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OBJECTIVE: To assess the loss to follow-up after emergency care and during 6-months of outpatient follow-up, and the associated variables, among adolescent sexual violence survivors. METHODS: This is a retrospective study with review of the medical records of 521 females, aged 10 to 18 years, who received emergency care in a referral service in São Paulo, Brazil. The variables were sociodemographic; personal history; characteristics of abuse, disclosure, and reactions triggered after abuse (physical and mental disorders as well as social changes), psychotropic prescription needs, and moment of abandonment: after emergency care and before completing 6 months of outpatient follow-up. To compare groups of patients lost to follow-up at each time point, we used the Chi-square and Fisher exact tests followed by multiple logistic regression with stepwise criterion for selection of associated variables. We calculated the odds ratio with confidence interval (OR, CI 95%). The level of significance adopted was 5%. RESULTS: A total of 249/521 (47.7%) adolescents discontinued follow-up, 184 (35.3%) after emergency care and 65 (12.4%) before completing outpatient follow-up. The variables of living with a partner (OR = 5.94 [CI 95%; 2.49-14.20]); not having a religion (OR = 2.38 [CI 95%;1.29-4.38)]), having a Catholic religion [OR = 2.11 (CI 95%; 1.17-3.78)]; and not disclosing the abuse [OR = 2.07 (CI 95%; 1.25-3.44)] were associated with loss to follow-up after emergency care. Not needing mental disorder care (OR = 2.72 [CI 95%; 1.36-5.46]) or social support (OR = 2.33 [CI 95%; 1.09-4.99]) were directly associated with loss to outpatient follow-up. CONCLUSION: Measures to improve adherence to follow-up should be aimed at adolescents who live with a partner and those who do not tell anyone about the violence.
OBJETIVOS: Avaliar a perda de seguimento de adolescentes vítimas de violência sexual após o atendimento de emergência, durante o seguimento ambulatorial e as variáveis associadas. MéTODOS: Estudo retrospectivo com a revisão de prontuários de 521 mulheres de 10 a 18 anos, que buscaram atendimento de emergência em um serviço de referência em São Paulo, Brasil. As variáveis foram sociodemográficas; antecedentes pessoais; características do abuso, atitude de revelação e reações desencadeadas após o abuso (distúrbios físicos, mentais e mudanças sociais), necessidades de prescrição de psicotrópicos e momento do abandono: após atendimento de emergência e antes de completar 6 meses de seguimento ambulatorial. Para comparar os grupos de perda de seguimento em cada momento, foram utilizados os testes do qui-quadrado e exato de Fisher, seguidos de regressão logística múltipla com critério stepwise para seleção das variáveis associadas. Calculamos a razão de probabilidade com intervalo de confiança (RP, IC 95%). O nível de significância adotado foi de 5%. RESULTADOS: Um total de 249 (47,7%) das adolescentes descontinuaram o acompanhamento, 184 (35.3%) após o atendimento de emergência e 65 (12.4%) antes de completar o seguimento ambulatorial. As variáveis de viver com companheiro [RP = 5,94 (IC 95%; 2,4914,20]; não ter religião [RP = 2,38 (IC 95%;1,294,38)], ter religião católica [RP = 2,11 (IC 95%; 1,173,78)] e não revelar o abuso [RP = 2,07 (IC 95%; 1,253,44)] foram associadas à perda de seguimento após o atendimento de emergência. Não necessitar de cuidados de saúde mental (RP = 2,72 [IC 95%; 1,365,46]) ou apoio social (RP = 2,33 [IC 95%; 1,094,99]) foram as variáveis associadas à perda do seguimento ambulatorial. CONCLUSãO: Medidas para melhorar a adesão ao seguimento devem ser direcionadas às adolescentes que vivem com parceiro e às que não revelam a violência sofrida.
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Serviços Médicos de Emergência , Delitos Sexuais , Humanos , Adolescente , Feminino , Estudos Retrospectivos , Pacientes Ambulatoriais , Seguimentos , BrasilRESUMO
OBJECTIVE: To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided. METHODS: A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%. RESULTS: The early group (n = 242) contained more adolescents who were enrolled in school (p < 0.001), suffered more daytime aggressions (p = 0.031), in their residences (p < 0.001), by an aggressor with whom they were acquainted (p < 0.001), had greater need of legal protection (p = 0.001), and took longer to seek care (p = 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n = 279), there was greater consumption of alcohol during the aggression (p = 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p = 0.033), sleep disorders (p = 0.003), symptoms of anxiety (p = 0.045), and feelings of anguish (p = 0.011); and had more prescriptions of psychotropics (p = 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups. CONCLUSION: The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.
