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.

Drug-Use Amongst Teenagers in Romania and the Republic of Moldavia"

Drug-use among teenagers in two ex-communist countries, Romania and the Republic of Moldova, was studied both in isolation and on a comparative basis. The group carried out a psycho-social study, gaining data from two representative samples of teenagers (N=713 in Romania and N=760 in Moldova). Teachers, parents and experts were also interviewed, using focus groups, questionnaires and 3 individual interviews. Aspects of the phenomenon investigated were the extent of drug use (frequency of consumption, kinds of drugs used, and categories of teenage consumers, by age, gender, residential areas, occupational status, marketplaces and traffickers); internal and external stimulating and inhibiting factors, the attitude of all four categories of subjects to drug abuse in teenagers, and strategies for combating this and other such problems.

Análisis de la Política Exterior Rusa en materia energética, comercial y militar hacia la República de Moldavia (Período 2000-2010)

Rusia sufrió grandes cambios tras la desintegración de la URSS en 1991. No obstante, con la llegada de Vladimir Putin al poder, los intereses geoestratégicos de Rusia sobre el espacio postsoviético revivieron con nuevo ímpetu debido a una mayor cantidad de recursos a disposición del Estado. La República de Moldavia es un claro ejemplo del resurgir de la política exterior rusa hacia el espacio postsoviético, siendo incluso, una región clave en la lucha de la Federación Rusa por recuperar su zona de influencia.

Description of Micropygomyia brandaoi sp. n. (Diptera: Psychodidae: Phlebotominae), a fossil phlebotomine from the Dominican Republic

The description of Micropygomyia brandaoi, a new species of fossil phlebotomine sand fly, is based on one male specimen obtained from Dominican amber of the Miocene period (20 million years). In this new species, the fifth palpal segment is long, the coxite lacks a setal tuft and the style shows four well-developed spines. This set of characters allowed us to place the new species in the genus Micropygomyia Barretto.

Description of micropygomyia brandaoi sp. N. (diptera: psychodidae: phlebotominae), a fossil phlebotomine from the Dominican Republic

The description of Micropygomyia brandaoi, a new species of fossil phlebotomine sand fly, is based on one male specimen obtained from Dominican amber of the Miocene period (20 million years). In this new species, the fifth palpal segment is long, the coxite lacks a setal tuft and the style shows four well-developed spines. This set of characters allowed us to place the new species in the genus Micropygomyia Barretto

Phytoseiid mites (Acari: Phytoseiidae) of the Dominican Republic, with a re-definition of the genus Typhloseiopsis De Leon

The phytoseiid mites of the Dominican Republic are virtually unknown. In a survey conducted in areas of natural vegetation of that country, 23 species were collected, two of which, Phytoseius dominicensis Ferragut & Moraes sp. nov. and Typhloseiopsis adventitius Ferragut & Moraes sp. nov., are new to science. We report the species found in that survey, describe the two new species, and provide complementary morphological information about other species. To accommodate the new Typhloseiopsis De Leon species, a redefinition of Typhloseiopsis is proposed. A key for the separation of the species in this genus is provided.

Within-stand and seasonal variations of specific leaf area in a clonal Eucalyptus plantation in the Republic of Congo

Specific leaf area (SLA; m(leaf)(2) kg(leaf)(-1)) is a key ecophysiological parameter influencing leaf physiology, photosynthesis, and whole plant carbon gain. Both individual tree-based models and other forest process-based models are generally highly sensitive to this parameter, but information on its temporal or within-stand variability is still scarce. In a 2-4-year-old Eucalyptus plantation in Congo, prone to seasonal drought, the within-stand and seasonal variability in SLA were investigated by means of destructive sampling carried out at 2-month intervals, over a 2-year period. Within-crown vertical gradients of SLA were small. Highly significant relationships were found between tree-average SLA (SLA(t)) and tree size (tree height, H(t), or diameter at breast height, DBH): SLA(t) ranged from about 9 m(2) kg(-1) for dominant trees to about 14-15 m(2) kg(-1) for the smallest trees. The decrease in SLA(t) with increasing tree size was accurately predicted from DBH using power functions. Stand-average SLA varied by about 20% during the year, with lowest values at the end of the 5-month dry season, and highest values about 2-3 months after the onset of the wet season. Variability in leaf water status according to tree size and season is discussed as a possible determinant of both the within-stand and seasonal variations in SM. (C) 2009 Elsevier B.V. All rights reserved.

