Mário Sérgio Ribeiro

Implantação de rotinas de rastreamento do uso de risco de álcool e de uma intervenção breve na atenção primária à saúde: dificuldades a serem superadas

The variety of problems related to the so-called hazardous patterns of alcohol use make the latter a prominent public health concern. Screening instruments associated with brief interventions in primary care provide one of the frequently recommended secondary prevention strategies. The objective of this study was to assess the implementation of this strategy as a routine practice in primary health care services in the city of Juiz de Fora, Minas Gerais State, Brazil. A qualitative design was employed, including the application of semi-structured interviews for managers and health care professionals in the citys public health system, in addition to content analysis and participant observation. Results point to difficulties in the effective implementation of such routines both by managers and health care professionals. Health care professionals limit the approach to alcohol-dependent patients and demonstrate lack of motivation for preventive work. Health services managers experience difficulties in the organization and administration of such instruments, despite affirming their interest in the project.

Fatores associados ao abandono de tratamento em saúde mental em uma unidade de nível secundário do Sistema Municipal de Saúde

A ocorrencia de abandono de tratamento psiquiatrico de nivel secundario e uma relevante questao clinica e economica. Taxas de abandono em psiquiatria sao mais altas que em outras especialidades medicas. Estudos publicados nos ultimos 15 anos tem identificado diversos fatores estatisticamente associados ao nao-comparecimento as consultas e/ou ao abandono de tratamento em saude mental. OBJETIVO: Avaliar variaveis demograficas, psicopatologicas, de diagnostico e tratamento enquanto possiveis preditores de abandono de tratamento em servico especializado de saude mental. METODO: Estudo observacional, avaliando 896 pacientes encaminhados, no periodo de abril de 2004 a marco de 2006, por Unidades Basicas de Saude da area de abrangencia do servico especializado. RESULTADOS: Pacientes solteiros, com idade abaixo da media do grupo (39,2 anos) e desempregados abandonaram significantemente mais o tratamento. Duas variaveis relativas ao exame psicopatologico se associaram significantemente com abandono de tratamento (memoria quanto ao passado recente e relacao do humor com fatos reais, atuais). Pacientes adultos que receberam diagnostico psiquiatrico de oligofrenia abandonaram significantemente menos e pacientes com diagnostico relativo aos transtornos da infância e adolescencia (F80-F98 da CID-10) tambem abandonaram significantemente mais o tratamento. O registro de comorbidade psiquiatrica e tratamento exclusivamente farmacologico se associaram a nao abandono do tratamento. CONCLUSAO: Os resultados confirmam achados de diferentes autores da evidencia de caracteristicas associadas a abandono ao tratamento. Tais achados sugerem que determinados subgrupos de pacientes necessitem de abordagens customizadas, a fim de influenciar positivamente sua adesao final ao tratamento indicado.

Comparação da assistência em saúde mental em unidades básicas de saúde com ou sem equipe do Programa de Saúde da Família

INTRODUCAO: O objetivo deste estudo foi comparar o perfil de assistencia em saude mental realizado por unidade basica de saude (UBS) com equipe de Programa de Saude da Familia (PSF) e sem equipe de PSF. METODO: Estudo observacional, avaliando pacientes encaminhados por UBS da area de abrangencia de um servico especializado de saude mental no periodo de abril de 2003 a marco de 2006. RESULTADOS: A UBS com equipe de PSF apresentou melhor padrao global de registros de dados, maior responsabilidade exclusiva do medico em suas referencias ao nivel especializado (p = 0,000), menor capacidade de retencao dos usuarios na UBS (p = 0,099), maiores taxas de abandono de tratamento em nivel secundario (p = 0,060) e menor percentual de contrarreferencia pela equipe especializada (p = 0,028). A taxa de concordância diagnostica global foi semelhante entre os dois modelos de UBS, com razoavel nivel de concordância (indice kappa de 44,5 e 43,0%, respectivamente, para UBS com e sem equipe PSF). CONCLUSAO: A UBS com equipe de PSF nao apresentou resultados compativeis com o que seria de se esperar, em funcao de sua hipotetica melhor qualidade de estrutura.

