The knowledge of primary health care professionals regarding mental health: diagnosis by mhGAP.

OBJECTIVE: To analyze knowledge about priority topics in mental health care of strategic actors who work in regions where the Health Care Planning (PAS) methodology is used. METHODS: This is a quantitative, descriptive, cross-sectional, and observational study carried out with professionals from six health regions, distributed in three Brazilian states (Goiás, Rondônia and Maranhão) and linked to the project "Saúde mental na APS" (Mental health in PHC) of the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (Proadi-SUS - Institutional Development Support Program of the Brazilian Unified Health System). The sample was made up of professionals who participated in the intervention guide multiplier training stage for mental, neurological and alcohol and other drug use disorders in the primary health care network, from July to September 2022. Data collection was through a self-administered instrument, in electronic format, consisting of a block with socioeconomic items and a structured questionnaire to assess participants' knowledge about priority topics in mental health. Descriptive analyses and comparison of proportions were conducted to analyze the data. RESULTS: A total of 354 health professionals participated in the study. Regarding the percentage of correct answers in the questionnaire on priority topics in mental health, the highest medians were identified in the "Depression" module. On the other hand, the content referring to the modules "Essential care and practices" and "Other important complaints" presented the lowest values. Furthermore, some participant characteristics were found to be associated with the percentage of correct answers in the questionnaire modules. CONCLUSIONS: The findings reveal opportunities for improvement, mainly in knowledge related to communication skills and the approach to emotional and physical distress without diagnostic criteria for a specific disease, offering support for planning actions aimed at intensifying the consideration of these themes during the operational stages of PAS.

Implementation of a digital tool for population management in Primary Health Care.

OBJECTIVE: Describe the implementation of a digital diagnostic and territorial monitoring tool in primary healthcare. METHODS: Quantitative and qualitative study, developed in 14 basic healthcare units in São Paulo, with community health workers, coordinators, nurses, and physicians. Data collection occurred in four phases: analysis of the instruments used by the team for territory management; development of the digital tool; training and implementation; and evaluation after 90 days using focus groups. Descriptive analyses were conducted by calculating absolute and relative frequencies to treat quantitative data. Qualitative data were subjected to content analysis. RESULTS: Three hundred thirty-four professionals participated in the study. In the first step, territory management's main challenges were filling out various instruments, system failures, data inconsistency, internet infrastructure/network, and lack of time. Therefore, a digital tool was developed consisting of 1) a spreadsheet recording the number of family members and markers of health conditions, date of visit, and number of return visits; 2) a spreadsheet with a summary of families visited, not visited, and refusals; and 3) a panel with a summary of the data generated instantly. In the evaluation, after the initial use of the tool, the themes that emerged were integration of the tool into daily work, evaluation of the digital tool implementation process, and improvement and opportunities for improvement. CONCLUSIONS: Faced with the challenges faced by family healthcare teams when filling out systems and managing the territory, the tool developed provided greater reliability and agility in data visualization, reduced the volume of instruments, and optimized the work process.

Brazilian Scale for Evaluation of Mental Health Care Needs: Additional Evidence.

OBJECTIVE: To investigate validity evidence of the Brazilian Scale for Evaluation of Mental Health Care Needs (CuidaSM). METHODS: This is a psychometric study, which seeks additional evidence of internal structure. Data collection was carried out in 11 Primary Health Care (PHC) services , which implement the Health Care Planning (HCP) methodology, distributed across the five Brazilian regions. The preliminary version of CuidaSM, containing a block self-referred by the user and another block evaluated by PHC professionals, was applied to users aged 18 or over who attended the PHC services for consultation with a higher education professional. The techniques of confirmatory factor analysis and network analysis were used to investigate validity evidence. For the primary data of the confirmatory factor analysis, the factorial loads and the item's predictive power (R2) were used. Six model adjustment indices were adopted and reliability was measured by three indicators using Bayesian estimation. RESULTS: A total of 879 users participated in the study. By confirmatory factor analysis, factorial loads ranged from 0.43 to 0.99 and R2 from 0.19 to 0.98. Both the primary indicators and the model adequacy indices were established at satisfactory and consistent levels. The network analysis showed that the items were appropriately associated with their peers, respecting the established dimensions, which again indicates the sustainability and stability of the proposed model. CONCLUSIONS: The study findings confirm a consistent and reliable model of the instrument, through a combination of techniques. Considering the importance of using solid instruments in clinical practice, CuidaSM is a promising tool for population-based management and network care organization, aligned with HCP proposals.

