Resting-state EEG as Biomarker of Maladaptive Motor Function and Depressive Profile in Stroke Patients.

Objective: Investigate the relationship between resting-state EEG-measured brain oscillations and clinical and demographic measures in Stroke patients. Methods: We performed a cross-sectional analysis of a cohort study (DEFINE cohort), Stroke arm, with 85 patients, considering demographic, clinical, and stroke characteristics. Resting-state EEG relative power from delta, theta, alpha, and beta oscillations were measured from the central region. Multivariate regression models were used for both affected and non-affected hemispheres. Results: Motor function was negatively associated with Delta and Theta oscillations, while positively associated with Alpha oscillations (both hemispheres). Similarly, cognition levels measured were negatively associated with Delta activity. Depression levels were negatively associated with Alpha activity specifically in the affected hemisphere, while positively associated with Beta activity in both hemispheres. Regarding pain measures, no significant association was observed, while CPM measure showed a positive association with Alpha activity in the non-affected hemisphere. Finally, we found that theta/alpha ratio was negatively associated with motor function and CPM scores. Conclusion: The results lead us to propose a framework for brain oscillations in stroke, whereas Delta and Beta would represent disrupted mal-adaptive brain plasticity and Theta and Alpha would represent compensatory and functional brain oscillations for motor and sensory deficits in stroke, respectively.

Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study.

BACKGROUND: Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. OBJECTIVES: The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). METHODS: Sixty participants were recruited from the rehabilitation program in São Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. RESULTS: We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. CONCLUSION: These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.

OPRM1 and BDNF polymorphisms associated with a compensatory neurophysiologic signature in knee osteoarthritis patients.

OBJECTIVE: The present study investigated the relationship between three genetic polymorphisms of OPRM1 (rs1799971 - A118G and rs1799972 - C17T) and BDNF (rs6265 - C196T) and EEG-measured brain oscillations in Knee Osteoarthritis (KOA) patients. MATERIALS AND METHODS: We performed a cross-sectional analysis of a cohort study (DEFINE cohort), KOA arm, with 66 patients, considering demographic (age, sex, and education), clinical (pain intensity and duration), OPRM1 (rs1799971 - A118G and rs1799972 - C17T) and BDNF (rs6265 - C196T) genotypes, and electrophysiological measures. Brain oscillations relative power from Delta, Theta, Alpha, Low Alpha, High Alpha, Beta, Low Beta and High Beta oscillations were measured during resting state EEG. Multivariate regression models were used to explore the main brain oscillation predictors of the three genetic polymorphisms. RESULTS: Our findings demonstrate that Theta and Low Beta oscillations are associated with the variant allele of OPRM1-rs1799971 (A118G) on left frontal and left central regions, respectively, while Alpha brain oscillation is associated with variant genotypes (CT/TT) of BDNF-rs6265 on frontal (decrease of oscillation power) and left central (increase of oscillation power) regions. No significant model was found for OPRM1-rs1799972 (C17T) in addition to the inclusion of pain intensity as a significant predictor of this last model. CONCLUSION: One potential interpretation for these findings is that polymorphisms of OPRM1 - that is involved with endogenous pain control - lead to increased compensatory oscillatory mechanisms, characterized by increased theta oscillations. Along the same line, polymorphisms of the BDNF lead to decreased alpha oscillations in the frontal area, likely also reflecting the disruption of resting states to also compensate for the increased injury associated with knee OA. It is possible that these polymorphisms require additional brain adaption to the knee OA related injury.

The impact of Exergames on emotional experience: a systematic review.

Background: Gamification has proven to be a significant tool for health promotion, with a particular focus on physical activities such as Exergames, which improve not only physical, but also cognitive health. However, it is still not clear what effect the practice of Exergames has on changing the emotional experience. Purpose: The objective of this systematic review is to evaluate the impact of Exergames training on emotional experience. Methods: A systematic search was conducted in the PUBMED and SCOPUS databases. The relevant articles were screened independently by three researchers. Data concerning emotional measures and Exergame practice were extracted for analysis. Results: The search yielded 38 articles, of which 16 were included. Exergames were found to significantly impact happiness, anxiety, depressive symptoms, mental health-related quality of life, self-worth, self-esteem, self-efficacy, perceived behavioral control, vigor, vitality, intrinsic motivation, perceived energy, and relaxation. Conclusion: Our review supports the evidence that the practice of physical activity through Exergames, on the emotional experience generally generates an increase in positive emotions. In this sense, the results found support both the use of Exergames as a leisure activity that promotes wellbeing and emotional regulation, as well as for health promotion, public health, and clinical practice purposes. Our review strongly supports the notion that engaging in physical activity through Exergames generally leads to an increase in positive emotions. As a result, these findings endorse the utilization of Exergames as a leisure activity to promote well-being and emotional regulation. Moreover, Exergames hold potential for health promotion, public health, and clinical practice purposes.

