The mental health of graduate students at the Federal University of São Paulo: a preliminary report

We present data regarding the care provided to graduate level health professionals at the mental health center of the Federal University of São Paulo. From September 1996 to September 2003, 146 graduate students (99 in the Master's degree program and 47 in the Doctoral program) were attended. This population was predominantly female (68.5%), with a mean (± SD) age of 28.6 ± 4.42 years, not married (71.9%). Most of the subjects were professionals who had not graduated from the Federal University (78.1%). The students who sought help for psychological and/or psychiatric problems were classified into two categories: situational-adaptive crises and psychopathological crises. The main diagnoses were depression and anxiety disorders (44%) causing 4.5% of the subjects to be temporarily suspended from their graduate studies; 19.2% reported that they had used psychotropic drugs within the previous month, and 47.9% referred to sleep disturbances. Suicidal tendencies were mentioned by 18% of those interviewed. Students with emotional disturbances and academic dysfunctions should be recognized at an early stage, and it is fundamental for them to have access to mental health programs that provide formal, structured and confidential care. Thus, it is important that professors and advisors in graduate programs build a warm and affective learning environment. If we consider the expressive growth in Brazilian scientific production resulting from the implementation of an extensive national system of graduate education, it is important to focus efforts on enhancing and upgrading the mental health care system.

Bolognan prosessi : koulutuspoliittisten tavoitteiden ja toimenpiteiden sulatusuuni

Referee-artikkeli

Oppaita haastattelemiseen, analysointiin ja vuorovaikutuksen tunnistamiseen

Kirjallisuusarvostelu

The modest but growing Brazilian presence in psychiatric, psychobiological and mental health research: assessment of the 1998-2002 period

The objective of the present survey was to assess the Brazilian scientific production in psychiatry, psychobiology, and mental health during the 1998-2002 period. The universities' graduate programs concentrate the vast majority of the scientific production in Brazil. We assessed the annual reports from the graduate programs to the Brazilian Ministry of Education concerning master's and doctoral theses and the articles published in journals indexed by the Institute of Scientific Information (ISI). There are nine Master's and Doctoral graduate programs dedicated to research in psychiatry, neuropsychiatry, psychobiology, and mental health in the country, seven being located in southern states. During the 5-year period, from 1998 to 2002, 186 students received their doctorate degree (37/year). The programs published 637 articles in journals indexed by ISI, the majority of them in journals with an impact factor higher than 2. The research advisors' productivity varied among graduate programs, ranging from 0.6 to 2.0 articles per year in ISI-indexed journals. Despite the substantial barriers faced by the Brazilian scientific community (mainly financial and writing difficulties), Brazil's scientific mental health production is on the rise. The number of articles published in ISI-indexed journals has doubled without a significant increase in the number of graduate theses, suggesting that there was an improvement in both the quality of the scientific production and the productivity of the graduate programs. Based on these data, it is reasonable to predict a tendency to an increase in production over the next few years.

Chance of psychiatric morbidity amongst recently diagnosed cancer outpatients attending a chemotherapy unit

The prevalent rate of psychiatry morbidity amongst patients with cancer reported in various studies ranges from 5 to 50%, a variation that can be attributed to differences in sample size, the disease itself and treatment factors. The objectives of the present study were to determine the frequency of psychiatric morbidity amongst recently diagnosed cancer outpatients and try to identify which factors might be related to further psychological distress. Two hundred and eleven (70.9%) female patients and 87 (29.1%) male patients from the chemotherapy unit of the Cancer Hospital A.C. Camargo (São Paulo) completed a questionnaire that featured data on demographic, medical and treatment details. The Self Reporting Questionnaire (SRQ-20) was administered to the patients to determine their personal psychiatric morbidity. Seventy-two patients (25.8%) scored > or = 8 in the SRQ-20, the cut-off point for a patient to be considered a psychiatric case. When the low and high scoring groups were compared no differences were detected regarding age, marital status, tumor site, sex, or previous treatment. Nonetheless, patients in the lowest social class and those who were bedridden less than 50% of the time had a significantly higher probability of being a psychiatric case. Regarding help-seeking behavior in situations in which they had doubts or were frightened, about 64% of the total sample did not seek any type of support and did not talk to anyone. This frequency of psychiatric morbidity agrees with data from the cancer literature. According to many investigators, the early detection of a comorbid psychiatric disorder is crucial to relieve a patient's suffering.

