Cost of a community mental health service: a retrospective study on a psychosocial care center for alcohol and drug users in São Paulo

ABSTRACT BACKGROUND: Psychosocial care centers for alcohol and drug users (CAPS-ad) are reference services for treatment of drug users within the Brazilian National Health System. Knowledge of their total costs within the evidence-based decision-making process for public-resource allocation is essential. The aims here were to estimate the total costs of a CAPS-ad and the costs of packages of care (according to intensity of care); to ascertain the ratio between total CAPS-ad costs and the federal funding allocated; and to describe the methods for estimating unit costs for each CAPS-ad cost component. DESIGN AND SETTING: Retrospective study conducted in a public community mental health service. METHODS: This was a retrospective cost description study on a CAPS-ad located in a city in the state of São Paulo, using a public healthcare provider perspective and a top-down approach, conducted over a 180-day period from March 1 to August 30, 2015. RESULTS: The total mean monthly costs of the CAPS-ad were BRL 64,017.54. Healthcare staff accounted for 56.5% of total costs. The mean costs per capita and per month for intensive and non-intensive care packages were, respectively, BRL 668.34 and BRL 37.12. CONCLUSIONS: The federal budget allocation covered 62.1% of the CAPS-ad costs and the remaining 37.9% end up funded by the municipal government. The cost of the intensive package of care was 18 times greater than the non-intensive package. Developing criteria for using services and different packages of care based on patients' needs, and optimizing human resources according to specific actions, may improve people's mental health and avoid wasted resources.

Evolução dos gastos hospitalares com internações psiquiátricas por drogas / Evolución de gastos con ingresos hospitalarios de psiquiatría por drogas / Evolution of hospital spending with drug-related psychiatric hospital admissions

RESUMO Objetivo Analisar a tendência dos gastos com internações hospitalares psiquiátricas por drogas no município de Maringá-PR, no período de 1999 a 2012. Método Estudo ecológico, de séries temporais, com dados secundários do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS). Foram calculados os gastos médios mais frequentes por diagnóstico principal de internação por drogas do Capítulo Cinco da CID-10: álcool; maconha; cocaína e substâncias psicoativas. Utilizou-se o modelo de tendência de regressão polinomial. Resultados Houve tendência de aumento no gasto médio por cocaína e de outras substâncias psicoativas e tendência decrescente nos gastos médios por maconha. Os gastos médios apresentaram aumento significativo por drogas ilícitas. Conclusões Estudos econômicos apresentam-se incipientes, sendo oportunas pesquisas nacionais que abordem os gastos com internações por drogas com a finalidade de promover subsídios para a implantação e implementação da rede de atenção psicossocial, ambulatorial e hospitalar em consonância com o gasto público em saúde.

RESUMEN Objetivo Analizar la tendencia del gasto en los ingresos hospitalarios psiquiátricos para las drogas en Maringá-PR, 1999-2012. Método Estudio ecológico de series temporales con datos secundarios del Sistema Información Hospitalaria del Sistema Único de Salud (SIH-SUS). Calculado el gasto promedio por diagnóstico de ingreso primario de drogas en Capítulo Cinco de CID-10 fueron frecuentes: alcohol; marihuana; cocaína y sustancias psicoactivas. Se utilizó modelo de tendencia de regresión polinómica. Resultados El aumento de la tendencia en el gasto promedio de la cocaína y otras sustancias psicoactivas y la tendencia a la baja en el gasto por marihuana. El gasto mostró aumento significativo de las drogas ilícitas. Conclusión Los estudios económicos se presentan incipientes siendo la investigación nacional oportuna sobre gastos de hospitalización de drogas con propósito de promover subsidios para el establecimiento y la aplicación de la atención psicosocial, ambulatorial y hospital de la red, en línea con el gasto público en salud.

ABSTRACT Objective To analyse the trend of expenditure on drug-related psychiatric hospital admissions in Maringá, Paraná, Brazil, from 1999 to 2012. Method Ecological time series research with secondary data from the hospital information system of the unified health system (“SIH-SUS”). The records of admissions with a main diagnosis of drug abuse were used to calculate average expenditure. Chapter V of the ICD-10 was used to classify the most frequent diagnoses, namely abuse of alcohol, cannabis, cocaine, and psychoactive substances. The trend was expressed using a polynomial regression model. Results Average expenditure showed an increasing trend for cocaine and other psychoactive substances, and a decreasing trend for cannabis. Average expenditure for illicit drugs increased significantly. Conclusion The scarcity of economic studies on this subject calls for national studies that address expenditure with drug-related hospital admission to promote the implementation of a psychosocial, outpatient and hospital care network in accord with public healthcare expenditure.

Fundamentos económicos y éticos que desaconsejan la legalización y liberación de la droga / Economic and ethical foundations that advise against legalization and drug release

El análisis desde el ángulo de la economía de los efectos de la legalización de la cadena de producción, comercialización y consumo de droga constituye una contribución importante a la cuestión tratada en este seminario. Importa profundizar este estudio ya que varios economistas referentes de las ideas de la libertad, se han manifestado a favor de la despenalización de toda la cadena de la droga. Tal ha sido el caso de Milton Friedman y Gary Becker, ambos ganadores del Premio Nobel. Tras su posición se alinearon figuras de la política, como Vicente Fox y Fernando Enrique Cardoso y literatos de la categoría de Mario Vargas Llosa.

