Erotildes Maria Leal

Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil

IntroductionStudies have shown important gender differences among drug (including crack) users related to: drug use patterns; health risks and consequences; criminal involvement; and service needs/use. Crack use is prevalent in Brazil; however, few comparative data by sex exist. We examined and compared by sex key drug use, health, socio-economic indicators and service use in a bi-city sample of young (18–24 years), regular and marginalized crack users in Brazil.MethodsStudy participants (total n = 159; n = 124 males and n = 35 females) were recruited by community-based methods from impoverished neighborhoods in Rio de Janeiro and Salvador. Assessments occurred by an anonymous interviewer-administered questionnaire and serum collection for blood-borne virus testing between November 2010 and June 2011. Descriptive statistics and differences for key variables by sex were computed; in addition, a ‘chi-squared automatic interaction detector’ (‘CHAID’) analysis explored potential primary factors differentiating male and female participants.ResultsMost participants were non-white, and had low education and multiple income sources. More women had unstable housing and income from sex work and/or panhandling/begging, whereas more men were employed. Both groups indicated multi-year histories of and frequent daily crack use, but virtually no drug injection histories. Men reported more co-use of other drugs. More women were: involved in sex-for-drug exchanges; Blood-Borne Virus (BBV) tested and HIV+. Both groups reported similar physical and mental health patterns; however women more commonly utilized social or health services. The CHAID analysis identified sex work; paid work; begging/panhandling; as well as physical and mental health status (all at p < 0.05) as primary differentiating factors by sex.ConclusionsCrack users in our study showed notable differences by sex, including socio-economic indicators, drug co-use patterns, sex risks/work, BBV testing and status, and service utilization. Results emphasize the need for targeted special interventions and services for males and female crack users in Brazil.

O processo de restabelecimento na perspectiva de pessoas com diagnóstico de transtornos do espectro esquizofrênico e de psiquiatras na rede pública de atenção psicossocial

O tema do restabelecimento (recovery) na perspectiva das pessoas portadoras de transtornos mentais graves, no contexto dos servicos comunitarios de saude mental e da transformacao da assistencia psiquiatrica, ainda carece de estudo, embora cada vez mais investigado. Objetivo: analisar como o processo de restabelecimento (recovery) e percebido por usuarios com diagnostico de transtornos do espectro esquizofrenico e psiquiatras inseridos na rede de atencao psicossocial. Metodo: pesquisa qualitativa multicentrica, informada pelo quadro de referencia da Analise Fenomenologica Interpretativa, na qual se utilizaram as tecnicas de observacao participante, entrevistas semiestruturadas e grupos focais para obtencao dos dados. Resultados: a partir do material analisado, identificaram-se as seguintes categorias tematicas: efeitos do adoecimento; contexto de tratamento no Centro de Atencao Psicossocial - CAPS; diagnostico; possibilidades e expectativas em relacao ao futuro/prognostico; e abertura para a experiencia do outro (posicao dialogica). Conclusao: existem pontos de convergencia e divergencia entre as perspectivas de usuarios e psiquiatras a respeito do processo de restabelecimento. Mesmo assim, e possivel criar contextos em que a experiencia dos usuarios ilumine o conhecimento tecnico/experiencia do psiquiatra e vice-versa.

Narrativas no estudo das práticas em saúde mental : contribuições das perspectivas de Paul Ricoeur, Walter Benjamim e da antropologia médica

