Andréia de Fátima Nascimento

Avaliação da estrutura dos centros de atenção psicossocial do município de São Paulo, SP

OBJECTIVE To describe infrastructure, human resources, and care approaches in psychosocial healthcare services. METHODS Descriptive study including 21 psychossocial healthcare services for adults affiliated to the local health department in the city of São Paulo, Southeastern Brazil, conducted between 2007 and 2008. Information about infrastructure of facilities, human resources available and patient care was collected using a standardized instrument. There were performed descriptive data analysis and chi-square test to test the association between care activities and service source and location. RESULTS Ten services were first created as outpatient clinics and later adapted, eight were day hospitals and only three were created as psychosocial healthcare services. None of them was open 24 hours a day. Half of them were located in rented buildings with inadequate infrastructure especially for group activities. Staff composition was very different among services, with emphasis on on-site group activities and little integration to other health services. All services provided mostly arts and cultural activities. Earlier outpatient services provided mainly craft activities and former day-hospitals offered mostly psychophysical integration activities. The profile of activities varied according to the geographical distribution of services. CONCLUSIONS Current heterogeneous character of psychosocial healthcare services seems associated to the history of mental health care programs that have been implemented in São Paulo since 1980s and to social, economic and cultural differences in different areas of the city. Different psychosocial care approaches were found ranging from on-site care with little integration with other health services to services that refer their users to other services after symptoms become stable in an attempt to create a network of mental health care.

Mortalidade de motociclistas em acidentes de transporte no Distrito Federal, 1996 a 2007

OBJETIVO: Descrever caracteristicas sociodemograficas e analisar a tendencia temporal da mortalidade de motociclistas traumatizados em acidentes de transporte. METODOS: Estudo de series temporais com dados de 580 obitos de motociclistas do Distrito Federal, de 1996 a 2007, obtidos do Sistema de Informacoes sobre Mortalidade. Foram calculadas as taxas de mortalidade especificas segundo idade e sexo, as taxas padronizadas (metodo direto) e a razao de obitos por frota (motocicletas). A media movel centralizada da taxa padronizada de mortalidade de homens foi calculada para o periodo de tres anos e um modelo de regressao linear foi construido para estudar a evolucao temporal da mortalidade. Para calcular o incremento anual da taxa de mortalidade padronizada utilizou-se o metodo joinpoint (ponto de inflexao). RESULTADOS: A maior parte dos motociclistas mortos era do sexo masculino, (94,3%), pardo (71,0%) e tinha entre 20 e 39 anos (73,8%). A taxa padronizada de mortalidade de motociclistas (homens) residentes foi de 1,9 para 7,2 obitos/100 mil homens entre 1996 e 2007. Entre 1998 e 2007, a razao de obitos por frota passou de 2,0 obitos/10 mil motocicletas para 10,0 obitos/10 mil motocicletas entre os homens. Estimou-se incremento anual de 0,48 obito/100 mil homens (IC95% 0,31;0,65; p < 0,001). O incremento percentual anual da taxa padronizada de mortalidade para o sexo masculino foi de 36,2% no periodo 1998-2007 (IC 95% 21,2%;53,2%; p < 0,05). CONCLUSOES: A taxa de mortalidade de motociclistas decorrente de acidentes de transporte aumentou expressivamente. Esse aumento e explicado apenas em parte pelo aumento da frota de motocicletas. Caracteristicas individuais dos condutores, bem como as condicoes locais do trafego, necessitam ser investigadas para o planejamento de politicas preventivas.OBJECTIVE To describe sociodemographic characteristics and analyze temporal trends in the mortality of motorcyclists injured in traffic accidents. METHODS This was a time-series study with data from 580 motorcyclist deaths in the Brazilian Federal District from 1996 to 2007. The data were obtained from the Mortality Information System. Mortality rates specific for age and sex, the standardized rates (direct method), and the ratio of deaths per fleet (motorcycles) were calculated. The centralized moving average of the standardized mortality rate for men was calculated for a three-year period, and a linear regression model was constructed to study the evolution of mortality. The joinpoint method (inflection point) was used to calculate the annual increase in the standardized mortality rate. RESULTS Most of the motorcyclists killed were male (94.3%), mixed skin color (71.0%), and between the ages of 20 and 39 years (73.8%). The standardized mortality rate for resident motorcyclists (men) was 1.9 to 7.2 deaths/100,000 men between 1996 and 2007. Between 1998 and 2007, the ratio of deaths per fleet increased from 2.0 deaths/10,000 motorcyclists to 10.0 deaths/10,000 motorcyclists among men. There was an estimated annual increase of 0.48 deaths/100,000 men (95%CI 0.31, 0.65; p <0.001). The percent increase of the annual standardized mortality rate for males was 36.2% in the period from 1998-2007 (95%CI 21.2%, 53.2%; p <0.05). CONCLUSIONS The mortality rate resulting from motorcycle road accidents has increased dramatically. This increase is partially explained by the increase of the fleet of motorcycles. Individual characteristics of drivers, as well as local traffic conditions, need to be investigated for the planning of preventive policies.

