HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil

OBJECTIVE: To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS: Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS: HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79). CONCLUSIONS: The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.

Stressful working conditions and poor self-rated health among financial services employees

OBJECTIVE: To assess the association between exposure to adverse psychosocial working conditions and poor self-rated health among bank employees. METHODS: A cross-sectional study including a sample of 2,054 employees of a government bank was conducted in 2008. Self-rated health was assessed by a single question: "In general, would you say your health is (...)." Exposure to adverse psychosocial working conditions was evaluated by the effort-reward imbalance model and the demand-control model. Information on other independent variables was obtained through a self-administered semi-structured questionnaire. A multiple logistic regression analysis was performed and odds ratio calculated to assess independent associations between adverse psychosocial working conditions and poor self-rated health. RESULTS: The overall prevalence of poor self-rated health was 9%, with no significant gender difference. Exposure to high demand and low control environment at work was associated with poor self-rated health. Employees with high effort-reward imbalance and overcommitment also reported poor self-rated health, with a dose-response relationship. Social support at work was inversely related to poor self-rated health, with a dose-response relationship. CONCLUSIONS: Exposure to adverse psychosocial work factors assessed based on the effort-reward imbalance model and the demand-control model is independently associated with poor self-rated health among the workers studied.

Effects of irregular-shift work and physical activity on cardiovascular risk factors in truck drivers

OBJECTIVE: To analyze the putative effect of type of shift and its interaction with leisure-time physical activity on cardiovascular risk factors in truck drivers.METHODS: A cross-sectional study was undertaken on 57 male truck drivers working at a transportation company, of whom 31 worked irregular shifts and 26 worked on the day-shift. Participants recorded their physical activity using the International Physical Activity Questionnaire along with measurements of blood pressure, body mass index and waist-hip ratio. Participants also provided a fasting blood sample for analysis of lipid-related outcomes. Data were analyzed using a factorial model which was covariate-controlled for age, smoking, work demand, control at work and social support.RESULTS: Most of the irregular-shift and day-shift workers worked more than 8 hours per day (67.7% and 73.1%, respectively). The mean duration of experience working the irregular schedule was 15.7 years. Day-shift workers had never engaged in irregular-shift work and had been working as a truck driver for 10.8 years on average. The irregular-shift drivers had lower work demand but less control compared to day-shift drivers (p < 0.05). Moderately-active irregular-shift workers had higher systolic and diastolic arterial pressures (143.7 and 93.2 mmHg, respectively) than moderately-active day-shift workers (116 and 73.3 mmHg, respectively) (p < 0.05) as well as higher total cholesterol concentrations (232.1 and 145 mg/dl, respectively) (p = 0.01). Irrespective of their physical activity, irregular-shift drivers had higher total cholesterol and LDL-cholesterol concentrations (211.8 and 135.7 mg/dl, respectively) than day-shift workers (161.9 and 96.7 mg/dl, respectively (ANCOVA, p < 0.05).CONCLUSIONS: Truck drivers are exposed to cardiovascular risk factors due to the characteristics of the job, such as high work demand, long working hours and time in this profession, regardless of shift type or leisure-time physical activity.

Depressive symptoms in institutionalized older adults

OBJECTIVE To estimate the prevalence of depressive symptoms among institutionalized elderly individuals and to analyze factors associated with this condition. METHODS This was a cross-sectional study involving 462 individuals aged 60 or older, residents in long stay institutions in four Brazilian municipalities. The dependent variable was assessed using the 15-item Geriatric Depression Scale. Poisson&#8217;s regression was used to evaluate associations with co-variables. We investigated which variables were most relevant in terms of presence of depressive symptoms within the studied context through factor analysis. RESULTS Prevalence of depressive symptoms was 48.7%. The variables associated with depressive symptoms were: regular/bad/very bad self-rated health; comorbidities; hospitalizations; and lack of friends in the institution. Five components accounted for 49.2% of total variance of the sample: functioning, social support, sensory deficiency, institutionalization and health conditions. In the factor analysis, functionality and social support were the components which explained a large part of observed variance. CONCLUSIONS A high prevalence of depressive symptoms, with significant variation in distribution, was observed. Such results emphasize the importance of health conditions and functioning for institutionalized older individuals developing depression. They also point to the importance of providing opportunities for interaction among institutionalized individuals.

