Nota Informativa N. 3/2021 - GSM - 18351 - Serviços hospitalares de referência: fluxo processual para implantacao de leitos em saúde mental em hospital geral / Informative Note N. 3/2021 - GSM - 18351 - Reference hospital services: procedural flow for the implementation of mental health beds in a general hospital

Este documento visa apoiar as Regionais de Saúde do Estado de Goiás, junto aos Apoiadores Regionais de Saúde Mental e Populações Específicas, no processo de implantação e habilitação de leitos em saúde mental em hospital geral

This document aims to support the Health Regionals of the State of Goiás, together with the Regional Health Supporters Mental Health and Specific Populations, in the process of implementing and enabling mental health beds in a hospital general

The mortality and psychological burden caused by response to COVID-19 outbreak.

The world is experiencing a severe COVID-19 outbreak. To control this outbreak, many governments in the world have imposed lockdown or quarantine measures. We hypothesize that these measures may cause additional mortality and morbidity in the (near) future due to delay in diagnosing diseases and other indirect effect on health (such as economic crisis). To support this hypothesis and to estimate the additional mortality that may linked to the COVID-19 controlling policy, we performed a step-by-step pragmatical approach. First, we chose a country (The Netherlands), and looked at the most common causes of mortality in this country. Then, we performed a literature study on the additional mortality when these causes were diagnosed late, and selected a paper with the most severe scenario. We also performed a literature study on the effect of economic crisis on additional mortality. The mortality data were then extrapolated to the demography of The Netherlands, and the results were compared with the present data on deaths directly due to COVID-19. Roughly, we forecast 388 additional deaths a week in The Netherlands in 5 years due to the direct and indirect effects of the lockdown measures. The most important implications of this hypothesis is that the additional mortality and increased mental health problem should be considered in evaluating the necessity of lock down and quarantine policy.

Socio-demographic predictors of well-being in United Kingdom adolescents, and the impact of well-being on a range of health-related outcomes.

The deleterious impact of low mental well-being, and higher levels psychological symptoms (collectively well-being), on concurrent and prospective health outcomes has elsewhere been demonstrated. Further, variables such as conurbation and deprivation have been found to be related to mental and physical heath. This study used data from a longitudinal study to examine which demographic predicted well-being scores, and how scores on these constructs were related to six health-related outcomes. Participants were adolescents (N = 4,956; Male = 2376[48%]), from 72 High Schools in Northern Ireland. Three waves of data were gathered on mental well-being, psychological symptoms, subjective life expectancy (living to age 35 and age 75 years), self-rated health, frequency of physical exercise, and lifetime use of cigarettes and cannabis. Results showed that both well-being scores were significantly associated with gender cross-sectionally, but demographic variables did not predict changes in well-being longitudinally. Both well-being measures were significantly associated with health outcomes cross-sectionally, with mental well-being (over time) predicting life subjective life expectancy, self-rated health, and addictive behaviors, while psychological symptoms (over time) predicted the former two, but not addictive behaviors. Overall, the relationship between mental well-being, psychological symptoms, and the health outcomes assessed, was small in terms of effect size.

Association between cumulating substances use and cumulating several school, violence and mental health difficulties in early adolescents.

Multiple substances (alcohol, tobacco, cannabis and other illicit drugs (OID)) have been frequently used in early adolescents maybe due to school, violence and mental-health difficulties. We investigated the associations between substance-use patterns and related difficulties among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ±â€¯1.3). They completed a questionnaire including socioeconomic features, school, violence and mental-health difficulties (school grade repetition, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms and suicide attempt; cumulated number noted SVMDscore) and the time of their first occurrence during the life course. Data were analyzed using logistic and negative binomial regression models. Alcohol, tobacco, cannabis and OID use affected 35.2, 11.2, 5.6 and 2.8% of the subjects respectively. The risk of using tobacco only, alcohol and tobacco, alcohol plus tobacco and cannabis, or all alcohol, tobacco, cannabis and OID strongly increased with the SVMDscore (socioeconomic features-adjusted odds ratio reaching 85). The risk began in early years in middle schools and then steadily increased, more markedly for elevated SVMDscore. Exposure to several SVMDs may be a transmission vector towards the substance use, starting mostly with alcohol/tobacco, and then shifting to cannabis/OID. These findings help to understand substance-use risk patterns and identify at-risk adolescents.

Population-Based Profile of Mental Health and Support Service Need Among Family Caregivers of Adults With Cancer.

