Mental health outcomes in frontline healthcare workers in Brazil during the COVID-19 epidemic: Results of an online survey in four regions using respondent-driven sampling (RDS).

BACKGROUND: The COVID-19 pandemic overwhelmed health facilities and presented healthcare workers (HCWs) with a new infectious disease threat. In addition to a sanitary crisis, Brazil still had to face major political, economic, and social challenges. This study aimed to investigate mental health outcomes in frontline HCWs in different regions of the country and at different epidemic times. We also sought to identify the main risk factors associated with these outcomes. METHODS: A cross-sectional online survey using respondent-driven sampling was conducted to recruit physicians (n = 584), nurses (n = 997), and nurse technicians (n = 524) in 4 regions of Brazil (North, Northeast, Southeast, and South) from August 2020 to July 2021. We used standardized instruments to screen for common mental disorders (CMD)(SRQ-20), alcohol misuse (AUDIT-C), depression (PHQ-9), anxiety (GAD-7), and post-traumatic stress disorder (PTSD)(PCL-5). Gile's successive sampling estimator was used to produce weighted estimates. We created a three-cluster data set for each HCW category and developed a hierarchical regression model with three levels: individual characteristics; workplace-related aspects; COVID-19 personal experience. The impact of the epidemic moment on the outcomes was also studied. RESULTS: The prevalence of probable CMD was 26.8-36.9%, alcohol misuse 8.7-13.6%, depression 16.4-21.2%, anxiety 10.8-14.2%, and PTSD 5.9-8.0%. We found a stronger association between mental health outcomes and the following factors: history of psychiatric disorders, female gender, and clinical comorbidities (level 1); work overload and family isolation (level 2); sick leave (level 3). Epidemic variables, such as the number of deaths and trend of deaths by COVID-19, had almost no impact on the outcomes. CONCLUSION: An alarmingly high prevalence of depression and anxiety was found in Brazilian frontline HCWs. Individual factors were the most strongly associated with mental health outcomes. These findings indicate the need to develop programs that provide emotional support, identify professionals at risk and refer them to specialized treatment when necessary.

BNT162b2 mRNA COVID-19 against symptomatic Omicron infection following a mass vaccination campaign in southern Brazil: A prospective test-negative design study.

BACKGROUND: Evidence regarding effectiveness of BNT162b2 mRNA COVID-19 vaccine against Omicron in Latin America is limited. We estimated BNT162b2 effectiveness against symptomatic COVID-19 in Brazil when Omicron was predominant. METHODS: This prospective test-negative, case-control study was conducted in Toledo, Brazil, following a mass COVID-19 vaccination with BNT162b2. Patients were included if they were aged ≥12 years, sought care for acute respiratory symptoms in the public health system between November 3, 2021 and June 20, 2022, and were tested for SARS-CoV-2 using RT-PCR. In the primary analysis, we determined the effectiveness of two doses of BNT162b2 against symptomatic COVID-19. RESULTS: A total of 4,574 were enrolled; of these, 1,758 patients (586 cases and 1,172 controls) were included in the primary analysis. Mean age was 27.7 years, 53.8 % were women, and 90.1 % had a Charlson comorbidity index of zero. Omicron accounted for >97 % of all identified SARS-CoV-2 variants, with BA.1 and BA.2 accounting for 84.3 % and 12.6 %, respectively. Overall adjusted estimate of two-dose vaccine effectiveness against symptomatic COVID-19 was 46.7 % (95 %CI, 19.9 %-64.6 %) after a median time between the second dose and the beginning of COVID-19 symptoms of 94 days (IQR, 60-139 days). Effectiveness waned from 77.7 % at 7-29 days after receipt of a second dose to <30 % (non-significant) after ≥120 days. CONCLUSION: In a relatively young and healthy Brazilian population, two doses of BNT162b2 provided protection against symptomatic Omicron infection. However, this protection waned significantly over time, underscoring the need for boosting with variant-adapted vaccines in this population prior to waves of disease activity. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number, NCT05052307 (https://clinicaltrials.gov/ct2/show/NCT05052307).

Impact of the COVID-19 pandemic on the mental health of frontline healthcare workers in a highly affected region in Brazil.