Mortality of motorcyclists in traffic accidents in the Brazilian Federal District from 1996 to 2007

OBJETIVO: Descrever caracteristicas sociodemograficas e analisar a tendencia temporal da mortalidade de motociclistas traumatizados em acidentes de transporte. METODOS: Estudo de series temporais com dados de 580 obitos de motociclistas do Distrito Federal, de 1996 a 2007, obtidos do Sistema de Informacoes sobre Mortalidade. Foram calculadas as taxas de mortalidade especificas segundo idade e sexo, as taxas padronizadas (metodo direto) e a razao de obitos por frota (motocicletas). A media movel centralizada da taxa padronizada de mortalidade de homens foi calculada para o periodo de tres anos e um modelo de regressao linear foi construido para estudar a evolucao temporal da mortalidade. Para calcular o incremento anual da taxa de mortalidade padronizada utilizou-se o metodo joinpoint (ponto de inflexao). RESULTADOS: A maior parte dos motociclistas mortos era do sexo masculino, (94,3%), pardo (71,0%) e tinha entre 20 e 39 anos (73,8%). A taxa padronizada de mortalidade de motociclistas (homens) residentes foi de 1,9 para 7,2 obitos/100 mil homens entre 1996 e 2007. Entre 1998 e 2007, a razao de obitos por frota passou de 2,0 obitos/10 mil motocicletas para 10,0 obitos/10 mil motocicletas entre os homens. Estimou-se incremento anual de 0,48 obito/100 mil homens (IC95% 0,31;0,65; p < 0,001). O incremento percentual anual da taxa padronizada de mortalidade para o sexo masculino foi de 36,2% no periodo 1998-2007 (IC 95% 21,2%;53,2%; p < 0,05). CONCLUSOES: A taxa de mortalidade de motociclistas decorrente de acidentes de transporte aumentou expressivamente. Esse aumento e explicado apenas em parte pelo aumento da frota de motocicletas. Caracteristicas individuais dos condutores, bem como as condicoes locais do trafego, necessitam ser investigadas para o planejamento de politicas preventivas.OBJECTIVE To describe sociodemographic characteristics and analyze temporal trends in the mortality of motorcyclists injured in traffic accidents. METHODS This was a time-series study with data from 580 motorcyclist deaths in the Brazilian Federal District from 1996 to 2007. The data were obtained from the Mortality Information System. Mortality rates specific for age and sex, the standardized rates (direct method), and the ratio of deaths per fleet (motorcycles) were calculated. The centralized moving average of the standardized mortality rate for men was calculated for a three-year period, and a linear regression model was constructed to study the evolution of mortality. The joinpoint method (inflection point) was used to calculate the annual increase in the standardized mortality rate. RESULTS Most of the motorcyclists killed were male (94.3%), mixed skin color (71.0%), and between the ages of 20 and 39 years (73.8%). The standardized mortality rate for resident motorcyclists (men) was 1.9 to 7.2 deaths/100,000 men between 1996 and 2007. Between 1998 and 2007, the ratio of deaths per fleet increased from 2.0 deaths/10,000 motorcyclists to 10.0 deaths/10,000 motorcyclists among men. There was an estimated annual increase of 0.48 deaths/100,000 men (95%CI 0.31, 0.65; p <0.001). The percent increase of the annual standardized mortality rate for males was 36.2% in the period from 1998-2007 (95%CI 21.2%, 53.2%; p <0.05). CONCLUSIONS The mortality rate resulting from motorcycle road accidents has increased dramatically. This increase is partially explained by the increase of the fleet of motorcycles. Individual characteristics of drivers, as well as local traffic conditions, need to be investigated for the planning of preventive policies.