PURPOSE: We examined associations between caregiving intensity and mental health among cancer caregivers at the population level and potential moderation by an actionable intervention target, support service needs. METHODS: Behavioral Risk Factors Surveillance System survey data (2015) from caregivers of adult patients with cancer was analyzed. Caregiving intensity included hours per week caregiving (high, > 20; low, ≤ 20) and caregiving duration (long, > 2 years; short, ≤ 2 years). Mental health was reported as number of mentally unhealthy days (MUDs) in the past 30. Support service needs comprised caregiving classes, service access, support groups, counseling, and respite care. Multivariable linear regression models were performed adjusting for sociodemographics and sampling weights. RESULTS: A total of 1,831 caregivers were included in the study, representing approximately 1.1 million cancer caregivers in the 18 US states, distributed with the following intensity: 122 (8.3%) caregivers reported care at high hours/long duration, 213 (13.1%) high hours/short duration, 329 (18.4%) low hours/long duration, and 910 (60.2%) low hours/short duration. Mean MUDs was 6 (SE, 0.5). The highest reported unmet service need was help with service access (48.4%). Higher caregiving intensity and support service need were associated with more MUDs ( P < .05), with a significant interaction ( P = .02) between caregiving intensity and unmet support service needs. High hour/long duration caregivers reporting any unmet needs had a mean of 15 versus 8 MUDs for those with no unmet needs. CONCLUSION: High-intensity cancer caregiving was associated with poor mental health, especially for those reporting support service needs. Developing strategies to optimize support service provision for high-intensity cancer caregivers is warranted.

Impact of oil recession on community mental health service utilization in an oil sands mining region in Canada.

OBJECTIVES: This retrospective clinical audit compared changes in community mental health service utilization before and during an economic recession in an oil sands region in Canada which was characterized by a doubling of unemployment rates and poor economic outlook. METHODS: Sociodemographic descriptors, psychiatric antecedents, clinical characteristics and follow-up care were compared before and during the recession for newly assessed patients in community mental health clinics located across a Northern Alberta oil mining region. Data were collected retrospectively as part of a clinical audit process and then analysed with descriptive statistics, cross-tabular univariate analyses with chi-square tests using SPSS version 20. RESULTS: A total of 1,465 patients were included. Sociodemographic factors disproportionately elevated during the recession included male sex, Caucasian ethnicity, own home ownership, higher levels of education and unemployment. More patients seeking mental health care were already taking psychotropic medications (e.g. antipsychotics, benzodiazepines and stimulants). At the same time, disproportionately fewer patients engaged in substance abuse or had a prior formal history of mental health problems. The referral reasons during recession were less likely to be associated with substance abuse or mood concerns and more likely for 'other' reasons. The patients seeking psychiatric help during a recession were disproportionately likely to be diagnosed with personality disorders and 'other' less common diagnostic categories and less likely to suffer from mood or trauma-related diagnoses. Referrals for counselling and social services were also disproportionately more common during the recession. CONCLUSION: This study provides a comprehensive description of longitudinal patterns of mental health service utilization before and during a recession. The findings provide important evidence for policy and planning decisions to encourage resource allocation to help promote accessibility of the most needed community mental health resources.

[Changes between pre-crisis and crisis period in socioeconomic inequalities in health and stimulant use in Netherlands]. / Sociaal-economische gezondheidsverschillen voor en tijdens de economische crisis.

OBJECTIVE: International research suggests an impact of economic crises on population health, with different effects among different socioeconomic groups. Since the end of 2008 the Netherlands experienced a period of economic crisis. Our study explores how inequalities in perceived general and mental health, and alcohol and tobacco use changed after the recession started. DESIGN: Cross-sectional study using routinely collected data from surveys of the Dutch population. METHOD: We used data from the Dutch Health Interview Surveys: 2006-2008 (pre-crisis period) and 2009-2013 (crisis period). Respondents aged 25-64 were divided into socioeconomic groups based on labour status, income level and income change. Inequalities in health and stimulant use among these socioeconomic groups were described by period and changes between the pre-crisis and crisis period were investigated using logistic regression models. RESULTS: Most inequalities did not change, with some exceptions. For perceived general health, inequalities between employed persons and persons not in the labour force were larger in the crisis-period (unfavourable trends for those not in the labour force). For smoking, inequalities between unemployed and employed persons were larger in the crisis period (decreasing smoking rates only for those employed), as did inequalities between persons with low and high income levels (decreasing smoking rates for those with higher income levels). Excessive drinking decreased among employed persons and persons with a decrease in income, while it remained stable among persons not in the labour force and among persons with an increase in income. CONCLUSION: The widening of some socioeconomic inequalities in health and stimulant use might suggest an enhanced vulnerability of lower socioeconomic groups to the post-2008 crisis.