Cross-cultural validity of the demand-control questionnaire: Swedish and Brazilian workers

OBJECTIVE To evaluate the cross-cultural validity of the Demand-Control Questionnaire, comparing the original Swedish questionnaire with the Brazilian version. METHODS We compared data from 362 Swedish and 399 Brazilian health workers. Confirmatory and exploratory factor analyses were performed to test structural validity, using the robust weighted least squares mean and variance-adjusted (WLSMV) estimator. Construct validity, using hypotheses testing, was evaluated through the inspection of the mean score distribution of the scale dimensions according to sociodemographic and social support at work variables. RESULTS The confirmatory and exploratory factor analyses supported the instrument in three dimensions (for Swedish and Brazilians): psychological demands, skill discretion and decision authority. The best-fit model was achieved by including an error correlation between work fast and work intensely (psychological demands) and removing the item repetitive work (skill discretion). Hypotheses testing showed that workers with university degree had higher scores on skill discretion and decision authority and those with high levels of Social Support at Work had lower scores on psychological demands and higher scores on decision authority. CONCLUSIONS The results supported the equivalent dimensional structures across the two culturally different work contexts. Skill discretion and decision authority formed two distinct dimensions and the item repetitive work should be removed.

Occupational stress and coping resources in physiotherapists: a survey of physiotherapists in three general hospitals

Objectives - To identify occupational stressors and coping resources in a group of physiotherapists, and to analyse interactions between subjective levels of stress, efficacy in stress resolution and coping resources used by these professionals. Design - A sample of 55 physiotherapists working in three general hospitals in Portugal completed the Coping Resources Inventory for Stress, the Occupational Stressors Inventory and two subjective scales for stress and stress resolution. Main results - Most physiotherapists perceived that they were moderately stressed (19/55, 35%) or stressed (20/55, 36%) due to work, and reported that their efficacy in stress resolution was moderate (25/54, 46%) or efficient (23/54, 42%). Issues related to lack of professional autonomy, lack of organisation in the hierarchical command chain, lack of professional and social recognition, disorganisation in task distribution and interpersonal conflicts with superiors were identified as the main sources of stress. The most frequently used coping resources were social support, stress monitoring, physical health and structuring. Perceived efficacy in stress resolution was inversely related to perceived level of occupational stress (r = ���0.61, P < 0.01). Significant correlations were found between several coping resources and the perceived level of stress and efficacy in stress resolution. Associations between problem solving, cognitive restructuring and stress monitoring and both low levels of perceived stress and high levels of perceived efficacy were particularly strong. Implications for practice - The importance of identifying stressors and coping resources related to physiotherapists��� occupational stress, and the need for the development of specific training programmes to cope with stress are supported.

Specialized care for people with AIDS in the state of Ceara, Brazil

OBJECTIVE To analyze if the distribution of specialized care services for HIV/AIDS is associated with AIDS rates. METHODS Ecological study, for which the distribution of 10 specialized care services in the Ceara state, Northeastern Brazil, was obtained, and the mean rates of the disease were estimated per mesoregion. We evaluated 7,896 individuals who had been diagnosed with AIDS, were aged 13 years or older, lived in Ceara, and had been informed of their condition between 2001 and 2011. Maps were constructed to verify the relationship between the distribution of AIDS cases and institutionalized support networks in the 2001-2006 and 2007-2011 periods. BoxMap and LisaMap were used for data analysis. The Voronoi diagram was applied for the distribution of the studied services. RESULTS Specialized care services concentrated in AIDS clusters in the metropolitan area. The Noroeste Cearense and west of the Sertoes Cearenses had high AIDS rates, but a low number of specialized care services over time. Two of these services were implemented where clusters of the disease exist in the second period. The application of the Voronoi diagram showed that the specialized care services located outside the metropolitan area covered a large territory. We identified one polygon that had no services. CONCLUSIONS The scenario of AIDS cases spread away from major urban areas demands the creation of social support services in areas other than the capital and the metropolitan area of the state; this can reduce access barriers to these institutions. It is necessary to create specialized care services for HIV/AIDS in the Noroeste Cearense and north of Jaguaribe.