OBJETIVO: Comparar a violência sexual sofrida por vítimas no início e no final da adolescência, as reações desencadeadas após a agressão, e o cuidado de saúde dispensado. MéTODOS: Estudo retrospectivo, em que foram revisados os prontuários de 521 mulheres adolescentes atendidas por equipe multiprofissional em hospital de referência em Campinas, São Paulo, Brasil. As variáveis foram sociodemográficas, e aquelas relativas às características da violência, ao atendimento de emergência, e às reações físicas e psicológicas observadas durante o seguimento nos grupos de adolescentes de idade precoce (10a 14 anos) e tardia (15 a 18 anos). Utilizamos os testes do Qui-quadrado/Exato de Fisher, Mann-Whitney e Kruskal-Wallis para comparar os grupos; adotamos o nível de significância de 5%. RESULTADOS: O grupo precoce (n = 242) continha maior número de estudantes (p < 0,001), que sofreram mais agressões diurnas (p = 0,031), em suas residências (p < 0,001), por agressor conhecido (p < 0,001), tiveram maior necessidade de proteção legal (p = 0,001), e demoraram mais a procurar atendimento (p = 0,048). Sentimentos de culpa, vergonha e a percepção da violência foram similares entre os grupos. No grupo tardio (n = 279) houve maior consumo de álcool durante a agressão (p = 0,005); as adolescentes receberam significativamente mais tratamentos de profilaxia; relataram mais sintomas físicos (p = 0,033), distúrbios do sono (p = 0,003), sintomas de ansiedade (p = 0,045), e sentimentos de angústia (p = 0,011); e receberam mais prescrições de psicotrópicos (p = 0,005). Apenas 52% completaram o seguimento de 6 meses, sem diferenças entre os grupos. CONCLUSãO: Os grupos apresentaram diferenças nas características da violência; as adolescentes precoces chegaram mais tardiamente ao serviço, e o grupo tardio apresentou maior sintomatologia e piora psicológica no seguimento. São necessárias medidas de prevenção e cuidados específicos voltados a essa população.
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Delitos Sexuais , Adolescente , Ansiedade , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Estudos RetrospectivosRESUMO
We aimed to assess the factors associated with frequent sadness and nervousness in Brazilian adolescents, during the Covid-19 pandemic, in 9470 adolescents (aged 12-17 years), interviewed from June 27 to September 17, 2020. Prevalences and prevalence ratios were estimated according to socio-demographic variables and factors related to family, school, friends, and health. Brazilian adolescents often felt sad (32.4%) and nervous (48.7%). Higher prevalences of these feelings were related to: being female; aged 15-17 year; from families with financial difficulties; having learned little or nothing with remote education; missing friends; having few friends; family disagreements; having regular/bad health before the pandemic; and worsened health and sleep during the pandemic. Higher prevalence of nervousness was also found in adolescents who worked before the pandemic and those who reported lack of concentration and not knowing if they had COVID-19. Sadness and nervousness in Brazilian adolescents is high and the need for action by the government, schools, health services, and parents to mitigate the impact of the pandemic on the physical and mental health of adolescents. Special attention must be paid to adolescents with previous health problems and those belonging to the most socially vulnerable population.
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OBJECTIVE: To analyze the association of depression with various health behaviors and to verify if they differ according to gender or income. METHODS: This is a cross-sectional study based on data of 65,803 Brazilian adults (18-59 years old) interviewed in the National Health Survey, conducted in 2019. Presence or absence of depression was evaluated using the Patient Health Questionnaire (PHQ)-9. The prevalence of smoking, alcohol consumption, physical activity, sedentary lifestyle and food indicators were estimated according to the presence of depression. Stratified analyses were made according to sex and income, and prevalence ratios were estimated using the Poisson Regression. RESULTS: We found a significant association between depression and all indicators studied, except occasional alcohol consumption. Depression was associated with heavy episodic drinking and insufficient consumption of fruits and vegetables only in women. In men, the associations of depression with sedentary lifestyle and with being a former smoker were stronger than in women. The occasional consumption of alcohol was more prevalent only in men without depression. The analysis stratified by income showed that the association of depression with physical inactivity is stronger in the higher-income group, while with heavy episodic drinking is only significant in the lower-income stratum. CONCLUSION: The results point to the need to consider mental health in programs aimed at reducing harmful health behaviors and the specificity of sociodemographic groups.
Assuntos
Depressão , Comportamentos Relacionados com a Saúde , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: To determine prevalence rates and identify patient characteristics associated with depression, alcohol use disorders and nicotine dependence among individuals admitted to a general teaching hospital. METHOD: Using the Hospital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test, we assessed 4,352 consecutive medical and surgical patients admitted over a 13-month period. The patients were also asked to report their daily cigarette smoking habits during the last month. Multiple logistic regression analyses were performed, and odds ratios (ORs) were calculated. RESULTS: The mean age of the sample was 49.3 years, and 56.6% were male. Prevalence rates of depression, alcohol use disorders and nicotine dependence were, respectively, 14%, 9.8% and 16.9%. In the multivariate analysis, depression was associated with previous suicide attempts (OR = 8.7), lower level of education (OR = 3.6), prior use of psychotropic medications (OR = 3.1), cancer (OR = 1.7) and pain (OR = 1.7). Alcohol use disorders were associated with male sex (OR = 6.3), smoking (OR = 3.5), admission for an external cause of injury, such as a traffic accident (OR = 2.4), and previous suicide attempts (OR = 2.3). Nicotine dependence was associated with alcohol use disorders (OR = 3.4), young adulthood (OR = 2.3), widowhood (OR = 2.2) and previous suicide attempts (OR = 1.8). CONCLUSION: This is the largest sample of medical and surgical patients ever surveyed with standardized screening instruments in a general hospital in Brazil. The high prevalence rates of psychiatric disorders and the profiles of the patients evaluated in this study underscore the need to develop methods that are more effective for detecting and managing such disorders. Hospital admission should be considered a major opportunity for the detection of psychiatric disorders and the subsequent implementation of the appropriate specific treatment strategies.
Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Depressão/epidemiologia , Tabagismo/epidemiologia , Adulto , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Adulto JovemRESUMO
OBJECTIVE: To determine prevalence rates of depression and suicidal behavior among cancer inpatients and factors associated with these conditions. METHODS: A total of 5357 patients consecutively admitted to a university hospital were assessed by means of the Hospital Anxiety and Depression Scale (HAD) and the suicide risk section of the Mini International Neuropsychiatric Interview (MINI). Univariate analyses adjusted for gender and age groups were performed with depression and suicide risk as dependent variables. RESULTS: Of those assessed, 675 had cancer. The prevalence rates for depression and suicide risk were 18.3% (95%CI = 15.4 - 21.4) and 4.7% (95%CI = 3.2 - 6.7) respectively. Depression was more frequently found in cancer bearers than in the other inpatients (13.2%; p = 0.0009). Female gender, low schooling level, long time of disease, pain, use of psychotropic drugs and suicide risk were associated with depression (p < 0.05). Pain and depression were associated with suicide risk. CONCLUSION: Because prevalence rates of depression and suicide risk are high among cancer inpatients, simple screening instruments and specific questions during interviews are needed to detect these clinical conditions.
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Transtorno Depressivo/psicologia , Neoplasias/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Tentativa de Suicídio/psicologia , Adulto JovemRESUMO
OBJECTIVE: To analyze the frequency of sadness, nervousness, and sleep disorders during the COVID-19 pandemic in Brazil, identifying the most affected demographic segments. METHODS: This was a cross-sectional study using an online questionnaire answered by adults and elderly people to collect information on living conditions, health and health-related behaviors. Prevalence rates and prevalence ratios adjusted for age and sex were estimated. RESULTS: The data on 45,161 Brazilian respondents showed that during the pandemic 40.4% (95%CI 39.0;41.8) frequently felt sad or depressed and 52.6% (95%CI 51.2;54.1) frequently felt anxious or nervous; 43.5% (95%CI 41.8;45.3) reported the onset of sleep problems and 48.0% (95%CI 45.6;50.5) had a prior sleep problem that had become worse. Frequent sadness and nervousness, as well as change in sleep patterns were higher in young adults, women and those with a history of depression. CONCLUSION: The high prevalence found indicates the need to guarantee the provision of services for mental health and quality of sleep that are adapted to the pandemic context.
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Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/psicologia , Depressão/epidemiologia , Pneumonia Viral/psicologia , Tristeza , Transtornos do Sono-Vigília/epidemiologia , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , COVID-19 , Intervalos de Confiança , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , SARS-CoV-2 , Adulto JovemRESUMO
OBJECTIVE: To evaluate the smokers' profile, immediate results and outcome after 25 months of treatment at a university public service. METHODS: One hundred and seventy one smokers were evaluated for treatment in the Therapeutic Group (TG) of the Service of Psychoactive Substances. We evaluated sociodemographic variables, history of smoking, presence of medical comorbidity and psychiatric symptoms, initial and late outcomes (median 25 months), by telephone contact. Frequency analysis and multiple logistic regression analysis were used, with a significance level of 5% for associated factors. RESULTS: Most patients were female (73.4%), married (48%), had basic education (74.6%), were working (57%); 65.2% started to smoke before the age of 15, 63.8% smoked for more than thirty years, 76% already had tried to stop smoking, 46.2% had severe dependence, 72.1% had medical comorbidity and 36% presented psychiatric symptoms. The service was sought by 51%, mainly concerned with health. During treatment, 79.1% stopped smoking. After 25 months, 62% remained abstinent. The variable associated with failure of smoking cessation was the presence of psychiatric symptoms. Variables related to relapse were psychiatric symptoms and lesser attendance at Motivation Group sessions. There was an association between clinical comorbidity and years of smoking and years of inactivity CONCLUSION: This study reinforces the importance of understanding the profile of the subjects to evaluate strategies employed and adequacy of treatment proposed for smokers to improve the rates of smoking cessation and reduce rates of relapse.
Assuntos
Psicoterapia de Grupo , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Abandono do Hábito de Fumar/psicologia , Fatores Socioeconômicos , Fatores de Tempo , Resultado do TratamentoRESUMO
Guidelines emphasize the importance of approaching substance use by adolescents, particularly in primary health care. However, there are problems with its incorporation. The objective of this study was to present the training stages on the theme for professionals in primary health care. Researchers conducted logistic structuring, content elaboration and evaluation of difficulties before and after training. Sixty percent of professionals involved in the care of adolescents in a medium-sized city participated in the study. More than half of them stated having difficulties in the approach, mainly theoretical limitations and short consultations. After the training, the professionals informed whether they felt more prepared, but practical difficulties remained.
