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BACKGROUND: Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. METHODS: We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. RESULTS: We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other's experiences. CONCLUSION: Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).
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Depressão , Enfermeiras e Enfermeiros , Brasil , Depressão/terapia , Humanos , Saúde Mental , PeruRESUMO
Importance: Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. Objective: To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. Design, Setting, and Participants: Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). Interventions: An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). Main Outcomes and Measures: The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. Results: Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. Conclusions and Relevance: In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. Trial Registration: ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima).
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Terapia Comportamental/métodos , Depressão/terapia , Diabetes Mellitus/psicologia , Hipertensão/psicologia , Aplicativos Móveis , Telemedicina , Adulto , Brasil , Depressão/complicações , Depressão/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Peru , SmartphoneRESUMO
OBJECTIVE: To ascertain whether sociodemographic and health-related characteristics known from previous research to have a substantive impact on recovery from depression modified the effect of a digital intervention designed to improve depressive symptoms (CONEMO). METHODS: The CONEMO study consisted of two randomized controlled trials, one conducted in Lima, Peru, and one in São Paulo, Brazil. As a secondary trial plan analysis, mixed logistic regression was used to explore interactions between the treatment arm and subgroups of interest defined by characteristics measured before randomization - suicidal ideation, race/color, age, gender, income, type of mobile phone, alcohol misuse, tobacco use, and diabetes/hypertension - in both trials. We estimated interaction effects between the treatment group and these subgroup factors for the secondary outcomes using linear mixed regression models. RESULTS: Increased effects of the CONEMO intervention on the primary outcome (reduction of at least 50% in depressive symptom scores at 3-month follow-up) were observed among older and wealthier participants in the Lima trial (p = 0.030 and p = 0.001, respectively). CONCLUSION: There was no evidence of such differential effects in São Paulo, and no evidence of impact of any other secondary outcomes in either trial. CLINICAL TRIAL REGISTRATION: NCT02846662 (São Paulo, Brazil - SP), NCT03026426 (Lima, Peru - LI).
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Depressão , Fatores Socioeconômicos , Telemedicina , Humanos , Masculino , Feminino , Brasil , Adulto , Pessoa de Meia-Idade , Peru , Depressão/terapia , Depressão/psicologia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: (1) To our knowledge, this is the first study to evaluate CAPS AD's ability to handle crises. (2) The ability to handle crises of the CAPS AD from downtown São Paulo was 86.6%. (3) Of the nine users referred to other services, only one evolved to hospitalization. to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users' crises in comprehensive care. METHOD: a quantitative, evaluative, and longitudinal study was conducted from February to November 2019. The initial sample consisted of 121 users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14 days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. RESULTS: 67 users (54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. CONCLUSION: both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.
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Reabilitação Psiquiátrica , Humanos , Estudos Longitudinais , Brasil , HospitalizaçãoRESUMO
The objective of this study was to perform the translation and cultural adaptation of the Global Appraisal of Individual Needs - Initial instrument, and calculate its content validity index. This is a methodological study designed for the cultural adaptation of the instrument. The instrument was translated into Portuguese in two versions that originated the synthesis of the translations, which were then submitted to the evaluation of four judges, experts in the field of alcohol and other drugs. After the suggested changes were made, the instrument was back-translated and resubmitted to the judges and authors of the original instrument, resulting in the final version of the instrument, Avaliação Global das Necessidades Individuais - Inicial. The content validity index of the instrument was 0.91, considered valid according to the literature. The instrument Avaliação Global das Necessidades Individuais - Inicial was culturally adapted to the Portuguese language spoken in Brazil; however, it was not submitted to tests with the target population, which suggests further studies should be performed to test its reliability and validity.
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Características Culturais , Necessidades e Demandas de Serviços de Saúde , Inquéritos e Questionários , Alcoolismo/terapia , Brasil , Humanos , Transtornos Relacionados ao Uso de Substâncias/terapia , TraduçãoRESUMO
OBJECTIVES: to analyze burden predictors in mental health workers during the COVID-19 pandemic. METHODS: a quantitative study, collected between October and December 2020 through a sociodemographic questionnaire and Mental Health Service Burden Assessment Scale, in four services in a municipality in the state of São Paulo, Brazil, with 108 workers. Descriptive analysis and multiple linear regression of ordinary least squares were performed, in search of predictors for variation in the scale score. RESULTS: it showed median work burden (2.03). Predictors: psychological or psychiatric follow-up; normal performance of activities during the pandemic; direct action with suspected or confirmed cases of COVID-19; and belonging to the risk group (people over 60 years of age, diabetics, hypertensive, cardiac, respiratory problems) (p<0.05). CONCLUSIONS: working conditions observed during the pandemic, simultaneously with workers' mental health care needs predict burden at work in health.
