Saúde mental dos profissionais de saúde no Brasil no contexto da pandemia por Covid-19

The pandemic caused by Covid-19 has negatively affected the mental health of health professionals, especially those working on the frontline dealing with the fear of infection and infecting others, lack of personal protective equipment and excessive workloads. This text discusses the nuances related to the mental health of Brazilian health professionals in times of pandemic, highlighting the importance of the psychosocial care network in providing support to those who need special care and psychological resilience as a strategy for tackling adversities posed by the pandemic. The mental health service continues to face urgent challenges and deserves the due attention of health authorities in Brazil.La pandemia causada por Covid-19 ha afectado significativamente la salud mental de los profesionales de la salud, especialmente de los que trabajan en la línea de frente asistencial, puesto que enfrentan diariamente el miedo de infectarse y de infectar a los demás, la carencia de equipos de protección individual y la sobrecarga de trabajo. El objetivo de este texto es discutir los matices relacionados con la salud mental de los profesionales de salud en Brasil en tiempos de la pandemia de Covid-19. Se cita la importancia de la Red de Atención Psicosocial como instrumento de apoyo a los profesionales que necesitan cuidados de base territorial y se subraya la resiliencia psicológica como estrategia de enfrentamiento de las adversidades provenientes de la pandemia. Además, se sabe que los desafíos relacionados a la salud mental permanecen urgentes y merecen el debido valor de las autoridades sanitarias en Brasil.A pandemia causada pela Covid-19 tem afetado negativamente a Saúde Mental de profissionais de saúde, especialmente os que trabalham na linha de frente assistencial, pois lidam diariamente com o medo de se infectarem e infectarem os outros, a carência de equipamentos de proteção individual e a sobrecarga de trabalho. Este texto objetiva discutir as nuances relacionadas à Saúde Mental dos profissionais de saúde do Brasil em tempos de pandemia por Covid-19. Elenca a importância da Rede de Atenção Psicossocial (Raps) como instrumento de apoio aos profissionais que precisam de cuidados de base territorial e destaca a resiliência psicológica como estratégia de enfrentamento das adversidades oriundas da pandemia. Ademais, sabe-se que os desafios relacionados à Saúde Mental permanecem urgentes e merecem, das autoridades sanitárias no Brasil, o devido valor

Sobreviventes enlutados por suicídio e as possibilidades para posvenção no contexto da saúde pública brasileira

Após um suicídio, diversas pessoas são afetadas negativamente. Muitos dos denominados sobreviventes enlutados, em algum momento, precisarão de cuidados e apoio, a conhecida posvenção do suicídio. O objetivo deste estudo é discutir as suas possibilidades no contexto da saúde pública brasileira. Metodologicamente, o texto configura-se como um ensaio teórico apoiado na literatura da área, assim como em documentos institucionais e marcos legais. No cenário internacional, a posvenção do suicídio está mais bem estruturada do que no Brasil que, atualmente, tem o enfoque em grupos de apoio aos sobreviventes enlutados centrados em organizações não governamentais. É preciso lançar o olhar para os serviços de saúde de base territorial e comunitária, a exemplo dos Centros de Atenção Psicossocial, e vislumbrar ações de posvenção acessíveis e resolutivas, como as linhas telefônicas gratuitas de acolhimento, as visitas domiciliares precoces, as escutas terapêuticas e o aconselhamento para o luto.Death by suicide leaves many people negatively affected in its wake. Many so-called bereaved survivors will at some point need care and support, known as suicide postvention. This theoretical essay, based on the corresponding literature, institutional documents, and legal frameworks, seeks to discuss possibilities for suicide postvention within Brazilian public health. Suicide postvention is better structured internationally than in Brazil, which currently focuses on support groups for bereaved survivors centered in non-governmental organizations. We must look to territorial and community-based health services, like the Psychosocial Care Centers, and envisage affordable and resolute postvention actions, such as free prevention lines, early home visits, therapeutic listening and grief counseling

Sobreviventes enlutados por suicídio e as possibilidades para posvenção no contexto da saúde pública brasileira

