Stigma and higher rates of psychiatric re-hospitalization: Sao Paulo public mental health system

Objective: The aim of this study was to assess re-hospitalization rates of individuals with psychosis and bipolar disorder and to study determinants of readmission. Methods: Prospective observational study, conducted in Sao Paulo, Brazil. One hundred-sixty-nine individuals with bipolar and psychotic disorder in need of hospitalization in the public mental health system were followed for 12 months after discharge. Their families were contacted by telephone and interviews were conducted at 1, 2, 6 and 12 months post-discharge to evaluate readmission rates and factors related. Results: One-year re-hospitalization rate was of 42.6%. Physical restraint during hospital stay was a risk factor (OR = 5.4-10.5) for readmission in most models. Not attending consultations after discharge was related to the 12-month point readmission (OR = 8.5, 95% CI 2.3-31.2) and to the survival model (OR = 3.2, 95% CI 1.5-7.2). Number of previous admissions was a risk factor for the survival model (OR = 6.6-11.9). Family's agreement with permanent hospitalization of individuals with mental illness was the predictor associated to readmission in all models (OR = 3.5-10.9) and resulted in shorter survival time to readmission; those readmitted were stereotyped as dangerous and unhealthy. Conclusions: Family's stigma towards mental illness might contribute to the increase in readmission rates of their relatives with psychiatric disorders. More studies should be conducted to depict mechanisms by which stigma increases re-hospitalization rates.

A Agência Nacional de Saúde e a política de saúde mental no contexto do sistema suplementar de assistência à saúde: avanços e desafios

O presente estudo trata das políticas de saúde mental conduzidas pela Agência Nacional de Saúde Suplementar - ANS, no cenário da assistência dispensada pelos planos privados de assistência à saúde. Dessa forma, analisa o modelo de regulação econômica e assistencial do setor suplementar, a forma de atuação da ANS como organismo regulador e o tratamento dispensado à assistência à saúde mental nos normativos emanados pela Agência. Concluiu-se que, apesar de avanços como a obrigatoriedade de cobertura para todas as doenças listadas na CID-10, a inclusão do tratamento das tentativas de suicídio e das lesões autoinfligidas, o atendimento por uma equipe multiprofissional, a ampliação do número de sessões com psicólogo, com terapeuta ocupacional e de psicoterapia, e a inclusão do hospital-dia na rede credenciada da operadora, a assistência à saúde mental ainda é pouco normatizada pelos regramentos vigentes no sistema de atenção à saúde suplementar, existindo muitas lacunas a serem preenchidas. A regulamentação dos mecanismos de coparticipação e franquia, a coparticipação crescente como limitador da internação psiquiátrica sem o repensar em uma rede substitutiva e a limitação do número de sessões de psicoterapia de crise são alguns dos desafios colocados para a ANS, no sentido de que esta cumpra realmente o seu papel institucional de promoção da defesa do interesse público na assistência suplementar à saúde.

Território e serviço comunitário de saúde mental: as concepções presentes nos discursos dos atores do processo da reforma psiquiátrica brasileira

Uma das proposições dos Centros de Atenção Psicossocial (CAPS), serviços substitutivos de assistência à saúde mental de base comunitária e territorial, , é a intervenção no contexto de vida dos usuários, buscando explorar os recursos existentes para a viabilização dos projetos terapêuticos, os quais devem possibilitar transformações concretas no cotidiano. Nesse contexto, foi desenvolvida a pesquisa que tem como referencial metodológico a teoria da vida cotidiana, proposta por Agnes Heller, e as categorias analíticas, território e reabilitação psicossocial. Trata-se de um estudo de caso com a finalidade de identificar e discutir as possibilidades das práticas territoriais na produção de mudanças no cotidiano dos usuários. Nesse artigo, buscamos discutir um dos objetivos delineados no estudo: compreender a representação que a equipe multiprofissional tem sobre "território" e "serviço de saúde mental de base territorial". O campo do estudo constituiu-se em um dos CAPS III da cidade de Campinas/SP e os colaboradores desta pesquisa foram os trabalhadores de saúde mental, os usuários e não usuários do serviço. Os dados foram coletados por meio de entrevistas semiestruturadas e sessões de grupo focal. Na análise dos dados, sob o enfoque da Análise do Discurso, obteve-se como resultado o reconhecimento de três categorias empíricas, dentre as quais o território. As ações no território é que dão significado para o cotidiano do serviço e nisso reside a importância dessas intervenções, as quais diferenciam um hospital psiquiátrico de um serviço comunitário.