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COVID-19 , Idoso , Brasil/epidemiologia , COVID-19/epidemiologia , Pessoal de Saúde/psicologia , Humanos , Saúde Mental , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2RESUMO
The current national mental health policies confirm the need to encourage teaching, research and extension practices that favor new professional attitude. A previous study has shown that the students' representation about the competencies required in mental health fall into categories about the concepts of competence, cognitive resources, expressed feelings, and the concept of health and illness, but with no reference to themes related to the users' citizenship or psychosocial rehabilitation, which are central concepts in the course discipline. In this study, an analysis was made of the representation about these concepts, the knowledge and skills identified as being necessary to practice rehabilitation. Participants were students of a public university, attending the Mental Health Nursing class. The results show that students value the users' needs, but the representations about citizenship and psychosocial rehabilitation are founded on common sense about hazards and basic rights like health and leisure.
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Educação Baseada em Competências , Educação em Enfermagem/normas , Saúde Mental , Enfermagem Psiquiátrica/educação , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/reabilitação , Ensino , Adulto JovemRESUMO
OBJECTIVE: To discuss remote activities in nursing education in the context of the COVID-19 pandemic for strengthening nursing from the perspective of the "Nursing Now" campaign. METHOD: Theoretical-reflective study based on literature and critical analysis. DISCUSSION: Reflection about the measures to control the COVID-19 pandemic and suspend in-person classes, the adoption of alternative forms of teaching, especially online ones, and their repercussions on nursing teaching strategies. There were difficulties regarding the quality of education, unequal access, and lack of knowledge from professors. FINAL CONSIDERATIONS: The negative impact that emergency distance teaching had on the education of nurses stands out, in contrast to the world movement for the valuing of nurses. The legacy of this crisis must be taken advantage of through the better use of technological resources and their incorporation in teaching, having as a certainty that the distance teaching model does not encompass the totality of nursing education.
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COVID-19/epidemiologia , Educação a Distância , Educação em Enfermagem/métodos , Pandemias , Ensino , Brasil , COVID-19/prevenção & controle , Educação a Distância/legislação & jurisprudência , Educação em Enfermagem/organização & administração , Humanos , Distanciamento FísicoRESUMO
OBJECTIVE: To compare the consequences of psychoactive substance use among users of mental health services in Brazil and Portugal. METHOD: Cross-sectional, comparative, quantitative study, carried out with 362 users of two specialized treatment services in the cities of São Paulo (n = 200) and Lisbon (n = 162). Data collected in 2019 through the application of the Substance Addiction Consequences scale. A descriptive analysis and ordinary least squares and logistic regressions were performed. RESULTS: All dimensions assessed by the scale were more severe for Brazilian users, with a difference for the physical domain and cognitive skills (p < 0.01). Brazilian participants were more likely to consume cocaine (p < 0.01) and have psychosis (p = 0.02) and Portuguese participants to have hepatitis (p < 0.01), personality disorders (p < 0.01), use benzodiazepines (p < 0.01) and tobacco (p < 0.01), and receive pharmacological support (p < 0.01). CONCLUSION: It was found that Brazilian users have more serious consequences related to substance use, and Portuguese users have more comorbidities and exposure to risky consumption. It emerges that Portuguese responses minimize the consequences severity.
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Transtornos Relacionados ao Uso de Substâncias , Brasil/epidemiologia , Cidades , Estudos Transversais , Humanos , Portugal/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
Background: Mental health difficulties are highly prevalent, yet access to support is limited by barriers of stigma, cost, and availability. These issues are even more prevalent in low- and middle-income countries, and digital technology is one potential way to overcome these barriers. Digital mental health interventions are effective but often struggle with low engagement rates, particularly in the absence of human support. Chatbots could offer a scalable solution, simulating human support at a lower cost. Objective: To complete a preliminary evaluation of engagement and effectiveness of Vitalk, a mental health chatbot, at reducing anxiety, depression and stress. Methods: Real world data was analyzed from 3,629 Vitalk users who had completed the first phase of a Vitalk program ("less anxiety," "less stress" or "better mood"). Programs were delivered through written conversation with a chatbot. Engagement was calculated from the number of responses sent to the chatbot divided by days in the program. Results: Users sent an average of 8.17 responses per day. For all three programs, target outcome scores reduced between baseline and follow up with large effect sizes for anxiety (Cohen's d = -0.85), depression (Cohen's d = -0.91) and stress (Cohen's d = -0.81). Increased engagement resulted in improved post-intervention values for anxiety and depression. Conclusion: This study highlights a chatbot's potential to reduce mental health symptoms in the general population within Brazil. While findings show promise, further research is required.
