Implementation progress of mental health services in Rwanda: Bugesera district case

RESUMO: O Ministério da Saúde do Governo do Ruanda identifica a saúde mental como uma área de prioridade estratégica para a intervenção em resposta à alta carga dos transtornos mentais no Ruanda. Ao longo dos últimos 20 anos após o genocídio, o sector público reconstruiu sua Resposta Nacional de Saúde Mental com base no acesso equitativo aos cuidados, através do desenvolvimento de uma Política Nacional de Saúde Mental e novas estruturas de saúde mental. A política de Saúde Mental do Ruanda, revista em 2010, prima pela descentralização e integração dos serviços de saúde mental em todas as estruturas nacionais do sistema de saúde e ao nível da comunidade. O presente estudo de caso tem como objetivo avaliar a situação do sistema de saúde mental de um distrito típico de uma área rural no Ruanda, e sugerir melhorias, incluindo algumas estratégias para monitoras as mudanças. Os resultados do estudo permitirão ao Ruanda reforçar a sua capacidade para implementar o Plano Nacional de Saúde Mental ao nível dos distritos. O relatório também será útil para monitorar o progresso da implementação de serviços de saúde mental nos distritos, incluindo a prestação de serviços de base comunitária e a participação dos usuários, suas famílias e outros interessados na promoção, prevenção, assistência e reabilitação em saúde mental. Este estudo também procurou avaliar o progresso da implementação dos cuidados de saúde mental a nível descentralizado, com vista a compreender as implicações em termos de recursos desses processos. Foi realizada uma análise situacional num local do distrito, baseado em entrevistas com as principais partes interessadas responsáveis, usando o Instrumento de Avaliação de Sistemas de Saúde Mental da Organização Mundial da Saúde (WHO-AIMS). Os resultados sugerem que os recursos humanos para a saúde mental e serviços de base comunitária de saúde mental no distrito continuam a ser extremamente limitados. Os profissionais de saúde mental são adicionalmente limitados na sua capacidade para oferecer intervenções de emergência a pacientes psiquiátricos e garantir a continuidade do tratamento farmacológico a pacientes com condições crônicas. Para planejar efetivamente, de acordo com as necessidades da comunidade, sugerimos que o sistema de saúde mental deve envolver também os representantes das famílias e dos usuários no processo de planificação de modo a melhorar a sua contribuição no processo de implementação das atividades de saúde mental. Este estudo de caso do Distrito de Bugesera oferece a primeira análise de nível distrital dos serviços de saúde mental no Ruanda, e pode servir como uma mais-valia para a melhoria do sistema de saúde mental, incluindo a advocacia para a melhoria da qualidade dos cuidados de saúde mental a este nível, aumentando o financiamento para a implementação de serviços clínicos de saúde mental e os recursos humanos disponíveis para a prestação de cuidados de saúde mental, principalmente a nível dos cuidados primários.--------------------- ABSTRACT: To deal with the high burden of mental health disorders resulting from consequences of the 1994 genocide against Tutsis, the Rwanda Ministry of Health (MoH) considers mental health as a priority intervention. For the last 20 years, Ministry of Health focused on rebuilding a national and equity-oriented mental health program responding to the population needs in mental health. Mental health services are now decentralized and integrated in the national health system, from the community level up to the referral level. This study assessed the situation of mental health services in one rural district in Rwanda. It was aimed at assessing the progress of implementation of mental health care at the decentralized level, focusing on resource implications and processes. This study is based on interviews conducted with key stakeholders, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). Findings show that human resources for mental health care and community-based mental health services of the assessed district remain extremely limited. Mental health professionals face limitation regarding the ability to provide emergency management of psychiatric patients and to ensure continuity of psychopharmacological treatment of patients with chronic conditions. To improve the implementation process of mental health interventions and activities, a planning process based on community needs and the involvement of representatives of families and users in planning process should be considered. The Bugesera case study on the situation of mental health services can serve as a baseline for improvement of the mental health program in Rwanda, in terms of quality care services, infrastructure and equipment, human and financial resources.

