Fatores relacionados ao insucesso na cessação tabágica: um estudo de coorte prospectivo

CONTEXT AND OBJECTIVE: Considering the difficulties in stopping smoking, this article aimed to identify factors relating to failure of attempts to quit smoking among smokers who sought care at an outpatient clinic in a general university hospital. DESIGN AND SETTING: Prospective cohort study evaluating 100 smokers who sought treatment at the Psychoactive Substances Outpatient Clinic. METHODS: The variables gathered were sociodemographic factors; degree of dependence (Fagerström questionnaire); stage of motivation for change (University of Rhode Island Change Assessment Scale); and presence of depression and anxiety (Hospital Anxiety and Depression Scale). The patients were followed up after 4, 8, 12 and 24 weeks to identify factors relating to failure to quit smoking. RESULTS: The patients were mostly women (75%), between 40 and 59 years of age (67%); with incomplete elementary education (60%); with leisure activities (57%); suffering from tobacco-related disease (53%); with previous attempts to quit smoking (70%); with a medical recommendation to stop (51%); with encouragement to stop (66%); and with a high degree of dependence (78%). The main motivational stage was contemplation/action (43%); the anxiety rate was 64% and the depression rate was 39%. The quitting rate was 66% among adherents and 17% among non-adherents (P < 0.001). Lack of success was correlated with absence of leisure, higher education and absence of tobacco-related disease. CONCLUSION: The variables of lack of leisure activities, higher education and/or lack of tobacco-related disease correlated with failure to quit smoking among smokers who sought treatment at an outpatient clinic in a tertiary general hospital.CONTEXTO E OBJETIVO: Considerando as dificuldades na cessação do tabagismo, este artigo objetiva identificar fatores relacionados ao insucesso na tentativa de cessação tabágica de fumantes que procuraram atendimento em ambulatório de um hospital geral universitário. TIPO DE ESTUDO E LOCAL: Estudo de coorte prospectivo, que avaliou 100 fumantes que procuraram tratamento no Ambulatório de Substâncias Psicoativas. MÉTODOS: Avaliaram-se variáveis sociodemográficas, grau de dependência (Questionário de Fagerström), estágio de motivação para a mudança (University of Rhode Island Change Assessment), presença de depressão e ansiedade (Hospital Anxiety and Depression Scale). Os pacientes foram acompanhados em 4, 8, 12 e 24 semanas para identificar fatores relacionados ao insucesso na cessação do tabagismo. RESULTADOS: Os pacientes eram, na maioria, mulheres (75%), entre 40 e 59 anos de idade (67%), com ensino fundamental incompleto (60%), com atividades de lazer (57%), portadores de doença tabaco-relacionada (DTR) (53%), com tentativas anteriores de parar de fumar (70%), que receberam recomendação médica (51%) e incentivo para a cessação (66%) e com elevado grau de dependência (78%). O estágio de motivação principal foi contemplação/ação (43%), a taxa de ansiedade foi de 64% e de depressão, 39%. A taxa de cessação foi de 66% entre os que aderiram e de 17% entre aqueles que não aderiram (P < 0,001). O insucesso foi relacionado à ausência de lazer, maior escolaridade e ausência de DTR. CONCLUSÃO: Falta de atividades de lazer, maior nível educacional e/ou não ter DTR foram variáveis relacionadas ao insucesso na cessação tabágica para tabagistas que procuram tratamento em ambulatório inserido em hospital geral terciário.38038

Real-life challenge: training program on drug use and adolescence in primary health care

Diretrizes ressaltam a importância da abordagem do uso de substâncias por adolescentes, particularmente na atenção básica. Todavia, observam-se problemas para sua incorporação. O objetivo deste estudo foi apresentar as etapas de capacitação no tema para profissionais da atenção básica. Realizou-se estruturação logística, elaboração do conteúdo e avaliação das dificuldades antes e após a capacitação. Participaram 60% dos profissionais envolvidos no atendimento de adolescentes em município de médio porte. Mais da metade afirmou ter dificuldades na abordagem, principalmente limitações teóricas e pouco tempo para atendimento. Após o treinamento, os profissionais informaram se sentir mais preparados, mas dificuldades práticas se mantiveram.Guidelines emphasize the importance of approaching substance use by adolescents, particularly in primary health care. However, there are problems with its incorporation. The objective of this study was to present the training stages on the theme for professionals in primary health care. Researchers conducted logistic structuring, content elaboration and evaluation of difficulties before and after training. Sixty percent of professionals involved in the care of adolescents in a medium-sized city participated in the study. More than half of them stated having difficulties in the approach, mainly theoretical limitations and short consultations. After the training, the professionals informed whether they felt more prepared, but practical difficulties remained

