Avaliação da sustentabilidade do Bairro Camobi, Santa Maria, RS

The accelerated increase in demographic density led to excessive and disorganized growth of cities from the decade of 1950, generating urban problems noticeable until current days. In response, new sustainable urban design methods emerged. This article presents an evaluation of the Camobi neighborhood in Santa Maria, RS, under the perspective of sustainable urbanism. The neighborhood has typical characteristics of suburban areas of Brazilian cities. The purpose of this analysis is to recognize the potentialities and weaknesses of the neighborhood, enabling the creation of guidelines to make it more attractive to people. The methodology used sought to characterize the neighborhood through instruments and parameters that address different factors: site analysis, neighborhood completeness, pedestrian permeability, user preferences, and form. The main conclusion is the inadequacy of the neighborhood to the needs of pedestrians especially about street furniture, infrastructure of walks and connections. The results presented may help in the planning of new suburban neighborhoods in Brazilian cities, as well as in the proposition of strategies to improve existing neighborhoods.O aumento acelerado da densidade demográfica levou a um crescimento excessivo e desorganizado das cidades a partir da década de 1950, causando problemas urbanos perceptíveis até hoje. Como resposta, surgem novos métodos de planejamento urbano mais sustentáveis. Este artigo apresenta uma avaliação do bairro Camobi, em Santa Maria, RS, sob a ótica do urbanismo sustentável. O bairro apresenta características típicas de áreas suburbanas de cidades brasileiras. O objetivo desta análise é reconhecer potencialidades e fragilidades do bairro, possibilitando a criação de diretrizes para torná-lo mais amigável às pessoas. A metodologia baseou-se em instrumentos e parâmetros que abordam a análise do terreno, completude do bairro, permeabilidade ao pedestre, preferências dos usuários e análise da forma. Como principal conclusão têm-se a inadequação do bairro às necessidades dos pedestres principalmente no que diz respeito a mobiliário urbano, infraestrutura de passeios e conexões. Os resultados apresentados podem auxiliar no planejamento de novos bairros suburbanos de cidades brasileiras bem na proposição de estratégias de readequação de bairros existentes

The characteristics and activities of child and adolescent mental health services in Italy: a regional survey

<p>Abstract</p> <p>Background</p> <p>To date, no studies have assessed in detail the characteristics, organisation, and functioning of Child and Adolescent Mental Health Services (CAMHS). This information gap represents a major limitation for researchers and clinicians because most mental disorders have their onset in childhood or adolescence, and effective interventions can therefore represent a major factor in avoiding chronicity. Interventions and mental health care are delivered by and through services, and not by individual, private clinicians, and drawbacks or limitations of services generally translate in inappropriateness and ineffectiveness of treatments and interventions: therefore information about services is essential to improve the quality of care and ultimately the course and outcome of mental disorders in childhood and adolescence.</p> <p>The present paper reports the results of the first study aimed at providing detailed, updated and comprehensive data on CAMHS of a densely populated Italian region (over 4 million inhabitants) with a target population of 633,725 subjects aged 0-17 years.</p> <p>Methods</p> <p>Unit Chiefs of all the CAMHS filled in a structured 'Facility Form', with activity data referring to 2008 (data for inpatient facilities referred to 2009), which were then analysed in detail.</p> <p>Results</p> <p>Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0-17 years. All outpatient units were well equipped and organized and all granted free service access. In 2008, approximately 6% of the target population was in contact with outpatient CAMHS, showing substantial homogeneity across the eleven areas thereby. Most patients in contact in 2008 received a language disorder- or learning disability diagnosis (41%). First-ever contacts accounted for 30% of annual visits across all units. Hospital bed availability was 5 per 100,000 inhabitants aged 0-17 years.</p> <p>Conclusion</p> <p>The percentage of young people in contact with CAMHS for mental disorders is in line with those observed in previous epidemiological studies. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and it is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours (e.g., nights and holidays).</p

Standard comparison of local mental health care systems in eight European countries

Aims. There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (>= 18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sor-Trondelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.Peer reviewe

Disuguaglianze e salute mentale

L’interesse per gli effetti della povertà e delle disuguaglianze sociali sulla salute degli individui sta sempre più diventando di primaria importanza. Chiunque si accosti allo studio di questa relazione deve affrontare il problema di definire il concetto di disuguaglianza e di povertà. Molti economisti e sociologi hanno cercato di dare una definizione precisa, e facilmente trasformabile in una misura, di disuguaglianza sociale e le teorie di riferimento sono diverse

Mental health care financing in Italy: current situation and perspectives.