Arte, cultura e cuidado nos centros de atencao psicossocial

OBJETIVO: Analizar el proceso de cuidado desarrollado por medio de arte y cultura en centros de atencion psicosocial. METODOS: Estudio integrado a la investigacion de evaluacion de los centros de atencion psicosocial, en Sao Paulo, SP, Brasil. Se analizaron los relatos de la observacion de tipo etnografico de 126 actividades grupales de arte y cultura realizadas en 21 de los centros, entre 2007 y 2008. El analisis incluyo declaraciones de coordinadores sobre los objetivos de las actividades observadas. Basandose en referencias teoricas de la atencion psicosocial, se utilizo la tecnica de analisis de contenido para investigar relaciones entre medios terapeuticos (castigos, actividades y vinculos) y objetivos de las actividades. RESULTADOS: Tres tendencias de cuidado se identificaron: (1) estrictamente clinica, predominante y definida por actividades realizadas dentro de los centros enfocandose en competencias personales e interacciones grupales; (2) psicosocial, que incluyo actividades en el territorio, ampliacion de los repertorios culturales y de la circulacion social; (3) residual, minoritaria y sin ganancias psicosociales. CONCLUSIONES: La realizacion de actividades de arte y cultura que produzcan cuidado en la perspectiva de la rehabilitacion psicosocial depende del acceso de los profesionales a los bienes culturales y a procesos creativos, de reconocimiento de tales actividades en el trabajo integrado de todo el grupo y considerando a todos los actores involucrados como productores de hechos de cultura.

Evaluation of psychosocial healthcare services in the city of São Paulo, Southeastern Brazil

OBJECTIVE To describe infrastructure, human resources, and care approaches in psychosocial healthcare services. METHODS Descriptive study including 21 psychossocial healthcare services for adults affiliated to the local health department in the city of São Paulo, Southeastern Brazil, conducted between 2007 and 2008. Information about infrastructure of facilities, human resources available and patient care was collected using a standardized instrument. There were performed descriptive data analysis and chi-square test to test the association between care activities and service source and location. RESULTS Ten services were first created as outpatient clinics and later adapted, eight were day hospitals and only three were created as psychosocial healthcare services. None of them was open 24 hours a day. Half of them were located in rented buildings with inadequate infrastructure especially for group activities. Staff composition was very different among services, with emphasis on on-site group activities and little integration to other health services. All services provided mostly arts and cultural activities. Earlier outpatient services provided mainly craft activities and former day-hospitals offered mostly psychophysical integration activities. The profile of activities varied according to the geographical distribution of services. CONCLUSIONS Current heterogeneous character of psychosocial healthcare services seems associated to the history of mental health care programs that have been implemented in São Paulo since 1980s and to social, economic and cultural differences in different areas of the city. Different psychosocial care approaches were found ranging from on-site care with little integration with other health services to services that refer their users to other services after symptoms become stable in an attempt to create a network of mental health care.

Methods and challenges for the health impact assessment of vaccination programs in Latin America

ABSTRACT OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS For this narrative review, we searched for the terms “rotavirus”, “pneumococcal”, “conjugate vaccine”, “vaccination”, “program”, and “impact” in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included. RESULTS We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed. CONCLUSIONS Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.

Arte, saúde mental e atenção pública: traços de uma cultura de cuidado na história da cidade de São Paulo

By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater Sao Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.

Art, culture and care in psychosocial healthcare services

OBJETIVO: Analizar el proceso de cuidado desarrollado por medio de arte y cultura en centros de atencion psicosocial. METODOS: Estudio integrado a la investigacion de evaluacion de los centros de atencion psicosocial, en Sao Paulo, SP, Brasil. Se analizaron los relatos de la observacion de tipo etnografico de 126 actividades grupales de arte y cultura realizadas en 21 de los centros, entre 2007 y 2008. El analisis incluyo declaraciones de coordinadores sobre los objetivos de las actividades observadas. Basandose en referencias teoricas de la atencion psicosocial, se utilizo la tecnica de analisis de contenido para investigar relaciones entre medios terapeuticos (castigos, actividades y vinculos) y objetivos de las actividades. RESULTADOS: Tres tendencias de cuidado se identificaron: (1) estrictamente clinica, predominante y definida por actividades realizadas dentro de los centros enfocandose en competencias personales e interacciones grupales; (2) psicosocial, que incluyo actividades en el territorio, ampliacion de los repertorios culturales y de la circulacion social; (3) residual, minoritaria y sin ganancias psicosociales. CONCLUSIONES: La realizacion de actividades de arte y cultura que produzcan cuidado en la perspectiva de la rehabilitacion psicosocial depende del acceso de los profesionales a los bienes culturales y a procesos creativos, de reconocimiento de tales actividades en el trabajo integrado de todo el grupo y considerando a todos los actores involucrados como productores de hechos de cultura.

