A trajetória das políticas de saúde mental e de álcool e outras drogas no século XX / The trajectory of mental health policies and alcoholand other drugs in the twentieth century

Resumo Este artigo tem por objetivo analisar a evolução temporal das regras que compõem o arcabouço legal das políticas públicas de saúde mental e de álcool e outras drogas entre os anos de 1900 até 2000. O estudo busca analisar a trajetória das regras, de modo que se possa compreender um pouco mais sobre o contexto e a forma no qual as questões relacionadas a estes dois temas foram tratados, até a Reforma Psiquiátrica no Brasil, em 2001. Para isso realizou-se uma pesquisa documental e bibliográfica, com o intuito de avançar no entendimento destas duas políticas sobre um ângulo mais normativo. Em um emaranhado de legislações, foram catalogadas 33 normas que, após análise, demonstram o processo de construção das políticas públicas relacionadas ao uso de álcool e outras drogas, alterando a lógica repressiva da justiça e da patologização do uso de drogas e possibilitando a transição da discussão do terreno da segurança para o da saúde pública, mais especificamente de saúde mental.

Abstract The scope of this article is to analyze the temporal evolution of the rules that comprise the legal framework of public policies on mental health and on alcohol and other drugs between the years 1900 to 2000. The study seeks to analyze the trajectory of the rules to make it possible to understand a little more about the context and the way in which the issues related to these two themes were addressed prior to the Psychiatric Reform in Brazil, in 2001. For this purpose, documentary and bibliographical research was conducted, with the intention of enhancing the understanding of these two policies from a more normative angle. In the skein of legislation, 33 norms were cataloged which, after analysis, reveal the process of construction of the public policies related to the use of alcohol and other drugs, changing the repressive logic of justice and the "pathologization" of drug use and enabling the transition of the discussion from the field of security to that of public health, more specifically of mental health.

Indications and visual outcomes of intrastromal corneal ring segment implantation in a large patient series

OBJECTIVES: To describe the indications for and visual outcomes of intrastromal corneal ring segment implantation. METHODS: A large retrospective case-series chart-review study was conducted using Sorocaba Ophthalmological Hospital medical records. This study included 1222 eyes (1196 patients) that were surgically treated between November 2009 and December 2012. The following preoperative data were collected: age, gender, type of medical care and funding source, surgical technique, best-corrected visual acuity, manifest sphere and cylinder refractive error, maximum and minimum central keratometry, and pachymetry measurements of the cornea at the thinnest point and at the ring channel. The postoperative best-corrected visual acuity and patient satisfaction were also determined. The cases were classified into six groups: four keratoconus groups (severe, advanced, moderate and mild), a pellucid marginal degeneration group and a post-graft irregular astigmatism group. This study was approved by the Brazilian Registry of Clinical Trials (UTN number 1111-1182-6181, TRIAL RBR-6S72RF). RESULTS: The age (mean±standard deviation) of the patients was 31.0±10.0 years. The most prevalent pathology was keratoconus (1147 eyes, 93.8%). A correlation was found between ectasia severity and medical assistance (p<0.001), and the most serious cases was treated by the Brazilian public health system. No complications were found in a total of 1155 surgeries, and after surgery, 959 patients were satisfied. Among the 164 dissatisfied patients, the majority failed to show improved best-corrected visual acuity. CONCLUSION: Patients in the public health system underwent surgical intervention for keratoconus later than those with private sources of funding. In the vast majority of operated cases, the patients reported improvements in vision.

Ultrasound biomicroscopy after palliative surgical procedures for bullous keratopathy: a descriptive comparative study / Biomicroscopia ultrassônica após procedimentos cirúrgicos paliativos na ceratopatia bolhosa: estudo comparativo descritivo

Purpose: To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. Methods: The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. Results: In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively (p<0.001); mean ET, 102.1 µm preoperatively and 245.2 µm postoperatively (p<0.001); and mean ST, 654.6 µm preoperatively and 681.5 µm postoperatively (p<0.999). Correlations between CCT and pain intensity in the AMT group (p=0.209 pre- and postoperatively) and the ASP group (p=0.157 preoperatively and p=0.426 at the 180-day follow-up) were not statistically significant. Epithelial and stromal edema, Descemet’s membrane folds, epithelial bullae, and the presence of interface fluid were frequently observed qualitative features. Conclusion: CCT increased over time in both groups. The magnitude of CCT did not correlate with pain intensity in the sample studied. The presence of interface ...

