Orientadores: Sílvia Maria Santiago, Celene Aparecida Ferrari Audi / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T13:54:25Z (GMT). No. of bitstreams: 1 Silva_HeloisaMarisMartins_M.pdf: 1807448 bytes, checksum: 276d2c0b7484cf3d6c14ed87727b8c72 (MD5) Previous issue date: 2014 / Resumo: O presente trabalho tem como principal objetivo descrever o perfil dos trabalhadores de uma penitenciária feminina do estado de São Paulo de forma a conhecer suas necessidades e desenvolver ações de promoção à saúde e prevenção de doenças. Para atingir este objetivo serão abordadas características sociodemográficas, estilo de vida, condições de saúde e transtorno mental comum. Trata-se de um estudo descritivo transversal que faz parte do Projeto Atenção Integral à Saúde da Mulher no Cárcere e dos Servidores da Penitenciária Feminina de Campinas ¿ SP, desenvolvido por pesquisadores do Departamento de Saúde Coletiva (DSC) da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP). Os dados foram obtidos através de questionário. O hábito de fumar, o consumo de bebidas alcoólicas e o transtorno mental comum foram avaliados a partir da aplicação de instrumentos validados que são respectivamente, Teste de Fagerström, AUDIT e SQR 20. Foram entrevistados 127 servidores envolvidos tanto na área administrativa quanto na área de segurança. A maioria dos trabalhadores é do sexo feminino (57,9%), a média de idade foi 41,3 anos (DP 10,2). Vivem em união conjugal 63,5% dos entrevistados e 75,4% tem filhos. Quanto à escolaridade, 50% dos servidores já cursou ou está cursando o curso superior. Foi encontrado que 63,5% trabalham na área de segurança, carga horária média de 38,6 horas por semana (DP=5,1), tempo de trabalho nesta unidade prisional de 10 anos ou mais em 48,7% dos casos, sendo que 68,2% tem renda de até 4 salários mínimos.Não foi encontrada prevalência de doenças crônicas estatisticamente diferente da população geral e de outros estudos. O transtorno mental comum foi encontrado em 15.2% da amostra / Abstract: This research was designed to describe the profile of the staff of a female prison in São Paulo State to subsidize actions of health promotion and disease prevention. Designed as a cross-sectional study, it is part of the project "Atenção Integral á Saúde da Mulher no Cárcere e dos Servidores da Penitenciária Feminina de Campinas-SP" and it investigates sociodemographic characteristics, lifestyle, health conditions and commom mental disorder. Data was collected through a questionnaire. Smoking cigarettes, alcohol use and common mental disorder were investigated using validated questionnaires: Fagesrström Test, AUDIT and SRQ20, respectively. There were interviewed 127 workers involved in administrative or security areas. The majority of the staff is female (57.9%), the mean age is 41.3 years (SD= 10,2). 63,5% of the interviewed workers live with a partner and 75.4% have children. Coming to education, 50% have reached or are enrolled in a graduate course. We found that 63,5% of the workers are in the security area, the mean weekly workload is 38.6 hours (SD=5.1), presenting a mean time of work in this prison of 10 or more years in 48.3% of the cases and 68.2% of the workers have a salary under 4 times the minimum wage valid in the country. There were no significantly statistical differences neither between the population in study and the general population nor between the population in study and other studies in this field. Mental common disorder was found in 15.2% of the sample / Mestrado / Política, Planejamento e Gestão em Saúde / Mestra em Saúde Coletiva

Mental disorder and criminal activity is always a current topic because of high promotion of offences in the media which enhances its stigmatization. The aim of the work was mapping of patient's view of his criminal activities. We described criminal proceedings with mentally ill offender and measures of protection. We addressed to chosen aspects of perceiving of criminal activities - motivation, attribution of guilt, self-image and punishment. We described mental disorders in psychiatric protective treatment and their forensic significance. We used the qualitative analysis of semi-structured interview, method called pie of guilt, medical records and forensic expert testimony. The sample consisted of 16 patients of psychiatric protective treatment in Psychiatric hospital Bohnice, Praha, Czech republic. Collected data are various and they account for the heterogenity of research group. The main work result is a support for opinion that not only mental disorder, but also many other factors such as personality, substance abuse or poor impulse control, are responsible for the origin of offence and that patients are conscious of it and they don't interpret it only within the frame of mental disorder. The work highlights on the using of many ego mechanisms of defense to cope with feelings of guilt and...

