Orientador: Neury Jose Botega / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T04:19:30Z (GMT). No. of bitstreams: 1 Stefanello_Sabrina_M.pdf: 2912070 bytes, checksum: 46f125568957a4af1cabc9400f3352fe (MD5) Previous issue date: 2007 / Resumo: Objetivo: Identificar diferenças entre os sexos em variáveis sócio-demográficas, psicossociais e clínicas entre aqueles que tentaram o suicídio e que foram atendidos no pronto socorro do Hospital de Clínicas (HC) da UNICAMP. Método: Trata-se de estudo transversal, sub-projeto do Estudo Multicêntrico de Intervenção no Comportamento Suicida (SUPRE-MISS), organizado pela Organização Mundial de Saúde (OMS). Duzentos e doze sujeitos participaram do estudo. A avaliação foi feita por meio de entrevista estruturada, contendo informações sobre saúde mental e física, contato com serviços de saúde, uso de substâncias psicoativas, eventos traumáticos de vida, dificuldades psicossociais, apoio social, diagnóstico psiquiátrico, problemas com a justiça, comportamento anti-social e escalas psicométricas. A comparação entre os sexos foi feita usando-se análise de regressão logística uni e multivariada. Resultados: Do total, 49% estavam na faixa etária entre 25 a 44 anos, e 143 (68,1%) foram do sexo feminino. Quase todos os que tentaram suicídio tiveram um diagnóstico psiquiátrico (96%). Os transtornos do humor foram mais freqüentes entre as mulheres (54% versus 32%, p=0,003) e os transtornos mentais por uso de substâncias psicoativas, especialmente álcool, foi mais freqüente entre os homens (31% versus 7%, p=0,0001). As mulheres tiveram piores escores no Índice de Bem-Estar OMS (p=0,005), na escala de Beck de Depressão (p=0,01) e na escala de Desempenho do Papel Social (p=0,03). Mais mulheres (58%) que homens (35%, p=0,002) haviam tentado o suicídio anteriormente, e tinham sofrido abuso físico e/ou sexual (26% versus 8%, p=0,002). As mulheres haviam procurado mais frequentemente tratamento psiquiátrico (50% versus 34%, p=0,03) e freqüentaram mais o culto religioso (uma vez por semana: 45% versus 23%, p=0,007). As tentativas de suicídio envolveram maior risco de morte entre os homens (48% versus 28%, p=0,01), assim como o uso de álcool/drogas associado à tentativa de suicídio (30% versus 13%, p=0,003). Após uma tentativa de suicídio prévia, os homens sentiram mais pena de si mesmos (64% versus 36%, p=0,01). Na análise multivariada, as variáveis que melhor discriminaram diferenças entre os sexos foram: uso de álcool e/ou drogas relacionado à tentativa de suicídio atual(2,9 vezes maior nos homens), abuso físico e/ou sexual (4,4 vezes menor nos homens), sentimento do Índice de Bem-Estar ¿sentir-se ativo e vigoroso¿ (4,5 vezes maior entre os homens) e a presença de transtorno mental por uso de substância psicoativa (3,6 vezes maior nos homens). Conclusão: Os homens tiveram menos diagnóstico de depressão, menores escores na escala de depressão e disseram que estavam sentindo-se mais ¿ativos e vigorosos¿. Embora os homens ingeriram bebida alcoólica mais frequentemente e fizeram tentativas de suicídio mais graves, eles sentiram mais vergonha e pena de si mesmos, tiveram mais problemas no trabalho e haviam feito menos tratamento psiquiátrico que as mulheres. As mulheres mais frequentemente sofreram abuso físico e/ou sexual prévio, estavam mais deprimidas e apresentaram mais dificuldades em lidar com crises / Abstract: Objective: The aim of this study was to identify sex differences in clinical, psicossocial and demographic variables among those who attempted suicide and were seen at the emergency room of the Hospital de Clínicas (HC) UNICAMP.Methods: This was a cross-sectional study, sub-project of the Suicide Prevention ¿ Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS) organized by the World Health Organization (WHO). 212 subjects were enrolled in the study. A structured questionnaire covered a series of variables, including mental and physical health status, contact with health services, alcohol and drug related questions, traumatic experiences, psychosocial difficulties, life satisfaction, social support, psychiatric diagnosis, problems with justice, anti-social behavior and specific psychometric scales. A comparison between sexes was made using uni and multivariate logistic regression analysis. Results: Overall 49% were between 25 and 44 years old, and 143 (68.1%) were females. Almost all suicide attempters had a mental disorder (96%). Affective disorders were more frequent among women (54% versus 32%, p=0.003) and mental disorders caused by psychoactive substance use, especially alcohol, were more frequent among men (31% versus 7%, p=0.0001). Females had worse scores at the WHO Index of Well-Being (p=0.005), at the Beck Depression Inventory (p=0.01) and at the Psychiatric Disability Assessment Schedule (p=0.03). More