Samuel Goihman

The mental health system in Brazil: Policies and future challenges

BackgroundThe aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population.MethodsThe World Health Organization Assessment Instrument for Mental Health Systems (WHO AIMS) was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a) mental health services; and b) human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a) the Executive Bureau of the Department of Health (Datasus); and b) the National Register of Health Institutions (CNS).ResultsThere are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS). At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents.The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days. In June 2006, there were 848 Community Psychosocial Centers (CAPS) registered in Brazil, a ratio of 0.9 CAPS per 200,000 inhabitants, unequally distributed in the different geographical areas: the Northeast and the North regions having lower figures than the South and Southeast regions.ConclusionThe country has opted for innovative services and programs, such as the expansion of Psychosocial Community Centers and the Return Home program to deinstitutionalize long-stay patients. However, services are unequally distributed across the regions of the country, and the growth of the elderly population, combined with an existing treatment gap is increasing the burden on mental health care. This gap may get even wider if funding does not increase and mental health services are not expanded in the country. There is not yet a good degree of integration between primary care and the mental health teams working at CAPS level, and it is necessary to train professionals to act as mental health planners and as managers. Research on service organization, policy and mental health systems evaluation are strongly recommended in the country. There are no firm data to show the impact of such policies in terms of community service cost-effectiveness and no tangible indicators to assess the results of these policies.

HIV Infection, Syphilis, and Behavioral Risks in Brazilian Male Sex Workers

To describe the epidemiology of HIV and syphilis infection and sexual practices among male sex workers, we studied 434 transvestites and 96 “hustlers” recruited by peers in the metropolitan area of São Paulo, Brazil, from 1992 to 1998. Participants were young adults with low education levels who had recently immigrated to São Paulo and supported themselves primarily through sex work. The prevalence of HIV infection among transvestites and hustlers was 40% and 22% respectively, and the prevalence of current or past syphilis was 43% and 27%, respectively. Infection was associated more with gender performance and duration of sex work than to recent unsafe sexual practices or recent condom use. As opposed to hustlers, whose clients came primarily from São Paulo and were homosexual, transvestites were more likely to have foreign and heterosexual clients. HIV and syphilis among sex workers are urgent public health problems that require continuous prevention programs for male sex workers and their clients.

Prognosis related to staging systems for chronic lymphocytic leukemia

CONTEXT Chronic lymphocytic leukemia (CLL) is a clonal lymphoproliferative disorder, characterized by B lymphocytic proliferation. CLL is the most frequent adult leukemia in Western countries, accounting for 25 to 30% of all white leukemic patients. OBJECTIVE To evaluate clinical and staging characteristics in prognosis of chronic lymphocytic leukemia. DESIGN Evaluation of clinical-staging data. SETTING Universidade Federal de São Paulo - Escola Paulista de Medicina / Universidade de Alfenas. SAMPLE 73 patients diagnosed from 1977 to 1994. MAIN MEASUREMENTS Sex, ethnic origin, age, lymphadenopathy, splenomegaly, hepatomegaly, three or more areas of lymphoid enlargement, hemoglobin (g/dl), lymphocytes/mm3, Platelets/mm3 RESULTS Mean survival of patients was 76 months, median age was 65 years, ranging from 33 to 87. Forty-four patients (60.3%) were male and 29 (39.7%) female. CONCLUSION The Binet system determined a better prognosis than Rai.

Graduação médica e especialização: uma incompatibilidade aparente

PURPOSE. Partial results of a continuous evaluation process of the undergraduate medical course at Escola Paulista de Medicina (EPM) started in 1989 are presented. METHODS. A survey on expectations and opinions about the medical course of EPM was carried out among faculty members, students and alumni. RESULTS. The authors call into question that the medical formation is non-terminal as indicated by the late entry to labor market. CONCLUSION. The authors consider that the phenomenon is not related to quality aspects but to the specialization process started during the medical course and completed only with graduated studies.

Building a Place for Counseling of Male Street Sex Workers in a Public Health Service: Sao Paulo, Brazil

There is no doubt that social life imposes limitations on individuals, and normative structures are developed to guide individuals toward well known objectives culturally determined. Although such structure determines a social rhythm, disorders may eventually happen.