Avaliação do impacto da prematuridade na saúde mental de puérperas

O presente estudo tem como objetivo comparar a ocorrência de sintomas de ansiedade e depressão em mães de bebês prematuros e mães de bebês a termo. Trata-se de um estudo transversal, descritivo, de abordagem quantitativa. As participantes (n=40) foram submetidas à avaliação de rastreamento executada como rotina pelo Serviço de Psicologia de um hospital filantrópico do interior paulista mediante a aplicação da Escala Hospitalar de Ansiedade e Depressão (HAD). Constatou-se que, entre as mães de bebês prematuros, 75% apresentavam sintomas clinicamente significativos de ansiedade e 50% apresentavam sintomas clinicamente significativos de depressão. Já entre as mães de bebês a termo, 65% não apresentavam sintomas clinicamente significativos de ansiedade e tampouco depressão. Ademais, a superioridade da pontuação média obtida pelas primeiras alcançou significância estatística. Os resultados corroboram a literatura, que sugere que a prematuridade tende a ter impacto negativo na saúde mental da mulher que vivencia essa situação.

Stigma and higher rates of psychiatric re-hospitalization: São Paulo public mental health system

OBJECTIVE: The aim of this study was to assess re-hospitalization rates of individuals with psychosis and bipolar disorder and to study determinants of readmission. METHODS: Prospective observational study, conducted in São Paulo, Brazil. One hundred-sixty-nine individuals with bipolar and psychotic disorder in need of hospitalization in the public mental health system were followed for 12 months after discharge. Their families were contacted by telephone and interviews were conducted at 1, 2, 6 and 12 months post-discharge to evaluate readmission rates and factors related. RESULTSOne-year re-hospitalization rate was of 42.6%. Physical restraint during hospital stay was a risk factor (OR = 5.4-10.5) for readmission in most models. Not attending consultations after discharge was related to the 12-month point readmission (OR = 8.5, 95%CI 2.3-31.2) and to the survival model (OR = 3.2, 95%CI 1.5-7.2). Number of previous admissions was a risk factor for the survival model (OR = 6.6-11.9). Family's agreement with permanent hospitalization of individuals with mental illness was the predictor associated to readmission in all models (OR = 3.5-10.9) and resulted in shorter survival time to readmission; those readmitted were stereotyped as dangerous and unhealthy. CONCLUSIONS: Family's stigma towards mental illness might contribute to the increase in readmission rates of their relatives with psychiatric disorders. More studies should be conducted to depict mechanisms by which stigma increases re-hospitalization rates.

An initial proposal for PDP of smes developing hospital furniture

A large percentage of the industrial SMEs has an organizational structure for product development too far from the adequate practices and models, elaborated by renowned authors with expertise in the theme of product development. On the other hand, the authors state that SMEs obtain considerable advantages by adopting a model of product development process (PDP) management. Healt is one of the most innovative sectors in the world, and countries like Brazil and Colombia are transitioning from a system that cares for contagious infecttions diseases where the drug product is the main form of treatment - to a system that cares for chronic degenerative conditions - where the equipment, including hospital furniture, has more relevance to the treatment. This change is offering better opportunities of specialized markets to hospital furniture SMEs that adopt an adquate PDF model. The present study proposes a first outline of a model of PDP management for industrial metal-mechanical SMEs that develop and manufacture hospital furniture, from a review of models proposed for great mechanical area.