BACKGROUND: The COVID-19 pandemic had a major impact on the mental health of healthcare workers (HCWs), especially in low and middle-income countries, which had to face additional political, social, and economic challenges. We thus aimed to assess the prevalence of mental health outcomes and the associated factors in HCWs treating COVID-19 patients in one of the most affected regions in Brazil. METHODS: We used the Respondent-Driven Sampling method to assess the risks of COVID-19 infection and symptoms of mental disorders in nurses, nursing technicians, and physicians who worked on the frontline in the metropolitan region of Recife. 865 healthcare workers completed a survey regarding sociodemographic data, work-related risks, and symptoms of mental disorders - SRQ-20 for common mental disorders (CMD); AUDIT-C for problematic alcohol use; GAD-7 for anxiety; PHQ-9 for depression; PCL-5 for post-traumatic stress disorder (PTSD). Gile's successive sampling estimator was used to produce the weighted estimates by professional category. A Poisson regression model with robust variance was used to analyze factors associated with a positive screening for CMD. We will present the results of a cross-sectional analysis of the mental health outcomes after the first peak of COVID-19 - from August 2020 to February 2021. RESULTS: The prevalence ratios for a positive screening for CMD were 34.9% (95% CI: 27.8-41.9) in nurses, 28.6% (95% CI: 21.3-36.0) in physicians, and 26.6% (95% CI: 16.8-36.5) in nursing technicians. Nurses presented a higher prevalence of depressive symptoms (23%). Positive screening for problematic alcohol use (10.5 to14.0%), anxiety (10.4 to 13.3%), and PTSD (3.3 to 4.4%) were similar between the professional categories. The main factors associated with CMD in nurses and physicians were related to an intrinsic susceptibility to mental illness, such as previous or family history of psychiatric disorder, and female sex. Among nurse technicians, work-related factors, such as accidents with biological material, presented the strongest association with CMD. CONCLUSION: The mental health of HCWs fighting COVID-19 in Recife was severely affected. It is crucial that healthcare services provide adequate working conditions and psychological support, investing in programs to promote and protect HCWs mental health.

Reports from the frontline: health workers describe COVID-19 risks and fears in five cities in Brazil.

BACKGROUND: Health providers are under unprecedented pressures to perform in the COVID-19 health crisis and under unprecedented risks. We initiated a large mixed-method survey of health professionals in five large metropolitan areas in Brazil to document the risks and needs of health professionals. To initiate the study, we conducted formative research. METHODS: We conducted 77 open-ended semi-structured interviews online in a convenience sample of physicians, nurses, nurse technicians, and physiotherapists in Belem, Fortaleza, Porto Alegre, Recife, and São Paulo, Brazil. Design, data collection, and analysis were informed by Rapid Ethnographic Analysis (REA). RESULTS: Responses are organized into three themes that emerged in the interviews: the lack of preparation - both locally and nationally-for the pandemic and its effects on staffing and training; the overlap of personal, family, and professional risk and consequences; and inadequately addressed anxiety and suffering among health staff. CONCLUSIONS: Our respondents were unprepared for the epidemic, especially the institutional sequelae and psychological cost. These consequences were exacerbated by both lack of leadership and sweeping changes undercutting the Brazilian health system noted by almost all participants.

BNT162b2 against COVID-19 in Brazil using a test-negative design: Study protocol and statistical analysis plan.

INTRODUCTION: Real-world data on COVID-19 vaccine effectiveness are needed to validate evidence from randomized clinical trials. Accordingly, this study aims to evaluate, in a real-world setting in Brazil, the effectiveness of Pfizer-BioNTech BNT162b2 against symptomatic COVID-19 and COVID-19-related complications across diverse populations. MATERIALS AND METHODS: A test-negative case-control study with follow-up of cases is currently being conducted in Toledo, a city in southern Brazil, following a mass COVID-19 vaccination campaign with BNT162b2. The study is being conducted among patients aged 12 years or older seeking care in the public health system with acute respiratory symptoms and tested for SARS-CoV-2 on reverse transcription polymerase chain reaction (RT-PCR). Cases are RT-PCR positive and controls RT-PCR negative. Test-positive cases are prospectively followed through structured telephone interviews performed at 15 days post-enrollment, and at 1, 3, 6, 9 and 12 months. Baseline demographic, clinical, and vaccination data are being collected by means of structured interviews and medical registry records reviews at the time of enrollment. All RT-PCR-positive samples are screened for mutations to identify SARS-CoV-2 variants. ETHICS AND DISSEMINATION: The study protocol has been approved by the research ethics committee of all participant sites. Study findings will be disseminated through peer-reviewed publications and conference presentations. TRAIL REGISTRATION: Clinicatrials.gov: NCT05052307.

