Opiniones de los inspectores médicos acerca de la distorsión clínica en la valoración de la incapacidad laboral en España / Opinions of medical inspectors about clinical distortion in assessment of work disability in Spain

El contexto médico-legal en el que se desarrolla la medicina evaluadora, permitiendo el acceso a prestaciones económicas, obliga a considerar la validez en las consultas de valoración médica de incapacidad para tratar de evitar el fraude por simulación. Por otra parte, en el ámbito médico asistencial son habituales los casos biomédicamente inexplicables que se acompañan de elevados niveles subjetivos de sufrimiento, para los que se ha propuesto el término MUPS (medically unexplained physical symptoms). Objetivos: Profundizar en el fenómeno de la distorsión clínica en la valoración médica de incapacidad, basado en los dos primeros criterios de Simulación del DSM-IV-TR, referido al marco teórico del Análisis de Conducta en Medicina. Métodos: Encuesta en línea dirigid el colectivo de los inspectores médicos evaluadores del Instituto Nacional de la Seguridad Social (INSS) de España para conocer sus opiniones acerca de estos casos, presentes en su práctica diaria, su manejo de los mismos y su grado de concordancia con respecto a la bibliografía de referencia. Resultados: Incluyen a una proporción representativa de dichos inspectores médicos (15 por ciento), que aparecen como un colectivo variado, por su distinta formación profesional, experiencia previa y práctica diaria en las diferentes Unidades Médicas. Conclusiones: Consideran la distorsión clínica y sus cuadros anexos como situaciones frecuentes y relevantes en sus consultas, principalmente el fraude por simulación. Pese a ello, los inspectores médicos no parecen contar actualmente con referencias específicas suficientes ni con un discurso científico común estructurado para estos casos, que son abordados según criterios individuales más o menos ajustados al estado actual del conocimiento.(AU)

The forensic context in which disability assessment medicine is practiced in Spain, allowing access to workers' compensation benefits, requires consideration of the validity of disability assessment examinations. On the other hand, in clinical medicine biomedically unexplained cases ­for which the term medically unexplained physical symptoms (MUPS) was proposed­ are common, often accompanied by high levels of subjective suffering. Aim: To deepen in the phenomenon of clinical distortion in disability assessment examinations, based on the first two criteria of Malingering in DSM-IV-TR, referring to the theoretical framework of the Behavior Analysis in Medicine. Methods: Online survey addressed to the group of medical examiners of the National Institute of Social Security (INSS) of Spain to know their opinions on these cases, present in their everyday practice, their management and the extent of agreement to the literature of reference. Results: Collected a representative proportion of medical examiners (15 percent), they appear as a miscellaneous group due to their different professional training, previous experience and everyday practice in their different Medical Units. Conclusions: medical examiners consider the clinical distortion and related cases as frequent and relevant situations in their practice, mainly malingering. Nonetheless, medical examiners do not seem to have sufficient specific references or a structured common scientific discourse for these cases, which are approached according to individual criteria more or less adjusted to the current state of knowledge. (AU)

Prevalência de transtornos mentais e comportamentais nas instituições públicas federais de Rondônia / Prevalence of mental and behavioral disorders in federal public institutions in the state of Rondônia, Brazil

Este artigo tem por objetivo avaliar a prevalência de transtornos mentais e comportamentais nas instituições públicas federais, registrados no Subsistema Integrado de Atenção à Saúde do Servidor Público Federal/SIASS de Rondônia. O estudo do tipo descritivo-exploratório transversal propôs-se analisar os prontuários das licenças no trabalho por motivos de saúde, enquadradas no grupo F, de acordo com a Classificação Internacional de Doenças CID-10. Foram estudadas vinte e três instituições públicas federais deste estado no ano de 2011. Foram concedidos 3.079 afastamentos por licença saúde, aos servidores públicos federais sendo que destes, 296 (9,6%) foram motivados por transtornos mentais e comportamentais. Observou-se diferenças na prevalência de afastamentos entre os sexos, as licenças saúde concedidas às mulheres (70,6%) foram superiores ao número concedido aos homens (29%), entretanto houve diferença nos diagnósticos entre os sexos. O uso de substâncias psicoativas foi superior entre os homens (10,3%) em relação às mulheres (1,4%), já para as mulheres prevaleceram os transtornos de humor associados aos transtornos neuróticos (11,4%) em relação aos homens (1,5%)...

This article aims to assess the prevalence of mental and behavioral disorders in federal public institutions, registered in the Integrated Care Subsystem for the SIASS Federal Public Service Health of the state of Rondônia. This descriptive and exploratory study aimed to examine the medical records of licenses at work due to health reasons, framed in group F, according to the International Classification of Diseases ICD-10. Three thousand and seventy-nine absences were granted for sick leave, and of these, 296 (9,6%) were motivated by mental and behavioral disorders. Differences in the prevalence of clearances between the sexes were observed: sick leaves granted to women (70,6%) were higher than the number granted to men (29%), however there was no difference in diagnoses between the sexes. In short, the use of psychoactive substances was higher among men (10,3%) than women (1,4%), while for women prevailed mood disorders associated with neurotic issues (11,4%) when compared to men (1,5%)...