Narratives are ever more frequent in qualitative studies seeking to interpret experiences and the different viewpoints of individuals in a given context. Starting from this concept, the tradition that addresses narrative is reexamined, including the philosophy of Paul Ricoeur, the historical perspective of Walter Benjamin and the field of medical anthropology grounded in phenomenology. In Ricoeur, with hermeneutics as a variation derived from phenomenology, narrative is linked to temporality. In Benjamin, narrative comprised of bits and pieces, always inconclusive, emerges in spite of the official stories. If Ricoeur retrieves tradition from Gadamer as a fundamental component for the construction of the world of a text that makes imitation of life possible, Benjamin, faced with the collapse of tradition, suggests the invention of narrative forms outside the traditional canons, making it possible to hark to the past in order to change the present. Assumptions of medical anthropology are also presented, as they consider narrative a dimension of life and not its abstraction, namely an embodied and situated narrative. Lastly, three distinct research projects in mental health that use narrative linked to the theoretical concepts cited with their differences and similarities are presented.The aim of this study is to assess Municipal School Nutrition Councils (CAEs) of the Brazilian School Nutrition Program (PNAE) in the state of Santa Catarina, Brazil. A cross-sectional study was conducted with a sample of municipalities in the state (n = 152; 52%). CAE presidents were interviewed and asked about the counselor profile, attributions performed and the relation of CAEs with other local councils. Poisson regression analysis was conducted to obtain unadjusted and adjusted prevalence ratios and the adjusted model adopted a hierarchic approach. The majority of councils analyzed their accounting reports, monitored resources and strived for quality of the CAEs at all levels. They coordinated the storage of food, participated in establishing the menu, monitored the purchasing of food and had an internal control system. However, only 22.4% carried out all their attributions once or more per year. A positive association was found between an adequate performance of the CAE and relations with other local councils. The awareness of the CAEs, as well as a stimulus to acting jointly with other councils and actors involved with food and nutrition security, are essential to ensure the right to healthy and adequate nutrition at school.

A inclusão da subjetividade no ensino da Psicopatologia

Current psychopathology studies have often been pre sented in their descriptive dimension. This perspec tive is important for teaching because it helps the student s to recognize and identify the symptomatology of e ach psychopathology case. However, subjectivity, the ex perience of suffering and interpersonal aspects are all lost in this perspective. Coming from another psychopathology tradition ‐ existential anthropology ‐ this paper pre sents practical psychopathology teaching experience which considers such dimensions as being relevant to the understan ding of mental suffering. The features and limitations of s uch traditions are briefly reviewed to support this teaching experience. Two new modalities of practical teachin g, used in the discipline of “Special Psychopatholo gy I” offered by the Department of Psychiatry and Forensic Medicine at the medical school of the Federal University of Rio de Janeiro for students of psychology, will be presented accor ding to descriptive case study methodology. With th ese activities we also expect to change the practice of teaching. Tra ditionally, interviewing of in-patients by a large group of students who observe passively what is happening is the cent er of this kind of education. We intend to develop a model of teaching which is closer to the proposal of the Bra zilian Psychiatric Reform which views mental illnes s as a complex phenomenon, always involving the relationship that the subject establishes with the world.O estudo da Psicopatologia tem sido frequentemente apresentado em sua dimensao descritiva. Apesar da relevância para o ensino - auxiliar o aluno a reconhecer a dimensao sintomatologica dos quadros psicopatologicos -, exclui a dimensao subjetiva da experiencia do adoecimento e seus aspectos relacionais. Partindo da tradicao antropologico-existencial, apresentamos uma experiencia de ensino de Psicopatologia que considera tais dimensoes relevantes para a compreensao do sofrimento mental. Trabalhando com estudo de caso descritivo, sao apresentadas duas novas modalidades de praticas na disciplina Psicopatologia Especial I, oferecida para alunos do curso de Psicologia da UFRJ. A proposta e ampliar o ensino pratico, tradicionalmente centrado no modelo da extensa entrevista clinica, realizada diante de um grande grupo de alunos que a tudo assistem passivamente. Pretendemos aproximar o ensino e a pratica da Psicopatologia dos ideais da Reforma Psiquiatrica Brasileira, que concebe o adoecimento mental como fenomeno complexo, envolvendo a relacao do sujeito com o mundo.

Psicopatologia da autonomia: a importância do conhecimento psicopatológico nos novos dispositivos de assistência psiquiátrica

O lugar que o conhecimento psicopatologico tem ocupado, e pode vir a ocupar na pratica clinica dos centros de atencao psicossocial (CAPS) - servicos comunitarios destinados ao tratamento de pacientes com transtornos mentais graves, persistentes, em quadros agudos ou nao - e a questao central deste artigo. Analisam-se brevemente as consequencias da hegemonia da psicopatologia descritiva para o desenho das intervencoes nesses servicos e discutese se a psicopatologia do ser social poderia ser ferramenta para o construcao de cuidado que visa promover a autonomia possivel para os pacientes viverem em comunidade.

