Bruxismo como consequência do estresse pandêmico: revisão integrativa / Bruxism as a consequence of pandemic stress: integrative review

O período pandêmico com todas as suas implicações possibilitou um aumento dos níveis de estresse em parte da população, que teve como consequência a obtenção ou o agravamento do bruxismo. Objetivo: O objetivo deste artigo foi realizar uma revisão integrativa sobre como o estresse causado pela pandemia de COVID-19 influenciou no desenvolvimento do bruxismo, considerando o perfil dos indivíduos acometidos. Realizou-se uma revisão integrativa da literatura a partir da seleção de artigos publicados nas bases de dados BVS, PubMed e EBSCOhost. Para isto, a seguinte questão de pesquisa foi formulada: "Existe relação entre o bruxismo e a pandemia de COVID-19?". A busca objetivou encontrar artigos publicados em português, espanhol e inglês, durante os anos de 2019 a 2023, utilizando os descritores "bruxismo", "COVID-19" e "estresse psicológico" e as suas respectivas versões em inglês, juntamente com a estratégia de busca AND. Revisão de literatura: Vinte estudos foram incluídos, ficando evidente uma prevalência do bruxismo como consequência do estresse pandêmico em pessoas jovens, do sexo feminino, além de estudantes/profissionais da área da saúde. Considerações finais: Acredita-se que a pandemia de COVID-19 vivenciada entre os anos de 2019 e 2023 tenha causado e/ou exacerbado estresse, sendo este um importante fator causador do bruxismo.(AU)

The pandemic period with all its implications allowed an increase in stress levels in part of the population, which resulted in the obstruction or worsening of bruxism. Objective: The aim of this article was to carry out an integrative review on how the stress caused by the COVID-19 pandemic influenced the development of bruxism, considering the profile of affected individuals. Method: An integrative literature review was carried out based on the selection of articles published in the VHL, PubMed and EBSCOhost databases. For this, the following research question was formulated: "Is there a relationship between bruxism and the COVID-19 pandemic?". The search aimed to find articles published in Portuguese, Spanish and English, during the years 2019 to 2023, using the descriptors "bruxism", "COVID-19" and "psychological stress" and their respective versions in English, together with the strategy of search AND. Integratve review: Twenty studies were included, revealing a prevalence of bruxism as a consequence of pandemic stress in young, females, in addition to students/health professionals. Final considerations: It is believed that the COVID-19 pandemic experienced between 2019 and 2023 caused and/or exacerbated stress, which is an important factor causing bruxism.(AU)

The Nucleus Accumbens CRH-CRHR1 System Mediates Early-Life Stress-Induced Sleep Disturbance and Dendritic Atrophy in the Adult Mouse / 神经科学通报·英文版

Adverse experiences in early life have long-lasting negative impacts on behavior and the brain in adulthood, one of which is sleep disturbance. As the corticotropin-releasing hormone (CRH)-corticotropin-releasing hormone receptor 1 (CRHR1) system and nucleus accumbens (NAc) play important roles in both stress responses and sleep-wake regulation, in this study we investigated whether the NAc CRH-CRHR1 system mediates early-life stress-induced abnormalities in sleep-wake behavior in adult mice. Using the limited nesting and bedding material paradigm from postnatal days 2 to 9, we found that early-life stress disrupted sleep-wake behaviors during adulthood, including increased wakefulness and decreased non-rapid eye movement (NREM) sleep time during the dark period and increased rapid eye movement (REM) sleep time during the light period. The stress-induced sleep disturbances were accompanied by dendritic atrophy in the NAc and both were largely reversed by daily systemic administration of the CRHR1 antagonist antalarmin during stress exposure. Importantly, Crh overexpression in the NAc reproduced the effects of early-life stress on sleep-wake behavior and NAc morphology, whereas NAc Crhr1 knockdown reversed these effects (including increased wakefulness and reduced NREM sleep in the dark period and NAc dendritic atrophy). Together, our findings demonstrate the negative influence of early-life stress on sleep architecture and the structural plasticity of the NAc, and highlight the critical role of the NAc CRH-CRHR1 system in modulating these negative outcomes evoked by early-life stress.

Stress-another possible mechanism of neurotoxicity in neurodegenerative diseases

Theliteratureassociatesoxidativestresswiththeproductionoffreeradicals,whichleadtoneurodegeneration.Theypresentinnumerablehypotheses,amongwhichareabnormalitiesinthefunctioningofthehypothalamic-pituitary-adrenalaxis,neurotoxiceffectsandneuronaloxidativedamage.ClinicalobservationhasshownthatinneurodegenerativediseasessuchasMultipleSclerosis(MS)andAmyotrophicLateralSclerosis(ALS)thereisareportofprolonged or violent emotionalstressprecedingthesymptoms.Aims:UsingtheCarilloComplexSystemsModel,presentsomepossibilitiesonhowstresscancontributetoneurodegeneration.Methodology:NinecasesofALSandsixcasesofMSwereevaluated,pathologiesalreadyclassifiedasbelongingtosyphilinism.Literaturereviewonstressandneurotoxicitycarriedout.Resultsanddiscussion:Syphilinism is instability with a predominantly intrinsicorigin to the system with a chronic caracter.This diathesis is characterized by a dissipative deficiency, predominantly hepatic, to the processing of certain elements or potentially toxic substances with exogenous origin or endogenous Such non-processed substances are unstable factors in the system, with greater affinity for certain tissues,like the nervous system. Among the toxins, we find alcohol, esters, formaldehyde, aloe, ketones, aldehydes, etc. The final hepatic metabolism of cortisol results in cortic acids and cortol, which use the same enzymatic system as alcohol, and can be considered syphilinic toxins. Ethanol can act directly at the circadian rhythm, disrupting it and generating stressful substances such as cortisol, regardless of an external event, increasing the toxin level. The inflammatory process generated by the production of free radicals and metabolic abnormalities, including the reduction of neuropeptide Y that modulates inflammatory activity in the nervous system, leads to changes that can result in neurodegeneration. Conclusion: Inflammation caused by toxins from prolonged/violent emotional stress can lead to several changes in syphilinic individuals, due to failure in the dissipative process, including neurodegeneration.

Association of Increased Amygdala Activity with Stress-Induced Anxiety but not Social Avoidance Behavior in Mice / 神经科学通报·英文版

Chronic stress leads to many psychiatric disorders, including social and anxiety disorders that are associated with over-activation of neurons in the basolateral amygdala (BLA). However, not all individuals develop psychiatric diseases, many showing considerable resilience against stress exposure. Whether BLA neuronal activity is involved in regulating an individual's vulnerability to stress remains elusive. In this study, using a mouse model of chronic social defeat stress (CSDS), we divided the mice into susceptible and resilient subgroups based on their social interaction behavior. Using in vivo fiber photometry and in vitro patch-clamp recording, we showed that CSDS persistently (after 20 days of recovery from stress) increased BLA neuronal activity in all the mice regardless of their susceptible or resilient nature, although impaired social interaction behavior was only observed in susceptible mice. Increased anxiety-like behavior, on the other hand, was evident in both groups. Notably, the CSDS-induced increase of BLA neuronal activity correlated well with the heightened anxiety-like but not the social avoidance behavior in mice. These findings provide new insight to our understanding of the role of neuronal activity in the amygdala in mediating stress-related psychiatric disorders.

