O acesso ao tratamento em saúde Mental na microregião de Itajubá/MG-Brasil

RESUMO: A integração da saúde mental à atenção básica é a recomendação feita para facilitar o acesso ao tratamento. A pesquisa teve por objetivo mapear e analisar os facilitadores e as barreiras ao acesso ao tratamento em saúde mental da Microrregião de Itajubá, estado de Minas Gerais, Brasil, composta por 15 municípios. A metodologia pautou-se na triangulação dos métodos, combinando a abordagem quantitativa e qualitativa de pesquisa. Para tal foi feito o mapeamento da capacidade instalada dos recursos existentes e identificação das principais lacunas com base nos parâmetros da saúde pública, a partir de roteiros de entrevistas e grupos focais com os principais atores sociais implicados. Constatou-se que o maior facilitador ao acesso ao tratamento tem sido a atuação das equipes de PSF (Programa Saúde da Família), que atuam diretamente nas comunidades. Outros facilitadores foram: a atuação dos CRAS (Centro de Referência de Assistência Social); a existência de um CAPS (Centro de Atenção Psicossocial), embora não credenciado ao SUS (Sistema Único de Saúde); Colegiados de Saúde Mental que promovem discussões, informação, educação, e pressionam os municípios para a implantação de serviços de saúde mental. A falta de “vontade política”, isto é, uma intervenção mais clara da gestão pública da saúde, com estabelecimento de prioridades para prover a ampliação do acesso, foi identificada como a maior barreira a ser enfrentada na microrregião, especialmente por falta de organização e planejamento das ações em saúde mental. Serviços que trabalham de forma isolada, sem a construção de uma rede; pouca participação política dos usuários dos serviços de saúde mental; e falta de recursos humanos, e profissionais pouco preparados para a função compõem as outras barreiras de acesso. Vê-se que diante dos facilitadores e barreiras expostos é preciso que os municípios realizem um levantamento sistemático, a fim de criar um plano de ação em saúde mental para compartilhar informações, recursos, serviços, disponibilidade, disposição e ações em rede.-------------- ABSTRACT: Integrating mental health care in primary-care services is recommended in order to improve access to treatment. Access to mental health treatment has been a worldwide debated theme. In Brazil, with the Psychiatric Reform, there has been a change of paradigm in the way of treating persons with mental disorders. Various health devices were created, building a net of treatment and care that replaces the asylum system and where human rights are respected and defended and the offered treatment is the closest possible to their social space. The research aims to map and analyse the barriers and the facilitators to mental health treatment in the micro-region of Itajubá, state of Minas Gerais/Brazil, made up of 15 counties. The methodology was based on the triangulation of methods, combining quantitative and qualitative research. For that, a mapping of the installed capacity of the existent resource was carried out; identification of the main voids based on the parameters of public health through scripts of interviews and focus groups with the social actors involved. It was found that the main facilitator to treatment has been the performance of PSF, who act directly in the communities. Other facilitators also stand out: the work of CRAS; the existence of CAPS, although not accredited to SUS; Mental Health Collegiate, promoting discussions, information, education, and forcing pressure on the counties for the implantation of mental health services. The lack of political will was identified as the major barrier to be faced in the micro-region, especially due to lack of organization and planning in the actions towards mental health. The services working isolatedly, without a communication net, and the lack of human resources as well as poorly prepared professional, are the main difficulties faced by access to mental health treatment. Becomes clear that the counties need to undertake a systematic survey towards creating a plan of action in mental health, in order to share information, resources, services, availability, disposition and networking.