Empathy, the physician-patient relationship, and medical training: a qualitative view

The physician-patient relationship (PPR) extends beyond the specific clinical encounter between two individuals, involving more than asking questions, performing a physical examination, and prescri bing medication and personal care. Studies suggest that the PPR is a mixture of technical and personal skills. Given the unpleasantness of homogenized clinical approaches that ignore each individual's in trinsically personal nature, empathy emerges as a diametrically opposed approach capable of fostering important progress in the PPR. In the clinical context, empathy refers to the physician's sensitivity towards the changes that are felt by and reflected in the patient, moment by moment. The meaning of empathy is probably best expressed in the famous quote by Ambroise Paré: Cure occasionally, relieve often, console always. If empathy can enhance medical practice, one should consider the possibility of teaching how to be empathetic or discussing the importance of empathy from the perspective of medical professors. The current article thus takes a qualitative approach to empathy and its impor tance in the PPR for training new physicians at a public university, while specifically discussing the possibility of teaching empathy.A Relação Médico-Paciente (RMP) vai além do encontro situacional entre esses dois intérpretes, algo maior do que fazer perguntas e exames físicos, receitar medicamentos e prescrever condutas. Estudos sugerem que a RMP mescla habilidades técnicas e pessoais. Frente ao dissabor de atuações médicas homogeneizantes que ignoram a pessoalidade intrínseca de cada vivente, a empatia surge de forma prática na RMP para promover grandes avanços diametralmente opostos a estas práticas. Empatia, no contexto médico, remete à sensibilização do médico pelas mudanças sentidas e refletidas, momento a momento, pelo paciente. Talvez a empatia encontre seu significado mais compreensível na célebre frase de Ambroise Paré: curar ocasionalmente, aliviar frequentemente e consolar sempre. Considerando que a empatia pode enriquecer a prática médica, pode-se cogitar a possibilidade de ensinar a ser empá tico ou discutir a importância da empatia sob a ótica de docentes do curso de Medicina. Para isto, este artigo aborda, de maneira qualitativa, a empatia e sua importância na RMP para a formação de novos médicos numa universidade pública e discute sua transmissibilidade.26126

Chronic Use Of Diazepam In Primary Healthcare Centers: User Profile And Usage Pattern.

Chronic use of benzodiazepines is frequent in general practice. The aim of this study was to describe the usage pattern and profile of chronic users of diazepam who had been consuming this drug for a minimum of thirty-six months continuously. This was a descriptive study (survey and clinical assessment) at five primary healthcare centers in Campinas, Brazil. Psychotropic drug control books revealed 48 eligible patients. Among these, 41 were assessed by means of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), the Hospital Anxiety and Depression scale (HAD) and a questionnaire on usage pattern. Most patients were women (85.4%). The patients' mean age was 57.6 years, and they were from the social strata C (39%), D (54%) and E (7%). The mean length of diazepam consumption was 10 years. The patients presented a lack of prescription compliance and had made frustrated attempts to stop using the drug. 55.5% said their doctor had never given any guidance on the effects of the drug. According to SCAN, 25 patients (61%) suffered from depressive disorders; only 12 cases of benzodiazepine dependence were detected by this instrument. There is a need to improve the detection and treatment of mental disorders, as well as to prevent inappropriate prescription and use of benzodiazepines. Diazepam dependence has distinctive characteristics that make it undetected by SCAN.125270-

Demographics And Complaints Of University Students Who Sought Help At A Campus Mental Health Service Between 1987 And 2004.

