Personality changes and return to work after severe traumatic brain injury: a prospective study

Objective: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. Methods: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. Results: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). Conclusions: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition. .

Personality changes and return to work after severe traumatic brain injury: a prospective study.

OBJECTIVE: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. METHODS: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. RESULTS: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). CONCLUSIONS: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition.

Limited predictive power of hospitalization variables for long-term cognitive prognosis in adult patients with severe traumatic brain injury.

OBJECTIVES: Traumatic brain injury (TBI) is a main cause of mortality and morbidity. Association studies between hospitalization variables and cognitive impairment after TBI are frequently retrospective, including non-consecutive patients showing variable degrees of TBI severity, and poor management of missing (drop out) cases. METHODS: We assessed prospectively the demographic and hospitalization variables of 234 consecutive patients with severe TBI (admission Glasgow Coma Scale [GCS] ≤8) and determined their independent association with cognitive performance in a representative sample (n = 46) of surviving patients (n = 172) evaluated 3 (±1.8) years after hospitalization. RESULTS: In all, 85% of patients were male and the mean age was 34 (SD ±13) years. The education level was 9 (±4.7) years. As expected, education and age showed a moderately to strong linear relationship with the cognitive performance in 14 of 15 neuropsychological tests (R coefficient = 0.6-0.8). The cognitive test scores were not independently associated with gender, admission GCS, associated trauma, and Marshal CT classification. Admission-elevated blood glucose levels and the presence of sub-arachnoid haemorrhage were independently associated with lower scores on Rey Auditory Verbal Learning retention and Logical Memory-I tests, respectively. CONCLUSIONS: After correction for education and age distribution, the variables that are commonly associated with mortality or Glasgow Outcome Scale including admission pupils' examination, Marshal CT Classification, GCS, and serum glucose showed a limited predictive power for long-term cognitive prognosis. Identification of clinical, radiological, and laboratory variables as well as new biomarkers independently associated with cognitive outcome remains an important challenge for further work involving severe TBI patients.

Indicativos para o dimensionamento de pessoal de enfermagem em emergência / Indicators for the measurement of emergency nursing personnel / Indicativos para el dimensionamiento de personal de enfermería en urgencia

Trata-se de um estudo exploratório-descritivo qualitativo, com o objetivo de levantar indicativos para o dimensionamento de pessoal de enfermagem em serviços de emergência. Os dados foram coletados utilizando-se observação do trabalho de enfermagem e entrevista semiestruturada com enfermeiros, sendo analisados à luz da teoria do processo de trabalho, originando as categorias: processo de trabalho e dimensionamento de pessoal de enfermagem e indicativos para o dimensionamento de pessoal de enfermagem em emergência. O estudo aponta indicativos quantitativos e qualitativos para subsidiar o dimensionamento de pessoal, entre os quais, a necessidade de se avaliar a organização do trabalho, o grau de cuidado dos usuários para além dos aspectos biológicos e a própria característica do serviço de emergência, que congrega internação e atendimento das urgências.

This exploratory-descriptive study was performed with a qualitative approach, aiming at finding indicators for the measurement of nursing personnel in adult emergency services. Data were collected using nursing work observation and a semi-structured interview with nurses; data were analyzed based upon the theory of working process, originating the following categories: working process and nursing personnel measurement, and indicators for the measurement of nursing personnel in emergency. The study presents both quantitative and qualitative indicators to ground personnel measurement, amongst which the need to evaluate the working organization, the degree of users' care besides biological aspects and the emergency service characteristic itself, which encompasses hospitalization and urgency care.

Estudio exploratorio-descriptivo con abordaje cualitativa, con el objetivo de obtener indicativos para el dimensionamiento de personal de enfermería en urgencia adulto. Los datos fueron colectados utilizando-se la observación del trabajo de enfermería y entrevista semiestructurada con enfermeros, y analizados de acuerdo con la teoría del trabajo, originando las categorías: proceso de trabajo y dimensionamiento de personal de enfermería, e indicativos para el dimensionamiento de personal de enfermería en urgencia. Apunta indicativos cuantitativos y cualitativos para subsidiar el dimensionamiento de personal, entre los cuales la necesidad de evaluarse la organización del trabajo, el grado de cuidado de los usuarios bien como de los aspectos biológicos e la propia característica del servicio de urgencia, que congrega internación y atendimiento de las urgencias.

