Dual diagnosis in mental health inpatient and day hospital settings.

Many mental health patients also have substance misuse problems, so mental health service staff need to be skilled to provide simple prevention and treatment interventions, assisted by drug and alcohol specialists. This guidance covers the assessment and clinical management of patients with mental illness being cared for in psychiatric inpatient or day care settings who also use or misuse alcohol and/or illicit or other drugs*. It also covers organisational and management issues to help mental health services manage these patients effectively. The key message is that the assessment and management of drug and alcohol use are core competences required by clinical staff in mental health services. The guidance aims to: â?¢ encourage integration of drug and alcohol expertise and related training into mental health service provision; â?¢ provide ideas and guidance to front-line staff and manages to help them provide the most effective therapeutic environments; â?¢ help mental health services plan action on dual diagnosisâ? .This resource was contributed by The National Documentation Centre on Drug Use.

The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems

BACKGROUND: Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. METHOD: The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. RESULTS: The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. CONCLUSIONS: Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts

The genetic diversity and phenotypic characterisation of Streptococcus agalactiae isolates from Rio de Janeiro, Brazil

Streptococcus agalactiae isolates are more common among pregnant women, neonates and nonpregnant adults with underlying diseases compared to other demographic groups. In this study, we evaluate the genetic and phenotypic diversity in S. agalactiae strains from Rio de Janeiro (RJ) that were isolated from asymptomatic carriers. We analysed these S. agalactiae strains using pulsed-field gel electrophoresis (PFGE), serotyping and antimicrobial susceptibility testing, as well as by determining the macrolide resistance phenotype, and detecting the presence of the ermA/B, mefA/E and lnuB genes. The serotypes Ia, II, III and V were the most prevalent serotypes observed. The 60 strains analysed were susceptible to penicillin, vancomycin and levofloxacin. Resistance to clindamycin, chloramphenicol, erythromycin, rifampin and tetracycline was observed. Among the erythromycin and/or clindamycin resistant strains, the ermA, ermB and mefA/E genes were detected and the constitutive macrolides, lincosamides and streptogramin B-type resistance was the most prevalent phenotype observed. The lnuB gene was not detected in any of the strains studied. We found 56 PFGE electrophoretic profiles and only 22 of them were allocated in polymorphism patterns. This work presents data on the genetic diversity and prevalent capsular serotypes among RJ isolates. Approximately 85% of these strains came from pregnant women; therefore, these data may be helpful in developing future prophylaxis and treatment strategies for neonatal syndromes in RJ.

Solvability of mental health care in the Family Health Strategy: social representation of professionals and users

Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, considering the words as units and providing context in the corpus. Results The representations emerge in two opposing poles: the users require satisfaction with care and the professionals realize the need for improvement of health actions. Although the matricial support in mental health and the home visits are developed, the barriers related to investment in health, continuing education and organization of care persist. Conclusion The different representations enable improvements in customer service, solvability of care and aggregate knowledge and practices in the expanded perspective of health needs in the family, social and therapeutic context.


Family impact in intellectual disability, severe mental health disorders and mental health disorders in ID. A comparison

Family impact (or family burden) is a concept born in the field of mental health that has successfully been exported to the ambit of intellectual disability (ID). However, differences in family impact associated with severe mental health disorders (schizophrenia), to ID or to mental health problems in ID should be expected. Seventy-two adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshops and vocational employment programmes in Madrid (Spain), 203 adults diagnosed with schizophrenia from four Spanish Community Mental Health Services (Barcelona, Madrid, Granada and Navarra) and 90 adults with mental health problems in ID (MH-ID) from the Parc Sanitari Sant Joan de Déu Health Care Site in Sant Boi de Llobregat, Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Family impact experienced by caregivers was assessed with the ECFOS-II/SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva/Objective and Subjective Family Burden Interview). In global terms, results showed that the higher family impact was found between caregivers to people with MH-ID. The interaction of both conditions (ID and mental health problems) results in a higher degree of burden on families than when both conditions are presented separately. There was also an impact in caregivers to people with schizophrenia, this impact being higher than the one detected in caregivers to people with intellectual disability. Needs of caregivers to people with disability should be addressed specifically in order to effectively support families.