O uso de álcool entre idosos atendidos na Atenção Primária à Saúde / Uso de alcohol entre ancianos atendidos en Atención Primaria de Salud / Use of alcohol among elderly people attending Primary Health Care

Resumo Objetivo: Verificar o padrão do uso de álcool entre idosos atendidos em um serviço de Atenção Primária à Saúde e descrever a relação do uso desta substância com as variáveis sociodemográficas. Métodos: Estudo observacional, transversal, quantitativo, com idosos de um serviço de saúde de Atenção Primária de município do interior de São Paulo/Brasil. De um total de 750 idosos, foram incluídos 112; entrevistados 85 e a amostra final foi de 25 que auto relataram uso de álcool. Os dados do estudo foram obtidos através de entrevistas para aplicação de instrumentos: questionário sociodemográfico, Michigan Alcoholism Screenig Test-Geriatric Version (MAST-G); Alcohol Use Disorders Identification Test (AUDIT). Resultados: Predominou o sexo feminino (56%), a condição de aposentados (56%), a idade média foi 69,8 anos (variação entre 60 e 83 anos), níveis de escolaridade, desde curso superior completo até não possuir grau de instrução, média de 7,4 anos estudados. No AUDIT, 15 idosos (60%) pontuaram entre 8 e 14, portanto uso de risco e 10 (40%) tiveram escore 7 incluídos no uso de baixo risco. No MAST-G, os 25 pacientes (100%) sugerem ter problema relacionado ao uso do álcool. Conclusão: O estudo contribui no que diz respeito à situação do uso de álcool por idosos e isto está na constatação de que, na população estudada, existe maior número de mulheres em situação de risco. Estas questões devem ser consideradas na abordagem e investigações pelos profissionais de saúde, na perspectiva de realizarem estratégias para o tratamento global e humanizado do idoso usuário de álcool.

Resumen Objetivo: Verificar el estándar de consumo alcohólico entre ancianos atendidos en servicio de Atención Primaria de Salud y describir la relación de dicho consumo con las variables sociodemográficas. Métodos: Estudio observacional, transversal, cuantitativo, con ancianos de un servicio de Atención Primaria de municipio del interior de São Paulo/Brasil. Sobre un total de 750 ancianos, fueron incluidos 112; entrevistados 85, con muestra final de 25 que refirieron consumo de alcohol. Datos obtenidos mediante entrevistas para aplicación de los instrumentos: cuestionario sociodemográfico, Michigan Alcoholism Screening Test-Geriatric Version (MAST-G); Alcohol Use Disorders Identification Test (AUDIT). Resultados: Predominio del sexo femenino (56%), la condición de jubilados (56%). La media etaria fue de 69,8 años (variando entre 60 y 83 años), niveles de escolarización desde curso superior completo hasta carecer de educación, promedio de 7,4 años de estudios. En el AUDIT, 15 ancianos (60%) obtuvieron puntajes entre 8 y 14, configurando consumo de riesgo, y 10 (40%) obtuvieron 7, correspondiéndoles bajo riesgo. En el MAST-G, los 25 pacientes (100%) sugieren tener problemas relacionados al consumo alcohólico. Conclusión: El estudio contribuye respecto a la situación del consumo alcohólico en ancianos, y esto constata que en la población estudiada existe mayor número de mujeres en situación de riesgo. Estas cuestiones deben ser consideradas por los profesionales de salud en el abordaje y en investigaciones, con el fin de elaborar estrategias para el tratamiento global y humanizado del anciano consumidor de alcohol.

Abstract Objective: To verify the pattern of alcohol use among the elderly attending a primary health care service and to describe the relationship between the use of alcohol and sociodemographic variables. Methods: Observational, cross-sectional, quantitative study with elderly patients from a primary health care service in a city in the interior of São Paulo/Brazil. Of 750 elderly subjects in total, 112 were included, 85 were interviewed, and the final sample was comprised of 25 subjects who self-reported alcohol use. Data of the study were obtained through interviews for application of the following instruments: sociodemographic questionnaire, Michigan Alcoholism Screening Test-Geriatric Version (MAST-G); and Alcohol Use Disorders Identification Test (AUDIT). Results: There was predominance of the female gender (56%), retirees (56%), mean age was 69.8 years (60-83 years range), educational level of 7.4 years of study, on average, ranging from no education to complete higher education. Fifteen elderly (60%) scored between 8 and 14 points in the AUDIT, which is risk use; and 10 (40%) had a score of 7 points, considered low risk use. In MAST-G, the 25 patients (100%) suggest the presence of problems related to alcohol use. Conclusion: The study contributes to the situation of alcohol use by the elderly. This is based on the existence of a greater number of women at risk in the population studied. These issues should be considered in health professionals' approach and investigations with a view to adopting strategies for the global and humanized treatment of elderly alcohol users.

Correction to: Mental Health Needs and Psychoactive Drug Use in a User Population of the Family Health Strategy (FHS) in Ribeirão Preto, São Paulo, Brazil.

The original version of this article unfortunately published without acknowledgement. The funding information and grant number is given below: Funding Research supported by Research in Public for the National Health Care System (PP-SUS), Grant number 12/51732-9.

Mental Health Needs and Psychoactive Drug Use in a User Population of the Family Health Strategy (FHS) in Ribeirão Preto, São Paulo, Brazil.