Objetivo: Descrever as características quantitativas e qualitativas da biomicroscopia ultrassônica (UBM) em olhos com ceratopatia bolhosa avançada, antes e após os procedimentos de punção estromal anterior (ASP) ou transplante de membrana amniótica (AMT) para alívio de dor crônica. Métodos: Estudo comparativo descritivo incluindo 40 olhos de 40 pacientes com dor crônica intermitente devido a ceratopatia bolhosa, randomizados em duas modalidades de tratamento (AMT e ASP). Biomicroscopia ultrassônica (Humphrey, UBM 840, transdutor de 50 MHz, técnica de imersão) foi utilizada, e um questionário de avaliação da intensidade da dor foi aplicado no pré-operatório, e após 90 e 180 dias de pós-operatório. Critérios de exclusão foram: idade abaixo de 18 anos, presença de infecção, hipertensão ocular, e ausência de dor. Resultados: No seguimento de 180 dias, o grupo Transplante de membrana amniótica apresentou: média da espessura corneana central (CCT): 899,4 µm (pré), 1.122,5 µm (pós-operatório) (p<0,001); média da espessura epitelial (ET): 156,4 µm (pré), 247,8 µm (pós-operatório) (p<0,001); média da espessura estromal (ST): 742,9 µm (pré), 826,3 µm (pós-operatório) (p=0,005), e, grupo ASP apresentou: CCT média: 756.7 µm (pré), 914,8µm (pós-operatório) (p<0,001); ET média: 102,1 µm (pré), 245,2 µm (pós-operatório) (p<0,001); ST média: 654,6 µm (pré), 681.5 µm (pós-operatório) (p<0,999). A correlação entre intensidade da dor e espessura corneana central no grupo AMT (p=0,209 pré e pós-operatórios) e no grupo ASP (p=0,157 pré-operatório e p=0,426 aos 180 dias de seguimento) não foi significativa. Edema epitelial e estromal, dobras na membrana de Descemet, bolhas epiteliais, e presença de fluido na interface foram características qualitativas frequentemente observadas. Conclusão: A espessura corneana central aumentou ao longo do tempo em ambos os grupos. A magnitude da espessura corneana central não interfere na intensidade da dor ...

Avaliação da qualidade de vida em pacientes submetidos à cirurgia de catarata, com implantes de lentes monofocais bifocais e multifocais / Evaluation of life quality of patients submitted to cataract surgery with implants of monofocal, bifocal and multifocal lenses

Objetivo: Fornecer uma avaliação objetiva e subjetiva da qualidade de vida e o nível de satisfação de pacientes que se submeteram à cirurgia de catarata, com implante de lentes bifocais, multifocais e monofocais. Métodos: Lentes bifocais foram implantadas em 72 pacientes; lentes multifocais asférica em 16 pacientes; lentes multifocais apodizada em 20 pacientes e lentes monofocais em 63 pacientes. Foi aplicado um questionário de 47 perguntas cujos resultados foram avaliados e analisados. Resultados: O nível de satisfação dos pacientes implantados com lentes bifocais e multifocais foi significantemente mais alto do que aqueles com lentes monofocais (teste Kruskal-Wallis p<0,01, seguido do teste Dunn, p<0,05). Quanto à comparação de lentes monofocais com lentes bifocais e multifocais, a visão para perto sem correção foi consideravelmente mais baixa em pacientes com lentes monofocais (teste Z, p<0,001). Os pacientes com lentes monofocais sem correção apresentaram uma menor capacidade de ler jornais ou livros e no que diz respeito a trabalhos manuais do que aqueles com lentes bifocais e multifocais (teste Z, p<0,001). Conclusão: Os resultados deste estudo mostram que os pacientes que receberam as lentes bifocais e multifocais tiveram uma melhora notável em sua acuidade visual para perto, estando satisfeitos com sua visão geral, sem óculos. A satisfação foi atribuída ao fato de conseguirem ler livros e jornais, preencher cheques, preencher formulários, praticar esportes, se barbear ou se maquiar sem correção. .