women (58%) than men (35%, p=0.002) had previously made a suicide attempt, and had suffered physical and/or sexual abuse (26% versus 8%, p=0.002). Women had more frequently looked for psychiatric treatment (50% versus 34%, p=0.03) and attended to religious cult (once a week: 45% versus 23%, p=0.007). Suicide attempts involved more risk of death among men (48% versus 28%, p=0.01), as well as the use of alcohol/drugs at the suicide attempt (30% versus 13%, p=0.003). After a previous suicide attempt men felt more pity of themselves (64% versus 36%, p=0.01). In the multivariate analysis, the variables which better discriminated differences between sexes were: ingestion of alcohol and/or drugs at suicide attempt (2.9 times more frequent in men), physical and/or sexual abuse (4.4 times less frequent in males), ¿active and vigorous¿ well-being feelings (4.5 times more frequent in men) and a mental disorder caused by psychoactive substance use (3.6 more frequent in males). Conclusion: Males had less diagnosis of affective disorder, lower scores at the depression scale and told they were feeling more ¿active and vigorous¿. Although men consumed alcohol more frequently and had more serious suicide attempts, they felt more pity and shame of themselves, had more problems at work and had had less treatment than females. Women had more frequently suffered physical and/or sexual abuse, were more depressed and had difficulties to handle crisis / Mestrado / Saude Mental / Mestre em Ciências Médicas

Crianças afetadas por transtornos mentais são, em grande parte, não identificadas nem tratadas em todo o mundo. O sistema educacional está intimamente relacionado com o campo da saúde mental na infância e as ações que ocorrem no contexto da educação podem ser fundamentais para melhorar o atendimento das pessoas afetadas por transtornos mentais. Neste projeto desenvolvemos um programa baseado na web (grupo de educação interativa baseada na web, EIBW) para educar e ajudar os professores do ensino fundamental no reconhecimento e manejo em sala de aula de crianças com possíveis transtornos mentais. Além disso, foi realizado um ensaio clinico controlado randomizado em clusters para testar a eficácia da intervenção EIBW em comparação com o mesmo programa, com base em materiais de texto e vídeo (grupo de educação baseada em texto e video, EBTV) e nenhum treinamento (controle de lista de espera, LE). As nove escolas de uma cidade do estado de São Paulo, Brasil, foram randomizados em três grupos, e os professores completaram os programas educacionais em três semanas. Em relação ao conhecimento, o grupo EIBW foi superior ao grupo EBTV em 2 de 9 resultados e o grupo EIBW foi superior ao grupo LE em 5 de 9 resultados. O grupo EBTV foi superior ao LE em 2 de 9 resultados. No que diz respeito as crenças e atitudes, o grupo EIBW apresentou conceitos menos estigmatizados do que o grupo EBTV e mais conceitos não-estigmatizados do que o grupo LE, que apresentou conceitos menos estigmatizados do que a EBTV. A intervenção não mostrou efeitos sobre atitudes em relação à saúde mental. Este ensaio clínico randomizado demonstrou a eficácia de um programa baseado na web para educar professores na identificação e no tratamento de crianças com transtornos mentais / Children affected by mental disorders are largely unrecognized and untreated across the world. The educational system is closely related to the childhood mental health field and actions that occur in the context of education may be critical to improve the care of those affected by mental illness. We developed a web-based program (web-based interactive educational group, WBIE) to educate and assist primary school teachers in the recognition and management of children with mental disorders. Additionally, we conducted a cluster-randomized controlled trial to test the effectiveness of the WEIE intervention in comparison to the same program based on text and video materials only (text and video-based educational group, TVBE) and to no training (waiting list control, WL). The nine schools of a community in São Paulo, Brazil, were randomized to the three groups, and teachers completed the educational programs during three weeks. Regarding knowledge, the WBIE group was superior to the TVBE group in 2 out of 9 outcomes and the WBIE group was superior to the WL group in 5 out of 9 outcomes. The TVBE was superior to the WL in 2 out of 9 outcomes. Regarding beliefs and attitudes, the WBIE group presented less stigmatized concepts than the TVBE group and more non-stigmatized concepts than the WL group, which presented less stigmatized concepts than the TVBE. There was no effect of the intervention over attitudes to mental health. This randomized controlled trial demonstrated the effectiveness of a web-based program to educate school teachers in the identification and management of children with mental disorders