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OBJETIVO: Analisar o sofrimento psíquico de trabalhadores dos serviços de saúde mental em contexto pandêmico e identificar os fatores associados. MÉTODO: Pesquisa transversal, com 108 trabalhadores de quatro serviços de saúde mental de um município do interior paulista. Coleta de dados realizada on-line entre outubro e dezembro de 2020 por meio de questionário sociodemográfico e Escala Self Report Questionnaire-20 (SRQ-20). Os dados foram analisados por estatística descritiva e por regressão linear múltipla de mínimos quadrados ordinários, na intenção de analisar os fatores associados para a variação no escore da escala. RESULTADOS: Os trabalhadores apresentaram média elevada na escala SRQ-20 (15,07), o que indica grande sofrimento psíquico. Fazer acompanhamento psicológico e/ou psiquiátrico durante a pandemia de covid-19 esteve associado à minimização deste sofrimento, com redução de, em média, três dos sintomas avaliados pela escala. CONCLUSÃO: O acompanhamento em saúde mental para os trabalhadores no contexto pandêmico pode ser uma importante estratégia de enfrentamento associada à redução do sofrimento psíquico.
OBJECTIVE: To analyze the psychological distress of mental health workers in a pandemic context and identify associated factors. METHOD: A cross-sectional study was conducted with 108 workers from four mental health services in a municipality in the interior of São Paulo. Data was collected online between October and December 2020 through a sociodemographic questionnaire and the Self Report Questionnaire-20 (SRQ-20) scale. The data were analyzed using descriptive statistics and multiple linear regression of ordinary least squares to analyze the factors associated with the variation in the scale score. RESULTS: The workers had a high average on the SRQ-20 scale (15.07), indicating significant psychological distress. Receiving psychological and/or psychiatric support during the COVID-19 pandemic was associated with reducing this distress, with an average reduction of three symptoms assessed by the scale. CONCLUSION: Mental health support for workers in the pandemic context can be an important coping strategy associated with reducing psychological distress.
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OBJETIVO: Analisar o sofrimento psíquico de trabalhadores dos serviços de saúde mental em contexto pandêmico e identificar os fatores associados. MÉTODO: Pesquisa transversal, com 108 trabalhadores de quatro serviços de saúde mental de um município do interior paulista. Coleta de dados realizada on-line entre outubro e dezembro de 2020 por meio de questionário sociodemográfico e Escala Self Report Questionnaire-20 (SRQ-20). Os dados foram analisados por estatística descritiva e por regressão linear múltipla de mínimos quadrados ordinários, na intenção de analisar os fatores associados para a variação no escore da escala. RESULTADOS: Os trabalhadores apresentaram média elevada na escala SRQ-20 (15,07), o que indica grande sofrimento psíquico. Fazer acompanhamento psicológico e/ou psiquiátrico durante a pandemia de covid-19 esteve associado à minimização deste sofrimento, com redução de, em média, três dos sintomas avaliados pela escala. CONCLUSÃO: O acompanhamento em saúde mental para os trabalhadores no contexto pandêmico pode ser uma importante estratégia de enfrentamento associada à redução do sofrimento psíquico.
OBJECTIVE: To analyze the psychological distress of mental health workers in a pandemic context and identify associated factors. METHOD: A cross-sectional study was conducted with 108 workers from four mental health services in a municipality in the interior of São Paulo. Data was collected online between October and December 2020 through a sociodemographic questionnaire and the Self Report Questionnaire-20 (SRQ-20) scale. The data were analyzed using descriptive statistics and multiple linear regression of ordinary least squares to analyze the factors associated with the variation in the scale score. RESULTS: The workers had a high average on the SRQ-20 scale (15.07), indicating significant psychological distress. Receiving psychological and/or psychiatric support during the COVID-19 pandemic was associated with reducing this distress, with an average reduction of three symptoms assessed by the scale. CONCLUSION: Mental health support for workers in the pandemic context can be an important coping strategy associated with reducing psychological distress.
