Clinical pathways in mental health

Caremaps [Clinical pathways] are like microwave ovens: five years from now, members of all disciplines will marvel at how they ever got along without them. Of course there will always be some that refuse to accept innovation or who are technophobic. Most people, however, will readily incorporate useful, practical new products into their daily lives.' Zander [1]

At-risk children: A demographic analysis of the children of clients attending mental health community clinics

Children of parents with mental illness have an increased risk of psychological problems. The aim of this study was to identify the demographic characteristics of dependent children of adults presenting at mental health clinics in Western Australia. A survey of clients who attended the clinics indicated that half reported having had children. Of these, 21% had a primary diagnosis of schizophrenia. Although schizophrenia was the most common illness, there were almost seven times more children living with a parent with a primary diagnosis of depression than schizophrenia. Recommendations include that children of clients with mental illness be included as part of a wider client focus.

Ações de prevenção da deficiência mental, dirigidas a gestantes e recém-nascidos, no âmbito da saúde pública da grande Vitória-ES

Fazer prevenção em Saúde Pública implica em conhecimento sistematizado para a proposição de programas e sua avaliação. Quanto à prevenção de Deficiência Mental, que atinge cerca de 10% da população, pouco se conhece no país. Adotando uma metodologia para levantamento de ações preventivas de DM em hospitais e unidades de saúde, junto a gestantes e recém-nascidos, foi possível descrever e analisar a atuação da rede pública de saúde da Grande Vitória/ES, indicando os níveis de prevenção mais atendidos. Foram levantadas as ações de prevenção (AP) de cinco hospitais públicos de grande porte, nove (31%) unidades de saúde e seis secretarias de saúde, entre 1996-97. Os dados de 25 entrevistas mostram que esses locais realizavam 51,5% das 433 AP possíveis (57,4% da prevenção primária e 45,5% da secundária). Particularizando a atuação de cada município e local pesquisado, os dados fornecem subsídios para análises e possíveis mudanças nos indicadores de saúde materno-infantil.

Social Work in the Portuguese empire Health Services

Muitos historiadores, particularmente estrangeiros, que vêem Portugal “de fora”, têm-se mostrado críticos do mau desempenho do império colonial português.Aintolerância religiosa, uso excessivo de força para conseguir o monopólio de especiarias, são alguns aspectos que mereceram críticas mais duras [Devo admitir que fui eu um destes críticos!] mas quase sempre bem fundamentadas e difíceis de rejeitar. Mas é preciso admitir que a história colonial portuguesa é também feita de elementos positivos e menos violentos. Os portugueses devem ser considerados pioneiros de assistência social através das suas políticas inovadoras que providenciaram cuidados para os doentes e desgraçados, embora estas políticas não abrangessem os sujeitos não-Cristãos do império.

Assessment of a consultation-liaison psychiatry and psychology health care program

OBJECTIVE: To investigate the relevance of subjective criteria adopted by a psychiatry and psychology consultation-liaison service, and their suitability in the evaluation of case registries and objective results. METHODS: Semi-structured interviews were conducted and all supervisors of the university hospital service were interviewed. Routinely collected case registries were also reviewed. Standardized assessment with content analysis for each category was carried out. RESULTS: The results showed distortions in the adopted service focus (doctor-patient relationship) and consultant requests. This focus is more on consulting physician-oriented interventions than on patients. DISCUSSION: Evaluation of the relevance of service criteria could help promoting quality assessment of the services provided, mainly when objective criteria have not yet been established to assure their suitability.

Cancer incidence projections for Lisbon and Santarém districts: an aid to radiotherapy services planning

Will the existing means in Radiotherapy respond to the needs of the potential user population in 2014 for Lisbon and Santarém districts? Number of treatment units? Number of Radiotherapy Technologists? Temporal variations of the dimension and age structure of the populations: Coastal areas/Interior areas, Urban areas/Rural areas. Temporal variations in the incidence of several types of cancer. Overall objectives: evaluate of the necessities of Radiotherapy for Lisbon and Santarém districts in 2014 and elaboration of proposals that aim the access/use for the potential user population.

