Flávia Batista Portugal

Brazilian multicentre study of common mental disorders in primary care: rates and related social and demographic factors

Problemas de saude mental sao comuns na atencao primaria e sao geralmente relacionados a ansiedade e a depressao. Este estudo tem o objetivo de avaliar a taxa de transtornos mentais comuns e suas associacoes com caracteristicas sociodemograficas em unidades de saude da familia. E um estudo multicentrico, transversal, com os usuarios da atencao primaria do Rio de Janeiro, Sao Paulo, Fortaleza (Ceara) e Porto Alegre (Rio Grande do Sul), Brasil. Utilizou-se o General Health Questionnaire (GHQ-12) e o Hospital Anxiety and Depression Scale (HAD). A taxa de transtornos mentais nos usuarios do Rio de Janeiro, Sao Paulo, Fortaleza e Porto Alegre foram, respectivamente, 51,9%, 53,3%, 64,3% e 57,7%, com diferencas significativas entre Porto Alegre e Fortaleza comparando-se ao Rio de Janeiro. Problemas de saude mental foram especialmente altos em mulheres, desempregados, em pessoas com baixa escolaridade e com baixa renda. Dadas as iniciativas do governo brasileiro para o desenvolvimento os cuidados primarios e para reorganizacao da politica publica de saude mental, e importante considerar os transtornos mentais comuns como uma prioridade tal como outras morbidades cronicas.Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed using the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HAD). The rate of mental disorders in patients from Rio de Janeiro, São Paulo, Fortaleza and Porto Alegre were found to be, respectively, 51.9%, 53.3%, 64.3% and 57.7% with significant differences between Porto Alegre and Fortaleza compared to Rio de Janeiro after adjusting for confounders. Prevalence proportions of mental problems were especially common for females, the unemployed, those with less education and those with lower incomes. In the context of the Brazilian governments moves towards developing primary health care and reorganizing mental health policies it is relevant to consider common mental disorders as a priority alongside other chronic health conditions.

Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study

OBJECTIVES The aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. The training intervention was a multifaceted program over 96 h focused on development of a shared care model. METHOD A quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes. RESULTS Six to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes. CONCLUSIONS Training professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary.

Uso de drogas por estudantes de Farmácia da Universidade Federal do Espírito Santo

OBJECTIVE: To trace the profile of the drug use between the university students of the course of Pharmacy Sciences Health Center of Federal University of Espirito Santo. METHODS: One is about explorer, descriptive, transversal and quantitative study. A survey was conducted with 148 undergraduate pharmacy students (80.4%). The instrument used is an adaptation of the developed one for the WHO. The data had been tabulated and analyzed through the Statistical Packcage for the Social Science (SPSS). RESULTS: 67.6% of the university students are female, 52.7% it had between 20 and 22 years and 47.3% belong to the social class B. Regarding the use of alcohol, 87.8% made use in the life, 77.7% in the year and 58.1% in the month. Between the other drugs, the use in life of inahaled drugs (18.2%) was the most common. CONCLUSION: As observed, the undergraduate students belong a concerned group, showing the significance of a better approach in this subject at colleges curriculum.

Qualidade de vida de estudantes de medicina da UERJ por meio do Whoqol-bref: uma abordagem multivariada

A UERJ reserva 45% das vagas para estudantes com carencia socioeconomica. O objetivo deste estudo e conhecer em que extensao, variaveis sociodemograficas, de saude, forma de ingresso e o ano da graduacao, influenciam simultaneamente os dominios da qualidade de vida (QV) dos estudantes de medicina aferida pelo Whoqol-bref. Participaram 394 estudantes (72% dos matriculados em 2010), idade media: 23 anos, 61% mulheres, 43% cotistas e 20% com morbidade cronica referida (MCR). Os menores escores de QV observados foram para: mulheres, com MCR, cotistas, da classe C e do terceiro e sexto ano. A analise por regressao linear multipla revelou que todas as variaveis independentes analisadas apresentaram associacao negativa com os dominios da QV, e em conjunto contribuiram parcialmente para sua explicacao, chegando a 22% no dominio meio ambiente, influenciada pela classe economica e forma de ingresso. A presenca de MCR associou-se negativamente aos dominios fisico, psicologico e relacoes sociais. Estes dois ultimos dominios tambem foram influenciados pelo ano da graduacao. Variaveis que colaboram positivamente com a QV precisam ser exploradas. Os dados obtidos sao suficientes para orientar estrategias de cuidado aos estudantes mais vulneraveis ao longo da formacao medica, com especial atencao aos cotistas.