This cross-sectional study was conducted in Family Health Care's field of  Ribeirão Preto city, São Paulo, Brazil to identify the prevalence of substance-related disorders and mental distress among patients with mental disorders. We also aimed to identify sociodemographic and social support risk factors. The data collection was done using medical records, the Social Support Questionnaire (SSQ-6), Self Report Questionnaire (SRQ-20) and home visits. Of the 272 families studied, 211 contained individuals with mental disorders, and 61 included individuals who had substance-related disorders, or both. The mental disorders recorded in these families were most frequently mood disorders, followed by neurotic disorders, stress-related disorders and somatoform disorders. Women received twice as many psychotropic prescriptions associated with non-psychiatric medication. A significant relationship was established between education and mental distress as measured using the SRQ-20 (p = 0.024). The SSQ-6 revealed a family presence of social support in all of the conditions established by the six questions.

Mental health in the Family Health Strategy as perceived by health professionals.

OBJECTIVE:: to analyze the management of mental health needs in primary care as perceived by Family Health Strategy professionals. METHOD:: this was a qualitative descriptive exploratory study developed within the coverage area of five family health teams. The data were collected using observation, group interviews, individual semi-structured interviews, and focus groups. Content analysis was conducted using text analysis software and interpretation was based on the corresponding analytical structures. RESULTS:: numerous and challenging mental health demands occur in this setting, for which the teams identified care resources; however, they also indicated difficulties, especially related to the operationalization and integration of such resources. CONCLUSION:: there is a need for a care network sensitive to mental health demands that are better coordinated and more effectively managed. OBJETIVO:: analisar o manejo das necessidades de saúde mental na atenção primária à saúde de acordo com a percepção dos profissionais da Estratégia Saúde da Família. MÉTODO:: estudo qualitativo, descritivo exploratório, desenvolvido no território de abrangência de cinco equipes de saúde da família. Os participantes foram cinco enfermeiras, cinco coordenadores e 17 agentes comunitários de saúde. Os dados foram coletados utilizando observação, entrevistas grupais, entrevistas individuais semiestruturadas e grupos focais. Fez-se a análise de conteúdo com o auxílio de um Software de análise textual, e a interpretação baseou-se nas estruturas analíticas correspondentes. RESULTADOS:: inúmeras e desafiadoras demandas de saúde mental têm sido acolhidas nesse setting, para as quais as equipes identificaram recursos de atendimento; no entanto, apontaram dificuldades, sobretudo relacionadas à operacionalização e integração destes recursos. CONCLUSÃO:: destaca-se a necessidade de uma rede de cuidados sensível a tais demandas, mais articulada e gerida de modo eficaz.

Mental health in the Family Health Strategy as perceived by health professionals / Salud mental en la Estrategia Salud de la Familia: la visión de los profesionales / Saúde mental na Estratégia Saúde da Família: a percepção dos profissionais

ABSTRACT Objective: to analyze the management of mental health needs in primary care as perceived by Family Health Strategy professionals. Method: this was a qualitative descriptive exploratory study developed within the coverage area of five family health teams. The data were collected using observation, group interviews, individual semi-structured interviews, and focus groups. Content analysis was conducted using text analysis software and interpretation was based on the corresponding analytical structures. Results: numerous and challenging mental health demands occur in this setting, for which the teams identified care resources; however, they also indicated difficulties, especially related to the operationalization and integration of such resources. Conclusion: there is a need for a care network sensitive to mental health demands that are better coordinated and more effectively managed.

RESUMEN Objetivo: analizar el manejo de necesidades de salud mental en la atención primaria de salud, según la visión de los profesionales de la Estrategia Salud de la Familia. Método: estudio cualitativo, descriptivo, exploratorio, desarrollado en el campo de acción de cinco equipos de salud familiar. Participaron cinco enfermeras, cinco coordinadores y diecisiete agentes comunitarios de salud. Datos recolectados mediante observación, entrevistas grupales, entrevistas individuales semiestructuradas y grupos focuses. Se aplicó análisis de contenido, con ayuda de software de análisis textual. La interpretación se basó en las correspondientes estructuras analíticas. Resultados: numerosas y desafiantes demandas de salud mental fueron recogidas en este setting, para las cuales los equipos identificaron recursos de atención; aunque detectaron dificultades, particularmente relacionadas a la puesta en marcha e integración de tales recursos. Conclusión: se enfatiza la necesidad de una red de atención sensible a tales demandas, aunque articulada y gerenciada de manera eficaz.

RESUMO Objetivo: analisar o manejo das necessidades de saúde mental na atenção primária à saúde de acordo com a percepção dos profissionais da Estratégia Saúde da Família. Método: estudo qualitativo, descritivo exploratório, desenvolvido no território de abrangência de cinco equipes de saúde da família. Os participantes foram cinco enfermeiras, cinco coordenadores e 17 agentes comunitários de saúde. Os dados foram coletados utilizando observação, entrevistas grupais, entrevistas individuais semiestruturadas e grupos focais. Fez-se a análise de conteúdo com o auxílio de um Software de análise textual, e a interpretação baseou-se nas estruturas analíticas correspondentes. Resultados: inúmeras e desafiadoras demandas de saúde mental têm sido acolhidas nesse setting, para as quais as equipes identificaram recursos de atendimento; no entanto, apontaram dificuldades, sobretudo relacionadas à operacionalização e integração destes recursos. Conclusão: destaca-se a necessidade de uma rede de cuidados sensível a tais demandas, mais articulada e gerida de modo eficaz.