Assuntos
Educação Continuada , Atenção Primária à Saúde/organização & administração , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente , Adulto , Brasil , Usuários de Drogas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Prevenção Primária/métodosRESUMO
The study evaluated the results of a smoking cessation training program including 40 public health providers from November 2004 to March 2007. A total of 3,419 smokers received minimum individual intervention and 982 had group intervention. Of all, 9.2% quit smoking. The main difficulties for smoking cessation reported by health providers were: low patient compliance (11%); lack of medications (38%); and lack of health unit infrastructure/support (29%). The training allowed to reaching out a larger population through smoking cessation approaches at health units.
Assuntos
Capacitação em Serviço/métodos , Recursos Humanos em Hospital/educação , Abandono do Hábito de Fumar/métodos , Hospitais Universitários , Humanos , Avaliação de Programas e Projetos de Saúde , Setor Público , Abandono do Hábito de Fumar/estatística & dados numéricosRESUMO
CONTEXT AND OBJECTIVE: Client characterization is an important step in evaluating the services offered by campus counseling and mental health centers and in their further planning and development. The objectives here were to describe reported complaints and demographics among students who sought counseling/mental healthcare at a Brazilian campus mental health service over a 17-year period and to compare these characteristics with those of the general university student body. DESIGN AND SETTING: Retrospective study at the Psychological and Psychiatric Service for Students (SAPPE), Universidade Estadual de Campinas (Unicamp). METHODS: The participants were all of the 2,194 students who sought counseling/mental health care at SAPPE from 1987 to 2004. Information was obtained from clients clinical charts. Unicamps database was consulted for general information on its students. RESULTS: The findings indicated overrepresentation, among the clients, of undergraduates, female students, students from Brazilian states other than São Paulo, students living in the campus residence hall and those whose main source of income was a scholarship grant. We also found overrepresentation of Humanities and Arts students among the clients. The most frequently reported complaints were difficulties in interpersonal relationships, family conflicts and poor academic performance. CONCLUSION: Course level (undergraduate or postgraduate), study field, living in a university residential facility and reliance on a scholarship grant were found to influence the behavior of seeking mental health counseling among Brazilian university students in this study. Course level was found to influence the pattern of complaints reported at first contact with the mental health service.
Assuntos
Aconselhamento Diretivo/estatística & dados numéricos , Transtornos Mentais/psicologia , Serviços de Saúde para Estudantes/estatística & dados numéricos , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Saúde Mental , Cooperação do Paciente , Estudos Retrospectivos , Fatores Socioeconômicos , Serviços de Saúde para Estudantes/normas , Adulto JovemRESUMO
This study aimed to evaluate the socioeconomic and demographic factors, behaviors and morbidities related to common mental disorders in adult women. This was a cross-sectional population-based study with cluster sample. We analyzed 848 women from a household survey held in Campinas, in 2008/2009. We used the Self-Reporting Questionnaire (SRQ-20) to evaluate common mental disorders. We estimated prevalence ratios by Poisson regression in hierarchical model of three steps, considering the weights relating to the sampling design. The prevalence of common mental disorders was 18.7%. The hierarchical model showed that older women, with low education level, housewives, separated or widowed, who did not consume fruit/vegetables daily, who slept six or fewer hours per night, who presented several chronic diseases and health problems, and with report of some type of violence were more vulnerable to common mental disorders and, therefore, should be treated with priority by health services. Early diagnosing women with common mental disorders, as well as accompanying and treating them, contribute for reducing the impacts on female quality of life.
O objetivo deste estudo foi avaliar os fatores socioeconômicos e demográficos, os comportamentos e as morbidades associados ao transtorno mental comum em mulheres adultas. Trata-se de um estudo transversal de base populacional com amostra por conglomerados. Foram analisadas 848 mulheres por inquérito domiciliar realizado em Campinas, em 2008/2009. Foi usado o instrumento Self-Reporting Questionnare (SRQ-20) para avaliar o transtorno mental comum. Foram estimadas razões de prevalências por meio de regressão múltipla de Poisson em modelo hierárquico de três etapas, considerando as ponderações relativas ao desenho amostral. A prevalência de transtorno mental comum foi de 18,7%. O modelo hierárquico evidenciou que mulheres mais velhas, com baixa escolaridade, donas de casa, separadas ou viúvas, que não consumiam frutas/verduras/legumes diariamente, dormiam seis ou menos horas por noite, apresentavam várias doenças crônicas e problemas de saúde e com relato de algum tipo de violência foram mais vulneráveis ao transtorno mental comum e, por isso, devem ser tratadas com prioridade pelos serviços de saúde. Diagnosticar precocemente mulheres com transtorno mental comum, bem como acompanhá-las e tratá-las, contribuem para reduzir os impactos na qualidade de vida feminina.