Psychiatric morbidity and quality of life of primary care attenders in two cities in Brazil

Objetivo: Identificar as associacoes entre qualidade de vida (QV), determinantes sociais e sofrimento psiquico na Atencao Primaria (AP) em dois municipios do Brasil. Metodos: Estudo transversal com 1.466 pacientes atendidos na AP de Sao Paulo e Rio de Janeiro nos anos de 2009 e 2010. Resultados: As prevalencias de Transtorno Mental Comum (TMC-3), Transtorno Mental Comum de intensidade grave (TMC-5), casos sugestivos de ansiedade e de depressao foram de 20,5%, 32%, 37% e 25,1%, respectivamente. Observou-se a associacao entre as variaveis socioeconomicas e a presenca de sofrimento psiquico, em especial para aqueles com idade superior a 40 anos. Nos casos de TMC-3, aqueles com maior renda e nivel educacional apresentaram maiores escores nos dominios fisico e psicologico. Para os casos sugestivos de ansiedade, maior nivel educacional apresentou menores escores nos dominios fisico e relacoes sociais. Conclusao: Entre os pesquisados, o sofrimento psiquico associou-se a menores escores de qualidade de vida, podendo ser influenciado pelas condicoes socioeconomicas. Dessa forma, e importante estruturar uma assistencia centrada no paciente, que tambem deve incluir o contexto social dos pacientes.

Carga de doença no Brasil: um olhar sobre o álcool e a cirrose não viral

Alcohol use/dependence are an important risk factor for cirrhosis of the liver. The article aims to describe and conduct a comparative analysis of Disability Adjusted Life Years (DALY), Years of Life Lost (YLL) and Years Lived with Disability (YLD) of alcohol use disorders and non-viral cirrhosis in Brazil in 2008. DALY was calculated as the sum of YLL and YLD. For YLL estimates, the mean number of deaths from 2007- 2009 in the country was considered. After revision of epidemiological data, prevalence of each disease was modelled with the DisMod tool, which generated incidence data for YLD estimates. Alcohol and non-viral cirrhosis were responsible for 3% and 1% of total DALYs, respectively. In both diseases, men contributed to a greater proportion of DALYs. Among the first ten causes of DALYs, alcohol use disorders occupied the second, third and sixth positions at the ages of 15-29, 30-44 and 45- 59, respectively. Non-viral cirrhosis was the eighth cause of DALY in the 30-44 age group in men; the fifth, in the 45-59 group and the eighth, in the 60-69 group. Age distribution suggests that interventions directed against alcohol use/dependence would have effects on the burden of alcoholic cirrhosis in the country.Alcohol use/dependence are an important risk factor for cirrhosis of the liver. The article aims to describe and conduct a comparative analysis of Disability Adjusted Life Years (DALY), Years of Life Lost (YLL) and Years Lived with Disability (YLD) of alcohol use disorders and non-viral cirrhosis in Brazil in 2008. DALY was calculated as the sum of YLL and YLD. For YLL estimates, the mean number of deaths from 2007- 2009 in the country was considered. After revision of epidemiological data, prevalence of each disease was modelled with the DisMod tool, which generated incidence data for YLD estimates. Alcohol and non-viral cirrhosis were responsible for 3% and 1% of total DALYs, respectively. In both diseases, men contributed to a greater proportion of DALYs. Among the first ten causes of DALYs, alcohol use disorders occupied the second, third and sixth positions at the ages of 15-29, 30-44 and 45- 59, respectively. Non-viral cirrhosis was the eighth cause of DALY in the 30-44 age group in men; the fifth, in the 45-59 group and the eighth, in the 60-69 group. Age distribution suggests that interventions directed against alcohol use/dependence would have effects on the burden of alcoholic cirrhosis in the country.

Qualidade de vida em pacientes da atenção primária do Rio de Janeiro e São Paulo, Brasil: associações com eventos de vida produtores de estresse e saúde mental

Quality of life (QoL) is a subjective construct, which can be negatively associated with factors such as mental disorders and stressful life events (SLEs). This article seeks to identify the association between socioeconomic and demographic variables, common mental disorders, symptoms suggestive of depression and anxiety, SLEs with QoL in patients attended in Primary Care (PC). It is a transversal study, conducted with 1,466 patients attended in PC centers in the cities of São Paulo and Rio de Janeiro in 2009 and 2010. Bivariate analysis was performed using the T-test and four multiple linear regressions for each QoL domain. The scores for the physical, psychological, social relations and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. By means of multivariate analysis, associations of the physical domain were found with health problems and discrimination; of the psychological domain with discrimination; of social relations with financial/structural problems; of external causes and health problems; and of the environment with financial/structural problems, external causes and discrimination. Mental health variables, health problems and financial/structural problems were the factors negatively associated with QoL.Quality of life (QoL) is a subjective construct, which can be negatively associated with factors such as mental disorders and stressful life events (SLEs). This article seeks to identify the association between socioeconomic and demographic variables, common mental disorders, symptoms suggestive of depression and anxiety, SLEs with QoL in patients attended in Primary Care (PC). It is a transversal study, conducted with 1,466 patients attended in PC centers in the cities of Sao Paulo and Rio de Janeiro in 2009 and 2010. Bivariate analysis was performed using the T-test and four multiple linear regressions for each QoL domain. The scores for the physical, psychological, social relations and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. By means of multivariate analysis, associations of the physical domain were found with health problems and discrimination; of the psychological domain with discrimination; of social relations with financial/structural problems; of external causes and health problems; and of the environment with financial/structural problems, external causes and discrimination. Mental health variables, health problems and financial/structural problems were the factors negatively associated with QoL.