The Role of Social Support for Patients with Mental Disorders in Primary Care in Brazil.

The aim of this article was to identify the health care providers and other agencies in a given region where psychiatric patients included in the study reside. In addition, we evaluated how these patients perceive social support for specific needs related to mental health. This study was carried out using fieldwork and face-to-face semistructured interviews with 25 patients who were receiving psychiatric treatment through primary health care. We performed structural analysis of the data focusing on relationship structure. We identified that a significant number of health care providers were involved with the patients; however, some of them were ignored by patients interviewed. Participants cited mostly general practitioners, psychiatrists, and nurses, as professional references.

Intervenção com familiares, usuários de álcool e álcool mais outras drogas: um estudo clínico / Intervention with relatives, alcohol and alcohol users plus other drugs: a clinical trial

A Atenção Primária à Saúde (APS) pode ser uma possibilidade de acesso a usuários de álcool em uso de risco ou dependência, sendo a Intervenção Breve (IB) uma possiblidade de intervenção. Este estudo clínico randomizado por cluster objetiva verificar a efetividade da IB quando comparado ao grupo controle. Os participantes do estudo (Grupo Intervenção - GI - e Grupo Controle - GC) foram contatados por visita domiciliar após indicação dos serviços de Estratégia de Saúde da Família (ESF) da região Oeste de Saúde de Ribeirão Preto - SP. Os usuários inclusos foram usuários maiores de 18 anos e com escore de consumo >= 7, segundo AUDIT. Os instrumentos utilizados foram AUDIT (Alcohol Use Disorders Identification Test), ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), perfil sociodemográfico e Diário de consumo de álcool. Após as intervenções foram realizados follow-up de um mês e seis meses após término da última intervenção. As medidas quantitativas de desfecho foram a pontuação no instrumento AUDIT, na qual se utilizou as alterações na pontuação do instrumento como balizador para verificar a efetividade das intervenções. No grupo intervenção realizou-se ainda uma entrevista semiestruturada. A análise estatística foi feita com uso Regressão Linear Multinível para a amostra do estudo (23 participantes) e o mesmo com a amostra simulada de 30, 50 e 100 participantes hipotéticos. Os 23 participantes (12 do GI e 11 do GC) tinham média de idade em 48.2 anos, sendo 16 participantes homens (nove no GI e sete no GC). Sobre os anos de estudo, a média foi de 7.8 anos (GI a média foi de 9.5 e no GC 6.3 anos). No total, foram realizadas 323 visitas domiciliares. Referente consumo, a bebida mais escolhida foi cerveja e 15 dos 23 participantes não sabiam expressar como se sentiam antes da ingestão de bebida alcoólica. No que diz respeito ao uso de outras drogas na vida, dez participantes da amostra usavam apenas álcool (quatro do GI e seis do GC). Sete participantes usavam álcool e tabaco (quatro GI e três GC). Cinco participantes eram usuários de múltiplas drogas (3 GI e 2 GC). Entre as múltiplas drogas, as mais comuns foram a maconha e a cocaína. Sobre o comportamento de consumo abusivo de álcool episódico o consumo mais abusivo variou de 2,85 a 16, 2 doses. A média dos AUDIT durante o follow up não diferiu muito. A média de AUDIT do GI foi de 15.5 (T0), 16.25 (T1) e 11.6 (T2). Para o GC a média foi de 15.36 (T0), 8.1 (T1), 16.36 (T2). Sobre os resultados da efeito multinivel misto, na amostra real deste estudo não houve diferença significativa (p= 0.80) entre os grupo intervenção e controle, embora tenha sido observado efeito da intervenção. Sobre os dados prevenientes da simulação com tamanho amostral de 30, 50 e 100 participantes hipotéticos, não teve significância estatística, embora o efeito seja mantido. No que se refere aos resultados qualitativos, processados em três classes pelo software Alceste, foram analisados 74% do conteúdo textual, com riqueza de palavras de 94.05%, cujo conteúdo resultou em três classes: classe 1, com 33% da análise e correspondeu ao contexto geral do beber: pessoas e ocasiões que promovem ou desestimulam o beber, e os estímulos foram encontros com os amigos, os sentimentos negativos e às relações sociais; classe 2, 28% da análise e fez alusão ao indivíduo estar dependente de drogas em geral, situou o consumo de todas as substâncias (incluído o álcool) num contexto prejudicial; classe 3, que predominou com 39%, referiu-se ao indivíduo nos aspectos frequência, quantidade e abandono do consumo. Dados referentes ao perfil da amostra, bebida de escolha e influência cultural foram corroborados em outros estudos. Apareceu ainda que, o consumo de álcool não está vinculado apenas às preferências pessoais. O estudo revelou ser possível realizar a IB, todavia, há necessidade de encontrar as estratégias mais efetivas para contactar os usuários e envolver suas famílias e a equipe local dos serviços de saúde. O conhecimento de aspectos qualitativos mostrou que o consumo ligado ao hábito cotidiano pareceu se relacionar a padrão de consumo mensal alto, por isso, mais danoso. Inferiu-se ainda que nesta amostra esse padrão de consumo pode ser devido à carência de orientações e aconselhamento dos profissionais de saúde sobre o hábito de beber. As vivências sociais foram relacionadas ao consumo, prover espaços e momentos de lazer na comunidade sem o incentivo ao uso de álcool e/ou substâncias psicoativas, poderia auxiliar na diminuição do consumo ou abstinência das mesmas

