Assessing the community needs of mental health residential care service users in Republic of Moldova

RESUMO: Background: Problemas de saúde mental são um grande problema clínico e social na República da Moldávia, representando uma quota significante de deficiência, sendo classificada no top cinco das dez linhas na hierarquia das condições. A taxa de incidência tem sido crescente na República da Moldávia, atingindo cerca de 15.000 por ano (14,655 em 2011), ou seja, 411,4 por 100 mil habitantes, e uma taxa de prevalência de 97.525 pessoas em 2011, ou seja, 2,737.9 por 100 mil habitantes. Sistema de atendimento psiquiátrico fornece serviços de saúde mental escassos a nível da comunidade, visando principalmente terapia hospitalar, centralizada, através de uma rede de três hospitais psiquiátricos, com 1.860 camas e 4 sanatórios psico- neurológicos com 1890 camas, assim alimentando-se a estigmatização do paciente. Objetivos: O objetivo deste estudo foi a avaliação das necessidades individuais dos beneficiários e do seu nível de autonomia dentro de cuidados residenciais, para o planeamento de reformas de saúde mental e desinstitucionalização na República da Moldávia. Este estudo foi encomendado pelo Ministério do Trabalho, Proteção Social e da Família e pelo Ministério da Saúde, com o apoio da Organização Mundial da Saúde, para determinar o cumprimento eficaz do artigo 19 da Convenção da ONU. O estudo tem os seguintes objetivos: Avaliar o nível de autonomia dos residentes nos hospitais psiquiátricos e sanatórios psico-neurológico, usando uma amostra representativa de 10 por ce nto do número total de pacientes/residentes e comparação cruzada; Para avaliar quatro sanatórios psico-neurológicos para adultos e três hospitais psiquiátricos; Para desenvolver recomendações para o planeamento da desinstitucionalização das pessoas com problemas de saúde mental e colocação na comunidade com base nos resultados do estudo. Metodologia e resultados: O estudo fez uso de duas ferramentas globais: questionário para a avaliação individual dos residentes do estabelecimento de saúde mental, e questionário de avaliação institucional. Todos os entrevistados foram divididos em quatro categorias conforme com o grau de dependência e preparação de viver de forma independente na comunidade. Apenas 1,2% dos entrevistados de PNHB eram totalmente dependentes de terceiros ou serviços especializados, tornando-se a categoria 4, que necessitam de cuidados e apoio contínuo. No PH esta categoria de pessoas é ausente. Conclusões: A condição dos entrevistados foi pior em PNBH que em PH. No entanto, ainda, aqueles que estão prontos para ser desinstitucionalizados correspondem com a maior parte dos entrevistados. Todos os hospitais tinham o consentimento do utente para admissão e tratamento, enquanto não houve consentimento qualquer em PNBH. É bastante óbvio que tanto os hospitais como também a sistema de assistência residencial não atingem a sua finalidade, o que significa que a maioria dos utentes pode ser desinstitucionalizados, sem qualquer terapia de suporte.------------------ABSTRACT: Background: Mental health problems are a major clinical and social issue in the Republic of Moldova,accounting for a significant share of disability and ranking in top five of the ten lines in the hierarchy of conditions. The incidence rate has been growing in the Republic of Moldova to reach approximately 15 thousand a year (14,655 in 2011), i.e. 411.4 per 100 thousand population, and a prevalence rate of 97,525 thousand people in 2011, i.e. 2,737.9 per 100 thousand population. Psychiatric care system provides for scanty mental health services at community level, aiming mainly at centralized hospital-based therapy through a network of three psychiatric hospitals tallying up 1,860 beds and 4 psycho-neurological boarding houses with 1,890 beds, thus fuelling up patient stigmatization. Objectives: The purpose of this study was to assess the individual needs of beneficiaries and their level of autonomy within residential care for the planning of mental health system reforms and deinstitutionalization in the Republic of Moldova. This study was commissioned by the Ministry of Labour, Social Protection and Family and by the Ministry of Health, with the World Health Organization support, to provide for effective enforcement of article 19 of the UN CRPD. The study pursued the following goals: To evaluate the level of autonomy of the psychiatric hospital and psycho-neurological boarding house residents by using a representative sample of 10 per cent of the total number of patients / residents and cross-comparison; To evaluate four psycho-neurological boarding houses for adults and three psychiatric hospitals; To develop recommendations for planning the deinstitutionalization of people with mental health problems and community placement based on the study findings.Methodology and results: The study made use of two global tools: questionnaire for individual assessment of mental health facility residents, and institutional assessment questionnaire. All interviewees were divided into four categories by one’s degree of dependence and readiness to live independently in the community. Only 1.2% of respondents from PNHB were fully dependent on a third party or specialized services, making up category 4, requiring continuous care and support. In PH this category of people is absent.Conclusions: The condition of respondents was worse in PNBH than in PH. However, yet, those ready to be deinstitutionalized accounted for most of respondents there. All hospitals had the resident’s consent to admission and treatment, whereas there was no consent in PNBH whatsoever. It is quite obvious that both the hospitals and residential care system do not achieve their intended purpose, meaning that the majority of residents may be deinstitutionalized without any support therapy.