[pt] O presente estudo objetivou analisar de que modo vêm se efetivando as legislações e as políticas públicas voltadas à garantia do direito à convivência familiar de crianças e adolescentes com deficiência mental e/ou transtorno mental. Durante muito tempo estas crianças e estes adolescentes ficaram fora do foco de preocupações das políticas públicas. Esquecidos em instituições de cunho asilar, comumente ligados à rede filantrópica, ou mesmo escondidos no seio de suas famílias, o fato é que crianças e adolescentes com deficiência e/ou transtorno mental ficaram fadados a uma certa invisibilidade, o que reforçou o desconhecimento que ainda recai sobre eles. Hoje vivemos um novo momento da história no que se refere aos modos de se conceber e agir o cuidado de crianças e adolescentes, que se amparam na Doutrina da Proteção Integral, preconizada pelo Estatuto da Criança e do Adolescente. Depreendem-se daí as diretrizes de centralidade da família, de excepcionalidade das medidas de acolhimento institucional e de co-responsabilidade entre Estado, sociedade e família no que se refere ao cuidado de crianças e adolescentes. No entanto, se ao nível do discurso, há um consenso de que a família é o lugar ideal onde crianças e adolescentes devem ser criados, educados e protegidos, na prática o que se observa é um descompasso entre a importância atribuída ao papel da família e a falta de condições mínimas para que esta possa oferecer aos seus filhos uma vida digna, sobretudo nos casos em que as condições econômicas das famílias são precárias. O cenário de desassistência às famílias se exacerba quando nos referimos à especificidade de crianças e adolescentes que têm deficiência e/ou transtorno mental, e que, por isso, apresentam demandas diferenciadas de cuidados e tratamentos. Na presente dissertação foram analisadas 36 entrevistas realizadas com profissionais referenciados a instituições públicas e privadas, que de algum modo estão envolvidas no cuidado de crianças e adolescentes com deficiência mental e/ou transtorno mental. Estas entrevistas, vale salientar, integram o conjunto de materiais produzidos por duas pesquisas realizadas pelo CIESPI – Centro Internacional de Estudos e Pesquisas sobre a Infância, em convênio com a PUC-Rio – entre os anos de 2006 e 2010 e que ainda não haviam sido exaustivamente analisados. Os resultados apontaram para o fato de que, embora tenham ocorrido progressos importantes nos últimos tempos, ainda há muito que se avançar no sentido de garantir a plena efetivação do direito de crianças e adolescentes com deficiência mental e/ou transtorno mental à convivência familiar. / [en] This study focused on the analysis of the implementation of the laws and public policies aimed at guaranteeing the right of children and adolescents with mental disabilities and/or mental disorders to live in the context of the family. For too long these children and adolescents remained excluded from public policy concerns. Forgotten in closed institutions, often run by the philanthropic sector, or even hidden in the bosom of their families, the fact is that children and adolescents with mental disabilities and / or mental disorders were doomed to a certain invisibility, which reinforced the lack of knowledge that still exists about them. At present, Brazil goes through a new moment in history when it comes to ways of conceiving children and adolescents as well as providing care for them, based on the Doctrine of Full Protection, as recommended by the Statute of the Child and the Adolescent. These changes have favored the emergence of a set of guidelines focusing on three aspects: the family setting as central for child development; residential care as an exceptional measure, and the co-responsibility between state, society and the family for the care of children and adolescents. However, if on the level of discourse, there is a consensus that the family setting is the place where children and adolescents should be raised, educated and protected, in practice what is observed is a mismatch between the importance given to the role of family and lack of minimum conditions to enable it to offer their children a decent life, particularly when these families are poor. The scenario of lack of support to families is exacerbated for those whose children have mental disabilities and / or mental disorders, and consequently need special care and treatment. In this dissertation were analyzed 36 interviews carried out with professionals who work for public and private organizations and are involved in the care of children and adolescents with mental disabilities and / or mental disorder. These interviews were conducted as part of two studies carried out by CIESPI - International Center for Research and Policy on Childhood, in association with PUC-Rio - between the years 2006 and 2010. The results pointed out to the conclusion that, although there have been important advances in recent years, much remains to be done in order to ensure the full realization of these children and adolescents’ rights to remain in their family setting.

