Estigma e percepções dos médicos de Clínica Geral sobre a doença mental e o suicídio

RESUMO: INTRODUÇÃO: A OMS (2001) revela que cerca de 450 milhões de pessoas sofrem de perturbações mentais ou comportamentais em todo o mundo, mas apenas uma pequena minoria tem tratamento, ainda que elementar. Transformam-se em vítimas por causa da sua doença e convertem-se em alvos de estigma e discriminação. O suicídio é considerado como um grande problema de saúde pública em todo o mundo, é uma das principais causas de morte de jovens adultos e situa-se entre as três maiores causas de morte na população entre 15-34 anos (OMS, 2001). As perturbações mentais aumentam o risco de suicídio. A depressão, esquizofrenia, e a utilização de substâncias incrementam o risco de suicídio. Estudos (Sartorius, 2002; Magliano et al., 2012) mostram que os profissionais de saúde, tal como o público em geral, podem ter atitudes negativas e estigma em relação às pessoas com perturbações mentais, podendo agir em conformidade, uma vez feito e conhecido o diagnóstico psiquiátrico. Os clínicos gerais são os receptores das perturbações mentais e tentativas de suicídio nas principais portas de entrada no acesso a cuidados de saúde. As crenças, conhecimentos e contacto com a doença mental e o suicídio, podem influenciar a atenção clínica. OBJECTIVOS: Avaliar o estigma e as percepções dos médicos de clínica geral em relação às tentativas de suicídio, o suicídio e perturbações mentais bem como os possíveis factores associados a estes fenómenos. MATERIAIS E MÉTODOS: Estudo do tipo transversal, combinando métodos quantitativos e qualitativos. A amostra é constituída por 125 sujeitos, médicos de clínica geral. Utilizaram-se as versões adaptadas dos seguintes instrumentos: Questionário sobre Percepções e Estigma em Relação à Saúde Mental e ao Suicídio (Liz Macmin e SOQ, Domino, 2005) e a Escala de Atitudes sobre a Doença Mental (Amanha Hahn, 2002). Para o tratamento estatístico dos dados usou-se a estatística 1) descritiva e 2) Análise estatística das hipóteses formuladas (Qui Quadrado - 2) a correlação entre variáveis (Spearman: ρ, rho). Os dados conectados foram limpos de inconsistências com base no pacote informático e estatístico SPSS versão 20. Para a aferição da consistência interna foi usado o teste de Alfa de Cronbach. RESULTADOS: Uma boa parte da amostra (46.4%) refere que não teve formação formal ou informal em saúde mental e (69.35%) rejeitam a ideia de que “grupos profissionais como médicos, dentistas e psicólogos são mais susceptíveis a cometer o suicídio”. Já (28.0%) têm uma perspectiva pessimista quanto a possibilidade de recuperação total dos sujeitos com perturbação mental. Sessenta e oito(54.4%) associa sujeitos com perturbação mental, a comportamentos estranhos e imprevisíveis, 115 (92.0%) a um baixo QI e 35 (26.7%) a poderem ser violentas e e perigosas. Os dados mostram uma associação estatisticamente significativa (p0.001) entre as variáveis: tempo de serviço no SNS, recear estar perto de sujeitos com doença mental e achar que os sujeitos com doença mental são mais perigosos que outros. Em termos estatísticos, existe uma associação estatitisticamente significativa entre as duas variáveis(X2=9,522; p0.05): percepção de que “é vergonhoso ter uma doença mental” e os conhecimentos em relação à doença mental. Existe uma correlação positiva, fraca e estatisticamente significativa entre os conhecimentos dos clínicos gerais(beneficiar-se de formação em saúde mental) e a percepção sobre os factores de risco (0,187; P0,039). DISCUSSÃO E CONCLUSÕES: A falta de conhecimento sobre as causas e factores de risco para os comportamentos suicidários, opções de intervenção e tratamento, particularmente no âmbito da doença mental, podem limitar a procura de ajuda individual ou dos próximos. Percepções negativas como o facto de não merecerem prioridade nos serviços, mitos (frágeis e cobarde, sempre impulsivo, chamadas de atenção, problemas espirituais) podem constituir-se como um indicador de que os clínicos gerais podem sofrer do mesmo sistema de estigma e crenças, de que sofre o público em geral, podendo agir em conformidade (atitudes de afastamento ereceio). As atitudes são influenciadas por factores como a formação, cultura e sistema de crenças. Sujeitos com boa formação na área da saúde mental têm uma percepção positiva e optimista sobre os factores de risco e uma atitude positiva em relação aos sujeitos com doença mental e comportamentos suicidários.