Primary Health Care (PHC) may be a possibility for access to alcohol users who use risk or dependence and Brief Intervention (IB) is a possible intervention. Thus, this clinical trial randomized by cluster aimed to verify the effectiveness of IB when compared to the control group. The participants of the study (Intervention Group - IG - and Control Group - CG) were contacted by a home visit after indicating the Family Health Strategy (ESF) services of the West Region of Health of Ribeirão Preto/São Paulo state. The included users were users older than 18 years and with consumption score >= 7, according to AUDIT score. The instruments used were AUDIT (Alcohol Use Disorders Identification Test), ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), sociodemographic profile and Alcohol consumption diary. After the interventions, follow-up was performed one month and six months after the last intervention. The quantitative measures of outcome were the score in the AUDIT instrument, in which the changes in the instrument score were used as a benchmark to verify the effectiveness of the interventions. In the IG, a semi-structured interview was also carried out. The statistical analysis was done using Multi Level Linear Regression for the study sample (23 participants) and the same with the simulated sample of 30, 50 and 100 hypothetical participants. The 23 participants (12 from IG and 11 from CG) had a mean age of 48.2 years, of which 16 were men (nine in IG and seven in CG). Over the years of study, the mean was 7.8 years (mean IG was 9.5 and in CG 6.3 years). In total, 323 home visits were carried out. Regarding consumption, the most chosen beverage was beer and 15 of the 23 participants could not express how felt before drinking alcohol. Concerning the use of other drugs in life, ten participants in the sample used only alcohol (four from IG and six from CG). Seven participants used alcohol and tobacco (four IG and three CG). Five participants were users of multiple drugs (3 IG and 2 CG). Among the multiple drugs, the most common were marijuana and cocaine. On the behavior of abusive consumption episodic, the most abusive consumption ranged from 2.85 to 16.2 doses. The average AUDIT during the follow up did not differ much. The mean AUDI of the IG was 15.5 (T0), 16.25 (T1) and 11.6 (T2). For CG, the mean was 15.36 (T0), 8.1 (T1), 16.36 (T2). Concerning the results of the mixed multilevel effect, in the actual sample of this study there was no significant difference (p = 0.80) between the intervention and control groups, although the intervention effect was observed. Regarding the data of the simulation with sample size of 30, 50 and 100 hypothetical participants, it was not statistically significant also, although the effect was maintained. Regarding the qualitative results, processed in three classes by the software Alceste, 74% of the textual content was analyzed, with a wealth of words of 94.05%. Regarding Class 1, 33% of the analysis corresponds to the general context of drinking, people and occasions that promote or discourage drinking, where the incentive can be encounters with friends, negative feelings and social relations. Class 2 accounted for 28% of the analysis and refers to the individual being dependent of drugs in general, not just alcohol, placing the consumption of all substances in the same context. As for Class 3, higher class with 39%, refers to the individual regarding the frequency, quantity and abandonment of consumption. The knowledge of qualitative aspects showed us that the consumption linked to the daily habits seems to be related to patterns of high consumption monthly doses and, therefore, more harmful, even if in this sample it was observed that the consumption is high also possibly due to lack of guidance and conversations with professional about the habit of drinking. As the social experiences were related to the consumption high doses of alcohol, perhaps provide spaces and moments of leisure free alcohol could help in the diminution or abstinence to the alcohol

Síndrome de dependencia alcohólica en servicios de urgencia: protocolo de evaluación para la práctica profesional de enfermería / Síndrome de dependência alcoólica em serviços de emergência: protocolo de avaliação para a prática profissional de enfermagem / Alcohol dependence syndrome in emergency services: assessment protocol for the professional nursing practice

Estudio cuantitativo exploratorio realizado en los servicios de urgencias del municipio de Ribeirão Preto, interior del Estado de São Paulo, Brasil. El objetivo del estudio fue evaluar señales y síntomas del Síndrome de Abstinencia Alcohólica (SAA) por el equipo de enfermería, utilizando para esto un protocolo. La colecta de datos se realizó durante 642 horas de turnos. De los 463 participantes, 297 presentaron AUDIT (Alcohol Use Disorders Identification Test) ≥7, de estos, 59 (12,7%) presentaban AUDIT ≥20, o sea, sugerente de SAA siendo, por esto, incluídos en esta investigación. En cuanto a las señales, de los 59 usuarios, 8 no sabían decir el tiempo de hospitalización, 7 no sabían en qué año o mes estaban, y 13 presentaban inquietud. En relación a los signos físicos de la dependencia, 17 presentaron signos de temblores, 8 refirieron convulsiones. Los servicios de urgencias pueden ser lugares privilegiados para identificar síntomas de consumo abusivo y de dependencia del alcohol y la utilización del protocolo de evaluación de enfermería puede ser una estratégia útil en el seguimiento e intervención (AU)