Rehabilitation and reintegration needs of female inmates and promotion mental health in Georgian prison

RESUMO: As mulheres presas encontram-se num sistema essencialmente dirigido por e concebido para homens. As mulheres que entram na prisão geralmente vêm de ambientes marginalizados e desfavorecidos e muitas vezes têm histórias de violência e abuso físico e sexual. As mulheres presas são um grupo particularmente vulnerável, uma vez que dentro do sistema prisional as suas necessidades de saúde e higiene são muitas vezes negligenciadas. O primeiro passo para o desenvolvimento de programas e práticas sensíveis ao género é compreender as características das mulheres delinquentes e definir fatores de vida específicos que contribuem para a formação do comportamento criminoso de mulheres. Em junho de 2012 foi realizada uma investigação na única prisão feminina da Geórgia, para estudar as necessidades mentais e psicossociais das mulheres presas. O objetivo da pesquisa foi o desenvolvimento de programas de apoio pertinentes para a reabilitação, ressocialização e reintegração, e a elaboração de recomendações práticas para a gestão das prisões. Foi desenvolvido um instrumento de pesquisa (inquérito) com uma fundamentação conceptual baseada em quatro principais teorias: Teoria dos Caminhos (Pathways Theory), teoria do desenvolvimento psicológico da mulher (Theory of Women’s Psychological Development), Trauma e Teorias da Dependência (Trauma and Addiction Theories). Foram inquiridas 120 mulheres presas. Os resultados deste estudo mostram que muitas das necessidades das mulheres presas são diferentes das dos homens e requerem estratégias adaptadas às suas características e situações psicossociais específicas. A maioria das mulheres encarceradas é jovem, enérgica, pode trabalhar, tem profissão e família. As presas sofrem de problemas psicológicos e muitas vezes são rejeitadas pelas suas famílias. Uma parte substancial das mulheres presas tem múltiplos problemas de saúde física e mental. A maioria delas tem filhos e sofre com o facto das crianças estarem a crescer longe da mãe. Com base nos resultados desta investigação é possível elaborar um contexto promotor do planeamento e desenvolvimento de serviços com um enfoque de género na prisão. Na perspetiva de longo prazo, o conhecimento das necessidades básicas e a introdução de programas e serviços com necessidades específicas pertinentes irá beneficiar as presas e as suas famílias, e melhorar a eficácia do sistema de justiça criminal.----------ABSTRACT: Female inmates find themselves in a system essentially run by men for men. Women who enter prison usually come from marginalized and disadvantaged backgrounds and are often characterized by histories of violence, physical and sexual abuse. Female prisoners constitute an especially vulnerable group given their specific health and hygienic needs within the system are often neglected. The first step in developing gender-sensitive program and practice is to understand female offenders’ characteristics and the specific life factors that shape women’s patterns of offending. In June 2012 a research was carried out in the Georgian only female prison facility to assess the mental and psychosocial needs of women prisoners, aiming to develop effective support programs for their rehabilitation, re-socialization and reintegration, as well as to elaborate new recommendations concerning prison management. A survey instrument (questionnaire) was developed within a theoretical framework based on four fundamental theories: Pathways Theory, Theory of Women’s Psychological Development and Trauma and Addiction Theories. Sample size was defined to be 120 surveyed persons. The study showed that needs of incarcerated women were different from those of men, thus requiring approaches tailored to their specific psychosocial characteristics and situations. The basic population of imprisoned women consisted of young, energetic, working-age females, most often with a professional qualification. Female prisoners suffered from psychological problems and are were more likely to be rejected by their families. Most of them had children and suffered that the children were growing without mothers. A substantial proportion of women offenders had multiple physical and mental health problems. Based on the study findings a conceptual framework can be elaborated towards planning and developing gender-sensitive services in prison. In the long-term perspective, acknowledgement of baseline needs and introduction of the relevant needs-specific programs and services may benefit women prisoners as well as their families, improving the effectiveness of the criminal justice system.