Mental health research in Brazil: policies, infrastructure, financing and human resources

The objective of this descriptive study was to map mental health research in Brazil, providing an overview of infrastructure, financing and policies mental health research. As part of the Atlas-Research Project, a WHO initiative to map mental health research in selected low and middle-income countries, this study was carried out between 1998 and 2002. Data collection strategies included evaluation of governmental documents and sites and questionnaires sent to key professionals for providing information about the Brazilian mental health research infrastructure. In the year 2002, the total budget for Health Research was US$101 million, of which US$3.4 million (3.4) was available for Mental Health Research. The main funding sources for mental health research were found to be the São Paulo State Funding Agency (Fapesp, 53.2%) and the Ministry of Education (CAPES, 30.2%). The rate of doctors is 1.7 per 1,000 inhabitants, and the rate of psychiatrists is 2.7 per 100,000 inhabitants estimated 2000 census. In 2002, there were 53 postgraduate courses directed to mental health training in Brazil (43 in psychology, six in psychiatry, three in psychobiology and one in psychiatric nursing), with 1,775 students being trained in Brazil and 67 overseas. There were nine programs including psychiatry, neuropsychiatry, psychobiology and mental health, seven of them implemented in Southern states. During the five-year period, 186 students got a doctoral degree (37 per year) and 637 articles were published in Institute for Scientic Information (ISI)-indexed journals. The investment channeled towards postgraduate and human resource education programs, by means of grants and other forms of research support, has secured the country a modest but continuous insertion in the international knowledge production in the mental health area.

Mental health and psychiatry research in Brazil: scientific production from 1999 to 2003

OBJECTIVE: To assess the extent of mental health scientific production in Brazil from 1999 to 2003, and to identify the nature of the publications generated, their sources of finance and the ways of publicly disseminating the research findings. METHODS: Searches for publications were conducted in the Medline and PsychInfo databases for the period 1999-2003. A semi-structured questionnaire developed by an international team was applied to 626 mental health researchers, covering each interviewee's educational background, research experience, access to funding sources, public impact and research priorities. The sample was composed by 626 mental health researchers identified from 792 publications indexed on Medline and PsychInfo databases for the period above, and from a list of reviewers of Revista Brasileira de Psiquiatria. RESULTS: In Brazil, 792 publications were produced by 525 authors between 1999 and 2003 (441 indexed in Medline and 398 in the ISI database). The main topics were: depression (29.1%), substance misuse (14.6%), psychoses (10%), childhood disorders (7%) and dementia (6.7%). Among the 626 Brazilian mental health researchers, 329 answered the questionnaire. CONCLUSIONS: There were steadily increasing numbers of Brazilian articles on mental health published in foreign journals from 1999 to 2003: the number of articles in Medline tripled and it doubled in the ISI database. The content of these articles corresponded to the priorities within mental health, but there is a need for better interlinking between researchers and mental health policymakers.

Prevalence of tobacco use in individuals with severe mental illnesses, São Paulo, Brazil

OBJECTIVE: To analyze the prevalence of cigarette smoking in individuals with severe mental illnesses in a large urban centre of a middle income country. METHODS: Cross-sectional study carried out in São Paulo. The sample (N=192) comprised individuals diagnosed with severe mental illnesses who had contact with public psychiatric care services from September to November 1997 and were aged between 18 and 65 years. Prevalence of daily tobacco smoking in the 12 months previous to the interview and characteristics associated were studied. RESULTS: Out of 192 subjects with severe mental illnesses interviewed, 115 (59.9%; 95% CI: 52.6%; 66.9%) reported smoking cigarettes on a daily basis. Male gender, marital status separated or widowed, irregular use of neuroleptic drugs and history of ten or more psychiatric admissions were independently associated with cigarette smoking. CONCLUSIONS: The prevalence of cigarette smoking in the present sample was higher than that found in the general Brazilian population. Mental care services should implement non-smoking policies and mental health providers need to help patients with severe mental illness who want to quit smoking.

Knowledge, attitude and practice of mammography among women users of public health services

OBJECTIVE: To evaluate knowledge, attitude and practice related to mammography among women users of local health services, identifying barriers to its performance. METHODS: A total of 663 women were interviewed at 13 local health centers in a city of Southeastern Brazil, in 2001. Interviewees were randomly selected at each center and they were representative from different socioeconomic conditions. The number of interviewees at each center was proportional to monthly mean appointments. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test. RESULTS: Only 7.4% of the interviewees had adequate knowledge on mammography, while 97.1% of women had an adequate attitude. The same was seen for the practice of mammography that was adequate in 35.7% of the cases. The main barrier to mammography was lack of referral by physicians working at the health center (81.8%). There was an association between adequacy of attitude and five years or more of education and being married. There was also an association between adequacy of mammography practice and being employed and family income up to four minimum wages. CONCLUSIONS: Women users of local health services had no adequate knowledge and practice related to mammography despite having an adequate attitude about this exam.

Sintomatologia depressiva e (in)satisfação escolar

Trabalho apresentado em XIII Congreso Internacional Galego-Portugués de Psicopedagoxía, Área 5 Familia, Escuela y Comunidad. Universidad da Coruña, 2 de Setembro de 2015.

Screening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil

OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.