Trends in elderly psychiatric admissions to the Brazilian public health care system

Objective: To evaluate trends in psychiatric bed occupancy by elderly inpatients in the Brazilian public health care system between 2000 and 2010 and to determine the leading psychiatric diagnosis for hospital admissions. Methods: Data from all 895,476 elderly psychiatric admissions recorded in the Brazilian Public Health Care Database (DATASUS) between January 2000 and February 2010 were analyzed. Polynomial regression models with estimated curve models were used to determine the trends. The number of inpatient days was calculated for the overall psychiatric admissions and according to specific diagnoses. Results: A moderate decreasing trend (p < 0.001) in the number of inpatient days was observed in all geriatric psychiatric admissions (R2 = 0.768) and in admissions for organic mental disorders (R2 = 0.823), disorders due to psychoactive substance use (R2 = 0.767), schizophrenia (R2 = 0.680), and other diagnoses (R2 = 0.770), but not for mood disorders (R2 = 0.472). Most admissions (60 to 65%) were due to schizophrenia. Conclusion: There was a decreasing trend in inpatient days for elderly psychiatric patients between 2000 and 2010. The highest bed occupancy was due to schizophrenia, schizotypal, and delusional disorders.

Child and adolescent mental health services in Brazil: structure, use and challenges / Serviços de saúde mental para crianças e adolescentes no Brasil: estrutura, uso e desafios

To examine the state of Child and Adolescent Mental Health (CAMH) services and to compare the availability and use of CAMH services across the five regions of Brazil. Methods: the Mental Health Matrix Model was used as a framework to describe the state of CAMH services. Documents and administrative datasets were consulted, covering the whole country and the five Brazilian regions as separate levels. This enabled crossregion comparisons and combination with thethree temporal dimensions (Input, Process andOutcome) Results: although there are national policies regulating CAMH, along with an integral protection doctrine, scarcity of services was unequally distributed across the regions. A number of trends relating to social development and mental health (e.g. intellectual disability treated prevalence) were also identified. Conclusion: substantial advances in CAMH policy characterize the contemporary Brazilian CAMH system, especially regarding the implementa tion of community based mental health services for children and adolescents. However, the data reveals great inequalities and geographic variation regarding social indicators, service structure and use...

Analisar a situação dos serviços de saúde mental para crianças e adolescentes ecomparar a disponibilidade e uso dos mesmos entre as cinco macrorregiões do Brasil. Métodos: utilizou-se o The Mental Health Matrix Model como marco referencial para descrever a situação dos serviços de saúde mental para crianças e adolescentes. Analisaram-se documentos e dados originais de bases administrativas do governo federal. Isso permitiu a comparação entre as regiões e em relação ao tempo (investimentos, processos e resultados) Resultados: embora existam políticas e regulamentos nacionais sobre a saúde mental de crianças e adolescentes, alinhadas com a doutrina da proteção integral, verificouse um insuficiente número de serviços com uma distribuição desigual entre as macrorregiões. Adicionalmente, foi possível identificar tendências relacionadas ao desenvolvimento social e a saúde mental (ex. prevalência de atendimentos em deficiência intelectual) Conclusões: avanços substanciais nas políticas caracterizam o sistema brasileiro de saúde mental para crianças e adolescentes principalmente no que se refere à implementação de serviços de base comunitária. No entanto, os dados mostram desigualdade evariações regionais dos indicadores sociais, de estrutura e uso dos serviços...

An evaluation of the burden of Alzheimer patients on family caregivers / Avaliação do impacto no cuidador familiar do doente de Alzheimer

Caregivers are indispensable to persons living with Alzheimer's disease; however, such care involves hard work, and the consequences of this activity on caregivers are often neglected. The objective of this study was to construct a profile for caregivers of Alzheimer patients and to evaluate the burden such care imposes on them. It is a transversal study of 122 caregivers from the metropolitan region of Londrina, Paraná State, Brazil. Socio-demographic data for the caregivers were analyzed, while the Katz scale and Lawton index were used to evaluate the functionality of Alzheimer's patients, and the Burden Interview Scale assessed the burden these patients impose on caregivers. Caregivers are predominantly married, are daughters who have learned to care for the patient on a daily basis, usually with some help, and they do so out of love. The caregiver's age (p < 0.01), whether or not the caregiver had help (p < 0.01), and the number of hours caring for the patient (p = 0.01) were associated with the impact. Results showed that the burden imposed on caregivers by Alzheimer patients is a heavy one.

O cuidador é indispensável ao paciente com doença de Alzheimer, no entanto cuidar é uma tarefa árdua, e as conseqüências dessa atividade em quem cuida são negligenciadas. Estudo transversal realizado na região metropolitana do Município de Londrina, Paraná, Brasil, tem por objetivo caracterizar o perfil e avaliar o impacto da ação sobre 122 cuidadores principais de pacientes com doença de Alzheimer. A escala de Katz e o índice de Lawton foram utilizadas para avaliar a funcionalidade dos pacientes com doença de Alzheimer, e a Burden Interview Scale, para avaliar o impacto no cuidador. Caracterizaram-se seus dados sócio-demográficos. Os cuidadores foram predominantemente filhas, casadas, que aprenderam o cuidado no dia-a-dia, contavam com auxílio e exerciam a função por afeto. Associaram-se ao impacto de forma independente: idade do cuidador (p < 0,01), contar com auxílio (p < 0,01) e número de horas de cuidado (p = 0,01). Os cuidadores estudados apresentaram impacto elevado.