Apoio social na prática de atividade física de trabalhadores / Apoyo social en la práctica de actividad física de trabajadores / Social support in workers' physical activity

Resumo Objetivo Analisar a função dos apoios sociais formal e informal na prática de atividade física durante o tempo livre de trabalhadores. Métodos Estudo transversal realizado com 395 trabalhadores técnicos administrativos em uma universidade pública. Os dados foram coletados utilizando: questionário sociodemográfico, Questionário de Atividade Física Habitual de Baecke e Escala de Apoio Social para a prática de Atividade Física. Os dados foram analisados por meio de estatística descritiva, teste t de Student, teste d de Cohen e Análise de Variância. Resultados Os participantes que referiram algum tipo de apoio para atividade física no tempo livre (92,2%) apresentaram maiores médias no escore de atividade física. O apoio institucional (58,0%) teve função de destaque como potencial influenciador em comparação ao apoio de chefias imediatas (14,2%), embora elas tenham exercido um certo diferencial entre os trabalhadores da manutenção. Conclusão O apoio social tem função importante na promoção da atividade física no tempo livre de trabalhadores. As iniciativas institucionais de estímulo ao comportamento ativo no ambiente de trabalho carecem de alinhamento com o incentivo por parte dos superiores imediatos, para que sejam mais efetivas.

Resumen Objetivo Analizar la función del apoyo social formal e informal en la práctica de actividad física durante el tiempo libre de trabajadores. Métodos Estudio transversal realizado con 395 trabajadores técnicos administrativos de una universidad pública. Los datos se recopilaron utilizando un cuestionario sociodemográfico, el Cuestionario de Actividad Física Habitual de Baecke y la Escala de Apoyo Social para la Práctica de Actividad Física. Los datos se analizaron mediante estadística descriptiva, test-T de Student, prueba d de Cohen y análisis de varianza. Resultados Los participantes que relataron algún tipo de apoyo para actividad física en el tiempo libre (92,2 %) presentaron mayores promedios en el puntaje de actividad física. El apoyo institucional (58,0 %) tuvo una función destacada como posible influenciador en comparación con el apoyo de jefes directos (14,2 %), aunque estos últimos hayan ejercido cierto diferencial entre los trabajadores de mantenimiento. Conclusión El apoyo social tiene una función importante en la promoción de la actividad física en el tiempo libre de trabajadores. Las iniciativas institucionales de estímulo a un comportamiento activo en el ambiente de trabajo necesitan estar alineadas con el incentivo por parte de los superiores inmediatos para que sean más efectivas.

Abstract Objective To analyze the role of formal and informal social support in the practice of physical activity during workers' leisure time. Methods A cross-sectional study carried out with 395 technical administrative workers at a public university. Data were collected using sociodemographic questionnaire, Baecke Habitual Physical Activity Questionnaire and Physical Activity and Social Support Scale. Data were analyzed using descriptive statistics, Student's t test, Cohen's d test and Analysis of Variance. Results Participants who reported some type of support for physical activity in their leisure time (92.2%) had higher means in the physical activity score. Institutional support (58.0%) had a prominent role as a potential influencer compared to support from immediate superiors (14.2%), although they had a certain differential among maintenance workers. Conclusion Social support plays an important role in promoting physical activity in workers' leisure time. Institutional initiatives to encourage active behavior in the work environment need to be aligned with encouragement by immediate superiors so that they are more effective.

Implementation of a digital tool for population management in Primary Health Care / Implementação de ferramenta digital para gestão populacional na atenção primária à saúde

ABSTRACT OBJECTIVE Describe the implementation of a digital diagnostic and territorial monitoring tool in primary healthcare. METHODS Quantitative and qualitative study, developed in 14 basic healthcare units in São Paulo, with community health workers, coordinators, nurses, and physicians. Data collection occurred in four phases: analysis of the instruments used by the team for territory management; development of the digital tool; training and implementation; and evaluation after 90 days using focus groups. Descriptive analyses were conducted by calculating absolute and relative frequencies to treat quantitative data. Qualitative data were subjected to content analysis. RESULTS Three hundred thirty-four professionals participated in the study. In the first step, territory management's main challenges were filling out various instruments, system failures, data inconsistency, internet infrastructure/network, and lack of time. Therefore, a digital tool was developed consisting of 1) a spreadsheet recording the number of family members and markers of health conditions, date of visit, and number of return visits; 2) a spreadsheet with a summary of families visited, not visited, and refusals; and 3) a panel with a summary of the data generated instantly. In the evaluation, after the initial use of the tool, the themes that emerged were integration of the tool into daily work, evaluation of the digital tool implementation process, and improvement and opportunities for improvement. CONCLUSIONS Faced with the challenges faced by family healthcare teams when filling out systems and managing the territory, the tool developed provided greater reliability and agility in data visualization, reduced the volume of instruments, and optimized the work process.