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BACKGROUND: Emerging researchers in low- and middle-income countries (LMIC) face many barriers, including inadequacies in funding, international exposure and mentorship. In 2012, the National Institute of Mental Health (NIMH) funded five research hubs aimed at improving the research core for evidence-based mental health interventions, enhancing research skills in global mental health, and providing capacity building (CB) opportunities for early career investigators in LMIC. In this paper emerging researchers contextualize their experiences. CASE PRESENTATION: Each of the five hubs purposively selected an emerging researcher who had experienced more than one hub-related CB opportunity and actively participated in hub-related clinical trial activities. The five 'voices' were invited to contribute narratives on their professional backgrounds, CB experience, challenges and successes as an emerging mental health researcher, and suggestions for future CB activities. These narratives are presented as case studies. CB activities provided broader learning opportunities for emerging researchers. Benefits included the receipt of research funding, hands-on training and mentorship, as well as exposure to networks and collaborative opportunities on a global scale. To overcome ongoing challenges of access to funding, mentoring, networking and global exposure, the emerging voices recommend making mentorship and training opportunities available to a wider range of emerging mental health researchers. CONCLUSIONS: Investing in CB is not enough to ensure sustainability and leave a legacy unless it is accompanied by ongoing mentorship and international exposure. Financial investment in building research capacity, promotion of mentorship and supervision, and international networking are essential to yield well-prepared young investigators in LMIC as experienced by these rising stars. Governments and policymakers should prioritize educational policies to support the continuous development and international engagement of emerging researchers. This can advance strategies to deal with one of most important and costly problems faced by healthcare systems in LMIC: the mental health treatment gap.
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Objective: To ascertain whether sociodemographic and health-related characteristics known from previous research to have a substantive impact on recovery from depression modified the effect of a digital intervention designed to improve depressive symptoms (CONEMO). Methods: The CONEMO study consisted of two randomized controlled trials, one conducted in Lima, Peru, and one in São Paulo, Brazil. As a secondary trial plan analysis, mixed logistic regression was used to explore interactions between the treatment arm and subgroups of interest defined by characteristics measured before randomization - suicidal ideation, race/color, age, gender, income, type of mobile phone, alcohol misuse, tobacco use, and diabetes/hypertension - in both trials. We estimated interaction effects between the treatment group and these subgroup factors for the secondary outcomes using linear mixed regression models. Results: Increased effects of the CONEMO intervention on the primary outcome (reduction of at least 50% in depressive symptom scores at 3-month follow-up) were observed among older and wealthier participants in the Lima trial (p = 0.030 and p = 0.001, respectively). Conclusion: There was no evidence of such differential effects in São Paulo, and no evidence of impact of any other secondary outcomes in either trial. Clinical trial registration: NCT02846662 (São Paulo, Brazil - SP), NCT03026426 (Lima, Peru - LI). Funded by the U.S. National Institute of Mental Health (grant U19MH098780).
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Objetivo: evaluar la capacidad de los Centros de Atención Psicosocial de Alcohol y Otras Drogas 24 horas para manejar situaciones de crisis de las personas que consumen AOD en la atención integral. Método: estudio cuantitativo, evaluativo y longitudinal, realizado de febrero a noviembre de 2019. La muestra inicial estuvo compuesta por 121 personas que consumen AOD, que recibieron atención integral en situaciones de crisis en dos Centros de Atención Psicosocial para Alcohol y Otras Drogas 24 horas en el centro de São Paulo. Los mismos fueron reevaluados después de 14 días de atención. La capacidad para manejar la crisis se evaluó mediante un indicador validado. Los datos se analizaron utilizando estadísticas descriptivas y modelos de regresión de efectos mixtos. Resultados: sesenta y siete personas que consumen AOD completaron el follow-up (54,9%). Durante la atención de las situaciones de crisis, nueve personas que consumen AOD (13,4%; p=0,470) fueron derivadas a otros servicios de la red de salud: siete por complicaciones clínicas, una por intento de suicidio y una por hospitalización psiquiátrica. La capacidad de los servicios para manejar situaciones de crisis fue del 86,6%, fue considerada positiva. Conclusión: los dos servicios evaluados fueron capaces de manejar situaciones de crisis en su área de influencia, evitando internaciones y contando con el apoyo de la red cuando fue necesario, logrando así los objetivos de desinstitucionalización.
Objective: to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users' crises in comprehensive care. Method: a quantitative, evaluative, and longitudinal study was conducted from February to November 2019. The initial sample consisted of 121 users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14 days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. Results: 67 users (54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. Conclusion: both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.