The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients' views

PURPOSE: Stigma is a frequent accompaniment of mental illness leading to a number of detrimental consequences. Most research into the stigma connected to mental illness was conducted in the developed world. So far, few data exist on countries in sub-Saharan Africa and no data have been published on population attitudes towards mental illness in Ghana. Even less is known about the stigma actually perceived by the mentally ill persons themselves. METHOD: A convenience sample of 403 participants (210 men, mean age 32.4 ± 12.3 years) from urban regions in Accra, Cape Coast and Pantang filled in the Community Attitudes towards the Mentally Ill (CAMI) questionnaire. In addition, 105 patients (75 men, mean age 35.9 ± 11.0 years) of Ghana's three psychiatric hospitals (Accra Psychiatry Hospital, Ankaful Hospital, Pantang Hospital) answered the Perceived Stigma and Discrimination Scale. RESULTS: High levels of stigma prevailed in the population as shown by high proportions of assent to items expressing authoritarian and socially restrictive views, coexisting with agreement with more benevolent attitudes. A higher level of education was associated with more positive attitudes on all subscales (Authoritarianism, Social Restrictiveness, Benevolence and Acceptance of Community Based Mental Health Services). The patients reported a high degree of experienced stigma with secrecy concerning the illness as a widespread coping strategy. Perceived stigma was not associated with sex or age. DISCUSSION: The extent of stigmatising attitudes within the urban population of Southern Ghana is in line with the scant research in other countries in sub-Saharan Africa and mirrored by the experienced stigma reported by the patients. These results have to be seen in the context of the extreme scarcity of resources within the Ghanaian psychiatric system. Anti-stigma efforts should include interventions for mentally ill persons themselves and not exclusively focus on public attitudes.

Shorter time since inflammatory bowel disease diagnosis in children is associated with lower mental health in parents.

AIM This study assessed the mental health of parents of children with inflammatory bowel disease (IBD), compared their mental health with age-matched and gender-matched references and examined parental and child predictors for mental health problems. METHODS A total of 125 mothers and 106 fathers of 125 children with active and inactive IBD from the Swiss IBD multicentre cohort study were included. Parental mental health was assessed by the Symptom Checklist 27 and child behaviour problems by the Strengths and Difficulties Questionnaire. Child medical data were extracted from hospital records. RESULTS While the mothers reported lower mental health, the fathers' mental health was similar, or even better, than in age-matched and gender-matched community controls. In both parents, shorter time since the child's diagnosis was associated with poorer mental health. In addition, the presence of their own IBD diagnosis and child behaviour problems predicted maternal mental health problems. CONCLUSIONS Parents of children with IBD may need professional support when their child is diagnosed, to mitigate distress. This, in turn, may help the child to adjust better to IBD. Particular attention should be paid to mothers who have their own IBD diagnosis and whose children display behaviour problems.

THE DISCHARGED PSYCHIATRIC PATIENT: POST-HOSPITAL ADJUSTMENT AND FACTORS AFFECTING REHOSPITALIZATION

Discharged psychiatric patients were studied six months post-discharge to determine those demographic, social and clinical characteristics affecting positive or negative adjustment and the degree to which the use of mental health services and medication compliance mediated the effects. With the exception of those with primary or secondary diagnoses of OBS, substance abuse or mental retardation, sixty-three psychiatric subjects between the ages of eighteen and sixty-four were chosen from all admissions into the hospital and interviewed six months after discharge using a specially designed questionnaire.^ The subjects' adjustment to community living was found to be marginal. Although not engaged in destructive activities, over half were living with their family members who supported them financially and emotionally. Most were unemployed and had been so for a long time. Others worked sporadically and frequently changed residences. Most did have substantial social ties with extended family and with friends with whom they interacted regularly, but one-fourth were socially isolated. Almost three-quarters continued to obtain regular mental health services after discharge and followed medication instructions under the supervision of their physician. The use of mental health services after discharge and the use of medication did not appear to affect the subjects' community adaption or their rate of rehospitalization.^ Forty percent of those discharged were rehospitalized by the end of the follow-up period. Four levels of risk of rehospitalization emerged. The highest risk was associated with a history of five or more prior hospitalizations, living alone, and social isolation. One third or more of the subjects expressed a need for more counseling, leisure time activities, case-manager assistance, vocational guidance, supervised housing, and placement into a transitional residential treatment program.^ Recommendations were made to enhance the ability to predict recidivism, to develop interorganizational casework management programs linking the patient and family to the community mental health system and to create computerized tracking and monitoring programs that systematically report patient treatment regimen and progress cross-sectionally and longitudinally. ^

