The impact of mental health workshops for community physicians in increasing access to Mental Health Care in a Brazilian primary care setting

ABSTRACT: Background: Many individuals with mental health disorders remain untreated although effective treatment exists. This is known as the mental health gap. The gap is particularly wide in low and middle income countries, such as Brazil. One of the strategies suggested by the World Health Organization to reduce the gap, is to integrate mental health into primary care. A group of family physicians and psychiatrist created a collaborative care model, in Brasilia, Federal District, Brazil. A series of workshops were delivered to primary care doctors, covering depression, anxiety, psychosis and substance misuse. Objective: To measure mental health referrals from primary to secondary care the year before the beginning of these workshops, and the year after, including the months in which the workshops took place. Method: An observational longitudinal study was conducted, with monthly measures of referrals from primary care to secondary care psychiatry, between October 2017 and October 2019. Twenty physicians who enrolled in the workshops were included in the analysis. The control group consists of 20 physicians working in the same health district who did not attend the workshops. All tests were performed with 95% confidence. The tests applied to samples were: Shapiro-Wilk Normality Test, Wilcoxon Test for two samples and Kruskall Wallis test for comparison of several samples. Results: For those who attended the workshops at least twice, there was a statistically significant decline in referrals, with a P value of 0.04. There is a general trend toward increase in referrals for those who did not attend the workshops, although with no statistical significance, probably due to sample size. Conclusion: The workshops seem to be an interesting strategy to increase access to mental health in primary care, and reduce referrals to secondary care

Missed opportunities for serological evaluation of human immunodeficiency virus infection during routine outpatient care at the University Hospital of Brasilia, Federal District

Foram estudados os fatores envolvidos na oferta de sorologia para detectar a infecção pelo vírus de imunodeficiência humana, no atendimento de adultos no ambulatório do Hospital Universitário de Brasília, por meio de aplicação de questionários específicos a 53 médicos e 347 usuários. Os resultados revelaram que 96,8% dos usuários identificaram como fator de risco para adquirir a infecção as relações sexuais desprotegidas e 13,6% desconheciam a possibilidade de transmissão vertical. Em relação à exposição dos usuários aos fatores de risco, 88,2% praticaram relações sexuais desprotegidas, 22,2% tiveram diagnóstico de outras doenças de transmissão sexual e 22,2% tinham recebido transfusões sangüíneas. Os fatores de risco mais questionados pelos médicos foram a prática de relações sexuais desprotegidas e o diagnóstico prévio de hepatite B ou C (35,9% para ambos). Dezoito por cento dos usuários receberam oferta de testes no Hospital Universitário de Brasília; 15,8% foram testados e 7,4% dos indivíduos testados não tiveram acesso ao resultado. Noventa e um por cento dos médicos referiram sentir-se confortáveis ao oferecer testes e apenas 30,4% oferecem-nos rotineiramente. O estudo confirma a perda de oportunidades de testagem sorológica para detectar a infecção no Hospital Universitário de Brasília e reforça a necessidade de implementar medidas para corrigir o problema.The factors involved in the provision of serological testing to detect human immunodeficiency virus infection, for adults within the outpatient care setting at the University Hospital of Brasilia, were studied. Specific questionnaires were applied to 53 physicians and 347 users. The results showed that 96.8% of the users identified unprotected sexual intercourse as a risk factor for acquiring this infection and that 13.6% were unaware of possibility of vertical transmission. Regarding users' exposure to risk factors, 88.2% practiced unprotected sexual intercourse, 22.2% had a diagnosis of other sexually transmitted diseases and 22.2% had received blood transfusions. The risk factors that physicians asked about most frequently were unprotected sexual practices and previous diagnoses of hepatitis B or C (35.9% for each). Eighteen percent of the users had been offered tests at the University Hospital of Brasilia; 15.8% underwent tests and 7.4% of the individuals tested had not had access to the results. Ninety-one percent of the physicians said that they felt comfortable about offering tests, while only 30.4% offered them routinely. The study confirms that opportunities for serological testing to detect this infection at the University Hospital of Brasilia have been missed and reinforces the need to implement measures to correct this problem