Caracterização dos beneficiários do Programa De volta para casa de Belo Horizonte/MG/Brasil quanto à autonomia e comportamento social

RESUMO: INTRODUÇÃO E OBJETIVOS: Trata-se de estudo transversal descritivo, em etapa única, cujo objetivo foi traçar o perfil dos beneficiários do Programa De volta para casa (PVC), munícipes de Belo Horizonte / Minas Gerais / Brasil, quanto ás habilidades de vida independente (autonomia) e comportamento social. MÉTODO: O universo inicial de beneficiários era de 210, em julho de 2013, data de aprovação do protocolo. Por questões operacionais, o público-alvo considerado e estudado foi de 121 beneficiários. Foram utilizados como instrumentos as escalas Independent Living Skills Survey (ILSS) e Social Behavior Scale (SBS). Foi feita a análise estatística dos dados e os resultados foram analisados à luz do paradigma emergente de produção social da saúde. RESULTADOS: Considerando o total válido estudado de 121 beneficiários, os resultados revelaram que 82,4% apresentam diagnóstico de esquizofrenia e 62% eram do sexo masculino. Apresentaram média de idade de 57,9 anos e tempo médio de internação psiquiátrica antes de inserção no programa de 30,9 anos. Quanto à autonomia, os resultados da ILSS revelaram uma média global de 1,6 sendo que os melhores índices foram alcançados nos subitens Cuidados pessoais (2,69), Alimentação (2,53), Saúde (2,07) e os piores índices foram encontrados nos subitens Emprego (0,47), Lazer (0,86) e Preparo e armazenamento de alimentos (0,98). Quanto aos problemas no comportamento social, os resultados da SBS revelaram uma média global de 0,69 sendo que as áreas de maiores dificuldade foram: Rir ou falar sozinho (40,5%), Incoerência da fala (29%), Auto-cuidado precário e Pouca atividade (ambas com 25,6% cada). As áreas de menores dificuldades, ainda quanto à SBS, foram: Idéias suicidas 92,4%), Comportamento sexual inapropriado (7,4%) e Depressão (9,9%). CONCLUSÃO: Concluiu-se que o perfil dos beneficiários do PVC, quanto à autonomia e aos problemas de comportamento social, aponta para médias relativamente baixas. O desafio para o enfrentamento desta questão deverá considerar estratégias múltiplas de ação à luz do paradigma emergente de saúde e da reabilitação psicossocial que priorize o empoderamento e protagonismo do beneficiário. É necessário o desenvolvimento de outros estudos que ampliem o evidenciamento desta clientela no que tange às suas reais necessidades e potencialidades para que se possa efetivar o ajuste necessário para a legitimação do programa enquanto ação efetivo-eficaz de promoção de saúde.-------------ABSTRACT: descriptive cross-sectional study in a single stage was conducted to investigate independent living skills and social behavior profile of beneficiaries of Programa De Volta para casa (PVC) who live in Belo Horizonte/Minas Gerais/Brazil. METHODS: The target population included a total of 210 individuals in july 2013, when the study was approved by the ethics committees. Because of operational reasons only 121 individuals were evaluated. Data were collected using the Independent Living Skills Survey (ILSS) and the Social Behavior Scale (SBS). Statistical results were analyzed considering as a reference framework both the emerging paradigm of social health production. RESULTS: Considering a sample of 121 individuals, results revealed that 82.4% were diagnosed with schizophrenia, and 62% were male. The mean age was 57.9 years and the mean stay in the psychiatric hospital prior to PVC was 30.9 years. Independent living skills measured by ILSS revealed a global mean of 1.6, and the best scores were in the following subscales: personal care (2.69), feeding (2.53) and health (2.07). On the other hand, the worst scores were in the following subscales: employment (0.47), leisure (0.86) and food preparation (0.98). Impairment of social functioning measured by SBS revealed a global mean of 0.69, and the best scores were in the following subscales: laughing and talking by itself (40.5%), conversation: incoherence (29%), appearance and personal hygiene (25.6%), and idleness (25.6%). The worst scores were in the following subscales: suicidal ideations (92.4%), improper sexual behavior (7.4%), and depression (9.9%). CONCLUSION: It was concluded that the profile of PVC beneficiaries, regarding their autonomy and their problems of social behavior, points to a relatively low average. The challenge of facing this issue should consider multiple strategies of intervention that prioritizes the empowerment and leadership of the beneficiaries, based on the emerging paradigm of health and psychosocial rehabilitation as a reference framework. The development of other studies that expand the evidencing of this target population with respect to their real needs and capabilities in order to carry out the necessary adjustments for the legitimacy of the program as effective health promotion action is required.

