BackgroundBurnout appears to be common among critical care providers. It is characterized by three components: emotional exhaustion, depersonalization and personal accomplishment. Moral distress is the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints. We aimed to estimate the correlation between moral distress and burnout among all intensive care unit (ICU) and the step-down unit (SDU) providers (physicians, nurses, nurse technicians and respiratory therapists).MethodsA survey was conducted from August to September 2015. For data collection, a self-administered questionnaire for each critical care provider was used including basic demographic data, the Maslach Burnout Inventory (MBI) and the Moral Distress Scale-Revised (MDS-R). Correlation analysis between MBI domains and moral distress score and regression analysis to assess independent variables associated with burnout were performed.ResultsA total of 283 out of 389 (72.7%) critical care providers agreed to participate. The same team of physicians attended both ICU and SDU, and severe burnout was identified in 18.2% of them. Considering all others critical care providers of both units, we identified that overall 23.1% (95% CI 18.0–28.8%) presented severe burnout, and it did not differ between professional categories. The mean MDS-R rate for all ICU and SDU respondents was 111.5 and 104.5, respectively, p = 0.446. Many questions from MDS-R questionnaire were significantly associated with burnout, and those respondents with high MDS-R score (>100 points) were more likely to suffer from burnout (28.9 vs 14.4%, p = 0.010). After regression analysis, moral distress was independently associated with burnout (OR 2.4, CI 1.19–4.82, p = 0.014).ConclusionsMoral distress, resulting from therapeutic obstinacy and the provision of futile care, is an important issue among critical care providers’ team, and it was significantly associated with severe burnout.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0293-2) contains supplementary material, which is available to authorized users.

Various studies describe the Singular Therapeutic Project (STP) as a powerful instru-

Objetivo: descrever as prevalências de fatores de risco e proteção para doenças crônicas na população adulta brasileira e analisar as diferenças segundo variáveis sociodemográficas. Métodos: estudo transversal com dados de 2012 do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), incluindo residentes nas capitais brasileiras com idade ≥18 anos; foram calculadas as prevalências e respectivos intervalos de confiança de 95% (IC 95% ) segundo sexo, faixa etária e escolaridade.

OBJECTIVE:To describe sociodemographic characteristics and analyze temporal trends in the mortality of motorcyclists injured in traffi c accidents. METHODS:This was a time-series study with data from 580 motorcyclist deaths in the Brazilian Federal District from 1996 to 2007. The data were obtained from the Mortality Information System. Mortality rates specifi c for age and sex, the standardized rates (direct method), and the ratio of deaths per fl eet (motorcycles) were calculated. The centralized moving average of the standardized mortality rate for men was calculated for a three-year period, and a linear regression model was constructed to study the evolution of mortality. The joinpoint method (infl ection point) was used to calculate the annual increase in the standardized mortality rate. RESULTS:Most of the motorcyclists killed were male (94.3%), mixed skin color (71.0%), and between the ages of 20 and 39 years (73.8%). The standardized mortality rate for resident motorcyclists (men) was 1.9 to 7.2 deaths/100,000 men between 1996 and 2007. Between 1998 and 2007, the ratio of deaths per fl eet increased from 2.0 deaths/10,000 motorcyclists to 10.0 deaths/10,000 motorcyclists among men. There was an estimated annual increase of 0.48 deaths/100,000 men (95%CI 0.31, 0.65; p <0.001). The percent increase of the annual standardized mortality rate for males was 36.2% in the period from 1998 p <0.05). CONCLUSIONS:The mortality rate resulting from motorcycle road accidents has increased dramatically. This increase is partially explained by the increase of the fl eet of motorcycles. Individual characteristics of drivers, as well as local traffi c conditions, need to be investigated for the planning of preventive policies.

OBJECTIVE:To describe infrastructure, human resources, and care approaches in psychosocial healthcare services. METHODS:Descriptive study including 21 psychossocial healthcare services for adults affi liated to the local health department in the city of São Paulo, Southeastern Brazil, conducted between 2007 and 2008. Information about infrastructure of facilities, human resources available and patient care was collected using a standardized instrument. There were performed descriptive data analysis and chi-square test to test the association between care activities and service source and location. RESULTS:Ten services were fi rst created as outpatient clinics and later adapted, eight were day hospitals and only three were created as psychosocial healthcare services. None of them was open 24 hours a day. Half of them were located in rented buildings with inadequate infrastructure especially for group activities. Staff composition was very different among services, with emphasis on on-site group activities and little integration to other health services. All services provided mostly arts and cultural activities. Earlier outpatient services provided mainly craft activities and former day-hospitals offered mostly psychophysical integration activities. The profi le of activities varied according to the geographical distribution of services. CONCLUSIONS:Current heterogeneous character of psychosocial healthcare services seems associated to the history of mental health care programs that have been implemented in São Paulo since 1980s and to social, economic and cultural differences in different areas of the city. Different psychosocial care approaches were found ranging from on-site care with little integration with other health services to services that refer their users to other services after symptoms become stable in an attempt to create a network of mental health care.

INTRODUCTION:Asthma in older adults is frequently underdiagnosed, as reflected by approximately 60% of asthma deaths occurring in people older than age 65.OBJECTIVE:The present study evaluates the effects of a respiratory exercise program tailored for elderly individuals with asthma. We are not aware of any other reports examining breathing exercises in this population.METHODS:Fourteen patients concluded the 16-week respiratory exercise program. All the patients were evaluated with regard to lung function, respiratory muscle strength, aerobic capacity, quality of life and clinical presentation.RESULTS:After 16 weeks of this open-trial intervention, significant increases in maximum inspiratory pressure and maximum expiratory pressure (27.6% and 20.54%, respectively) were demonstrated. Considerable improvement in quality of life was also observed. The clinical evaluations and daily recorded-symptoms diary also indicated significant improvements and fewer respiratory symptoms. A month after the exercises were discontinued, however, detraining was observed.DISCUSSION:In conclusion, a respiratory exercise program increased muscle strength and was associated with a positive effect on patient health and quality of life. Therefore, a respiratory training program could be included in the therapeutic approach in older adults with asthma.

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were analyzed. The analysis included statements from coordinators on the objectives of the observed activities. Based on theoretical psychosocial health care frameworks, content analysis was used to investigate the relationship between the therapeutic tools used and the objectives of the activities. RESULTS:Three trends of health care were identifi ed: (1) strictly clinical, was predominant and characterized by activities carried out within the centers, with a focus on personal skills and group interactions; (2) psychosocial, including outdoor activities, widening the cultural repertoire and social circulation and; (3) residual, in the minority and without psychosocial benefi ts. CONCLUSIONS:Carrying out rat and cultural activities which result in health care from the perspective of psychosocial rehabilitation depends on the health care professionals' access to cultural assets and creative procedures, on the recognition of these activities as part of the coordinated work of a team and on all those involved being considered as actual producers of culture.