Quality of life of family primary caregivers of individuals with bipolar disorder and schizophrenia in south of Brazil.

BACKGROUND: The process of deinstitutionalization of individuals with mental disorders (MD) brought greater family responsibility in terms of patient care. AIMS: Evaluate the Quality of Life (QoL) and its associated factors of primary caregivers of bipolar and schizophrenic subjects. METHODS: A cross-sectional survey was conducted from 2012 to 2015 with 125 caregivers at an outpatient service of a teaching hospital in the South of Brazil. QoL instruments (WHOQOL-Bref, SF-36), questionnaires regarding socio-demographic, clinical data and depressive symptoms (BDI) were applied. RESULTS: Caregivers of schizophrenic individuals presented lower QoL scores than caregivers of bipolar individuals, with moderate effect in physical, and social domains of WHOQOL-Bref, and in physical functioning, role-physical, and role-emotional domains of SF-36. QoL scores of caregivers were lower when compared with the normative data of the Brazilian population. The factors associated with lower QoL scores were: patient diagnosis of schizophrenia, female gender, presence of clinical disease and presence of depressive symptoms in the caregiver. CONCLUSIONS: Caregivers of patients with schizophrenia or bipolar disorder present a significant impairment in their QoL when compared with the general population, highlighting the relevance of developing support programs in the mental health services that include these caregivers.

Bipolar Disorder Mixed Episodes: A Pragmatic Trial of a Public Health Treatment Effectiveness.

OBJECTIVES: To evaluate the effectiveness of an algorithm for the treatment of mixed episodes in bipolar disorder (BD) using the medications available under the Unified Health System (Sistema Único de Saúde) in Brazil. METHODS: The study included 107 individuals with BD in a current mixed episode, assessed biweekly for the outcomes of response and remission. The subjects were randomly assigned to start treatment with lithium, valproic acid, or carbamazepine, following a clinical protocol at a public outpatient clinic. Eligibility screening instruments, semistructured interview, and clinical psychiatric evaluation were used for diagnosis. To measure response and remission, the Hamilton Rating Scale for Depression and the Young Mania Rating Scale were used. A parameter of 50% or less in the symptom scales was used to define responses, as assessed by Kaplan-Meier time-event analysis. RESULTS: For the main outcome, response to treatment, all interventions proposed were proven to be effective, with no difference in response time for any of them. There was a lack of placebo control and blinding for intervention or outcomes. Individuals with mixed episodes in BD often face contradictory symptoms, and these inherent difficulties are the main obstacles to stabilize such a condition. CONCLUSIONS: The findings presented in this study show that the treatments available under the Unified Health System are able to reduce the overall burden of disease in terms of symptom reduction.

Effectiveness evaluation of mood disorder treatment algorithms in Brazilian public healthcare patients

Objective: To assess the effectiveness of three mood disorder treatment algorithms in a sample of patients seeking care in the Brazilian public healthcare system. Methods: A randomized pragmatic trial was conducted with an algorithm developed for treating episodes of major depressive disorder (MDD), bipolar depressive episodes and mixed episodes of bipolar disorder (BD). Results: The sample consisted of 259 subjects diagnosed with BD or MDD (DSM-IV-TR). After the onset of symptoms, the first treatment occurred ∼6 years and the use of mood stabilizers began ∼12 years. All proposed algorithms were effective, with response rates around 80%. The majority of the subjects took 20 weeks to obtain a therapeutic response. Conclusions: The algorithms were effective with the medications available through the Brazilian Unified Health System. Because therapeutic response was achieved in most subjects by 20 weeks, a follow-up period longer than 12 weeks may be required to confirm adequate response to treatment. Remission of symptoms is still the main desired outcome. Subjects who achieved remission recovered more rapidly and remained more stable over time. Clinical trial registration: NCT02901249, NCT02870283, NCT02918097

Effectiveness evaluation of mood disorder treatment algorithms in Brazilian public healthcare patients.