Variables asociadas a abuso físico y psicológico a la pareja

ResumenEl abuso físico y el abuso psicológico representan un problema de salud pública frecuente en mujeres colombianas. No obstante, pocas investigaciones exploran las variables asociadas en mujeres adultas. Objetivo: establecer variables psicosociales asociadas a abuso físico y psicológico en mujeres de Bogotá (Colombia). Materiales y métodos: se diseñó un estudio analítico transversal. Se solicitó la participación de mujeres adultas con pareja de estrato socioeconómico bajo. Se aplicaron las escalas: Apgar familiar (disfunción familiar), Escala de Rosenberg (autoestima), Cuestionario General de Salud (GHQ-12, trastornos mentales comunes) e Índice de Abuso a la Pareja (Index of Spouse Abuse, ISA-8, ISA-F e ISA-P). Mediante regresión logística se ajustaron la variables psicosociales asociadas al abuso físico y al abuso psicológico. Resultados: participaron 292 mujeres. La media para la edad fue 33,0 años (DE = 9,23). La prevalencia de baja autoestima fue del 29,1%; de disfunción familiar, del 82,5%; de trastornos mentales comunes, del 73,6%; de abuso psicológico, del 68,5% y de abuso físico, del 70,2%. Los trastornos mentales comunes (OR = 4,0; IC 95% 2,2-7,5), baja autoestima (OR = 2,4; IC 95% 1,2-4,7) y disfunción familiar (OR = 2,3; IC 95% 1,1-4,8) se asociaron a abuso psicológico; y baja autoestima (OR = 2,6; IC 95% 1,4-5,0) y trastornos mentales comunes (OR = 2,4; IC 95% 1,4-4,3) a abuso físico. Conclusiones: es alta la frecuencia de maltrato conyugal en mujeres de estrato socioeconómico bajo de Bogotá. El trastorno mental común y la baja autoestima se asocian a abuso psicológico y a abuso físico.

Description of the risk factors for relapse in patients diagnosed with severe mental disorders

Objective: The objective of this paper is to describe the population served in mental health institutionsfor mental illness relapse, and the process of identifying risk factors in relapsing patientsdiagnosed with severe mental illness. To this end a descriptive exploratory multicenter, multistageepidemiological study was carried out in mental health institutions of the Order of San Juan deDios Hospital (OHSJD) with hospitalized relapsing patients with a diagnosis of severe mentaldisorder. This study comes from a working network of Psychology professionals in the OHSJDnationwide. Materials and methods: The population sample was of 1005 patients diagnosed withsevere mental disorders, who had presented relapse during the last year. First, the characterizationof the general population was conducted; then, it was narrowed down to the centers, taking intoaccount similarities and differences found according to the clinical and demographic variables.Results: Major risk factors for relapse found in patients diagnosed with severe mental disorderswere: having between 38 and 58 years of age, being female, single, graduates, unemployed, witha prevalence of bipolar affective disorder diagnosis, number of hospitalizations between 2 and10, number of drugs at the time of leaving hospital 2 to 6, with severe difficulties relating withothers and difficulties in adherence to treatment. The need for a caregiver was also found, as wellas a limited number of received psychological interventions. How the system of beliefs affects thedisease and the poor adherence to treatment was identified. Conclusions: These results indicatethe requirement of a design of team intervention strategies, ranging from the assessment team(home), definition of therapeutic action plans (for) and the posthospitalizacion (egress) following.There is a poor support network and limited adherence to comprehensive treatment.

Promotor da Saúde : o Farmacêutico Promotor de Saúde nas Empresas

Para as sociedades contemporâneas, onde o predomínio de transtornos mentais parece comprometer a qualidade de vida e a prosperidade económica, não só através de custos diretos de saúde e serviços sociais, mas também devido à perda de emprego e produtividade, a implementação de programas de promoção de saúde ocupacional é imperativa. Os principais objetivos desta monografia são o estudo dos níveis de stresse ocupacional de uma amostra de trabalhadores portugueses, análise do seu conhecimento sobre gestão de stresse e o desenvolvimento de um projeto de promoção de saúde, a realizar por farmacêuticos, que visa um incremento de saúde e bem-estar dos colaboradores no seu local de trabalho. Trata-se de um estudo descritivo observacional e transversal. Aplicou-se um questionário por inquérito online, confidencial e voluntário, onde participaram 240 indivíduos dos quais 104 preencheram os critérios de inclusão. Sessenta e seis são mulheres. Os conhecimentos sobre sintomas associados ao stresse são apenas alguns (51%) ou até mesmo inexistentes (46%), e a maioria da população em estudo não sabe como prevenir (77%) e/ou gerir (82%) o stresse no local de trabalho. O estudo corrobora a existência de fatores de stresse profissional. Programas de promoção de saúde ocupacional, como aquele planificado ao longo do trabalho, podem melhorar o bem-estar, a saúde mental e consequentemente aumentar a produtividade, diminuindo o absentismo dos trabalhadores em Portugal.

