New evidence in support of staging approaches in schizophrenia: Differences in clinical profiles between first episode, early stage, and late stage.

Few studies have examined the progression of symptom dimensions in schizophrenia patients over the course of the illness. The objective of this study was to investigate whether clinical and psychopathological differences exist between first-episode schizophrenia (FES) and multiple-episode patients in an inpatient setting. Patients (N=203) were evaluated using the Positive and Negative Syndrome Scale (PANSS) over time. Five different generalized estimating equations were built for the PANSS factors using the following as covariates: sex, patient's age, assessment time point (i.e., moment of patient's evaluation, with a minimum of two and a maximum of four assessments throughout the study timeframe). The FES group was used as the reference to which the groups with up to five years of illness and more than five years of illness were compared. Remission rates and treatment resistance (TRS) rates were also compared. Generalized estimating equations were used to allow for different numbers of assessments over the study period. Patients with FES showed significantly milder severity in positive, disorganized, and hostility factors. Also, FES patients were more likely to achieve remission (P=0.002) and had lower rates of TRS (P=0.001). First-episode schizophrenia seems to be the critical period to improve outcome, as multiple-episode patients were similar in clinical characteristics regardless of illness duration.

[Integrated management of childhood illness (IMCI) in the practice of nurses graduated from USP]. / Atenção integrada as doenças prevalentes na infância (AIDPI) na prática de enfermeiros egressos da USP.

This is a description of the Integrated Management of Childhood Illness (IMCI) strategy in the professional practice of nurses graduated from the School of Nursing of University of São Paulo (EE-USP). This is a case study of qualitative approach. The data were collected through focus groups and analyzed using thematic content analysis. IMCI strategy was considered an important tool in child health care, but only the assessment module was apart of professional practice. Difficulties in the use of the IMCI were: the strategy was not implanted at health services, it was unknown by co-workers and institutional obstacles. In spite of the limited and non-systematic use of IMCI, it has allowed nurses to provide integrated and comprehensive attention to the child, which justifies its teaching on undergraduate courses. Maintenance of the educational video, expansion of the practice, integration of courses and optimization of content and workload were suggested for improving the teaching of IMCI at the undergraduate level.

Disorganized Symptoms Predicted Worse Functioning Outcome in Schizophrenia Patients with Established Illness.

Most patients with schizophrenia will have subsequent relapses of the disorder, with continuous impairments in functioning. However, evidence is lacking on how symptoms influence functioning at different phases of the disease. This study aims to investigate the relationship between symptom dimensions and functioning at different phases: acute exacerbation, nonremission and remission. METHODS: Patients with schizophrenia were grouped into acutely ill (n=89), not remitted (n=89), and remitted (n=69). Three exploratory stepwise linear regression analyses were performed for each phase of schizophrenia, in which the five PANSS factors and demographic variables were entered as the independent variables and the total Global Assessment of Functioning Scale (GAF) score was entered as the dependent variable. An additional exploratory stepwise logistic regression analysis was performed to predict subsequent remission at discharge in the inpatient population. RESULTS: The Disorganized factor was the most significant predictor for acutely ill patients (p<0.001), while the Hostility factor was the most significant for not-remitted patients and the Negative factor was the most significant for remitted patients (p=0.001 and p<0.001, respectively). In the logistic regression, the Disorganized factor score presented a significant negative association with remission (p=0.007). CONCLUSIONS: Higher disorganization symptoms showed the greatest impact in functioning at acute phase, and prevented patients from achieving remission, suggesting it may be a marker of symptom severity and worse outcome in schizophrenia.

Effects of depression on the cytokine profile in drug naïve first-episode psychosis.

Schizophrenia is accompanied by alterations in immuno-inflammatory pathways, including abnormalities in cytokine profile. The immune assessment of patients in a first episode of psychosis (FEP) and particularly in drug naïve patients is very important to further elucidate this association. The objectives of this study are to delineate the cytokine profile (IL-2, IL-10, IL-4, IL-6, IFNγ, TNFα and IL-17) in FEP patients (n=55) versus healthy controls (n=57) and to examine whether the presence of depressive symptoms in FEP is accompanied by a specific cytokine profile. We found increased levels of IL-6, IL-10 and TNFα in FEP patients when compared to healthy controls. FEP patients with depression showed higher IL-4 and TNFα levels versus those without depression. Cytokine levels were not correlated to the total PANSS and the positive or negative subscale scores. Our results suggest that FEP is accompanied by a cytokine profile indicative of monocytic and T regulatory cell (Treg) activation. Depression in FEP is accompanied by monocytic and Th-2 activation, whereas FEP without depression is characterized by Treg activation only. In conclusion, depression emerged as a key component explaining the cytokines imbalance in FEP that is responsible for a large part of the immune-inflammatory abnormalities described.

Increased expression of NDEL1 and MBP genes in the peripheral blood of antipsychotic-naïve patients with first-episode psychosis.

