Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Síndrome de Fadiga Crônica/mortalidade , Transtorno Depressivo/mortalidade , Suicídio/estatística & dados numéricos , País de Gales , Síndrome de Fadiga Crônica/psicologia , Sistema de Registros , Estudos Retrospectivos , Estudos de Coortes , Inglaterra , Neoplasias/mortalidadeRESUMO
Este livro proporciona ao leitor a oportunidade de conhecer e refletir sobre o desafio de conviver no mundo do trabalho com pessoas e situações inesperadas nos diversos cenários das empresas. Como a pessoa independente, totalmente isolada, é uma abstração, ele é levada a manter constante interação com outras e a concordar com metas, objetivos e valores propostos pelas pessoas com quem convive, ou a discordar de tais decisões. Por essa razão, o trabalho pode submeter as pessoas a um stress contínuo e freqüentemente crônico e, em conseqüência, a doenças, frustrações. A preservação da saúde, vista como resultado do desenvolvimento da auto estima e da realização pessoal-profissional, em compatibilidade com a cultura da empresa, é preocupação central no desenvolvimento deste texto. Entre os temas tratados no livro, destacam-se: Abordagem biopsicossocial; Ampliação do conhecimento sobre o adoecer; Mecanismos de formação de sintomas e doenças; Contrato psicológico de trabalho e saúde; Conceito, tipos e formas de adaptação ao stress; Evolução e novas abordagens sobre stress e burnout; Qualidade de vida: recomendações e indicadores.
Assuntos
Humanos , Esgotamento Profissional/psicologia , Qualidade de Vida , Trabalho/psicologia , Depressão/psicologia , Diabetes Mellitus/psicologia , Cultura Organizacional , Síndrome de Fadiga Crônica/psicologia , Transtornos Traumáticos Cumulativos/psicologia , Transtornos do Sono-Vigília/psicologiaRESUMO
OBJECTIVE: Causal attribution influences symptom experience, help-seeking behaviour and prognosis in chronic fatigue syndrome. We compared causal attribution of patients with unexplained chronic fatigue (UCF) in Brazil and Britain. METHOD: Primary care attenders in São Paulo (n = 3914) and London (n = 2459) were screened for the presence of UCF. Those with UCF (São Paulo n = 452; London n = 178) were assessed for causal attribution (physical vs. psychosocial), perceived chronicity (i.e. reported duration of fatigue) and disability. RESULTS: British UCF patients were more likely to attribute their fatigue to physical causes (adjusted odds ratio 1.70, P = 0.037) and perceived their fatigue to be more chronic (adjusted beta 0.15, P = 0.002). There was no significant difference in current disability (adjusted beta -0.01, P = 0.81). CONCLUSION: Despite similar disability levels, UCF patients in different cultural settings presented different attributions and perceptions about their illness. Sociocultural factors may have an important role in shaping illness attribution and perception around chronic fatigue.
Assuntos
Comparação Transcultural , Cultura , Síndrome de Fadiga Crônica/psicologia , Papel do Doente , Transtornos Somatoformes/psicologia , Adolescente , Adulto , Brasil , Causalidade , Avaliação da Deficiência , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/etiologia , Feminino , Humanos , Londres , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Atenção Primária à Saúde , Prognóstico , Grupos de Autoajuda , Licença Médica , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/etiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: While in many Western affluent countries there is widespread awareness of chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), little is known about the awareness of CFS/ME in low- and middle-income countries. We compared the awareness of CFS in Brazil and the United Kingdom. METHODS: Recognition and knowledge of CFS were assessed among 120 Brazilian specialist doctors in two major university hospitals using a typical case vignette of CFS. We also surveyed 3914 and 2435 consecutive attenders in Brazilian and British primary care clinics, respectively, concerning their awareness of CFS. RESULTS: When given a typical case vignette of CFS, only 30.8% [95% confidence interval (CI), 22.7-39.9%] of Brazilian specialist doctors mentioned chronic fatigue or CFS as a possible diagnosis, a proportion substantially lower than that observed in Western affluent countries. Similarly, only 16.2% (95% CI, 15.1-17.4%) of Brazilian primary care attenders were aware of CFS, in contrast to 55.1% (95% CI, 53.1-57.1%) of their British counterparts (P<.001). This difference remained highly significant after controlling for patients' sociodemographic and socioeconomic characteristics (P<.001). CONCLUSIONS: The awareness of CFS was substantially lower in Brazil than the United Kingdom. The observed difference may influence patients' help-seeking behavior and both doctors' and patients' beliefs and attitudes in relation to fatigue-related syndromes. Attempts to promote the awareness of CFS should be considered in Brazil, but careful plans are required to ensure the delivery of sound evidence-based information.
