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.

Non emergency patients transport - a mixed integer linear programming

This work presents a model and a heuristic to solve the non-emergency patients transport (NEPT) service issues given the new rules recently established in Portugal. The model follows the same principle of the Team Orienteering Problem by selecting the patients to be included in the routes attending the maximum reduction in costs when compared with individual transportation. This model establishes the best sets of patients to be transported together. The model was implemented in AMPL and a compact formulation was solved using NEOS Server. A heuristic procedure based on iteratively solving problems with one vehicle was presented, and this heuristic provides good results in terms of accuracy and computation time.

The non-emergency patient transport modelled as a team orienteering problem

This work presents an improved model to solve the non-emergency patients transport (NEPT) service issues given the new rules recently established in Portugal. The model follows the same principle of the Team Orienteering Problem by selecting the patients to be included in the routes attending the maximum reduction in costs when compared with individual transportation. This model establishes the best sets of patients to be transported together. The model was implemented in AMPL and a compact formulation was solved using NEOS Server. A heuristic procedure based on iteratively solving Orienteering Problems is presented, and this heuristic provides good results in terms of accuracy and computation time. Euclidean instances as well as asymmetric real data gathered from Google maps were used, and the model has a promising performance mainly with asymmetric cost matrices.

Genetic algorithms for the non emergency patients transport service

The authors would like to thank the anonymous reviewers for their valuable comments and suggestions to improve the paper. The authors would like to thank Dr. Elaine DeBock for reviewing the manuscript.

Towards effective control of P2P traffic aggregates in network infrastructures

Nowadays, many P2P applications proliferate in the Internet. The attractiveness of many of these systems relies on the collaborative approach used to exchange large resources without the dependence and associated constraints of centralized approaches where a single server is responsible to handle all the requests from the clients. As consequence, some P2P systems are also interesting and cost-effective approaches to be adopted by content-providers and other Internet players. However, there are several coexistence problems between P2P applications and In- ternet Service Providers (ISPs) due to the unforeseeable behavior of P2P traffic aggregates in ISP infrastructures. In this context, this work proposes a collaborative P2P/ISP system able to underpin the development of novel Traffic Engi- neering (TE) mechanisms contributing for a better coexistence between P2P applications and ISPs. Using the devised system, two TE methods are described being able to estimate and control the impact of P2P traffic aggregates on the ISP network links. One of the TE methods allows that ISP administrators are able to foresee the expected impact that a given P2P swarm will have in the underlying network infrastructure. The other TE method enables the definition of ISP friendly P2P topologies, where specific network links are protected from P2P traffic. As result, the proposed system and associated mechanisms will contribute for improved ISP resource management tasks and to foster the deployment of innovative ISP-friendly systems.

Information systems assessment in pathologic anatomy service

Information technologies changed the way of how the health organizations work, contributing to their effectiveness, efficiency and sustainability. Hospital Information Systems (HIS) are emerging on all of health institutions, helping health professionals and patients. However, HIS are not always implemented and used in the best way, leading to low levels of benefits and acceptance by users of these systems. In order to mitigate this problem, it is essential to take measures able to ensure if the HIS and their interfaces are designed in a simple and interactive way. With this in mind, a study to measure the user satisfaction and their opinion was made. It was applied the Technology Acceptance Model (TAM) on a HIS implemented on various hospital centers (AIDA), being used the Pathologic Anatomy Service. The study identified weakness and strengths features of AIDA and it pointed some solutions to improve the medical record.

Improving quality of medical service with mobile health software

An increasing number of m-Health applications are being developed benefiting health service delivery. In this paper, a new methodology based on the principle of calm computing applied to diagnostic and therapeutic procedure reporting is proposed. A mobile application was designed for the physicians of one of the Portuguese major hospitals, which takes advantage of a multi-agent interoperability platform, the Agency for the Integration, Diffusion and Archive (AIDA). This application allows the visualization of inpatients and outpatients medical reports in a quicker and safer manner, in addition to offer a remote access to information. This project shows the advantages in the use of mobile software in a medical environment but the first step is always to build or use an interoperability platform, flexible, adaptable and pervasive. The platform offers a comprehensive set of services that restricts the development of mobile software almost exclusively to the mobile user interface design. The technology was tested and assessed in a real context by intensivists.