Participação da radiologia nas perícias necroscópicas de baleados realizadas no Instituto Médico-Legal do Rio de Janeiro

OBJETIVO: Este trabalho aborda as conseqüências de laudos necroscópicos incompletos de baleados, nos casos em que não foi possível o uso de recursos radiológicos para localizar os projéteis de arma de fogo. MATERIAIS E MÉTODOS: Foram analisados 8.185 laudos necroscópicos do Instituto Médico-Legal Afrânio Peixoto, Rio de Janeiro, RJ, referentes à demanda total de cadáveres no período de 1º de janeiro a 31 de dezembro de 2001, dos quais 3.122 casos corresponderam a necropsias de baleados. RESULTADOS: Desses casos, 309 corpos foram sepultados contendo ainda, no seu interior, projéteis de arma de fogo, podendo suscitar futuras indagações judiciais. No mesmo período foram solicitadas 23 exumações, 12 delas com a finalidade de recolher projéteis. Foram calculados os gastos relacionados à realização de necropsias de baleados - R$ 996,85 - e custos alusivos à realização de exumações com a finalidade de recolher projéteis de arma de fogo - R$ 1.155,40, visando a estabelecer o montante financeiro que poderia ser poupado pelos cofres públicos, a ser alocado para finalidades outras, se a perícia médico-legal de baleados, no exame inicial, obtivesse sucesso. CONCLUSÃO: Os resultados permitiram concluir que todos os atos necroscópicos de baleados devem seguir protocolos específicos, uma vez que perícias incompletas exigem exumação posterior, com gastos adicionais desnecessários.

“Weathering a Hidden Storm”: An Application of Andersen’s Behavioral Model of Health, and Health Services Use for Those with Diagnosable Anxiety Disorder

Abstract: Research has primarily focused on depression and mood disorders, but little research has been devoted to an examination of mental health services use amongst those with diagnosable anxiety disorder (Wittchen et al., 2002; Bergeron et al., 2005). This study examined the possible predicting factors for mental health services utilization amongst those with identifiable anxiety disorder in the Canadian population. The methods used for this study was the application of Andersen’s Behavioral Model of Health Services Use, where predisposing, need and enabling characteristics were regressed on the dependent variable of mental health services use. This study used the Canadian Community Health Survey (cycle 1.2: Mental Health and Well-Being) in a secondary data analysis. Several multiple logistics models predicted the likelihood to seek and use mental health services. Predisposing characteristics of gender and age, Enabling characteristics of education and geographical location, and those with co-occurring mood disorders were at the greatest increased likelihood to seek and use mental health services.

"Weathering a hidden storm" : an application of Andersen's behavioral model of health, and health services use for those with diagnosable anxiety disorder

"Weathering a Hidden Storm": An App~ication of Andersen's Behaviora~ Mode~ of Hea~th, and Hea~th Services Use for Those With Diagnosab~e Anxiety Disorder Research has primarily focused on depression and mood disorders, but little research has been devoted to an examination of mental health services use amongst those with diagnosable anxiety disorder (Wittchen et al., 2002; Bergeron et al., 2005). This study examined the possible predicting factors for mental health services utilization amongst those with identifiable anxiety disorder in the Canadian population. The methods used for this study was the application of Andersen's Behavioral Model of Health Services Use, where predisposing, need and enabling 111 characteristics were regressed on the dependent variable of mental health services use. This study used the Canadian Community Health Survey (cycle 1.2: Mental Health and Well- Being) in a secondary data analysis. Several multiple logistics models predicted the likelihood to seek and use mental health services. Predisposing characteristics of gender and age, Enabling characteristics of education and geographical location, and those with co-occurring mood disorders were at the greatest increased likelihood to seek and use mental health services.