Democracy versus Republic: Inclusion and Desire in Social Struggles

This paper argues that the idea of inclusion is linked to the democratic tradition rather than to the republican one. By analyzing the origins and meaning of these two concepts, the author holds that democracy is rather linked to desire and republic to will (and to the expression of desire), and concludes that, since North Atlantic political tradition has not given a key role to desire, democracy, in order to overcome the difficulties it has been encountering in all parts of the world, should take more account of desire and of the social struggles it brings to the fore.

Schistosomiasis in the People's Republic of China: Prospects and challenges for the 21st century

Schistosomiasis japonica is a serious communicable disease and a major disease risk for more than 30 million people living in the tropical and subtropical zones of China. Infection remains a major public health concern despite 45 years of intensive control efforts. It is estimated that 865, 000 people and 100,250 bovines are today infected in the provinces where the disease is endemic, and its transmission continues. Unlike tire other schistosome species known to infect humans, the oriental schistosome, Schistosoma japonicum, is a true zoonotic organism, with a range of mammalian reservoirs, making control efforts extremely difficult. Clinical features of schistosomiasis range from fever; headache, and lethargy to severe fibro-obstructive pathology leading to portal hypertension, ascites, and hepatosplenomegaly, which can cause premature death. Infected children ale stunted and have cognitive defects impairing memory and learning ability. Current control programs are heavily based on community chemotherapy with a single dose of the drug praziquantel, but vaccines (for use in bovines and humans) in combination with other control strategies ale needed to make elimination of the disease possible. In this article, we provide an overview of the biology, epidemiology clinical features, and prospects for cona ol of oriental schistosomiasis in the People's Republic of China.

The K5 gamble: National defence and nation building under the People's Republic of Kampuchea

The K5 Plan for the defence of the Cambodian-Thai border was the response of the People's Republic of Kampuchea and its Vietnamese mentors to the threat posed by the resistance forces, particularly the Khmer Rouge, to its efforts to rebuild the nation and consolidate its administration. The very real defence gains, however, were made at the cost of bitter popular resentment over the way those gains were made.

Mathematical modelling of schistosomiasis japonica: comparison of control strategies in the People's Republic of China

We present the first mathematical model on the transmission dynamics of Schistosoma japonicum. The work extends Barbour's classic model of schistosome transmission. It allows for the mammalian host heterogeneity characteristic of the S. japonicum life cycle, and solves the problem of under-specification of Barbour's model by the use of Chinese data we are collecting on human-bovine transmission in the Poyang Lake area of Jiangxi Province in China. The model predicts that in the lake/marshland areas of the Yangtze River basin: (1) once-early mass chemotherapy of humans is little better than twice-yearly mass chemotherapy in reducing human prevalence. Depending on the heterogeneity of prevalence within the population, targeted treatment of high prevalence groups, with lower overall coverage, can be more effective than mass treatment with higher overall coverage. Treatment confers a short term benefit only, with prevalence rising to endemic levels once chemotherapy programs are stopped (2) depending on the relative contributions of bovines and humans, bovine treatment can benefit humans almost as much as human treatment. Like human treatment, bovine treatment confers a short-term benefit. A combination of human and bovine treatment will dramatically reduce human prevalence and maintains the reduction for a longer period of time than treatment of a single host, although human prevalence rises once treatment ceases; (3) assuming 75% coverage of bovines, a bovine vaccine which acts on worm fecundity must have about 75% efficacy to reduce the reproduction rate below one and ensure mid-term reduction and long-term elimination of the parasite. Such a vaccination program should be accompanied by an initial period of human treatment to instigate a short-term reduction in prevalence, following which the reduction is enhanced by vaccine effects; (4) if the bovine vaccine is only 45% efficacious (the level of current prototype vaccines) it will lower the endemic prevalence, but will not result in elimination. If it is accompanied by an initial period of human treatment and by a 45% improvement in human sanitation or a 30% reduction in contaminated water contact by humans, elimination is then possible. (C) 2002 Elsevier Science B.V. All rights reserved.

Genetic Jacobinism in the republic of choice

Revista de Filosofia da Unidade de Investigação em Ciência, Tecnologia e Sociedade da Universidade Lusófona