Influencia del cáncer cérvico-uterino y la alteración de la salud mental en pacientes menores de 25 años en Ecuador / Influence of cervico-uterine cancer and the alteration of mental health in patients under 25 years of age in Ecuador

INTRODUCCIÓN: Los problemas sanitarios en los pacientes que padecen cáncer cérvico-uterino influyen en la satisfacción personal y evitan una gran adherencia a la terapia médica, y además están relacionados con un número más notable de efectos secundarios y la estancia en la clínica de emergencia junto afecciones depresivas y problemas de ansiedad. OBJETIVO: Identificar la influencia del cáncer cérvico -uterino en las alteraciones en la salud mental de pacientes menores de 25 años en el Ecuador. METODOLOGÍA: La investigación fue de tipo cuantitativo, descriptivo, y de corte transversal. Se utilizaron encuestas de manera virtual dirigida a pacientes menores de 25 años que padecen de cáncer al cuello uterino en diversas Fundaciones que luchan contra el cáncer, contando con una muestra de 178 mujeres, estas se dividieron en 4 categorías: Salud mental, Estrés, Depresión y Total de escalas. RESULTADOS: El porcentaje que se obtuvo de manera general tuvo un rango variado, el 32,9% dio como resultado que la alteración que causa en la mujer es contundente, seguido del 30,6 que su afección en la salud mental es más baja. CONCLUSIÓN: Se concluye afirmando que el cáncer uterino es el segundo cáncer más prevalente en la mujer, el cual influye de manera progresiva en la salud mental, presentando reacciones negativas y percepciones, falta de control en las emociones, consecuentemente aquello debilita el sistema inmunológico previamente comprometido, generando alteraciones en el curso del tratamiento.

INTRODUCTION: Health problems in patients suffering from cervical-uterine cancer influence personal satisfaction and prevent a high adherence to medical therapy, and are also related to a more notable number of side effects and stay in the emergency clinic together depressive conditions and anxiety problems. OBJECTIVE: To identify the influence of cervical cancer -uterine in the alterations in the mental health of patients under 25 years in Ecuador. MATERIALS AND METHODS: The research was quantitative, descriptive, andcross-sectional. Surveys were used in a virtual way directed at patients under 25 years of age who suffer from cervical cancer in various Foundations that fight against cancer, with a sample of 178 women, these were divided into 4 categories: Mental health, Stress, Depression and Total stopovers. RESULTS: The percentage that was obtained in a general way had a varied range, 32.9% gave as a result that the alteration it causes in women is overwhelming, followed by 30.6 that their mental health condition is lower. CONCLUSION: It is concluded by stating that uterine cancer is the second most prevalent cancer in women, which progressively influences mental health, presenting negative reactions and perceptions, lack of control over emotions, consequently that weakens the previously compromised immune system, generating alterations in the course of treatment.

Early childhood traffic-related air pollution and risk of allergic rhinitis at 2-4 years of age modification by family stress and male gender: a case-control study in Shenyang, China

BACKGROUND@#Few studies have explored the modifications by family stress and male gender in the relationship between early exposure to traffic-related air pollution (TRAP) and allergic rhinitis (AR) risk in preschool children.@*METHODS@#We conducted a case-control study of 388 children aged 2-4 years in Shenyang, China. These children AR were diagnosed by clinicians. By using measured concentrations from monitoring stations, we estimated the exposures of particulate matter less than 10 μm in diameter (PM@*RESULTS@#The prevalence of AR in children aged 2-4 years (6.4%) was related to early TRAP exposure. With an IQR (20 μg/m@*CONCLUSIONS@#Family stress and male gender may increase the risk of AR in preschool children with early exposure to PM

Induction of brain injury and depression in rats by chronic unpredictable stress associated with the augmentation of nitrosative stress and apoptosis / Inducción de lesión cerebral y depresión en ratas por estrés crónico impredecible asociado con el aumento del estrés nitrosativo y la apoptosis

SUMMARY: Repeated stress is a risk factor for memory impairment and neurological abnormalities in both humans and animals. We sought to investigate the extent of (i) brain tissue injury; (ii) nitrosative and oxidative stress in brain tissue homogenates; (iii) apoptotic and survival biomarkers in brain tissue homogenates; and (iv) immobility and climbing abilities, induced over a period of three weeks by chronic unpredictable stress (CUS). Wistar rats were either left untreated (Control group) or exposed to a variety of unpredictable stressors daily before being sacrificed after 3 weeks (model group). Assessment of depression-like behavior was performed and animals were then culled and harvested brain tissues were stained with basic histological staining and examined under light microscopy. In addition, brain tissue homogenates were prepared and assayed for these parameters; inducible nitric oxide synthase (iNOS), malondialdehyde (MDA), superoxide dismutase (SOD), caspase-3, and B-cell lymphoma 2 (Bcl-2). Histology images showed CUS induced profound damage to the cerebral cortex as demonstrated by severe neuronal damage with shrunken cells, disrupted atrophic nuclei, perineuronal vacuolation and swollen glial cells. CUS also significantly (p<0.05) induced iNOS, MDA, and caspase-3, whereas SOD and Bcl-2 brain tissue levels were inhibited by CUS. In addition, data from the depression-like behavior, forced swimming test showed significant (p<0.05) increase in animal immobility and decrease in climbing ability in the model group of rats. Thus, here we demonstrated a reliable rat model of chronic stress-induced brain injury, which can further be used to investigate beneficial drugs or agents used for a period of three weeks to protect against CUS-induced brain damage.

RESUMEN: El estrés crónico es un factor de riesgo para el deterioro de la memoria y las anomalías neurológicas tanto en humanos como en animales. Intentamos investigar el alcance de lesión del tejido cerebral; (ii) estrés nitrosativo y oxidativo en homogeneizados de tejido cerebral; (iii) biomarcadores apoptóticos y de supervivencia en homogeneizados de tejido cerebral; y (iv) inmovilidad y habilidades de escalada, inducidas durante un período de tres semanas por estrés crónico impredecible (ECI). Se dejaron sin tratamiento (grupo control) ratas Wistar, o se expusieron a una variedad de factores estresantes impredecibles diariamente antes de ser sacrificadas después de 3 semanas (grupo modelo). Se realizó una evaluación del comportamiento similar a la depresión y luego se sacrificaron los animales y se tiñeron los tejidos cerebrales con tinción histológica básica y se examinaron con microscopía óptica. Además, se prepararon homogeneizados de tejido cerebral y se analizaron los siguientes parámetros; óxido nítrico sintasa inducible (iNOS), malondialdehído (MDA), superóxido dismutasa (SOD), caspasa- 3 y linfoma de células B 2 (Bcl-2). Las imágenes histológicas mostraron que el CUS indujo un daño profundo en la corteza cerebral como lo demuestra el daño neuronal severo con células encogidas, núcleos atróficos alterados, vacuolación perineuronal y células gliales inflamadas. ECI también indujo significativamente (p <0,05) iNOS, MDA y caspase-3, mientras que los niveles de tejido cerebral SOD y Bcl-2 fueron inhibidos por ECI. Además, los datos del comportamiento similar a la de- presión, la prueba de natación forzada mostró un aumento significativo (p <0,05) en la inmovilidad animal y una disminución en la capacidad de escalada en el grupo modelo de ratas. Por lo tanto, aquí demostramos un modelo confiable de daño cerebral crónico en rata inducido por el estrés, que se puede utilizar para investigar medicamentos o agentes beneficiosos usados durante un período de tres semanas para proteger el daño cerebral inducido por ECI.

Determinación social del malestar psicológico y el estrés en hombres que ejercen violencia familiar en la Ciudad de México / Social determinants of psychological distress and stress in men who perpetrate family violence in Mexico City

RESUMEN El objetivo es describir y analizar la determinación social del malestar psicológico y el estrés en dos grupos de hombres de la Ciudad de México que asistían a programas reeducativos por violencia familiar. Para ello, se realizó un estudio no experimental, transversal, descriptivo con metodología cualitativa y enfoque interpretativo, en el que se aplicó un cuestionario y se realizaron grupos focales. Los síntomas de estrés reportados fueron dolores musculares; insomnio y pesadillas; náuseas, dolor de estómago e indigestión; dolores de cabeza, mareos, irritabilidad o mal humor. Los principales problemas que podrían estar generando esta sintomatología serían la economía personal y familiar; la salud de ellos y sus familiares y los malestares mentales, entre otros aspectos. Existen diferencias relacionadas con las condiciones de vida y los efectos de la violencia doméstica. Los abordajes que solo consideran la masculinidad hegemónica o el género para el trabajo con varones en sus diferentes condiciones y problemáticas, sin considerar la desigualdad social y, en especial, las condiciones de vida, pueden ser insuficientes para explicar y modificar las causas de las afectaciones generadas y experimentadas por los varones.

ABSTRACT The social determinants of psychological distress and stress are described and analyzed in two groups of men attending reeducation programs for family violence in Mexico City. A non-experimental, descriptive, transversal study was conducted employing a qualitative methodology and an interpretive approach, in which questionnaires were utilized and focus groups were held. Symptoms of stress that were reported included muscle aches, insomnia and nightmares, headaches or dizziness, irritability or bad mood, nausea, stomach pain and indigestion. The principal issues that could be identified as the root of these symptoms included personal and family finances, their own health or that of their family members, and mental distress, among others. Differences with respect to living conditions and the effects of domestic violence were present. We argue that initiatives directed at men and their particular conditions and problems which are based on a hegemonic view of masculinity and gender are likely to be limited in their capacity to explain and modify the causes of situations generated by and experienced by men.

Work overload and risk behaviors in motorcyclists / Sobrecarga de trabajo y comportamientos de riesgo en motociclistas / Sobrecarga de trabalho e comportamentos de risco em motociclistas

ABSTRACT Objective: to analyze the association between work overload and risk behaviors adopted by motorcyclists. Method: a cross-sectional study of injured motorcycle drivers hospitalized at the Hospital da Restauração Governador Paulo Guerra in the city of Recife, PE, from May to September 2016. A questionnaire was applied containing sociodemographic variables related to work overload and risk behaviors adoption. Odds Ratio (OR) and 95% Confidence Interval were used to analyze the association between the variables. Results: there was a predominance of males (97.6%), mean age 31.44 years (SD = 9.50). There was an association of sleep/fatigue at the accident time with difficulties carrying out work tasks (OR = 3.7), feeling tired during work (OR = 4.6) and feeling under pressure to carry out work tasks (OR = 3.5). Conclusion: work overload was associated with risk behaviors adoption. It is believed that this fact can have an impact on the occurrence and severity of accidents.

RESUMEN Objetivo: analizar la asociación entre sobrecarga de trabajo y comportamiento de riesgo adoptado por los motociclistas. Método: El estudio transversal con trabajadores accidentados conductores de motocicletas, internados en el Hospital da Restauração Governador Paulo Guerra en Recife-PE, en el período de mayo a septiembre de 2016. Se aplicó un cuestionario que contenía variables sociodemográficas relacionadas con la sobrecarga de trabajo y la adopción de comportamientos de riesgo. Para el análisis de la asociación entre las variables, se utilizó el Odds Ratio (OR) y el Intervalo de Confianza del 95%. Resultados: se observó predominio del sexo masculino (97,6%), con media de edad 31,44 años (DE = 9,50). Se observó una asociación de sueño/fatiga en el momento del accidente con dificultades en realizar tareas de trabajo (OR = 3,7), sentirse cansado durante el trabajo (OR = 4,6) y sentirse presionado a realizar tareas de trabajo (OR = 3,7) OR = 3,5). Conclusión: la sobrecarga de trabajo se asoció a la adopción de comportamiento de riesgo. Se cree que tal hecho puede repercutir en la ocurrencia y gravedad de los accidentes.

RESUMO Objetivo: analisar a associação entre sobrecarga de trabalho e comportamento de risco adotado por motociclistas. Método: estudo transversal com trabalhadores acidentados condutores de motocicletas, internados no Hospital da Restauração Governador Paulo Guerra no Recife-PE, no período de maio a setembro de 2016. Aplicou-se um questionário contendo variáveis sociodemográficas relacionadas à sobrecarga de trabalho e adoção de comportamentos de risco. Para análise da associação entre as variáveis, utilizou-se Odds Ratio (OR) e Intervalo de Confiança de 95%. Resultados: observou-se predomínio do sexo masculino (97,6%), com média de idade 31,44 anos (DP = 9,50). Houve associação de sono/fadiga no momento do acidente com dificuldades em realizar tarefas de trabalho (OR = 3,7), sentir-se cansado durante o trabalho (OR = 4,6) e sentir-se pressionado a realizar tarefas de trabalho (OR = 3,5). Conclusão: a sobrecarga de trabalho associou-se à adoção de comportamento de risco. Acredita-se que tal fato pode repercutir na ocorrência e gravidade dos acidentes.

Correlação entre sintomas de disfunção temporomandibular, hábitos orais deletérios e sintomas de estresse em estudantes universitários / Correlation between temporomandibular dysfunction symptoms, deleterious oral habits and symptoms of stress in university students / Correlación entre síntomas de disfunción temporomandibular, hábitos orales deletéreos y síntomas de estrés en estudiantes universitarios

Objetivo: investigar os sintomas de disfunção temporomandibular, presença de hábitos orais deletérios e estresse em universitários dos cursos de Fonoaudiologia, Fisioterapia e Biomedicina dos períodos iniciais e finais de um Centro Universitário; comparar os resultados do período inicial em relação ao período final de cada curso; e verificar a correlação entre hábitos orais deletérios, idade, sexo, sintomas de disfunção temporomandibular e sintomas de estresse. Métodos: Questionários foram aplicados a uma amostra composta por 83 acadêmicos. Foram utilizados o Índice Anamnésico de Fonseca para investigação dos sintomas de disfunção temporomandibular; uma lista com hábitos orais deletérios; e, para avaliar o estresse, o Inventário de Sintomas de Stress para Adultos de Lipp. Os dados foram analisados com nível de significância de 5%. Resultados: Encontrou-se alta prevalência de sintomas de disfunção temporomandibular na amostra, sendo a maioria de grau leve. Houve associação com significância estatística entre apresentar sintomas de disfunção temporomandibular e os períodos finais dos cursos, apoiar objeto sob o queixo, morder os lábios e estresse. Houve associação do grau da disfunção temporomandibular com os períodos finais dos cursos, com os hábitos de ranger ou apertar os dentes, colocar a mão no queixo e morder a bochecha e com o número de hábitos praticados. O diagnóstico de estresse apresentou correlação com o período do curso. Conclusão: Os dados sugerem correlação positiva entre presença de sintomas de disfunção temporomandibular, hábitos orais deletérios e estresse em estudantes dos últimos períodos dos cursos da área de saúde.

Purpose: To investigate temporomandibular dysfunction symptoms, presence of deleterious oral habits and stress in college students of Speech-Language and Hearing Sciences, Physiotherapy and Biomedicine undergraduate courses from the first and last years of a University Center; compare the results of the first period and the final period of each course; and verify the correlation between deleterious oral habits, age, sex, temporomandibular dysfunction symptoms and stress symptoms. Methods: Questionnaires were administered to a sample composed by 83 undergraduate students. We used Fonseca's Anamnestic Index to evaluate temporomandibular dysfunction symptoms; a list with deleterious oral habits; and, to evaluate the stress, Lipp's Inventory of Symptoms of Stress for Adults. Data were analyzed with significance level of 5%. Results: There was a high prevalence of symptoms of temporomandibular dysfunction in the sample, most of which were mild. There was association with statistical significance between having symptoms of temporomandibular dysfunction and the final year of the courses, supporting object under the chin, lip biting and stress. There was association between the degree of temporomandibular dysfunction and the final year of the courses, the habits of clenching or grinding of the teeth, leaning of the head on the arm, cheek biting and the number of habits performed. The stress diagnosis was correlated with the undergraduate course year. Conclusion: Data suggest a positive correlation between the presence of symptoms of temporomandibular dysfunction, deleterious oral habits and stress in undergraduate students of the last years of health care courses.

Objetivo: Investigar los síntomas de disfunción temporomandibular, presencia de hábitos orales deletéreos y estrés en universitarios de los cursos de Fonoaudiología, Fisioterapia y Biomedicina de los períodos iniciales y finales de un Centro Universitario; comparar los hallazgos del período inicial con el período final de cada curso; y verificar la correlación entre hábitos orales nocivos, edad, sexo, síntomas de disfunción temporomandibular y síntomas de estrés. Métodos: Los cuestionarios fueron aplicados a una muestra compuesta por 83 académicos. Se utilizó el Índice Anamnésico de Fonseca para la investigación de los síntomas de disfunción temporomandibular; una lista con hábitos orales deletéreos; y para evaluar el estrés, el inventario de síntomas de estrés para adultos de Lipp. Los datos fueron analizados con un nivel de significancia del 5%. Resultados: Se encontró una alta prevalencia de síntomas de disfunción temporomandibular en la muestra, siendo la mayoría de grado leve. Se observó asociación con significancia estadística entre presentar síntomas de disfunción temporomandibular y los períodos finales de los cursos, apoyar el objeto bajo la barbilla, morder los labios y el estrés. Se asociado el grado de disfunción temporomandibular con los períodos finales de los cursos, con los hábitos de ranger o apretar los dientes, colocar la mano en la barbilla y morder la mejilla y el número de hábitos practicados. El diagnóstico de estrés presentó correlación con el período del curso. Conclusión: Los datos sugieren correlación positiva entre presencia de síntomas de disfunción temporomandibular, hábitos orales deletéreos y estrés en estudiantes de los últimos períodos de los cursos del área de salud.

Psychosocial risks related to the nurse in the psychiatric hospital and management strategies / Riesgos psicosociales relacionados al enfermero en un hospital psiquiátrico y estrategias de gestión / Riscos psicossociais relacionados ao enfermeiro no hospital psiquiátrico e estratégias de gerenciamento

ABSTRACT Objective: To characterize the presence of psychosocial risks related to the work of the nurse in a psychiatric hospital and the strategies for managing these risks. Methods: Qualitative, in which 25 nurses from a psychiatric hospital participated using semi-structured interviews from November 2014 to January 2015. Data analysis was performed using the thematic method. Results: The results showed psychosocial risks related to the work of psychiatric nurses, such as: insufficient academic training; lack of preparation and maintenance of equipment; poor relationship with colleagues; shortage of human resources and lack of capacity building; conflict between the demands of the home and work, as well as strategies for managing psychosocial risks such as family, cinema, music, reading, among others. Final considerations: This study should provoke the reflection of managers and future nurses regarding the working conditions in a psychiatric hospital and possible psychosocial risks to which they are exposed.

RESUMEN Objetivo: Identificar la presencia de riesgos psicosociales relacionados al trabajo del enfermero en un hospital psiquiátrico y las estrategias de gestión de esos riesgos. Métodos: Estudio cualitativo, del cual participaron 25 enfermeros de un hospital psiquiátrico, en el que se utilizaron entrevistas semiestructuradas en el período de noviembre de 2014 a enero de 2015. Se realizó el análisis de datos mediante el método temático. Resultados: Los resultados mostraron la existencia de problemas psicosociales relacionados al trabajo de los enfermeros psiquiátricos, como: la insuficiente formación académica; la falta de preparación y mantenimiento de equipos; la escasa relación con los compañeros de trabajo; la escasez de recursos humanos y falta de capacitación; y el conflicto entre las exigencias del hogar y del trabajo, así como las estrategias de gestión de los riesgos psicosociales como recurrir a la familia, cine, música, lectura, entre otros. Consideraciones finales: Este estudio permite provocar la reflexión de los gestores y futuros enfermeros sobre las condiciones laborales en el hospital psiquiátrico y los posibles riesgos psicosociales a los que están expuestos.

RESUMO Objetivo: Caracterizar a presença de riscos psicossociais relacionados ao trabalho do enfermeiro em um hospital psiquiátrico e as estratégias de gerenciamento desses riscos. Métodos: Pesquisa qualitativa, realizada no período de novembro de 2014 a janeiro de 2015, da qual participaram 25 enfermeiros de um hospital psiquiátrico, que responderam a entrevistas semiestruturadas. A análise dos dados foi realizada pelo método temático. Resultados: Os resultados mostraram problemas psicossociais relacionados ao trabalho dos enfermeiros psiquiátricos, como formação acadêmica insuficiente; falta de preparo e manutenção de equipamentos; pobre relacionamento com colegas; escassez de recursos humanos e falta de capacitação; e conflito entre exigências do lar, do trabalho e estratégias de gerenciamento dos riscos psicossociais, como recorrer à família, ao cinema, à música, à leitura etc. Considerações finais: Este estudo deve provocar a reflexão dos gestores e futuros enfermeiros quanto às condições de trabalho em hospital psiquiátrico e aos riscos psicossociais a que podem estar expostos.

Psycho social risks noted by oncology workers related to their quality of life / Riscos psicossociais identificados por profissionais de oncologia associados à sua qualidade de vida / Riesgos psicosociales percibidos por trabajadores oncológicos asociados a su calidad de vida

ABSTRACT Objective: To analyze the relation between occupational psychosocial risks and quality of life related to health, felt by workers who work in oncology and palliative care units in a region of Chile. Method: Cross-sectional analytical study of quantitative approach, in which 110 health workers participated. Research met the ethical requirements of E. Emanuel. Results: Participants perceive greater exposure to psychosocial risks in the dimension of psychological demands and double presence. On the other hand, they see better results in the physical health component (��: 76.72; SD 9.75) versus the mental health component (��: 71.13; SD 6.38). In addition, there are relations with statistical significance, between psychosocial risks and quality of life related to Health (p≤0.05). Conclusions: This study shows that there the perception of psychosocial risks and quality of life are related, when considering the health of workers.

RESUMO Objetivo: Analisar a relação entre os riscos psicossociais do trabalho e a qualidade de vida relacionada à saúde, identificada por profissionais que atuam em unidades de oncologia e cuidados paliativos em uma região do Chile. Método: Estudo analítico transversal, de abordagem quantitativa, em que participaram 110 profissionais da Saúde. A pesquisa atendeu os requisitos éticos de E. Emanuel. Resultados: Os participantes identificam uma maior exposição a riscos psicossociais na dimensão de demandas psicológicas e presença dupla; por outro lado, notam melhores resultados no componente da saúde física (��: 76,72; DE 9,75) versus o componente da saúde mental (��:71,13; DE:6,38). Além disso, há conexão, com estatísticas significantes, entre os riscos psicossociais e a qualidade de vida relacionada à Saúde (p ≤0,05). Conclusões: O presente estudo permite afirmar que há uma conexão entre a percepção de riscos psicossociais e a qualidade de vida relacionada com a saúde dos profissionais.

RESUMEN Objetivo: analizar la relación entre riesgos psicosociales laborales y calidad de vida relacionada con salud, percibida por trabajadores que se desempeñan en unidades de oncología y cuidados paliativos de una región de Chile. Método: estudio analítico transversal de abordaje cuantitativo, en el cual participaron 110 trabajadores de salud. La investigación cumplió con los requisitos éticos de E. Emanuel. Resultados: los participantes perciben mayor exposición a riesgos psicosociales en la dimensión demandas psicológicas y doble presencia, por otra parte, perciben mejores resultados en el componente de salud física (��: 76,72; DE 9,75) versus el componente de salud mental (��:71,13; DE:6,38). Además, existen relaciones con significancia estadística, entre riesgos psicosocial y calidad de vida relacionada con Salud (p ≤0,05). Conclusiones: este estudio permite afirmar que hay una relación entre la percepción de riesgo psicosocial y calidad de vida relacionada con salud de los trabajadores.

Stress-induced hashitoxicosis: case report and relative HLA serotype and genotype

SUMMARY OBJECTIVE Even though stress has been long known as a provocative factor for Graves' disease, its relationship with Hashimoto's thyroiditis is more controversial. Studies on this topic are scanty. This paper aims to report a case of stress-induced Hashitoxicosis. RESULTS Here we report a case of Hashitoxicosis induced by a psychological stressful event in a 28-year-old woman with Hashimoto's thyroiditis. She had remained stably euthyroid for 12 years. She was first observed in April 2016, while euthyroid. She came back after 11 months because of fatigue and palpitations, in the absence of neck pain. Thyroid function tests revealed moderate thyrotoxicosis (undetectable TSH; FT4 36.94 pmol/L, normal values 9.0-24.46; FT3 13.50 pmol/L, normal values 3.07-6.14) with negative TSH-receptor antibodies. In the previous three months, she had experienced a psychological stressful event. Inflammatory markers were negative, and the white cell count was normal. Thyroid ultrasound revealed a modest increase in vascularization. Transient subclinical hypothyroidism ensued after seven weeks and spontaneously recovered. On the last visit, the patient was still on euthyroidism. (TSH 1.01 mU/L; FT4 9.22 pmol/L; FT3 3.98 pmol/L). We also performed HLA serotyping and genotyping. CONCLUSION This case demonstrates that, similarly to Graves' disease, Hashitoxicosis can also be triggered by stressful life events.

RESUMO OBJETIVO Mesmo que o estresse seja conhecido há muito tempo como um fator provocativo para a doença de Graves, sua relação com a tireoidite de Hashimoto é mais controversa. Estudos sobre esse tema são escassos. O objetivo deste artigo é relatar um caso de Hashitoxicose induzida por estresse. RESULTADOS Aqui nós relatamos um caso de Hashitoxicose induzido por um evento psicológico estressante em uma mulher de 28 anos com tireoidite de Hashimoto. Ela permaneceu estável eutireoidiana por 12 anos. Ela veio a nossa observação pela primeira vez em abril de 2016, enquanto eutireoidiana. Voltou após 11 meses por causa de fadiga e palpitações, na ausência de dor no pescoço. Testes de função tireoidiana revelaram uma tireotoxicose moderada (TSH indetectável; T4F 36,94 pmol/L, valores normais 9,0-24,46; FT3 13,50 pmol/L, valores normais 3,07-6,14) com anticorpos negativos para o receptor de TSH. Nos últimos três meses ela experimentou um evento psicológico estressante. Os marcadores inflamatórios foram negativos e a contagem de leucócitos foi normal. A ultrassonografia da tireoide revelou um aumento modesto da vascularização. Hipotireoidismo subclínico transitório ocorreu após sete semanas e se recuperou espontaneamente. Na última visita, a paciente ainda estava em eutireoidismo. (TSH 1,01 mU/L; FT4 9,22 pmol/L; FT3 3,98 pmol/L). Também realizamos a sorotipagem e a genotipização do HLA. CONCLUSÃO Este caso demonstra que, similarmente à doença de Graves, também a Hashitoxicose pode ser desencadeada por eventos estressantes da vida.

Intervenção baseada em Mindfulness para redução do estresse percebido, depressão e ansiedade em trabalhadores de uma universidade pública: ensaio clínico randomizado / Mindfulness-based intervention for reducing perceived stress, depression and anxiety among workers in a public university: randomized clinical trial

Introdução. Práticas baseadas em Mindfulness têm apresentado resultados promissores para saúde mental e mudanças positivas no contexto laboral. Objetivo. Determinar se a intervenção de práticas baseadas em Mindfulness aplicada por oito semanas é capaz de diminuir os níveis de estresse percebido, depressão, ansiedade e burnout, e aumentar o nível de atenção plena em uma amostra de trabalhadores técnico-administrativos de uma universidade pública. Método. O estudo contou com duas etapas. A primeira trata-se de um estudo analítico de corte transversal, e a segunda de um ensaio clínico controlado randomizado. Realizado em unidades de ensino e setores administrativos do campus da Universidade de São Paulo de Ribeirão Preto, com trabalhadores da categoria técnico-administrativa. Participaram da primeira etapa 929 sujeitos. Realizada regressão linear logística múltipla em modelo ajustado e não ajustado para os escores de estresse percebido, com intervalo de confiança de 95%. Na segunda etapa participaram 60 sujeitos, randomizados para um grupo que recebeu uma intervenção com práticas baseadas em Mindfulness por oito semanas (Programa Mindfulness) (Grupo Experimental [GE]: 30 participantes) e outro que não recebeu nenhuma intervenção (Grupo Controle [GC]: 30 participantes). O principal desfecho avaliado foi o estresse percebido por meio da Escala de Estresse Percebido (PSS14). Os desfechos secundários foram: depressão pelo Inventário de Depressão de Beck (BDI-II), ansiedade pelo Inventário Ansiedade de Beck (BAI), burnout pela escala Maslach Burnout Inventory-General Survey (MBI-GS) e atenção plena pelo Questionário das Cinco Facetas de Mindfulness (FFMQ-BR). Todos avaliados antes (T0) e após a intervenção (T1). Realizada análise descritiva, teste do Qui-quadrado de Pearson e teste Exato de Fisher para comparar distribuições das variáveis entre GE e GC, teste de Mann-Whitney para avaliar mudanças intergrupos entre T0 e T1. Adotado critério de significância de 0,05 em todas as análises. Ensaio clínico registrado sob o número UTN: U1111-1179-7619. Resultados. Na primeira etapa, dentre as variáveis que isoladamente se associaram ao escore do estresse percebido, cinco permaneceram preditoras no modelo ajustado: idade (p<0,001), ser do sexo masculino (p<0,001), ocupar cargo de nível técnico (p=0,013) quando comparado ao nível básico, e o escores de depressão (p<0,001) e ansiedade (p<0,001). O modelo ajustado explicou 57,9% da variação dos dados da Escala de Estresse Percebido. Na segunda etapa, o GE apresentou redução dos escores médios de estresse percebido (p<0,001), depressão (p<0,001), ansiedade (p=0,003) e aumento do escore médio total de atenção plena (p=0,012) e em duas facetas da escala (3-observar: p=0,010 e 6-não reagir à experiência interna: p=0,002), quando comparado ao GC. O mesmo efeito pós-intervenção não foi observado para burnout em escore total (p=0,314) e em nenhuma das dimensões da escala (Exaustão Emocional: p=0,083; Cinismo: p=0,736 e Eficácia no Trabalho: p=0,486). Conclusões. Os resultados da primeira etapa contribuem para a compreensão dos principais preditores do estresse percebido em uma amostra de trabalhadores técnico-administrativos de uma instituição pública de ensino superior. Na segunda etapa, os resultados demonstram que o Programa Mindfulness resultou na diminuição do estresse percebido, depressão, ansiedade e aumento da atenção plena, constatando o potencial benéfico da intervenção para uma amostra não clínica de trabalhadores

Introduction. Mindfulness-based practices have showing promising results for mental health and positive changes at workplace context. Objective. Determinate that Mindfulness-based practice intervention applied for eight weeks is able to decrease the levels of perceived stress, depression, anxiety and burnout, and increase the level of mindfulness in a sample of technicaladministrative workers from a public university. Method. The study had two fases. The first is a cross-sectional study, and the second is a randomized clinical trial. It was carried out in teaching and administrative sectors at the University of São Paulo campus of Ribeirão Preto, with technical-administrative workers. A total of 929 subjects participated in first stage. Multiple logistic linear regression performed in an adjusted and not adjusted model for perceived stress scores, with the confidence interval at 95%. In the second fase, 60 subjects were randomized to a group that received a Mindfulness-based practices intervention for eight weeks (Mindfulness Program) (Experimental Group [EG]: 30 participants) and to a group that received no intervention (Control Group [CG]: 30 participants). The main outcome evaluated was perceived stress, through the Perceived Stress Scale (PSS14). The secondary outcomes were depression by Beck Depression Inventory (BDI-II), anxiety by Beck Anxiety Inventory (BAI), burnout by Maslach Burnout Inventory - General Survey (MBI-GS), and Mindfulness by Five Facet Mindfulness Questionnaire (FFMQ-BR). Outcomes were assessed before (T0) and after the intervention (T1). Descriptive analysis, Pearson's Chi-square test and Fisher's exact test were performed to compare distributions of the variables between EG and CG groups. Mann-Whitney test performed to evaluate intergroup changes between T0 and T1. We adopted a significance criteria of 0.05 in all analyzes. Clinical trial registered under the number UTN: U1111-1179-7619. Results. In the first fase, five variables were individually associated with the perceived stress score, remaining predictors in the adjusted model: age (p <0.001), being male (p <0.001), occupying a technical level position (p = 0.013) when compared to basic level position and depression (p <0.001) and anxiety scores (p <0.001). The adjusted model explained 57.9% of the variation in the Perceived Stress Scale. At the second stage, the EG presented a reduction in the mean scores for perceived stress (p<0.001), depression (p<0.001) and anxiety (p=0.003), and increased the total mean score for Mindfulness (p=0.012) and at the facet 3observe p=0.010 and facet 6-do not react to internal experience: p=0.002, when compared to CG. The same post-intervention effect was not observed for burnout at the total score (p=0.314) and in none of the dimensions of the scale (Emotional Exhaustion: p=0.083; Cynicism: p=0.736 and Work Efficacy: p=.486). Conclusions. The results obtained in the first fase contribute to understand the main predictors of perceived stress in a sample of technical-administrative workers in a higher education public institution. In the second fase, the results show that Mindfulness Program resulted in reduction of perceived stress, depression, anxiety and increased Mindfulness, noting the beneficial potential of the intervention for a non-clinical sample of workers

Bruxismo do sono: estudo de base populacional em pessoas com 18 anos ou mais na cidade de Rio Grande, Rio Grande do Sul / Sleep bruxism: population based study in people with 18 years or more in the city of Rio Grande, Brazil

RESUMO: Objetivos: Avaliar a prevalência do bruxismo do sono, bem como seus principais sinais e sintomas, na cidade de Rio Grande, Rio Grande do Sul. Avaliar a associação do bruxismo do sono com sexo, idade, escolaridade e estresse psicológico. Método: O estudo foi do tipo transversal. Uma amostra representativa da população (1.280 pessoas residentes na zona urbana da cidade com idade maior ou igual a 18 anos de idade) foi entrevistada. A avaliação do bruxismo do sono foi realizada por meio de questionário baseado nos critérios diagnósticos da Classificação Internacional de Distúrbios do Sono. Resultados: A prevalência de bruxismo do sono encontrada na população foi de 8,1% (intervalo de confiança de 95% - IC95% - 6,6 - 9,5). Entre os sinais e sintomas da disfunção utilizados para o diagnóstico de bruxismo do sono, o desgaste dentário (70,3%) e a dor nos músculos mastigatórios (44,5%) foram os mais frequentemente relatados pelas pessoas que declararam ranger os dentes durante o sono. Não houve diferença significativa na prevalência de bruxismo do sono entre os sexos. A faixa etária com mais de 40 anos teve maior prevalência de bruxismo do sono. A disfunção foi associada a um maior nível de escolaridade (razão de prevalência - RP = 1,92; IC95% 1,35 - 2,72) e de estresse psicológico (RP = 1,76; IC95% 1,11 - 2,81). Conclusão: O bruxismo do sono tem uma importante prevalência na população em geral, causando diversos danos ao sistema estomatognático. O estresse psicológico é um fator de risco para essa disfunção.

ABSTRACT: Objective: To evaluate the prevalence of sleep bruxism, as well as its principal signs and symptoms, in the city of Rio Grande. Evaluate the association of sleep bruxism with gender, age, education and psychological stress. Method: The study was cross-sectional type. A representative sample of the population (1280 people residing in the urban area of the city aged greater than or equal to 18 years old) were interviewed. The evaluation of sleep bruxism was by mean of questionnaire based on diagnostic criteria of the International Classification of Sleep Disorders. Results: The prevalence of sleep bruxism found in the population was 8,1% (confidence interval of 95% - 95%CI - 6,6 - 9,5). Among the signs and symptoms of dysfunction used for the diagnosis of sleep bruxism, tooth wear (70,3%) and pain in masticatory muscles (44,5%) were the most frequently reported by people who report teeth grinding during sleep. There was no significant difference in the prevalence of sleep bruxism between sexes. People older than 40 had a higher prevalence of sleep bruxism. The dysfunction was associated with a higher level of education (prevalence ratio - PR = 1.92; 95%CI 1,35 - 2,72) and psychological stress (PR 1,76; 95%CI 1,11 - 2,81). Conclusion: There was a significant prevalence of sleep bruxism in the general population, causing various damages to the Stomatognathic system. The psychological stress is a risk factor for this dysfunction.

Estrés psicológico y síndrome metabólico / Longitudinal association between chronic psychological stress and metabolic syndrome

Background: Psychological stress and depressive symptoms are variables associated with metabolic syndrome (MetS). Aim: To determine the longitudinal association between psychological stress, depressive symptoms and MetS, and whether these variables predict MetS and its component trajectories. Material and Methods: Four hundred and twenty-three participants aged 44 ± 9 years (59% women), free of cardiovascular disease at baseline were enrolled into the Chilean study of psychological stress, obesity and MetS. Participants were followed-up for three years (three waves). Each year, they completed psychological questionnaires, anthropometric variables were measured, and blood samples were obtained. Results: Hierarchical linear regression showed that chronic psychological stress at baseline predicted the total number of MetS components (MetS score) during the third assessment wave (β = 0.147; p < 0.01). Growth curve modeling allowed to determine that participants who scored +1 standard deviation (SD) at baseline over the mean in psychological stress (βchronic stress = 0.903; 95% confidence intervals (CI) = 0.065; 1.741), and depressive symptoms (βdepressive symptoms = 2.482; 95% CI = 0.040; 4.923) had a higher waist circumference trajectory, as compared to those scoring −1 SD above the mean. Conclusions: Chronic psychological stress is longitudinally associated with the MetS score. Further, psychological stress and depressive symptoms at baseline predicted elevated MetS score trajectories, and a highest waist circumference.

Estudio Transversal: Prevalencia del Estrés Académico en Estudiantes de Medicina, Asociado al Rendimiento Académico, Universidad de Cuenca, Cuenca ­ Ecuador, 2015 / Cross-Section Research: Prevalence of Academic Stress in Medicine Students, Associated with Academic Performance, University of Cuenca, Cuenca - Ecuador, 2015

INTRODUCCIÓN: El estrés académico es la respuesta ante las demandas de la institución académica, se cree que el nivel de estrés influye de manera directa sobre el académico de forma positiva o negativo. El objetivo del estudio fue determinar la prevalencia de estrés académico y su asociación con el rendimiento escolar de los estudiantes de medicina. MÉTODO: Se realizó un estudio transversal, el universo estuvo conformado por 1 060 alumnos, desde primero hasta décimo ciclo en el año 2015, de los cuales se tomó una muestra de 285 alumnos, de forma aleatoria y se aplicó el inventario SISCO de Estrés Académico (modificado). El rendimiento académico se determinó por el promedio del último año cursado. Para el análisis de los datos se utilizó Microsoft Excel V15.0 y el servidor SPSS Statistics V 15.0. La asociación estadística se obtuvo con pruebas de Chi2 entre el nivel de estrés académico y el promedio. RESULTADOS: El 91.58 % de los estudiantes refirieron cierto grado de estrés académico; 46.7 % moderada intensidad y un 36.48 % percibieron un nivel de alta intensidad. La prevalencia de estrés académico en mujeres (95.45 %), fue mayor al sexo masculino (85 %). Se demostró que no existe una asociación significativa entre el estrés académico y el rendimiento académico. CONCLUSIONES: La prevalencia de estrés académico en los estudiantes es alta y no existe asociación con el rendimiento académico, afectando mayoritariamente al sexo femenino. Sería importante realizar un estudio sobre la forma en que los estudiantes afrontan el estrés académico.

