Pacientes com distúrbios mentais em um centro de atuação psicossocial (caps ii): percepção dos profissionais de saúde / Pacientes con disturbios mentales en un servicio de salud mental: percepción de los profesionales de salud / Patients with mental disorders in a mental health services: perception of health professionals

Introdução: Pessoas com transtornos mentais necessitam de cuidados humanizados e integrais. Objetivo: Identificar as percepções que os profissionais de saúde têm em relação ao paciente com distúrbios mentais, no cotidiano assistencial. Material e Método: Trata-se de um estudo descritivo exploratório desenvolvido junto a 14 profissionais de um Centro de Atenção Psicossocial de uma cidade do interior paulista. A coleta de dados foi realizada mediante duas entrevistas semiestruturadas. As diretrizes metodológicas do Discurso do Sujeito Coletivo foram utilizadas para extrair os discursos dos sujeitos do estudo. Da percepção dos profissionais apreenderam-se significados quanto à segurança na assistência no Centro de Atenção Psicossocial, interferência e história de agressividade no cuidado assistencial e o significado de doente mental, emergindo as representações do imaginário científico e social dos profissionais. Conclusão: É fundamental que a equipe multiprofissional desenvolva conhecimentos e habilidades no cuidado assistencial a essa clientela e aos seus familiares, pois o diagnóstico correto e realizado em tempo possibilita aplicar as terapêuticas e estratégias necessárias, tendo em vista, acolher e oferecer segurança, necessárias aos usuários do Centro de Atenção Psicossocial e à equipe assistencial.

Introduction: People with mental disorders require humanized and comprehensive care. Objective: To identify the perceptions of health professionals in relation to patients with mental disorders in their everyday care. Methods: It was a descriptive exploratory study conducted with 14 health professionals at a Mental Health Services of a city in São Paulo state. Data collection was carried out by two semi-structured interviews. The methodological guidelines of the Collective Subject Discourse were used to obtain the speeches of the study subjects. From their perception it was possible to seize up meanings in terms of safety in care at Mental Health Services, interference and aggressions history in the healthcare process as well as the meaning of mental patient, emerging the representations of scientific and social imagination of health professionals. Conclusion: It is essential that the multidisciplinary team may be able to develop knowledge and skills in assisting care to this population and their families, once a correct and timely diagnosis allows to apply the correct therapies and strategies in order to welcome and offer security, as necessary for Mental Health Services users and for the support staff as well.

Introducción: Personas con trastornos mentales necesitan de cuidados humanizados e integrales. Objetivo: Identificar las percepciones que los profesionales de salud tienen en relación al paciente con disturbios mentales, en el cotidiano assistencial. Material y Método: Se trata de un estudio descriptivo exploratório desarrollado junto a 14 profesionales de un Servicio de Salud Mental de una ciudad del interior paulista. La recolección de datos fue realizada mediante dos entrevistas semiestruturadas. Las directrices metodológicas del discurso del sujeto colectivo fueron utilizadas para extraer los discursos de los sujetos del estudio. De la percepción de los profesionales se incautaron significados en cuanto a la seguridad en la asistencia en el Servicio de Salud Mental, interferencia y historia de agressividade en el cuidado assistencial y el significado de enfermo mental, emergiendo las representaciones del imaginario científico y social de los profesionales. Conclusión: Es fundamental que el equipo multiprofissional desarrolle conocimientos y habilidades en el cuidado assistencial a esa clientela y a sus familiares, pues el diagnóstico correcto y realizado en tiempo posibilita aplicar las terapéuticas y estrategias necesarias, con miras a, acoger y ofertar seguridad, necesarias a los usuarios del Servicios de Salud Mental y al equipo assistencial.

Non-alcoholic fatty liver disease and insulin resistance: importance of risk factors and histological spectrum.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has been associated with several metabolic conditions (MC) and secondary causes, but the relationship between insulin resistance (IR) and the underlying aetiology of NAFLD has not been extensively explored. OBJECTIVE: To determine the frequency of IR among NAFLD patients and to describe IR according to risk factors and histological findings of the disease. METHODOLOGY: A case-series study of 64 patients with clinical and histological diagnosis of NAFLD. IR was calculated by homeostasis model assessment (HOMA) and IR was considered when HOMA > or = 3. Histological grades of NAFLD were: stage 1, steatosis isolated; stage 2, steatosis and inflammation; stage 3, steatosis and ballooning degeneration; stage 4, steatosis and fibrosis and/or Mallory bodies. Fibrosis was graded 0-4 (cirrhosis). RESULTS: IR was found in 21 (33%) patients. Among those with IR, 16 patients (76%) had associated MC and five patients (24%) had exposure to petrochemicals. The mean value of HOMA varied from 3.5 in NAFLD associated with MC to 1.6 in patients with exposure to petrochemicals (P < 0.03). Waist circumference was the metabolic factor most strongly associated with IR (P < 0.005). Steatohepatitis (NASH) was observed in 54 (84.3%) cases. The HOMA mean value was significantly higher in patients with advanced fibrosis. CONCLUSIONS: IR occurred in 33% of the NAFLD patients, being more frequent among those with MC than among those with exposure to petrochemicals. The presence of IR in cases with advanced fibrosis suggests that it may influence the prognosis of NAFLD.