Schizophrenia is a multifactorial neurodevelopmental disorder with high heritability. First-episode psychosis (FEP) is a critical period for determining the disease prognosis and is especially helpful for identifying potential biomarkers associated with the onset and progression of the disorder. We investigated the mRNA expression of 12 schizophrenia-related genes in the blood of antipsychotic-naïve FEP patients (N=73) and healthy controls (N=73). To evaluate the influences of antipsychotic treatment and progression of the disorder, we compared the gene expression within patients before and after two months of treatment with risperidone (N=64). We observed a significantly increased myelin basic protein (MBP) and nuclear distribution protein nudE-like 1 (NDEL1) mRNA levels in FEP patients compared with controls. Comparing FEP before and after risperidone treatment, no significant differences were identified; however; a trend of relatively low NDEL1 expression was observed after risperidone treatment. Animals chronically treated with saline or risperidone exhibited no significant change in Ndel1 expression levels in the blood or the prefrontal cortex (PFC), suggesting that the trend of low NDEL1 expression observed in FEP patients after treatment is likely due to factors other than risperidone treatment (i.e., disease progression). In addition to the recognized association with schizophrenia, MBP and NDEL1 gene products also play an essential role in the functions that are deregulated in schizophrenia, such as neurodevelopment. Our data strengthen the importance of these biological processes in psychotic disorders, indicating that these changes can be detected peripherally and potentially represent putative novel blood biomarkers of susceptibility and disorder progression.

Teaching of the Integrated Management of Childhood Illness strategy in undergraduate nursing programs.

OBJECTIVE: To describe and analyze the teaching of the Integrated Management of Childhood Illness (IMCI) strategy on Brazilian undergraduate nursing programs. METHOD: Integrating an international multicentric study, a cross-sectional online survey was conducted between May and October 2010 with 571 undergraduate nursing programs in Brazil RESULTS: Responses were received from 142 programs, 75% private and 25% public. 64% of them included the IMCI strategy in the theoretical content, and 50% of the programs included IMCI as part of the students' practical experience. The locations most used for practical teaching were primary health care units. The 'treatment' module was taught by the fewest number of programs, and few programs had access to the IMCI instructional manuals. All programs used exams for evaluation, and private institutions were more likely to include class participation as part of the evaluation. Teaching staff in public institutions were more likely to have received training in teaching IMCI. CONCLUSION: In spite of the relevance of the IMCI strategy in care of the child, its content is not addressed in all undergraduate programs in Brazil, and many programs do not have access to the IMCI teaching manuals and have not provide training in IMCI to their teaching staff.

Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) na prática de enfermeiros egressos da USP / Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI) en la práctica de enfermeros graduados en USP / Integrated Management of Childhood Illness (IMCI) in the practice of nurses graduated from USP

Descreveu-se a incorporação da estratégia Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) na prática de enfermeiros egressos da Escola de Enfermagem da Universidade de São Paulo (EE-USP). Desenvolveu-se estudo de caso de abordagem qualitativa, com coleta de dados em grupo focal e análise de conteúdo do tipo temática. A estratégia AIDPI foi considerada ferramenta importante na atenção à saúde infantil, porém apenas o módulo de avaliação fazia parte da prática profissional. Destacam-se como dificuldades para sua utilização: não implantação nos serviços, desconhecimento por parte de colegas e barreiras institucionais. Ainda que com uso restrito e não sistematizado, a AIDPI possibilita ao enfermeiro prestar atenção integrada e integral à criança o que justifica sua abordagem na graduação. Manutenção do vídeo didático, ampliação da prática, integração das disciplinas e otimização dos conteúdos e da carga horária foram apontadas como relevantes para o aperfeiçoamento do ensino da AIDPI na graduação.

Se describió la incorporación de la estrategia Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI) en la práctica de enfermeros formados en la Escuela de Enfermería de la Universidad de São Paulo (EE-USP). Estudio de caso de carácter cualitativo, con recogida de datos en grupos focales y análisis de contenido temático. AIEPI fue considerada importante herramienta en el cuidado del niño, pero sólo el módulo de evaluación hacía parte de la práctica profesional. Dificultades en el uso de AIEPI fueron: no implantación en los servicios, desconocimiento de la estrategia por parte de colegas, barreras institucionales. Aunque con uso restringido y no sistematizado, cuando utilizado AIEPI permite a los enfermeros prestar atención integrada y integral al niño, lo que justifica su contenido en la graduación. Mantenimiento de vídeo educativo, expansión de práctica, integración de disciplinas y optimización del contenido y carga horaria fueron destacados como importantes para mejorar la enseñanza de AIEPI en el pregrado.

We described the use of the Integrated Management of Childhood Illness (IMCI) strategy in the professional practice of nurses graduated from the School of Nursing of University of São Paulo (EE-USP). A case study of qualitative approach was conducted. Data were collected from focus groups and we did thematic content analysis. IMCI strategy was considered an important tool in child health care, but only the assessment module was part of professional practice. Difficulties in the use of the IMCI were: the strategy was not implanted at health services, it was unknown to part of co-workers and institutional obstacles. Despite of the limited and non-systematic use of IMCI, it has allowed nurses to provide integrated and comprehensive attention to the child, which justifies its teaching on undergraduate courses. Maintenance of the tutorial video, expansion of the practice, integration of disciplines and optimization of content and workload were suggested for improving the teaching of IMCI in undergraduate courses.