Death by suicide leaves many people negatively affected in its wake. Many so-called bereaved survivors will at some point need care and support, known as suicide postvention. This theoretical essay, based on the corresponding literature, institutional documents, and legal frameworks, seeks to discuss possibilities for suicide postvention within Brazilian public health. Suicide postvention is better structured internationally than in Brazil, which currently focuses on support groups for bereaved survivors centered in non-governmental organizations. We must look to territorial and community-based health services, like the Psychosocial Care Centers, and envisage affordable and resolute postvention actions, such as free prevention lines, early home visits, therapeutic listening and grief counseling.Após um suicídio, diversas pessoas são afetadas negativamente. Muitos dos denominados sobreviventes enlutados, em algum momento, precisarão de cuidados e apoio, a conhecida posvenção do suicídio. O objetivo deste estudo é discutir as suas possibilidades no contexto da saúde pública brasileira. Metodologicamente, o texto configura-se como um ensaio teórico apoiado na literatura da área, assim como em documentos institucionais e marcos legais. No cenário internacional, a posvenção do suicídio está mais bem estruturada do que no Brasil que, atualmente, tem o enfoque em grupos de apoio aos sobreviventes enlutados centrados em organizações não governamentais. É preciso lançar o olhar para os serviços de saúde de base territorial e comunitária, a exemplo dos Centros de Atenção Psicossocial, e vislumbrar ações de posvenção acessíveis e resolutivas, como as linhas telefônicas gratuitas de acolhimento, as visitas domiciliares precoces, as escutas terapêuticas e o aconselhamento para o luto

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

The influence of the age-period-cohort effects on male suicide in Brazil from 1980 to 2019

Suicide is a complex and multi-determined phenomenon. Higher rates are observed in men and are related to multiple risk factors, including mental disorders, financial crises, unemployment, and easy access to highly lethal means of perpetration, such as firearms. We studied the effects of age, period, and cohort (APC) on total and firearm-related suicides in men in Brazil and its major regions from 1980 to 2019. Death records were extracted from the Brazilian Ministry of Health’s Mortality Information System. Estimable functions were used to estimate APC models, through the Epi library of the R statistical program, version 4.2.1. During the study period, Brazil had an average rate of 10.22 deaths per 100,000 men. Among regions, rates ranged from 8.62 (Northeast) to 16.93 (South). The same profile was observed in suicides by firearms. After estimating the APC models, we observed a temporal trend of increasing total suicides for Brazil and regions, except for the South region, where the trend was stationary. The trend was downward for firearm suicides for all locations. A positive gradient was observed in the mortality rate with advancing age for total suicides; and peak incidence between 20–29 years, with subsequent stabilization, for suicides perpetrated by firearms. There was a reduction in the risk of death for suicides perpetrated by firearms in relation to the reference period (1995–1999) for all locations, except in the North region, where the effect was not significant. The younger generations from the 1960s onwards had a higher risk of death from total suicide and a lower risk for those perpetrated by firearms in relation to the reference cohort (1950–1954). We observed a reduction in the mortality trend for suicides perpetrated by firearms, a reduction in the risk of death in the 2000s and for men born after 1960. Our results suggest reducing the risk of death from suicide by firearms in Brazil and regions. However, there is an upward trend in mortality from total suicides in the study period (1980–2019) and for younger cohorts

Mortality rates by age group, per 100,000 men, adjusted for period and cohort effect, for total suicide by firearms, from 1980 to 2019, Brazil and its major regions.

Mortality rates by age group, per 100,000 men, adjusted for period and cohort effect, for total suicide by firearms, from 1980 to 2019, Brazil and its major regions.</p

Total suicide rates in Brazilian men, smoothed by three-year moving means, according to major Brazilian regions, from 1980 to 2019.

Total suicide rates in Brazilian men, smoothed by three-year moving means, according to major Brazilian regions, from 1980 to 2019.</p

Suicide by firearms mortality rates per 100,000 men in Brazil, according to age group, period, and cohort, from 1980 to 2019.

Suicide by firearms mortality rates per 100,000 men in Brazil, according to age group, period, and cohort, from 1980 to 2019.</p

Death records from the Mortality Information System of the SUS Information Technology Department (SIM/DATASUS), according to ICD-9 and ICD-10.

Death records from the Mortality Information System of the SUS Information Technology Department (SIM/DATASUS), according to ICD-9 and ICD-10.</p

Firearm suicide rates among Brazilian men, smoothed by three-year mean averages, according to major Brazilian regions, from 1980 to 2019.

Firearm suicide rates among Brazilian men, smoothed by three-year mean averages, according to major Brazilian regions, from 1980 to 2019.</p