Treatment of depression in older adults beyond fluoxetine

This review aimed to discuss the importance of the comprehensive treatment of depression among older adults in Brazil. The abuse of selective serotonin reuptake inhibitors, including fluoxetine hydrochloride, as antidepressants has been considered a serious public health problem, particularly among older adults. Despite the consensus on the need for a comprehensive treatment of depression in this population, Brazil is still unprepared. The interface between pharmacotherapy and psychotherapy is limited due to the lack of healthcare services, specialized professionals, and effective healthcare planning. Fluoxetine has been used among older adults as an all-purpose drug for the treatment of depressive disorders because of psychosocial adversities, lack of social support, and limited access to adequate healthcare services for the treatment of this disorder. Preparing health professionals is a sine qua non for the reversal of the age pyramid, but this is not happening yet.

Sa��de mental, qualidade de vida e acesso aos cuidados de sa��de na comunidade brasileira de Lisboa

Introdu����o: A utiliza����o de servi��os de sa��de tem implica����es importantes para o estado de sa��de das popula����es. As pol��ticas de imigra����o adoptadas nos pa��ses de destino t��m influ��ncia no estado de sa��de das comunidades imigrantes. Pol��ticas que limitam o acesso de imigrantes aos cuidados de sa��de aumentar��o a vulnerabilidade e os riscos na sa��de. Apesar da imigra����o promover uma s��rie de rupturas na vida do sujeito, migrar, por si s��, n��o pode ser considerado como factor de risco no ��mbito da sa��de e da sa��de mental. O peso dos determinantes socioecon��micos tem ganho relev��ncia no estudo das migra����es, estado de sa��de geral e mental. Isto porque, em geral, os imigrantes est��o em situa����o mais prec��ria do que a popula����o aut��ctone. O estatuto socioecon��mico baixo, as condi����es prec��rias de habita����o e de trabalho, a falta de suporte social e a irregularidade jur��dica s��o indicadores de risco acrescido para a sa��de mental. Neste sentido �� um desafio de monta os governos estabelecerem medidas sustentadas e, simultaneamente, integradoras dos imigrantes. Em Portugal, considera-se que h�� escassez de estudos relacionados com a ��rea das migra����es e da sa��de.Metodologia: Estudo explorat��rio, descritivo e transversal. A finalidade foi a de identificar o estado de sa��de, sa��de mental e qualidade de vida da comunidade brasileira residente em Lisboa e o seu acesso aos servi��os de sa��de. Este estudo teve como principais objectivos a caracteriza����o sociodemogr��fica, a identifica����o de vari��veis inerentes ao processo migrat��rio, a identifica����o da auto-aprecia����o do estado de sa��de, a caracteriza����o do acesso aos cuidados de sa��de, a identifica����o do grupo em prov��vel sofrimento psicol��gico, a compara����o entre os resultados dos imigrantes juridicamente regulares e irregulares e a compara����o entre a popula����o imigrante e a popula����o portuguesa. Inicialmente, foi prevista a utiliza����o da t��cnica de amostragem de propaga����o geom��trica ou snowball, pois a amostra tornar-se-ia maior �� medida que os pr��prios inquiridos identificam outros potenciais respondentes. Ao longo do estudo, a metodologia inicial mostrou-se insuficiente para estabelecer uma amostra mais representativa dos imigrantes juridicamente irregulares. Para este feito, foi utilizada a metodologia de amostragem por conveni��ncia e o local escolhido para a recolha da amostra foi o Consulado do Brasil em Lisboa. O instrumento de recolha de dados empregue baseou-se no question��rio utilizado no 4�� Inqu��rito Nacional de Sa��de. O MHI-5 (Mental Health Index 5) �� um instrumento de sa��de mental e �� parte integrante do inqu��rito, sendo recomendado pela Organiza����o Mundial de Sa��de. Consta de cinco itens relativos �� sa��de mental e os resultados s��o classificados atrav��s de um indicador que mede a exist��ncia de prov��vel sofrimento psicol��gico. Foram inclu��dos no estudo 213 brasileiros. De seguida, procedeu-se ao tratamento estat��stico dos dados. Resultados: A popula����o inquirida �� jovem, a maior parte tem entre 18 e 44 anos. As mulheres representam mais de metade da amostra. A taxa de actividade �� elevada e a taxa de desemprego �� similar �� nacional. A inser����o laboral priorit��ria �� nos segmentos pouco qualificados ou de semi-qualifica����o. Aproximadamente um ter��o dos inquiridos afirmou ser benefici��rio do Sistema Nacional de Sa��de. A autoaprecia����o do estado de sa��de �� classificada como bastante positiva, assim como a qualidade de vida. O prov��vel sofrimento psicol��gico, definido no MHI-5 pelo ponto de corte no score 52, atinge 23,3% dos participantes. Os homens apresentam melhores resultados do que as mulheres. Al��m disso, para os valores mais baixos no MHI-5 foram encontradas rela����es com as longas jornadas de trabalho e o diagn��stico de doen��a cr��nica.Discuss��o: O presente estudo apresenta limita����es em rela����o �� dimens��o da amostra e �� prov��vel exist��ncia de enviesamento pela aus��ncia de aleatoriza����o. Apesar da legisla����o portuguesa garantir o acesso aos servi��os de sa��de e garantir a equidade no caso dos imigrantes que fazem descontos para a Seguran��a Social, apenas um ter��o referiu ser benefici��rio do Sistema Nacional de Sa��de. Este dado pode ser justificado por factores como o cumprimento da lei por alguns servi��os e, tamb��m, pela falta de conhecimento da legisla����o e da forma de funcionamento do Servi��o Nacional de Sa��de por parte dos imigrantes. O facto das mulheres representarem o maior grupo em prov��vel sofrimento psicol��gico �� consistente com a literatura. As hip��teses levantadas para explicar este resultado podem ser agrupadas em: artefactos metodol��gicos, causalidade biol��gica e determina����o social. Em rela����o ao instrumento, �� poss��vel que o MHI-5 se comporte de forma diferente no que diz respeito ao g��nero.