OBJECTIVE: To assess the effectiveness of three mood disorder treatment algorithms in a sample of patients seeking care in the Brazilian public healthcare system. METHODS: A randomized pragmatic trial was conducted with an algorithm developed for treating episodes of major depressive disorder (MDD), bipolar depressive episodes and mixed episodes of bipolar disorder (BD). RESULTS: The sample consisted of 259 subjects diagnosed with BD or MDD (DSM-IV-TR). After the onset of symptoms, the first treatment occurred ∼6 years and the use of mood stabilizers began ∼12 years. All proposed algorithms were effective, with response rates around 80%. The majority of the subjects took 20 weeks to obtain a therapeutic response. CONCLUSIONS: The algorithms were effective with the medications available through the Brazilian Unified Health System. Because therapeutic response was achieved in most subjects by 20 weeks, a follow-up period longer than 12 weeks may be required to confirm adequate response to treatment. Remission of symptoms is still the main desired outcome. Subjects who achieved remission recovered more rapidly and remained more stable over time. CLINICAL TRIAL REGISTRATION: NCT02901249, NCT02870283, NCT02918097.

[Cue exposure treatment and coping skills training as adjuvant therapies in the management of craving in a crack cocaine addict]. / Tratamento de exposição a estímulos e treinamento de habilidades como coadjuvantes no manejo do craving em um dependente de crack.

OBJECTIVE: An increased prevalence of crack cocaine users has been observed in clinical samples over the past years, underscoring the need for conducting research and developing treatment strategies aimed at this population. The objective of this study was to describe the case of a crack cocaine addict (inpatient) submitted to cue exposure treatment (CET) and coping skills training (CS) as adjuvant approaches to the conventional addiction treatment. CASE DESCRIPTION: A male patient, 29 years old, single, with complete high school, was dependent on crack cocaine and marijuana and also had a diagnosis of harmful alcohol use. The patient had been hospitalized for 2 weeks and had undertaken a protocol comprising four motivational interview and relapse prevention sessions. Six sessions of CET and CS were carried out over 2 weeks, including both in vivo and imaginal exposure to stimuli evoking craving for crack cocaine, such as a crack pipe, a lighter, and simulated crack cocaine rocks (in vivo exposure), or remembering places and friends associated with drug use (imaginal exposure). The patient was also trained to use strategies for the management of craving. Three months after hospital discharge, toxicological screening was performed to assess abstinence. CET and CS were considered by the patient to be important techniques for the maintenance of abstinence and of a low level of craving 3 months after discharge. COMMENTS: These findings suggest that the two techniques may be useful as adjuvant therapies in the treatment of crack cocaine dependents. CET and CS should be assessed in clinical trials in order to demonstrate their real benefits.

Produção científica e inovação na gestão do Sistema Nacional de Vigilância Sanitária: rede de autoria e complexo industrial da saúde (1999-2009) / Scientific production and innovation in the management of the National Health Surveillance: A Network of authorship and health-industrial complex (1999-2009)

Ao identificar as inovações introduzidas na gestão do Sistema Nacional de Vigilância Sanitária (SNVS) na última década, este estudo analisa suas estratégias e diretrizes as relacionando com a agenda política governamental e sua missão constitucional. Para tal, foram aplicados o modelo de análise e as variáveis propostas por Souza e Contandriopoulos (2004) para avaliação da utilização do conhecimento científico no processo decisório (Acessibilidade, disponibilidade, validade, características do contexto científico). Busca, assim, compreender o contexto político e científico que conforma o ambiente no qual o conhecimento científico é priorizado na gestão do SNVS, observando os seguintes aspectos: decisões políticas e conhecimento científico; características dos formuladores de política e de suas instituições; características dos pesquisadores; características das instituições científicas; discursos dos policy makers e dos pesquisadores. Neste processo, foram privilegiados documentos de diretrizes para o SNVS, como o Protocolo das Ações de Vigilância Sanitária (2005) e o Plano Diretor de Vigilância Sanitária (2007), assim como a produção científica, cujo foco está na análise da totalidade de artigos em publicações classificadas como Qualis A no campo da saúde pública (20 artigos) e das teses de doutorado na mesma área (85 teses), ambos identificados pela palavra chave ―vigilância sanitária em busca por expressão completa no Portal de Periódicos da Capes, na última década (1999-2009). O objetivo é analisar o foco dado ao conhecimento científico na gestão do SNVS, identificando suas principais estratégias, a produção científica e a rede de atores e refletindo sobre as tensões induzidas pela agenda política indutora da incorporação dos pressupostos do complexo industrial da saúde às suas diretrizes, centradas na promoção e proteção da saúde...

