Prevenção terciária em saúde mental : novas respostas em Portugal

RESUMO - Apresenta-se a caracterização e a descrição das novas respostas, bem como dos dispositivos que as permitiram organizar, quanto à prevenção terciária em saúde mental em Portugal. Detalha-se a Região de Lisboa e Vale do Tejo por ser a que mais estruturas criou e que foi alvo do estudo das autoras. Até ao final de 2001 beneficiavam 754 pessoas desta oferta de serviços no nosso país, das quais 473 na Região de Lisboa e Vale do Tejo. A maior parte destes beneficiários, 299, participa em actividades de fórum sócio-ocupacional, estando 99 pessoas inseridas em estruturas residenciais. Daí que se entenda que houve uma melhoria quanto à cobertura de necessidades em termos de prevenção terciária/ reabilitação no nosso país. Considera-se, contudo, que ainda muito está por fazer, uma vez que se continua muito aquém dos ratios de oferta de serviços internacionalmente recomendados. Considera-se desejável que se alargue e aprofunde este projecto, enquadrado com mais rigor em termos de diagnóstico de necessidades nacionais e com uma coordenação mais centralizada que potencie uma melhor gestão do seu quadro de exigências.

Methodology for WSN communication technologies automated field tests

Wireless Sensor Networks(WSN) are networks of devices used to sense and act that applies wireless radios to communicate. To achieve a successful implementation of a wireless device it is necessary to take in consideration the existence of a wide variety of radios available, a large number of communication parameters (payload, duty cycle, etc.) and environmental conditions that may affect the device’s behaviour. However, to evaluate a specific radio towards a unique application it might be necessary to conduct trial experiments, with such a vast amount of devices, communication parameters and environmental conditions to take into consideration the number of trial cases generated can be surprisingly high. Thus, making trial experiments to achieve manual validation of wireless communication technologies becomes unsuitable due to the existence of a high number of trial cases on the field. To overcome this technological issue an automated test methodology was introduced, presenting the possibility to acquire data regarding the device’s behaviour when testing several technologies and parameters that care for a specific analysis. Therefore, this method advances the validation and analysis process of the wireless radios and allows the validation to be done without the need of specific and in depth knowledge about wireless devices.

Role of Intersectoral Collaboration in Mental Health Policy Formulation And Service Delivery in Saint Lucia

RESUMO: Santa Lúcia pequena ilha de país em desenvolvimento com recursos limitados e é confrontada com uma série de desafios socioeconômicos que exigem soluções criativas e inovadoras. É comprovado que a combinação de recursos entre setores para estabelecer os determinantes social, econômico e ambiental da saúde são uma estratégia útil para melhorar a saúde da população, principalmente a sua saúde mental. Este estudo, o primeiro do seu tipo em Santa Lúcia, procurou examinar até que ponto a disponibilidade de uma política nacional de saúde mental levou a ação intersetorial para o fornecimento de serviços e promoção da saúde mental. Além disso, o estudo examinou o nível de colaboração intersetorial que existe entre as agências que prestam cuidados diretos e serviços de suporte para pessoas com doenças mentais e problemas sérios de saúde mental. O estudo também teve como objetivo identificar os fatores que promovem ou dificultam a colaboração intersectorial e gerar recomendações que possam ser aplicadas para países muito pequenos e com perfis socioeconômicos semelhantes. Os dados gerados a partir de três (3) fontes foram sintetizados para formar uma visão ampla das questões. Uma avaliação da política de saúde mental de 2007, uma avaliação que identifica até que ponto a ação intersetorial atualmente deixa a prestação de serviços de saúde mental e a administração de entrevistas semiestruturadas nas mãos de gestores do programa de diferentes agências em todos os setores. O estudo concluiu que, apesar da disponibilidade de uma política de saúde mental, que articula clara e explicitamente a colaboração intersetorial como área prioritária para ação, quase não existe no sistema de fornecimento atual do serviço. Os provedores de serviços em todos os setores reconhecem que há os benefícios da colaboração intersectorial e com entraves significativos em relação à colaboração intersetorial, que por sua vez, impede uma abordagem nacional para o planejamento e o fornecimento do serviço. A colaboração intersetorial não será possível se os próprios setores dependerem da abordagem direta do setor da saúde ou se a atmosfera geral for ofuscada pela estigmatização das doenças mentais.------------------------------------------------------------------------ABSTRACT: Saint Lucia a small island developing country with limited resources, is faced with a number of socio-economic challenges which require creative and innovative solutions to address. Combining resources across sectors to address the social, economic and environmental determinants of health has proven to be a useful strategy for improving population health in particular mental health. This study, the first of its kind for Saint Lucia sought to examine the extent to which the availability of a national mental health policy led to intersectoral action for mental health promotion and service delivery. In addition the study examined the level of intersectoral collaboration which actually exist between agencies which provide direct care and support services to people with mental illnesses and significant mental health problems. The study also aimed to identify the factors which promote or hinder intersectoral collaboration and generate recommendations which can be applied to extremely small countries with similar socio-economic profiles. Data generated from three (3) sources was synthesized to form a broad picture of the issues. An evaluation of the mental health policy of 2007, an assessment of the extent to which intersectoral action currently exist in mental health service delivery and the administration of semi-structured interviews with program managers from different agencies across sectors to identify implementation issues. The study concluded that despite the availability of a mental health policy which clearly and explicitly articulates intersectoral collaboration as a priority area for action, very little exists in the current service delivery system. Services providers across sectors acknowledge the benefits of intersectoral collaboration and that there are significant barriers to intersectoral collaboration, which in turn hinders a national approach to service planning and delivery. Intersectoral collaboration is not possible if sectors themselves are dependent on a top-down health sector driven and dominated approach, or if the general atmosphere is clouded by stigmatization of mental health illnesses.