RESUMO OBJETIVO Descrever a implementação de uma ferramenta digital de diagnóstico e monitoramento territorial na atenção primária à saúde. MÉTODOS Estudo quanti-qualitativo, desenvolvido em 14 Unidades Básicas de Saúde do município de São Paulo, com agentes comunitários de saúde, coordenadores, enfermeiros e médicos. A coleta de dados ocorreu em quatro fases: análise dos instrumentos utilizados pela equipe para gestão do território; desenvolvimento da ferramenta digital; treinamento e implantação; avaliação após 90 dias por meio de grupos focais. Foram realizadas análises descritivas por meio do cálculo de frequências absolutas e relativas para tratamento dos dados quantitativos. Os dados qualitativos foram tratados pela análise de conteúdo. RESULTADOS 334 profissionais participaram do estudo. Na primeira etapa foram identificados como principais desafios para gestão do território o preenchimento de diversos instrumentos, falhas no sistema, inconsistência dos dados, infraestrutura/rede de internet e falta de tempo. Assim, foi desenvolvida uma ferramenta digital composta por: i) planilha com registro do número de membros familiares e marcadores de condições de saúde, data da visita e quantidade de revisitas; ii) planilha com resumo de famílias visitadas, não visitadas e recusas; e iii) um painel com resumo dos dados gerados instantaneamente. Na avaliação, após uso inicial da ferramenta, as temáticas que emergiram foram: integração da ferramenta no cotidiano de trabalho; avaliação do processo de implementação da ferramenta digital; aperfeiçoamento e oportunidades de melhoria. CONCLUSÃO Frente aos desafios encontrados por parte das equipes de saúde da família para preenchimento dos sistemas e gestão do território, a ferramenta desenvolvida proporcionou maior fidedignidade e agilidade na visualização dos dados, redução no volume de instrumentos e otimização do processo de trabalho.

The knowledge of primary health care professionals regarding mental health: diagnosis by mhGAP / Conhecimento de profissionais da atenção primária em saúde mental: diagnóstico pelo mhGAP

ABSTRACT OBJECTIVE To analyze knowledge about priority topics in mental health care of strategic actors who work in regions where the Health Care Planning (PAS) methodology is used. METHODS This is a quantitative, descriptive, cross-sectional, and observational study carried out with professionals from six health regions, distributed in three Brazilian states (Goiás, Rondônia and Maranhão) and linked to the project "Saúde mental na APS" (Mental health in PHC) of the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (Proadi-SUS - Institutional Development Support Program of the Brazilian Unified Health System). The sample was made up of professionals who participated in the intervention guide multiplier training stage for mental, neurological and alcohol and other drug use disorders in the primary health care network, from July to September 2022. Data collection was through a self-administered instrument, in electronic format, consisting of a block with socioeconomic items and a structured questionnaire to assess participants' knowledge about priority topics in mental health. Descriptive analyses and comparison of proportions were conducted to analyze the data. RESULTS A total of 354 health professionals participated in the study. Regarding the percentage of correct answers in the questionnaire on priority topics in mental health, the highest medians were identified in the "Depression" module. On the other hand, the content referring to the modules "Essential care and practices" and "Other important complaints" presented the lowest values. Furthermore, some participant characteristics were found to be associated with the percentage of correct answers in the questionnaire modules. CONCLUSIONS The findings reveal opportunities for improvement, mainly in knowledge related to communication skills and the approach to emotional and physical distress without diagnostic criteria for a specific disease, offering support for planning actions aimed at intensifying the consideration of these themes during the operational stages of PAS.

RESUMO OBJETIVO Analisar o conhecimento sobre temas prioritários do cuidado em saúde mental de atores estratégicos que atuam em regiões nas quais se utiliza a metodologia da Planificação da Atenção à Saúde (PAS). MÉTODOS Trata-se de um estudo quantitativo, descritivo, transversal e observacional realizado com profissionais de seis regiões de saúde, distribuídas em três estados brasileiros (Goiás, Rondônia e Maranhão) e vinculadas ao projeto "Saúde mental na APS" do Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (Proadi-SUS). A amostra foi composta por profissionais que participaram da etapa de formação de multiplicadores do manual de intervenções para transtornos mentais, neurológicos e por uso de álcool e outras drogas na rede de atenção básica à saúde, no período de julho a setembro de 2022. A coleta de dados foi realizada a partir de um instrumento autoaplicável, em formato eletrônico, composto por um bloco com itens socioeconômicos e um questionário estruturado para avaliação do conhecimento dos participantes acerca de temas prioritários em saúde mental. Para análise dos dados, foram empreendidas análises descritivas e comparação de proporções. RESULTADOS Participaram do estudo 354 profissionais de saúde. Em relação ao percentual de acerto no questionário sobre temas prioritários em saúde mental, as medianas mais altas foram identificadas no módulo de "Depressão". Em contrapartida, o conteúdo referente aos módulos "Cuidados e práticas essenciais" e "Outras queixas importantes" apresentaram os valores mais baixos. Além disso, identificou-se que algumas características dos participantes apresentaram associações com o percentual de acertos nos módulos do questionário. CONCLUSÕES Os achados revelam oportunidades de melhoria, principalmente no conhecimento relacionado às habilidades de comunicação e a abordagem ao sofrimento emocional e físico sem critérios diagnósticos para uma doença específica, oferecendo subsídios para o planejamento de ações que visem a intensificação do olhar destas temáticas durante as etapas operacionais da PAS.