-------------ABSTRACT: INTRODUCTION: The WHO (2001) reveals that about 450 million people suffer from mental or behavioral disorders worldwide, but only a small minority have access to treatment, though elementary. They become victims because of their disease and they become the targets of stigma and discrimination. Suicide is seen as a major public health problem worldwide, is a leading cause of death for young adults and is included among the three major causes of death in the population aged 15-34 years (WHO, 2001). Mental disorders increase the risk of suicide. Depression, schizophrenia, and the substances misuse increase the risk of suicide. Studies (Sartorius, 2002; Magliano et al, 2012) show that health professionals, such as the general public, may have negative attitudes and stigma towards people with mental disorders, and can act accordingly after psychiatric diagnosis is known. General practitioners are the main entry points of mental disorders and suicide attempts in the health sistem. Beliefs, knowledge and contact with mental illness and suicide, may influence clinical care. OBJECTIVES: To assess stigma and perceptions of general practitioners in relation to suicide attempts, suicide and mental disorders as well as possible factors associated with these phenomena. MATERIAL AND METHODS: This was a descriptive cross-sectional study, combining quantitative and qualitative methods. The sample consisted of 125 subjects, general practitioners. We used adapted versions of the following instruments: Questionnaire of Perceptions and Stigma in Relation to Mental Health and Suicide (Liz Macmin and SOQ, Domino, 2005) and the Scale of Attitudes on Mental Illness (Tomorrow Hahn, 2002). For the statistical treatment of the data we used: 1) descriptive (Data distribution by absolute and relative frequencies for each of the variables under study (including mean and standard deviation measures of central tendency and deviation), 2) statistical analysis of hypotheses using (Chi Square - 2, a hypothesis test that is intended to find a value of dispersion for two nominal variables, evaluating the association between qualitative variables) and the correlation between variables (Spearman ρ, rho), a measure of non-parametric correlation, which evaluates an arbitrary monotonic function can be the description of the relationship between two variables, without making any assumptions about the frequency distribution of the variables). For statistical analysis of the correlations were eliminated subjects who did not respond to questions. The collected data were cleaned for inconsistencies based on computer and statistical package SPSS version 20. To measure the internal consistency was used the Cronbach's alpha test. RESULTS: A significant part of the sample 64 (46.4%) reported no formal or informal training in mental health and 86 (69.35%) reject the idea that "professional groups such as doctors, dentists and psychologists are more likely to commit suicide." On the other hand, 42 (28.0%) have a pessimistic view of the possibility of full recovery of individuals with mental disorder. Sixty-eight ( 54.4 % ) of them associates subjects with mental disorder to strange and unpredictable behavior, 115 ( 92.0 % ), to low IQ, 35 ( 26.7 % ) and even to violent and dangerous behavior, 78 ( 62.4 % ) The data show a statistically significant (p = 0.001) relationship between the following variables: length of service in the NHS, fear of being close to individuals with mental illness and considering individuals with mental illness more dangerous than others. In statistical terms, there is a dependency between the two variables (X2 = 9.522, p> 0.05): the perception that "it is shameful to have a mental illness" and knowledge regarding mental illness. There is a positive and statistically significant weak correlation between knowledge of general practitioners (benefit from mental health training) and the perception of the risk factors (0,187; P0,039). DISCUSSION AND CONCLUSIONS: The lack of knowledge about the causes and risk factors for suicidal behavior, intervention and treatment, particularly in the context of mental illness options, may decreaseseeking for help by individual and their relatives. Negative perceptions such as considering that they dont deserve priority in services, myths (weak and cowards, always impulsive, seeking for attentions, spirituals problems) may indicate that general practitioners, may suffer the same stigma and beliefs systems as the general public, and can act accordingly (withdrawal and fear attitudes). Attitudes are influenced by factors such as education, culture and belief system. Subjects with good training in mental health have a positive and optimistic perception of the risk factors and a positiveattitude towards individuals with mental illness and suicidal behaviour.

