Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective

Aim of this study was to identify knowing-doing actions constituted the practice of Family Health (FH), in view of nurses in relation to the person and family care in mental distress in terms of professional knowledge of Le Boterf. Method: Descriptive exploratory qualitative study, to deepen contruction of nurse in FH. The survey was conducted in 3 Units FH. Result: Doing a thematic analysis, came to the following categories: “Knowing how to act and react with relevance”; “Knowing how to combine resources and mobilize them in a professional context”; “Knowing how to interact with multiple knowledges”; “Knowing how to transpose”; “Knowing how to learn and knowing how to learn to learn”; “Knowing how to engage”. Final considerations: the greatest difficulty was "be able to transpose," and that the daily demand of the FH teams requires a lot of this knowledge. Little transposition of knowing-doing in real situations has been verified.

Mental ill health in the elderly: medical students’ social representations in the United Kingdom

Objective This study aims to explore medical students’ social representations of mental ill health in older adults. Method It comprises an exploratory and qualitative investigation based on the theory of social representations. Two focus groups with pre-clinical medics (group 1, N=4; group 2, N=4) and 10 individual interviews with clinical medical students were conducted. Thematic analysis at a latent level explored meanings and differences between groups. Results Three overarching themes reflect participants’ representations of mental health problems in later life – mental ill health in old age, polarisation of care, and challenges to care. Primary health care appears as an important strategy to overcome barriers to mental health care in the community. Nevertheless, disqualifying representations, stigma and organization of services constitute the main challenges to quality mental health care in later life. Conclusion This paper highlights the need to address cultural and organizational barriers to promote quality care.

Prevalença de factors de risc cardiovascular i qualitat de vida en pacients amb trastorn mental sever

L’objectiu és descriure els factors de RCV i variables relacionades amb la qualitat de vida de pacients amb TMS. Estudi transversal on s’analitzen variables clíniques, antropomètriques, anàlitiques i d’estils de vida en 212 pacients. Distribució dels factors de RCV: 61,6% tabaquisme, 84,4% perímetre de cintura alterat, 67,5% obesitat, 15% hipercolesterolèmia, 41,1% hipertrigliceridèmia i 27,8% HTA. La qualitat de vida percebuda és pitjor en la majoria de dimensions respecte a població general. Calen estudis per a determinar intervencions efectives per a millorar el control metabòlic i la qualitat de vida en aquests pacients.

Special investigation of the Dallas County Mental Health Advocate for the period September 1, 2005 through March 31, 2006

Special investigation of the Dallas County Mental Health Advocate for the period September 1, 2005 through March 31, 2006

Relatório de Estágio Saúde e Doença Mental Centro Psicogeriátrico Nossa Senhora de Fátima

O estágio clínico consiste no culminar de um processo de formação base, consistindo num primeiro contacto com o contexto profissional, pelo que nesta etapa espera-se que, os conhecimentos adquiridos no decorrer do percurso académico, sejam aplicados no contexto real, contemplando todas as vicissitudes que os contextos profissionais possam apresentar. Deste modo, o relatório de estágio torna-se um instrumento fundamental para a promoção da reflexão das práticas, assim como para dar visibilidade das actividades desenvolvidas. Posto isto, constata-se que o estágio académico é essencial para o desenvolvimento de competências fundamentais para o exercício da psicologia, pelo que o momento em que é escolhido o local do estágio é de facto importante. Assim, optei pela psicogeriatrica por vários motivos, por se tratar de uma faixa etária com a qual me agrada intervir, na medida em que considero que o geronte é um ser humano que já possui uma vasta experiência de vida, sendo um privilégio intervir com pessoas que têm uma história de vida tão rica. Para além disso, a população portuguesa tende a envelhecer, pelo que é essencial investir numa perspectiva de promoção do envelhecimento saudável.