Brazilian Scale for Evaluation of Mental Health Care Needs: Additional Evidence / Escala de Avaliação da Necessidade de Cuidado em Saúde Mental: evidências adicionais

ABSTRACT OBJECTIVE To investigate validity evidence of the Brazilian Scale for Evaluation of Mental Health Care Needs (CuidaSM). METHODS This is a psychometric study, which seeks additional evidence of internal structure. Data collection was carried out in 11 Primary Health Care (PHC) services , which implement the Health Care Planning (HCP) methodology, distributed across the five Brazilian regions. The preliminary version of CuidaSM, containing a block self-referred by the user and another block evaluated by PHC professionals, was applied to users aged 18 or over who attended the PHC services for consultation with a higher education professional. The techniques of confirmatory factor analysis and network analysis were used to investigate validity evidence. For the primary data of the confirmatory factor analysis, the factorial loads and the item's predictive power (R2) were used. Six model adjustment indices were adopted and reliability was measured by three indicators using Bayesian estimation. RESULTS A total of 879 users participated in the study. By confirmatory factor analysis, factorial loads ranged from 0.43 to 0.99 and R2 from 0.19 to 0.98. Both the primary indicators and the model adequacy indices were established at satisfactory and consistent levels. The network analysis showed that the items were appropriately associated with their peers, respecting the established dimensions, which again indicates the sustainability and stability of the proposed model. CONCLUSIONS The study findings confirm a consistent and reliable model of the instrument, through a combination of techniques. Considering the importance of using solid instruments in clinical practice, CuidaSM is a promising tool for population-based management and network care organization, aligned with HCP proposals.

RESUMO OBJETIVO Investigar evidências de validade da Escala de Avaliação da Necessidade de Cuidado em Saúde Mental (CuidaSM). MÉTODOS Trata-se de um estudo de natureza psicométrica, que busca evidências adicionais de estrutura interna. A coleta de dados foi realizada em 11 unidades básicas de saúde (UBS), que executam a metodologia da Planificação da Atenção à Saúde (PAS), distribuídas nas cinco regiões brasileiras. A versão preliminar da CuidaSM, contendo um bloco autorreferido pelo usuário e outro avaliado por profissionais da atenção primária à saúde (APS), foi aplicada em usuários com 18 anos ou mais que compareceram às UBS para consulta com profissional de nível superior. As técnicas de análise fatorial confirmatória e network analysis foram utilizadas para investigação das evidências de validade. Para os dados primários da análise fatorial confirmatória, utilizou-se as cargas fatoriais e o poder preditivo do item (R2). Foram adotados seis índices de ajustamento do modelo e a confiabilidade foi aferida por três indicadores por meio de bayesian estimation. RESULTADOS Participaram do estudo 879 usuários. Pela análise fatorial confirmatória, as cargas fatoriais variaram de 0,43 a 0,99 e R2 de 0,19 a 0,98. Tanto os indicadores primários como os índices de adequação do modelo estabeleceram-se em níveis satisfatórios e consistentes. A network analysis apontou que os itens se associaram de forma adequada a seus pares, respeitando as dimensões estabelecidas, o que indica, novamente, a sustentabilidade e estabilidade do modelo proposto. CONCLUSÕES Os achados do estudo confirmam um modelo consistente e confiável do instrumento, por meio da combinação de técnicas. Considerando a relevância do uso de instrumentos sólidos na prática clínica, a CuidaSM se apresenta como uma ferramenta promissora para a gestão de base populacional e organização do cuidado em rede, alinhada às propostas da PAS.

Implementation of advanced practice nursing in Brazilian Primary Health Care: methodological path.

OBJECTIVES: to describe the operationalization of the steps of a model proposed by the Pan American Health Organization for implementing advanced practice nursing in Primary Health Care services. METHODS: a methodological study, with a qualitative approach, carried out in a local health system located in southern São Paulo. The first six steps of the model were followed: 1) improve health outcomes; 2) identify stakeholders; 3) determine unmet health needs; 4) identify priorities and goals to introduce advanced nursing practices in primary health care; 5) define advanced practice nursing in primary health care; 6) plan implementation strategies. RESULTS: in each step, the objectives, methodological strategies and operationalization were described. FINAL CONSIDERATIONS: the model proved to be effective to support the process of development and implementation of advanced practice nursing in the local system studied.

What are the implications of problem-solving capacity at Primary Health Care in older adult health?

OBJECTIVE: To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. METHODS: A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). RESULTS: Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. "First contact access - use", "longitudinality" and "coordination - information system" were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. CONCLUSION: The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.

Implementation of advanced practice nursing in Brazilian Primary Health Care: methodological path / Implementación de prácticas avanzadas de enfermería en la Atención Primaria de Salud brasileña: camino metodológico / Implantação de práticas avançadas de enfermagem na Atenção Primária à Saúde brasileira: percurso metodológico

ABSTRACT Objectives: to describe the operationalization of the steps of a model proposed by the Pan American Health Organization for implementing advanced practice nursing in Primary Health Care services. Methods: a methodological study, with a qualitative approach, carried out in a local health system located in southern São Paulo. The first six steps of the model were followed: 1) improve health outcomes; 2) identify stakeholders; 3) determine unmet health needs; 4) identify priorities and goals to introduce advanced nursing practices in primary health care; 5) define advanced practice nursing in primary health care; 6) plan implementation strategies. Results: in each step, the objectives, methodological strategies and operationalization were described. Final Considerations: the model proved to be effective to support the process of development and implementation of advanced practice nursing in the local system studied.