The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26

In a cross-sectional study conducted four years ago to assess the validity of the Brazilian version of the Eating Attitudes Test-26 (EAT-26) for the identification of abnormal eating behaviors in a population of young females in Southern Brazil, 56 women presented abnormal eating behavior as indicated by the EAT-26 and the Edinburgh Bulimic Investigation Test. They were each matched for age and neighborhood to two normal controls (N = 112) and were re-assessed four years later with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI). The EAT results were then compared to diagnoses originating from the CIDI. To evaluate the temporal stability of the two screening questionnaires, a test-retest design was applied to estimate kappa coefficients for individual items. Given the prevalence of eating disorders of 6.2%, the CIDI psychiatry interview was applied to 161 women. Of these, 0.6% exhibited anorexia nervosa and 5.6%, bulimia nervosa (10 positive cases). The validity coefficients of the EAT were: 40% sensitivity, 84% specificity, and 14% positive predictive value. Cronbach's coefficient was 0.75. For each EAT item, the kappa index was not higher than 0.344 and the correlation coefficient was lower than 0.488. We conclude that the EAT-26 exhibited low validity coefficients for sensitivity and positive predictive value, and showed a poor temporal stability. It is reasonable to assume that these results were not influenced by the low prevalence of eating disorders in the community. Thus, the results cast doubts on the ability of the EAT-26 test to identify cases of abnormal eating behaviors in this population.

Decision support system for the diagnosis of schizophrenia disorders

Clinical decision support systems are useful tools for assisting physicians to diagnose complex illnesses. Schizophrenia is a complex, heterogeneous and incapacitating mental disorder that should be detected as early as possible to avoid a most serious outcome. These artificial intelligence systems might be useful in the early detection of schizophrenia disorder. The objective of the present study was to describe the development of such a clinical decision support system for the diagnosis of schizophrenia spectrum disorders (SADDESQ). The development of this system is described in four stages: knowledge acquisition, knowledge organization, the development of a computer-assisted model, and the evaluation of the system's performance. The knowledge was extracted from an expert through open interviews. These interviews aimed to explore the expert's diagnostic decision-making process for the diagnosis of schizophrenia. A graph methodology was employed to identify the elements involved in the reasoning process. Knowledge was first organized and modeled by means of algorithms and then transferred to a computational model created by the covering approach. The performance assessment involved the comparison of the diagnoses of 38 clinical vignettes between an expert and the SADDESQ. The results showed a relatively low rate of misclassification (18-34%) and a good performance by SADDESQ in the diagnosis of schizophrenia, with an accuracy of 66-82%. The accuracy was higher when schizophreniform disorder was considered as the presence of schizophrenia disorder. Although these results are preliminary, the SADDESQ has exhibited a satisfactory performance, which needs to be further evaluated within a clinical setting.

Work and non-work : on work and meaning

I den politiska retoriken florerar debattinlägg om arbetslivet, och målsättningen är för det mesta att så många som möjligt ska arbeta så länge som möjligt. Att skapa jobb och minimera arbetslösheten ses som de främsta utmaningarna. På ett individuellt plan beskrivs arbete ofta som personligt självförverkligande eller som en nödvändig form av inkomst som kräver att livet struktureras enligt behovet av sysselsättning. I avhandlingen diskuteras hur de här till synes självklara rollerna som arbete spelar kan sägas neutralisera arbete. Med detta menas att kontroverser kring arbetets mening åsidosätts så att politiskt och etiskt grundläggande frågor om ett gott liv och mänskliga gemenskaper inte ges plats. Genom att gå i dialog med kritiska tänkare som Hannah Arendt, André Gorz, Kathi Weeks, Karl Marx och Richard Sennett diskuteras riskerna med att behandla arbete som en resurs, ett gemensamt samhällsprojekt eller individuellt självförverkligande. Vad är nödvändigt arbete? Vad innebär det att arbete är en vara? Vad är problemet med fragmentering av arbete? Det sägs ofta att arbete har blivit alltmer gränslöst – är detta något positivt eller negativt? Utifrån sådana frågor tar avhandlingen fasta på spänningar i arbetets roll i våra liv och i samhället. Genom att artikulera spänningar utmanas en neutralisering av arbetets etiskt och politiskt brännbara dimensioner. Avhandlingen syftar därmed till att lyfta fram ständigt pågående sätt att ifrågasätta och reflektera kring arbetets mening.