An antibody-based survey of Toxoplasma gondii and Neospora caninum Infection in client-owned cats from Portugal

Toxoplasma gondii and Neospora caninum are intracellular parasites with a great impact on human and animal health, respectively. This work aims to investigate the presence of antibodies against T. gondii and N. caninum in client-owned cats from Portugal and to identify risk factors. A total of 183 domestic cats were sampled and their owners answered an online questionnaire designed to obtain background information. The overall anti-T. gondii and anti-N. caninum seroprevalences were 13.1% and 3.8%, respectively. An indoor lifestyle was identified as a significant protection factor against T. gondii infection, while the presence of a chronic disease and the presence of antibodies against N. caninum were identified as significant risk factors to T. gondii seroprevalence. To the best of our knowledge, this is the first serosurvey on N. caninum seroprevalence in cats from Portugal.A91F-E8B8-FA62 | Teresa Susana Letra MateusN/

Abordagens terapêuticas em pacientes com vaginismo: uma revisão de literatura / Therapeutic approaches in patients with vaginismus: a literature review

INTRODUÇÃO: O vaginismo é uma disfunção do aparelho genital feminino na qual ocorre uma contração involuntária da musculatura pélvica, tendo uma etiologia multifatorial. Existem inúmeros fatores predisponentes ao sucesso do tratamento, no entanto há poucas publicações sobre o assunto. Portanto, o objetivo deste trabalho é avaliar a eficácia das diferentes intervenções terapêuticas no tratamento desse transtorno. METODOLOGIA: Trata-se de uma revisão integrativa realizada por meio da base de dados PubMed na qual foram selecionados 31 artigos entre os anos de 2011 a 2021.RESULTADOS: Durante a revisão foram identificados diferentes métodos terapêuticos que auxiliam no tratamento do vaginismo, como a abordagem multidisciplinar associada à educação sexual, hipnoterapia, tratamento farmacológico (incluindo antidepressivos, ansiolíticos, anestésicos locais ou toxina botulínica), tratamento psicológico e combinações entre diferentes intervenções. DISCUSSÃO: Repercussões como depressão, dificuldade para engravidar, fobia a dor e resistência a atividades sexuais são comuns em pacientes com vaginismo e evidenciam a importância de um tratamento adequado. Os artigos abordam a importância de uma terapia personalizada para maior chance de eficácia no tratamento. CONCLUSÃO: Com intuito de diminuir os impactos psicológicos e interpessoais das pacientes com vaginismo e proporcionar maior qualidade de vida sexual é essencial uma abordagem terapêutica multimodal e multidisciplinar. 

Effect of Cr(V) on reproductive organ morphology and sperm parameters: An experimental study in mice

BACKGROUND: Cr(V) species are formed during the intracellular reduction of Cr(VI), a ubiquitous environmental pollutant. In this study, the acute toxicity of a physiologically stable Cr(V) compound, [Cr(V)-BT](2- )(BT = bis(hydroxyethyl)aminotris(hydroxymethyl)methane) was investigated in the male reproductive system of sexually mature 60-day-old male ICR-CD1 mice. METHODS: Eight-week-old animals were subcutaneously injected daily with a dose of ca 8 μmol of Cr/mouse, during 5 days. The control group was injected with 0.5 mL of BT buffer. Testis and epididymis morphology was evaluated using light and transmission electron microscopy. Epididymal sperm counts, motility and acrosome integrity were also assayed using standard methods. RESULTS: Seminiferous epithelium abnormalities were detected in the Cr(V)-BT experimental group, including intraepithelial vacuolation, and remarkable degeneration of Sertoli cells, spermatocytes and spermatids. The premature release of germ cells into the tubular lumen was also evident. Histological evaluation of epididymal compartments revealed apparently normal features. However, the epididymal epithelium presented vacuolation. [Cr(V)-BT](2- )induced a reduction in sperm acrosome integrity. However, sperm motility and density were not significantly affected. CONCLUSION: This in vivo study using a Cr(V) compound, provides evidence for the potential reproductive hazards caused on male reproductive system by species containing chromium in intermediate oxidation states