RESUMEN Objetivos: describir la operacionalización de las etapas del modelo propuesto por la Organización Panamericana de la Salud para la implementación de prácticas avanzadas de enfermería en los servicios de Atención Primaria de Salud. Métodos: estudio metodológico, con enfoque cualitativo, realizado en un sistema local de salud ubicado en el sur de la ciudad de São Paulo. Se siguieron los primeros seis pasos del modelo: 1) mejorar los resultados de salud; 2) identificar a las partes interesadas; 3) determinar las necesidades de salud insatisfechas; 4) identificar prioridades y objetivos para introducir prácticas avanzadas de enfermería en la Atención Primaria de Salud; 5) definir prácticas avanzadas de enfermería en la atención primaria de salud; 6) estrategias de implementación del plan. Resultados: en cada etapa se describieron objetivos, estrategias metodológicas y operacionalización. Consideraciones Finales: el modelo demostró ser efectivo para apoyar el proceso de desarrollo e implementación de la práctica avanzada de enfermería en el sistema local estudiado.

RESUMO Objetivos: descrever a operacionalização das etapas do modelo proposto pela Organização Pan-Americana da Saúde para a implantação de práticas avançadas de enfermagem em serviços da Atenção Primária à Saúde. Métodos: estudo metodológico, de abordagem qualitativa, realizado em um sistema local de saúde localizado na zona sul do município de São Paulo. Foram seguidas as seis primeiras etapas do modelo: 1) melhorar os resultados de saúde; 2) identificar os interessados; 3) determinar as necessidades de saúde não atendidas; 4) identificar prioridades e metas para introduzir as práticas avançadas de enfermagem na Atenção Primária à Saúde; 5) definir as práticas avançadas de enfermagem em cuidados primários de saúde; 6) planejar as estratégias de implementação. Resultados: em cada etapa, foram descritas os objetivos, as estratégicas metodológicas e a operacionalização. Considerações Finais: o modelo mostrou-se eficaz para apoiar o processo de desenvolvimento e implantação da prática avançada de enfermagem no sistema local estudado.

What are the implications of problem-solving capacity at Primary Health Care in older adult health?

ABSTRACT Objective To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. Methods A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). Results Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. "First contact access - use", "longitudinality" and "coordination - information system" were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. Conclusion The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.

Social support networks of users of crack cocaine and the role of a Brazilian health program for people living on the street: A qualitative study.

This cross-sectional qualitative study analyzed characteristics of social support for users of crack cocaine and the role of "Consultório na Rua" (CR), or "Office in the Street," a Brazilian program for people living on the street. Data were collected using 1) ethnographic field observations during the delivery of services from this program, 2) in-depth interviews with 17 users of crack cocaine, and 3) a focus group with professionals from CR. To analyze data, we used content analysis and analytical categories based on Social Network Analysis (SNA) theoretical statements. Results showed that family, peers, community members, and professionals from CR were the main social support providers. Participants mentioned receiving material, informational, and emotional support from CR members. It was observed that CR had a welcoming and inclusive approach, but CR team members identified challenges related to stigma directed toward people who use substances and live on the street. CR assumed a central role in the health and social assistance of users of crack cocaine living on the street, providing an important link to healthcare and social services. However, initiatives related to motivation to receive mental health services, treatment, or social reintegration were not observed in conjunction with this program.

Trabalho e desemprego entre pacientes com transtornos mentais / Trabajo y desempleo en pacientes con trastornos mentales / Work and unemployment among patients with mental disorders

RESUMO Objetivo: identificar a prevalência de desempregados entre pessoas com transtornos mentais e analisar os possíveis preditores para o desemprego nessa população. Método: estudo quantitativo, descritivo, desenvolvido em um ambulatório de saúde mental. A amostra aleatória estratificada contou com 258 participantes e os dados foram coletados por meio das fichas de admissão considerando-se o período de 2012 a 2014. Empreenderam-se análises descritivas, bivariadas e de regressão logística. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: a maioria dos participantes era do gênero feminino e com baixo nível de escolaridade. O percentual de desempregados foi de 37%. Os fatores associados ao desemprego no grupo estudado foram sexo feminino e ter os transtornos esquizofrenia, retardo mental e transtorno de personalidade. Conclusão: o número de desempregados foi maior tanto em relação ao estimado na população brasileira quanto aos estudos prévios. Tendo em vista que o trabalho é um dos vértices da reabilitação psicossocial, pontua-se que a questão da capacidade funcional precisa ser priorizada no cuidado de saúde mental e na assistência de Enfermagem.