Damage propagation in composite Materials meso-mechanical models

Composite materials have a complex behavior, which is difficult to predict under different types of loads. In the course of this dissertation a methodology was developed to predict failure and damage propagation of composite material specimens. This methodology uses finite element numerical models created with Ansys and Matlab softwares. The methodology is able to perform an incremental-iterative analysis, which increases, gradually, the load applied to the specimen. Several structural failure phenomena are considered, such as fiber and/or matrix failure, delamination or shear plasticity. Failure criteria based on element stresses were implemented and a procedure to reduce the stiffness of the failed elements was prepared. The material used in this dissertation consist of a spread tow carbon fabric with a 0°/90° arrangement and the main numerical model analyzed is a 26-plies specimen under compression loads. Numerical results were compared with the results of specimens tested experimentally, whose mechanical properties are unknown, knowing only the geometry of the specimen. The material properties of the numerical model were adjusted in the course of this dissertation, in order to find the lowest difference between the numerical and experimental results with an error lower than 5% (it was performed the numerical model identification based on the experimental results).

A FEM-based model to study the behaviour of corroded RC beams shear repaired by NSM CFRP rods technique

This paper presents the main features of finite element FE numerical model developed using the computer code FEMIX to predict the near-surface mounted NSM carbon-fiber-reinforced polymer CFRP rods shear repair contribution to corroded reinforced concrete RC beams. In the RC beams shear repaired with NSM technique, the Carbon Fibre Reinforced Polymer (CFRP) rods are placed inside pre-cut grooves onto the concrete cover of the RC beam’s lateral faces and are bonded to the concrete with high epoxy adhesive. Experimental and 3D numerical modelling results are presented in this paper in terms of load-deflection curves, and failure modes for 4 short corroded beams: two corroded beams (A1CL3-B and A1CL3-SB) and two control beams (A1T-B and A1T-SB), the beams noted with B were let repaired in bending only with NSM CFRP rods while the ones noted with SB were repaired in both bending and shear with NSM technique. The corrosion of the tensile steel bars and its effect on the shear capacity of the RC beams was discussed. Results showed that the FE model was able to capture the main aspects of the experimental load-deflection curves of the RC beams, moreover it has presented the experimental failure modes and FE numerical modelling crack patterns and both gave similar results for non-shear repaired beams which failed in diagonal tension mode of failure and for shear-repaired beams which failed due to large flexural crack at the middle of the beams along with the concrete crushing, three dimensional crack patterns were produced for shear-repaired beams in order to investigate the splitting cracks occurred at the middle of the beams and near the support.

A FEM-based model to study the behaviour of corroded RC beams shear repaired by NSM CFRP rods technique

This paper presents the main features of finite element FE numerical model developed using the computer code FEMIX to predict the near-surface mounted NSM carbon-fiber-reinforced polymer CFRP rods shear repair contribution to corroded reinforced concrete RC beams. In the RC beams shear repaired with NSM technique, the Carbon Fibre Reinforced Polymer (CFRP) rods are placed inside pre-cut grooves onto the concrete cover of the RC beam’s lateral faces and are bonded to the concrete with high epoxy adhesive. Experimental and 3D numerical modelling results are presented in this paper in terms of load-deflection curves, failure modes and slip information of the tensile steel bars for 4 short corroded beams: two corroded beams (A1CL3-B and A1CL3-SB) and two control beams (A1T-B and A1T-SB), the beams noted with B were let repaired in bending only with NSM CFRP rods while the ones noted with SB were repaired in both bending and shear with NSM technique. The corrosion of the tensile steel bars and its effect on the shear capacity of the RC beams was discussed. Results showed that the FE model was able to capture the main aspects of the experimental load-deflection curves of the RC beams, moreover it has presented the experimental failure modes and FE numerical modelling crack patterns and both gave similar results for non-shear repaired beams which failed in diagonal tension mode of failure and for shear-repaired beams which failed due to large flexural crack at the middle of the beams along with the concrete crushing, three dimensional crack patterns were produced for shear-repaired beams in order to investigate the splitting cracks occurred at the middle of the beams and near the support.