Estudo quantitativo exploratório realizado em serviços de emergências do município de Ribeirão Preto, interior do Estado de São Paulo, Brasil. O objetivo do estudo foi avaliar sinais e sintomas da Síndrome de Abstinência Alcoólica (SAA) pela equipe de enfermagem, utilizando para isso um protocolo. A coleta de dados foi realizada durante 642 horas de plantões. Dos 463 participantes, 297 apresentaram AUDIT (Alcohol Use Disorders Identification Test) ≥7, destes, 59 (12,7%) apresentavam AUDIT ≥20, ou seja, sugestivo de SAA sendo, por isso, incluídos nesta investigação. Quanto aos sinais, dos 59 usuários, 8 não sabiam mencionar o tempo de hospitalização, 7 não souberam afirmar em que ano ou mês estavam, e 13 apresentavam inquietação. Em relação aos sinais físicos da dependência, 17 apresentaram sinais de tremores, 8 referiram convulsões. Os serviços de emergências podem ser locais privilegiados para identificar sintomas de uso abusivo e de dependência de álcool e a utilização do protocolo de avaliação de enfermagem pode ser uma estratégia útil no rastreamento e intervenção (AU)

This is a quantitative study carried out in emergency services of Ribeirao Preto, a city located in the countryside of Sao Paulo state. The aim of this study was to assess signs and symptoms of the Alcohol Withdrawal Syndrome (AWS) by the nursing team with the use of a protocol. Data collection took place over 642 on duty hours. Of the 463 participants, 297 had AUDIT ≥7, and of these, 59 (12.7%) had AUDIT ≥20, which indicates the occurrence of SAA and, due to this, were included in this investigation. Concerning the signs, of the 59 users, 8 were unable to tell the time of hospitalization, 7 could not say what year or month it was, and 13 seemed uneasy. In relation to the physical signs of the dependence, 17 had signs of tremor, 8 mentioned to have had seizures. The emergency services may be privileged places to identify symptoms of alcohol abuse and dependence and the use of the nursing assessment protocol may be a useful strategy in the monitoring and intervention (AU)

Mental health care situation in family health units: perceptions of community health agents / Situaciones de salud mental en las unidades de salud familiar: percepción de los agentes comunitarios de salud / Situações de saúde mental nas unidades de saúde da família: percepção dos agentes comunitários de saúde

This was a qualitative, descriptive study, performed with 17 Community Health Agents. The aim was to analyze the perception of these professionals regarding the most frequent mental health cases in the region. Data was collected through observation of the region and two focus groups. We used the structuralist perspective for the analysis. The results showed that these professionals perceived mental health demands from an expanded concept of health, in which the resources fit together between the various sectors. They deal with difficulties, develop actions based on soft technologies and do not necessarily focus on the disease. It was concluded that these elements reinforce the power of the Community Health Agents as performers of mental health care practices and as an important link between the healthcare service and the community.

Se trata de una investigación descriptiva cualitativa, con 17 Agentes Comunitarios de Salud tuvo como objetivo analizar la percepción de estos profesionales con respecto a las situaciones de salud mental frecuente. Las tareas de los agentes comunitarios de salud son la identificación, prevención, promoción de la salud de las familias en el territorio. Se les considera actores importantes en la identificación de las necesidades de salud mental en la atención primaria. Para la recolección de datos se utilizó la observación y dos grupos focales. Para el análisis de los datos se utilizó la perspectiva estructuralista. El método utilizado fue la observación del territorio y grupos focales. Los resultados mostraron que estos profesionales tienen una visión amplia de las necesidades de salud mental y que los recursos de atención de salud se insertan en una propuesta intersectorial. Estos profesionales, aunque las dificultades que señalan, están desarrollando acciones basadas en las tecnología ligeras, y no necesariamente centrado en la enfermedad. Se concluye que estos aspectos refuerzan el poder de la agentes comunitarios de salud como actores de prácticas de salud mental y importante vínculo entre el servicio de salud y la comunidad.

Trata-se de pesquisa qualitativa, descritiva, com 17 Agentes Comunitários de Saúde. O objetivo foi analisar a percepção destes profissionais quanto às situações de saúde mental mais frequentes no território. Os dados foram coletados utilizando observação do território e dois grupos focais. Para a análise utilizou-se a perspectiva estruturalista. Os resultados apontaram que estes profissionais percebem as demandas de saúde mental a partir de uma concepção ampliada de saúde, na qual os recursos se articulam intersetorialmente. Apesar de referirem dificuldades, desenvolviam ações calcadas em tecnologias leves e não, necessariamente, centradas na doença. Concluiu-se que estes aspectos reforçam a potência dos agentes comunitários de saúde como atores de práticas de saúde mental e importante elo entre o serviço de saúde e a comunidade.