-------------------------------------------Introduction: The utilization of health services has important implications for the health state of the populations. The immigration policies adopted in the destiny countries are going to influence the health state of immigrant communities. Policies that limit the access of immigrants to health care are going to increase the vulnerability and the risk factor in health. Although immigration promotes several disruptive actions in ones life, migrating, on its own, cannot be considered as a risk factor for health and mental health. The preponderance of the socioeconomic factors has gained relevance in the study of migrations and also in the study of general health state and mental health. This happens because, in general, immigrants are in a more unfavorable situation compared with the destiny country population. The low socioeconomic status, the poor working and housing conditions, the lack of social support and the juridical irregularity are indicators of the incremented risk to mental health. Therefore, it is a major challenge for governments to find sustainable, and simultaneously, integrative measures for the immigrants. The studies related with the migrations and health in Portugal were considered to be few.Methods: It is an exploratory, descriptive and transversal study. The purpose is to identify the health state, mental health, quality of life and the access to health care of the Brazilian community resident in Lisbon. In addition, this study has as main goals the sociodemographic characterization, the variables identification inherent to the migrating process, the identification of the self-appreciation of health state, the characterization of the access to health care, the identification of the group in probable psychological suffer, the comparison between the results of regular and irregular immigrants and the comparison between the immigrant population and the Portuguese population. Initially it was predicted the utilization of the geometric propagation or ���snowball���, as sampling technique, because the sample becomes larger as one answerer identify other potential answering persons. Along with the study, the methodology has shown insufficient to establish a more representative sample of the irregular immigrants. For this latter case, it was used a convenient sample methodology and the place chosen for the sample gathering was the ���Consulate of Brazil in Lisbon���. The instrument was based in the questionnaire used in the ���4th National Health Inquiry���. The MHI-5 (Mental Health Index 5) is a mental health instrument which is part of the enquiry and it is recommended by the World Health Organization. There are five items related to mental health and the results are classified through an indicator which measures the existence of a probable psychological suffer. It were included 213 Brazilian in the study. After, the statistical treatment of the data took place.Results: The answering population is young and the majority is between the 18 and 44 years of age. The women represent more than one half of the sample. The activity rate is high and the unemployment rate is similar to the national one. The priority labor insertion is in the few qualified or of semi-qualification segments. Approximately, one third of the answering people has stated to be beneficiary of the National Health System. The self-appreciation of the health state as well as the quality of life are classified as fairly positive ones. The probable psychological suffer, as defined in the MHI-5 through the cut point in the score below or equal to 52, reaches 23,3% of the sample population. Men show the better results than women. Further, for the lower values of MHI-5 it was found a relation with the long work periods and chronic disease diagnostic. Discussion: The present study evidences limitations in relation to the sample dimension and in relation to the existence of biases due to the lack of randomness. Although the Portuguese legislation guarantees the access to health services and the equality in the cases of the immigrants that do their Social Security discounts, only one third has mentioned to be beneficiary of the National Health System. This can be justified by several facts such as the non-fulfillment of law by some national services or the lack of knowledge of the legislation or the functioning process of the National Health System. Women representing the bigger group in probable psychological suffer has been coherent with the literature review. The hypothesis set to explain this result might be grouped in: methodological artifacts, biologic cause and social determination. In relation to the instrument used, it may be that MHI-5 behaves in a different way in respect to gender.