Assuntos
Conscientização , Comparação Transcultural , Países em Desenvolvimento , Síndrome de Fadiga Crônica/diagnóstico , Adulto , Atitude do Pessoal de Saúde , Brasil , Estudos Transversais , Cultura , Diagnóstico Diferencial , Síndrome de Fadiga Crônica/psicologia , Feminino , Inquéritos Epidemiológicos , Hospitais Universitários , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/psicologia , Especialização , Reino UnidoRESUMO
OBJECTIVE: We reviewed previous studies that have described an association between abnormal functioning of the hypothalamic-pituitary-adrenal axis and depression. In addition to melancholic depression, a spectrum of conditions may be associated with increased and prolonged activation of the hypothalamic-pituitary-adrenal axis. In contrast another group of states is characterized by hypoactivation of the stress system, rather than sustained activation, in which chronically reduced secretion of corticotropin releasing factor may result in pathological hypoarousal and an enhanced hypothalamic-pituitary-adrenal negative feedback. Patients with atypical depression, seasonal affective disorder and chronic fatigue syndrome fall in this category. METHOD: The literature data on the overlap between the key-words were reviewed, summarized and discussed. RESULTS: Many studies suggest that these conditions themselves overlap biologically, showing hypofunction of central corticotropin releasing factor neuronal systems. CONCLUSIONS: Therefore, in the real world of clinical practice, patients often present in a grey area between classical idiopathic fatigue and early chronic atypical depression and/or seasonal depression. This underscores the potential common biological links underpinning common symptom clusters not only between depression (atypical and seasonal) and chronic fatigue syndrome, but also other conditions characterized by the hypothalamic-pituitary-adrenal axis mainly diminished the corticotropin realising factor activity.
Assuntos
Transtorno Depressivo/fisiopatologia , Síndrome de Fadiga Crônica/fisiopatologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Transtorno Afetivo Sazonal/fisiopatologia , Hormônio Liberador da Corticotropina/fisiologia , Transtorno Depressivo/psicologia , Transtorno Depressivo Maior/fisiopatologia , Síndrome de Fadiga Crônica/psicologia , Humanos , Transtorno Afetivo Sazonal/psicologia , Estresse Psicológico/fisiopatologiaRESUMO
OBJETIVO: Foram revisados estudos que descrevem que as alterações na função do eixo hipotálamo-hipófise-adrenal são relacionadas com o estado psicopatológico em depressão. Além da depressão melancólica, uma série de condições podem ser associadas à hiperativação prolongada do eixo hipotálamo-pituitária-adrenal. Um outro grupo de psicopatologias é caracterizado por hipoativação do mesmo eixo com redução crônica na secreção do fator de liberação de corticotrofina. Pacientes com depressão atípica, doença afetiva sazonal e síndrome da fadiga crônica estão inclusos nesta categoria. MÉTODO: Foram revisados os dados da literatura que incluem a interseção entre estes descritores, resumidos e discutidos os principais e recentes achados. RESULTADOS: Muitos estudos têm enfatizado que estes quadros se sobrepõem biologicamente, demonstrando hipofunção no sistema relacionado ao fator de liberação de corticotrofina. CONCLUSÕES: Na prática clínica, os pacientes frequentemente se apresentam de forma intermediária entre a fadiga e a depressão atípica crônica e/ou a depressão sazonal. Isto enfatiza o potencial biológico comum que fundamenta o grupo de sintomas não somente entre depressão (atípica e sazonal) e a síndrome da fadiga crônica e as condições caracterizadas por alterações no eixo hipotálamo-pituitária-adrenal, principalmente hipofunção e, em particular, diminuição da atividade do fator de liberação de corticotrofina.