Public service culture collections of microorganisms: are they important for biotechnology?

Microbiology as a scientific discipline recognised the need to preserve microorganisms for scientific studies establishing from its very beginning research culture collections (CC). Later on, to better serve different scientific fields and bioindustries with the increasing number of strains of scientific, medical, ecological and biotechnological importance public service CC were established with the specific aims to support their user communities. Currently, the more developed public service CC are recognised as microBiological Resources Centres (mBRC). mBRC are considered to be one of the key elements for sustainable international scientific infrastructure, which is necessary to underpin successful delivery of the benefits of biotechnology, whether within the health sector, the industrial sector or other sectors, and in turn ensure that these advances help drive economic growth. In more detail, mBRCs are defined by Organisation for Economic Co-operation and Development (OECD) as service providers and repositories of the living cells, genomes of organisms, and information relating to heredity and functions of biological systems. mBRCs contain collections of culturable organisms (e.g., microorganisms, plant, animal cells), replicable parts of these (e.g. genomes, plasmids, virus, cDNAs), viable but not yet culturable organisms, cells and tissues, as well as database containing molecular, physiological and structural information relevant to these collections and related bioinformatics. Thus mBRCs are fundamental to harnessing and preserving the world’s microbial biodiversity and genetic resources and serve as an essential element of the infrastructure for research and development. mBRCs serve a multitude of functions and assume a range of shapes and forms. Some are large national centres performing a comprehensive role providing access to diverse organisms. Other centres play much narrower, yet important, roles supplying limited but crucial specialised resources. In the era of the knowledge-based bio-economy mBRCs are recognised as vital element to underpinning the biotechnology.

Cladistic analysis of the Neotropical genera Cerqueirellum Py-Daniel, 1983, Coscaroniellum Py-Daniel, 1983 and Shelleyellum Py-Daniel & Pessoa, 2005 (Diptera: Simuliidae)

Females of simuliid black flies are haematophagous insects and vectors of several pathogenic agents of human diseases such as the filarial worms Mansonella ozzardi and Onchocerca volvulus. The genus Cerqueirellum is one of the most important groups of vectors of mansonellosis and onchocerciasis diseases in South America, and the genera Coscaroniellum and Shelleyellum are phylogenetically close to Cerqueirellum. There is not yet an agreement among authors about the generic classification of the species which compose these three genera, being all lumped by some taxonomists within Psaroniocompsa. A cladistic analysis of all species of Coscaroniellum, Cerqueirellum, and Shelleyellum, based on 41 morphological characters were done. Species closely related to Cerqueirellum were included in the analysis. The genera Cerqueirellum, Coscaroniellum and Shelleyellum were demonstrated as consistent basal entities and well-defined monophyletic clades.

Recensão de Lee, E. (2005). How internet radio can change the world : an activist’s handbook. Nova Iorque : iUniverse, Inc.

(Excerto) O entusiasmo pela comunicação digital percorre transversalmente a obra How Internet Radio Can Change the World: An Activist’s Handbook, de Eric Lee. Esta postura tão apologista das possibilidades comunicativas oferecidas pela Internet reforça provavelmente um conjunto alargado de entendimentos sobre a conquista do quotidiano pelo digital. Em 1967, McLuhan e Fiore já se referiam aos circuitos eletrónicos como ‘extensões do sistema nervoso central’. Numa leitura mais contemporânea, José Bragança de Miranda refere: “vivemos, nos nossos dias, no meio de conexões, de links, do on‑line, estamos votados à participação, à ‘interactividade’, etc. Algo de novo está a emergir” (2001, p. 265). Maria Teresa Cruz (2001) define a convergência tecnológica das relações sociais como a ‘mobilização erótica da técnica’. Esta obra aqui recenseada pretende, assim, desafiar a utilização da rádio digital para “melhorar a comunicação e solidificar as organizações” (p. 1), em torno de três grupos de reflexão.