South Africa is a developing country and children in South Africa are at a high risk for developing communication disorders with more than 10% of children under three likely to have communication disorders. The ideal is to prevent as many of these communication disorders as possible. This requires the identification of factors within specific communities which may increase the risk for or resilience against developing communication disorders. Providing information on communication development is a form of primary prevention which has proven to be highly successful. There is a continuum of communities in the South African context that range from the developing to the developed and at each level parents have specific requirements regarding the need for information on communication development. Considering the large number of South African infants who are at risk for developing communication disorders and in recognition of the many different communities in the South African context, the need for prevention tools which are developed to meet the needs of specific communities, becomes apparent. This study aimed to develop a tool for parents of a specific South African community, identified as Pretoria East, for the stimulation of communication skills in infants that is valid in terms of content and is judged by parents to be practical and empowering. In order to achieve this aim three phases of research were planned. Phase one aimed to identify the needs of parents and professionals in terms of the informational content and format of a tool for the stimulation of communication in infants. Phase two aimed to develop a tool for the stimulation of communication in infants based on the needs and preferences expressed by parents and professionals, the active involvement of parents from the community in focus group discussions as well as on sound theoretical underpinnings of infant development. Phase three aimed to validate the tool by determining whether the tool fulfilled the needs of parents in terms of informational content and format. The results of this research indicated that a need was identified in parents and professionals alike for a tool for parents on the stimulation of communication skills in infants. A video was indicated as the most popular choice of format. The content of the stimulation tool which was developed in phase two reflected the needs and preferences of the community and included the following topics, namely: discussions and demonstrations on the normal development of communication skills in infants, techniques that would facilitate normal development, risk factors and resilience factors which may influence communication development as well as information on locating a professional. In phase three parents from the community evaluated the video tool as practical and empowering, therefore achieving the main objective of the research. This research highlighted the need within a specific community for information on the facilitation of communication development in young children, implying the need for further research in order to determine the needs of other South African communities. Recommendations were also made regarding the need for speech-language therapists to increase their involvement in prevention initiatives and community work. / Thesis (PhD (Communication Pathology))--University of Pretoria, 2005. / Speech-Language Pathology and Audiology / unrestricted

This thesis is focused on social exclusion. Theoretical part is concerned with social exclusion - its definition, forms and consequences. The next topic is inklusion, that is relatively new phenomenon in czech education. The last part includes prevention, that means prevention programs and especially school psychologists. Practical part is composed of thematical analysis of semistructured interviews with school psychologists. These school psychologists work with children who attend primary and lower secondary education. My intention was to answer these three questions. How do school psychologists perceive children, who are getting on the margin of class group? How do the prevention programs, that are supposed to help socially excluded childer work, according to school psychologists? How do school psychologists co-work with other adults who take care of a child, that is socially excluded? All respondents (school psychologists) meet socially excluded children in their school. They pay special attention to the children. They also do comprehend short-term and long-term consequences of such environment, not only for the excluded child but for the whole group. Primary prevention programs are, according to interviewees, the more effective the sooner the first program starts. There are two groups of...