Objetivo: avaliar a capacidade dos Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas em manejar situações de crise dos usuários no acolhimento integral. Método: estudo quantitativo, avaliativo e longitudinal, realizado de fevereiro a novembro de 2019. A amostra inicial foi composta por 121 usuários, acolhidos integralmente em situações de crise por dois Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas do centro de São Paulo. Estes foram reavaliados após 14 dias de acolhimento. A capacidade de manejar a crise foi avaliada por um indicador validado. Os dados foram analisados por estatística descritiva e por regressão de modelos de efeitos mistos. Resultados: sessenta e sete usuários concluíram o follow-up (54,9%). Durante o acolhimento às situações de crise, nove usuários (13,4%; p=0,470) foram encaminhados para outros serviços da rede de saúde: sete por complicações clínicas, um por tentativa de suicídio e um para internação psiquiátrica. A capacidade de manejo das situações de crise pelos serviços foi de 86,6%, avaliada como positiva. Conclusão: os dois serviços avaliados foram capazes de manejar situações de crise no próprio território, evitando internações e tendo apoio da rede quando necessário, atingindo assim, os objetivos da desinstitucionalização.
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Humanos , Brasil , Estudos Longitudinais , Transtornos Relacionados ao Uso de Substâncias/terapia , Intervenção em Crise , Reabilitação Psiquiátrica , Hospitais PsiquiátricosRESUMO
OBJECTIVE: To analyze and characterize the use of night beds in a Psychosocial Attention Care Center for Alcohol and Drugs (Centro de Atenção Psicossocial Álcool e Drogas - CAPS ad). METHOD: It is a quantitative, documental, descriptive and retrospective study. Data were gathered from 565 medical records. An analysis of continuous variables was performed. RESULTS: When admitted to the beds, most users (87.6%) consumed multiple substances daily and were vulnerable, specially in street situation (68.3%). These users were admitted on an average of two times, undergoing a previous evaluation by the nurse (85.8%), usually for detoxication or due to the vulnerable condition. They stayed in the center for an average of seven days and 31.1% did not finish what was proposed. For a few cases, hospital support was needed. Overall, discharges were planned, but the return happened without booking. CONCLUSION: Social issues cut through the use of night beds, however, it is a therapeutic resource that meets significant demands and is present in the daily lives of vulnerable users as a comprehensive care.
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Plantão Médico/estatística & dados numéricos , Ocupação de Leitos/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/métodos , Adolescente , Adulto , Plantão Médico/métodos , Idoso , Brasil , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
Objetivo: analisar os preditores de problemas relacionados ao uso de substâncias psicoativas entre usuários de um Centro de Atenção Psicossocial Álcool e Drogas. Método: estudo transversal de abordagem quantitativa realizado com 200 usuários de um Centro de Atenção Psicossocial Álcool e Drogas do interior paulista. Os dados foram coletados por meio de um questionário sociodemográfico e do instrumento denominado Avaliação Global de Necessidades Individuais - Triagem Curta. Realizou-se análise descritiva e regressão linear múltipla de mínimos quadrados ordinários, em busca de preditores para a variação no escore da escala. Resultados: o perfil dos usuários foi de 84% do sexo masculino, com idade média de 38,97 anos, brancos (85%), vivendo com familiares (43,5%) e com vínculo de trabalho informal (53%). Os preditores de gravidade dos problemas relacionados ao uso de substâncias foram: problemas de internalização e externalização, crime e violência, escolaridade e padrão de uso. Com relação a escala total, os preditores foram: sexo feminino, idade, situação de rua e padrão de uso. Conclusão: os preditores analisados apontam para fatores biopsicossociais que devem ser considerados no processo de cuidado desta população. Tais resultados destacam a necessidade de uma abordagem interdisciplinar, interprofissional e intersetorial, que pode ser norteada pelo projeto terapêutico singular.(AU)
Objective: to analyze the predictors of problems related to the consumption of psychoactive substances among users of a Psychosocial Care Center-Alcohol and Drugs. Method: a cross-sectional study with a quantitative approach conducted with 200 users of a Psychosocial Care Center-Alcohol and Drugs from inland São Paulo. The data were collected by means of a sociodemographic questionnaire and through the instrument called Global Assessment of Individual Needs - Short Screener. A descriptive analysis and multiple regression of ordinary least squares were performed searching predictors for the variation in the scale score. Results: the users' profile showed 84% males with a mean age of 38.97 years old, white-skinned (85%), living with family members (43.5%) and with informal employment contracts (53%). The predictors corresponding to severity of the substance-related problems were internalization and externalization, crime and violence, schooling and use pattern. In relation to the total scale, the predictors were female gender, age, street situation and use pattern. Conclusion: the predictors analyzed pointed to biopsychosocial factors that should be considered in the care process for this population group. The results highlight the need for an interdisciplinary, interprofessional and intersectoral approach that can be guided by the singular therapeutic project.(AU)