Barriers preventing the successful integration of mental health services into Primary Health Care in Nigeria : a mixed methods approach

RESUMO: A Nigéria tem uma população estimada em cerca de 170 milhões de pessoas. O número de profissionais de saúde mental é muito diminuto, contando apenas com 150 psiquiatras o que perfaz aproximadamente um rácio de psiquiatra: população de mais de 1:1 milhão de pessoas. O Plano Nacional de Saúde Mental de 1991 reconheceu esta insuficiência e recomendou a integração dos serviços de saúde mental nos cuidados de saúde primários (CSP). Depois de mais de duas décadas, essa política não foi ainda implementada. Este estudo teve como objetivos mapear a estrutura organizacional dos serviços de saúde mental da Nigéria, e explorar os desafios e barreiras que impedem a integração bem-sucedida dos serviços de saúde mental nos cuidados de saúde primários, isto segundo a perspectiva dos profissionais dos cuidados de saúde primários. Com este objetivo, desenvolveu-se um estudo exploratório sequencial e utilizou-se um modelo misto para a recolha de dados. A aplicação em simultâneo de abordagens qualitativas e quantitativas permitiram compreender os problemas relacionados com a integração dos serviços de saúde mental nos CSP na Nigéria. No estudo qualitativo inicial, foram realizadas entrevistas com listagens abertas a 30 profissionais dos CSP, seguidas de dois grupos focais com profissionais dos CSP de duas zonas governamentais do estado de Oyo de forma a obter uma visão global das perspectivas destes profissionais locais sobre os desafios e barreiras que impedem uma integração bem-sucedida dos serviços de saúde mental nos CSP. Subsequentemente, foram realizadas entrevistas com quatro pessoas-chave, especificamente coordenadores e especialistas em saúde mental. Os resultados do estudo qualitativo foram utilizados para desenvolver um questionário para análise quantitativa das opiniões de uma amostra maior e mais representativa dos profissionais dos CSP do Estado de Oyo, bem como de duas zonas governamentais locais do Estado de Osun. As barreiras mais comummente identificadas a partir deste estudo incluem o estigma e os preconceitos sobre a doença mental, a formação inadequada dos profissionais dos CPS sobre saúde mental, a perceção pela equipa dos CSP de baixa prioridade de ação do Governo, o medo da agressão e violência pela equipa dos CSP, bem como a falta de disponibilidade de fármacos. As recomendações para superar estes desafios incluem a melhoria sustentada dos esforços da advocacia à saúde mental que vise uma maior valorização e apoio governamental, a formação e treino organizados dos profissionais dos cuidados primários, a criação de redes de referência e de apoio com instituições terciárias adjacentes, e o engajamento da comunidade para melhorar o acesso aos serviços e à reabilitação, pelas pessoas com doença mental. Estes resultados fornecem indicações úteis sobre a perceção das barreiras para a integração bem sucedida dos serviços de saúde mental nos CSP, enquanto se recomenda uma abordagem holística e abrangente. Esta informação pode orientar as futuras tentativas de implementação da integração dos serviços de saúde mental nos cuidados primários na Nigéria.------------ABSTRACT: Nigeria has an estimated population of about 170 million people but the number of mental health professionals is very small, with about 150 psychiatrists. This roughly translates to a psychiatrist:population ratio of more than 1:1 million people. The National Mental Health Policy of 1991 recognized this deficiency and recommended the integration of mental health into primary health care (PHC) delivery system. After more than two decades, this policy has yet to be implemented. This study aimed to map out the organizational structure of the mental health systems in Nigeria, and to explore the challenges and barriers preventing the successful integration of mental health into primary health care, from the perspective of the primary health care workers. A mixed methods