RESUMEN Objetivo: identificar la prevalencia de desempleados entre personas con trastornos mentales y analizar los posibles predictores de desempleo en esta población. Método: estudio cuantitativo, descriptivo, desarrollado en una clínica de salud mental. La muestra aleatoria estratificada contó con 258 participantes y los datos se recolectaron a través de los formularios de admisión considerando el período de 2012 a 2014. Se realizaron análisis descriptivos, bivariados y de regresión logística. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: la mayoría de los participantes eran mujeres y tenían un bajo nivel educativo. El porcentaje de desempleados fue del 37%. Los factores asociados al desempleo en el grupo estudiado fueron el sexo femenino y tener esquizofrenia, retraso mental y trastorno de personalidad. Conclusión: el número de desempleados fue mayor tanto con relación a la estimación en la población brasileña como en estudios previos. Teniendo en cuenta que el trabajo es uno de los pilares de la rehabilitación psicosocial, se señala que la cuestión de la capacidad funcional debe ser priorizada en la atención de salud mental y de enfermería.

ABSTRACT Objective: to identify the prevalence of unemployed among people with mental disorders and to analyze the possible predictors for unemployment in this population. Method: quantitative, descriptive study, developed in a mental health clinic. The stratified random sample had 258 participants and the data were collected through the admission forms considering the period from 2012 to 2014. Descriptive, bivariate and logistic regression analyzes were undertaken. The study was approved by the Research Ethics Committee. Results: most of the participants were female and had a low level of education. The percentage of unemployed was 37%. The factors associated with unemployment in the studied group were female gender and having schizophrenia, mental retardation and personality disorder. Conclusion: the number of unemployed was higher both in relation to the estimate in the Brazilian population and in previous studies. Bearing in mind that work is one of the cornerstones of psychosocial rehabilitation, it is pointed out that the issue of functional capacity needs to be prioritized in mental health care and Nursing care.

The role of mood states in alcohol consumption, a study with workers / El papel de los estados de ánimo en el consumo de alcohol, un estudio con los trabajadores / O papel dos estados de humor no consumo de álcool, um estudo com trabalhadores

ABSTRACT Objective: to identify factors related to harmful alcohol consumption, considering both sociodemographic characteristics and mood states. Method: a quantitative cross-sectional study, carried out with 395 non-teaching workers on a campus of a public university in the interior of the state of São Paulo, from July 2017 to June 2018. Information on the sociodemographic profile, mood state and alcohol use pattern were used. Pearson's Chi Square, Fischer Exact and Logistic Regression Tests were performed for data analysis, using the SPSS statistical program. Results: it was identified that 66% of workers had consumed alcoholic beverages in the last 12 months. Of these, 19% were classified in the range of harmful alcohol consumption. It is noteworthy that 35.2% (n=139) of workers mentioned the use in binge and 26.5% (n=105) consume alcohol two to four times a month. These variables were statistically associated with gender, religion and educational level. In addition, a negative correlation was identified between the AUDIT score and the "fatigue" factor of the mood scale. In the end, it was observed that male individuals and those with less education were more likely to consume alcohol in the harmful pattern. Conclusion: it is suggested the development of health promotion and disease prevention initiatives through health education actions and other psychosocial strategies for welcoming these workers.

RESUMEN Objetivo: identificar factores relacionados con el consumo nocivo de alcohol, considerando tanto características sociodemográficas como estados de ánimo. Método: estudio cuantitativo transversal, realizado con 395 trabajadores no docentes en un campus de una universidad pública del interior del estado de São Paulo, de julio de 2017 a junio de 2018. Se utilizó información sobre el perfil sociodemográfico, el estado de ánimo y el patrón de consumo de alcohol. Se realizaron Pruebas de Chi-cuadrado de Pearson, Regresión Logística y Exacta de Fischer para el análisis de datos, utilizando el programa estadístico SPSS. Resultados: se identificó que el 66% de los trabajadores había consumido bebidas alcohólicas en los últimos 12 meses. De estos, el 19% se clasificó en el rango de consumo nocivo de alcohol. Es de destacar que el 35,2% (n=139) de los trabajadores mencionó el uso binge y el 26,5% (n=105) consumen alcohol de dos a cuatro veces al mes. Además, se identificó una correlación negativa entre la puntuación AUDIT y el factor de "fatiga" de la escala del estado de ánimo. Al final, se observó que los hombres y los que tenían menos educación tenían más probabilidades de consumir alcohol en el patrón nocivo. Conclusión: se sugiere el desarrollo de iniciativas de promoción de la salud y prevención de agravios a través de acciones de educación en salud y otras estrategias psicosociales para la acogida de estos trabajadores.