Purpose: Providing an objective and subjective evaluation of life quality and satisfaction level of the patients who underwent cataract surgery with implant of bifocal, multifocal and monofocal lenses. Methods: Bifocal lenses were implanted in 72 patients, aspheric multifocal lenses in 16 patients, apodized multifocal lenses in 20 patients and Monofocal lenses were implanted in 63 patients. The patients answered a 47 question questionnaire, whose results were evaluated and analyzed. Results: The level of satisfaction of the patients implanted with bifocal and multifocal lenses was significantly higher than of those with monofocal lenses (kruskal - Wallis test, p< 0.001 followed by the Dunn test, p< 0.05). As to the comparison of monofocal lenses with bifocal and multifocal lenses, the near vision without correction was considerably lower in patients with monofocal lenses (Z test p< 0.001). The patients with monofocal lenses without correction presented a much lower capacity of reading newspapers or books and as far as manual work than the ones with bifocal and multifocal lenses (Z test, p<0.001). Conclusion: The result of this study shows that the patients who received the bifocal and multifocal lenses had a remarkable improvement in their visual acuity for the near vision, being pleased with their general vision without wearing glasses. This is because they were able to read books and newspapers, write checks, fill out forms, do sports, shave or put on make-up, hence having high quality of life without correction. .

Dry eye evaluation and immunohistochemical study of the conjunctiva and lacrimal gland of patients submitted to bone marrow transplantation

Purpose: The primary ocular targets of chronic graft-versus-host disease (GVHD) are the lacrimal gland (LG) and the conjunctiva, and their involvement results in keratoconjunctivitis sicca (KCS). The purpose of the present study was to evaluate the frequancy of signs and symptoms of KCS present in patients submitted to BMT, to identify the cellular phenotype of the conjunctival and lacrimal gland biopsies of these patients by immunohistochemistry and to correlate the findings with the present of dry eye due to GVHD. Methods: Forty-Seven patients were clinically classified into two groups: group I, with ocular GVHD, submitted to allogeneic BMT and Group II, without ocular GVHD, submitted to autologous and allogeneic BMT. Thorough eye examination, including clinical lacrimal function tests and biopsies of the conjunctiva and of the LG were performed in the pre- and posttransplantation period, The biopsies were submitted to imunohistochemical analysis using a panel of monoclonal antibodies. Results: Of the 28 (84,4 percent) patients with chronic GVHD, 13 (46,4 percent) presented ocular GVHD. Of the six patients without GVHD, one (16,7 percent) presented ocular GVHD. None of those submitted to autologous BMT presented ocular GVHD and 14 (41,2 percent) of 34 patients with allogeneic BMT presented ocular GVHD. All patients with ocular GVHD (Group I) has symptoms and the most frequent were burning, foreign body sensation, blurred vision and dryness. the rose bengal test was one of the most sensitive in this study and slit lamp examination was very useful in the evaluation of corneal and conjunctival alterations, since these alterations were always present in patients with dry eye in our study. neither symptoms and signs of dry eye nor significant immunologic reaction was observed in the conjunctiva and in the LG of patients without ocular GVHD (Group II). There was as increase in the T Lymphocyte population, Of the helper lymphocyte (Th/i) and the supressor-cytotoxic lymphocyte (Ts/c) subpopulaton in the conjunctiva and in the LG of patients with ocular GVHD after the transplantation. Conclusions: Patients submitted to allogeneic BMT may develop ocular GHVD characterized by KCS. The immunohistochemical study of the conjunctiva and lacrimal gland biopsies of these patients suggested that these tissue are the target of the T cell mediated immunological reaction.