Objetivo: analizar los predictores de problemas relacionados al uso de sustancias entre usuarios de un Centro de Atención Psicosocial de Alcohol y Drogas. Método: estudio transversal de abordaje cuantitativo realizado con 200 usuarios de un Centro de Atención Psicosocial de Alcohol y Drogas del interior de São Paulo. Los datos fueron recolectados a través de un cuestionario sociodemográfico y de un instrumento denominado Evaluación Global de las Necesidades Individuales - Análisis Breve. Se realizó análisis descriptivo y regresión lineal múltiple por mínimos quadrados ordinarios en busca de predictores de la variación en la puntuación de la escala. Resultados: el perfil de los usuarios fue 84% masculino, edad media 38,97 años, raza blanca (85%), viviendo con familiares (43,5%) y con relación laboral informal (53%). Los predictores de gravedad de los problemas relacionados con el consumo de sustancias fueron: problemas de internalización y externalización, delincuencia y violencia, educación y patrón de consumo. En cuanto a la escala total, los predictores fueron: sexo femenino, edad, situación de calle y patrón de consumo. Conclusión: los predictores analizados apuntan a factores biopsicosociales que deben ser considerados en el proceso de atención a esta población. Estos resultados destacan la necesidad de un abordaje interdisciplinar, interprofesional e intersectorial, que puede ser norteado por el proyecto terapéutico singular.(AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Saúde Mental , Transtornos Relacionados ao Uso de Substâncias , Reabilitação Psiquiátrica , Transtornos Mentais/diagnóstico , Fatores Socioeconômicos , Inquéritos e Questionários , Serviços de Saúde MentalRESUMO
ABSTRACT Objective: to present the representative model of the social interaction of women exposed to the Human Immunodeficiency Virus and AIDS based on the meanings attributed by them. Method: an interpretative and qualitative research study carried out in Rio de Janeiro, Brazil, from 2017 to 2018, through semi-structured interviews with 17 women who made up four sample groups, in the period between June 2017 and January 2018. The framework for data analysis is the Grounded Theory and Symbolic Interactionism, and the study was ethically approved as required by the National Health Council. Results: for women, the representative model of the social interaction process of exposure to the Human Immunodeficiency Virus and AIDS means "not protecting themselves" and "not being protected by the other". It is seen as a sloppy, irresponsible and reckless act. The women know the measures to prevent exposure; however, they do not use condoms and acknowledge that they are both exposed and exposing others simultaneously. The central category entitled "Neglecting one's own life although being aware of exposure to the Human Immunodeficiency Virus and AIDS" stands out. Conclusion: understanding this social interaction can contribute to the apprehension of the main factors that influence the construction of these meanings by women, thus helping them to give a new meaning to this exposure and allowing them to modify their actions to protect themselves and others against AIDS. Consequently, effective assistance based on preservation of life is encouraged, with a view to comprehensive care to women and reducing their exposure to infection.
RESUMEN Objetivo: presentar un modelo representativo de la interacción social de mujeres expuestas al Virus de la Inmunodeficiencia Humana y al SIDA a partir de los significados que ellas les atribuyen. Método: investigación interpretativa y cualitativa realizada en Río de Janeiro, Brasil, entre 2017 y 2018, por medio de entrevistas semiestructuradas con 17 mujeres que conformaron cuatro grupos muestrales, entre junio de 2017 y enero de 2018. El marco referencial para el análisis de los datos está compuesto por la Grounded Theory y por el Interaccionismo Simbólico, y el estudio contó con la debida aprobación ética según lo exigido por el Consejo Nacional de Salud. Resultados: para las mujeres, el modelo representativo del proceso de interacción social, con exposición al Virus de la Inmunodeficiencia Humana y al SIDA significa "no protegerse" y "no ser protegida por la otra persona". Se considera como una acción descuidada, irresponsable e imprudente. Las mujeres conocen las medidas de prevención para evitar la exposición; sin embargo, no usan preservativos y reconocen que están expuestas y exponiendo a los demás simultáneamente. Se destaca la categoría central: "Descuidar la vida propia a pesar de ser conscientes de la exposición al Virus de la Inmunodeficiencia Humana y al SIDA". Conclusión: entender este proceso de interacción social podrá contribuir para aprehender los principales factores que influencian la elaboración de estos significados por parte de las mujeres, proporcionándoles así ayuda para atribuir un nuevo significado a esta exposición y permitiendo que modifiquen sus acciones para protegerse del SIDA. De este modo, se fomenta una asistencia efectiva basada en preservar la vida, vislumbrando atención integral a las mujeres y reduciendo su exposición a la infección.