COMPLICAÇÕES E MANEJO DO ACRETISMO PLACENTÁRIO: UMA REVISÃO INTEGRATIVA

Introduction: Placental accreta is a severe and complex obstetric condition that is becoming more common due to the increase in cesarean sections and other uterine interventions. This condition occurs when the placenta adheres abnormally to the uterine muscle, varying in severity as placenta accreta, increta, and percreta. It can cause serious complications, such as heavy bleeding and the need for a hysterectomy. Early diagnosis, made by ultrasound and magnetic resonance imaging, is crucial for proper management. The increased incidence is linked to risk factors such as previous cesarean sections, multiparity, advanced maternal age, and a history of uterine curettage. Methodology: Ten relevant scientific articles were selected, published in Portuguese, English and Spanish, found in databases such as PubMed, SciELO and Google Scholar, using terms such as "placental accreta", "diagnosis", "clinical management" and "complications". Original studies, systematic reviews, and case reports on the diagnosis, management, and complications of placental accreta were included, excluding studies with non-human populations, non-full-text articles, and publications prior to 2010. Results: The integrative review resulted in the selection of ten relevant scientific articles that address the management and complications of placental accreta. The main topics include diagnosis, clinical management and treatment, with emphasis on medical management and the multidisciplinary team. The most frequent complications identified were postpartum hemorrhage, need for hysterectomy, and damage to other organs. The introduction of multidisciplinary teams and new surgical techniques has been shown to be effective in reducing maternal morbidity. Conclusions: The creation of specialized teams has been shown to be effective in reducing maternal morbidity in severe cases. Major complications, such as postpartum hemorrhage and the need for hysterectomy, can be better managed with proper planning and timely interventions. Diagnostic tools, such as ultrasound and magnetic resonance imaging, are essential for early detection. The implementation of protocols and new surgical techniques has also shown promise. However, there is a need for further studies with larger samples to consolidate the evidence and improve management strategies for this complex condition.Introduction: Placental accreta is a severe and complex obstetric condition that is becoming more common due to the increase in cesarean sections and other uterine interventions. This condition occurs when the placenta adheres abnormally to the uterine muscle, varying in severity as placenta accreta, increta, and percreta. It can cause serious complications, such as heavy bleeding and the need for a hysterectomy. Early diagnosis, made by ultrasound and magnetic resonance imaging, is crucial for proper management. The increased incidence is linked to risk factors such as previous cesarean sections, multiparity, advanced maternal age, and a history of uterine curettage. Methodology: Ten relevant scientific articles were selected, published in Portuguese, English and Spanish, found in databases such as PubMed, SciELO and Google Scholar, using terms such as "placental accreta", "diagnosis", "clinical management" and "complications". Original studies, systematic reviews, and case reports on the diagnosis, management, and complications of placental accreta were included, excluding studies with non-human populations, non-full-text articles, and publications prior to 2010. Results: The integrative review resulted in the selection of ten relevant scientific articles that address the management and complications of placental accreta. The main topics include diagnosis, clinical management and treatment, with emphasis on medical management and the multidisciplinary team. The most frequent complications identified were postpartum hemorrhage, need for hysterectomy, and damage to other organs. The introduction of multidisciplinary teams and new surgical techniques has been shown to be effective in reducing maternal morbidity. Conclusions: The creation of specialized teams has been shown to be effective in reducing maternal morbidity in severe cases. Major complications, such as postpartum hemorrhage and the need for hysterectomy, can be better managed with proper planning and timely interventions. Diagnostic tools, such as ultrasound and magnetic resonance imaging, are essential for early detection. The implementation of protocols and new surgical techniques has also shown promise. However, there is a need for further studies with larger samples to consolidate the evidence and improve management strategies for this complex condition.Introdução: O acretismo placentário é uma condição obstétrica grave e complexa que está se tornando mais comum devido ao aumento das cesarianas e outras intervenções uterinas. Esta condição ocorre quando a placenta adere anormalmente ao músculo uterino, variando em gravidade como placenta acreta, increta e percreta. Ela pode causar complicações sérias, como hemorragias intensas e a necessidade de histerectomia. O diagnóstico precoce, feito por ultrassonografia e ressonância magnética, é crucial para um manejo adequado. O aumento da incidência está ligado a fatores de risco como cesarianas anteriores, multiparidade, idade materna avançada e histórico de curetagem uterina. Metodologia: Foram selecionados dez artigos científicos relevantes, publicados em português, inglês e espanhol, encontrados em bases de dados como PubMed, SciELO e Google Scholar, usando termos como "acretismo placentário", "diagnóstico", "manejo clínico" e "complicações". Incluíram-se estudos originais, revisões sistemáticas e relatos de casos sobre o diagnóstico, manejo e complicações do acretismo placentário, excluindo estudos com populações não humanas, artigos sem texto completo e publicações anteriores a 2010. Resultados: A revisão integrativa resultou na seleção de dez artigos científicos relevantes que abordam o manejo e as complicações do acretismo placentário. Os principais temas incluem diagnóstico, manejo clínico e tratamento, com ênfase na conduta médica e da equipe multiprofissional. As complicações mais frequentes identificadas foram hemorragia pós-parto, necessidade de histerectomia e lesões a outros órgãos. A introdução de equipes multidisciplinares e novas técnicas cirúrgicas mostrou-se eficaz na redução da morbidade materna. Conclusões: A criação de equipes especializadas mostrou-se eficaz na redução da morbidade materna em casos graves. As principais complicações, como hemorragia pós-parto e necessidade de histerectomia, podem ser melhor gerenciadas com planejamento adequado e intervenções oportunas. Ferramentas diagnósticas, como ultrassonografia e ressonância magnética, são essenciais para a detecção precoce. A implementação de protocolos e novas técnicas cirúrgicas também se mostrou promissora. No entanto, há necessidade de mais estudos com amostras maiores para consolidar as evidências e aprimorar as estratégias de manejo dessa condição complexa