A tênue fronteira entre a saúde e a doença mental: um estudo de casos psiquiátricos à luz da nova história cultural (1937-1950)

Esta dissertação visa analisar, através de um exercício de interdisciplinaridade e de estudo de casos psiquiátricos, as representações simbólicas relativas à doença mental, pertinentes ao imaginário de um segmento da sociedade gaúcha, no período histórico que compreende os anos de 1937 a 1950. Através da relação de conceitos da Nova História Cultural e da Psicologia Analítica de C.G. Jung, lança-se luzes sobre os dados encontrados nas fontes, quais sejam, as representações encontradas no imaginário dos doentes, cotejando-as sempre com aquelas que determinam a terapêutica dentro de uma instituição psiquiátrica, mais especificamente no Hospital Psiquiátrico São Pedro de Porto Alegre.

Uma intervenção abrangente para reduzir a evasão de escolas públicas

Objetivos: A evasão escolar é um importante problema social, educacional e de saúde nos países em desenvolvimento. Este estudo tem como objetivos: a) realizar uma revisão sistemática da literatura mundial sobre evasão escolar, focalizando em fatores de risco e possíveis intervenções; b) avaliar a efetividade de uma intervenção abrangente planejada para reduzir a evasão de escolas públicas em uma cidade no Brasil; c) descrever as barreiras encontradas na implementação dessa intervenção; e d) comparar os estudantes em risco para evasão escolar que responderam a essa intervenção com os que abandonaram a escola. Métodos: 1) Para a revisão, foram acessadas as bases de dados computadorizadas mais importantes para a psiquiatria, psicologia e pesquisa comunitária. Os estudos relevantes publicados em revistas científicas são descritos; 2) duas escolas públicas com taxas similares de evasão nas séries fundamentais foram selecionadas. Em uma delas, um programa de intervenções universais de prevenção em diferentes níveis foi implementado durante um ano letivo. Para os alunos que permaneceram ausentes durante dez dias consecutivos sem justificativa, foram oferecidos avaliação de saúde mental e encaminhamento para serviços de saúde mental disponíveis na comunidade. Na segunda escola, não foi implementado nenhum tipo de intervenção As variáveis de desfecho eram as taxas de evasão escolar e de abstenções no último trimestre; e 3) as barreiras à implementação da intervenção são descritas. Os estudantes que responderam à intervenção retornando para a escola e aqueles que evadiram são comparados quanto a variáveis demográficas, QI, transtornos mentais, psicopatologia materna e funcionamento familiar. Resultados: Na revisão sistemática da literatura, 37 estudos realizados em cinco países são descritos. Após a intervenção, houve diferenças significativas entre as duas escolas nas taxas de evasão escolar (p < 0,001) e de abstenção no último trimestre (p < 0,05). De 40 alunos em risco para evasão, 18 (45%) retornaram para a escola após a intervenção. O principal problema na implementação da intervenção foi o pequeno comprometimento da equipe escolar. Na regressão logística multivariada, apenas uma tendência para diferença entre os grupos nos escores de hierarquia familiar do FAST foi detectada (p = 0,06). ). Conclusões: Nossos achados sugerem a eficácia de uma intervenção abrangente, que combina aspectos de prevenção primária com outros focados em estudantes em risco para evasão escolar, em países em desenvolvimento. É necessária a preparação intensiva da equipe escolar antes da implementação da intervenção. Intervenções abordando aspectos do funcionamento familiar devem ser incluídas no programa. São necessários mais estudos envolvendo a população dos países em desenvolvimento.