Shear strengthening of damaged reinforced concrete beams with hybrid composite plates

This paper aims to evaluate experimentally the potentialities of Hybrid Composite Plates (HCPs) technique for the shear strengthening of reinforced concrete (RC) beams that were previously subjected to intense damage in shear. HCP is a thin plate of Strain Hardening Cementitious Composite (SHCC) reinforced with Carbon Fiber Reinforced Polymer (CFRP) laminates. For this purpose, an experimental program composed of two series of beams (rectangular and T cross section) was executed to assess the strengthening efficiency of this technique. In the first step of this experimental program, the control beams, without steel stirrups, were loaded up to their shear failure, and fully unloaded. Then, these pre-damaged beams were shear strengthened by applying HCPs to their lateral faces by using a combination of epoxy adhesive and mechanical anchors. The bolts were applied with a certain torque in order to increase the concrete confinement. The obtained results showed that the increase of load carrying capacity of the damaged strengthened beams when HCPs were applied with epoxy adhesive and mechanical anchors was 2 and 2.5 times of the load carrying capacity of the corresponding reference beams (without HCPs) for the rectangular and T cross section beam series, respectively. To further explore the potentialities of the HCPs technique for the shear strengthening, the experimental tests were simulated using an advanced numerical model by a FEM-based computer program. After demonstration the good predictive performance of the numerical model, a parametric study was executed to highlight the influence of SHCC as an alternative for mortar, as well as the influence of torque level applied to the mechanical anchors, on the load carrying capacity of beams strengthened with the proposed technique.

Evaluation of the performance of recycled textile fibres in the mechanical behaviour of a gypsum and cork composite material

Given the need for using more sustainable constructive solutions, an innovative composite material based on a combination of distinct industrial by-products is proposed aiming to reduce waste and energy consumption in the production of construction materials. The raw materials are thermal activated flue-gas desulphurization (FGD) gypsum, which acts as a binder, granulated cork as the aggregate and recycled textile fibres from used tyres intended to reinforce the material. This paper presents the results of the design of the composite mortar mixes, the characterization of the key physical properties (density, porosity and ultrasonic pulse velocity) and the mechanical validation based on uniaxial compressive tests and fracture energy tests. In the experimental campaign, the influence of the percentage of the raw materials in terms of gypsum mass, on the mechanical properties of the composite material was assessed. It was observed that the percentage of granulated cork decreases the compressive strength of the composite material but contributes to the increase in the compressive fracture energy. Besides, the recycled textile fibres play an important role in the mode I fracture process and in the fracture energy of the composite material, resulting in a considerable increase in the mode I fracture energy.

High performance electromechanical actuators based on ionic liquid/poly(vinylidene fluoride)

Due to the increasing need of low voltage actuators, independent from electrochemical processes, electroactive actuators based on poly(vinylidene fluoride) composites with 10, 25 and 40 % of 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide, [C2mim] [NTf2], ionic liquid are prepared by solvent casting and melting. We show that the charge structure of [C2mim] [NTf2] induces the complete piezoelectric -phase crystallization of the PVDF within the composite and decreases its crystallinity fraction significantly. [C2mim] [NTf2] also works as a plasticizer of PVDF, reducing the elastic modulus down to 12 % of the initial value. Moreover, the composites show significant displacement and bending under applied voltages of 2, 5 and 10 Vpp. The displacement and bending of the composite membranes are also evaluated as a function of [C2mim] [NTf2] content and sample thickness. Increasing amounts of ionic liquid result in larger deformations independently of the applied voltage.