Through a review of the studies conducted on the analysis of the costs of the Italian mental health provision of care, this study aimed at describing the current financing system for mental health care in Italy. From the deinstitutionalization to the present days, Italian mental health care financing has evolved in line with both national plans and the actual European directives. The description of the current situation of mental health care financing in Italy can be useful to inform service planning and resource allocation, and to offer a wider European perspective

Mortality and cause of death among psychiatric patients: a twenty year case-register study in an area with a community-based system of care

BACKGROUND: Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services. METHOD: All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population. RESULTS: The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6-1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5-328.6) and personality disorders (20.87, 95% CI 5.2-83.4). CONCLUSIONS: This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals

Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia

Background: In Georgia, difficult socioeconomic conditions have resulted in a drastic decrease in government financing for the health sector. State mental hospitals continue to be the main solution for the mentally ill, due to the severe lack of community-based services, and mental health services are inadequate to meet the needs of patients. Methods: An experimental intervention of assertive community care was implemented with the aim to engage socially isolated patients who lacked contact with outpatient services and to answer their different social and psychological needs. The intervention lasted 10 months and consisted of outpatient visits, visits at home, meetings outside and telephone calls to the services' facilities; all services were provided by a multidisciplinary team. The intervention was conducted in a psychiatric dispensary in the district of Tbilisi, Georgia. Results: This pilot study showed the economic sustainability of community care and its effectiveness to facilitate continuity of care and to improve clinical and social outcomes. Conclusions: High-quality community care costs less than usual treatment and inpatient care and seems to be effective to improve clinical and social outcomes; for these reasons, policymakers should consider, in their future mental health reforms, allocating more resources to community-based care

Which factors affect the costs of residential psychiatric care? Findings from the Italian PROGRES study

Objective: In the latest years, mental hospitals have gradually beenreplaced by a community-based network of facilities, including nonhospitalresidential facilities (RFs). Little information is still availableabout their costs. Our aims were to estimate the costs of Italian RFsand to evaluate which factors affect the cost of RFs and their patients.Method: A representative sample of 265 Italian RFs, hosting 2962patients, was selected for the study. RFs costs and costs of psychiatric,medical and informal care were estimated.Results: Patients in RFs cost between 7851 and 34 650 US$per year;to this amount, it should be added from 2032 to 4702 US$ per year forthe community psychiatric services (CPS). Significant differences werefound by facility type, geographical areas, number of beds and age anddiagnosis. About 45% of the variability for RF costs and 19% for CPScosts was explained by the regression models.Conclusion: The results can be useful to inform service planning andresource allocation

Burnout, compassion fatigue, and compassion satisfaction among staff in community-based mental health services

Providing care to individuals with complex mental health needs can be stressful. However, little research has focused on the emotional, cognitive, and physical consequences of providing mental health care. The aim of this study is to assess burnout (BO), compassion fatigue (CF) and compassion satisfaction (CS) among staff at the four community-based mental health services (CMHS) of Verona, Italy. All staff were asked to complete anonymously the Professional Quality of Life Scale, the General Health Questionnaire, and a socio-demographic questionnaire. In total 260 staff participated (a response rate of 84%). Psychiatrists and social workers were the professionals with the highest levels of BO and CF. Workers with psychological distress reported both higher BO and CF scores, and lower levels of CS. A significant increase in the BO and CF scores was also detected for each extra year spent working in a CMHS. A higher level of CF was associated with female and having been experienced one negative life event in the previous year. These findings are useful for health managers and team leaders to identify factors affecting the professional quality of life of mental healthcare staff, and can provide a rationale for detecting staff at risk for developing negative work-related outcomes

Diagnosing psychotic disorders: validity, reliability and applications of the Diagnostic Interview for Psychosis (DIP) Italian version

Aims \u2013 The Diagnostic Interview for Psychoses (DIP) is a comprehensive interview schedule for psychotic disorders,linked to the OPCRIT diagnostic algorithm, bridging the gap between fully structured, lay-administered schedules and semistructured,psychiatrist-administered interviews. Here we describe the validity, reliability and applications of the Italian version ofthe DIP. Methods \u2013 The interview was translated into Italian and its content validity tested by back translation. Sixty patients,drawn from among those who contacted the South-Verona Community Mental Health Service, were included in the study. Eachpatient was first assessed independently by two raters, one of whom conducted the interview, while the other assumed the role ofobserver. Subsequently (median: 89 days), 44 of these patients were re-interviewed by a third rater, who made an independentassessment. Diagnostic validity was assessed in 18 cases, interviewed with the DIP and using the SCAN as \u2018gold standard\u2019. Results\u2013 The mean duration of the interview was 37 minutes for the inter-rater interviews and 39 minutes for the retest interviews. Goodto excellent inter-rater reliability was demonstrated for both ICD-10 and DSM-IV diagnoses, while in the test-retest reliabilitypairwise agreement was high for half of the items. Diagnostic validity was good, with twelve out of the 18 DIP-OPCRIT diagnoses(67%) matching the SCAN diagnosis. Conclusions \u2013 Overall, the results support the reliability and validity of the Italian translationof the DIP. The Italian version will be useful both in routine practice to establish standard reference diagnoses of psychosisand in the research field, where it can be used by academic researchers in clinical trials and epidemiological studies