Desenvolvimento da fluência no cálculo mental através do uso de estratégias de cálculo: um estudo no 4.º e no 6.º ano de escolaridade

Relatório de estágio de mestrado em Ensino do 1º e 2º Ciclo do Ensino Básico

Tensile stress–crack width law for steel fibre reinforced self-compacting concrete obtained from indirect (splitting) tensile tests

In this work, the fracture mode I parameters of steel fibre reinforced self-compacting concrete (SFRSCC) were derived from the numerical simulation of indirect splitting tensile tests. The combined experimental and numerical research allowed a comparison between the stress-crack width (σ - w) relationship acquired straightforwardly from direct tensile tests, and the σ - w response derived from inverse analysis of the splitting tensile tests results. For this purpose a comprehensive nonlinear 3D finite element (FE) modeling strategy was developed. A comparison between the experimental results obtained from splitting tensile tests and the corresponding FE simulations confirmed the good accuracy of the proposed strategy to derive the σ – w for these composites. It is concluded that the post-cracking tensile laws obtained from inverse analysis provided a close relationship with the ones obtained from the experimental uniaxial tensile tests.

Shaking table tests of a two-storey log house

This paper presents the findings of an experimental campaign that was conducted to investigate the seismic behaviour of log houses. A two-storey log house designed by the Portuguese company Rusticasa® was subjected to a series of shaking table tests at LNEC, Lisbon, Portugal. The paper contains the description of the geometry and construction of the house and all the aspects related to the testing procedure, namely the pre-design, the setup, instrumentation and the testing process itself. The shaking table tests were carried out with a scaled spectrum of the Montenegro (1979) earthquake, at increasing levels of PGA, starting from 0.07g, moving on to 0.28g and finally 0.5g. The log house did not suffer any major damage and remained in working condition throughout the entire process. The preliminary analysis of the overall behaviour of the log house is also discussed.

General and mental health of poor and multiproblematic families

The main feature of the so called multiproblem families is the persistence along time of a set of problems in various areas of the individual’s functioning in several family members.This research study aims: a) To identify and characterise the major health problems faced by the members of these families; b) To explore the perceived relevance of these problems; c) To explore the perceived effectiveness of health care interventions received by respondents; d) To explore the level of control perceived over these problems.

Rockburst laboratory tests database - Application of data mining techniques

Rockburst is characterized by a violent explosion of a block causing a sudden rupture in the rock and is quite common in deep tunnels. It is critical to understand the phenomenon of rockburst, focusing on the patterns of occurrence so these events can be avoided and/or managed saving costs and possibly lives. The failure mechanism of rockburst needs to be better understood. Laboratory experiments are undergoing at the Laboratory for Geomechanics and Deep Underground Engineering (SKLGDUE) of Beijing and the system is described. A large number of rockburst tests were performed and their information collected, stored in a database and analyzed. Data Mining (DM) techniques were applied to the database in order to develop predictive models for the rockburst maximum stress (σRB) and rockburst risk index (IRB) that need the results of such tests to be determined. With the developed models it is possible to predict these parameters with high accuracy levels using data from the rock mass and specific project.