O ensino de cuidados continuados: proposta de modelo multim��dia sobre o tema

As altera����es demogr��ficas verificadas nos ��ltimos anos, com um peso cada vez maior da popula����o idosa, a par da altera����o do tecido social provocada pela aus��ncia do domic��lio da mulher, cuidadora tradicional, levaram �� necessidade de encontrar respostas para apoio de pessoas em situa����o de depend��ncia. Reabilitar e reinserir, a par de pol��ticas de envelhecimento ativo, s��o alguns dos desafios no momento, a n��vel global. A Rede Nacional de Cuidados Continuados Integrados (RNCCI), criada pelo Decreto-Lei n.�� 101/2006, de 6 de junho, tem por miss��o prestar os cuidados adequados, de sa��de e apoio social, a todas as pessoas que, independentemente da idade, se encontrem em situa����o de depend��ncia. A Presta����o de Cuidados na RNCCI significa fornecer os melhores cuidados poss��veis dispon��veis a um indiv��duo e ou fam��lia/cuidador com uma necessidade, num contexto espec��fico. O ��mbito de interven����o na RNCCI fundamenta-se no princ��pio dos 3 R���s ��� Reabilita����o, Readapta����o e Reinser����o. Tradicionalmente, verifica-se uma boa prepara����o dos profissionais de sa��de que acompanham o paciente mas tem-se verificado que estes cuidados se devem prolongar para al��m dos apenas prestados em ambiente hospitalar e/ou familiar. De facto, constata-se a necessidade de este tipo de cuidados ser mais abrangente, podendo vir a envolver outras pessoas (familiares, amigos, ou outros cuidadores), verificando-se, por��m, que na maioria dos casos n��o disp��em de conhecimentos ou t��cnicas necess��rias para o acompanhamento dos mesmos pelo facto de n��o terem uma forma����o efetiva relacionada com este problema. Neste sentido, e com o aux��lio das tecnologias de informa����o emergentes e cada vez mais poderosas �� atualmente poss��vel desenvolver solu����es de apoio aos cuidadores deste tipo de cuidados. Pretendemos com o presente estudo investigar essa possibilidade, contribuindo para solu����es capazes de proporcionar de forma simples e intuitiva um conhecimento adicional em prol de um apoio mais eficaz nestas situa����es. Para o efeito, foi desenvolvido um prot��tipo com essa finalidade que foi posto em pr��tica e para o qual se apresentam os resultados obtidos.

A solid��o na gravidez : determinantes da solid��o e seu impacto na liga����o materno-fetal