Concepções e vivências de estudantes quanto ao desenvolvimento com substâncias psicoativas em uma escola pública de Ribeirão Preto, São Paulo, Brasil / Las concepciones y experiencias de lo estudiantes en relación al involucramiento con sustancias psicoactivas en una escuela publica de Ribeirao Preto, São Paulo, Brasil / Conceptions and experiences of students about their involvement with psychoactive substances from one public school in Ribeirao Preto, São Paulo, Brazil

Objetiva-se identificar fatores de risco que atuam no envolvimento de estudantes do ensino basico publico com substâncias psicoativas. Trata-se de pesquisa qualitativa realizada com 19 estudantes do sétimo ano do ensino fundamental de uma escola pública de Ribeirão Preto, que teve como coleta de dados o grupo focal. Na análise de conteúdo temática foram identificadas 3 categorias: Local de encontro das drogas, consequências decorrentes do consumo e comércio de drogas. Os resultados apontam que tais adolescentes apresentam disponibilidade de substâncias psicoativas na comunidade, fácil acesso, falta de vigilância da família e envolvimento de familiares no consumo e tráfico de drogas. Aponta como possível fator protetor, a proximidade com as consequências negativas do consumo e tráfico de drogas. O estudo possibilitou identificar o conhecimento dos adolescentes sobre o tema, sendo um meio de reflexão sobre as atitudes face à oferta de drogas e também foi um espaço para livre expressão, estreitamento de vínculos e apoio, o que demonstra o potencial desse procedimento como meio promotor da prevenção do consumo de drogas.

This study aimed to identify risk factors associated with the participation of students from an elementary public school with psychoactive substances. This is a qualitative research with 19 students from the seventh grade of an elementary school at Ribeirão Preto, whose data collection was performed by focus group. The thematic content analysis idenfied 3 categories: Venue of drugs, consequences arising from the consumption and trade of drugs. Results indicate that adolescents have availability of psychoactive substances in the community, easy access, lack of family supervision and family involvement in consumption and drugs trafficking. Findings indicated as possible protective factor, the proximity with the negative consequences of consumption and drugs trafficking. The study identified the knowledge of adolescents on the topic, being a way of reflection on attitudes to drug supply and was also a space for free expression, and support the strengthening of support, demonstrating the potential of this procedure as a way of promoting prevention of drug use and abuse.

Este estudio tuvo como objetivo identificar los factores de riesgo asociados a la participación de estudiantes de enseñanza básica pública con las sustancias psicoactivas. Se trata de una investigación cualitativa, con 19 estudiantes de séptimo grado de una escuela primaria em Ribeirão Preto, cuya recolección de datos se realizó mediante grupo focal. En el análisis de contenido temático fueron listadas 3 categorías: Lugar donde se encuentran las drogas, consecuencias derivadas del consumo y comercio de drogas. Los resultados indican que los adolescentes tenían disponibilidad de sustancias psicoactivas en la comunidad, fácil acceso, falta de supervisión de la familia y participación de las familias en consumo y el tráfico de drogas. Señala como posible factor protector, la proximidad con las consecuencias negativas del consumo y tráfico de drogas. El estudio identificó los conocimientos de los adolescentes sobre el tema, como una forma de reflexión sobre las actitudes hacia la oferta de drogas y fue también un espacio para la libre expresión, y apoyar el fortalecimiento de los lazos, lo que demuestra el potencial de este procedimiento como una forma de promover la prevención del consumo de sustancias.

Assistance to drug users in emergency care: perspective of health professionals / Atendimento aos usuários de substâncias psicoativas em pronto atendimento: perspectiva dos profissionais de saúde / Atención a los usuarios de substancias psicoactivas en presto servicio: perspectiva de los profesionales de salud

The objective was to analyze how is the care of drug users from the perspective of practicing professionals in an emergency care service in Ribeirão Preto-SP. For data collection, it was used a semi-structured interview conducted with 17 participants and found the Content Analysis of thematic type. It was found that most professionals do not have the knowledge to meet this demand, they feel insecure and their postures were guided by moral judgment and prejudice. Actions proved ineffective in attendance, as often the same were concentrated on clinical problems. It was reinforced the need for training of health professionals for this service, mainly due to the increasing demand for these services.(AU)

Objetivou-se analisar como ocorre o atendimento de usuários de substâncias psicoativas, a partir da perspectiva dos profissionais atuantes, num serviço de pronto atendimento do município de Ribeirão Preto, SP. Para a coleta de dados, utilizou-se entrevista semiestruturada, realizada com 17 participantes e procedeu-se à Análise de Conteúdo do tipo temática. Constatou-se que a maioria dos profissionais não dispõe de conhecimento para o atendimento a essa demanda, sentiam-se inseguros e suas posturas eram guiadas por julgamento moral e preconceito. As ações mostraram-se pouco eficazes no atendimento, visto que quase sempre as mesmas se concentravam em problemas clínicos. Reforça-se a necessidade de formação dos profissionais de saúde para esse atendimento, sobretudo devido à crescente procura por esses serviços.(AU)