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Background: Despite a slight decline in the prevalence of substance use among adolescents in last years, there is a constant need for effective, available and well-targeted preventive interventions. Children of parents with substance use experiences are considered to be more endangered. Although the quality and availability of universal prevention programs has improved, their effectiveness is not usually systematically verified, moreover, the impact on children of parents with substance use experiences is unknown. The Unplugged preventive intervention was supplemented by nPrevention booster sessions in order to support its research-proven preventive impact. Aims: The main objective was to evaluate the effect of Unplugged and nPrevention programs combination (Un+nP) after 24 months in comparison with Unplugged program (Un) alone and control in respect of the substance use experience in parents. The secondary objective was to test the reliability of anonymous self-generated identification code (SGIC) and the process of matching children's questionnaires between waves of data collection and with parents' questionnaires. Methods: A cluster randomized, controlled, 3-arm, prospective, school-based prevention trial was conducted between years 2013 and 2017 to evaluate the Unplugged (implemented in the 6th...

The United States is in the midst of an opioid epidemic, which is leading to approximately 130 deaths each day. While research on family-based approaches for substance misuse prevention, such as alcohol and tobacco prevention, has been conducted, few if any studies have focused on prescription opioid misuse prevention. Previous literature suggests that a comprehensive family-based approach can be effective in preventing substance misuse at the family-level. Considering the multiple age groups the sandwich generation cares for, the sandwich generation may have greater access to reaching multiple age groups to prevent prescription opioid misuse. Therefore, the purpose of this study is to use formative research findings to inform family-based approaches focused on preventing opioid misuse. A dual method approach that includes qualitative focus groups and quantitative surveys is used to explore adults’ perceptions of prescription opioid misuse, factors perceived as influencing opioid misuse prevention, and perceived predictors of prescription opioid misuse prevention. Participants were adults, 30 to 59 years of age, which is the average age range of the sandwich generation. Extension agents recruited focus group participants (n = 55) and Qualtrics recruited survey participants (n = 335) for this study. Focus group transcripts were coded based on common ideas that arose during the focus groups, previous literature, and the PRECEDE-PROCEED model. Focus group findings indicate that participants view the opioid crisis as a family problem, in which they have a role in preventing, and identified predisposing, reinforcing, and enabling factors that influence whether family members take a role in preventing prescription opioid misuse. Univariate frequencies and multiple linear regression analyses results of the survey data indicate that Theory of Planned Behavior determinants are predictive of the intention to talk about opioids with friends and family. In addition, comfort predicts intention to talk about opioids with friends and family, suggesting that Theory of Planned Behavior determinants and comfort predict intention. Extension agents, family life educators, and other community-health professionals can collaborate and use these findings to develop family-based approaches, such as family communication training and brief strategic family therapy, combined with community-based approaches such as motivational interviewing and media campaigns.

The public is often surprised by the high prevalence of relationship violence. With more than 50% of adults experiencing some form of physical or psychological violence in their intimate relationships during their lifetime, IPV is a public health crisis that particularly affects marginalized communities (Breiding et al., 2015; Johns et al., 2019, 2020; Stockman et al., 2015). The variable results of perpetrator and victim treatments make prevention particularly important if it is effective (Anderson & Van Ee, 2018; Babcock et al., 2004; Cheng et al., 2021; Karakurt et al., 2019; Maguire, 2018; Stith, Rosen, et al., 2004; Stover et al., 2009). Thus, researchers are interested in developing empirically tested programs that reduce IPV (Jennings et al., 2017; Niolon et al., 2017). The current meta-analysis builds on the existing literature by analyzing the broad effectiveness of IPV primary prevention in adolescence and young adulthood while specifically analyzing the moderator of novel intervention methods (e.g., online, mobile app, or mailed interventions). Additional moderators included age; gender; at-risk populations; intervention type, whether focused on IPV or relationship health; setting, whether school or community; and length of the intervention. Looking at the included studies as a whole, the aggregate of the intervention outcomes indicates that there is a small but significant positive effect from primary prevention programs (d = 0.175, k = 47, p < 0.001). As broad categories, attitudes (d = 0.166, k = 29, p < 0.001), knowledge (d = 0.212, k = 12, p < 0.001), and behaviors (d = 0.160, k = 36, p < 0.001) had small, significant effect sizes. Taken together, IPV primary prevention programs were able to successfully address their targeted outcomes in these domains. There was not a significant difference between facilitated and self-directed prevention programs (dF = 0.177, k = 39, p < 0.001; dSD = 0.160, k= 8, p = 0.132; Q = 0.023, p = 0.878). These findings have important implications for IPV prevention strategies and interventions. Although the effect size is described as small, even small reductions in IPV can have a significant impact on behavior that impacts millions of people and is costly economically and socially. Future research should further explore self-directed programs and extend our work to LGBTQ+ populations.