McGill Entrevista Narrativa de Adoecimento - MINI: tradução e adaptação transcultural para o português

This paper presents the process of translation and cultural adaptation into Portuguese of the McGill Illness Narrative Interview - MINI, an interview protocol that is used to research meanings and modes of narrating illness experiences, tested, in the Brazilian context, for psychiatric and cancer-related problems. Two translations and their respective back-translations were developed. In addition, semantic equivalence was evaluated, a synthesis version and a final version were prepared, and two pre-tests were administered to the target populations (people with auditory verbal hallucinations or breast cancer). A high degree of semantic equivalence was found between the original instrument and the translation/back-translation pairs, and also in the perspective of referential and general meanings. The semantic and operational equivalence of the proposed modifications was confirmed in the pre-tests. Therefore, the first adaptation of an interview protocol that elicits the production of narratives about illness experiences has been provided for the Brazilian context.This paper presents the process of translation and cultural adaptation into Portuguese of the McGill Illness Narrative Interview – MINI, an interview protocol that is used to research meanings and modes of narrating illness experiences, tested, in the Brazilian context, for psychiatric and cancer-related problems. Two translations and their respective back-translations were developed. In addition, semantic equivalence was evaluated, a synthesis version and a final version were prepared, and two pre-tests were administered to the target populations (people with auditory verbal hallucinations or breast cancer). A high degree of semantic equivalence was found between the original instrument and the translation/back-translation pairs, and also in the perspective of referential and general meanings. The semantic and operational equivalence of the proposed modifications was confirmed in the pre-tests. Therefore, the first adaptation of an interview protocol that elicits the production of narratives about illness experiences has been provided for the Brazilian context.

Experiência, narrativa e conhecimento: a perspectiva do psiquiatra e a do usuário

O presente estudo, realizado em parceria entre UFRJ, UNICAMP e UFBA, pretendeu conhecer a experiencia das pessoas com o diagnostico de transtorno do espectro esquizofrenico, em tratamento nos CAPS, e a experiencia dos psiquiatras inseridos na rede publica de atencao a saude mental. Narrativas relacionadas ao processo saude-doenca, no caso de pessoas com diagnostico de esquizofrenia, e narrativas sobre o processo de formulacao do diagnostico de esquizofrenia, prognostico e tratamento, no caso dos psiquiatras, foram estudadas. Este e um estudo qualitativo, multicentrico, informado pelas abordagens teoricas da Analise Interpretativa Fenomenologica e da Antropologia medica, realizado nas cidades de Campinas, Rio de Janeiro e Salvador. A principal ferramenta metodologica empregada para producao das narrativas foram os grupos focais. Tecnicas da entrevista de explicitacao foram incorporadas. As categorias identificadas no estudo - Experiencia de Adoecimento, Diagnostico de Esquizofrenia, Estigma Social, Experiencia de Restabelecimento e Tratamento e o Contexto Dinâmico dos CAPS - e as narrativas que as compuseram foram apresentadas e discutidas com o proposito de dar visibilidade aos elementos que caracterizam as narrativas-experiencias dos parcipantes e indicar o modo como se configura sua complexidade.

Acesso à experiência em primeira pessoa na pesquisa em Saúde Mental

This article presents and discusses the epistemological and methodological challenges related to the empirical study of first-person experience in mental health research. Considering the field of qualitative research, the methodological principles of phenomenology and medical anthropology are examined from a historical and conceptual perspective. The main operational concepts of the phenomenological method applied to empirical research, as well as their two main lines of approach, namely descriptive and psychological/transcendental phenomenology and hermeneutical or interpretative phenomenology, are described. The contributions of medical anthropology are studied especially with respect to the experience of illness and its forms of narrative. Lastly, considering the distinction between experience and narrative based on the theoretical benchmarks of phenomenology and medical anthropology, a more in-depth debate on access to first-person experience is conducted.