By identifying the innovations in the management of the Sistema Nacional deVigilância Sanitária (Brazilian National Sanitary Surveillance - SNVS) in the lastdecade, this study examines the strategies and guidelines relating to government policy agenda and its constitutional mission. To this end, the author applied the analytical model and the variables proposed by Souza and Contandriopoulos (2004)1 to evaluatethe use of scientific knowledge in decision-making process (accessibility, availability, validity, characteristics of the scientific context). It is, thus, understand the scientific and political context that shapes the environment in which scientific knowledge is prioritized in the SNVS management, noting the following aspects: policy making andscientific knowledge, characteristics of policy makers and their institutions, thecharacteristics of the researchers; the characteristics of scientific institutions, the discourses of policy makers and researchers. In this process, guidance documents were privileged to SNVS, as the “Protocolo das Ações de Vigilância Sanitária” – 2005 (Protocol of Actions for Health Surveillance) and the “Plano Diretor de Vigilância Sanitária” - 2007 (Master Plan for Sanitary Surveillance), as well as the scientific, whose focus is on analysis of all articles in publications known as the “Qualis A” in the field of public health (20 articles) and doctoral theses in the same area (85 theses), both identified by the keyword "health surveillance" by searching at the complete expression at Portal de Periódicos CAPES (Journals Portal Capes) in the last decade (1999-2009)...

Tratamento de exposição a estímulos e treinamento de habilidades como coadjuvantes no manejo do craving em um dependente de crack / Cue exposure treatment and coping skills training as adjuvant therapies in the management of craving in a crack cocaine addict

OBJETIVO: Tem-se observado um aumento da prevalência de dependentes de crack em amostras clínicas, o que torna necessária a realização de pesquisas quanto a estratégias de tratamento direcionadas a essa clientela. O objetivo deste estudo foi descrever o caso de um dependente de crack internado no qual foram utilizados o tratamento de exposição a estímulos (TEE) e o treinamento de habilidades (TH) como coadjuvantes ao tratamento tradicional. DESCRIÇÃO DO CASO: O paciente é do sexo masculino, 29 anos de idade, solteiro, ensino médio completo. Era dependente de crack e de maconha e fazia uso nocivo de álcool. O paciente já estava internado havia 2 semanas e tinha passado por um protocolo de quatro sessões com entrevista motivacional e prevenção à recaída. Foram feitas seis sessões, ao longo de 2 semanas, de TEE e TH, nas quais o paciente foi exposto in vivo e pela imaginação a estímulos evocadores de fissura, como cachimbo de crack, isqueiro, pedras simuladas, lembranças de locais e amigos associados ao uso da droga. Ele também foi treinado para utilizar estratégias de manejo da fissura. Após 3 meses da alta hospitalar, foi realizado screening toxicológico para avaliar a manutenção de abstinência. O paciente avaliou o uso das técnicas como importante para a manutenção da abstinência após 3 meses da alta e para sua baixa média de fissura pelo crack. COMENTÁRIOS: Talvez o TEE e o TH para manejo da fissura possam ser úteis como coadjuvantes no tratamento de dependentes de crack. Tal uso deve ser avaliado em ensaios clínicos para demonstrar seu real benefício (AU)

OBJECTIVE: An increased prevalence of crack cocaine users has been observed in clinical samples over the past years, underscoring the need for conducting research and developing treatment strategies aimed at this population. The objective of this study was to describe the case of a crack cocaine addict (inpatient) submitted to cue exposure treatment (CET) and coping skills training (CS) as adjuvant approaches to the conventional addiction treatment. CASE DESCRIPTION: A male patient, 29 years old, single, with complete high school, was dependent on crack cocaine and marijuana and also had a diagnosis of harmful alcohol use. The patient had been hospitalized for 2 weeks and had undertaken a protocol comprising four motivational interview and relapse prevention sessions. Six sessions of CET and CS were carried out over 2 weeks, including both in vivo and imaginal exposure to stimuli evoking craving for crack cocaine, such as a crack pipe, a lighter, and simulated crack cocaine rocks (in vivo exposure), or remembering places and friends associated with drug use (imaginal exposure). The patient was also trained to use strategies for the management of craving. Three months after hospital discharge, toxicological screening was performed to assess abstinence. CET and CS were considered by the patient to be important techniques for the maintenance of abstinence and of a low level of craving 3 months after discharge. COMMENTS: These findings suggest that the two techniques may be useful as adjuvant therapies in the treatment of crack cocaine dependents. CET and CS should be assessed in clinical trials in order to demonstrate their real benefits (AU)