RESUMO - O sentimento de solid��o tem vindo a tornar-se cada vez mais frequente entre os indiv��duos, fruto do desenvolvimento da sociedade moderna. Especificamente, ocorrendo durante a gravidez, situa����o que produz na mulher importantes altera����es n��o s�� f��sicas, como tamb��m psicol��gicas, familiares e sociais, deve passar a ser alvo de uma aten����o especial. De um ponto de vista da Sa��de Mental, o desenvolvimento saud��vel da gravidez exige uma rede de suporte social e uma rela����o conjugal satisfat��rias. Tais elementos devem ser considerados como factores protectores do aparecimento de sentimentos de solid��o. Pelo contr��rio, um baixo sentido de coer��ncia e o aparecimento de depress��o durante a gravidez s��o factores de risco que, inevitavelmente, ir��o interferir na qualidade da liga����o materno-fetal, com repercuss��es no desenvolvimento psico-social do futuro ser humano. Este protocolo de projecto prop��e um estudo transversal, explorat��rio e de natureza quantitativa. Engloba dois sub-estudos, focando os determinantes da solid��o e o impacto desta na liga����o materno-fetal, e pretende identificar associa����es pertinentes entre as v��rias dimens��es envolvidas. A amostra em estudo ser�� constitu��da por 202 gr��vidas que frequentam o Centro de Sa��de de Torres Vedras. As vari��veis correspondentes ser��o operacionalizadas atrav��s de question��rios estandardizados e validados para a popula����o portuguesa, sendo eles a Escala de Solid��o da UCLA, a Escala de Satisfa����o com o Suporte Social, a Escala de Avalia����o de ��reas da Vida Conjugal, a Escala de Liga����o Materno-Fetal, a Escala de Depress��o P��s-Parto de Edimburgo e o Question��rio de Orienta����o para Viver. Espera-se identificar e caracterizar as poss��veis associa����es entre a solid��o e a satisfa����o com o suporte social, a satisfa����o conjugal, a depress��o durante a gravidez e o sentido de coer��ncia, que a explicar��o, e a liga����o materno-fetal, que ser�� influenciada por ela. Os question��rios ser��o respondidos pelas gr��vidas seleccionadas de acordo com crit��rios de inclus��o e exclus��o. Al��m das descri����es estat��sticas iniciais, as an��lises de associa����o ser��o realizadas em fun����o das distribui����es encontradas, e tendo em conta dimens��es do contexto sociodemogr��fico. Os resultados da investiga����o ser��o divulgados num relat��rio final. ----------------------- ABSTRACT - The feeling of loneliness is increasing as a result of developments in modern society. Specifically occurring during pregnancy, when important changes - physical, psychological and related to the family structure and interaction with society - take place, special attention should be devoted. To maintain good mental health during pregnancy it is important to have good social support and harmonious conjugal relations, both considered as factors preventing the emergence of feelings of loneliness. By contrast low sense of coherence and depression during the pregnancy are risk factors which, inevitably, will affect the quality of the maternal-fetal attachment and have repercussions on the psycho-social development of the future individual. This protocol of draft proposes a transversal exploratory study of a quantitative nature on two sub-studies, exploring the determinants of loneliness and its impact on the maternal-fetal attachment, which intends to identify some correlations between parameters. The study sample is made up of 202 pregnant women who are patients at the Health Centre of the city of Torres Vedras. They will be selected according to criteria of inclusion and exclusion. All variables will be measured through standardized and validated surveys illustrating the Portuguese population, like the Scale of Loneliness of the UCLA, Scale of Satisfaction with the Social Support, Scale of Evaluation of Areas of the Conjugal Life, Maternal-Fetal Attachment Scale, Edinburgh Postnatal Depression Scale, and Orientation To Life Questionnaire. We expect to identify correlations between loneliness and satisfaction with social support and conjugal relations, depression during pregnancy and sense of coherence, which will explain it, and the maternal-fetal attachment, which will influence it. Beyond the initial statistical descriptions, the data analysis will be executed according to the distributions found and will be carried taking into account the socio-demographic context. The results of the survey will be published in a final report.

Hopelessness and Related Variables among Cancer Patients in the Southern European Psycho-Oncology Study (SEPOS).

BACKGROUND: Although hopelessness has been studied in cancer, no data are available in non-English-speaking countries. OBJECTIVE: The authors sought to amass data from Southern European countries (Italy, Portugal, Spain, and Switzerland) in order to fill this void. METHOD: A group of 312 cancer patients completed the Mini-MAC Hopelessness subscale, the Hospital Anxiety and Depression Scale (HADS), the Cancer Worry Inventory (CWI), and a six-item Visual Analog scale (VAS) to measure intensity of physical symptoms, general well-being, difficulty in coping with cancer, intensity of social support from close relationships, leisure activity, and support from religious beliefs. RESULTS: Regression analysis indicated that HADS-Depression, VAS Maladaptive Coping and Well-Being, and the CWI explained 42% of the variance. CONCLUSION: Hopelessness in cancer patients seems not exclusively to correspond to depression, but is related to various other psychosocial factors, such as maladaptive coping, as well.