exploratory sequential study design was employed, which entails the use of sequential timing in the combined methods of data collection. A combination of qualitative and uantitative approaches in sequence, were utilized to understand the problems of mental health services integration into PHC in Nigeria. The initial qualitative phase utilized free listing interviews with 30 PHC workers, followed by two focus group discussions with primary care workers from two Local Government Areas (LGA) of Oyo State to gain useful insight into the local perspectives of PHC workers about the challenges and barriers preventing successful integration of mental health care services into PHC. Subsequently, 4 key informant interviews with PHC co-ordinators and mental health experts were carried out. The findings from the qualitative study were utilized to develop a quantitative study questionnaire to understand the opinions of a larger and more representative sample of PHC staff in two more LGAs of Oyo State, as well as 2 LGAs from Osun State. The common barriers identified from this study include stigma and misconceptions about mental illness, inadequate training of PHC staff about mental health, low government priority, fear of aggression and violence by the PHC staff, as well as non-availability of medications. Recommendations for overcoming these challenges include improved and sustained efforts at mental health advocacy to gain governmental attention and support, organized training and retraining for primary care staff, establishment of referral and supportive networks with neighbouring tertiary facilities and community engagement to improve service utilization and rehabilitation of mentally ill persons. These findings provide useful insight into the barriers to the successful integration of mental health into PHC, while recommending a holistic and comprehensive approach. This information can guide future attempts to implement the integration of mental health into primary care in Nigeria.

Galen on Mental Disorders

Este trabalho aborda a conceito de desordem psíquica na obra de Galeno (129-216). A primeira parte enquadra o pensamento de Galeno na visão da Filosofia e Medicina em vigor no início do séc. II d.C. De seguida descrevo a concepção Hipocrática de epilepsia, e a abordagem que Platão desenvolve no Timeu e Fedro acerca da loucura, para de seguida abordar a concepção de doença em Galeno, onde são analisados os conceitos de nosêma, diathesis, pathos e energeia. Após este excurso descrevo o ponto de vista de Galeno acerca da controvérsia sobre a localização da parte dirigente da alma (hêgemonikon) que se dividia entre defensores do encefalocentrismo (Platão, Hipócrates e Herófilo) e do cardiocentrismo (Aristóteles e os Estóicos). De modo a aprofundar a compreensão de Galeno acerca deste tema descrevo o trabalho anatómico-fisiológico desenvolvido pelos médicos Alexandrinos Erasistrato e Herófilo, activos no sec. III a. C., que descobriram, através de dissecação de animais e muito provavelmente de humanos, o papel dos nervos e tendões nas atividades cognitivas e sensório-motoras. Esta foi uma descoberta central para a argumentação de Galeno acerca da interacção mente-corpo assim como para a descrição das desordens psíquicas. Posteriormente apresento a metodologia de Galeno no que concerne ao processo de diagnóstico e etiologia, essencial para se compreender como é possível aceder a ‘entidades’ não visíveis, como o hêgemonikon e as suas diferentes faculdades: ‘imaginação’, memória e raciocínio. Por fim, analiso alguns casos clínicos de pacientes afectados por desordens do hêgemonikon, a saber: phrenitis, mania e melancolia. Os principais textos objecto de análise são: Acerca dos Lugares Afectados, Acerca das Teses de Hipócrates e Platão e Que as Faculdades da Alma Seguem as Disposições do Corpo. Todavia, outros textos de Galeno serão convocados consoante a necessidade de analisar os conceitos que me proponho compreender, entre eles Acerca do Método Terapêutico e Acerca da Utilidade das Partes.