RESUMO Objetivo: apresentar o modelo representativo da interação social de mulheres com a exposição ao Vírus da Imunodeficiência Humana e Aids a partir dos significados por elas atribuídos. Método: pesquisa interpretativa e qualitativa, realizada no Rio de Janeiro, Brasil, de 2017 a 2018, por meio de entrevistas semiestruturadas com 17 mulheres que formaram quatro grupos amostrais, no período entre junho de 2017 e janeiro de 2018. O referencial para a análise de dados é a Grounded Theory e o Interacionismo Simbólico e o estudo foi aprovado eticamente como exigido pelo Conselho Nacional de Saúde. Resultados: o modelo representativo do processo de interação social, exposição ao Vírus da Imunodeficiência Humana e Aids significa, para as mulheres, "não se proteger" e "não ser protegida pelo outro". É tido como ato desleixado, irresponsável, imprudente. As mulheres conhecem as medidas de prevenção à exposição, entretanto, não usam preservativos e reconhecem que estão, ao mesmo tempo, expostas e expondo outros. Destaca-se a categoria central: "Descuidando da própria vida apesar da consciência da exposição ao Vírus da Imunodeficiência Humana e Aids". Conclusão: entender esse processo de interação social poderá contribuir para a apreensão dos principais fatores que influenciam a construção desses significados pela mulher, assim, proporcionando auxílio a ela na ressignificação dessa exposição e permitindo que ela modifique suas ações para a proteção contra a Aids. Desse modo, fomenta-se uma assistência efetiva baseada na preservação da vida, vislumbrando um atendimento integral à mulher e diminuindo sua exposição à infecção.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Saúde da Mulher , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Interacionismo Simbólico , Interação Social , Conhecimentos, Atitudes e Prática em Saúde , Entrevistas como Assunto , Pesquisa QualitativaRESUMO
ABSTRACT Objectives: to analyze burden predictors in mental health workers during the COVID-19 pandemic. Methods: a quantitative study, collected between October and December 2020 through a sociodemographic questionnaire and Mental Health Service Burden Assessment Scale, in four services in a municipality in the state of São Paulo, Brazil, with 108 workers. Descriptive analysis and multiple linear regression of ordinary least squares were performed, in search of predictors for variation in the scale score. Results: it showed median work burden (2.03). Predictors: psychological or psychiatric follow-up; normal performance of activities during the pandemic; direct action with suspected or confirmed cases of COVID-19; and belonging to the risk group (people over 60 years of age, diabetics, hypertensive, cardiac, respiratory problems) (p<0.05). Conclusions: working conditions observed during the pandemic, simultaneously with workers' mental health care needs predict burden at work in health.
RESUMEN Objetivos: analizar los predictores de sobrecarga del trabajador de salud mental durante la pandemia de COVID-19. Métodos: estudio cuantitativo, recolectado entre octubre y diciembre de 2020 a través de un cuestionario sociodemográfico y la Escala de Evaluación de la Carga de los Profesionales en Servicios de Salud Mental, en cuatro servicios de un municipio del estado de São Paulo, Brasil, con 108 trabajadores. Se realizó análisis descriptivo y regresión lineal múltiple por mínimos cuadrados ordinarios, en busca de predictores para la variación en el puntaje de la escala. Resultados: hubo mediana sobrecarga de trabajo (2,03). Predictores: seguimiento psicológico o psiquiátrico; normal desempeño de actividades durante la pandemia; actuación directa con casos sospechosos o confirmados de COVID-19; y pertenecer al grupo de riesgo (personas mayores de 60 años, diabéticos, hipertensos, cardíacos, respiratorios) (p<0,05). Conclusiones: las condiciones de trabajo observadas durante la pandemia, simultáneamente con las necesidades de atención a la salud mental de los trabajadores, predicen sobrecarga laboral en salud.