Achados neuropsiquiátricos e neuroquímicos em dependentes de cocaína

Resumo não disponível

Qualidade de vida do servidor da Universidade Federal do Rio Grande do Norte em condição crônica de saúde

The study aimed to analyze the influence of chronic health conditions (CHC) on quality of life (QOL) of UFRN servers assaulted by CHC. It is a descriptive and cross-sectional study with prospective data and quantitative approach, accomplished in the ambulatory clinic of the Department of Server Assistance (DSA) of the Pro-Rectory of Human Resources, during three months. The sample was composed by accessibility, totaling 215 people, being 153 active and 62 inactive servers, in chronic health condition. The data were collected through the application of the sociodemographic characterization, health, environmental and laboral form, the Medical Outcome Study 36-Item Short Form (SF-36). The study was evaluated by the HUOL Ethics Committee (CAAE no. 0046.0.294.000.10), obtaining assent. The results were analyzed in the SPSS 15.0 program through the descriptive and inferential statistics. It was identified servants predominantly male (59,1%), under 60 years old, married or in stable union, Catholics, brown color, living in the capital and residents in own home. Regarding labor issues, there was a predominance of active servers technical-administrative with intermediate and medium level positions and small proportion of docents. Among the CHC, the non-communicable diseases - NCDs (95.8%) had a higher frequency, followed by persistent mental disorders - PMDs (18.6%) and, finally, the continuous and structural physical deficiency - CSPD (16.9 %). The QOL of servers was considered good, with a mean score of 72.5 points in the total score, with the most affected domains: physical (59.1), general health (66.2), bodily pain (66.3) and functional aspects (72.0). The mental health dimension (76.5) had a better average than the physical dimension (68.0 points). It was found that the decrease in QOL scores is significant statistically related to higher number of CHC (ρ <0.001), with no statistical significance regarding the functional situation (p = 0.259). The administrative technicians of elementary, primary, secondary levels and docents had the worst QOL scores. After the correlation analysis of CHC with the domains and dimensions of the SF-36, there was statistically significant, negative and weak correlation of the domains: functional aspect (ρ = 0.002, r = -0.207), physical aspects (ρ = 0.007; r = -0.183), vitality (ρ = 0.002, r = -0.213), social function (ρ = 0.000, r = -0.313), emotional aspects (ρ = 0.000, r = -0.293), mental health (ρ = 0.000 , r = -0.238), physical health dimension (ρ = 0.002, r = -0.210) and mental health dimension (ρ = 0.000, r = -0.298). The presence of PMD isolated or together, contributed to a lower SF-36 scores, being the domains variation of mean significant, except for bodily pain, general health and physical aspects. By correlating the categories of CHC and QOL, there was a weak correlation (r ≤ -0.376) and significant (ρ ≤ 0.011), mainly related to the NCD, PMDs and NCD + PMD, affecting the mental health, social function, emotional aspects, vitality and functional aspect domains. Front of the results, it was concludes that the servers quality of life is influenced by the CHC. Thus, it was inferred that the presence of CHC causes a negative effect on quality of life, leading the active and inactive servers to exposure their overall life activities and work over the years, due to the morbidity affected, mainly related to NCDs and PMDs. Descriptors: Quality of life. Chronic disease. Occupational Health. Nursing

A morte a concepção de estudantes de enfermagem

Understanding the meaning of death for student nurses is the subject of this research. The motivation for the meeting place of my difficulties as a person and especially as a teacher in the face of nursing students in dealing with death on a day-to-day hospital during the undergraduate course. Death became known that this evil looms before men and destabilizing, causing often irreversible mental disorders when faced with family loss. Therefore, it is appropriate to study it the possibility of making us reflect on our way of living life and dealing with human beings from the perspective of finitude. Aimed to understand the meaning of death for nursing students. For this purpose, it was based on the following guiding question: What is the meaning of death for you as a nursing student? From this perspective, the study was developed within a qualitative dimension of the phenomenological approach. To perform ten students were interviewed during the month of July 2009. Emerged from these interviews a variety of feelings such as fear, anxiety, insecurity, failure, sadness, as the sensory experience of each. To understand the meaning units that emerged from the empirical data which constitute the essence of this research were fundamental studies dealing with Heidegger about the death in a phenomenological perspective, as well as authors Bicudo, D'Assunção, Dastur, Morin, Boff, Kübler-Ross, Boemer, among others. From the understanding of the phenomenon, we can say that death produces mixed feelings in these students that lead to selfprotection, understood, often as a departure from the other, at the approach of death. However, it proved to be sensitive and receptive to the approach of death in other dimensions, beyond the highly technical aspects, pointing to a paradigm shift that has the yeast's own willingness to change. In addition, the research highlights the weaknesses in the education of nurses regarding the understanding of the whole human death and the need to overcome them.