Chemotherapy versus support cancer treatment in advanced gastric cancer: a meta-analysis

The aim of the present study was to compare the efficacy of chemotherapy and support treatment in patients with advanced non-resectable gastric cancer in a systematic review and meta-analysis of randomized clinical trials that included a comparison of chemotherapy and support care treatment in patients diagnosed with gastric adenocarcinoma, regardless of their age, gender or place of treatment. The search strategy was based on the criteria of the Cochrane Base, using the following key words: 1) randomized clinical trials and antineoplastic combined therapy or gastrointestinal neoplasm, 2) stomach neoplasm and drug therapy, 3) clinical trial and multi-modality therapy, 4) stomach neoplasm and drug therapy or quality of life, 5) double-blind method or clinical trial. The search was carried out using the Cochrane, Medline and Lilacs databases. Five studies fulfilled the inclusion criteria, for a total of 390 participants, 208 (53%) receiving chemotherapy, 182 (47%) receiving support care treatment and 6 losses (1.6%). The 1-year survival rate was 8% for support care and 20% for chemotherapy (RR = 2.14, 95% CI = 1.00-4.57, P = 0.05); 30% of the patients in the chemotherapy group and 12% in the support care group attained a 6-month symptom-free period (RR = 2.33, 95% CI = 1.41-3.87, P < 0.01). Quality of life evaluated after 4 months was significantly better for the chemotherapy patients (34%; RR = 2.07, 95% CI = 1.31-3.28, P < 0.01) with tumor mass reduction (RR = 3.32, 95% CI = 0.77-14.24, P = 0.1). Chemotherapy increased the 1-year survival rate of the patients and provided a longer symptom-free period of 6 months and an improvement in quality of life.

Espoon puhdistamolietteen käsittelymenetelmien selvitys Ämmässuon käsittelykeskukselle

Ravinteiden kierrätys yhä enemmän luonnonvaroja kuluttavassa yhteiskunnassa on noussut tärkeäksi. Hyötykäyttämällä luonnollisesti syntyvät orgaaniset virrat yhteiskunnasta voidaan kierrättää pellolta nostetut ravinteet takaisin. Tässä diplomityössä on tarkasteltu Helsingin seudun ympäristöpalveluiden toteuttamaa mädätetyn puhdistamolietteen käsittelyä ja pohdittu sen käsittelymahdollisuuksia erityisesti Ämmässuon käsittelykeskuksessa. Tarkastelussa on keskitytty kahteen yleisimpään kompostointimenetelmään, eli auma- ja tunnelikompostointiin. Kompostointimenetelmien tarkastelussa on pyritty löytämään optimaalinen tukiaine sekä prosessiaika käsiteltävälle lietteelle Ämmässuolla olemassa olleilla resursseilla. Tutkimuksessa toteutettiin käytännön pilot -kokeita sekä toteutettiin teoreettista prosessin parametrien laskentaa mukaan lukien kustannukset ja resurssit. Tutkimuksen perusteella voidaan todeta, että kyseisen tyyppisellä käsittelyalueella tunneli-kompostointi on näillä parametreilla testattuna paras vaihtoehto. Menetelmällä voidaan saavuttaa nopeampi käsittelyaika sekä vähentää kompostoinnista aiheutuvia hajuhaittoja ympäristöön. Tukiaineseoksessa voidaan korvata yleisestikin käytetty turve vastaanotettavalla lehti-puru viherjäteseoksella sekä risuhakkeella ja prosessiaika on noin 12 -16 viikkoa. Käsittelyn kustannukset verrattuna tämän hetkiseen käsittelyyn Metsäpirtissä eivät olleet merkittävästi suuremmat ja ympäristövaikutusarvioinnin perusteella syntypaikkaa lähellä oleva käsittelyalue sekä prosessin pienemmät vaikutukset tuovat ympäristöedun käsittelylle Ämmässuolla.