Evaluation of the diagnostic value of the tourniquet test in predicting severe dengue cases in a population from Belo Horizonte, State of Minas Gerais, Brazil

Introduction Dengue is prevalent in many tropical and sub-tropical regions. The clinical diagnosis of dengue is still complex, and not much data are available. This work aimed at assessing the diagnostic accuracy of the tourniquet test in patients with suspected dengue infection and its positivity in different classifications of this disease as reported to the Information System for Notifiable Disease in Belo Horizonte, State of Minas Gerais, Brazil between 2001 and 2006. Methods Cross-section analysis of the diagnostic accuracy of the tourniquet test for dengue, using IgM-anti-DENV ELISA as a gold standard. Results We selected 9,836 suspected cases, of which 41.1% were confirmed to be dengue. Classic dengue was present in 95.8%, dengue with complications in 2.5% and dengue hemorrhagic fever in 1.7%. The tourniquet test was positive in 16.9% of classic dengue cases, 61.7% of dengue cases with complications and 82.9% of cases of dengue hemorrhagic fever. The sensitivity and specificity of the tourniquet test were 19.1% and 86.4%, respectively. Conclusions A positive tourniquet test can be a valuable tool to support diagnosis of dengue where laboratory tests are not available. However, the absence of a positive test should not be read as the absence of infection. In addition, the tourniquet test was demonstrated to be an indicator of dengue severity.

Effects of quantitative easing on the USA economy: A test for policy effectiveness

The catastrophic disruption in the USA financial system in the wake of the financial crisis prompted the Federal Reserve to launch a Quantitative Easing (QE) programme in late 2008. In line with Pesaran and Smith (2014), I use a policy effectiveness test to assess whether this massive asset purchase programme was effective in stimulating the economic activity in the USA. Specifically, I employ an Autoregressive Distributed Lag Model (ARDL), in order to obtain a counterfactual for the USA real GDP growth rate. Using data from 1983Q1 to 2009Q4, the results show that the beneficial effects of QE appear to be weak and rather short-lived. The null hypothesis of policy ineffectiveness is not rejected, which suggests that QE did not have a meaningful impact on output growth.

Performance of a rapid diagnostic test for the detection of visceral leishmaniasis in a large urban setting

Introduction Rapid diagnostic tests (RDTs) may improve the early detection of visceral leishmaniasis (VL), but their real-world performance requires additional study. Therefore, we evaluated the performance of an rK39-based RDT (Kalazar Detect™) for the detection of VL in an endemic, large urban area. Methods Data were collected from a registry of rK39 RDT performed at 11 emergency care units in Belo Horizonte, Brazil, and from a national database of reportable communicable diseases of the Sistema de Informação de Agravos de Notificação (SINAN). Results The rapid rK39 test was performed in 476 patients, with 114 (23.9%) positive results. The analysis of rK39 RDT performance was based on 381 (80%) cases reported to the SINAN database, of which 145 (38.1%) were confirmed cases. Estimates for sensitivity and specificity were 72.4% (95% CI: 64.6-79%) and 99.6% (95%CI: 97.6-99.9%), respectively. Positive and negative predictive values were estimated at 99.1% (95%CI: 94.9-99.8%) and 85.5% (95%CI: 80.8-89.1%), respectively. In addition, close agreement between the rK39 RDT and indirect immunofluorescence was observed. Conclusions In summary, the rK39 RDT showed a high specificity but only moderate sensitivity. In endemic areas for VL, treatment may be considered in cases with clinical manifestations and a positive rK39 RDT, but those with a negative test should be subjected to further investigation.