Client characterization is an important step in evaluating the services offered by campus counseling and mental health centers and in their further planning and development. The objectives here were to describe reported complaints and demographics among students who sought counseling/mental healthcare at a Brazilian campus mental health service over a 17-year period and to compare these characteristics with those of the general university student body. Retrospective study at the Psychological and Psychiatric Service for Students (SAPPE), Universidade Estadual de Campinas (Unicamp). The participants were all of the 2,194 students who sought counseling/mental health care at SAPPE from 1987 to 2004. Information was obtained from clients clinical charts. Unicamps database was consulted for general information on its students. The findings indicated overrepresentation, among the clients, of undergraduates, female students, students from Brazilian states other than São Paulo, students living in the campus residence hall and those whose main source of income was a scholarship grant. We also found overrepresentation of Humanities and Arts students among the clients. The most frequently reported complaints were difficulties in interpersonal relationships, family conflicts and poor academic performance. Course level (undergraduate or postgraduate), study field, living in a university residential facility and reliance on a scholarship grant were found to influence the behavior of seeking mental health counseling among Brazilian university students in this study. Course level was found to influence the pattern of complaints reported at first contact with the mental health service.12658-6

Why is environmental adaptation and acculturation relevant when seeking to conduct qualitative research in drug dependency services?

This study conducted at the Outpatient Service of Psychoactive Substances, in the University General Hospital of Campinas, sought to report on an experience of proactive participation to study the life experience of chemically dependent patients attended in a specialized university service. These observations emerged from the researcher's experiences in the environmental adaptation and acculturation period, namely through the researcher insertion in the outpatient service, during the preliminary data collection for qualitative research. This experience was important as it enabled clearer comprehension of the psycho-cultural universe of the population attended and how the relation professional-patient is conducted, broadening the knowledge of the field where the research was later carried out. From this initial entry in the field, it was possible to define the subject-matter and the population being studied more clearly, adapting to the needs and the reality observed in that service, as well as to reflect on the research method that serve to better understand the issues raised, and even draw up a roadmap for future interviews in the study. It was concluded that this preliminary stage is very useful as standard practice in new studies using the same methodology in clinical settings.Este trabalho realizado no Ambulatório de Substâncias Psicoativas do Hospital das Clínicas da Unicamp, objetivou relatar uma experiência de entrada em campo como fator de facilitação do estudo das vivências de sujeitos dependentes químicos vistos em um serviço universitário especializado. As observações surgiram a partir das vivências da pesquisadora em fase de ambientação e aculturação, ou seja, a partir da inserção no ambulatório, em fase preliminar à coleta de dados para uma pesquisa qualitativa. A experiência foi importante, pois permitiu compreender melhor o universo psicocultural da população atendida e como se dão as relações profissional-paciente, ampliando o conhecimento do campo onde depois foi realizada a pesquisa. A partir desta entrada inicial em campo, delimitou-se melhor o tema e a população a ser pesquisada, adequando às necessidades e à realidade observada naquele serviço, bem como refletir sobre o método de pesquisa (clínico-qualitativo) que melhor serviria para compreender as questões levantadas, e, inclusive, elaborar um roteiro para as futuras entrevistas do estudo. Conclui-se ser muito útil esse momento preliminar como fase habitual em novas pesquisas que usem a mesma metodologia nos settings clínicos.18271834Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Caracterizacao de pacientes atendidos em emergencia psiquiatrica de hospital geral universitario

CONTEXT AND OBJECTIVE:The prevalence of psychiatric conditions in clinical settings is high, particularly in emergency services. This is a challenge for healthcare professionals and an essential element in the functioning of the mental health network. The objective here was to describe the sociodemographic and clinical profile and the practices among patients treated psychiatrically in the Emergency Unit.DESIGN AND SETTING:Descriptive and quantitative study, conducted at Hospital das Cl&#237;nicas (HC), Universidade Estadual de Campinas (Unicamp).METHODS:Sociodemographic data, reasons for attendance, diagnostic hypotheses and practices were analyzed.RESULTS:Psychiatric staff attended 1,835 cases over the study period, corresponding to 1465 patients. The patients were predominantly women (53.7%) and white (79.6%); their mean age was 37 years and 41.3% lived with their parents. The commonest reasons for attendance were depressive symptoms (28.1%), agitation (23.6%) and problems with psychoactive substances (19.5%). The commonest diagnoses were psychoactive substance-related disorders (23%) and depressive disorders (18.5%). 31.6% of the patients were referred to healthcare centers and 29.2% to specialized outpatient clinics, while 8.2% were hospitalized.CONCLUSIONS:This study emphasizes that it is important for professionals working in emergency service to have information about the patients' profile and the main reasons that lead them to seek psychiatric care, and to establish a diagnosis that will allow proper management at the emergency service and case referral.CONTEXTO E OBJETIVO:A prevalência de quadros psiquiátricos em contextos clínicos é elevada, particularmente em serviços de emergência, representando um desafio para os profissionais da saúde e um elemento essencial no funcionamento da rede de saúde mental. Objetivou-se descrever o perfil sócio-demográfico, clínico e condutas para pacientes atendidos pela psiquiatria na Unidade de Emergência.TIPO DE ESTUDO E LOCAL:Estudo descritivo e quantitativo, conduzido no Hospital das Clínicas (HC), Universidade Estadual de Campinas (Unicamp).MÉTODOS:Foram analisados dados sócio-demográficos, motivos de atendimento, hipóteses diagnósticas e condutas.RESULTADOS:Houve 1.835 atendimentos pela Psiquiatria no período, correspondendo a 1.465 pacientes. Encontrou-se predomínio de mulheres (53,7%), idade média de 37 anos, maioria branca (79,6%); 41,3% moravam com os pais. Os motivos mais frequentes de atendimento foram sintomas depressivos (28,1%), agitação (23,6%) e problemas com substâncias psicoativas (SPA) (19,5%). Os diagnósticos mais frequentes foram transtornos relacionados a SPA (23%) e transtornos depressivos (18,5%). 31,6% dos pacientes foram encaminhados para centros de saúde, 29,2% para ambulatórios especializados e 8,2% foram internados.CONCLUSÃO:O estudo reforça a importância de que profissionais que atuem em serviços de emergência tenham informações sobre o perfil, os principais motivos que levam os pacientes a procurar atendimento psiquiátrico, além do estabelecimento de uma hipótese diagnóstica que permita uma adequada conduta no serviço e o seu encaminhamento.39840