Arte, cultura y cuidado en los centros de atencion psicosocial

OBJETIVO: Analizar el proceso de cuidado desarrollado por medio de arte y cultura en centros de atencion psicosocial. METODOS: Estudio integrado a la investigacion de evaluacion de los centros de atencion psicosocial, en Sao Paulo, SP, Brasil. Se analizaron los relatos de la observacion de tipo etnografico de 126 actividades grupales de arte y cultura realizadas en 21 de los centros, entre 2007 y 2008. El analisis incluyo declaraciones de coordinadores sobre los objetivos de las actividades observadas. Basandose en referencias teoricas de la atencion psicosocial, se utilizo la tecnica de analisis de contenido para investigar relaciones entre medios terapeuticos (castigos, actividades y vinculos) y objetivos de las actividades. RESULTADOS: Tres tendencias de cuidado se identificaron: (1) estrictamente clinica, predominante y definida por actividades realizadas dentro de los centros enfocandose en competencias personales e interacciones grupales; (2) psicosocial, que incluyo actividades en el territorio, ampliacion de los repertorios culturales y de la circulacion social; (3) residual, minoritaria y sin ganancias psicosociales. CONCLUSIONES: La realizacion de actividades de arte y cultura que produzcan cuidado en la perspectiva de la rehabilitacion psicosocial depende del acceso de los profesionales a los bienes culturales y a procesos creativos, de reconocimiento de tales actividades en el trabajo integrado de todo el grupo y considerando a todos los actores involucrados como productores de hechos de cultura.

Mortalidad de motociclistas en accidentes de transporte en el Distrito Federal de Brasil, 1996 a 2007

OBJETIVO: Descrever caracteristicas sociodemograficas e analisar a tendencia temporal da mortalidade de motociclistas traumatizados em acidentes de transporte. METODOS: Estudo de series temporais com dados de 580 obitos de motociclistas do Distrito Federal, de 1996 a 2007, obtidos do Sistema de Informacoes sobre Mortalidade. Foram calculadas as taxas de mortalidade especificas segundo idade e sexo, as taxas padronizadas (metodo direto) e a razao de obitos por frota (motocicletas). A media movel centralizada da taxa padronizada de mortalidade de homens foi calculada para o periodo de tres anos e um modelo de regressao linear foi construido para estudar a evolucao temporal da mortalidade. Para calcular o incremento anual da taxa de mortalidade padronizada utilizou-se o metodo joinpoint (ponto de inflexao). RESULTADOS: A maior parte dos motociclistas mortos era do sexo masculino, (94,3%), pardo (71,0%) e tinha entre 20 e 39 anos (73,8%). A taxa padronizada de mortalidade de motociclistas (homens) residentes foi de 1,9 para 7,2 obitos/100 mil homens entre 1996 e 2007. Entre 1998 e 2007, a razao de obitos por frota passou de 2,0 obitos/10 mil motocicletas para 10,0 obitos/10 mil motocicletas entre os homens. Estimou-se incremento anual de 0,48 obito/100 mil homens (IC95% 0,31;0,65; p < 0,001). O incremento percentual anual da taxa padronizada de mortalidade para o sexo masculino foi de 36,2% no periodo 1998-2007 (IC 95% 21,2%;53,2%; p < 0,05). CONCLUSOES: A taxa de mortalidade de motociclistas decorrente de acidentes de transporte aumentou expressivamente. Esse aumento e explicado apenas em parte pelo aumento da frota de motocicletas. Caracteristicas individuais dos condutores, bem como as condicoes locais do trafego, necessitam ser investigadas para o planejamento de politicas preventivas.OBJECTIVE To describe sociodemographic characteristics and analyze temporal trends in the mortality of motorcyclists injured in traffic accidents. METHODS This was a time-series study with data from 580 motorcyclist deaths in the Brazilian Federal District from 1996 to 2007. The data were obtained from the Mortality Information System. Mortality rates specific for age and sex, the standardized rates (direct method), and the ratio of deaths per fleet (motorcycles) were calculated. The centralized moving average of the standardized mortality rate for men was calculated for a three-year period, and a linear regression model was constructed to study the evolution of mortality. The joinpoint method (inflection point) was used to calculate the annual increase in the standardized mortality rate. RESULTS Most of the motorcyclists killed were male (94.3%), mixed skin color (71.0%), and between the ages of 20 and 39 years (73.8%). The standardized mortality rate for resident motorcyclists (men) was 1.9 to 7.2 deaths/100,000 men between 1996 and 2007. Between 1998 and 2007, the ratio of deaths per fleet increased from 2.0 deaths/10,000 motorcyclists to 10.0 deaths/10,000 motorcyclists among men. There was an estimated annual increase of 0.48 deaths/100,000 men (95%CI 0.31, 0.65; p <0.001). The percent increase of the annual standardized mortality rate for males was 36.2% in the period from 1998-2007 (95%CI 21.2%, 53.2%; p <0.05). CONCLUSIONS The mortality rate resulting from motorcycle road accidents has increased dramatically. This increase is partially explained by the increase of the fleet of motorcycles. Individual characteristics of drivers, as well as local traffic conditions, need to be investigated for the planning of preventive policies.