Assuntos
Transtornos Mentais/epidemiologia , Qualidade de Vida , Saúde da Mulher , Adolescente , Adulto , Brasil/epidemiologia , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
Abstract Objective To assess the loss to follow-up after emergency care and during 6-months of outpatient follow-up, and the associated variables, among adolescent sexual violence survivors. Methods This is a retrospective study with review of the medical records of 521 females, aged 10 to 18 years, who received emergency care in a referral service in São Paulo, Brazil. The variables were sociodemographic; personal history; characteristics of abuse, disclosure, and reactions triggered after abuse (physical and mental disorders as well as social changes), psychotropic prescription needs, and moment of abandonment: after emergency care and before completing 6 months of outpatient follow-up. To compare groups of patients lost to follow-up at each time point, we used the Chi-square and Fisher exact tests followed by multiple logistic regression with stepwise criterion for selection of associated variables. We calculated the odds ratio with confidence interval (OR, CI 95%). The level of significance adopted was 5%. Results A total of 249/521 (47.7%) adolescents discontinued follow-up, 184 (35.3%) after emergency care and 65 (12.4%) before completing outpatient follow-up. The variables of living with a partner (OR = 5.94 [CI 95%; 2.49-14.20]); not having a religion (OR = 2.38 [CI 95%;1.29-4.38)]), having a Catholic religion [OR = 2.11 (CI 95%; 1.17-3.78)]; and not disclosing the abuse [OR = 2.07 (CI 95%; 1.25-3.44)] were associated with loss to follow-up after emergency care. Not needing mental disorder care (OR = 2.72 [CI 95%; 1.36-5.46]) or social support (OR = 2.33 [CI 95%; 1.09-4.99]) were directly associated with loss to outpatient follow-up. Conclusion Measures to improve adherence to follow-up should be aimed at adolescents who live with a partner and those who do not tell anyone about the violence.
Resumo Objetivos Avaliar a perda de seguimento de adolescentes vítimas de violência sexual após o atendimento de emergência, durante o seguimento ambulatorial e as variáveis associadas. Métodos Estudo retrospectivo com a revisão de prontuários de 521 mulheres de 10 a 18 anos, que buscaram atendimento de emergência em um serviço de referência em São Paulo, Brasil. As variáveis foram sociodemográficas; antecedentes pessoais; características do abuso, atitude de revelação e reações desencadeadas após o abuso (distúrbios físicos, mentais e mudanças sociais), necessidades de prescrição de psicotrópicos e momento do abandono: após atendimento de emergência e antes de completar 6 meses de seguimento ambulatorial. Para comparar os grupos de perda de seguimento em cada momento, foram utilizados os testes do qui-quadrado e exato de Fisher, seguidos de regressão logística múltipla com critério stepwise para seleção das variáveis associadas. Calculamos a razão de probabilidade com intervalo de confiança (RP, IC 95%). O nível de significância adotado foi de 5%. Resultados Um total de 249 (47,7%) das adolescentes descontinuaram o acompanhamento, 184 (35.3%) após o atendimento de emergência e 65 (12.4%) antes de completar o seguimento ambulatorial. As variáveis de viver com companheiro [RP = 5,94 (IC 95%; 2,49-14,20]; não ter religião [RP = 2,38 (IC 95%;1,29-4,38)], ter religião católica [RP = 2,11 (IC 95%; 1,17-3,78)] e não revelar o abuso [RP = 2,07 (IC 95%; 1,25-3,44)] foram associadas à perda de seguimento após o atendimento de emergência. Não necessitar de cuidados de saúde mental (RP = 2,72 [IC 95%; 1,36-5,46]) ou apoio social (RP = 2,33 [IC 95%; 1,09-4,99]) foram as variáveis associadas à perda do seguimento ambulatorial. Conclusão Medidas para melhorar a adesão ao seguimento devem ser direcionadas às adolescentes que vivem com parceiro e às que não revelam a violência sofrida.
Assuntos
Humanos , Feminino , Adolescente , Estupro , Delitos Sexuais , Estudos Retrospectivos , Perda de SeguimentoRESUMO
Resumo: Introdução: Médicos e alunos de Medicina são grupos de risco para o suicídio e comportamento suicida. Comportamentos suicidas abrangem fenômenos que vão desde pensamentos, planejamentos, tentativas e até a morte por suicídio. Sabe-se pouco sobre o comportamento suicida entre estudantes de Medicina brasileiros. Objetivo: Este estudo teve como objetivos avaliar a prevalência de ideação, planejamentos e tentativas suicidas em uma amostra de estudantes de graduação em Medicina do Brasil, e identificar os fatores sociodemográficos, de vida estudantil e de saúde mais associados a esses comportamentos. Método: Participaram do estudo 722 alunos do curso de Medicina da Unicamp, durante os anos de 2017 e 2018, que responderam de forma voluntária e anônima a um questionário amplo, que incluía dados sociodemográficos, de vida acadêmica e de comportamento suicida. A análise estatística foi realizada por meio do teste de qui-quadrado, do teste de Mann-Whitney e da regressão logística múltipla. Adotou-se o nível de significância estatística de 95%. Resultado: As prevalências de pensamentos, planejamento e tentativas de suicídio ao longa da vida foram respectivamente 196 (27,3%), 64 (8,9%) e 26 (3,6%). Nos 30 dias que antecederam a pesquisa, 36 (5%) pensaram seriamente em pôr fim à própria vida, e 11 (1,5%) planejaram concretamente colocar fim a própria vida. Bullying, presença de transtorno mental, procura de assistência em saúde mental na universidade, uso de calmante sem prescrição médica, baixo nível socioeconômico, morar sozinho, religião (ateus, agnósticos e espiritualistas) e grau de religiosidade são os fatores que, conjuntamente, melhor explicam a chance de comportamento suicida. Conclusão: Alunos de Medicina apresentam prevalências importantes de comportamento suicida.
