Revisão sobre tuberculose e transtornos mentais comuns

Apesar de possuir vacina e tratamento, atuberculose permanece como problema de saúde pública. Publicações têm descrito elevadaproporção de tuberculose entre pessoas com ansiedade, depressão e transtornosmentais comuns. Objetivou-se identificar publicações sobre associação entre transtornosmentais comuns e tuberculose e descrever o estado da arte. Trata-se de revisãoda literatura, com palavras chaves tuberculosis,common mental desordens, anxiety e depression, excluiu-seestudos sobre tuberculose extra-pulmonar e em animais. Foram selecionados 09artigos, apenas um especifico sobre transtornos mentais comuns, que comparou aproporção destes em casos de tuberculose (46,7%) e tuberculose infectados pelovírus da imunodeficiência (63,7%), há poucos estudos referente a temática, a maioriasobre problemas específicos de ansiedade e depressão, são proveniente de paísesonde a incidência de tuberculose é elevada, possuem estratégias metodológicasde baixo poder analítico e não investigam os mecanismos causais da relação entresaúde mental e tuberculos

Common mental disorders associated with tuberculosis: a matched case-control study.

INTRODUCTION: Despite the availability of treatment and a vaccine, tuberculosis continues to be a public health problem worldwide. Mental disorders might contribute to the burden of the disease. OBJECTIVE: The objective of this study was to investigate the association between common mental disorders and tuberculosis. METHODS: A matched case-control study was conducted. The study population included symptomatic respiratory patients who attended three referral hospitals and six community clinics in the city of Salvador, Brazil. A doctor's diagnosis defined potential cases and controls. Cases were newly diagnosed tuberculosis cases, and controls were symptomatic respiratory patients for whom tuberculosis was excluded as a diagnosis by the attending physician. Cases and controls were ascertained in the same clinic. Data collection occurred between August 2008 and April 2010. The study instruments included a structured interview, a self-reporting questionnaire for the identification of common mental disorders, and a questionnaire for alcoholism. An univariate analysis included descriptive procedures (with chi-square statistics), and a multivariate analysis used conditional logistic regression. RESULTS: The mean age of the cases was 38 years, and 61% of the cases were males. After adjusting for potential confounders, the odds of tuberculosis were significantly higher in patients diagnosed with a common mental disorder (OR: 1.34; 95% CI 1.05-1.70). CONCLUSION: There appears to be a positive and independent association between common mental disorders and tuberculosis; further epidemiological studies are required to increase our understanding of the possible biological and social mechanisms responsible for this association. Independent of the direction of the association, this finding has implications for the provision of care for mental disorders and for tuberculosis

Interconsultas entre enfermagem e psicologia na puericultura: uma experiência de fortalecimento da vigilância do desenvolvimento infantil

The psychosocial aspects of child development should be addressed in childcare appointments, and an interdisciplinary approach is essential to achieve an adequate process of monitoring child development. This article describes a childcare inter-consultation experience in a Family Health Unit involving Nursing and Psychology, focusing on the development surveillance instrument of the Child Health Handbook. Participant observation of childcare inter-consultations was performed, focusing on child development monitoring and conducting Continuing Health Education with the Unit’s professionals. We found that childcare appointments prioritized growth aspects. Thus, an expanded approach to child development was appropriate. The Continuing Health Education involved Psychology and Nursing themes, focusing on the child’s comprehensive health, enabling the construction of interprofessional work. The experience contributed to health education and strengthened childcare, understanding childhood as a process influenced by multifactorial aspects.Os aspectos psicossociais do desenvolvimento infantil têm sido negligenciados nas consultas de puericultura, sendo fundamental uma abordagem interdisciplinar para alcançar um adequado processo de vigilância do desenvolvimento infantil. Este artigo descreve uma experiência de interconsultas na puericultura em uma Unidade de Saúde da Família, envolvendo Enfermagem e Psicologia, tendo como foco o instrumento de vigilância do desenvolvimento da Caderneta da Criança. Realizou-se observação participante de interconsultas na puericultura, com foco na vigilância do desenvolvimento infantil e realização de Educação Permanente em Saúde com os profissionais da unidade. Verificou-se que as consultas de puericultura priorizavam aspectos do crescimento, cabendo, portanto, uma abordagem do desenvolvimento infantil de forma ampliada. A Educação Permanente em Saúde envolveu temáticas da Psicologia e Enfermagem com foco na saúde integral da criança, possibilitando construção do trabalho interprofissional. A experiência contribuiu para a educação em saúde e fortalecimento da puericultura, entendendo a infância como um processo influenciado por aspectos multifatoriais

Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence.

