Prevention of mental ill-health and suicide: Public health perspectives

According to the World Health Organization (WHO) estimates for the year 2020, approximately 1.5 million people will commit suicide, and at least 10 times that many will make an attempt. This paper offers a brief overview of the current state of the epidemiology of suicide, a burgeoning public health problem. The information provided is based in large measure on reports of suicide mortality from 130/193 countries. In order to contextualize these data, this paper explores the contribution of both individual and sociocultural factors that influence suicidal behavior, from which much has been learned. Outlining the history of attempts by international and national organizations like WHO, United Nations, member states in the European community and other countries to regularize identification and suicide reporting procedures, this paper also demonstrates that serious knowledge gaps remain. Minimal requirements for successful evidence-based interventions are presented. (C) 2010 Published by Elsevier Masson SAS.

Análise das condições de saúde e de vida da população urbana de Botucatu, São Paulo (Brasil): IV - Morbidade referida em entrevistas domiciliárias, 1983-1984

Objetivou-se estudar a morbidade referida pela população urbana amostrada, no Município de Botucatu, SP, Brasil, em 1983/84, segundo sexo, idade, escolaridade e renda per capita. O método consistiu em entrevistas domiciliárias, com aplicação de dois formulários pré-codificados. Os entrevistadores eram leigos treinados e supervisionados, e a pessoa entrevistada foi quase sempre a mãe de família. O período recordatório estabelecido em relação aos eventos informados (queixas, sintomas, acidentes comuns e diagnósticos) foi de três semanas. Das 7.075 pessoas amostradas (12% da população), 56% apresentaram episódios mórbidos, totalizando 6.649 episódios. As mulheres, bem como o grupo etário de 50 e mais anos apresentaram maior freqüência de queixas. A escolaridade e a renda per capita não diferenciaram os entrevistados quanto à ocorrência maior ou menor de episódios. A prevalência de episódios mórbidos foi de 939/1.000 entrevistados. Predominaram queixas do aparelho respiratório (20% do total de queixas), principalmente as infecções respiratórias agudas. em segundo lugar, os sinais e sintomas mal definidos (19%) e, a seguir, as doenças do sistema osteo-muscular, do sistema nervoso e do sistema circulatório, com proporções similares (ao redor de 9%) e, finalmente, as do sistema digestivo e as lesões e envenenamentos (ao redor de 8%). Foram estimados os coeficientes de prevalência por grupos de doença (pela CID), segundo as variáveis estudadas. São comentadas as dificuldades de comparação dos resultados obtidos com os de trabalhos congêneres, face às diferenças nos métodos usados, apontando-se para a necessidade de uma padronização metodológica dos estudos de morbidade referida, cuja importância epidemiológica e para o planejamento em saúde vem sendo amplamente reconhecida.

Echocardiographic Doppler estimation of pulmonary artery pressure in critically ill patients with severe hypoxemia

BACKGROUND: In spontaneously breathing cardiac patients, pulmonary artery pressure (PAP) can be accurately estimated from the transthoracic Doppler study of pulmonary artery and tricuspid regurgitation blood flows. In critically ill patients on mechanical ventilation for acute lung injury, the interposition of gas between the probe and the heart renders the transthoracic approach problematic. This study was aimed at determining whether the transesophageal approach could offer an alternative. METHODS: Fifty-one consecutive sedated and ventilated patients with severe hypoxemia (arterial oxygen tension/fraction of inspired oxygen < 300) were prospectively studied. Mean PAP measured from the pulmonary artery catheter was compared with several indices characterizing pulmonary artery blood flow assessed using transesophageal echocardiography: preejection time, acceleration time, ejection duration, preejection time on ejection duration ratio, and acceleration time on ejection duration ratio. In a subgroup of 20 patients, systolic PAP measured from the pulmonary artery catheter immediately before withdrawal was compared with Doppler study of regurgitation tricuspid flow performed immediately after pulmonary artery catheter withdrawal using either the transthoracic or the transesophageal approach. RESULTS: Weak and clinically irrelevant correlations were found between mean PAP and indices of pulmonary artery flow. A statistically significant and clinically relevant correlation was found between systolic PAP and regurgitation tricuspid flow. In 3 patients (14%), pulmonary artery pressure could not be assessed echocardiographically. CONCLUSIONS: In hypoxemic patients on mechanical ventilation, mean PAP cannot be reliably estimated from indices characterizing pulmonary artery blood flow. Systolic PAP can be estimated from regurgitation tricuspid flow using either transthoracic or transesophageal approach. © 2008 American Society of Anesthesiologists, Inc.

Characterization of the intrahospital transport of critically ill patients

Objective: Characterizing the transport of critically ill patients in an adult intensive care unit.Methods: Cross-sectional study in which 459 intra -hospital transports of critically ill patients were included. Data were collected from clinical records of patients and from a form with the description of the materials and equipment necessary for the procedure, description of adverse events and of the transport team.Results: A total of 459 transports of 262 critically ill patients were carried out, with an average of 51 transports per month. Patients were on ventilatory support (41.3 %) and 34.5 % in use of vasoactive drugs. Adverse events occurred in 9.4% of transports and 77.3 % of the teams were composed of physicians, nurses and nurse technicians.Conclusion: The transport of critically ill patients occurred in the morning period for performing computerized tomographies (CT scans) with patients dependent on mechanical ventilation and vasoactive drugs. During the transports the equipment was functioning, and the adverse events were attributed to clinical changes of patients.

Percepção da doença mental por profissionais de saúde: possibilidades de ampliação do cuidado

This study approached perceptions of mental illness by nineteen professionals who work in a Family Health Unit, by means of graphic representations (drawings). We used qualitative methods. Data was collected by means of a Presentative-Expressive Procedure. Four themes were identified using Thematic Analysis. The professionals associate mental disorders with: health care, medical-centered view, exclusion/inclusion, social environment. These perceptions are related to a biological paradigm, favoring the reproduction of prejudices about mental illness. The analysis also emphasizes the importance of a wide range of cares, while considering how difficult it may be for the professionals. We conclude that it is necessary to invest on professional preparation, in an attempt to transform ideoaffective contents presented by the subjects’ imaginary.