Avaliação dos Tipos 1 e 2 de alcoolismo de Cloninger em homens participantes de um programa de tratamento ambulatorial

CONTEXTO: A classificacao Tipo 1/Tipo 2 de Cloninger e uma das mais estudadas tipologias de alcoolismo. OBJETIVOS: Testar a aplicabilidade dessa tipologia, caracterizar os subtipos identificados e avaliar seu comportamento ante um programa terapeutico. METODOS: Partindo das variaveis descritas por Cloninger et al., 16 caracteristicas de 308 homens alcoolistas tratados ambulatorialmente foram submetidas a analise de cluster para identificacao de dois subgrupos (clusters). Posteriormente, efetivaram-se cruzamentos de dados para testar possivel associacao dos clusters identificados com variaveis demograficas e clinicas. RESULTADOS: Pacientes do cluster 1 foram caracterizados por inicio mais tardio dos problemas relacionados ao alcool, menos problemas sociais e maior sentimento de culpa em relacao a seu consumo. O cluster 2 incluiu pacientes com historia familiar de alcoolismo mais evidente, caracteristicas anti-sociais mais presentes, mais uso disfuncional de outras substâncias psicoativas e piores niveis de adesao ao tratamento. CONCLUSOES: Os resultados evidenciaram a diferenciada associacao dos clusters a variaveis de tratamento e prognostico; em sua maior parte foram coerentes com a classificacao Tipo 1/Tipo 2 e reforcam a tese de que o simples diagnostico de dependencia ao alcool nao e suficiente para atender as necessidades terapeuticas de subgrupos especificos de pacientes.

Psychometric evaluation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among Brazilian young adults.

The objective was evaluating the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) among Brazilian young adults of both genders. The sample was composed by 506 undergraduate students (295 females and 211 males), aged between 17 and 29 years old. Exploratory and confirmatory factor analyses were used for construct validity (N = 506). Correlations between the SATAQ-3 scores and those of the Tripartite Influence Scale (TIS) and Body Shape Questionnaire (BSQ) were used for convergent validity. Reliability was assessed through internal consistency (α) and reproducibility (test-retest) through comparison of the means obtained at two different time points and through intra-class correlation. The scale presented a factor structure composed of five factors, replicated in the confirmatory factor analysis with satisfactory values for the measurements of adjustment to the model. Correlations with the BSQ and TIS scores were rho = .52 and rho = -.35, respectively. Cronbachs alpha coefficients were satisfactory, and their stability was demonstrated. Brazilian SATAQ-3 had good validity and reproducibility, being indicated for use in samples of Brazilian youths.

Fatores associados à adesão a um programa de tratamento de alcoolistas

Objective: The evaluation of adherence to treatment has been considered an objective and versatile alternative to alcoholism treatment result assessment. The purpose of this study is to identify factors associated with adherence to an outpatient alcoholism treatment program. Method: This study included 300 alcoholic patients that concluded the program assessment stage. Crosstabs were performed to verify the association of adherence to treatment on all other (more than 1,000) variables in the data bank. Statistical significance was given by Pearson’s Quisquare test (p < 0.1). Results: Among variables with a positive association to adherence were:

Oscilação do humor em pacientes com doença de Crohn: incidência e fatores associados

OBJECTIVE: To assess the incidence of mood swings (MS) and possible associated factors in patients with Crohns disease (CD). METHODS: Prospective longitudinal study of 50 patients (60% females; mean age 40.6 years) with a diagnosis of CD over a 16-month follow-up. Clinical activity was assessed by the CD activity index. Psychological status self-report tools (Beck Depression Inventory and the anxiety subscale of the Hospital Anxiety and Depression Scale) were used for mood disorder diagnosis. The tools were applied at baseline and at four-month intervals thereafter. RESULTS: The inflammatory phenotype was the most common (86%); 36% had a previous history of surgery related to CD; 82% were in clinical remission at baseline. MS occurred in 58% of patients; 28% had progression of depression and/or anxiety symptoms from baseline normal mood, and 30% had baseline depressive and/or anxious mood normalized. In 38% of patients with MS, no change in the disease clinical activity could be found (p = 0.015), whereas 20% had a change in CD activity. Female gender and absence of previous surgery related to CD complications were associated with higher MS incidence (p = 0.04 for both). CONCLUSION: In this study, a high MS incidence (58%) was found in patients with CD. Female gender and absence of previous surgery from CD complications were associated with a higher MS incidence. Periodic psychological assessment could be useful to detect and approach MS in patients with CD.