Establishing a recovery orientation in first line mental health teams in Québec : perspectives from social workers and managers

Le Plan d’action en santé mentale institué en 2005 marque le début d’une période de changements profonds qui auront un impact significatif sur les équipes de première ligne qui assurent la plupart des services au Québec. Le changement se manifestera sur deux fronts distincts. En premier lieu, le passage de services historiquement ancrés dans un modèle biomédical vers des services centrés sur le rétablissement. En second lieu, l’adoption de processus administratifs s’inscrivant dans une philosophie de gestion axée sur les résultats qui ont pour objectif de mesurer et d’assurer l’efficacité des services. L'objectif de cette étude est d’explorer le statu du développement des pratiques axées sur le rétablissement au niveau des travailleurs sociaux de première ligne dans le contexte administratif mentionné ci-haut. Le travail de recherche qualitatif et exploratoire est construit sur l’analyse de 11 interviews semi structurés avec des travailleurs sociaux et des gestionnaires dans des équipes de première ligne en santé mentale. Les entretiens m’ont non seulement permis d’identifier et d’examiner des actions concrètes s’inscrivant dans l’effort d’implantation du Plan d’action mais aussi de sonder et d’explorer la signification qui est donnée au rétablissement par les travailleurs sociaux de première ligne. Les résultats indiquent que certains facteurs relatifs à l'organisation du travail tels que la flexibilité, l'autonomie, la réflexivité et l’interdisciplinarité peuvent favoriser une pratique orientée vers le rétablissement. Aussi, les résultats démontrent que le modèle du rétablissement et la profession du travail social partagent des valeurs fondamentales mais que la signification et l'expression du rétablissement ont été profondément influencés par les modèles organisationnels et obligations administratives en vigueur. Il appert que les travailleurs sociaux sont confrontés, dans leur pratique, à des contraintes qui dépassent leur mandat professionnel et, à certains égards, leur savoir-faire. En somme, les résultats obtenus indiquent que le passage avec succès vers la pratique de services basés sur le rétablissement est compromis par les exigences d’un modèle de gestion axé sur les résultats.

Is NHS Direct meeting the needs of mental health callers?

Background: NHS Direct is a new service that offers 24-hour advice from trained nurses. The National Service Framework for Mental Health and the National Strategy for Carers both mention NHS Direct as an important source of support for people with mental health problems. Aims: This paper reports findings from an evaluation of the Department of Health's NHS Direct mental health initiative. This initiative was established to ensure that NHS Direct can meet the needs of callers with mental health problems by offering additional training to all staff and improving the database of mental health services. Method: The findings reported here are based on routine computer data provided by 12 out of 17 NHS Direct sites, 552 data forms completed by nurse advisers from the 17 sites, and 111 questionnaires administered over the telephone with callers to the 17 sites. Results: Mental health calls accounted for 3% of NHS Direct's workload, although these calls were often longer and more complex than other calls. The majority of callers to the service were in touch with other services for their mental health problems (59%), typically their GP. Most callers had 'moderate' mental health problems, as indicated by the Global Assessment of Functioning Scale. Generally callers were satisfied with the service they received, although satisfaction was lower in some areas than previous studies of NHS Direct. Conclusions: Improvements could be made in the mechanisms for referring callers on to other services, and training to increase nurse advisers' knowledge of mental health problems.

Estimação do preço hedônico: uma aplicação para o mercado imobiliário da cidade do Rio de Janeiro

O objetivo da dissertação foi obter um modelo de previsão para os preços dos imóveis, praticados no mercado imobiliário da cidade do Rio de Janeiro no ano 2000, utilizando a Metodologia do Preço Hedônico (HPM), que deve reponder a duas questões: a) Quais são as características relevantes; b) Qual é a forma de relacionamento entre os preços e as características. O modelo de previsão foi obtido, com base em procedimentos econométricos, e teve duas etapas distintas. Na primeira etapa, de formulação do modelo, foram realizadas regressões paras as formas funcionais mais utilizadas pelos estudos na área, a saber, a forma funcional linear, dupla logarítmica e semilogarítmica. Em seguida foi utilizado o procedimento de seleção de modelos “geral para específico”. A segunda etapa consistiu na previsão fora da amostra. Isto é, a partir das formas funcionais reduzidas e utilizando-se dos coeficientes das variáveis significativas, obteve-se os preços estimados e em seguida foram comparados com os preços efetivamente praticados pelo mercado. Calculou-se, então, os Erro Quadrático Médio (EQM) e o Erro Absoluto Médio (EAM) e com o auxílio dos testes de diagnósticos e igualdade de variância, escolheu-se a forma funcional que melhor se adequou aos dados Desta forma, para um nível de significância de 5%, a forma funcional que melhor se adequou aos critérios estabelecidos foi a dupla logarítmica e apresentou como resultado da estimação um R2=92,63% e dentre as características mais relevantes para estimação do preço do imóvel pode-se destacar, entre outras, o tamanho do imóvel como características físicas; a ocorrência de roubos como características de segurança, a quantidade disponível de bens e serviços destinados ao lazer como características de vizinhança e a disponibilidade ou não de serviços de hotelaria como características dummies.