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Síndrome do coração Pós-feriado: pacientes acometidos por arritmia cardíaca em detrimento do consumo exagerado de álcool: Post Holiday coração Syndrome: patients suffered by cardiac arrhythmia to the detriment of exaggerated alcohol consumption

INTRODUÇÃO: O álcool é conhecido por beneficiar o sistema cardiovascular com a ativação do sistema fibrinolítico, redução da agregação de plaquetas e aperfeiçoamento do perfil lipídico, entre outros mecanismos, quando consumido em doses moderadas. Todavia, seu uso de maneira abusiva culmina em patologias graves que podem evoluir para a morte, como a hipertensão arterial, a cardiomiopatia alcoólica, a arritmia cardíaca e até a “Síndrome do Coração Pós Feriado” ou do inglês, “Holiday Heart Syndrome”. OBJETIVOS: O presente estudo tem como objetivo delinear sobre a Síndrome do Coração Pós Feriado, transpassando por suas características clínicas, repercussões eletrofisiológicas, diagnóstico e manejo terapêutico. MATERIAIS E MÉTODOS: Dessa forma, o presente trabalho realizou uma revisão sistemática qualitativa, realizado no período entre julho e agosto de 2022, através de artigos das bases de dados Biblioteca Virtual em Saúde (BVS) e United States National Library of Medicine (PubMed). RESULTADOS E DISCUSSÃO: A interação do álcool no organismo está diretamente relacionada com o sistema nervoso autônomo do indivíduo, gerando um estado de desequilíbrio autonômico, assim há alterações elétricas, como acréscimo da frequência cardíaca, gerando um estado de taquicardia. A principal patologia encontrada em questão foi a taquicardia sinusal, sendo um tipo de arritmia e por conseguinte, notou-se a presença da fibrilação atrial, sendo o excesso no consumo de etanol é causador de aproximadamente 67% dos casos de emergências desta última enfermidade. CONCLUSÃO: Portanto, com base na literatura analisada, observou-se que a ingestão alcoólica aguda age retardando o sistema de condução cardíaco, atua no encurtamento do período refratário e o aumento da atividade simpática, além de aumentar os níveis de catecolaminas circulantes. Por fim, também se evidenciou uma associação entre álcool e fatores de risco, principalmente hipertensão e obesidade e essas patologias aumentam os episódios de fibrilação atrial