Veralice Maria Gonçalves

A falácia da adequação da cobertura dos Centros de Atenção Psicossocial no estado do Rio Grande do Sul

Introduction: Analysis of the results of the ongoing expansion of the Brazilian public mental health care network has used the indicator of coverage offered by Psychosocial Care Centers (Centros de Atencao Psicossocial, CAPS), which considers the rate of one CAPS per 100,000 inhabitants to be adequate, as its outcome measure. The state of Rio Grande do Sul ranks third in nationwide CAPS coverage standings, with 0.7 centers per 100,000 inhabitants. The present study sought to assess the variability of coverage in different regions in order to verify the representativeness of the overall coverage rate. Method: We used data collected from the National Database of Health Facilities (Cadastro Nacional de Estabelecimentos de Saude, CNES) and 2009 population data made available at the website of the Ministry of Health Department of Information Technology. We calculated 19 coverage indicators, one for each health region, and computed a coverage rate based on the ratio between the actual indicator and the expected indicator according to the population of each region. Results: Analysis of the variability of coverage for each region showed that seven regions had inadequate coverage, with 49% of the state population receiving inadequate coverage. Conclusion: This study showed that the use of an overall rate for mental health care coverage can be considered a fallacy, as it fails to represent regional realities; roughly half of the regions with excessive coverage masked the regions with poor coverage. This finding suggests that analysis of care coverage must be broken down into geographic areas, in order to identify regional needs and provide support for equal expansion of the community mental health care network for users living in different geographic areas.

Factors associated with recurrence of alcohol-related traffic violations in southern Brazil

OBJECTIVE To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil. METHOD This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level. RESULTS A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for ≥ 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08). CONCLUSIONS In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated.

Following Up Crack Users after Hospital Discharge Using Record Linkage Methodology: An Alternative to Find Hidden Populations.

This paper presents the probabilistic record linkage (PRL) methodology as an alternative way to find or follow up hard-to-reach population as crack users. PRL was based on secondary data from public health information systems and the strategy used from standardization; phonetic encoding and the rounds of matching data were described. A total of 293 patient records from medical database and two administrative datasets obtained from Ministry of Health Information Systems were used. Patient information from the medical database was the identifiers to the administrative datasets containing data on outpatient treatment and hospital admissions. 40% of patient records were found in the hospital database and 12% were found in the outpatient database; 95% of the patients were hospitalized up to 5 times, and only 10 out of them had outpatient information. The record linkage methodology by linking government databases may help to address research questions about the path of patients in the care network without spending time and financial resources with primary data collection.

Unequal Advances in the Coverage of Psychosocial Care Centers in Rio Grande do Sul, Brazil, From 2009 to 2010

The Centers for Psychosocial Care (CAPS) are mental health services and community open the Unified Health System (SUS). With the advancement of public mental health in the reorientation of a care model that for decades was reduced to the supply of beds in psychiatric hospitals, generating segregation and exclusion of patients with mental disorders. Considering Ordinance of the Ministry of Health GM/MS No. 336 of February 19, 2002, laying down the rules and guidelines for the organization of services that provide mental health care. This objective of this study was to determine whether there was an increase in the coverage of CAPS in the state of Rio Grande do Sul, Brazil, from 2009 to 2010.

Confirmatory factor analysis (CFA) of the Crack Use Relapse Scale (CURS)

Background When it comes to crack/drug use, relapse is a relatively common event in the first weeks after the end of treatment. However little is known about what happens to patients who relapse after discharge. Objective To report the confirmatory factor analysis (CFA) of the Crack Use Relapse Scale (CURS) in an inpatient population. Methods A five-point Likert scale with 25 items and, initially, 9 theoretical factors was generated and utilized in a cross-sectional study with a sample of 333 hospitalized male crack users. Results CFA indicated a well-fitting model for the CURS. Discussion The CFA shows that the CURS model is appropriate and well-fitting for assessment of latent variables common to psychiatric and psychological constructs – in this case, relapse of crack cocaine use after inpatient treatment.

High rates of relapse in adolescents crack users after inpatient clinic discharge

Objetivo O objetivo do presente estudo foi avaliar 88 adolescentes usuarios de crack no que se refere a hospitalizacao e dar-lhes seguimento apos a alta, para investigar as recaidas e os fatores associados ao tratamento. Metodos Coorte (30 e 90 dias apos a alta) de um hospital psiquiatrico e uma clinica de reabilitacao, para o tratamento de dependencia quimica em Porto Alegre, entre 2011 e 2012. Instrumentos: entrevista semiestruturada, realizada para avaliar o perfil sociodemografico da amostra e descrever o padrao de uso de substâncias psicoativas; Escala de Recaida dos Usuarios de Crack/ERUC; Questionario de Seguimento de Usuarios de Crack/QSUC; K-SADS-PL. Resultados No primeiro periodo de seguimento (30 dias apos a alta), 65,9% dos participantes recairam. No segundo periodo de seguimento (90 dias apos a alta), 86,4% dos participantes tiveram recairam. Conclusao Este e um dos primeiros estudos que mostram a prevalencia extremamente alta de recaida precoce em adolescentes usuarios de crack apos a alta, questionando o custo-beneficio do tratamento em regime de internacao para essa populacao. Alem disso, esses resultados corroboram estudos que sugerem que usuarios de psicoestimulantes jovens podem precisar de um adaptado Tratamento Ambulatorial Intensivo, com manejo de contingencias e outras estrategias comportamentais, a fim de aumentar a adesao, reduzir o uso da droga ou recaida ao crime. No entanto, essa modalidade terapeutica especifica ainda e escassa e deve ser desenvolvida no Brasil.

Vulnerable users' deaths in Brazilian road safety 10 cities (RS-10)

Background In Brazil since 2006, deaths among Vulnerable Road Users (VRU) have made up more than half of all traffic-related deaths, with 51.1% of all deaths in 2010 occurring among motorcyclists, pedestrians, and bicyclists. We investigated mortality rates among motorcyclists and pedestrians in five state capitals targeted by a global road safety initiative. Objective To evaluate road traffic fatalities among VRU in five Brazilian cities from 2000 to 2010, describing demographic trends among victims. Methods Mortality data were obtained from the Ministry of Health, compiled using ICD-10 codes (V01–V89), subcategorised by VRU type and disaggregated by gender, age, and city. Results The five cities represent 18.4% of total deaths occurred in capitals from 2000 to 2010. Mortality rates varied from 25.0 per 100 000 (Belo Horizonte) to 42 (Palmas), all above the national rate (21.5). Motorcyclist deaths increased by 288.4%, while pedestrian deaths fell by 5.6% over the decade. The highest pedestrian death rate was observed in Belo Horizonte (9.7/100 000, 39.8% cars/fleet, Gross National Product-GDP US

Challenges associated with drink driving measurement: combining police and self-reported data to estimate an accurate prevalence in Brazil

9679). The highest rate of deaths among motorcyclists occurred in Palmas (13.9 deaths/100 000, 13% motorcycles/fleet, GDP US

Shortage and underutilization of psychiatric beds in southern Brazil: independent data of Brazilian mental health reform

8364). Disaggregated by age, VRUs between 61 and 80 died at the highest rates. Contribution to the Field Given high proportion of road traffic fatalities that occur among VRU, policy implications can be gleaned from the results. Brazils transit authorities vary from between states, so analysis of the burden of VRU deaths between capitals can be helpful in targeting interventions towards appropriate risk groups.