Implantação de Unidade Psiquiátrica livre de tabaco em um hospital geral

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Associação entre comportamentos de saúde e depressão: resultados da Pesquisa Nacional de Saúde - 2019

Objective:&nbsp;To analyze the association of depression with various health behaviors and to verify if the associations differ according to gender or income.&nbsp;Methods:&nbsp;This is a cross-sectional study based on data from 65,803 Brazilian adults (18-59 years old) from the National Health Survey, conducted in 2019.&nbsp;The presence of depression was evaluated using PHQ-9.&nbsp;The prevalence of smoking, alcohol consumption, physical activity, sedentary lifestyle and feeding indicators were estimated according to the presence of depression.&nbsp;Stratified analyses were developed according to sex and income and prevalence ratios was estimated using Poisson Regression.&nbsp;Results:&nbsp;There was a significant association between depression and all indicators studied, except for eventual alcohol consumption.&nbsp;Depression was associated with heavy episodic drinking and insufficient consumption of fruits and vegetables only in women. In men, the associations of depression with sedentary lifestyle and with being a former smoker were stronger than in women. Only in men, the occasionally consumption of alcohol was more prevalent in those without depression. The analysis stratified by income revealed that the association of depression with physical inactivity is stronger in the upper income group and the association with heavy episodic drinking is only significant in the lower income stratum. Conclusion:&nbsp;The results indicate the need to consider mental health in programs aimed at reducing harmful health behaviors and the specificity of sociodemographic groups.Objetivo: Analisar a associação da depressão com comportamentos de saúde e verificar se as associações diferem segundo sexo e renda. Métodos: Estudo transversal com dados de 65.803 adultos brasileiros (18-59 anos) da Pesquisa Nacional de Saúde, realizada em 2019. A presença de depressão foi avaliada com uso do PHQ-9. As prevalências de tabagismo, consumo de álcool, atividade física, sedentarismo e indicadores de alimentação foram estimadas segundo a presença de depressão. Foram desenvolvidas análises estratificadas por sexo e renda e estimadas razões de prevalência com uso de Regressão de Poisson. Resultados: Verificou-se associação significativa da depressão com todos os indicadores estudados, exceto com o consumo eventual de álcool. Apenas nas mulheres a depressão se mostrou associada com heavy episodic drinking e com consumo insuficiente de frutas, legumes e verduras. Nos homens, as associações da depressão com sedentarismo e com ser ex-fumante foram mais fortes do que nas mulheres. E apenas nos homens o consumo eventual de álcool foi mais prevalente naqueles sem depressão. A análise estratificada segundo renda mostrou que a associação da depressão com inatividade física foi mais forte no segmento de renda superior e a associação com heavy episodic drinking só foi significativa no estrato de renda inferior. Conclusão: Os resultados apontam a necessidade de considerar a saúde mental nos programas que visam a redução de comportamentos nocivos à saúde e as especificidades dessas associações nos diferentes estratos sociodemográficos