Da intercepção de comunicações, acções encobertas e serviços de informações

The Portuguese Intelligence Services have their operational skills limited due to the grievances caused by the Dictatorship and, in particular, by its political police. With the help of historical elements, and by analyzing current legislation, we demonstrate that such grievances are today unjustified and misplaced, mainly taking into account the Risk Society’s multifaceted threats. Also part of our analysis is the impugnment of the Constitutional Court’s decision nº 413/2015, which pronounced unconstitutional the norm contained in Decree nº 426/XII, of the Republic’s Assembly, article nº 78, nº2, which intended to allow Intelligence Services access to the so-called “metadata”, as well as to tax and banking information. It is our understanding, and we demonstrate it in our dissertation, that should be allowed the access of, not only the above mentioned information, but also the means known as communications interception and undercover operations to the Intelligence Services, as long as properly supervised and inspected.

Real-Time Automatic Object Classification and Tracking using Genetic Programming and NVIDIA R CUDA TM

Genetic Programming (GP) is a widely used methodology for solving various computational problems. GP's problem solving ability is usually hindered by its long execution times. In this thesis, GP is applied toward real-time computer vision. In particular, object classification and tracking using a parallel GP system is discussed. First, a study of suitable GP languages for object classification is presented. Two main GP approaches for visual pattern classification, namely the block-classifiers and the pixel-classifiers, were studied. Results showed that the pixel-classifiers generally performed better. Using these results, a suitable language was selected for the real-time implementation. Synthetic video data was used in the experiments. The goal of the experiments was to evolve a unique classifier for each texture pattern that existed in the video. The experiments revealed that the system was capable of correctly tracking the textures in the video. The performance of the system was on-par with real-time requirements.

HG 78.45-78.55

Coarse sediment with grains ranging from small to large . Clast shape ranges from sub-angular to sub-rounded. Grain crushing is common throughout the sample, with many grains being crushed into one another. A few lineations and rotation structures can also be seen throughout.

Barnes Wines, Limited By-Law No. 78

The summary of the By-Law reads: "A By-Law to authorize the setting aside of certain monies annually out of the net profits of the Company before payment of dominion and provincial income taxes and provincial corporation tax to be paid to a trustee for distribution to the employees and officers of the Company and to authorize the execution of an agreement with a trustee to effect such purpose."

License no. 7 of season 1877/78 made out to S.D. Woodruff for 35 ¾ square miles in berth no. 198

License no. 7 of season 1877/78 made out to S.D. Woodruff for 35 ¾ square miles in berth no. 198, May 31, 1877.

License no. 6 of season 1877/78 made out to S.D. Woodruff for 36 square miles in berth no.192

License no. 6 of season 1877/78 made out to S.D. Woodruff for 36 square miles in berth no.192, May 31, 1877.

Fractura de cadera subtrocantéricas e intertrocantéricas y los antecedentes personales no patológicos de mujeres de 50-78 años de edad en un hospital de 3er. nivel del área metropolitana de Monterrey, enero 1999 a enero 2000

Tesis (Maestría en Salud Pública con Especialidad en Salud en el Trabajo) UANL.

