media tumoral fue 54 Gy. El 80% experimentó complicaciones agudas, y el 56% requirió interrupción de tratamiento. No hubo diferencias significativas en supervivencia global, supervivencia libre de progresión, supervivencia libre de colostomía ni control local a dos años entre ambos grupos. La IMRT tuvo menos suspensión del tratamiento (48% vs. 65%) (p=0.0261). El grupo IMRT tuvo una reducción significativa de todas las toxicidades agudas ≥3 y gastrointestinales (GI) tardías, en comparación con los tratados con 3DCRT. Esta serie representa una de las mayores comparaciones 3DCRT vs. IMRT para el tratamiento definitivo de cáncer anal. Los resultados a largo plazo no difieren significativamente en función de la técnica de radioterapia (RT). La IMRT reduce todas las toxicidades ≥ grado 3 y la necesidad de interrupción en comparación con 3DCRT (AU)

The definitive techniques of chemo-radiotherapy for anal cancer, 3DCRT or IMRT, give excellent long-term results. We evaluated results in community-based radiation centers. We retrospectively evaluated 281 patients treated with definitive chemo-radiotherapy for locoregional anal carcinoma, between 2006 and 2014. The 95% performed chemotherapy. Toxicity data, progression of the disease, need of colostomy during the follow-up period were evaluated. Global survival (GS), progression free survival (PFS), and free colostomy survival (CFS) were calculated with Kaplan-Meier methods. Mean age was 63.7 years with a mean follow-up of 60 months. One hundred and sixty nine patients received IMRT and 112 received 3DCRT. The total mean tumor dose was 54 Gy. The 80% experienced acute complications, and 56% required treatment interruption. There was no significant difference in GS, PFS, CFS or local control at two years between both groups. The IMRT had less treatment discontinuation (48% vs. 65%) (p = 0.0261). The IMRT group had a significant reduction in all acute toxicities ≥3 and late gastrointestinal, compared with those treated with 3DCRT. This series represents one of the largest 3DCRT vs. IMRT comparisons for the definitive treatment of anal cancer. The long-term results do not differ significantly depending on the RT technique. The IMRT reduces all toxicities ≥ grade 3 and the need for interruption compared to 3DCRT (AU)