Dilemas do processo de gestão descentralizada da vigilância sanitária no Estado do Rio de Janeiro / Dilemmas of the process of decentralized management of health surveillance in Rio de Janeiro State

Com a criação do Sistema Único de Saúde, em 1990, o Ministério da Saúde tomou as primeiras medidas para descentralizar as ações de vigilância sanitária, o que significou decisiva inovação na tradicional institucionalidade dessa área e grande desafio para os gestores nos três níveis da Federação. Os efeitos dessa determinação somente foram sentidos após criação da Agência Nacional de Vigilância Sanitária, em fins de 1999, quando foi possível estruturar o atual Sistema Nacional de Vigilância Sanitária numa concepção que incentiva o papel diretor, coordenador e executor das ações de maior complexidade das Secretarias Estaduais de Saúde. Este estudo analisa a descentralização da gestão da VISA empreendida pela Secretaria de Estado de Saúde do Rio de Janeiro no período 2002-2006 e as condições das Secretarias Municipais no exercício das respectivas funções, através de pesquisa baseada em análise dos relatórios de avaliação da descentralização elaborados pelo Centro de Vigilância Sanitária. Entre as conclusões, destaca a fragilidade da própria Secretaria de Saúde do estado para assumir os encargos a ela atribuídos e questões subjacentes ao exercício municipal. Tais constatações refletem as muitas dificuldades enfrentadas nas relações intergovernamentais diante do imperativo de as partes agirem solidariamente numa área fundamental para a saúde individual e coletiva e para o bem-estar da população. O estudo informa requisitos básicos do processo de estruturação de um órgão de VISA e constitui importante contribuição para melhor compreender os entraves políticos, institucionais, técnicos, materiais e humanos que desafiam os gestores, para implementar as inovações ensejadas com a descentralização neste complexo campo.

With the creation of the Unified Health System in 1990, the Ministry of Health has taken the first steps to decentralize health surveillance actions, which meant a decisive innovation in the traditional institutional framework in this area and challenge for managers at all three levels of the Federation. The effects of this determination were felt only after the creation of the National Sanitary Surveillance Agency, in late 1999, when it was possible to structure the current National System of Sanitary Surveillance in a design that encourages the role director, coordinator and executor of the more complex actions of the State Health Secretariats. This study analyzes the decentralization of management of VISA undertaken by the State Secretariat of Health of Rio de Janeiro between 2002-2006 and the conditions of the municipal acting in their duties by providing research-based analysis of reports evaluation of decentralization developed by the Center for Health Surveillance. Among the findings, it highlights the fragility of the State Health Secretariat to shoulder the burden assigned to it and issues underlying the performance hall. These findings reflect the many difficulties in intergovernmental relations on the need for parties to act jointly in a key area for the individual and collective health and welfare of the population. The study states the basic requirements of the process of structuring a body of VISA and makes an important contribution to better understand the political barriers, institutional, technical, material and human challenge to managers, to implement the innovations occasioned by decentralization in this complex field.

Tratamento de idosos com depressão utilizando antidepressivos / Treatment of elderly people with depression using antidepressants

Antidepressivos são eficazes no tratamento da depressão em idosos. O sucesso do tratamento depende do tipo e da gravidade da depressão; das comorbidades com outras doenças psiquiátricas ou clínicas; da escolha adequada de antidepressivos, de sua eficácia e perfil de efeitos adversos; da orientação do paciente e de sua aderência ao tratamento. O manejo dos efeitos adversos em pacientes idosos, que usam muito mais medicações e apresentam mais doenças, é o ponto forte na escolha de antidepressivos. Em geral, os inibidores seletivos da recaptação de serotonina têm sido preferidos por apresentar menos riscos de complicações por efeitos adversos. Porém, diferentes antidepressivos podem ser preferíveis para diferentes pacientes. É indispensável que o médico conheça o paciente que irá tratar e o perfil de efeitos adversos e de possíveis interações medicamentosas dos antidepressivospara poder escolher o mais adequado para cada paciente. Neste artigo, são abordados os diferentes grupos de antidepressivos no tratamento agudo da depressão em idosos.