Sorafenib prevents liver fibrosis in a non-alcoholic steatohepatitis (NASH) rodent model

Liver fibrosis occurring as an outcome of non-alcoholic steatohepatitis (NASH) can precede the development of cirrhosis. We investigated the effects of sorafenib in preventing liver fibrosis in a rodent model of NASH. Adult Sprague-Dawley rats were fed a choline-deficient high-fat diet and exposed to diethylnitrosamine for 6 weeks. The NASH group (n=10) received vehicle and the sorafenib group (n=10) received 2.5 mg·kg-1·day-1 by gavage. A control group (n=4) received only standard diet and vehicle. Following treatment, animals were sacrificed and liver tissue was collected for histologic examination, mRNA isolation, and analysis of mitochondrial function. Genes related to fibrosis (MMP9, TIMP1, TIMP2), oxidative stress (HSP60, HSP90, GST), and mitochondrial biogenesis (PGC1α) were evaluated by real-time quantitative polymerase chain reaction (RT-qPCR). Liver mitochondrial oxidation activity was measured by a polarographic method, and cytokines by enzyme-linked immunosorbent assay (ELISA). Sorafenib treatment restored mitochondrial function and reduced collagen deposition by nearly 63% compared to the NASH group. Sorafenib upregulated PGC1α and MMP9 and reduced TIMP1 and TIMP2 mRNA and IL-6 and IL-10 protein expression. There were no differences in HSP60, HSP90 and GST expression. Sorafenib modulated PGC1α expression, improved mitochondrial respiration and prevented collagen deposition. It may, therefore, be useful in the treatment of liver fibrosis in NASH.

Violencia y adicciones: problemas de salud pública / Violence and addictions: public health problems

La violencia y las adicciones constituyen problemas de gran impacto en las personas, las familias y las comunidades, pues alteran el normal desenvolvimiento y la posibilidad de desarrollarse plenamente. En su presentación participan múltiples factores que obligan a que las alternativas de solución sean articuladas desde diferentes sectores y con una mirada integradora. Las perspectivas de un buen desarrollo individual y colectivo dependerán de la eficacia de las acciones que se tomen, desde la mirada de la Salud Pública.

Violence and addictions produce a great impact over persons, families, and communities. They impair their normal development and affect the possibility of individuals to fully grow. There are many different factors involved in their presentation, so proposed solutions must come from different sectors with an integrated point of view. The prospects of an adequate individual and collective development depend on the efficacy of the actions taken, from the public health point of view.

Adolescence and the consumption of psychoactive substances: the impact of the socioeconomic status

Recent studies have pointed that it is necessary to define the impact of specific dimensions of the social-economic context that can work as risk factors regarding drug addiction. This study aimed to verify potential relationships between the drug addiction during adolescence and the social-economic level. A total of 568 adolescents participated in this study answering an anonymous self-filled questionnaire. The analyses involved the description of the variable distribution in the sample and statistical analyzes to determine the differences found. Contrary to the common sense, adolescents from the higher social classes presented a significant higher perceptual of alcohol, tobacco, weed and solvent consumption when compared to their counterparts from lower social classes. These data suggest the importance of studies that seek to clarify the possible influences of the social-economic status on the consumption of drugs among adolescents.

Estudos recentes têm enfatizado que é necessário precisar o impacto de dimensões específicas do contexto socioeconômico que pode funcionar como fator de risco em relação ao uso de drogas. Objetivou-se, com esse estudo, verificar possíveis relações entre uso de drogas psicoativas na adolescência e nível socioeconômico. Participaram 568 adolescentes que responderam questionário anônimo de autopreenchimento. As análises envolveram a descrição da distribuição das variáveis na amostra e análises estatísticas para determinar as diferenças encontradas. Contrariando expectativas do senso comum, adolescentes das classes média/média superior apresentaram percentual significativamente maior de uso, na vida, de álcool, tabaco, maconha e solventes, quando comparados com seus pares das classes baixa/baixa inferior. Esses dados sugerem a importância de estudos que busquem clarificar as possíveis influências do status socioeconômico sobre o consumo de drogas entre adolescentes.

Estudios recientes han acentuado que es necesario precisar el impacto de dimensiones específicas del contexto socioeconómico que pueden funcionar como factores de riesgo en relación al uso de drogas. El objetivo de esta investigación fue verificar las posibles relaciones entre el uso de drogas en la adolescencia y el nivel socioeconómico. Participaron 568 adolescentes, que contestaron a un cuestionario anónimo de auto relleno. Contrario las expectativas del senso común, los adolescentes de las clases más altas presentaron un porcentaje perceptiblemente mayor de uso del alcohol, tabaco, marijuana y solventes en la vida en comparación con sus pares de las clases más bajas. Estos datos sugieren la importancia de los estudios que buscan clarificar las influencias posibles del estado socioeconómico en el consumo de drogas entre los adolescentes.

Impacto economico em familias de pessoas com transtornos mentais graves e com transtornos devido ao uso de substancias psicoativas / Economic impact on families of people with severe mental illness and substance use disorder

Em diversos paises desenvolvidos o transtorno por uso de substancias psicoativas e um problema relativamente comum em pacientes com transtornos mentais graves, e esta frequentemente associado a efeitos negativos, como aumento de agressividade, criminalidade, internacoes, infeccoes por HIV e falta de moradia, acarretando um custo adicional a familia e a sociedade. O objetivo dessa revisao e apresentar as evidencias existentes sobre o impacto economico, em familias de pessoas com transtornos mentais graves e com...