Iowa Budget Report, Building on our Progress: Protecting our Priorities, 2009

*********** Some files are large and will take time to load. *********** Seven Files: 1)Report Cover, 2)Table of Contents, 3)Statewide Financial Summaries, 4)Department Budgets, 5)Capitol Projects, 6)Associated Financial Documents, 7)Budget Report. To Members of the 82nd General Assembly, As we begin the second year of our Administration, we are pleased to submit the Fiscal Year 2009 budget for the State of Iowa pursuant to Iowa Code Section 8.21 and our constitutional authority. This budget recognizes the progress that we began last year with improvements in education, economic development, energy independence, and health care; provides funding for new policy initiatives in these areas; and is based on fiscally sound budget practices. Building on last year’s accomplishments, our Fiscal Year 2009 General Fund budget proposes an additional $75 million for increasing teachers’ salaries as part of our goal to move Iowa closer to the national average. We lay the foundation for student achievement by recommending $32.1 million for pre-school education, and we also propose $177.5 million in total for community colleges and $726.2 million in total for Regents universities. To make our State more energy independent, our General Fund budget appropriates the second-year funding of $25 million for the new Iowa Power Fund. The newly established Office of Energy Independence will soon start making awards from the Power Fund. Apart from the budget, we will be making several proposals to implement the new State energy plan. We have pledged to expand the number of Iowans who have health-care coverage. As a result, we are recommending additional funding for enrollment growth in the State Children Health Insurance Program (SCHIP). These additional funds will help the State provide coverage for another 25 percent of children who are eligible but not yet enrolled in hawk-i and the Iowa Medicaid Program. To protect the safety of Iowans, we are recommending issuance of revenue bonds for approximately $260 million in net proceeds to build a new state penitentiary in Ft. Madison, renovate and expand the Women’s Correctional Institution at Mitchellville, upgrade kitchen facilities at the Rockwell City and Mt. Pleasant Correctional Institutions, and expand Community-Based Correctional Facilities in Ottumwa, Sioux City, Waterloo, and Des Moines. Additionally, we are including funding for developing a prototype program for providing parolees and low-risk offenders with mental health and drug abuse treatment and educational services to help them make a crime-free re-entry into our communities. As part of this Capitals Budget, we also propose using $20 million for the State’s matching share for building new facilities at the Iowa Veterans Home. Iowa Budget Report iv Fiscal Year 2009 Importantly, our budget continues to fully fund our State’s Reserve Funds to help buffer Iowa from any future economic downturn. We recommend reimbursing $78.2 million to the Property Tax Credit Fund as part of our multi-year proposal to correct bad budgeting practices and eventually restore $160.0 million to this Fund. To provide more transparency, we are transferring operational expenditures in the Rebuild Iowa Infrastructure Fund to the General Fund and expenditures from the Endowment for Healthy Iowans and Healthy Iowans Tobacco Trust Funds to the General Fund. We believe that Iowa has charted a new course of becoming energy independent, providing quality pre-school education, recognizing the importance of our teachers, and providing greater health coverage for children. Our Fiscal Year 2009 budget and policy priorities reflect our continuing faith in Iowa’s ability to be the best state in the nation. We look forward to working with you in a bi-partisan and all-inclusive manner to build on our progress and protect our priorities. Sincerely, Chester J. Culver Governor Patty Judge Lt. Governor

Nitric ocide mediates the blood pressure response to mental stress in humans

Objectif : Le monoxyde d'azote (NO) régule la pression artérielle en modulant le tonus vasculaire périphérique et l'activité sympathique vasoconstrictrice. La synthèse du NO est altérée dans plusieurs maladies cardiovasculaires importantes. La perte de l'effet vasodilatateur du NO et de son effet freinateur sur la décharge sympathique pourrait entraîner une réponse vasopressive exagérée au stress mental. Méthodes : Nous avons donc comparé les réponses sympathique (activité nerveuse musculaire sympathique) et hémodynamique au stress mental pendant une perfusion isotonique de NaCI et lors de l'administration d'un inhibiteur systémique de la NO- synthase (NG-monomethyl-L-arginine, L-NMMA). Résultats : Le résultat principal est que le stress mental qui pendant la perfusion saline augmente l'activité nerveuse sympathique d'environ 50% et la pression artérielle moyenne d'environ 15%, n'a eu aucun effet sympathoexcitateur et vasopresseur détectable lors de la perfusion de L-NMMA. Ces observations ne sont pas liées à une atteinte généralisée de la réponse hémodynamique et/ou sympathique lors de la perfusion de L-NMMA, car ces réponses étaient conservées lors de l'immersion de la main dans de l'eau glacée. Conclusions : Le stress mental induit des effets vasopresseurs et sympathoexcitateurs chez l'homme qui sont médiés par le NO. Ces résultats laissent penser que, contrairement à ce qui a été généralement supposé, le NO peut dans certaines circonstances augmenter la pression artérielle in vivo.