Estudo de comorbidade: sofrimento psíquico e abuso de drogas em pessoas em centros de tratamento, Macaé - Brasil

Study of prevalence and psychological distress among people attending a public day care service and two private in patientsservicesinthecityofMacae,�RiodeJaneiro,�Brazil.�Cross-sectionalstudy.�AquestionnaireadaptedbytheformEULAC-CICAD� was applied to characterize the participants. The scale of Kessler-10 was used as a screening tool for psychological distress. The sample was 60 people: 88.3% men and 51.5% between 24-39 years old. Depression was referred as the most important previous diagnosis in 35%, followed by anxiety in 33.33%. During the current treatment this relationship changed: anxiety was the main diagnosis in 38.3%, followed by depression in 28.3%. The 34% of the sample had severe psychological distress and 27.2% very severe psychological distress. The levels of psychological distress severe and very severe in 61.2% screened by K-10, a scale especially sensitive to anxiety and depression, are similar to international studies on this population. dEsCriptors: Comorbidity. Substance use-related disorders. Psychological distress. Mental health assistance.Study of prevalence and psychological distress among people attending a public day care service and two private in patients services in the city of Macae, Rio de Janeiro, Brazil. Cross-sectional study. A questionnaire adapted by the form EULAC-CICAD was applied to characterize the participants. The scale of Kessler-10 was used as a screening tool for psychological distress. The sample was 60 people: 88.3% men and 51.5% between 24-39 years old. Depression was referred as the most important previous diagnosis in 35%, followed by anxiety in 33.33%. During the current treatment this relationship changed: anxiety was the main diagnosis in 38.3%, followed by depression in 28.3%. The 34% of the sample had severe psychological distress and 27.2% very severe psychological distress. The levels of psychological distress severe and very severe in 61.2% screened by K-10, a scale especially sensitive to anxiety and depression, are similar to international studies on this population. dEsCriptors: Comorbidity. Substance use-related disorders. Psychological distress. Mental health assistance. Estudio dE la Comorbilidad: distrEs psiColOgiCo Y abuso dE drogas En pErsonas En CEntros dE tratamiEnto, maCae – brasil rEsumEn: Estudio de prevalencia de distres psicologicos entre personas que acuden a los servicios publicos de atencion de dia y dos centros de hospitalizacion privada en la ciudad de Macae, Rio de Janeiro, Brasil. Estudio transversal. Se aplico un cuestionario adaptado de lo formulario de la EULAC-CICAD para caracterizar a los participantes. Para la deteccion de los distres psicologicos se utilizo la escala de Kessler-10. Participaron 60 personas, y los hombres eran 88.3%. De la muestra total, el 51.5% tenian entre 24 a 39 anos de edad. La depresion fue el principal diagnostico relatado en 35%, seguido de la ansiedad en 33.33%. Durante el tratamiento actual la ansiedad fue el diagnostico principal en 38.3%, seguido de depresion en 28.3%. De los encuestados el 34% tenian niveles graves de distres psicologicos y el 27.2% niveles muy graves. Las conclusiones de que los niveles de distres psicologico grave y muy grave en 61.2% identificados pela escala K-10, especialmente sensibles a la ansiedad y la depresion, son similares a los estudios internacionales de esta poblacion. dEsCriptorEs: Comorbilidad. Distres psicologico. Trastornos relacionados con sustancias. Atencion en salud mental.

Adaptação multicêntrica do guia para a gestão autônoma da medicação

O uso crescente de psicofarmacos e o baixo empowerment dos usuarios mostram-se criticos a qualificacao da assistencia em Saude Mental no Brasil. Este estudo, abrangendo tres cidades brasileiras, objetivou a elaboracao do Guia Brasileiro da Gestao Autonoma da Medicacao (GGAM-BR), com base na traducao e adaptacao de guia desenvolvido no Canada; e a avaliacao dos efeitos do uso do GGAM-BR na formacao de trabalhadores de saude mental. Constituiram-se grupos de intervencao (GIs) para compartilhamento das experiencias com tratamento medicamentoso, a partir dos temas propostos no guia; e foram realizados grupos focais antes e apos os GIs. Importantes mudancas em relacao ao texto original do guia Canadense foram implementadas, levando em conta a realidade brasileira. Constatou-se que o GGAM-BR constitui estrategia potente de fomento a participacao ativa dos usuarios na gestao do tratamento e do servico, incidindo positivamente na formacao de trabalhadores.