OBJECTIVE: We reviewed previous studies that have described an association between abnormal functioning of the hypothalamic-pituitary-adrenal axis and depression. In addition to melancholic depression, a spectrum of conditions may be associated with increased and prolonged activation of the hypothalamic-pituitary-adrenal axis. In contrast another group of states is characterized by hypoactivation of the stress system, rather than sustained activation, in which chronically reduced secretion of corticotropin releasing factor may result in pathological hypoarousal and an enhanced hypothalamic-pituitary-adrenal negative feedback. Patients with atypical depression, seasonal affective disorder and chronic fatigue syndrome fall in this category. METHOD: The literature data on the overlap between the key-words were reviewed, summarized and discussed. RESULTS: Many studies suggest that these conditions themselves overlap biologically, showing hypofunction of central corticotropin releasing factor neuronal systems. CONCLUSIONS: Therefore, in the real world of clinical practice, patients often present in a grey area between classical idiopathic fatigue and early chronic atypical depression and/or seasonal depression. This underscores the potential common biological links underpinning common sympton clusters not only between depression (atypical and seasonal) and chronic fatigue syndrome, but also other conditions characterized by the hypothalamic-pituitary-adrenal axis mainly diminished the corticotropin realising factor activity.
Assuntos
Humanos , Transtorno Depressivo/fisiopatologia , Síndrome de Fadiga Crônica/fisiopatologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Transtorno Afetivo Sazonal/fisiopatologia , Hormônio Liberador da Corticotropina/fisiologia , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo/psicologia , Síndrome de Fadiga Crônica/psicologia , Transtorno Afetivo Sazonal/psicologia , Estresse Psicológico/fisiopatologiaRESUMO
OBJECTIVE: To compare effectiveness of oral therapy with reduced nicotinamide adenine dinucleotide (NADH) to conventional modalities of treatment in patients with chronic fatigue syndrome (CFS). BACKGROUND: CFS is a potentially disabling condition of unknown etiology. Although its clinical presentation is associated to a myriad of symptoms, fatigue is a universal and essential finding for its diagnosis. No therapeutic regimen has proven effective for this condition. METHODS: A total of 31 patients fulfilling the Centers for Disease Control criteria for CFS, were randomly assigned to either NADH or nutritional supplements and psychological therapy for 24 months. A thorough medical history, physical examination and completion of a questionnaire on the severity of fatigue and other symptoms were performed each trimester of therapy. In addition, all of them underwent evaluation in terms of immunological parameters and viral antibody titers. Statistical analysis was applied to the demographic data, as well as to symptoms scores at baseline and at each trimester of therapy. RESULTS: The twelve patients who received NADH had a dramatic and statistically significant reduction of the mean symptom score in the first trimester (p < 0.001). However, symptom scores in the subsequent trimesters of therapy were similar in both treatment groups. Elevated IgG and Ig E antibody levels were found in a significant number of patients. CONCLUSIONS: Observed effectiveness of NADH over conventional treatment in the first trimester of the trial and the trend of improvement of that modality in the subsequent trimesters should be further assessed in a larger patient sample.
Assuntos
Síndrome de Fadiga Crônica/tratamento farmacológico , NAD/uso terapêutico , Administração Oral , Adulto , Suplementos Nutricionais , Síndrome de Fadiga Crônica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia/métodos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
OBJECTIVE: To compare effectiveness of oral therapy with reduced nicotinamide adenine dinucleotide (NADH) to conventional modalities of treatment in patients with chronic fatigue syndrome (CFS). BACKGROUND: CFS is a potentially disabling condition of unknown etiology. Although its clinical presentation is associated to a myriad of symptoms, fatigue is a universal and essential finding for its diagnosis. No therapeutic regimen has proven effective for this condition. METHODS: A total of 31 patients fulfilling the Centers for Disease Control criteria for CFS, were randomly assigned to either NADH or nutritional supplements and psychological therapy for 24 months. A thorough medical history, physical examination and completion of a questionnaire on the severity of fatigue and other symptoms were performed each trimester of therapy. In addition, all of them underwent evaluation in terms of immunological parameters and viral antibody titers. Statistical analysis was applied to the demographic data, as well as to symptoms scores at baseline and at each trimester of therapy. RESULTS: The twelve patients who received NADH had a dramatic and statistically significant reduction of the mean symptom score in the first trimester (p < 0.001). However, symptom scores in the subsequent trimesters of therapy were similar in both treatment groups. Elevated IgG and Ig E antibody levels were found in a significant number of patients. CONCLUSIONS: Observed effectiveness of NADH over conventional treatment in the first trimester of the trial and the trend of improvement of that modality in the subsequent trimesters should be further assessed in a larger patient sample