PURPOSE: To examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally. METHODS: We used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of "caseness indicators" based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of 'definite' or 'severe' difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA's creator, working in conjunction with experienced local professionals. RESULTS: As judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8-56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators. CONCLUSIONS: The relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires

Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy.

Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions

Cadernos de Saúde Pública

p.1955-1956Rio de Janeir

Maternal mental health and social support: effect on childhood atopic and non-atopic asthma symptoms.

BACKGROUND: Atopic and non-atopic asthma have distinct risk factors and immunological mechanisms, and few studies differentiate between the impacts of psychosocial factors on the prevalence of these disease phenotypes. The authors aimed to identify whether the effect of maternal mental health on prevalence of asthma symptoms differs between atopic and non-atopic children, taking into account family social support. METHODS: This is a cross-sectional study of 1013 children participating in the Social Change Allergy and Asthma in Latin America project. Psychosocial data were collected through a household survey utilising Self-Reporting Questionnaire and Medical Outcome Study Social Support Scale. Socioeconomic and wheezing information was obtained through the questionnaire of the International Study of Allergy and Asthma in Childhood, and level of allergen-specific IgE was measured to identify atopy. Polytomous logistic regression was used to estimate the association between maternal mental health, social support and atopic and non-atopic wheezing. Effect modification was evaluated through stratified polytomous regression according to social support level. RESULTS: Maternal mental disorder had the same impact on atopic and non-atopic wheezing, even after adjusting for confounding variables. Affective, material and informational supports had protective effects on non-atopic asthma, and there is some evidence that social supports may act as a buffer for the impact of maternal mental disorder on non-atopic wheezing. CONCLUSION: Poor maternal mental health is positively associated with wheezing, independent of whether asthma is atopic or non-atopic, but perception of high levels of social support appears to buffer this relationship in non-atopic wheezers only

Suicídio no Brasil, de 2000 a 2012.

Objetivos: Identificar as causas e o perfil das vítimas, analisar a mortalidade nos últimos 13 anos e mapear mudanças assistenciais e socioeconômicas. Métodos: Utilizaram-se dados do SIM e Datasus. Calcularam-se as proporções das causas de suicídio segundo as categorias do CID10, X60-X84, estratificando-se por lesões (X70-X84) e autointoxicações (X60-X69). Analisaram-se as incidências por raça/cor, escolaridade e faixa etária, de 2000 a 2012. Compararam-se variações na mortalidade por suicídio com mudanças regionais nos indicadores de cobertura, características socioeconômicas e demográficas. Resultados: As maiores causas de suicídio foram enforcamento, lesão por armas de fogo e autointoxicação por pesticidas. Os mais acometidos foram os menos escolarizados, indígenas (132% superior à população geral) ou maiores de 59 anos (29% superior). As taxas entre homens são três vezes maiores em todas as regiões, embora tenha maior crescimento entre as mulheres (35%). A mortalidade mais elevada se encontra na região Sul (9,8/100.000) e o maior crescimento percentual, no Nordeste (72,4%). Conclusão: A mortalidade por suicídio continua a crescer no país, com importantes variações regionais. A assistência à saúde também apresenta inequidades regionais, com importantes lacunas nos serviços de saúde. O Brasil ainda carece de programas governamentais que trabalhem efetivamente na prevenção do suicídio. Considera-se necessário estabelecer uma estratégia nacional de prevenção focalizando as populações de maior risco identificadas: índios, pessoas com menor escolaridade, homens e maiores de 60 anos, além da necessidade de ampliar a vigilância na comercialização ilegal de pesticidas.Rio de Janeir

Saúde mental na atenção básica

p.19-24A escassez de informações no contexto brasileiro sobre ações de Saúde Mental na Atenção Básica tem sido apontada. Este estudo teve como objetivo identificar o perfil diagnóstico e sócio-demográfico de pacientes assistidos em Saúde Mental no Programa de Saúde da Família em Cachoeira, Bahia. Realizou-se um estudo de corte transversal, examinando 100 (cem) prontuários com diagnósticos psiquiátricos atendidos em ambulatório. Encontrou-se que 54% dos atendimentos foram do sexo masculino, sendo 67% adultos jovens, 49% de procedência urbana e 63% sem ocupação. Dos diagnósticos encontrados 37% foram de esquizofrenia, transtornos esquizotípicos e delirantes e 18% de transtornos afetivos. Os achados sugerem a inclusão das ações de Saúde Mental na Atenção Básica, considerando o elevado percentual de transtornos mentais severos e a precária inserção sócio econômica desses indivíduos no território onde vivem.Salvado