RESUMO Objetivo: identificar os fatores relacionados ao consumo nocivo de álcool, considerando tanto as características sociodemográficas quanto os estados de humor. Método: estudo quantitativo transversal, realizado com 395 trabalhadores não docentes em um campus de uma universidade pública do interior do estado de São Paulo, no período de julho de 2017 a junho de 2018. Foram utilizadas informações sobre o perfil sociodemográfico, o estado de humor e o padrão de uso de álcool. Foram empreendidos os Testes de Qui Quadrado de Pearson, Exato de Fischer e Regressão Logística para análise dos dados, utilizando o programa estatístico SPSS. Resultados: identificou-se que 66% dos trabalhadores consumiram bebidas alcoólicas nos últimos 12 meses. Desses, 19% foram classificados na faixa de consumo nocivo de álcool. Destaca-se que 35,2% (n=139) dos trabalhadores mencionaram o uso em binge e 26,5% (n=105) consomem álcool de duas a quatro vezes ao mês. Essas variáveis foram associadas estatisticamente com o sexo, religião e nível de escolaridade. Além disso, identificou-se correlação negativa entre o escore AUDIT e o fator "fadiga" da escala de humor. Ao final, observou-se que os indivíduos do sexo masculino e aqueles com menor escolaridade tinham mais chances de consumir álcool no padrão nocivo. Conclusão: sugere-se o desenvolvimento de iniciativas de promoção de saúde e prevenção de agravos por meio de ações de educação em saúde e outras estratégias psicossociais para o acolhimento destes trabalhadores.

Violence, drugs, and psychiatric disorders: news from the Brazilian press.

The aim of this study is to describe the way that the Brazilian press reports on episodes of violence involving people with substance-related problems or psychiatric disorders. To develop this documentary study, we analyzed news reports from September 2009 to August 2015 in two major Brazilian newspaper who make their published articles available electronically in the Lexis Nexis Academic® database. The analyses were conducted using descriptive statistics and association tests. We identified 269 news stories related to these themes during the study period. The reported events occurred mainly in São Paulo and Rio de Janeiro, and 68% of the stories suggested a causal relationship between substance use or mental illness and violence. A marked minority (10%) of the stories made reference to prevention or treatment for the conditions studied. We concluded that the Brazilian press issues incomplete reports on episodes of violence involving people with substance-related problems or psychiatric disorders, emphasizing the relationships between these conditions and potential danger, particularly in cases involving drugs.

Mental health actions and nurse's work.

OBJECTIVE: to analyze the perception of nurses and other members of the patient care team about nurses' actions in mental health care. METHODS: the study was conducted with professionals from mental health services in the interior of the state of São Paulo. The data collected through semi-structured interviews, a questionnaire with closed questions and a focus group were submitted to content analysis. RESULTS: the participants referred mainly to the nursing care with the body and physical health, but also identified the nurse as a "gateway" for care, facilitator and integrator of actions and as the professional who has more contact with the user. Final considerations: although the stereotype of nursing as "body caregiver" refers to the beginnings of psychiatric nursing, the perception of the participants showed aspects that suggest a change in relation to the role traditionally attributed to this profession.

Psychosocial care network: managers' perception and tensions of the field.

OBJECTIVE: to analyze the perception of workers and managers about the psychosocial care network in a medium-sized municipality in the inlands of the state of Minas Gerais. METHOD: qualitative, descriptive and exploratory study involving twelve participants from different points of the network. The semi-structured interviews were analyzed in the light of Pierre Bourdieu's framework of constructionist structuralism. RESULTS: the actions offered by the services were based on the perspectives of resocialization, user embracement, group and multiprofessional care, and on approaches to harm reduction, recreation and daily organization. These were configured as the network resources/capital. Tensions were identified in family embracement and in relationships between families and users, as well as in the prejudice towards people with mental disorders. Final considerations: the social agents were willing to contribute to processes of change in order to overcome the focus on specialties, the lack of training of some teams, lack of infrastructure and of some components, especially those related to leisure and community life.

Diagnósticos de enfermagem em gestantes de alto risco: as necessidades psicossociais em foco / Nursing diagnoses in high-risk pregnant women: the psychosocial needs in focus

Objetivo: Identificar as necessidades psicossociais referidas nos estudos sobre gestação de alto risco buscando os diagnósticos correspondentes na Classificação Internacional das Práticas de Enfermagem em Saúde Coletiva (CIPESC®). Método: Estudo qualitativo de revisão narrativa. Inicialmente, realizou-se um levantamento bibliográfico na base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Após leitura e organização dos dados, os aspectos psicossociais abordados nos estudos foram listados e relacionados com os diagnósticos da CIPESC@ correspondentes. Resultados: Fatores como relação profissional-paciente, reações emocionais negativas, redes de apoio, insegurança, aceitação e conflitos apresentavam correspondentes específicos na CIPESC®. Em contrapartida, circunstâncias que se caracterizavam como riscos psicossociais a estas gestantes não tinham diagnósticos correspondentes, sendo abordadas de forma abrangente nesta classificação. Conclusão: O presente estudo reforça a complexidade do uso de classificações no âmbito psicossocial e convida os profissionais e pesquisadores a repensarem seus planos de cuidado e práticas assistenciais às gestantes de alto risco. (AU)