Study of natural ventilation for a modular façade system in wind tunnel tests

Wind tunnel tests are a reliable tool to determine the effect of natural ventilation on buildings. This paper presents results of wind tunnel tests conducted to evaluate the influence of ventilation modules positioning on a façade system. Modules positioning was modified, resulting in different façade configurations. The tests were carried out with the use of a model, varying the position of the ventilation modules in the façade configuration. The cases tested were six ventilation modules positioned below the window-sill (ventilated window-sill), and three ventilation modules positioned above and below the façade. The façade system proposed was movable and interchangeable so that the same basic model could be used to test the possibilities for ventilation. Wind speed measurements were taken inside and outside the model for the different façades configurations to evaluate the best performance in relation to natural ventilation. Singleâ sided and Cross ventilation were considered for wind speed measurements. Results show the use of six ventilation modules positioned below the window-sill, forming "a ventilated window-sill" is the best solution in terms of natural ventilation.

Abstract computation in schizophrenia detection through artificial neural network based systems

Schizophrenia stands for a long-lasting state of mental uncertainty that may bring to an end the relation among behavior, thought, and emotion; that is, it may lead to unreliable perception, not suitable actions and feelings, and a sense of mental fragmentation. Indeed, its diagnosis is done over a large period of time; continuos signs of the disturbance persist for at least 6 (six) months. Once detected, the psychiatrist diagnosis is made through the clinical interview and a series of psychic tests, addressed mainly to avoid the diagnosis of other mental states or diseases. Undeniably, the main problem with identifying schizophrenia is the difficulty to distinguish its symptoms from those associated to different untidiness or roles. Therefore, this work will focus on the development of a diagnostic support system, in terms of its knowledge representation and reasoning procedures, based on a blended of Logic Programming and Artificial Neural Networks approaches to computing, taking advantage of a novel approach to knowledge representation and reasoning, which aims to solve the problems associated in the handling (i.e., to stand for and reason) of defective information.

Influence of climate on clinical diagnostic dry eye tests: pilot study

Purpose. To analyze dry eye disease (DED) tests and their consistency in similar nonsymptomatic population samples living in two geographic locations with different climates (Continental vs. Atlantic). Methods. This is a pilot study including 14 nonsymptomatic residents from Valladolid (Continental climate, Spain) and 14 sex-matched and similarly aged residents from Braga (Atlantic climate, Portugal); they were assessed during the same season (spring) of two consecutive years. Phenol red thread test, conjunctival hyperemia, fluorescein tear breakup time, corneal and conjunctival staining, and Schirmer test were evaluated on three different consecutive visits. Reliability was assessed using the intraclass correlation coefficient and weighted kappa (J) coefficient for quantitative and ordinal variables, respectively. Results. Fourteen subjects were recruited in each city with a mean (TSD) age of 63.0 (T1.7) and 59.1 (T0.9) years (p = 0.08) in Valladolid and Braga, respectively. Intraclass correlation coefficient and J values of the tests performed were below 0.69 and 0.61, respectively, for both samples, thus showing moderate to poor reliability. Subsequently, comparisons were made between the results corresponding to the middle and higher outdoor relative humidity (RH) visit in each location as there were no differences in mean temperature (p Q 0.75) despite RH values significantly differing (p e 0.005). Significant (p e 0.05) differences were observed between Valladolid and Braga samples on tear breakup time (middle RH visit, 2.76 T 0.60 vs. 5.26 T 0.64 seconds; higher RH visit, 2.61 T 0.32 vs. 5.78 T 0.88 seconds) and corneal (middle RH, 0.64 T 0.17 vs. 0.14 T 0.10; higher RH, 0.60 T 0.22 vs. 0.0 T 0.0) and conjunctival staining (middle RH, 0.61 T 0.17 vs. 0.14 T 0.08; higher RH, 0.57 T 0.15 vs. 0.18 T 0.09). Conclusions. This pilot study provides initial evidence to support that DED test outcomes assessing the ocular surface integrity and tear stability are climate dependent. Future large-sample studies should support these outcomes also in DED patients. This knowledge is fundamental for multicenter clinical trials. Lack of consistency in diagnostic clinical tests for DED was also corroborated. (Optom Vis Sci 2015;92:e284Ye289)