Mercosul educativo na carreira de Enfermagem / Educational Mercosur in the Nursing career / Mercosur educativo en la carrera de Enfermeria

O Mercosul, instituído com vistas à integração econômica, política, social e cultural entre os países membros, atualmente destaca-se pelas estratégias integrativas de âmbito educacional. Este artigo aborda os movimentos acerca da formação acadêmica dos cursos de Enfermagem e o trajeto histórico de integração educacional, apresentando o Sistema de Acreditação dos Cursos Universitários do Mercosul, o ARCU-SUL, além dos setores responsáveis por esse processo e as perspectivas para a Enfermagem nos países do Mercosul. Entendemos que para o desenvolvimento de profissionais críticos, reflexivos e com compromisso político-social, é fundamental investir na formação e na qualidade dos centros de ensino em Enfermagem.

The Mercosul, established with the objective of integrate economics, political, social and cultural differences among member countries, currently is highlighted by its strategies of educational framework. This article discusses the movement on the academic background of the Nursing career and the history of educational integration, presenting the accreditation system for university courses of Mercosul, the Arcu-Sul, and also the sectors responsible for this process and the prospects for Nursing in Mercosul. We believe that for the development of a critic, reflective and social-political committed professional is essential to invest in training and in the quality of education centers in Nursing.

El Mercosur, establecido con miras a la integración económica, el intercambio político, social y cultural entre los países miembros, actualmente se destaca por las estrategias del marco educativo. Este artículo aborda el movimiento en la formación académica de la carrera de Enfermería y el récord del campo de la integración educativa, al presentar el sistema de acreditación de carreras universitarias del Mercosur, el Arcu-Sur, y los sectores responsables de este proceso y las perspectivas para la Enfermería en el Mercosur. Creemos que para el desarrollo de profesionales críticos, reflexivos y con el compromiso social-político es esencial invertir en la formación y en la calidad de los centros de educación en enfermería.

Instrumento para classificação do grau de dependência de usuários: um estudo para contribuir no dimensionamento de pessoal

Pesquisa que visa a testar instrumento de classificação de usuários, adaptada do modelo de Fugulin et al. (2005) e ampliada com a inclusão dos itens: regulação hormonal; educação em saúde/comunicação; sono/repouso; segurança emocional; percepção dos órgãos dos sentidos; e família/acompanhante ou gregária. Foi aplicada em unidades de internação pelo período de dois meses e apontou: necessidade de aprimorar os subitens avaliados, explicitando cada necessidade, e distribuição de cinco graus de avaliação: mínimo, intermediário, alta dependência, semi-intensivo e intensivo. A proposta mostrou-se adequada à avaliação do fazer da enfermagem, contribuindo no estudo da carga de trabalho para o dimensionamento do pessoal de enfermagem...

This research aims to test users’ classification instrument, adapted from the model Fugulin et al (2005), and expanded with the inclusion of the items: hormonal regulation, health education/communication, sleep/rest, emotional security, perception of senses organs, and family/caregivers or gregarious. It was applied at internment units for a period of two months and pointed out: the need to improve the sub items, explained each assessed need, distribution of five degrees of evaluation: minimum, intermediate, high dependency, intensive and semi-intensive. The proposal proved to be suitable for assessment of the nursing activity, contributing to the evaluation of the workload for the dimensioning of nursing staff...

Se trata de una investigación que tiene por objectivo testar instrumento de clasificación de usuarios, adaptado del modelo de Fugulin et al (2005), y ampliado con inclusión de los aspectos: regulación hormonal, educación en salud/comunicación; sueno/repuso; aseguranza emocional; percepción de los órganos de los sentidos; y familia/acompañante o gregario. Se aplicó a las unidades de hospitalización por un período de dos meses e apunto: necesidad de mejorar los subitens evaluados explicitando cada necesidad, distribución de cinco grados de evaluación: mínimo, intermediario, alta dependencia, semiintensivo e intensivo. La propuesta consistía en una evaluación adecuada de la enfermería, lo que contribuye a la evaluación de la carga de trabajo para el cálculo del personal de enfermería...

Psychiatric disorders and health-related quality of life after severe traumatic brain injury: a prospective study.