Análise comparativa do registro médico-pericial do diagnóstico de transtornos mentais de segurados do Instituto Nacional do Seguro Social requerentes de auxílio-doença

OBJECTIVES: Comparative analysis of the expertise recordings of diagnoses of the secured citizens of the Brazilian National Institute of Social Security (INSS) requiring sickness benefit and presenting mental disorders. METHOD: Retrospective study of the recordings of initial expertise examinations performed in the INSS offices in Juiz de Fora, MG, Brazil, between July/2004 and December/2006. Bivariate analyses according to the site where the expertise examination was conducted, category of the medical examiner and period of assessment were undertaken. RESULTS: Mild or moderate depressive disorders and persistent mood disorders (39.6%) and anxiety disorders (34.5%) - milder conditions that would not impair labor ability - were the most frequently recorded diagnoses. Among comorbidities, mental disorders were more frequent (33.6%) than clinical ones, especially at the Riachuelo office, involving examiners admitted after 2005 and during the fourth period studied. Concordance rates between the present diagnosis and the previous one were low, lower than 50% in most cases, even for severe mental disorders with better defined clinical characteristics, such as psychoses. Higher concordance rates were seen for disorders due to the use of psychoactive substances and certified expertise examiners (66.7%). CONCLUSION: This study shows possible failures in the training of Juiz de Fora expertise examiners about the recording of the diagnoses of mental disorders of the secured citizens assessed.

Aplicabilidade da classificação de alcoolismo tipo A/tipo B

OBJETIVOS: Avaliar a aplicabilidade da tipologia e caracterizar os subtipos identificados. METODOS: Caracteristicas de 300 homens alcoolistas atendidos em um programa ambulatorial foram submetidas a analise de cluster para separa-los em dois subgrupos de acordo com a tipologia de Babor et al. Efetivaram-se cruzamentos de dados (significância avaliada pelo Teste do qui-quadrado de Pearson) para se verificar a associacao dos clusters com variaveis clinicas e demograficas. RESULTADOS: Comparado ao outro grupo e pacientes, um dos clusters identificados foi caracterizado por um perfil de maior gravidade clinica. Pacientes do subtipo menos grave foram mais frequentemente (65,3%) encaminhados a tratamentos simbolicos, enquanto pacientes do subtipo mais grave foram atendidos predominantemente (58,5%) por abordagem exclusivamente farmacologica e aderiram mais ao tratamento proposto. CONCLUSOES: Como os resultados identificaram subtipos de alcoolistas com distintas caracteristicas, este estudo evidenciou a aplicabilidade clinica da tipologia de Babor et al. em nosso meio sociocultural1. Tambem aponta para a relevância de estudos tipologicos que possam contribuir para uma mais ampla compreensao dos aspectos etiologicos, preventivos e terapeuticos do alcoolismo.

A experiência do adoecer: uma discussão sobre saúde, doença e valores

Starting from a discussion of the concept of health and disease, it is clear that one of the current approaches includes the perception of the subject in relation to his/her condition. But the hegemony of the clinical method fails to consider such individuality, leading some professionals to discuss the changing needs of the medical approach. By discussing this case in question, it becomes clear that the doctor-patient relationship directly or indirectly influences the satisfaction and health of the patient, as well as the quality of the health services. Effective care requires a careful eye to the patients real needs and respect for their opinions about the illness, their perceptions and culture. Person-Centered Medicine is a clinical method that proposes a medical approach that enables comprehensive, humanistic care and respect for the autonomy of individuals.