Turismo cultural no Rio de Janeiro: um ponto de vista a partir do Theatro Municipal do Rio de Janeiro

Esta dissertação apresenta uma leitura do turismo cultural na cidade do Rio de Janeiro a partir da análise da visitação de um equipamento cultural o Theatro Municipal do Rio de Janeiro. Por meio de entrevistas realizadas com atores sociais envolvidos no turismo e na culturalocal, e da aplicação e análise de uma pesquisa de perfil junto aos turistas que visitaram o teatro, pretendeu-se abordar a oportunidade e a necessidade da implantação de ações públicas e privadas para o desenvolvimento do segmento de turismo cultural como uma forma de expansão do mercado turístico.

Com a palavra, Sua Excelência, o Vereador: Projeto de implantação de Programa de História Oral na Câmara Municipal do Rio de Janeiro

O presente trabalho tem por objetivo a implantação de um Programa de História Oral na Câmara Municipal do Rio de Janeiro, com a constituição de um acervo de entrevistas gravadas sobre a história do Legislativo do novo município formado com a fusão dos antigos estados da Guanabara e Rio de Janeiro, em 1975.Esse acervo servirá não só como fonte de informação sobre o papel da Câmara Municipal na história da cidade, a trajetória de seus vereadores e a lógica do processo legislativo, mas também como importante ferramenta de preservação e divulgação do passado e da memória da instituição.

O planejamento estratégico como instrumento de gestão em cenários complexos: um estudo sobre os planos estratégicos do Rio de Janeiro e de Barcelona

O presente trabalho se configura como um estudo exploratório sobre os condicionantes que permitiram a adoção e a perpetuação do processo de planificação das cidades do Rio de Janeiro e de Barcelona. Foram verificados os condicionantes políticos, históricos e sociais, e a gestão de políticas pública. Dentro desta análise, procurou-se desvendar a visão dos agentes envolvidos na concepção dos planos estratégicos instituídos nas duas cidades, observando o que sustentou ao longo do tempo os seus planejamentos e de que forma estes se configuraram. Para tal, utilizaram-se pesquisa documental, bibliográfica, conjuntamente com entrevistas em profundidade semi-estrutradas com agentes envolvidos diretamente na concepção dos planos estratégicos das duas cidades. A partir daí, geraram-se as categorias para a análise do material, que foi analisado por meio da técnica de análise de conteúdo. Concluiu-se ao final que o condicionante que mais influenciou na adoção e na perpetuação do método de planificação em Barcelona foi o condicionante institucional, e no Rio de Janeiro foi o condicionante político.

Juizados Especiais Criminias da Comarca da Capital do Estado do RIo de janeiro: Desafios organizacionais

The Judicial Authority has more and more prominence for the principal place on the public discussion. His role performed as political institution and agency in charged of the jurisdiction installment has been object of discussion. Frequently diagnostics are made about a crisis that include the Judicial System. At the same way are made diverse changes, searching transform from formalities until the ritual of fill a job of Judge. We¿re certainly, by this point of view, far from the period that the judicial questions were corresponded to jurisconsult. The discussion has increased, calling to order not only jurisconsult but also members of Congress, press and of the civil organisms. Thus international organisms, despite their economic issues, entered at the discussion being watchful to the emergency reforms to be taken by the Judicial Authority. However, although the changes end the relative agreement of the emerging crisis, the Judicial System continue to be unknown. Still now with the beginning of the Juizados Especiais Criminais, the organizational form originated in 1995. The main core of the discussion about Juizados Especiais Criminais is centralized in isolated cases instead of a global analysis, resulting of the join between data and observations about historic series. The final object of this dissertation is centered on the analysis of the activities of the organizational variables of the Juizados Especiais Criminais da Comarca da Capital do Estado do Rio de Janeiro in its first years of functioning.