Doença de Parkison / Parkinson's disease

A doença de parkinson [DP] é uma enfermidade neurodegenerativa caracterizada principalmente por lentificação dos movimentos [ bradicinesia], hipertonia muscular do tipo rígida, tremor geralmente de repouso e instabilidade postural. Os sintomas motores decorrem, em sua maioria, da degeneração do sistema nigroestriatal dopaminérgico, havendo, entretanto, o envolvimento progressivo de outros sistemas neurotransmissores. A principal abordagem farmacológica envolve principalmente as drogas dopaminérgicas, em especial a levodopa, ainda considerada o tratamento mais efetivo no controle dos sintomas motores DP. Este artigo tem por finalidade fazer uma revisão sobre os principais aspectos clínicos e fisiopatogênicos da doença, bem como das estratégias farmacológicas mais utilizadas atualmente.

Ansiedade no idoso: diagnóstico e abordagens terapêuticas / Anxiety in the aged: diagnosis and therapeutical boardings

Este artigo tem como objetivo revisar o diagnóstico e tratamento do transtorno de ansiedade no idoso, apresentando as diversas peculiaridades desta faixa etária nesta patologia. Com o estabelecimento do processo de envelhecimento da população brasileira, urge uma necessidade de novos estudos voltados para a terceira idade, buscando uma maior compreensão desta última etapa do ciclo da vida e a mobilização de serviços e tratamentos voltados especificamente para os idosos. Tendo em vista a ansiedade como uma patologia comum na terceira idade, de extrema importância por elevar a morbimortalidade e por ser comumente subdiagnosticada, os autores se propõem a revisar conceitos diagnósticos e a a apresentar as melhores formas de tratamento.

Expressão da proteína oligomérica da matriz da cartilagem (COMP/Trombospondina 5) em pacientes portadores de C crônica / Cartilage oligomeric matrix expression in patients with chronic hepatitis c

A hepatite C é uma doença insidiosa e progressiva que necessita de avaliação histológica hepática. Vários marcadores séricos têm sido estudados. A Cartilagem Oligométrica da Matrix Extracelular (C0MP) é o quinto elemento da família das trombospondinas, proteínasextracelulares ligadoras de cálcio, sendo inicialmente isoladano tecido cartilaginoso. Um único estudo investigou a expressão da COMP em tecido hepático normal, portador de cirrose e hepatocarcinoma. Nosso estudo visa avaliar os níveis séricos de COMP em pacientes portadores de hepatite C crônica. Níveis séricos de COMP foram dosados em 10 pacientes com hepatite C crônica (casos) e 100 pacientes com Hepatite C (controles). A diferença entre a COMP dos dois grupos não foi significativamente estatística e nem relacionada ao estágio clínico de fibrose hepática genótipo viral, níveis plaquetários ou alterações de transaminases.

Descentralização das ações de vigilância sanitária nos municípios em gestão plena, estado do Rio de Janeiro / Descentralization of health surveillance actions in cities with local health managment in the state of Rio de Janeiro

O centro de Vigilância Sanitária da Secretaria do Estado da Saúde do Rio de Janeiro pretende, com a descentralização das ações de vigilância sanitária para os municípios, atender condições mínimas para fortalecer o sistema estadual de vigilância sanitária, criando estrutura de apoio ao processo de descentralização. Este trabalho objetiva apresentar o diagnóstico situacional dos órgãos de vigilância sanitária dos municípios em gestão plena do sistema municipal, discutindo os principais resultados. A metodologia compreende a análise dos 22 órgãos de vigilância sanitária em gestão plena do sistema municipal, conforme a norma operacional básica 96, no período de julho a dezembro de 2002, através de questionário padrão aplicado pelo Centro de Vigilância Sanitária e de observação participante. Com base nos resultados, conclui-se que a maioria dos órgãos de de vigilância sanitária municipais em gestão plena do sistema municipal, possuem profundas dificuldades técnico-operacionais no desenvolvimento das ações descentralizadas, denotando a fragilidade do processo de descentralização das ações de vigilância sanitária no Estado e a necessidade de sensibilizar os gestores para a efetiva estruturação das vigilâncias sanitárias locais, em parceria com o órgão estadual de de vigilância sanitária.