A saúde mental global, a depressão, a ansiedade e os comportamentos de risco nos estudantes do ensino superior : estudo de prevalência e correlação

RESUMO: A saúde mental é influenciada pelos comportamentos tanto como estes são influenciados pela saúde mental. Por isso é importante compreender quer a saúde mental quer os comportamentos adoptados pelo indivíduo em qualquer momento do seu ciclo vital para melhor poder actuar quando e sempre que necessário. Nos estudantes universitários, não sendo uma população de risco, a saúde mental e os comportamentos de risco afectam não só o próprio estudante e quem com ele convive mas também as próprias instituições que o acolhem. O presente estudo teve como objectivos: nos estudantes universitários 1) caracterizar a saúde mental global; 2) caracterizar os níveis de sintomatologia depressiva e ansiosa; 3) identificar os padrões de comportamentos de risco; 4) analisar a relação entre saúde mental global, depressão, ansiedade e comportamentos de risco. Para tal realizou-se um estudo quantitativo, descritivo, correlacional, transversal e exploratório com 1968 estudantes do 1º ciclo da Universidade da Beira Interior e dos Institutos Politécnicos da Guarda, Castelo Branco e Portalegre. Foram utilizados como instrumentos de investigação uma ficha de Caracterização Socio-Demográfica; o Mental Health Inventory-5; o Patient Health Questionnaire-9; Generalized Anxiety Disorder-7; e o Questionário de Comportamentos de Risco em Estudantes Universitários. Os principais resultados mostraram que 18,3% (n=360) apresentavam saúde mental negativa; 17,7% sintomatologia depressiva moderada a severa; 15,6% sintomatologia ansiosa moderada a severa; e que apenas 15% dos que apresentavam saúde mental global negativa recorreu a ajuda profissional. As mulheres, os alunos de 1ª e 4º ano, e os alunos dos cursos de Artes e Letras apresentavam níveis de saúde mental global inferiores. O Consumo de álcool foi superior nos homens, nos estudantes das áreas de Ciências e Ciências da Saúde e nos estudantes deslocados. Os estudantes com mais de 3 unidades curriculares em atraso apresentavam maior sintomatologia depressiva e ansiosa. Os resultados mostraram ainda que quanto mais positiva a saúde mental global maior o consumo de bebidas alcoólicas e menor a sintomatologia depressiva e ansiosa. As variáveis Curso e Sexo influenciam significativamente a saúde mental global, a depressão e a ansiedade. Apesar de a maioria dos estudantes inquiridos não revelar problemas de saúde mental nem apresentar comportamentos de risco, as principais conclusões apontam para a necessidade de programas de educação para a saúde assim como de programas de literacia de saúde mental para as instituições poderem identificar precocemente as situações problemáticas e ajudar os próprios estudantes a reconhecer em si o sofrimento psicológico e a necessidade de procurar apoio profissional.---------------------------------- ABSTRACT: Mental health is influenced by behaviours as much as behaviours are influenced by mental health. Thus, it is important to understand not only the mental health but also the behaviours adopted by an individual at any stage of its vital cycle in order to accurately intervene whenever and always deemed necessary. Regarding college students, despite not being deemed as a population at risk, mental health and risk behaviours affect not only the student itself and whoever interacts with him but also the institutions that host them. The main purposes of this study were regarding college students 1) characterize the overall mental health; 2) characterize the levels of depression and anxiety symptoms; 3) identify the risk behaviours patterns; and 4) analyse the relation between overall mental health, depression, anxiety and risk behaviours. With that scope a quantitative, descriptive, correlated, transversal and exploratory study has been conducted with 1968 students of the 1st cycle of the University of Beira Interior and of the Polytechnic Institutions of Guarda, Castelo Branco and Portalegre. The investigation instruments used were a chart of Socio-Demographic Characterization; the Mental Health Inventory-5; the Patient Health Questionnaire-9; the Generalized Anxiety Disorder-7; and one Questionnaire of Risk Behaviours in College Students. The main results showed that 18.3% (n=360) revealed negative mental health; 17.7% moderated to severe depression symptoms; 15.6% moderated to severe anxiety symptoms; and that only 15% of those revealing negative overall mental health have seek for professional help. Females, students of the 1st and 4th years and students of the Artes and Letras courses revealed inferior levels of overall mental health. Alcohol consumption is higher in males, in the Sciences and Health Sciences’ students and on displaced students. Students with more than 3 curricular units in delay revealed higher depression and anxiety symptoms. The results also showed that the more positive overall mental health the higher alcohol consumption and the lower depression and anxiety symptoms. The Course and Sex variations significantly influence the overall mental health, the depression and the anxiety. Although the majority of the enquired students did not reveal mental health issues or present risk behaviours, the main conclusions indicate the need to implement health education and mental health literacy programmes in order to enable the institutions to prematurely identify problematic situations and help students to recognize the psychological suffering and the need to seek for professional help.