Atenção Integrada às Doenças Prevalentes na Infância: conhecimento e prática de egressos da Escola de Enfermagem da Universidade de São Paulo – um estudo de caso / Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI): el conocimiento y la práctica de los enfermeros que se han graduado de la Escuela de Enfermería de la Universidad de São Paulo – un estudio de caso / Integrated Management of Childhood Illness (IMCI): knowledge and practice of nurses who have graduated from School of Nursing at University of São Paulo – a case study

The aim of this study was to identify knowledge and practice about the strategy of Integrated Management of Childhood Illness (IMCI) in the professional practice of graduates of the School of Nursing at University of São Paulo (EEUSP). It was developed a descriptive study from a quantitative approach. Online questionnaire, created and managed by the editor Dream Weaver, was sent to 396 graduate students from 2003-2007. From this total, 62 (16.6%) were labeled as non-existent addresses and 61 (15.4%) questionnaires were filled. The descriptive analysis was performed using SPSS version 16.0. Most respondents were women (91.8%) and the participant ages concentrated between 25 and 29 years old (65.6%). Two-thirds had made at least one graduate course, mostly in hospitals. Only one-third worked or works in primary care. Two ex-students correctly answered all the questions about knowledge, one of them with training in IMCI. The strategy was remembered as part of the undergraduate curriculum for almost all graduates (95.1%) and useful for 86.9%. For 45.9%, the workload was insufficient for their learning and practice and 37.7% did not feel confident to apply the strategy in professional practice. The results showed that almost all participants remembered the strategy in the undergraduate curriculum and most consider it useful. On the other hand, more than one third did not feel confident to apply it, and little of the theoretical content has been consolidated. This data suggests the need for a revision of the teaching methodology adopted.

Com o objetivo de identificar conhecimentos adquiridos sobre a estratégia de Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) e consolidados na prática profissional de egressos da Escola de Enfermagem da Universidade de São Paulo (EEUSP), desenvolveu-se um estudo descritivo de abordagem quantitativa. Constituiu-se no envio de questionário online, criado e gerenciado pelo editor Dream Weaver, a 396 egressos de 2003-2007. Desse total, 62 (15,6%) retornaram por endereços inexistentes e obteve-se retorno de 61 (15,4%) questionários preenchidos. As análises foram realizadas com uso do programa SPSS versão 16.0. A maioria dos respondentes foram mulheres (91,8%) com idade entre 25-29 anos (65,6%). Dois terços haviam feito pelo menos um curso de aperfeiçoamento, em sua maioria na área hospitalar. Apenas um terço atua ou atuou na atenção básica. Dois egressos responderam corretamente todas as questões sobre conhecimento, sendo um deles o único que referiu capacitação em AIDPI. A estratégia foi lembrada como parte do currículo da graduação por quase todos os egressos (95,1%) e útil para 86,9% Para 45,9%, a carga horária foi insuficiente para seu aprendizado e 37,7% não se sentiram seguros para aplicar a estratégia na vida profissional. Os resultados evidenciaram que quase a totalidade se lembra da estratégia no currículo da graduação e a grande maioria a considera útil, porém mais de um terço não se sentia seguro e pouco do conteúdo teórico foi consolidado. Esses dados sugerem a necessidade de revisão da metodologia de ensino empregada.

Con el objetivo de identificar conocimiento acerca de la estrategia de Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI), consolidadas en la práctica profesional de egresados de la Escuela de Enfermería de la Universidad de São Paulo (EEUSP), se desarrolló un estudio descriptivo de enfoque cuantitativo. Consistió en el envío de cuestionario en línea, creado y administrado por el editor Dream Weaver, a 396 estudiantes graduados en el período 2003-2007. De este total, 62 (15,6%) regresó por e-mail no existentes y se obtuvo retorno de 61 (15,4%) cuestionarios completados. El análisis se realizó mediante SPSS versión 16.0. La mayoría de los encuestados fueron mujeres (91,8%) de edades entre 25-29 años (65,6%). Dos tercios habían hecho al menos un curso de postgrado, principalmente en área hospitalario. Sólo un tercio trabajaba o tenía trabajado en la atención primaria. Dos ex-alumnos respondieran correctamente a todas las preguntas de conocimiento, uno de ellos el único con capacitación postgrado en AIEPI. La estrategia fue recordada como parte del currículo de pregrado por casi todos los graduados (95,1%) y referida como útil por 86,9%. Para 45,9%, el volumen de contenido fuera insuficiente para su aprendizaje y 37,7% no se sentirán seguros para aplicar la estrategia en la práctica profesional. Los resultados mostraron que casi todos recordaban de la estrategia en el currículo de pregrado y la gran mayoría considera que es útil, pero más de un tercio no se sentía seguro y poco contenido teórico se ha consolidado. Estos datos sugieren la necesidad de revisión de la metodología de enseñanza utilizada.