Espiritualidade e Saúde Mental e Geral nos Idosos Institucionalizados

O estudo da espiritualidade e a sua relação com a saúde mental e geral, sobretudo, associada ao envelhecimento, continua ainda muito escasso a nível nacional. Assim, o presente estudo tem como objetivo avaliar a relação entre a espiritualidade e a saúde mental e geral nos idosos institucionalizados. Trata-se de uma investigação quantitativa, do tipo observacional, descritivo e correlacional, transversal e entre-sujeitos. A amostra foi composta por 55 idosos, utentes da Santa Casa de Misericórdia de Braga (SCMB), de ambos os géneros, com idades compreendidas entre os 55 e os 99 anos. Os instrumentos utilizados foram a Escala de Avaliação da Espiritualidade (EE), o Brief Symptom Inventory (BSI), o Short-Form Health Survey (MOS SF-36v2) e um Questionário sociodemográfico complementar. Os resultados evidenciam que estamos perante uma amostra de sujeitos com elevada espiritualidade, sem problemas psicopatológicos e saúde física satisfatória, sendo as dimensões menos elevadas o desenvolvimento emocional e funcionamento físico. Para além disso, constatamos uma associação estatisticamente significativa negativa entre as dimensões da espiritualidade e as do BSI e uma associação significativa positiva entre as dimensões da espiritualidade e o funcionamento social do SF-36 v2. Por fim, relativamente à variação dos resultados da espiritualidade em função das variáveis sociodemográficas, verificamos que as mulheres apresentam resultados significativamente superiores nas duas dimensões, as pessoas mais velhas apresentam resultados significativamente superiores na dimensão crenças e os idosos que não foram à escola mas sabem ler/escrever também apresentam resultados superiores nessa dimensão. Não se verificaram diferenças em função do estado civil. Uma vez que esta é uma temática pouco estudada em Portugal, esperamos ter contribuído para o aprofundamento do conhecimento nesta área e que novos estudos continuem a incidir sobre a mesma, de forma a conseguirmos desenvolver programas de intervenção cada vez mais eficazes e direcionados para a promoção do bem-estar nos idosos e de um processo de envelhecimento saudável.

Contribuições da Enfermagem na Integração do Doente Mental na Família

Com este estudo pretendeu-se, descrever o papel da Enfermagem no processo de integração do Doente Mental na família. Trata-se de um estudo exploratório descritivo de natureza qualitativa, realizado no Serviço de Saúde Mental do Hospital Baptista de Sousa. Para tal, participaram 5 enfermeiros que prestam os cuidados de enfermagem neste serviço. Os dados foram recolhidos com base numa entrevista semiestruturada e posteriormente submetidos à uma análise de conteúdo, revelando défices a nível dos recursos materiais e humanos, que dificultam o campo de acção do Enfermeiro, diminuindo a sua autonomia. Este estudo tem implicações práticas; incentivar futuras investigações no ramo da Enfermagem, promover e fomentar especialização do Enfermeiro na área de Saúde Mental e Psiquiatria. A nível teórico: servir de suporte bibliográfico, para próximos estudos e investigações. Apelar pela autonomia do Enfermeiro. Em geral, conclui-se que a Enfermagem em Saúde Mental e Psiquiatria, precisa ser mais valorizada, e ganhar maior autonomia profissional, por parte dos Enfermeiros.

A comunicação terapêutica na prestação dos cuidados de enfermagem aos portadores de doença mental no Hospital Baptista Sousa

A comunicação terapêutica é uma competência diária da parte dos enfermeiros na prestação de cuidados de Enfermagem nos Serviços de Saúde Mental. É, portanto, fulcral tanto para os enfermeiros como também para os doentes mentais, ao permitir a cultivação de uma relação básica na comunicação, visando a diminuição do tempo de internamento do utente, o que o faz ser um factor determinante na relação de ajuda nos cuidados de saúde. Este estudo visa realçar a importância da comunicação como ajuda terapêutica nos portadores de doença mental. Trata-se, portanto, de um estudo exploratório descritivo com abordagem qualitativa, realizado no Serviço de Saúde Mental do Hospital Baptista de Sousa. Participaram no estudo quatro enfermeiros que actuam no serviço de saúde mental, sendo os dados colhidos com base numa entrevista semiestruturada e submetidos, posteriormente, a uma análise de conteúdo. Os discursos apontaram que os enfermeiros reconhecem a importância da comunicação terapêutica na prestação dos cuidados de enfermagem no serviço de saúde mental, no estabelecimento de uma relação de empatia e na recuperação do utente. Concluiu-se que a inadequação do espaço neste sector constitui o principal obstáculo à comunicação terapêutica.