Evaluation of: Bangalore S, Steg PG, Deedwania P et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 308(13), 1340–1349 (2012). The number of myocardial infarctions (MIs) in population remains high and this event is a significant predictor of mortality. Information in the literature points to a reduction in mortality, reinfarction and sudden death in first year, especially in patients with high risk, if β-blockers (BBs) are used after MI. In a perspective study, Zuckerman et al. have determined outcome following pharmacotherapy after acute MI in older adults. It is apparent that a number of matters require consideration in evaluation of the effectiveness of BBs. It seems that not all patients benefit equally from treatment with BBs but such an intervention reduces mortality. It is also important to recognize that the beneficial effects of BBs should not be considered in isolation since the biological system is too complex to manipulate with the use of a single class of drugs.

INTRODUCTION With effective highly active antiretroviral therapy (HAART), individuals with human immunodeficiency virus (HIV) infection now enjoy life expectancies approaching those of uninfected individuals. Prolonged longevity has increased the prevalence of non-communicable comorbidities within the HIV patient population. HIV is a known independent risk factor for atherosclerotic cardiovascular disease (ASCVD), imparting a 1.5-2 -fold higher incidence of major adverse cardiovascular events (MACE) on infected patients. Deaths from ASCVD have increased as a result, despite a decline in total mortality. The Center of Excellence for HIV/AIDS care established a Cardiovirology Clinic (CvC) focused on providing primary and secondary preventative cardiovascular care to its patients. To date, there are no known data on the efficacy of such an intervention. We sought to define the performance of this care model for primary prevention. METHODS Unique CvC patients (n=68) with a treatment delivery window between September 1, 2017 to August 31, 2018 were identified through billing records. All patients were receiving HAART as prescribed by their infectious disease provider. Those with established ASCVD (n=10) were excluded from analysis to limit the study to primary prevention patients. We collected data on ASCVD risk factors (family history of premature ASCVD and personal histories of smoking, diabetes, hypertension [with degree of control], dyslipidemia, drug and alcohol use, and exercise) from the electronic health record. Body-mass index and systolic (SBP) and diastolic (DBP) blood pressures were also collected. Laboratory values including CD4 cell count, HIV-1 viral load, proteinuria, glomerular filtration rate, total cholesterol (TC), triglycerides (TG), and high (HDL) and low density (LDL) lipoprotein were included in the data collection. Estimates of 5-year risk of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or need for major revascularization was calculated using the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) equations. Patient data were de-identified. Two-tailed, paired T-testing was performed for each factor comparing the initial and most recent follow-up values. Significance was defined as p value <0.05. RESULTS Using univariate analysis, reductions in D:A:D risk (relative 32.01%, absolute 1.49%, p CONCLUSION In this initial assessment, treated HIV patients appeared to enjoy meaningful reductions in MACE risk through the preventive care they received in this clinic, suggesting that CvCs could be a partial solution to the growing ASCVD morbidity and mortality among HIV-infected individuals. Limitations of this study include a small patient population (n=58) (limiting us to univariate analyses) and short duration of follow up (≤ 1 year). Data collection will continue annually for 4 additional years. With increasing subject numbers, multivariate analyses to determine if components of ASCVD risk reduction show interactions, and which factors, interactions and interventions impart the greatest risk reduction, will be performed in improve the quality of care.