Clinical Epidemiology of Buruli ulcer from Benin (2005-2013): effect of time-delay to diagnosis on clinical forms and severe phenotypes

Buruli Ulcer (BU) is a neglected infectious disease caused by Mycobacterium ulcerans that is responsible for severe necrotizing cutaneous lesions that may be associated with bone involvement. Clinical presentations of BU lesions are classically classified as papules, nodules, plaques and edematous infiltration, ulcer or osteomyelitis. Within these different clinical forms, lesions can be further classified as severe forms based on focality (multiple lesions), lesions' size (>15 cm diameter) or WHO Category (WHO Category 3 lesions). There are studies reporting an association between delay in seeking medical care and the development of ulcerative forms of BU or osteomyelitis, but the effect of time-delay on the emergence of lesions classified as severe has not been addressed. To address both issues, and in a cohort of laboratory-confirmed BU cases, 476 patients from a medical center in Allada, Benin, were studied. In this laboratory-confirmed cohort, we validated previous observations, demonstrating that time-delay is statistically related to the clinical form of BU. Indeed, for non-ulcerated forms (nodule, edema, and plaque) the median time-delay was 32.5 days (IQR 30.0-67.5), while for ulcerated forms it was 60 days (IQR 20.0-120.0) (p = 0.009), and for bone lesions, 365 days (IQR 228.0-548.0). On the other hand, we show here that time-delay is not associated with the more severe phenotypes of BU, such as multi-focal lesions (median 90 days; IQR 56-217.5; p = 0.09), larger lesions (diameter >15 cm) (median 60 days; IQR 30-120; p = 0.92) or category 3 WHO classification (median 60 days; IQR 30-150; p = 0.20), when compared with unifocal (median 60 days; IQR 30-90), small lesions (diameter =15 cm) (median 60 days; IQR 30-90), or WHO category 1+2 lesions (median 60 days; IQR 30-90), respectively. Our results demonstrate that after an initial period of progression towards ulceration or bone involvement, BU lesions become stable regarding size and focal/multi-focal progression. Therefore, in future studies on BU epidemiology, severe clinical forms should be systematically considered as distinct phenotypes of the same disease and thus subjected to specific risk factor investigation.

A ocorrência de malária em quatro municípios do estado do Pará, de 1988 a 2005, e sua relação com o desmatamento

O objetivo deste trabalho foi estudar a ocorrência de malária em quatro diferentes regiões representativas do estado do Pará, buscando suas possíveis relações com as taxas de desmatamento. Foi realizado um estudo retrospectivo, com dados secundários, no período de 1988 a 2005, através de casos de malária registrados em quatro municípios do Estado (Anajás, Itaituba, Santana do Araguaia e Viseu), como também das taxas de desmatamento fornecidas pelo PRODES-INPE. Aplicou-se a técnica dos Quantis para se estabelecer cinco categorias ou classes de incidência da malária para cada município, sendo gerado posteriormente um IPA representativo para o Estado. De 1988 até 1994, as curvas de incidência de malária acompanham os números de desmatamento. A partir de 1995, evidenciaram-se anos consecutivos com altos índices de ocorrência da doença logo após os períodos de altas taxas de desmatamento, como registrado nos anos de 1995, 2000 e 2004. Percebeu-se que após a época de intenso desmatamento, os casos de malária variaram entre alto e muito alto no seu padrão de incidência, apontando que o desmatamento pode ser um fator de incremento na frequência e aumento no número de pessoas infectadas no estado do Pará.