Objective: To identify the psychosocial needs mentioned in studies on high-risk pregnancies seeking the corresponding diagnoses in the International Classification of Nursing Practices in Public Health (CIPESC®). Method: Qualitative study of narrative review. Initially, a bibliographic survey was carried out in the database "Latin American and Caribbean Literature in Health Sciences (LILACS)". After reading and organizing the data, the psychosocial aspects covered in the studies were listed and related to the corresponding CIPESC® diagnoses. Results: Factors such as professional-patient relationship, negative emotional reactions, support networks, insecurity, acceptance and conflicts had specific correspondents CIPESC®. On the other hand, circumstances that were characterized as psychosocial risks to these pregnant women did not have corresponding diagnoses, being addressed comprehensively in this classification. Conclusion: Present study reinforces the complexity of the use of classifications in the psychosocial context and invites professionals and researchers to rethink their care plans and care practices for high-risk pregnant women. (AU)

Objetivo: Identificar las necesidades psicosociales a las que se refieren los estudios sobre embarazos de alto riesgo que buscan los diagnósticos correspondientes en la Clasificación Internacional de Prácticas de Enfermería en Salud Pública (CIPESC®). Método: Estudio cualitativo de la revisión narrativa. Inicialmente, se realizó una encuesta bibliográfica en la base de datos "Literatura latinoamericana y caribeña en ciencias de la salud (LILACS)". Después de leer y organizar los datos, se enumeraron los aspectos psicosociales abordados en los estudios y se relacionaron con los diagnósticos CIPESC@ correspondientes. Resultados: Factores como la relación profesional-paciente, reacciones emocionales negativas, redes de apoyo, inseguridad, aceptación y conflictos tuvieron corresponsales específicos en CIPESC®. Por otro lado, las circunstancias que se caracterizaron como riesgos psicosociales para estas mujeres embarazadas no tuvieron los diagnósticos correspondientes, y se abordaron de manera integral en esta clasificación. Conclusión: El presente estudio refuerza la complejidad del uso de clasificaciones en el contexto psicosocial e invita a profesionales e investigadores a repensar sus planes de atención y prácticas de atención para mujeres embarazadas de alto riesgo. (AU)

Psychosocial care network: managers' perception and tensions of the field / Red de atención psicosocial: percepción de gerentes y tensiones del campo / Rede de atenção psicossocial: percepção de gestores e tensionamentos do campo

ABSTRACT Objective: to analyze the perception of workers and managers about the psychosocial care network in a medium-sized municipality in the inlands of the state of Minas Gerais. Method: qualitative, descriptive and exploratory study involving twelve participants from different points of the network. The semi-structured interviews were analyzed in the light of Pierre Bourdieu's framework of constructionist structuralism. Results: the actions offered by the services were based on the perspectives of resocialization, user embracement, group and multiprofessional care, and on approaches to harm reduction, recreation and daily organization. These were configured as the network resources/capital. Tensions were identified in family embracement and in relationships between families and users, as well as in the prejudice towards people with mental disorders. Final considerations: the social agents were willing to contribute to processes of change in order to overcome the focus on specialties, the lack of training of some teams, lack of infrastructure and of some components, especially those related to leisure and community life.

RESUMEN Objetivo: analizar la percepción de los trabajadores y gerentes sobre la red de atención psicosocial en un municipio de tamaño mediano en el interior de Minas Gerais. Método: investigación cualitativa, descriptiva y exploratoria con doce participantes de diferentes puntos de la red. Las entrevistas semiestructuradas se analizaron con el marco teórico referencial de estructuralismo construccionista de Pierre Bourdieu. Resultados: las acciones ofrecidas por los servicios se basaron en la perspectiva de resocialización, acogida, atención grupal y multiprofesional, así como en enfoques de reducción de daños, recreación y organización diaria y se configuraron en recursos/capital de la red. Se identificaron tensiones en la acogida de las familias y en las relaciones entre familias y usuarios, así como en el prejuicio hacia las personas con trastornos mentales. Consideraciones finales: los agentes sociales estaban dispuestos a contribuir a los procesos de cambio para superar el enfoque en las especialidades, la falta de capacitación de algunos equipos, la falta de infraestructura y de algunos componentes, especialmente aquellos relacionados con el ocio y la convivencia.

RESUMO Objetivo: analisar a percepção de trabalhadores e gestores sobre a rede de atenção psicossocial em município de médio porte do interior de Minas Gerais. Método: estudo qualitativo, descritivo e exploratório envolvendo doze participantes dos diferentes pontos da rede. As entrevistas semiestruturadas foram analisadas com o referencial do estruturalismo construcionista de Pierre Bourdieu. Resultados: as ações oferecidas pelos serviços estavam pautadas na perspectiva de ressocialização, acolhimento, atendimento grupal, multiprofissional, bem como abordagens de redução de danos, recreação e organização do cotidiano e se configuraram em recursos/capitais da rede. Foram identificadas tensões no acolhimento das famílias e nas relações entre famílias e usuários, além do preconceito em relação à pessoa com transtorno mental. Considerações finais: os agentes sociais mostraram-se dispostos a contribuir em processos de mudanças para superar o foco nas especialidades, a falta de capacitação de algumas equipes, falta de infraestrutura e de alguns dispositivos, sobretudo aqueles relacionados ao lazer e convivência.