Closed doors: Predictors of stress, anxiety, depression, and PTSD during the onset of COVID-19 pandemic in Brazil.

BACKGROUND: The rise in mental health problems in the population directly or indirectly because of the coronavirus disease 2019 (COVID-19) pandemic is a major concern. The aim of this study was to investigate and compare independent predictors of symptoms of stress, anxiety, depression, and posttraumatic stress disorder (PTSD) in Brazilians one month after the implementation of measures of social distancing. METHODS: This cross-sectional study was performed using a web-based survey. The Depression, Anxiety, and Stress Scale (DASS-21) and PTSD Checklist for DSM-5 (PCL-5) were the outcomes. Data were gathered regarding demographics, social distancing, economic problems, exposure to the news of the pandemic, psychiatric history, sleep disturbances, traumatic situations, and substance use. The Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) was also administered. The predictors of the symptoms were investigated using hierarchical multiple linear regression. RESULTS: Of a sample of 3587 participants, approximately two-thirds considered that their mental health worsened after the beginning of the social restriction measures. The most important predictors of the symptoms investigated were the intensity of the distress related to the news of the pandemic, younger age, current psychiatric diagnosis, trouble sleeping, emotional abuse or violence, and economic problems. CONCLUSIONS: These results confirmed the hypothesis that the pandemic impacted the mental health of the population and indicated that the level of distress related to the news was the most important predictor of psychological suffering.

Therapeutic itineraries in medical education: a device for teaching Public Health in times of pandemic / Itinerários terapêuticos na formação médica: dispositivo para o ensino da Saúde Coletiva

Abstract: Introduction: The implementation of innovative pedagogical strategies in medical training is the discipline of this experience report. It aims to present the systematization of Therapeutic Itineraries (TI) and the production of Singular Therapeutic Projects (STP) for users of the Brazilian Unified Health System as a learning tool for the teaching of Public Health. Experience report: created based on the experience of teachers and monitors involved with this training in the undergraduate Medical School of Universidade Federal de Santa Maria, Rio Grande do Sul, Brazil, between the years 2017 and 2019. The TIs were initially considered from a perspective restricted to the description and analysis of the organization of the health care network (HCN), the access and flows in the services. Based on the debates, contents and production of the STPs, the TIs were revisited in order to contribute to students' understanding of the relationship between the broader social structure and the individuality of people, their needs and the health care processes. Discussion: The experience, as proposed in its formulation, allowed the articulation of theoretical and practical fields and was a tool that articulated the different programmatic contents proposed in the Discipline of Public Health II. It has also become a viable pedagogical strategy in the real circumstances of offering the discipline, in a context in which Public Health can be more present in professional training. Conclusion: The action-reflection-action process allowed, at first, to recognize the Health Care Network, a structural component of the system. Based on the construction of the STP and the debate on the lines of comprehensive care, it was possible to qualify the analysis. The systematization of TI is a theoretical-methodological approach consolidated in health research and was a tool that showed to be effective for the teaching of Public Health and for learning about the practices and reconfiguration of the work of teachers and monitors on the discipline and, therefore, a permanent education strategy for both students and those responsible for their training.

Resumo: Introdução: A implementação de estratégias pedagógicas inovadoras na formação médica é o tema deste relato de experiência. O objetivo deste relato é apresentar a sistematização de itinerários terapêuticos (IT) e a produção de projetos terapêuticos singulares (PTS) de usuários do Sistema Único de Saúde como dispositivo de aprendizagem para o ensino da saúde coletiva. Relato de experiência: Este relato foi produzido com base na vivência dos docentes e monitores implicados com essa formação na graduação em Medicina da Universidade Federal de Santa Maria, no Rio Grande do Sul, no Brasil, entre os anos de 2017 e 2019. Os IT foram considerados inicialmente numa perspectiva restrita à descrição e análise da organização da rede de atenção à saúde (RAS), do acesso e dos fluxos nos serviços. A partir dos debates, dos conteúdos e da produção dos PTS, os IT foram revisitados com o intuito de contribuir para a compreensão dos estudantes sobre a relação entre a estrutura social mais ampla e a singularidade das pessoas, de suas necessidades e dos processos de cuidado voltado à saúde. Discussão: A experiência, como proposto na sua formulação, viabilizou a articulação dos campos teóricos e práticos, e foi uma ferramenta que articulou os diferentes conteúdos programáticos propostos na disciplina de Saúde Coletiva II. Tornou-se, também, uma estratégia pedagógica viável nas condições reais da oferta da disciplina, num contexto em que a saúde coletiva pode estar mais presente na formação profissional. Conclusão: O processo de ação-reflexão-ação possibilitou, num primeiro momento, o reconhecimento da RAS, componente estrutural do sistema. A partir da construção do PTS e do debate sobre as linhas de cuidado integral, foi possível qualificar a análise. A sistematização de IT é uma abordagem teórico-metodológica consolidada na pesquisa em saúde e foi um dispositivo que se mostrou potente para ensino da saúde coletiva e para o aprendizado sobre as práticas e a reconfiguração do trabalho dos docentes e monitores da disciplina; portanto, trata-se de uma estratégia de educação permanente tanto para os estudantes quanto para os responsáveis pela formação.