The long-term burden of military deployment on the health care system.

Health care providers need to be aware that stress complaints that result from deployment can emerge even after many years. This has important implications for health care policies. The main aim of this study is to investigate the relation between the development of posttraumatic stress and other mental health complaints and the burden on (mental) health care after a deployment. For this study we used data from a large prospective cohort study on stress-factors related to deployment in 1007 Dutch soldiers, who were deployed to Afghanistan. Participants were assessed at six follow up times up until five years after deployment. In a Generalized Estimated Equations model we estimated the relation between mental health complaints and the utilization of psychological treatment and a general practitioner, respectively. Moreover, we studied the relation between mental health complaints and health care costs using bootstrap techniques. The results showed that higher scores for PTSD, depression and fatigue relate to increased use of a psychologist. And lower PTSD scores and higher depression, anxiety and somatization scores relate to increased odds to visit a GP. Furthermore, mental health complaints relate to higher costs. In conclusion, monitoring soldiers is important in order to be informed on the current demand for (mental) health care to satisfy the health care need of veterans. Early treatment, which is enabled by lowering barriers to care, relates to positive results and therefore, lower health care costs.

The EARN-Health Trial: protocol for a randomised controlled trial to identify health effects of a financial savings programme among low-income US adults.

INTRODUCTION: A theory within the social epidemiology field is that financial stress related to having inadequate financial savings may contribute to psychological stress, poor mental health and poor health-related behaviours among low-income US adults. Our objective is to test whether an intervention that encourages financial savings among low-income US adults improves health behaviours and mental health. METHODS AND ANALYSIS: A parallel group two-arm controlled superiority trial will be performed in which 700 participants will be randomised to the intervention or a wait list. The intervention arm will be provided an online Individual Development Account (IDA) for 6 months, during which participants receive a $5 incentive (£3.2, €4.5) for every month they save $20 in their account (£12.8, €18), and an additional $5 if they save $20 for two consecutive months. Both groups will be provided links to standard online financial counselling materials. Online surveys in months 0 (prior to randomisation), 6 and 12 (6 months postintervention) will assess self-reported health behaviours and mental health among participants in both arms. The surveys items were tested previously in the US Centers for Disease Control and Prevention national health interviews and related health studies, including self-reported overall health, health-related quality of life, alcohol and tobacco use, depression symptoms, financial stress, optimism and locus of control, and spending and savings behaviours. Trial data will be analysed on an intent-to-treat basis. ETHICS AND DISSEMINATION: This protocol was approved by the Institutional Review Board of Stanford University (Protocol ID: 30641). The findings of the trial will be disseminated through peer-reviewed publication. TRIAL REGISTRATION NUMBER: Identifier NCT02185612; Pre-results.

Significados en torno a la reparación, la ayuda humanitaria, la indemnización y la restitución en víctimas del conflicto armado en el municipio de San Carlos / Meanings around reparation, humanitarian assistance, indemnification, and restitution in victims of the armed conflict in the municipality of San Carlos, Antioquia

Se presentan los primeros resultados de las indagaciones sobre la valoración que las mismas víctimas del conflicto armado, del municipio de San Carlos Antioquia (Colombia), hacen dela implementación de la Ley 1448 (Ley de Victimas); dicho proceso de investigación, en esta primera entrega, evidenció entre otros hallazgos, la contradicción entre el discurso oficial yel relato de las víctimas en relación a los procesos de reparación, discursos contradictorios respecto a la transición, el estado de vulneración e insatisfacción de necesidades básicas de las personas victimizadas así como una alta confusión en la implementación de la Ley. Estos resultados, entre otros, permiten afirmar que, la reparación hoy, dista mucho de ser un proceso que aporte a la reconstrucción del tejido social, a la paz y la reconciliación.

The first results of the inquiries on the valuation made by the very victims of the armed conflict, in the municipality of San Carlos Antioquia (Colombia) are shown in this paper, which are part of the implementation of the 1448 Law (Law of Victims); such a research process of, in this first installment, evidenced among other findings, the contradiction between the official discourse and the story of the victims in relation to the reparation processes, contradictory speeches regarding the transition, the state of infringement and dissatisfaction of victimized people’s basic needs, as well as a high confusion as for theimplementation of the Law. These findings, among others, allow to affirm that reparation today, is far from being a process that contributes to the reconstruction of the social fabric, to peace, and reconciliation.

Can China diminish its burden of non-communicable diseases and injuries by promoting health in its policies, practices, and incentives?