Abstract: Introduction: Physicians and medical students constitute groups at risk for suicide and suicidal behavior. Suicidal behaviors encompass phenomena ranging from thoughts, planning, and finally death by suicide. Little is known about suicidal behavior among Brazilian medical students. Objective: The aim of this study was to assess the prevalence of suicidal ideation, planning and suicide attempt in a sample of undergraduate medical students in Brazil, as well as to identify the sociodemographic, student life aspects and health factors most often associated with suicidal behavior. Method: A total of 722 medical students at Unicamp, during 2017 and 2018, voluntarily and anonymously answered a broad questionnaire, including sociodemographic data, aspects of academic life and suicidal behavior. A statistical analysis was performed using the chi-square test, Mann-Whitney test, and multivariate logistic regression. A statistical significance level of 95% was adopted. Results: The lifetime prevalence rates of suicidal thoughts, planning and attempts were respectively 196 (27.3%), 64 (8.9%), and 26 (3.6%). In the 30 days prior to the survey, 36 (5%) seriously thought about ending their own lives, and 11 (1.5%) concretely planned to end their own lives. Bullying, presence of mental disorder, seeking mental health care at the university, use of sedatives without a prescription, low socioeconomic level, living alone, religion (atheists, agnostics and spiritualists) and degree of religiousness are the factors that, together, best explain the chance of suicidal behavior. Conclusion: Medical students show important prevalence rates of suicidal behavior.
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OBJECTIVE: To evaluate the prevalence of health-related behaviors according to presence and type of depression in Brazilian adults. METHODS: Based on a sample of 49,025 adults (18 to 59 years) from the National Survey on Health 2013 (PNS 2013), we estimated the prevalence of health-related behaviors (smoking; passive smoking; frequent or risky alcohol consumption; leisure time physical activity; time watching TV; and eating pattern indicators), according to the presence of depression (minor and major), evaluated by the Patient Health Questionnaire - 9 (PHQ-9), and the report of depressive mood (in up to seven days or more than seven days) over a two-week period. Prevalence ratios were estimated by Poisson regression. RESULTS: Evaluated by the PHQ-9 scale, 9.7% of the Brazilian adults had depression and 3.9% presented major depression. About 21.0% reported depressive mood and, in 34.9% of them, that feeling has been present for more than seven days. In individuals with major depression (PHQ-9), higher prevalence was found in almost all unhealthy behaviors analyzed, in particular, smoking (PR = 1.65), passive smoking (PR = 1.55), risk alcohol consumption (PR = 1.72), TV for ≥ 5 hours/day (PR = 2.13), consumption of fat meat (PR = 1.43) and soft drink (PR = 1.42). The prevalence ratios tended to be lower in those with minor depression. Similar results were observed in adults with depressive mood. CONCLUSIONS: This study detected relevant association between depression and health behaviors, in particular for smoking and physical activity. The associations found with the PHQ were similar to those observed with the application of a single question about depressive mood. Our results indicate the importance of assessing the presence of depression and the frequency and severity of symptoms when implementing actions for the promotion of healthy behaviors.
OBJETIVO: Avaliar a prevalência de comportamentos relacionados à saúde segundo a presença e tipo de depressão em adultos brasileiros. MÉTODOS: Com base em amostra de 49.025 adultos (18 a 59 anos) da Pesquisa Nacional de Saúde 2013, foram estimadas as prevalências de comportamentos relacionados à saúde (tabagismo, fumo passivo, consumo frequente ou de risco de álcool, atividade física de lazer, horas de TV e indicadores de padrão alimentar), segundo a presença de depressão (menor e maior), avaliada pela escala PHQ-9, e o relato de humor depressivo (em até sete dias ou em mais de sete dias) em um período de duas semanas. Razões de prevalências foram estimadas por meio de regressão de Poisson. RESULTADOS: Avaliados pela escala PHQ-9, 9,7% dos adultos brasileiros apresentaram depressão, e 3,9%, depressão maior. Cerca de 21,0% relataram humor depressivo e em 34,9% deles esse sentimento esteve presente por mais de sete dias. Nos indivíduos com depressão maior (PHQ-9), foram constatadas prevalências mais elevadas de quase todos os comportamentos não saudáveis analisados, principalmente tabagismo (RP = 1,65), fumo passivo (RP = 1,55), consumo de risco de álcool (RP = 1,72), horas de TV ≥ 5 h/dia (RP = 2,13), consumo de carne gordurosa (RP = 1,43) e refrigerante (RP = 1,42). As razões de prevalência tenderam a ser menores na depressão menor. Resultados similares foram observados nos adultos com humor depressivo. CONCLUSÕES: O estudo detectou relevante associação entre depressão e comportamentos de saúde, em especial, para tabagismo e atividade física. As associações encontradas com o uso do PHQ foram similares às observadas com a aplicação de uma única pergunta sobre humor depressivo. Os resultados do estudo sinalizam a importância da avaliação da presença de depressão e da frequência e gravidade dos sintomas quando da implementação de ações para a promoção de comportamentos saudáveis.