Histórias de vidas de Usuários de psicofármacos: o desafio do cuidar para a enfermagem

Study of qualitative approach using the oral history methodology, in modality oral history of life, which aimed to: tell the stories of lives of users of psychotropic drugs for prolonged period of time, in Family Health Unit Santarém (FHU Santarém), Natal-RN-Brazil; identify possible causes which influence and trigger, respectively, use of psychotropic for prolonged period of time; search for greater knowledge about this problem of public health; contribute with the planning and development of nursing cares, to users of psychotropic drugs for prolonged period of time, as well as in Mental Health Care, integrally, in perspective of Family Health Strategy (FHS). It was used as a baseline survey, the coverage area of family health team, from FHU Santarém, which belongs to Health District North II, from Municipal Health Secretariat, in Natal-RN-BR. Eight employees who use psychotropic drugs for prolonged period of time were interviewed. They volunteered to narrate their life stories, which were analyzed by using the thematic modality, since the study is focused on the question of the use of psychotropic drugs for prolonged period of time. The thematic axis crisis, prejudice and care, defined by the categorization of common elements, found through successive and careful readings of narratives, were used to analyze these stories of lives. The study found that users of psychotropic drugs for prolonged period of time are affected by mental health crisis, feeling need to be heard, as well as the existence of social prejudice towards people with mental disorders, and non-completion of development of managed care, by the family health team, and particularly, the nursing care to people suffering from mental disorders and users of psychotropic drugs for prolonged period of time. It is proposed that, in the search of development and planning of nursing care to users of psychotropic drugs for prolonged period of time, and in mental health care, integrally, in FHS, the nurse can think and make a drawing about manners of performing nursing care to this clientele through the use of consultation of nursing, conducting home visits, collective construction of spaces for listening and socialization, which can be used as possible paths for the construction of such care

Estudo da organização funcional do sistema circadiano por meio de ferramentas computacionais e matemáticas

Circadian rhythms are variations in physiological processes that help living beings to adapt to environmental cycles. These rhythms are generated and are synchronized to the dark light cycle through the suprachiasmatic nucleus. The integrity of circadian rhythmicity has great implication on human health. Currently it is known that disturbances in circadian rhythms are related to some problems of today such as obesity, propensity for certain types of cancer and mental disorders for example. The circadian rhythmicity can be studied through experiments with animal models and in humans directly. In this work we use computational models to gather experimental results from the literature and explain the results of our laboratory. Another focus of this study was to analyze data rhythms of activity and rest obtained experimentally. Here we made a review on the use of variables used to analyze these data and finally propose an update on how to calculate these variables. Our models were able to reproduce the main experimental results in the literature and provided explanations for the results of experiments performed in our laboratory. The new variables used to analyze the rhythm of activity and rest in humans were more efficient to describe the fragmentation and synchronization of this rhythm. Therefore, the work contributed improving existing tools for the study of circadian rhythms in mammals

No pulsar da clínica: a repetição e as produções corporais de uma criança

This study investigates the Repetition of movements shown in a stereotypical case of a child three years old. In line with the psychoanalysis model of search, this work presents fragments of the clinic process, the locus for the observation of repetitive, ritualized and choreographically movements of this child who used not to speak. The contrast between their movements and the issuance of a word verbalized at the end of the treatment caused the following question: repetition in this child production would be a reproduction of the same or would be directing for the difference? In the psychiatric speech, the stereotypes are listed as diagnostic criteria for certain mental disorders. In the psychoanalysis studies a question about the psych nature of ritualistic gestures apparently without purpose or direction is included. Thus, the route followed was the reading of the theoretical concept of repetition in the psychoanalytic works of S. Freud and J. Lacan. With Freud, the repetition is linked to the transfer and resistance. In that context, when it appears in act, in the place of the talk, it constitutes a particular way of remembering. But the existence of a force in the psychic apparatus that acts independent and involuntarily of the Principle of pleasure (the repetition compulsion) subsidizes the discovery of Freudian pulsion of death that is the tendency to return to itself. In the Lacan reading, the function of Repetition is magnified, as it fulfils two functions: the automaton - reminders of repetitive signs, and that the service of tiqué - the meeting of the subject with his lack constituent. In this sense, repetition is not simply a reproduction, but the search for new, the difference, caused by the lack of continuity that pushes the circuit. Finally, the clinic process and the theoretical readings made the comprehension of the child repetitive and choreographically movements and the pronouncement of a "good-bye", full of meaning. This repetitive scenario which is full of questions, by this very nature, insists in remains inconclusive