BACKGROUND: Academic stress is the answer at the demands of the academic institution. It is believed that the level of stress affects directly in the academic performance in positive or negative ways. The objective of the study was to determine the prevalence of academic stress and the association on the academic performance of medical students. METHODS: It is a cross-sectional study. The universe was performed of 1 060 students, from the first to the tenth cycle in 2015, the sample was taken of 285 students; randomized and It was applied the SISCO Inventory of Academic (modified). The academic performance was determined by the average of the last year studied. Microsoft Excel V15.0 and SPSS Statistics V 15.0 server were used to analyze the data. The statistical association was obtained with Chi2 tests between the level of academic stress and the average. RESULTS: The 91.58 % of the students reported a certain degree of academic stress; 46.7 % moderate intensity and 36.48 % perceived a high intensity level. The prevalence of academic stress in women (95.45 %) was higher than the man (85 %). It was shown that academic stress is not significantly associated with academic performance. CONCLUSIONS: The prevalence of academic stress in students is high and It is not significantly associated with academic performance, affecting mainly the women. It would be important to conduct a study on how students deal with academic stress.

Síndrome de Takotsubo e o uso do InterTAK Diagnostic Score no diagnóstico diferencial com a síndrome coronariana aguda: relato de um caso / Takotsubo syndrome and the use of InterTAK Diagnostic Score in the differential diagnosis of acute coronary syndrome: a case report

A Cardiomiopatia de Takotsubo (CT) é uma síndrome cardíaca caracterizada por quadro clínico compatível com síndrome coronariana aguda (SCA), com alterações eletrocardiográficas, aumento de enzimas cardíacas e anormalidades na contratilidade ventricular, geralmente associada a artérias coronárias livres de obstruções ou espasmos significativos à cineangiocoronariografia. Por apresentar curso clínico semelhante ao do infarto agudo do miocárdio, muitas vezes é abordada como tal. O presente trabalho busca, ao relatar um caso clássico de CT, destacar a importância da realização do diagnóstico diferencial entre a CT e a SCA, usando como ferramenta o InterTAK Diagnostic Score. (AU)

Takotsubo cardiomyopathy (TC) is a cardiac syndrome characterized by clinical symptoms compatible with acute coronary syndrome (ACS), including electrocardiographic changes, increased cardiac enzymes, and ventricular wall motion abnormalities, usually associated with absence of obstructive coronary artery disease or significant spasms at coronary angiography. Because its clinical course is similar to that of acute myocardial infarction, TC is often treated as such. The present paper reports a classic case of TC seeking to highlight the importance of performing a differential diagnosis between TC and ACS, using a tool named InterTAK Diagnostic Score. (AU)

Indicators of burnout in Primary Health Care workers / Indicadores de agotamiento profesional en trabajadores de la Atención Primaria de Salud / Indicadores de esgotamento profissional em trabalhadores da Atenção Primária à Saúde

ABSTRACT Objective: to analyze the indicators of burnout peculiar to health workers from units of Primary Health Care. Method: integrative review of the literature structured in the stages: guiding question; search; categorization of studies; assessment; discussion; and interpretation of results, and synthesis of knowledge. Search for original articles and reviews published from 2000 to 2016, in Portuguese, English and Spanish, in the main databases of the health area. Descriptors used: Nursing, Burnout and Primary Health Care. Results: 14 articles met the proposed inclusion criteria, six (42.85%) presented a sample of nurses and eight (57.15%) health professionals. Conclusion: Primary Health Care workers are exhausted due to inadequate working conditions characterized by the lack of human and physical resources that leads to work overload, workplace violence and difficulty with teamwork, despite being satisfied with the work environment.

RESUMEN Objetivo: analizar los indicadores de agotamiento profesional peculiares a los trabajadores de la salud de unidades de la Atención Primaria de Salud. Método: la revisión integrativa de la literatura fue estructurada en las etapas: cuestión orientadora; buscar; categorización de los estudios; evaluación; discusión; e interpretación de los resultados y síntesis del conocimiento. Busca artículos originales y revisiones publicadas desde 2000 hasta 2016, en portugués, Inglés y Español, las principales bases de la salud. Descriptores usados: Enfermería, Agotamiento Profesional y Atención Primaria de Salud. Resultados: 14 artículos atendieron a los criterios de inclusión propuestos, seis (42,85%) presentan muestra de enfermeros y ocho (57,15%) profesionales de la salud. Conclusión: los trabajadores de la salud de la Atención Primaria de Salud se encuentran agotados debido a las inadecuadas condiciones de trabajo caracterizadas por escasez de recursos humanos y físicos que llevan a la sobrecarga de trabajo, a la violencia en el ambiente de trabajo y dificultad en el trabajo en equipo, presentarse satisfechos con el entorno de trabajo.

RESUMO Objetivo: analisar os indicadores de esgotamento profissional peculiares aos trabalhadores de saúde de unidades da Atenção Primária à Saúde. Método: revisão integrativa da literatura estruturada nas etapas: questão norteadora; busca; categorização dos estudos; avaliação; discussão; e interpretação dos resultados e síntese do conhecimento. Busca a artigos originais e revisões publicadas de 2000 a 2016, em português, inglês e espanhol, nas principais bases da área da saúde. Descritores usados: Enfermagem, Esgotamento Profissional e Atenção Primária à Saúde. Resultados: 14 artigos atenderam aos critérios de inclusão propostos, seis (42,85%) apresentam amostra de enfermeiros e oito (57,15%) profissionais da saúde. Conclusão: os trabalhadores de saúde da Atenção Primária à Saúde apresentam-se esgotados, devido às inadequadas condições de trabalho caracterizadas por escassez de recursos humanos e físicos que leva a sobrecarga de trabalho, a violência no ambiente de trabalho e dificuldade no trabalho em equipe, apesar de apresentarem satisfeitos com o ambiente de trabalho.

Impact of stressful life events on central adiposity in the Pelotas Birth Cohort

ABSTRACT OBJECTIVE: To investigate how stressful life events and social support relate to central adiposity in Southern Brazil. METHODS: Data included information from 802 participants in the 1982 Pelotas Birth Cohort that was collect in 2004-2005 and 2006. Stratifying by sex, we studied self-reported stressful life events during the year before 2004-2005 in relation to change in waist circumference between 2004-2005 and 2006 and waist-to-hip ratio in 2006, using both bivariate and multivariate linear regression models. RESULTS: In adjusted models, the experience of stressful life events during the year before 2004-2005 predicted a change in waist circumference in 2006 in men and a change in both waist-to-hip ratio in 2006 and waist circumference between 2004-2005 and 2006 in women. Men who experienced two or more stressful events had on average a one centimeter increase in their waist circumference between 2004-2005 and 2006 (β = 0.97, 95%CI 0.02-1.92), compared to those reporting no stressful events. For women, those who had one and those who had two or more stressful life events had over a 1 cm increase in their waist circumference from 2004-2005 to 2006 (β = 1.37, 95%CI 0.17-2.54; β = 1.26, 95%CI 0.11-2.40, respectively), compared to those who did not experience any stressful event. For both sexes, social support level was not significantly related to either waist-to-hip ratio or change in waist circumference, and it did not modify the association between stress and central adiposity. CONCLUSIONS: The experience of more than one stressful life event was associated with distinct indicators of central adiposity for men versus women.