Salud ocupacional de los enfermeros psiquiátricos del Hospital El Sauce

Teniendo en cuenta que en distintos documentos de programas nacionales y de organizaciones como la O.M.S y O.P.S, se mencionan medidas estratégicas de protección al personal y todo lo que ello implique en pos de“una participación responsable y gratificante de todo el personal en el quehacer del servicio" se encontró de interés abordar el tema de la Salud Ocupacional de los enfermeros. Específicamente se tomó la situación del personal de enfermeríapsiquiátrica del Hospital “El Sauce" de la provincia de Mendoza por las particularidades de la especialidad, su evolución histórica, ausentismo laboral por problemas de salud y las situaciones dadas en determinadas épocas del año en que se efectivizan las licencias anuales del personal (donde se patentiza falta de personal para cubrir las tareas) y las situaciones que se derivan de la aplicación de la nueva ley de salud mental Nº 26657. Se abordaron así, aspectos históricos, la salud ocupacional propiamente dicha, legislaciones que la abordan y situaciones en otros países de la región, la enfermería psiquiátrica, aspectos de formación y tratamiento en otros países del mundo, Las variables en estudio como edad, sexo, antigüedad laboral, nivel de formación, capacitación laboral, tareas desvirtuadas, etc. y la observación de los cruces de datos de algunas de ellas ayudaron a sacar conclusiones importantes. El propósito de este trabajo ha sido identificar los factores que afecten la salud de los enfermeros de referencia como punto de partida a futuras investigaciones que permitan mejorar las condiciones de trabajo y, consecuentemente,la eficacia y eficiencia en las tareas,así como el perfil de la profesión.

Estrés profesional en el personal de enfermería del área crítica del Hospital El Carmen

El presente estudio pretende conocer los factores modificables que se encuentran en el ámbito laboral que favorecen el estrés del personal de enfermería, con la finalidad de lograr un ambiente laboral saludable y disminuir el riesgo al que se encuentran expuestos los agentes de salud mencionados. Los objetivos son: determinar cuales son las conductas de autocuidado que tiene o debe tener el personal de enfermería y recuperar o mantener el bienestar en el área de trabajo.

Derechos de las mujeres y salud mental

La presente investigación intenta abordar los modelos de intervención de los/as trabajadores/as sociales en el ámbito de la Salud Mental, con el objeto de dar cuenta de los diferentes procesos que se han ido llevando a cabo en los últimos años, respecto de la transformación de las instituciones psiquiátricas, dando visibilidad por un lado a las condiciones que son sometidas las mujeres dentro de este dispositivo, siendo víctimas de todo tipo de violencias y vulneración de derechos. Se propone evidenciar los procesos alternativos puestos en marcha para la restitución de dichos derechos; en relación a ello se analiza críticamente el rol que cumple el trabajo social en la interdisciplinariedad de los abordajes y la importancia que tiene la intervención del trabajador social para que la recuperación de derechos se haga efectiva. El estudio se limita a en las mujeres externadas del Hospital “Colonia Nacional Manuel A. Montes de Oca."

Embarazo no deseado, continuación forzosa del embarazo y afectación y afectación de la salud mental. Documento de posición.