La jeunesse est communément considérée comme une période de transition d’une situation de dépendance familiale à une situation d’autonomie et qui se réalise selon différentes étapes de décohabitation familiale, d’indépendance financière par l’emploi et par la création de sa propre cellule familiale.Cette thèse a l’ambition de décrire des passages à l’âge adulte de jeunes souffrant de troubles psychiques. Dans un contexte où les parcours individuels sont de plus en plus marqués par une exigence d’autonomie, ce temps particulier du parcours de vie est un moment critique où les tensions liées aux relations de dépendance propres à l’enfance d’un côté et au travail de gestion collective de la maladie de l’autre se heurtent aux difficultés d’avoir accès à l’activité salariale et à l’indépendance financière. Avec une approche qualitative et longitudinale, l’objectif de cette recherche est de comprendre la construction collective de ce passage dans une situation de troubles et/ou de handicap psychique à travers ses enjeux individuels (empowerment, expérience et gestion des troubles, participation sociale et accès aux ressources, définition d’un projet), relationnels (travail collectif de gestion de la trajectoire de la maladie, travail de care, travail d’accompagnement) et institutionnels (définition du handicap psychique, dispositifs d’accompagnement, autonomie comme règle institutionnelle, place des usagers/patients dans les différents services psychiatriques, sanitaires, médico-sociaux, judiciaires ou sociaux). / Youth is commonly considered as a period of transition, from a situation of dependence upon one’s family to a situation of autonomy. This takes place according to several steps: leaving the family’s nest, acquiring financial independence through employment and creating one’s own familial unit.This thesis aims at describing the passages according to which young people with mental disorders move onto adulthood. On top of the individual and collective ordeal that is becoming an adult exists another difficulty, which is no less shared: dealing with mental disorders. In a context in which the demand for autonomy and self-fulfilment increasingly influences individual paths, the passage to adulthood is a critical step. On the one hand are the tensions resulting from relations of dependence that are inherent to childhood, and on the other hand is the collective effort to manage the disability. These run up against the challenges of the access to a compensated activity and, thus, financial independence.The objective of this research is to understand the collective construction of this passage in a situation of mental disorder or disability while taking into account what is at stake at different levels. First the individual level: empowerment, experiencing and dealing with the disorders, getting involved in society and accessing facilities, defining a project. Then the relational level: collective management of the disease’s evolution, care and support. Finally the institutional level: defining mental disorders, support facilities, autonomy established as an institutional rule, the patients’/ users’ status in the psychiatric, sanitarian, medico-social, judicial and social facilities.