Troubles emotionnels en médecine de famille ou le visage caché d'une souffrance [Mental disorders in primary care].

Mental disorders (depression, anxiety and somatization) are frequent in Primary care and are often associated to physical complaints and to psychosocial stressors. Mental disorders have in this way a specific presentation and in addition patients may present different associations of them. Sometimes it is difficult to recognize them, but it is important to do so and to take rapidly care of these patients. Specific screening questions exist and have been used in a research of the Institute of General Medicine and the Department of Ambulatory Care and Community Medicine (PMU), University of Lausanne, Switzerland.

The size and burden of mental disorders and other disorders of the brain in Europe 2010.

Aims: To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU. Method: Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY). Results: Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8 million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165 m vs. 2005: 82 m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke. Conclusion: In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past.Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for isorders of the brain as the core health challenge of the 21st century. (C) 2011 Published by Elsevier B.V.

Handicap mental et psychiatrie [Mental retardation and psychiatry]

In the canton de Vaud (Switzerland) the psychiatric units devoted to mental retardation have been suppressed during the deinstitutionalization process in the 1970/80s. However, the use of psychiatric hospitalizations has increased these last years. This increase is accompanied by an interdiction of seclusion and restraint outside of the specialized psychiatric unit. A unit of liaison psychiatry has been created as an alternative to psychiatric hospitalization and to assist directly the staff of specialized institutions for people with mental retardation or the family of the patient. The article describes the challenges of liaison psychiatry in this field and the potential benefits of research for the psychiatry of mental retardation.

Lidar com a doença mental : a pluralidade de sistemas de cuidados e de itinerários terapêuticos : análise comparativa de dois estudos efectuados junto de duas populações residentes em Portugal

Several studies point to the plurality of care systems to deal with illness. They can be organized into professional, popular and alternative systems (the latter includes the complementary and the traditional ones). What the particular setup is in each cultural system is the core question of both the empirical studies we report. The purpose of this article is to understand how lay people deal with mental illness, examining the therapeutic itineraries that are constructed between plural care systems, featuring in particular the use of traditional medicine. The analysis of the two studies (one carried out in the north region and the other in Lisbon) allowed us to interpret these practices and discuss the social and cultural factors that determine and explain the settings that were found. Both researches fit into a qualitative methodology. In-depth, semi-structured interviews were performed and were analyzed using discourse analysis to describe and interpret data. The results point to a plurality of therapeutic itineraries, built around public and private speeches, where the explanatory systems underlying the use of official medicine and/or traditional practices found plural meanings. People may use these systems in several forms, using one or combining more than one, simultaneously or sequentially, depending on the context and on the needs they feel to face both illness and mental suffering. It is in between the space of the impotence and ‘incompetence’ of the ‘wise’ medicine that other therapeutic systems develop. It is important to understand those systems because of their achievements and their heuristic power to explain society and culture.

Predictors and Moderators of Clinical Outcomes in Adolescents with Severe Mental Disorders After an Assertive Community Treatment.

Previous studies have shown that stressful life events (SLEs), gender, social functioning and pretreatment severity are some of the predictors and/or moderators of treatment outcome in psychiatric care. The current study explored the effect of these predictors and moderators on the treatment outcome related to assertive community treatment (ACT) proposed to young people with severe mental disorders. 98 patients were assessed for externalizing and emotional difficulties, at admission and then at discharge of an ACT. Analyses revealed significant improvements in terms of symptomatology. In particular, regression analyses showed that pretreatment severity is a significant predictor of the outcome on emotional symptoms and is moderated by SLE on the outcome on externalizing symptoms. Furthermore, higher social functioning proved to predict better outcome on externalizing symptoms. Our results further evidence that these factors can explain inter-individual differences in outcome related to ACT. The theoretical and clinical implications of these results are discussed.