Se objetivó analizar como ocurre el servicio de usuarios de substancias psicoactivas, desde la perspectiva de los profesionales actuantes, en un servicio de presto servicio del municipio de Ribeirão Preto-SP. Para recogida de datos se utilizó entrevista semiestructurada realizada con 17 participantes y se procedió el Análisis de Contenido del tipo temática. Se constató que la mayoría de los profesionales no dispone de conocimiento para el servicio la esa demanda, se sienten inseguros y sus posturas eran guiadas por juicio moral y preconcepto. Las acciones se mostraron poco eficaces en el servicio, visto que casi siempre las mismas se concentraban en problemas clínicos. Reforzamos la necesidad de formación de los profesionales de salud para ese servicio, especialmente debido a la creciente busca de estos servicios.(AU)

Assistance to drug users in emergency care: perspective of health professionals / Atendimento aos usuários de substâncias psicoativas em pronto atendimento: perspectiva dos profissionais de saúde / Atención a los usuarios de substancias psicoactivas en presto servicio: perspectiva de los profesionales de salud

The objective was to analyze how is the care of drug users from the perspective of practicing professionals in an emergency care service in Ribeirão Preto-SP. For data collection, it was used a semi-structured interview conducted with 17 participants and found the Content Analysis of thematic type. It was found that most professionals do not have the knowledge to meet this demand, they feel insecure and their postures were guided by moral judgment and prejudice. Actions proved ineffective in attendance, as often the same were concentrated on clinical problems. It was reinforced the need for training of health professionals for this service, mainly due to the increasing demand for these services...

Objetivou-se analisar como ocorre o atendimento de usuários de substâncias psicoativas, a partir da perspectiva dos profissionais atuantes, num serviço de pronto atendimento do município de Ribeirão Preto, SP. Para a coleta de dados, utilizou-se entrevista semiestruturada, realizada com 17 participantes e procedeu-se à Análise de Conteúdo do tipo temática. Constatou-se que a maioria dos profissionais não dispõe de conhecimento para o atendimento a essa demanda, sentiam-se inseguros e suas posturas eram guiadas por julgamento moral e preconceito. As ações mostraram-se pouco eficazes no atendimento, visto que quase sempre as mesmas se concentravam em problemas clínicos. Reforça-se a necessidade de formação dos profissionais de saúde para esse atendimento, sobretudo devido à crescente procura por esses serviços...

Se objetivó analizar como ocurre el servicio de usuarios de substancias psicoactivas, desde la perspectiva de los profesionales actuantes, en un servicio de presto servicio del municipio de Ribeirão Preto-SP. Para recogida de datos se utilizó entrevista semiestructurada realizada con 17 participantes y se procedió el Análisis de Contenido del tipo temática. Se constató que la mayoría de los profesionales no dispone de conocimiento para el servicio la esa demanda, se sienten inseguros y sus posturas eran guiadas por juicio moral y preconcepto. Las acciones se mostraron poco eficaces en el servicio, visto que casi siempre las mismas se concentraban en problemas clínicos. Reforzamos la necesidad de formación de los profesionales de salud para ese servicio, especialmente debido a la creciente busca de estos servicios...

Estratégia de Saúde da Família: recursos comunitários na atenção à saúde mental / Family Health Strategy: community resources in mental health care

OBJETIVO: Investigar a percepção de profissionais de estratégia de saúde da família sobre recursos existentes no território para atendimento de demandas em saúde mental. MÉTODOS: Estudo transversal, qualitativo realizado com 27 profissionais da saúde de serviços de atenção primária. Os dados foram coletados utilizando entrevistas, grupos focais e observação. Após a coleta, os dados foram transcritos e submetidos à análise à luz do conceito estruturalista. RESULTADOS: Os enfermeiros referiram dispositivos formais para apoio em saúde mental, enfatizando serviços de saúde. Os coordenadores mencionaram serviços de saúde, universidade e parcerias como conselho tutelar e promotoria pública. Os agentes comunitários demonstraram maior integração com o território e conhecimento abrangente de fontes de apoio social formal e informal. Na observação do território foram identificados recursos sociais não mencionados nas entrevistas. CONCLUSÃO: A percepção dos enfermeiros em relação aos recursos comunitários centrou-se em instituições formais relacionadas à saúde ou ao ensino de cursos na área da saúde. Os coordenadores identificaram outros serviços de saúde e dispositivos de proteção social. Os agentes comunitários têm a maior percepção dos recursos existentes em saúde mental.

OBJECTIVE: Assess the perception of the professionals working at the family health strategy on the resources present within the territory toward meeting mental health care demands. METHODS: Cross-sectional, qualitative study carried out with 27 primary health care professionals. Data were collected by means of interviews, focus groups and observation. Following data collection, data were transcribed and analyzed in the light of the structuralist theory. RESULTS: Nurses referred to the existence of formal instruments toward promoting mental health care and highlighted the health services. Care coordinators mentioned health services, universities and partnerships with Child Protective Services and the District Attorney's Office. Community agents showed to be more integrated with the territory and to have a broader knowledge of formal and informal social support sources. The observation of the territory pointed out social resources that were not addressed in the interviews. CONCLUSION: The perception of the nurses regarding the community resources focused on formal health institutions or other entities related to the health care or health education areas. The coordinators identified other health services and social protection instruments. Community agents have a clearer perception of existing mental health resources.