Traumatic brain injury (TBI) is a major cause of death and disability and impairs health-related quality of life (HRQOL). Psychiatric disorders have been recognized as major components of TBI morbidity, yet few studies have addressed the relationship between these outcomes. Sample size, selection bias, and retrospective design, are methodological limitations for TBI-related psychiatric studies. For this study, 33 patients with severe TBI were evaluated prospectively regarding demographic, clinical, radiological, neurosurgical, laboratory, and psychosocial characteristics, as well as psychiatric manifestations and HRQOL, 18 months after hospitalization. Psychiatric manifestations were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS), the Brief Psychiatric Rating Scale (BPRS), and the Apathy Evaluation Scale (AES). HRQOL was determined using the Medical Outcomes Study's 36-item Short-Form Health Survey (SF-36). Following TBI, a significant increase in the prevalence of major depressive disorder (MDD) and generalized anxiety disorder (p=0.02), and a significant decrease in the prevalence of alcohol and cannabinoid abuse (p=0.001) were observed. The most frequent psychiatric disorders following severe TBI were found to be MDD (30.3%), and personality changes (33.3%). In comparison to patients without personality changes, patients with personality changes experienced a decline in general health and impairments in physical and social functioning. Patients with MDD showed impairment in all SF-36 domains compared to non-depressed patients. This prospective TBI-related psychiatric study is the first to demonstrate a significant association between MDD, personality changes, and HRQOL, following severe TBI in a well-defined sample of patients.

[Educational Mercosur in the Nursing career]. / Mercosul educativo na carreira de Enfermagem.

The Mercosul, established with the objective of integrate economics, political, social and cultural differences among member countries, currently is highlighted by its strategies of educational framework. This article discusses the movement on the academic background of the Nursing career and the history of educational integration, presenting the accreditation system for university courses of Mercosul, the Arcu-Sul, and also the sectors responsible for this process and the prospects for Nursing in Mercosul. We believe that for the development of a critic, reflective and social-political committed professional is essential to invest in training and in the quality of education centers in Nursing.

[Nursing workloads and working conditions: integrative review]. / Cargas de trabalho e condições de trabalho da enfermagem: revisão integrativa.

This study reviews theoretical production concerning workloads and working conditions for nurses. For that, an integrative review was carried out using scientific articles, theses and dissertations indexed in two Brazilian databases, Virtual Health Care Library (Biblioteca Virtual de Saúde) and Digital Database of Dissertations (Banco Digital de Teses), over the last ten years. From 132 identified studies, 27 were selected. Results indicate workloads as responsible for professional weariness, affecting the occurrence of work accidents and health problems. In order to adequate workloads studies indicate some strategies, such as having an adequate numbers of employees, continuing education, and better working conditions. The challenge is to continue research that reveal more precisely the relationships between workloads, working conditions, and health of the nursing team.

Cargas de trabalho e condições de trabalho da enfermagem: revisão integrativa / Carga de trabajo y condiciones de trabajo de la enfermería: revisión integradora / Nursing workloads and working conditions: integrative review

O presente estudo teve por objetivo conhecer a produção teórica sobre cargas de trabalho e condições de trabalho dos profissionais de enfermagem. Para tanto, foi realizada uma revisão integrativa que incluiu artigos científicos, teses e dissertações, indexados nas bases da Biblioteca Virtual de Saúde e Banco Digital de Teses nos últimos dez anos. Entre os 132 trabalhos identificados, foram selecionadas 27 produções. Os resultados indicaram as cargas de trabalho como responsáveis pelo desgaste dos profissionais, influenciando a ocorrência de acidentes e os problemas de saúde. Para amenizar tais cargas de trabalho, os estudos apontam algumas estratégias, como adequação do quantitativo de pessoal, educação continuada e melhores condições de trabalho. Tem-se como desafio a realização de pesquisas que revelem com mais precisão a relação entre as cargas e as condições de trabalho da equipe de enfermagem, haja vista o quanto comprometem a saúde dos trabalhadores.

Estudio que objetivó conocer la producción teórica sobre las cargas de trabajo y condiciones de trabajo de profesionales de enfermería. Para eso, se realizó una revisión integradora que incluyó artículos científicos, tesis o disertaciones, indexados en bases de Biblioteca Virtual de Salud y Banco Digital de Tesis en los últimos diez años. Entre los 132 trabajos identificados, fueron seleccionadas 27 producciones. Los resultados indicaron las cargas de trabajo como responsables por el desgaste de los profesionales, influenciando la ocurrencia de accidentes y problemas de salud. Para amenizar esas cargas de trabajo los estudios apuntan algunas estrategias: adecuación del cuantitativo de personal, educación continuada y mejores condiciones de trabajo. Se tiene el desafío de la realización de pesquisas que revelen con mayor precisión la relación entre las cargas de trabajo y las condiciones de trabajo de la equipe de enfermería, considerándose cuanto estas comprometen la salud de los trabajadores.