Desde nuestro compromiso con la promoción de una atención en salud para las mujeres de acuerdo con los más altos estándares de cuidado, y con base en la evidencia, afirmamos que el embarazo no deseado y su continuación forzada afectan la salud mental. Existe suficiente evidencia que sustenta que la continuación de un embarazo no deseado aumenta el riesgo de experimentar problemas de salud mental y, desde ese punto de vista, toda mujer en esta situación enfrenta un riesgo para su salud que no está obligada a asumir a la luz de la legislación vigente en Colombia y, por lo tanto, tiene derecho a interrumpir su embarazo.

David Ziziemsky y el ingreso del psicoanálisis francés en el Hospital de Niños Sor María Ludovica de la ciudad de La Plata

El presente trabajo forma parte de un proyecto de investigación más amplio cuyo fin es delimitar el contexto de recepción del psicoanálisis francés en la ciudad de La Plata en el período que se extiende desde 1966 hasta 1976. El concepto de recepción, supone que la lectura de una obra no consiste en una mera asimilación pasiva sino en un proceso que, concebido desde una perspectiva dialéctica, pone en juego una selección que realiza el lector en tanto se ve implicado su propio punto devista. Por lo tanto el acto de lectura involucra siempre tres factores: el autor, la obra y el público,ocurriendo un intercambio entre producción y recepción. El objetivo de este escrito es abordar una de las vías de ingreso del psicoanálisis francés en la ciudad de La Plata, a saber, la labor de los profesionales de la salud mental en las instituciones públicas, en este caso el Hospital de Niños Sor María Ludovica de La Plata. La lectura de la bibliografía de la época y la realización de entrevistas a algunos de los actores institucionales -cuyo testimonio resultaba relevante en tanto habían formado parte de ese período o bien se desempeñan en la institución- nos permiten afirmar que existió untiempo durante el cual fueron conformándose las bases del interés que conduciría a la convocatoria de la figura de Oscar Masotta en el año 1970 en dicha institución, entre otros exponentes de la filosofía, la epistemología, la psicología y otras corrientes psicoanalíticas. De este modo, se otorgará el estatuto de acontecimiento a la conferencia allí dictada por Masotta, titulada 'Significante y psicoanálisis' y publicada un año más tarde dentro de la compilación 'Métodos de investigación en psicología y psicopatología. Durante ese período fue de suma relevancia la gestión del Dr. David Ziziemsky, principal impulsor de la organización de ese ciclo de conferencias. Como jefe del Servicio de Neurología y Psiquiatría del Hospital -fundado por él mismo en 1962- su labor propició el ingreso del psicoanálisis en esa institución a partir de la inclusión en el Servicio de estudiantes de psicología y psicólogos recientemente graduados. Si bien su formación como psiquiatra llevaba principalmente el sello de los desarrollos jasperianos, la práctica clínica desplegada en el Servicio no excluía la existencia de otros desarrollos tales como el psicoanálisis kleiniano y el lacaniano. Asimismo, concebía un punto de articulación posible entre la fenomenología y el psicoanálisis, aportando la primera las bases para que este último se constituyera en tanto conocimiento científico. A su vez la realización de cursos, conferencias, supervisiones grupales y ateneos, entre otras actividades promovidas desde el Servicio demostraba un interés constante por la formación de los recursos humanos y la revisión de los fundamentos de la práctica clínica. Es en este contexto que adquiere sentido la invitación de Ziziemsky a Masotta como expositor dentro del ciclo de conferencias. La presentación de esta figura en un ámbito diferente al académico y al de los grupos de estudio privados, que ya había iniciado en Buenos Aires en el año 1967, cobra aún mayor importancia si consideramos que durante esa época la APA sólo admitía el ingreso de profesionales médicos para el estudio de un psicoanálisis de orientación kleiniana. Situamos así esta conferencia como un acontecimiento que da cuenta de los inicios de un período durante el cual el psicoanálisis lacaniano comenzaría a posicionarse como una nueva oferta posible para la formación de los psicólogos