Mulheres encarceradas em São Paulo: saúde mental e religiosidade

OBJETIVO: A religião tem um importante papel na vida de indivíduos encarcerados. A saúde mental e a possibilidade de reabilitação parecem ser favorecidas através da religião. Entretanto poucos estudos no Brasil abordaram a saúde mental em população carcerária feminina e a relacionaram com a religiosidade. O objetivo deste estudo é verificar o perfil de saúde mental e a relação entre religião, religiosidade e saúde mental numa amostra de mulheres encarceradas em São Paulo. MÉTODOS: Foram entrevistadas 358 mulheres, detentas da Penitenciária Feminina da Capital (São Paulo-SP). Foi aplicado um questionário amplo que abrangeu dados sociodemográficos e culturais (incluindo a religiosidade), assim como itens sobre saúde mental e perfil criminal. A avaliação psicopatológica foi feita com o General Health Questionnaire (GHQ-12). Análises estatísticas comparando as variáveis com o GHQ-12 foram realizadas. Foi utilizada também a análise de regressão logística multivariada para respostas dicotômicas para as variáveis que possivelmente interagiram com a saúde mental. RESULTADOS: A idade média da amostra foi 30,7 anos ± 8,5. A prevalência de possível caso psiquiátrico foi 26,6%. CONCLUSÕES: Uma maior religiosidade pessoal associou-se a menor freqüência de possível transtorno mental. Não foram encontradas associações entre tipo de crime e saúde mental.

Migration and mental health: Japanese Brazilians in Japan and in Brazil

OBJECTIVE: Brazil is the country with the largest community of Japanese descendants in the world, from a migration movement that started in 1908. However, more recently (1988), a movement in the opposite direction began. Many of these descendants went to Japan for work purposes and suffered mental distress. Some of them sought treatment in Japan, while others returned to Brazil to seek treatment. The aim of the present study was to compare the sociodemographic profile and diagnoses of Japanese Brazilian psychiatric outpatients in Japan (remaining group) and in Brazil (returning group). METHOD: All consecutive Japanese Brazilian outpatients who received care from the psychiatric units in Japan and Brazil from April 1997 to April 2000 were compared. The diagnoses were based on ICD-10 and were made by psychiatrists. Sociodemographic data and diagnoses in Brazil and Japan were compared by means of the Chi-Squared Test. RESULTS: The individuals who returned to Brazil were mostly male and unmarried, had lived alone in Japan, had stayed there for short periods and were classified in the schizophrenia group. The individuals who remained in Japan were mostly female and married, were living with family or friends, had stayed there for long periods and were classified in the anxiety group. Logistic regression showed that the most significant factors associated with the returning group were that they had lived alone and stayed for short periods (OR = 0.93 and 40.21, respectively). CONCLUSION: We conclude that living with a family and having a network of friends is very important for mental health in the context evaluated.

Saúde mental, qualidade de vida e religião em idosos de um Programa de Saúde da Família

OBJETIVO: Avaliar as relações entre as dimensões da vida sociocultural, como rede social de apoio e religião, saúde mental e qualidade de vida (QV) em idosos de um Programa de Saúde da Família (PSF). MÉTODOS: Avaliou-se uma amostra de 82 idosos (> 60 anos), cadastrados em um PSF. Foram descritos o perfil de saúde física e mental, a capacidade funcional e a qualidade de vida, assim como fatores demográficos, socioeconômicos e culturais associados a essas dimensões. Foram utilizados os seguintes instrumentos: Inventário Sociodemográfico, Clínico e de Religiosidade, MINI, WHOQOL-bref e o Índice de Barthel. RESULTADOS: Dos 82 idosos, 47 (57%) eram mulheres e 35 (43%) homens, porquanto 42 (51%) com de idade de 60 a 69 anos e 40 (49%) com idade de 70 anos ou mais. Por meio de modelos multivariados, identificou-se que a presença de transtornos mentais associa-se a morar só ou com apenas uma pessoa. Apresentaram uma pior QV os idosos que não recebem aposentadoria e que fizeram uso de benzodiazepínicos no último ano. A religião revelou-se dimensão importante associada à QV; em todos os domínios da WHOQOL-bref os idosos membros de igrejas evangélicas apresentaram piores escores. CONCLUSÕES: O presente estudo evidencia que idosos com menores escolaridade e renda tendem a ter pior QV e saúde.

Common mental disorders among medical students

OBJECTIVE: Common mental disorders (CMD) have a high impact on interpersonal relationships and quality of life and are potential underlying causes for the development of more serious disorders. Medical students have been indicated as a risk population for the development of CMD. The aim of this study was to determine the frequency of CMD in undergraduate medical students and to identify related factors. METHODS: A cross-sectional study was performed in a sample population of medical students. CMD was identified according to the 20-item Self-Report Questionnaire. RESULTS: Two hundred and twenty-three students completed the questionnaire. The overall prevalence of CMD was 29.6% and its presence was independently associated with sleep disorders, not owning a car, not working and sedentary lifestyle. CONCLUSIONS: These findings indicate a high prevalence of CMD in the sample studied and are important for supporting actions to prevent mental disorders in future doctors and for reflecting on the curricula currently in use in medical schools.