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Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Comportamentos Relacionados com a Saúde , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Feminino , Comportamentos Relacionados com a Saúde/classificação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto JovemRESUMO
Abstract: Introduction: Studies methylphenidate (MPH) has been used by medical students to increase their mental activity and improve the performance required during undergraduate school, generating concern regarding the risks to their physical and mental health. This scenario indicates the need for specifically aimed measures in medical schools. Objective: To review the literature about the use of MPH without medical indication amongst medical students. Method: A thorough review of the literature published in English, Spanish, and Portuguese, between 2013 and 2019, based on data made available by Pubmed and Scielo, utilizing keywords in the three above languages, along the four stages of the selection process. Results and Discussion: Altogether, 224 articles were found, of which 25 were selected after reading, dealing with the use of MPH or 'cognition enhancer' by undergraduate medical students without a doctor's prescription. The research indicated significant variability in the frequency of consumption, related to the investigated pattern of use, use with or without indication, before or after entering University and country where the study was carried out. The most frequent justification for the use without medical indication was to attain improvement in academic performance. A lack of research with a fair appraisal of the cognition, behavioral and psychic risks involved, among them addiction and the approach of the topic in medical schools, was noted. Conclusion: The high rates of usage of MPH by medical students aiming at cognitive enhancement strengthens the importance of preventative actions in medical schools. The strategies must consider information concerning the risks of use (of MPH) without medical indication; non-pharmacological interventions for performance improvement; sleep hygiene measures organization for adequate study activities; broad discussions about ethical aspects and curricular structure.
Resumo: Introdução: Estudos mostram que o metilfenidato (MPH) tem sido utilizado por estudantes de medicina para aumentar sua atividade mental e melhorar o desempenho exigido durante a graduação, gerando preocupações quanto aos riscos à sua saúde física e mental. Esse cenário indica a necessidade de medidas especificamente direcionadas nas escolas médicas. Objetivo: Revisar a literatura sobre o uso de MPH sem indicação médica entre estudantes de medicina. Método: Revisão minuciosa da literatura publicada em inglês, espanhol e português, entre 2013 e 2019, com base em dados disponibilizados pelo PUBMED e SCIELO, utilizando palavras-chave nos três idiomas acima, ao longo das quatro etapas do processo de seleção. Resultados e Discussão: Ao todo, foram encontrados 224 artigos, dos quais 25 foram selecionados após leitura, tratando do uso de MPH ou 'potencializador da cognição' por graduandos de medicina sem prescrição médica. A pesquisa indicou variabilidade significativa na frequência de consumo, relacionada ao padrão de uso investigado, uso com ou sem indicação, antes ou após a entrada na Universidade e país onde o estudo foi realizado. A justificativa mais frequente para o uso sem indicação médica foi a de obter melhora no desempenho acadêmico. Notou-se a carência de pesquisas com uma avaliação adequada dos riscos cognitivos, comportamentais e psíquicos envolvidos, entre eles o risco de adição e a abordagem do tópico nas escolas médicas. Conclusão: As altas taxas de uso do MPH por estudantes de medicina visando o aprimoramento cognitivo reforça a importância de ações preventivas nas escolas médicas. As estratégias devem considerar informações sobre os riscos do uso (do MPH) sem indicação médica; intervenções não farmacológicas para melhoria do desempenho cognitivo; medidas de higiene do sono; organização para atividades de estudo adequadas; amplas discussões sobre aspectos éticos e estrutura curricular.
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Abstract Objective To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided. Methods A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%. Results The early group (n= 242) contained more adolescents who were enrolled in school (p< 0.001), suffered more daytime aggressions (p= 0.031), in their residences (p< 0.001), by an aggressor with whom they were acquainted (p< 0.001), had greater need of legal protection (p= 0.001), and took longer to seek care (p= 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n= 279), there was greater consumption of alcohol during the aggression (p= 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p= 0.033), sleep disorders (p= 0.003), symptoms of anxiety (p= 0.045), and feelings of anguish (p= 0.011); and had more prescriptions of psychotropics (p= 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups. Conclusion The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.