Introdução: Obesidade central é um fator de risco para o diabetes e as doenças cardiovasculares. O estudo da sua associação com os transtornos mentais comuns pode ajudar a entender melhor a epidemia de obesidade que acontece no Brasil, e a relação entre saúde mental e doenças crônicas. Objetivo: Investigar a associação entre transtornos mentais comuns e obesidade central em uma coorte ocupacional- ELSA-Brasil. Métodos: Para a avaliação do transtorno mental comum (TMC) foi aplicado o questionário CIS-R em 15102 participantes entre 35 e 74 anos. A circunferência da cintura foi aferida junto com outras medidas antropométricas. Variáveis demográficas e comportamentais também foram coletadas através de questionários. Resultados: O transtorno mental comum mostrou associação com obesidade central (RP = 1,30; IC95% 1,25-1,36), e mesmo quando ajustada para sexo, idade, raça/cor da pele e centro de investigação ELSA, continuou significativa a associação (RP = 1,21; IC95% 1,16-1,27). Os transtornos específicos depressão (RP = 1,24, IC95% 1,14-1,34), ansiedade (RP = 1,18, IC95% 1,12-1,24) e misto de ansiedade e depressão (RP = 1,12; IC95% 1,06-1,18) também se mostraram associados, inclusive quando ajustados para as mesmas covariáveis. Conclusão: Participantes com transtorno mental comum e com os diagnósticos específicos de depressão e ansiedade apresentam maior prevalência de obesidade central comparados com os que não apresentam transtornos mentais. / Background: Central obesity is a risk factor for diabetes and cardiovascular disease, and the study of its association with common mental disorders can help understand the obesity epidemic in Brazil, and the relationship between mental health and chronic diseases. Objective: To investigate the association between common mental disorders and central obesity in an occupational cohort ELSA-Brasil. Methods: Waist circumference, among other anthropometric measures, was obtained, and the CIS-R questionnaire was applied in 15102 participants between 35 and 74 years old. Demographic and behavioral variables were also obtained. Results: Common mental disorder was significantly associated with central obesity in crude analysis (PR = 1,30, CI95%: 1,25-1,36), and when adjusted for gender, age, skin color and center study (PR = 1,21, CI95%: 1,16 – 1,27). The specific mental disorders depression and anxiety were also associated. Conclusion: Participants with common mental disorder, and with specific diagnoses of depression and anxiety, report a higher prevalence of central obesity than people without a mental disorder.

Orientador: Alessandro Ferrari Jacinto / Resumo: Introdução: O envelhecimento populacional é um fenômeno mundial que está associado ao aumento da incidência de doenças crônico-degenerativas, como as demências. As demências desafiam não somente os pacientes, mas também seus cuidadores. Em geral, cuidar de idosos é uma responsabilidade que pertence à esfera familiar. Como consequência, familiares cuidadores estão em maior risco de adoecimento mental, resultando em depressão, sobrecarga, sintomas ansiosos e transtorno mental comum. Objetivo: O presente estudo tem por objetivo verificar a prevalência de TMC em familiares cuidadores de pacientes idosos com diagnóstico de demência rotineiramente acompanhados nos ambulatórios de geriatria do Centro de Saúde Escola da Faculdade de Medicina de Botucatu, UNESP. Métodos: Neste estudo transversal, aprovado pelo Comitê de Ética e Pesquisa da Faculdade de Medicina de Botucatu os instrumentos de avaliação utilizados foram: Self Reporting Questionnaire, Hospital Anxiety and Depression Scale, Zarit Burden Interview, Mini Exame do Estado Mental para cuidadores com 65 anos ou mais, além de questionário para coleta de dados sociodemográficos. A variável de desfecho foi “com transtorno mental comum”, definida como pontuação ≥ 7 no Self Reporting Questionnaire. As variáveis explanatórias foram de natureza sociodemográfica e clínica do cuidador. Resultados: A amostra foi composta por 90 cuidadores; 83 (92,2%) era do sexo feminino, 51 (56,7%) casada, 60 (66,7%) filho (a) e 62 (68,6%) possuíam algu... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Pharmaceutical expenditures are an important part of the entire hospital operating budget, and inpatient pharmaceuticals denote one of the highest costs in hospital care. Predictions for medication budgets based on the types of patients have been largely undertaken in medical hospitals and not psychiatric facilities. According to several previous studies, gender, age, diagnosis, comorbidity and length of stay (LOS) affect the general inpatient treatment expenditures. However, whether or not the impact of these factors differs in psychiatric hospitals remains to be investigated. To that end, the current study examines medication costs for mental and behavioral health disorder as well as the primary chronic diseases commonly comorbid with mental and behavioral health disorders that suggest formulary management control might be helpful. Multiple regression models were developed to determine the leading drivers associated with the growing inpatient hospital medication costs among patients admitted to an acute psychiatric hospital. We also analyzed LOS using a Poisson model in order to determine whether it is a proxy for psychiatric inpatient medication costs. Our finding selected 51 medications (14% of the 364 total medications consumed 90% of the total medication cost) under A category (AV, AE, and AN) and B category (BV, BE, and BN) in order to develop a medication list (MUC, medication under control) that suggested cost control measures based on cost and clinical criticality could be important. This study demonstrated that comorbidity, principal and secondary diagnoses, LOS, and MUC are associated with higher inpatient medication costs than other factors, including age, gender, insurance type, and month admitted. Our study also observed that the principal ICD-10-CM codes F10 (Alcohol related disorders) is associated with high inpatient medication cost. Secondary diagnosis related groups (DRGs) 203 (Bronchitis & asthma), 192 (Chronic obstructive pulmonary disease, COPD), 201 (pneumothorax), 639 (Diabetes), 642 (Inborn and other disorders of metabolism), 645 (Endocrine disorders), 641 (Nutritional & miscellaneous metabolic disorders), 690 (Kidney & urinary tract infections), 675 (Other kidney & urinary tract procedures), 699 (Other kidney & urinary tract diagnoses), and 700 (Other kidney and urinary tract diagnoses), 305 (Hypertension), 310 (Cardiac arrhythmia & conduction disorders), 303 (Atherosclerosis), 293 (Heart failure & shock), and 316 (Other circulatory system diagnoses) were found to be associated with higher inpatient medication costs. In addition, LOS can be used as an indicator (proxy) for inpatient medication cost when patients present with a secondary DRG 639 (diabetes) and 690 (kidney & urinary tract infections) in an acute psychiatric hospital. Viewed collectively, this study would enable executives of acute psychiatric hospitals to identify the most important factors that are associated with high inpatient medication costs, thereby assisting in the development of the hospital pharmaceutical budget using a novel and scientific approach.

Introduction: Faravelli et al. [1, 2] present findings on the lifetime, point and 1-year prevalence of mental disorders from their recent Sesto Fiorentino community survey in Italy. The publication of these study findings occurs at a time where some researchers and journal editors seem to have come to the conclusion that there is currently no further need for such cross-sectional studies on the prevalence of mental disorders. In fact, there have been pleas for a pause of such studies [3]. Highlighting several noteworthy features and findings from the survey of Faravelli et al. [1, 2], this editorial will challenge this attitude. The status, past and recent progress in the field of epidemiology of mental disorders will be critically discussed, in an attempt to underline the continued core role of descriptive epidemiological studies for our field and to identify future research needs.

