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.

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.

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.

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.

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 semistructured 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. DESCRIPTORS: Emergency nursing. Personnel downsizing. Personnel administration, Hospital. INDICATIVOS PARA O DIMENSIONAMENTO DE PESSOAL DE ENFERMAGEM EM EMERGÊNCIARESUMO: 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. DESCRITORES:Enfermagem em emergência. Downsizing organizacional. Administração de recursos humanos em hospitais. INDICATIVOS PARA EL DIMENSIONAMIENTO DE PERSONAL DE ENFERMERÍA EN URGENCIA RESUMEN: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. DESCRIPTORES:Enfermería de urgência. Reducción de personal. Administración de personal en hospitales. Schmoeller R, Gelbcke FL

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.

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.Descritores: Serviços de Saúde, Dimensionamento de Pessoal, Administração de Serviços de Saúde.Instrument for grading the degree of dependence of users: a study to contribute to the dimensionig of personalThis 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.Descriptors: Health Services, Personnel Dimensioning, Health Services, Administration.Instrumiento para clasificación del grado de dependência de usuários: un estudio para contribuir en el dimensionamiento de personalSe 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.Descriptores: Servicios de Salud, Dimensionamiento de Personal, Administración los Servicios de Salud.