Resumo Objetivo Comparar a violência sexual sofrida por vítimas no início e no final da adolescência, as reações desencadeadas após a agressão, e o cuidado de saúde dispensado. Métodos Estudo retrospectivo, em que foram revisados os prontuários de 521 mulheres adolescentes atendidas por equipe multiprofissional em hospital de referência em Campinas, São Paulo, Brasil. As variáveis foram sociodemográficas, e aquelas relativas às características da violência, ao atendimento de emergência, e às reações físicas e psicológicas observadas durante o seguimento nos grupos de adolescentes de idade precoce (10a 14 anos) e tardia (15 a 18 anos). Utilizamos os testes do Qui-quadrado/Exato de Fisher, Mann-Whitney e Kruskal-Wallis para comparar os grupos; adotamos o nível de significância de 5%. Resultados O grupo precoce (n= 242) continha maior número de estudantes (p< 0,001), que sofreram mais agressões diurnas (p= 0,031), em suas residências (p< 0,001), por agressor conhecido (p< 0,001), tiveram maior necessidade de proteção legal (p= 0,001), e demoraram mais a procurar atendimento (p= 0,048). Sentimentos de culpa, vergonha e a percepção da violência foram similares entre os grupos. No grupo tardio (n= 279) houve maior consumo de álcool durante a agressão (p= 0,005); as adolescentes receberam significativamente mais tratamentos de profilaxia; relataram mais sintomas físicos (p= 0,033), distúrbios do sono (p= 0,003), sintomas de ansiedade (p= 0,045), e sentimentos de angústia (p= 0,011); e receberam mais prescrições de psicotrópicos (p= 0,005). Apenas 52% completaram o seguimento de 6 meses, sem diferenças entre os grupos. Conclusão Os grupos apresentaram diferenças nas características da violência; as adolescentes precoces chegaram mais tardiamente ao serviço, e o grupo tardio apresentou maior sintomatologia e piora psicológica no seguimento. São necessárias medidas de prevenção e cuidados específicos voltados a essa população.
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Humanos , Feminino , Adolescente , Delitos Sexuais , Saúde Mental , Estudos Retrospectivos , Serviços Médicos de EmergênciaRESUMO
The scope of this article is to present the Brazilian version of the CRAFFT scale for screening drug use among adolescents and to assess its comprehensibility. It is a descriptive and quantitative study, which evaluated the applicability of the Brazilian version of the CRAFFT scale through a convenience sample of adolescents aged 14-21 enrolled at two technical schools. Three main aspects were evaluated: difficulty in understanding the scale; the validity of the translated scale comparing a subsample (28,8%) that also filled out the CEBRID questionnaire; and the percentage of adolescents who scored positive on the CRAFFT/CESARE using the pre-established cutoff point. The kappa coefficient was applied to establish correspondence between questionnaires and the ROC curve was used to evaluate the psychometric differences within different cutoffs. The CRAFFT/CESARE scale was applied in 2005 students, of which 1882 are within the defined age bracket. Only 2.2% of adolescents had difficulty in understanding the questions. The specificity of the CRAFFT/CESARE scale was 73.3%, and sensitivity was 87.1%. The concordance degree (Kappa) was considered good (0.461). The CRAFFT/CESARE scored positive in 36.2% of the adolescents.
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Psicometria , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Brasil , Feminino , Humanos , Masculino , Programas de Rastreamento , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto JovemRESUMO
ABSTRACT Objective: To analyze the association of depression with various health behaviors and to verify if they differ according to gender or income. Methods: This is a cross-sectional study based on data of 65,803 Brazilian adults (18-59 years old) interviewed in the National Health Survey, conducted in 2019. Presence or absence of depression was evaluated using the Patient Health Questionnaire (PHQ)-9. The prevalence of smoking, alcohol consumption, physical activity, sedentary lifestyle and food indicators were estimated according to the presence of depression. Stratified analyses were made according to sex and income, and prevalence ratios were estimated using the Poisson Regression. Results: We found a significant association between depression and all indicators studied, except occasional alcohol consumption. Depression was associated with heavy episodic drinking and insufficient consumption of fruits and vegetables only in women. In men, the associations of depression with sedentary lifestyle and with being a former smoker were stronger than in women. The occasional consumption of alcohol was more prevalent only in men without depression. The analysis stratified by income showed that the association of depression with physical inactivity is stronger in the higher-income group, while with heavy episodic drinking is only significant in the lower-income stratum. Conclusion: The results point to the need to consider mental health in programs aimed at reducing harmful health behaviors and the specificity of sociodemographic groups.
RESUMO: Objetivo: Analisar a associação da depressão com comportamentos de saúde e verificar se as associações diferem segundo sexo e renda. Métodos: Estudo transversal com dados de 65.803 adultos brasileiros (18-59 anos) da Pesquisa Nacional de Saúde realizada em 2019. A presença de depressão foi avaliada com o uso do Patient Health Questionnaire-9 (PHQ-9). As prevalências de tabagismo, consumo de álcool, atividade física, sedentarismo e indicadores de alimentação foram estimadas segundo a presença de depressão. Foram desenvolvidas análises estratificadas por sexo e renda e estimadas as razões de prevalência com a regressão de Poisson. Resultados: Verificou-se associação significativa da depressão com todos os indicadores estudados, exceto com o consumo eventual de álcool. Apenas nas mulheres a depressão se mostrou associada com heavy episodic drinking e com o consumo insuficiente de frutas, legumes e verduras. Nos homens, as razões de prevalência das associações de depressão com sedentarismo e com ser ex-fumante foram mais elevadas de que nas mulheres e apenas nos homens o consumo eventual de álcool foi mais prevalente naqueles sem depressão. A análise estratificada segundo a renda mostrou que a associação da depressão com a inatividade física foi mais forte no segmento de renda superior e a associação com heavy episodic drinking só foi significativa no estrato de renda inferior. Conclusão: Os resultados apontam a necessidade de considerar a saúde mental nos programas que visam à redução de comportamentos nocivos à saúde e também de levar em conta as especificidades dessas associações nos diferentes estratos sociodemográficos.