Las medidas tomadas por la Organización Mundial de la Salud para afrontar la pandemia actual, han generado un gran impacto en el estilo de vida de las personas. Uno de los ámbitos que más se vio afectado fue la educación, teniendo que adaptar el material a un medio no presencial mientras se acataba el aislamiento obligatorio, incrementando los factores de riesgo para desarrollar la depresión. La presente investigación buscó determinar la presencia de síntomas depresivos y los niveles de depresión en estudiantes de secundaria de una institución pública durante la pandemia. La población estará conformada por 74 alumnas de 5to año de secundaria. Se aplicó la escala de autoevaluación de depresión de Zung, validada a través de la correlación de Pearson con valores de .26 y .78. La fiabilidad se midió a través del índice Omega, obteniendo un alfa de .95 y, en cuanto a las normas percentilares se utilizó la prueba de normalidad de Kolmogorov-Smirnov, teniendo una distribución normal. Los resultados obtenidos evidencian la presencia de varios síntomas depresivos, siendo el más resaltante la pérdida de placer frente a cosas que antes resultaban disfrutables. La mayoría de estudiantes participantes en este estudio se encuentran en el nivel de depresión leve. / The measures taken by the World Health Organization to face the current pandemic have had a great impact on people's lifestyles. One of the areas that was most affected was education, having to adapt the material to a non-presential environment while complying with mandatory isolation, increasing the risk factors for developing depression. The present research sought to determine the presence of depressive symptoms and levels of depression in high school students from a public institution during the pandemic. The population will be made up by 74 5th year high school students. The Zung self-rating depression scale will be applied, validated through Pearson's correlation with values of .26 and .78. Reliability was measured through the Omega index, obtaining an alpha of .95 and, regarding the percentile norms, the Kolmogorov-Smirnov normality test was used, having a normal distribution. The results obtained show the presence of several depressive symptoms, the most notable being the loss of pleasure compared to things that were previously enjoyable. Most of the students participating in this study are at the level of mild depression.

Psykisk ohälsa bland elitidrottare har varit ett stigmatiserat område och forskning kring ämnet växer. Idag finns mycket som tyder på att elitidrottare utövar en livsstil med stora fysiska och psykiska belastningar vilket har visat sig vara mer ohälsosamt än vad den generella uppfattningen tidigare varit. Som elitidrottare förväntas en att leva efter idrottens alla regler för att bli framgångsrik. I den här uppsatsen studeras förekomst av, och skillnader i psykosomatiska besvär mellan tre grupper av gymnasieelever i årskurs tre som har elitidrottsinriktning (Nationellt godkänd idrottsutbildning, NIU), allmän idrottsinriktning (Idrottsprogram, IDR) och elever utan idrottsinriktning. Det undersöks även om det förekommer samband mellan psykosomat­iska besvär och de olika gymnasiala inriktningarna. Studien har genomförts med en kvant­itativ tvärsnittsstudie med enkäter som delades ut till två skolor i en ort i mellersta Sverige. Totalt deltog 116 elever i undersökningen, med elit- och idrotts- samt utan idrottsinriktning. Resultatet visade att det fanns psykosomatiska besvär hos de olika gymnasiala in­riktning­arna, men inga signifikanta skillnader eller samband fastställdes. Ett intressant biresultat som påträffades är ett signifikant samband mellan att vara nervös och irriterad och att vara stress­ad och ha svårt att sova, samt att sambandet stärktes för samtliga elever att ha nämnda besvär. Nyckelord: Folkhälsa, psykisk ohälsa, psykosomatiska besvär, elitidrott, gymnasieelever, gymnasial idrottsinriktning. / Mental illness among elite athletes has been a stigmatized area and the research area is growing. Today, a lot of things points towards that elite athletes are practicing a lifestyle with great physical and mental tension. Having a profession as an elite athlete has proven to be more unhealthy than the general perception was. As an elite athlete you are expected to live for the sport, to follow its rules in order to achieve a successful career. This study investigates the prevalence of, and differences in psychosomatic disorders between three groups of secondary school students in their last year who have elite sport special­ization (Nationally certified physical education), public sports specialization (sports program) and students without sport specialization. It also investigates whether there is an association between psychosomatic disorders and the three various sport specializations. A quantitative cross-sectional study was performed and a questionnaire were distributed to two schools in central Sweden. A total of 116 students in their 3rd and last year of the secondary school with elite- and sport orientation and without sport orientation participated in the survey. The results showed a difference in the prevalence of psychosomatic disorders among the various orientations in secondary school. Eventhough no significant diff­erences or associations between psychosomatic disorders and secondary school orientation was found, a secondary finding was found in the form of significant correlations for the student to be nervous and irritated with being stressed and having trouble falling asleep, and the associations became stronger for students having these problems. Keywords: Public health, mental disorder, psychosomatic disorder, elite sports, secondary school students, secondary school sport specialization.