The objective of this study was to know theoretical production concerning workloads and working conditions for nursing professionals. In order to do this investigation, an integrative review was carried out using scientific articles, theses and dissertations available in two Brazilian databases Virtual Health Care Library and Digital Bank of Dissertations over the last ten years. From 132 identified studies, 27 productions were selected. The results indicate workloads as responsible for professional wearing, which influences the occurrence of work accidents and health care problems. In order to decrease workloads, studies point out some strategies such as adequate numbers of employees, continued education, and better working conditions. The challenge is to continue doing research which reveals with increasing precision the relationships among workloads, working conditions and health of the nursing team.

Influencia do estresse em pessoas com diabetes mellitus tipo 2 / Influence fo stress on people with type 2 diabetes mellitus / La influencia del estrés em personas com diabetes mellitus tipo 2

O objetivo do estudo é conhecer a percepção de pessoas com diabetes mellitus tipo 2 (DM2) acerca da influência do estresse em sua condição crônica. Trata-se de um estudo quantitativa de caráter exploratório-descritivo. Foram entrevistados 56 pessoas com DM2, vinculadas a um hospital de ensino da região sul do Brasil. 0 instruento para coleta de dados foi um questionário e a análise ocorreu através de estatística descritiva. Os resultados evidenciam que 50% dos participantes estavam vivendo uma situação especial ligada a fatores estressantes nos momentos precedentes ao diagnostico do DMZ. Para a maioria, a estresse influencia o controle de sua doença crônica, pois percebem alteração dos níveis glicêmicos perante exposição a fatores estressantes, sendo os principais: as problemas familiares, a própria doença crônica e a hospitalização.. Conclui-se que o estudo é relevante para que as equipes de saúde reconheçam que o estresse é uma fonte complicadora no processo de sáude/doença em pessoas com DM2. Logo, é necessário que a assistência seja repensada, percebendo-se a importância da influência do estresse ao se planejar o tratamento e cuidado a pessoas com doenças crônicas.

The objective of this study is to know diabetic people's perception about the influence of stress on its chronicle condition. It is a quantitative study of descriptive-exploratory character. Fifty-six people with type 2 diabetes Were interviewed, linked to a teaching hospital in the southern region of Brazil. Data collection was carried out througha questionnaire. The results show that 50% of the participants were living through a special situation linked tostressful factors previousl y the diagnosis of type 2 diabetes. It has become evident that, for most of them, stress influences the control of their chronicle disease, because they notice changes on the glicemic levels When exposed to stress ful factors like familiar problems, the chronicle disease it self, and hospitalization, which were the most cited ones. It was concluded that the study will help health teams realize that stress is a complicating factor for the health/disease process of people with type 2 diabetes. Thus, it is necessary to think about the assistance realizing the importance of stress by planning the treatment and care of people with chronicle diseases.

EI objetivo de este estudio es conocer la percepción de personas con diabetes mellitus tipo 2 (DM2) acercade la influencia del estres en su condición crónica. Setrata de un estudio cuantitativo de caracter exploratorio-descriptivo. Se entrevistaron a 56 personas con DM2, vinculadas a un hospital universitario de la región sur delBrasil. La recolección de los datos se llevó a cabo mediante cuestionario, y el análisis se realizó por media de estadística descriptiva. Los resultados evidencian que el 50% de los participantes vivian en una situación especial vinculada a factores estresantes en los momentos precedentes al diagnostico de DM2. Para la mayoría, el estres influencia el control de su enfermedad cr6nica, pues se nota una alteraci6n de los niveles de glucemia delantede la exposición a factores estresantes, siendo los principales: los problemas familiares, la propia enfermedad crónica y la hospitalización. Se concluye que el estudio es relevante para que los equipos de salud reconozcanque el estres acarrea complicaciones en el proceso de salud/enfermedad en personas con DM2. Es necesariorepensar la asistencia, con especial atención a la importancia de la influencia del estrés al planear el tratamientoy el cuidado de personas con enfermedades crónicas.(