Desenvolvimento de um servi��o local de Sa��de Mental em Famalic��o��

RESUMO: O desenvolvimento de servi��os locais adequados deve ser baseado numa avalia����o sistem��tica das necessidades e resultados obtidos nos cuidados a uma popula����o de indiv��duos identificados como apresentando uma doen��a mental na ��rea de referencia����o do servi��o. Neste sentido foram utilizados os seguintes m��todos: dados epidemiol��gicos acerca das necessidades locais e taxas de utiliza����o de servi��os a n��vel nacional e local, este ��ltimo com base no case-register. Os diagn��sticos de maior preval��ncia em ambulat��rio s��o as perturba����es de humor e as perturba����es neur��ticas de stress ou somatoformes, com uma preponder��ncia de doen��as mentais comuns (depress��o e ansiedade) em servi��os de psiquiatria. Constatam-se baixas taxas de abandono da consulta (12%). A idade, a doen��a e a escolaridade est��o correlacionados com o risco de drop-out, mas utilizada a regress��o log��stica, a idade e a escolaridade perdem o seu significado estat��stico. Encontram-se taxas reduzidas de drop-out dos indiv��duos com psicose ou perturba����es bipolares, em virtude da interven����o activa da equipa. Os custos de transporte, a dist��ncia ao local de consulta e o tempo de espera para a primeira consulta s��o barreiras no acesso aos cuidados a n��vel local. Os cuidadores n��o se sentem apoiados pela rede de suporte social e queixam-se sobretudo da acessibilidade, mas exibem elevadas taxas de satisfa����o com os servi��os prestados. Decidiu-se apostar numa organiza����o do servi��o baseada na comunidade, com interven����es baseadas na evid��ncia, dando prioridade ao doente mental grave e �� qualidade dos cuidados.----------- ABSTRACT: The development of appropriate local services should be based on a systematic assessment of the needs and outcomes of the population of individuals identified as mentally ill within the service���s catchment area. A number of methods may be used as proxies in assessing local needs for services, such as service utilization rates found nationally and locally, by case-register. The most prevalent diagnoses in ambulatory care are mood disorders and neurotic, stress and somatoform disorders, with a majority of common mental disorders (depression and anxiety) in psychiatric services. Low dropout rates (12%) are found in ambulatory care. Age, disease and education are correlated with the risk of drop-out, but after using logistic regression, age and education lose their statistical significance. Low drop-out rates are found in individuals with psychosis or bipolar disorders, because the active intervention from the team. The costs of transportation, distance and the waiting time for the first consultation are barriers in access of care locally. Carers do not feel supported by the network of social support and complain primarily of accessibility, but exhibit high levels of satisfaction with the services provided. It was decided to invest in a service organization based in the community with evidence-based interventions, giving priority to severe mental illness and quality of care.

The Role of Psychological Adjustment in the Decision-Making Process for Voluntary Termination of Pregnancy

BACKGROUND: This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. METHODS: In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. RESULTS: The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. CONCLUSION: Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.

Psychiatric and Psychosocial Predictors of Medical Outcome After Liver Transplantation: a Prospective, Single-Center Study

OBJECTIVE: Recognizing the potential impact of psychiatric and psychosocial factors on liver transplant patient outcomes is essential to apply special follow-up for more vulnerable patients. The aim of this article was to investigate the psychiatric and psychosocial factors predicted medical outcomes of liver transplanted patients. METHODS: We studied 150 consecutive transplant candidates, attending our outpatient transplantation clinic, including 84 who had been grafted 11 of whom died and 3 retransplanted. RESULTS: We observed that active coping was an important predictor of length of stay after liver transplantation. Neuroticism and social support were important predictors of mortality after liver transplantation. CONCLUSION: It may be useful to identify patients with low scores for active coping and for social support and high scores for neuroticism to design special modes of follow-up to improve their medical outcomes.