China has rapidly progressed through epidemiological and demographic transitions and is now confronting an increasing burden from non-communicable diseases and injuries. China could take advantage of what has been learnt about prevention and control of non-communicable diseases and injuries, which is well summarised in the WHO best buys (a set of affordable, feasible, and cost-effective intervention strategies in any resource setting), to improve individual and population health. Implementation of these strategies could allow China to exceed the incremental gains in decreasing non-communicable diseases and injury burdens of high-income countries, and greatly shorten the interval needed to achieve decreased morbidity and mortality in its population. With the lessons learnt from other countries and its own programmes and policies, China could provide a health model for the world.

Los diálogos de la habana y las perspectivas de una paz duradera en Colombia / Talks with havana and the perspectives of a lasting peace in Colombia

Este artículo de investigación, presenta rutas de análisis histórico en torno a los alcances y falencias que dejaron los diálogos de Paz en Colombia entre las Frac-Ep y el Gobierno Nacional durante el siglo XX, el papel que han jugado los medios de comunicación en dichos procesos y una descripción analítica de los discursos de Oslo y la Habana, que dan inicio al actual proceso de Negociación en la Habana; se resalta el profundo alcance que este proceso de negociaciones marca en la última década en Colombia, en lo que concierne a la posible terminación del conflicto armado y la construcción de una paz estable y duradera.

This research article presents routes of historical analysis over the scope and shortcomings left by the talks of peace in Colombia between FARC-EP and theNational government during the twentieth century, as well as the role played by the mass media in those processes and an analytical description of the discourses in Oslo and Havana, initiating the current process of negotiations at Havana; the deep scope of this process of negotiations marks in the last decade in Colombia, is highlighted with regard to the possible termination of the armed conflict and the construction of a stable and lasting peace.

Economic evaluation in the field of mental health: conceptual basis

Objective: Technological advances in medicine have given rise to a dilemma concerning the use of new health technologies in a context of limited financial resources. In the field of psychiatry, health economic evaluation is a recent method that can assist in choosing interventions with different cost and/or effectiveness for specific populations or conditions. This article introduces clinicians to the fundamental concepts required for critical assessment of health economic evaluations. Methods: The authors conducted a review with systematic methods to assess the essential theoretical framework of health economic evaluation and mental health in Brazil through textbooks and studies indexed in the PubMed, Cochrane Central, LILACS, NHS CRD, and REBRATS databases. A total of 334 studies were found using the specified terms (MeSH - Mental Health AND Economic, Medical) and filters (Brazil AND Humans); however, only five Brazilian economic evaluations were found. Results and conclusions: Economic evaluation studies are growing exponentially in the medical literature. Publications focusing on health economics as applied to psychiatry are increasingly common, but Brazilian data are still very incipient. In a country where financial resources are so scarce, economic analyses are necessary to ensure better use of public resources and wider population access to effective health technologies. .

La salud mental desde los textos de Florencia Nightingale / The mental health since Florence Nightgale’s writings

Con frecuencia cuando se habla de Florence Nightingale, se piensa en la visión romántica de su imagen en unescenario de guerra cuidando de los heridos y se asume su significado para la enfermería de todos los tiempos alestablecer medidas generales de lo que debe ser esta disciplina. Hoy por hoy sus textos son, o deberían ser, un referenteobligado y tan actual que resulta difícil pensar en iniciar una reflexión de la práctica de enfermería sin considerarsu obra. De este modo y en el intento de mostrar que sus escritos son tan vigentes como ayer, los autoreshacen una reflexión del tema de la salud mental desde la obra “Notas de enfermería. Qué es y qué no es”, escritoque después de más de un siglo, nos permite descubrir derroteros a seguir dentro de la enfermería hoy llamadacontemporánea. Es entonces el presente escrito un acercamiento a los cánones que plantea Nightingale sobre lasalud mental, aspecto de relevancia mundial.

When referring to Florence Nightingale, people frequently picture a romantic vision of her taking care of thewounded in a war scene, and this is taken in nursing of all times as generally established measures that this discipleshould represent. Nowadays, her writings are and should be an essential reference without which it woulddifficult to start a reflection on nursing practices. Likewise, in an attempt to show that her writings are as up-todateas they were before, the authors reflect on the topic of mental health in the piece “Notes on Nursing: What itis and what it is not.” After more than one century, this work, allows us to discover the course to follow in what isnow referred to as contemporary nursing. This writing indeed constitutes an approach to the standards proposedby Nightingale about mental health, which is of world relevance.