Em defesa da reforma psiquiátrica :por um amanhã que há de renascer sem pedir licença

Insanity was victim of several arbitrary acts perpetrated on behalf of the science. Psychiatric reform constitues an important movement which has attempted to rescue dignity and humanity in the treatment of mental disorder patients. Some countries have advanced in the implement of substutive models that work on the construction of a new social place for madness. The model of attention to mental health in Brazil has also suffered extensive modifications due to the wearing out of the psychiatric hospital model. In Santos, a town in the State of Sao Paulo, we have found a landmark in the development of an anti internment politics, through the creation of a dail care service, including psychosocial assistance. It is in this context that it has been founded in Natal, Rio Grande do Norte, the NAPS and CAPS ( Nucleus and Centres of Psychosocial Attention), municipal strategies that put into effect the law # 10.216/2001, which estabilishes the gradual extinction of psychiatric hospitals. This work has the purpose of carrying out a study about the historical process of psychiatric reform implantation in the State of Rio Grande do Norte, emphasizing the actors involved in process, their trajectory, achievements, improvements, and the movement s perspectives of achieving the ideal of reinstating mental disorder patients. In order to accomplish this purpose, it was necessary to understand the process occurred at the Municipal Secretary s Office for Health, since 1992, for it was the impelling experience towards the reflections about the psychiatric reform in the State of Rio Grande do Norte. The instruments used for this work were documentary analysis, through reports, legislation and handbooks, as well as the staments of people involved in this process. Through the statements analysis, we attempted to estabilish the social actors identity, their perception, emphasizing congruences and incongruences concerning the history of psychiatric reform in the State of Rio Grande do Norte. It is also analyzed the contribution of Psychology in this process, which has become a protagonist in the struggle for the rights of mental disorder patients

Saúde mental na estratégia saúde da família: notas cartográficas sobre processos de trabalho em saúde

This study aims to map the working process in the health area starting from the meeting between the family and health teams and mental trouble carriers./MTC. The area of research was the Family Health Unit of Ozeas Sampaio, which is located in the county of Teresina-PI. As regard to the methodology procedure, we used a semi-structured interview timetable, aimed to detail the care practices, admittance and diagnostics that those teams realize with their users. Three teams of eleven workers each were interviewed. There was a doctor, a nurse and two health community agents in each team. The other tools we used were a camp logbook, in which we wrote down some informal dialogs, daily observations and feelings of the unit, and also the accompaniment of the staffs in house calls as well as the weekly meetings in the unit. Those meetings allowed us the construction of two analytic axes: 1) description of the establishment (Family Health Unit) of the organization, (municipal foundation of health and the service network), and the institutions and practice of health. 2) Analysis of the meetings between the worker and the user of Mental Trouble Carriers. In the first axis, we verified the repetition of the working logic focused on jobs in the hospital with the maintenance of the hierarchical relations between worker and the work processes which dissociate management and watchfulness in health care. We identified the lack of physical structure, the lack of self-confidence of the worker in the attention of the mental health care. At the second axis, we assess that the meetings, at the Family Health Unit (FHU) or at the dwelling of the users cause nuisance, discomfort and anxiety to the workers because they deal with issues that go beyond what is named as being the health order such as life stories, family conflicts, unemployment, hunger, sexual and psychological violence. As a matter of fact, they involve difficulties for having new relationships, reception and responsibility for this request

Caracterização de aspectos da cognição social, habilidades sociais e funções executivas de crianças diagnosticadas com transtorno autista e transtorno de asperger

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior