Vidas Esquecidas: Reforma Psiquiátrica, Dignidade e Desinstitucionalização

O presente trabalho tem por objetivo analisar as políticas públicas brasileiras voltadas à execução das diretrizes de incentivo à desinstitucionalização trazidas pela Lei 10.216/2001. Para tanto, pretende-se inicialmente traçar um histórico geral da relação do homem com as doenças mentais para, em seguida, trazer as origens da Reforma Psiquiátrica de 2001 e os principais elementos ligados a essa escolha do Estado em relação à assistência à saúde mental. Na sequência, serão apresentados dados que indicam as falhas nas estratégias governamentais de execução da política pública de redução de hospitais e leitos psiquiátricos e o impacto gerado na exclusão social da pessoa com deficiência mental. Por fim, tecer-se-ão comentários a respeito da responsabilidade estatal em virtude da inexecução sistemática das diretrizes da Reforma e da necessidade de reformulação da política de assistência focalizada em pacientes egressos dos hospitais psiquiátricos.

Relevância clínica em não fi brose cística bronquiectasia seguida em uma prática real

INTRODUCTION: Bronchiectasis is a chronic disorder characterized by permanent dilation of the bronchi and bronchioles accompanied by inflammatory changes in the walls of these structures and adjacent lung parenchyma. OBJECTIVE: The aim of the present study was to perform a clinical and functional characterization of adult patients with non-cystic fibrosis bronchiectasis. METHODS: A clinical, descriptive, retrospective, case-series study was carried out involving 232 patients with non-cystic fibrosis bronchiectasis treated at a lung ambulatory between 2004 and 2012. RESULTS: The sample consisted of 232 patients (134 females; mean age: 52.9 years ± 17.7; body mass index: 23.5 kg/m² ± 4.4). The predominant symptoms were cough (91.4%), expectoration (85.8%) and dyspnea (76.3%). The majority of cases were of a non-tuberculosis etiology (64.7%). Regarding lung function, the obstructive breathing pattern was predominant (43.5%). The most common comorbidities were of a cardiovascular origin (51.0%). CONCLUSIONS: Adult patients with non-cystic fibrosis bronchiectasis (mainly post-infection or post-tuberculosis in origin) are characterized by a low educational level, excessive cough, sputum, dyspnea, muscle fatigue, an obstructive breathing pattern with frequent hypoxemia and multiple comorbidities, mainly of a cardiovascular origin. However, our patients have a low index of exacerbations and hospitalizations that can be assigned to a clinical protocol for monitoring.INTRODUÇÃO: Bronquiectasia é uma doença crônica caracterizada pela dilatação permanente dos brônquios e bronquíolos acompanhada por alterações inflamatórias nas paredes dessas estruturas e parênquima pulmonar adjacente. OBJETIVO: O objetivo do presente estudo é realizar uma caracterização clínica e funcional de pacientes adultos com bronquiectasias e fibrose não cística. Métodos: Um estudo clínico descritivo e retrospectivo foi realizado com pacientes com bronquiectasias e fibrose não cística atendidos em um ambulatório de pulmão entre 2004 e 2012. RESULTADOS: A amostra foi composta por 232 pacientes (134 mulheres, idade média: 52,9 anos ± 17,7, índice de massa corporal: 23,5 ± 4,4 kg/m2). Os sintomas predominantes foram tosse (91,4%), expectoração (85,8%) e dispneia (76,3%). A maioria dos casos foi de etiologia não tuberculosa (64,7%). Em relação à função pulmonar, o padrão de respiração obstrutiva foi predominante (43,5%). As comorbidades mais comuns foram de origem cardiovascular (51,0%). CONCLUSÕES: pacientes adultos com bronquiectasias de fibrose não cística (principalmente pós-infecção ou pós-tuberculose de origem) são caracterizados por um baixo nível de escolaridade, tosse excessiva, expectoração, dispneia, fadiga muscular, um padrão de respiração obstrutiva com hipoxemia frequente e múltiplas comorbidades, essencialmente de origem cardiovascular. No entanto, nossos pacientes têm um baixo índice de exacerbações e hospitalizações que podem ser atribuídos a um protocolo clínico para o acompanhamento.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Nove de JulhoUniversidade Federal de São Paulo (UNIFESP) Center for Pulmonary Rehabilitation, Pulmonology DepartmentUniversity of Fortaleza Medicine SchoolUniversidade Federal de São Paulo (UNIFESP) Pulmonology DepartmentUNIFESP, Center for Pulmonary Rehabilitation, Pulmonology DepartmentUNIFESP, Pulmonology DepartmentSciEL

General Characteristics and Risk Factors of Cardiovascular Disease among Interstate Bus Drivers

Workers in the transportation industry are at greater risk of an incorrect diet and sedentary behavior. The aim of our study was to characterize a population of professional bus drivers with regard to clinical and demographic variables, lipid profile, and the presence of cardiovascular risk factors. Data from 659 interstate bus drivers collected retrospectively, including anthropometric characteristics, systolic and diastolic blood pressure, lipid profile, fasting blood glucose, meatoscopy, and audiometry. All participants were male, with a mean age of 41.7 ± 6.9 years, weight of 81.4 ± 3.3 kg, and BMI 27.2 ± 3.3 Kg/m2; the mean abdominal and neck circumferences were 94.4 ± 8.6 cm and 38.9 ± 2.2  cm; 38.2% of the sample was considered hypertensive; mean HDL cholesterol was 47.9 ± 9.5 mg/dL, mean triglyceride level was 146.3 ± 87.9 mg/dL, and fasting glucose was above 100 mg/dL in 249 subjects (39.1%). Drivers exhibited reduced audiometric hearing at 4–8 kHz, being all sensorineural hearing loss. The clinical characterization of a young male population of interstate bus drivers revealed a high frequency of cardiovascular risk factors, as obesity, hypertension, hyperlipidemia, and hyperglycemia, as well as contributing functional characteristics, such as a low-intensity activity, sedentary behavior, long duration in a sitting position, and high-calorie diet, which lead to excessive weight gain and associated comorbidities

A novel protocol for occlusal splint adjustment to treat TMD in sleep bruxism

Introduction: Sleep bruxism (SB) is a stereotypical movement disorder that is characterized by rhythmic masticatory muscle activity associated with tooth grinding and occasional jaw clenching. Objectives: The aim of this study was to determine the relief time for temporomandibular disorders (TMD), cervical and otological signs and symptoms in patients with BS treated with occlusal splints (OS) for a period of 180 days. Materials and methods: Thirty patients, between ages 22 and 53 years old, presenting SB and TMD, including cervical and otological symptoms, were enrolled in this study. The patients treatment protocol consisted of using the OS applying a novel adjustment protocol. The total follow-up period was 180 days. The paired Student t-test was used to compare before and after long-term OS treatment. Results: For all variables, the results were statistically significant (p elt; 0.001). As to the TMD symptoms, in most patients the relief of pain in masseter, temporalis, cervical and TMDs occurred in the 3rd month. Twenty percent of the patients were aware of clenching teeth while awake and reported that this parafunction decreased by the end of 6 months, and 90% reported an improvement in sleep quality as well. Conclusion: The use of an OS with a novel adjustment protocol was an effective treatment for TMD sign and symptoms in patients with SB

A novel protocol for occlusal splint adjustment to treat TMD in sleep bruxism

INTRODUCTION: Sleep bruxism (SB) is a stereotypical movement disorder that is characterized by rhythmic masticatory muscle activity associated with tooth grinding and occasional jaw clenching. OBJECTIVES: The aim of this study was to determine the relief time for temporomandibular disorders (TMD), cervical and otological signs and symptoms in patients with BS treated with occlusal splints (OS) for a period of 180 days. MATERIALS AND METHODS: Thirty patients, between ages 22 and 53 years old, presenting SB and TMD, including cervical and otological symptoms, were enrolled in this study. The patient’s treatment protocol consisted of using the OS applying a novel adjustment protocol. The total follow-up period was 180 days. The paired Student t-test was used to compare before and after long-term OS treatment. RESULTS: For all variables, the results were statistically significant (p < 0.001). As to the TMD symptoms, in most patients the relief of pain in masseter, temporalis, cervical and TMDs occurred in the 3rd month. Twenty percent of the patients were aware of clenching teeth while awake and reported that this parafunction decreased by the end of 6 months, and 90% reported an improvement in sleep quality as well. CONCLUSION: The use of an OS with a novel adjustment protocol was an effective treatment for TMD sign and symptoms in patients with SB