RESUMO Objetivos: analisar os preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19. Métodos: estudo quantitativo, coletado entre outubro e dezembro de 2020 por meio de questionário sociodemográfico e Escala de Avaliação da Sobrecarga de Profissionais em Serviços de Saúde Mental, em quatro serviços de um município do estado de São Paulo, Brasil, com 108 trabalhadores. Realizou-se análise descritiva e regressão linear múltipla de mínimos quadrados ordinários, em busca de preditores para a variação no escore da escala. Resultados: evidenciou-se mediana sobrecarga de trabalho (2,03). Preditores: acompanhamento psicológico ou psiquiátrico; desempenho normal das atividades durante a pandemia; atuação direta com casos suspeitos ou confirmados de COVID-19; e pertencer ao grupo de risco (pessoas acima de 60 anos, diabéticos, hipertensos, cardiopatas, problemas respiratórios) (p<0,05). Conclusões: condições de trabalho observadas durante a pandemia, simultaneamente com necessidades de cuidado à saúde mental dos trabalhadores, predizem sobrecarga no trabalho em saúde.
RESUMO
RESUMO Objetivo: realizar revisão da literatura e pela síntese de evidências elaborar um fluxograma de assistência de Enfermagem na síndrome de abstinência alcoólica (SAA). Método: foram executadas as primeiras etapas de elaboração de um protocolo clínico de Enfermagem. Na etapa "a" definiu-se o objetivo do protocolo; na etapa "b" realizou-se pesquisa da literatura científica para levantamento de evidências; e na etapa "c", a partir das evidências, elaborou-se um fluxograma de assistência de Enfermagem na SAA. A coleta de dados ocorreu em janeiro de 2019 nas bases de dados: Biblioteca Virtual em Saúde, PubMed, CINAHL, PSYINFO e MEDLINE. Os resultados foram apresentados em tabelas e figuras. Resultados: oito estudos foram incluídos na revisão. As evidências subsidiaram a elaboração do fluxograma de assistência de Enfermagem na SAA sistematizado nas seguintes fases: acolhimento e abordagem dos usuários de álcool com manifestação de sinais e sintomas de SAA; rastreio; intervenções; e encaminhamento. Conclusão: com a síntese das evidências foi possível a elaboração de um fluxograma de assistência de Enfermagem na SAA, o qual pode contribuir para o aprimoramento das respostas em saúde a esse problema, bem como é suficiente para dar seguimento às etapas de validação de um protocolo clínico.
RESUMEN Objetivo: revisar la literatura y, a través de la síntesis de evidencia, elaborar un diagrama de flujo de los cuidados de enfermería en el síndrome de abstinencia alcohólica (SAA). Método: se realizaron los primeros pasos para desarrollar un protocolo clínico de enfermería. En el paso "a" se definió el objetivo del protocolo; en el paso "b" se realizó una búsqueda de la literatura científica para recolectar evidencia; y en el paso "c", con base en la evidencia, se elaboró un diagrama de flujo de la atención de enfermería en la SAA. La recolección de datos se realizó en enero de 2019 en las siguientes bases de datos: Biblioteca Virtual en Salud, PubMed, CINAHL, PSYINFO y MEDLINE. Los resultados se presentaron en tablas y figura. Resultados: se incluyeron ocho estudios en la revisión. La evidencia apoyó la elaboración del diagrama de flujo de cuidados de enfermería en el SAA sistematizado en las siguientes fases: recepción y abordaje de consumidores de alcohol con manifestación de signos y síntomas de SAA; Seguimiento; intervenciones; y reenvío. Conclusión: con la síntesis de evidencias, fue posible desarrollar un diagrama de flujo de cuidados de enfermería en el SAA, que puede contribuir a la mejora de las respuestas de salud a esta problemática, además de ser suficiente para dar seguimiento a los pasos de validación de un protocolo clínico.
ABSTRACT Objective: to review the literature and, through the synthesis of evidence, elaborate a flowchart of Nursing care in the alcohol withdrawal syndrome (AWS). Method: the first steps of elaboration of a clinical Nursing protocol were carried out. In step "a" the objective of the protocol was defined; in step "b" a search of the scientific literature was carried out to gather evidence; and in step "c", based on the evidence, a flowchart of Nursing care in the AWS was elaborated. Data collection took place in January 2019 in the following databases: Virtual Health Library, PubMed, CINAHL, PSYINFO and MEDLINE. The results were presented in tables and figures. Results: eight studies were included in the review. The evidence supported the elaboration of the Nursing care flowchart in the AWS systematized in the following phases: reception and approach to alcohol users with manifestation of AWS signs and symptoms; Tracking; interventions; and forwarding. Conclusion: with the synthesis of evidence, it was possible to develop a flowchart of Nursing care in the SAA, which can contribute to the improvement of health responses to this problem, as well as being sufficient to follow up on the steps of validation of a clinical protocol.