La reelección del presidente de la república y gobernadores de los estados : memorándum acerca de la reforma de los artículos 78 y 109 de la constitución mexicana

UANL

La reelección del Presidente: Boceto político con motivo de la iniciativa de reforma de los Artículos 78 y 109 de la Constitución Federal, presentada a la Cámara de Diputados en la sesión del día 4 del actual, proponiendo la reelección del Presidente de la República

UANL

A Variational Calculation of TE and TM Cutoff Wavenumbers in Circular Eccentric Guides by Conformal Mapping

The cutoff wavenumbers of higher order modes in circular eccentric guides are computed with the variational analysis combined with a conformal mapping. A conformal mapping is applied to the variational formulation, and the variational equation is solved by the finite-element method. Numerical results for TE and TM cutoff wavenumbers are presented for different distances between the centers and ratio of the radii. Comparisons with numerical results found in the literature validate the presented method

Magnetische Kopplungen in magneto-optischen Speicherschichten

Im Rahmen dieser Arbeit wurden magneto-optische Speicherschichten und ihre Kopplungen untereinander untersucht. Hierzu wurden zum Einen die für die magneto-optische Speichertechnologie "klassischen" Schichten aus RE/TM-Legierungen verwendet, zum Anderen aber auch erfolgreich Granate integriert, die bisher nicht in diesem Anwendungsgebiet verwendet wurden. Einleitend werden die magneto-optischen Verfahren, die resultierenden Anforderungen an die dünnen Schichten und die entsprechenden physikalischen Grundlagen diskutiert. Außerdem wird auf das Hochfrequenz-Sputtern von RE/TM-Legierungen eingegangen und die verwendeten magneto-optischen Messverfahren werden erläutert [Kap. 2 & 3]. Die Untersuchungen an RE/TM-Schichten bestätigen die aus der Literatur bekannten Eigenschaften. Sie lassen sich effektiv, und für magneto-optische Anwendungen geeignet, über RF-Sputtern herstellen. Die unmittelbaren Schicht-Parameter, wie Schichtdicke und Terbium-Konzentration, lassen sich über einfache Zusammenhänge einstellen. Da die Terbium-Konzentration eine Änderung der Kompensationstemperatur bewirkt, lässt sich diese mit Messungen am Kerr-Magnetometer überprüfen. Die für die Anwendung interessante senkrechte magnetische Anisotropie konnte ebenfalls mit den Herstellungsbedingungen verknüpft werden. Bei der Herstellung der Schichten auf einer glatten Glas-Oberfläche (Floatglas) zeigt die RE/TM-Schicht bereits in den ersten Lagen ein Wachstumsverhalten, das eine senkrechte Anisotropie bewirkt. Auf einer Quarzglas- oder Keramik-Oberfläche wachsen die ersten Lagen in einer durch das Substrat induzierten Struktur auf, danach ändert sich das Wachstumsverhalten stetig, bis eine senkrechte Anisotropie erreicht wird. Dieses Verhalten kann auch durch verschiedene Pufferschichten (Aluminium und Siliziumnitrid) nur unwesentlich beeinflusst werden [Kap. 5 & Kap. 6]. Bei der direkten Aufbringung von Doppelschichten, bestehend aus einer Auslese-Schicht (GdFeCo) auf einer Speicherschicht (TbFeCo), wurde die Austausch-Kopplung demonstriert. Die Ausleseschicht zeigt unterhalb der Kompensationstemperatur keine Kopplung an die Speicherschicht, während oberhalb der Kompensationstemperatur eine direkte Kopplung der Untergitter stattfindet. Daraus ergibt sich das für den MSR-Effekt erwünschte Maskierungsverhalten. Die vorher aus den Einzelschichten gewonnen Ergebnisse zu Kompensationstemperatur und Wachstumsverhalten konnten in den Doppelschichten wiedergefunden werden. Als Idealfall erweist sich hier die einfachste Struktur. Man bringt die Speicherschicht auf Floatglas auf und bedeckt diese direkt mit der Ausleseschicht [Kap. 7]. Weiterhin konnte gezeigt werden, dass es möglich ist, den Faraday-Effekt einer Granatschicht als verstärkendes Element zu nutzen. Im anwendungstauglichen, integrierten Schichtsystem konnten die kostengünstig, mit dem Sol-Gel-Verfahren produzierten, Granate die strukturellen Anforderungen nicht erfüllen, da sich während der Herstellung Risse und Löcher gebildet haben. Bei der experimentellen Realisierung mit einer einkristallinen Granatschicht und einer RE/TM-Schicht konnte die prinzipielle Eignung des Schichtsystems demonstriert werden [Kap. 8].