Performance of the Vitek 2 system software version 5.03 in the bacterial identification and antimicrobial susceptibility test: evaluation study of clinical and reference strains of Gram-positive cocci

Introduction. The genera Enterococcus, Staphylococcus and Streptococcus are recognized as important Gram-positive human pathogens. The aim of this study was to evaluate the performance of Vitek 2 in identifying Gram-positive cocci and their antimicrobial susceptibilities. Methods. One hundred four isolates were analyzed to determine the accuracy of the automated system for identifying the bacteria and their susceptibility to oxacillin and vancomycin. Results. The system correctly identified 77.9% and 97.1% of the isolates at the species and genus levels, respectively. Additionally, 81.8% of the Vitek 2 results agreed with the known antimicrobial susceptibility profiles. Conclusion. Vitek 2 correctly identified the commonly isolated strains; however, the limitations of the method may lead to ambiguous findings.

Evaluation of three enzyme immunoassays and a nucleic acid amplification test for the diagnosis of Clostridium difficile-associated diarrhea at a university hospital in Brazil

Introduction Despite the known importance of Clostridium difficile as a nosocomial pathogen, few studies regarding Clostridium difficile infection (CDI) in Brazil have been conducted. To date, the diagnostic tests that are available on the Brazilian market for the diagnosis of CDI have not been evaluated. The aim of this study was to compare the performances of four commercial methods for the diagnosis of CDI in patients from a university hospital in Brazil. Methods Three enzyme immunoassays (EIAs) and one nucleic acid amplification test (NAAT) were evaluated against a cytotoxicity assay (CTA) and toxigenic culture (TC). Stool samples from 92 patients with suspected CDI were used in this study. Results Twenty-five (27.2%) of 92 samples were positive according to the CTA, and 23 (25%) were positive according to the TC. All EIAs and the NAAT test demonstrated sensitivities between 59 and 68% and specificities greater than 91%. Conclusions All four methods exhibited low sensitivities for the diagnosis of CDI, which could lead to a large number of false-negative results, an increased risk of cross-infection to other patients, and overtreatment with empirical antibiotics.

Construct and diagnostic validities of the Free and Cued Selective Reminding Test in the alzheimer’s disease spectrum

The Free and Cued Selective Reminding Test (FCSRT) is a memory test that controls attention and acquisition, by providing category cues in the learning process. Because it enables an assessment of memory not confounded by normal age-related changes in cognition and a high accuracy on Alzheimer's disease (AD) evaluation, it has been suggested by the International Working Group on AD. Our aim was to assess the construct related validity of the FCSRT in the AD spectrum disorders.