Método para estimação de prevalência de hepatites B e C crônicas e cirrose hepática - Brasil, 2008

OBJETIVO:estimar as prevalencias nacionais de hepatites virais cronicas e cirrose hepatica no Brasil em 2008.METODOS:as estimativas das hepatites B e C basearam-se em inquerito nacional, considerando-se casos cronicos todos os HBsAg (antigeno de superficie de hepatite B) positivos e 70% dos anti-HCV (marcador sorologico para hepatite C) positivos; sobre dados do inquerito, estimou-se a prevalencia de cirrose viral; complementarmente, calculou-se a prevalencia da cirrose por alcool.RESULTADOS:as prevalencias nacionais de hepatites B e C cronicas foram de 370/100 mil e 959/100 mil habitantes, respectivamente; a cirrose apresentou prevalencia de 0,35% no pais, com 151/100 mil hab. para hepatite C, 17/100 mil hab. para hepatite B e 182/100 mil hab. para alcool e outras causas.CONCLUSAO:tais prevalencias, embora compativeis com baixa endemicidade, destacam as hepatites virais e a cirrose como relevantes problemas de saude no pais; estudos de base populacional contribuiriam no refinamento das estimativas apresentadas.OBJECTIVE to estimate chronic viral hepatitis and liver cirrhosis prevalence in Brazil, 2008. METHODS: hepatitis B and C prevalence estimates were calculated based on a national survey, considering chronic cases to be all positive HBsAg and 70% of positive anti-HCV. Hepatitis prevalence was used to estimate viral cirrhosis and cirrhosis due to alcohol and other causes were considered complementary to the former. RESULTS: national chronic hepatitis B and C prevalence estimates were 370/100,000 and 959/100,000 inhabitants, respectively. Liver cirrhosis prevalence was 0.35% overall, with the following distribution by causes: 151/100,000 for hepatitis C; 17/100,000 for hepatitis B and 182/100,000 for alcohol and other causes. CONCLUSION: prevalence estimates, although compatible with low endemicity, highlight viral hepatitis and cirrhosis as relevant health problems in the country. Further population-based studies are required in order to obtain better prevalence estimates.

Uso de substâncias psicoativas por futuros educadores

OBJECTIVE: This study aimed at tracing the profile of psychoactive substance (PAS) consumers among university students at the Federal University of Espirito Santo (UFES), Brazil. METHODS: A transversal quantitative study was carried out among Pedagogy University students, registered for the second semester of 2010 at the UFES. The study used an anonymous and closed questionnaire proposed by the National Anti-drug Secretariat (SENAD). RESULTS: Alcohol and tobacco were the most frequently used PAS in life, 62.9 and 23.8%, respectively. According to the multivariate analysis, the use of legal PAS in life was associated to religion, whereas illegal PAS were associated to gender and socioeconomic class. CONCLUSION: Universities are a privileged place for discussion, and they need further approaches to this topic, especially among future educators, since they will deal with this issue in their professional life.

Estudo multicêntrico brasileiro sobre transtornos mentais comuns na atenção primária: prevalência e fatores sociodemográficos relacionados

Problemas de saude mental sao comuns na atencao primaria e sao geralmente relacionados a ansiedade e a depressao. Este estudo tem o objetivo de avaliar a taxa de transtornos mentais comuns e suas associacoes com caracteristicas sociodemograficas em unidades de saude da familia. E um estudo multicentrico, transversal, com os usuarios da atencao primaria do Rio de Janeiro, Sao Paulo, Fortaleza (Ceara) e Porto Alegre (Rio Grande do Sul), Brasil. Utilizou-se o General Health Questionnaire (GHQ-12) e o Hospital Anxiety and Depression Scale (HAD). A taxa de transtornos mentais nos usuarios do Rio de Janeiro, Sao Paulo, Fortaleza e Porto Alegre foram, respectivamente, 51,9%, 53,3%, 64,3% e 57,7%, com diferencas significativas entre Porto Alegre e Fortaleza comparando-se ao Rio de Janeiro. Problemas de saude mental foram especialmente altos em mulheres, desempregados, em pessoas com baixa escolaridade e com baixa renda. Dadas as iniciativas do governo brasileiro para o desenvolvimento os cuidados primarios e para reorganizacao da politica publica de saude mental, e importante considerar os transtornos mentais comuns como uma prioridade tal como outras morbidades cronicas.Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed using the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HAD). The rate of mental disorders in patients from Rio de Janeiro, São Paulo, Fortaleza and Porto Alegre were found to be, respectively, 51.9%, 53.3%, 64.3% and 57.7% with significant differences between Porto Alegre and Fortaleza compared to Rio de Janeiro after adjusting for confounders. Prevalence proportions of mental problems were especially common for females, the unemployed, those with less education and those with lower incomes. In the context of the Brazilian governments moves towards developing primary health care and reorganizing mental health policies it is relevant to consider common mental disorders as a priority alongside other chronic health conditions.