High-temperature polymer based magnetoelectric nanocomposites

The use of polymer based magnetoelectric materials for sensing and actuation applications has been the subject of increasing scientific and technological interest. One of the drawbacks to be overcome in this field is to increase the temperature range of application above 100 ºC. In this way, a nanocomposite material composed by a mixture of two aromatic diamines, 1,3-Bis-2-cyano-3-(3 aminophenoxy)phenoxybenzene (diamine 2CN) and 1,3-Bis(3-aminophenoxy)benzene (diamine 0CN) and CoFe2O4 (CFO) nanoparticles was designed, fabricated and successfully tested for high temperature magnetoelectric applications. Results revealed that CFO nanoparticles are well distributed within the 0CN2CN polymer matrix and that the addition of CFO nanoparticles does not significantly alter the polyimides structure. The magnetization response of the composite is determined by the CFO nanoparticle content. The piezoelectric response of the 0CN2CN polymer matrix (≈11 pC.N-1) and the maximum α33 value (0.8mV.cm-1.Oe-1) are stable over time and decrease only when the composite is subjected to temperatures above 130 ºC. Strategies to further improve the ME response are also discussed.

One-step in situ synthesis of polyamide microcapsules with inorganic payload and their transformation into responsive thermoplastic composite materials

Well-dispersed loads of finely powdered metals, metal oxides, several carbon allotropes or nanoclays are incorporated into highly porous polyamide 6 microcapsules in controllable amounts via an original one-step in situ fabrication technique. It is based on activated anionic polymerization (AAP) of ε-caprolactam in a hydrocarbon solvent performed in the presence of the respective micro- or nanosized loads. The forming microcapsules with typical diameters of 25-50 µm entrap up to 40 wt% of load. Their melt processing produces hybrid thermoplastic composites. Mechanical, electric conductivity and magnetic response measurements show that transforming of in situ loaded microcapsules into composites by melt processing (MP) is a facile and rapid method to fabricate materials with high mechanical resistance and electro-magnetic characteristics sufficient for many industrial applications. This novel concept requires low polymerization temperatures, no functionalization or compatibilization of the loads and it is easy to scale up at industrial production levels.

Mechanical, fatigue and wear properties of sintered Carbon Nanotube-based functionally graded materials

Tese de Doutoramento Engenharia Mecânica

Protein-based nanodevices for therapeutic applications

Tese de Doutoramento em Biologia Molecular e Ambiental (área de especialização em Biologia Celular e Saúde).

Development of hybrid composite plate (HCP) for strengthening and repair of RC structures

Tese de Doutoramento em Engenharia Civil

Influence of chitosan coating on protein-based nanohydrogels properties and in vitro gastric digestibility

Chitosan coating was applied in Lactoferrin (Lf)-Glycomacropeptide (GMP) nanohydrogels by layer-by-layer coating process. A volume ratio of 0.1 of Lf-GMP nanohydrogels (0.2 mg.mL-1, at pH 5.0) to chitosan (1 mg.mL-1, at pH 3) demonstrated to be the optimal condition to obtain stable nanohydrogels with size of 230 ± 12 nm, a PdI of 0.22 ± 0.02 and a -potential of 30.0 ± 0.15 mV. Transmission electron microscopy (TEM) images showed that the application of chitosan coating in Lf-GMP did not affect the spherical shape of nanohydrogels and confirmed the low aggregation of nanohydrogels in solution. The analysis of chemical interactions between chitosan and Lf-GMP nanohydrogels were performed by Fourier transform infrared spectroscopy (FTIR) and by circular dichroism (CD) that revealed that a specific chemical interaction occurring between functional groups of protein-based nanohydrogels and active groups of the chitosan was established. The effect of chitosan coating on release mechanisms of Lf-GMP nanohydrogels at acid conditions (pH 2, 37 ºC) was evaluated by the encapsulation of a model compound (caffeine) in these systems. Linear Superposition Model was used to fit the experimental data and revealed that Fick and relaxation mechanisms are involved in caffeine release. It was also observed that the Fick contribution increase with the application of chitosan coating. In vitro gastric digestion was performed with Lf-GMP nanohydrogels and Lf-GMP nanohydrogels with chitosan coating and it was observed that the presence of chitosan improve the stability of Lf and GMP (proteins were hydrolysed at a slower rate and were present in solution by longer time). Native electrophoreses revealed that the nanohydrogels without coating remained intact in solution until 15 min and with chitosan coating remained intact until 60 min, during gastric digestion.

Zeolite-based nanomaterials for the control of opportunistic pathogenic microorganisms

Dissertação de mestrado em Applied Biochemistry (área de especialização em Biomedicine)