EFFECT – Efficient finite element code

The theme of this dissertation is the finite element method applied to mechanical structures. A new finite element program is developed that, besides executing different types of structural analysis, also allows the calculation of the derivatives of structural performances using the continuum method of design sensitivities analysis, with the purpose of allowing, in combination with the mathematical programming algorithms found in the commercial software MATLAB, to solve structural optimization problems. The program is called EFFECT – Efficient Finite Element Code. The object-oriented programming paradigm and specifically the C ++ programming language are used for program development. The main objective of this dissertation is to design EFFECT so that it can constitute, in this stage of development, the foundation for a program with analysis capacities similar to other open source finite element programs. In this first stage, 6 elements are implemented for linear analysis: 2-dimensional truss (Truss2D), 3-dimensional truss (Truss3D), 2-dimensional beam (Beam2D), 3-dimensional beam (Beam3D), triangular shell element (Shell3Node) and quadrilateral shell element (Shell4Node). The shell elements combine two distinct elements, one for simulating the membrane behavior and the other to simulate the plate bending behavior. The non-linear analysis capability is also developed, combining the corotational formulation with the Newton-Raphson iterative method, but at this stage is only avaiable to solve problems modeled with Beam2D elements subject to large displacements and rotations, called nonlinear geometric problems. The design sensitivity analysis capability is implemented in two elements, Truss2D and Beam2D, where are included the procedures and the analytic expressions for calculating derivatives of displacements, stress and volume performances with respect to 5 different design variables types. Finally, a set of test examples were created to validate the accuracy and consistency of the result obtained from EFFECT, by comparing them with results published in the literature or obtained with the ANSYS commercial finite element code.

Mental health and neuroscience. A perspective from the magazine market

Mental health awareness has been rising worldwide, motivated by its social and economic costs. Despite the investment in research in neuroscience in the recent years, little is known about the underlying mechanisms in the brain that are correlated with psychiatric conditions. This project, through two feature articles suitable to be published in magazines, provides perspectives onto mental health research. First it presents an example where psychiatry joins forces with neuroscience and computer science in an interdisciplinary effort to improve the life of those affected by mental disorders. The second article gathers opinions which claim that mental health research priorities should be set by patients themselves, or even that people with lived experience of mental health issues should have an active role in that research. This project was planned and researched while I was an Erasmus student at Nottingham Trent University, in the United Kingdom.

Evaluation of the reference value for the Montenegro skin test

Abstract:INTRODUCTION:The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL). However, no studies have validated the reference value (5mm) typically used to discriminate positive and negative results. We investigated MST results and evaluated its performance using different cut-off points.METHODS:The results of laboratory tests for 4,256 patients with suspected ATL were analyzed, and 1,182 individuals were found to fulfill the established criteria. Two groups were formed. The positive cutaneous leishmaniasis (PCL) group included patients with skin lesions and positive direct search for parasites (DS) results. The negative cutaneous leishmaniasis (NCL) group included patients with skin lesions with evolution up to 2 months, negative DS results, and negative indirect immunofluorescence assay results who were residents of urban areas that were reported to be probable sites of infection at domiciles and peridomiciles.RESULTS:The PCL and NCL groups included 769 and 413 individuals, respectively. The mean ± standard deviation MST in the PCL group was 12.62 ± 5.91mm [95% confidence interval (CI): 12.20-13.04], and that in the NCL group was 1.43 ± 2.17mm (95% CI: 1.23-1.63). Receiver-operating characteristic curve analysis indicated 97.4% sensitivity and 93.9% specificity for a cut-off of 5mm and 95.8% sensitivity and 97.1% specificity for a cut-off of 6mm.CONCLUSIONS:Either 5mm or 6mm could be used as the cut-off value for diagnosing ATL, as both values had high sensitivity and specificity.