Saúde mental na atenção básica: uma avaliação por meio da Teoria da Resposta ao Item

OBJECTIVE: To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS: This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach’s alpha, Spearman’s correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS: The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach’s alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS: There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.OBJETIVO: Determinar os itens do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica que melhor avaliam a capacidade de oferta de cuidados em saúde mental. MÉTODOS: Estudo transversal efetuado por meio do Modelo de Resposta Gradual da Teoria da Resposta ao Item, utilizando dados secundários do segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, tendo sido avaliadas 30.523 equipes de atenção básica no período de 2013 a 2014. A consistência interna, a correlação entre os itens e dos itens com o escore total foram testadas usando os coeficientes alfa de Cronbach, correlação de Spearman e ponto bisserial, respectivamente. Foram testados os pressupostos de unidimensionalidade e independência local dos itens. Utilizaram-se como uma das formas de apresentação dos resultados as nuvens de palavras. RESULTADOS: Programar a agenda de acordo com a estratificação de risco, manter registro dos casos mais graves de usuários em sofrimento psíquico e ofertar algum atendimento em grupo foram os itens com maior capacidade de discriminação. Ofertar alguma modalidade de atendimento em grupo e ofertar ações educativas e de promoção de saúde mental foram os itens que requereram maior nível de oferta de cuidados em saúde mental no parâmetro de locação. O coeficiente alfa de Cronbach total foi 0,87. Realizar o registro dos casos mais graves de usuários em sofrimento psíquico e programar a agenda de acordo com a estratificação de risco foram os itens que obtiveram maior correlação com o escore total. Os escores finais obtidos oscilaram entre -2,07 (mínimo) e 1,95 (máximo). CONCLUSÕES: São aspectos relevantes na discriminação da capacidade de ofertar cuidados em saúde mental pelas equipes de atenção básica: a estratificação do risco para gestão do cuidado, o acompanhamento dos casos mais graves, o atendimento em grupo e as ações preventivas e de promoção da saúde

O efeito Sunk Cost no Processo Decisório dos discentes de Instituições de Ensino Superior

O objetivo deste estudo foi verificar a influência do efeito sunk cost nas decisões, gerenciais e pessoais, tomadas pelos discentes do Curso de Ciências Contábeis das Instituições de Ensino Superior. A pesquisa caracterizou-se como descritiva e de levantamento com abordagem quantitativa. Foram aplicados questionários a discentes de cinco Instituições de Ensino Superior que possuíam o curso Ciências Contábeis, na modalidade presencial. A coleta de dados, realizada nos meses de outubro e novembro de 2019, foi realizada fazendo uso de um questionário, adaptado do modelo de Domingos (2007), Rover et al. (2009) e Segantini et al. (2011) e, quanto aos dados levantados, utilizou-se a análise descritiva das respostas dos participantes e também se empregou o teste estatístico do qui-quadrado (χ2) para testar a significância entre as respostas obtidas. Os resultados encontrados evidenciaram que o valor do custo irrecuperável pode influenciar na ocorrência do efeito sunk costs. Isto pode ser constatado, pois à medida que diminuía o montante do custo perdido, menor era a disposição dos discentes em prosseguir investindo nos cursos de ação que deveriam ser abandonados. Quando a decisão é voltada para o contexto pessoal, os discentes levaram em consideração a premissa de aversão ao desperdício e senso de responsabilidade

Psychiatric hospitalizations by the Unified Health System in Brazil between 2000 and 2014

OBJECTIVE To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period. METHODS Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested. RESULTS We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients. CONCLUSION Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy’s implementation, becoming less pronounced in recent years.OBJETIVO Caracterizar o perfil dos pacientes que foram internados por transtornos mentais e comportamentais pelo Sistema Único de Saúde (SUS) no Brasil entre 2000 e 2014, bem como verificar como aspectos da nova política de saúde mental influenciaram a taxa de pacientes internados no referido período. MÉTODOS Estudo de coorte prospectiva não concorrente utilizando dados secundários de pacientes internados com diagnóstico primário de transtornos mentais e comportamentais entre 01/01/2000 e 31/12/2014. Foram selecionadas variáveis sociodemográficas, clínicas e de características do hospital, além disso, foram calculadas as taxas gerais de pacientes internados segundo motivo de internação, tipo de hospital, natureza jurídica e número de internações de cada paciente por ano. Foi testada a associação entre taxas de pacientes internados, número de leitos psiquiátricos por ano e número de Centros de Atenção Psicossocial por ano. RESULTADOS Foram selecionados 1.549.298 pacientes dos quais os diagnósticos mais frequentes na primeira internação foram os transtornos devidos ao uso de substâncias psicoativas, seguidos por esquizofrenia e transtornos de humor. A mediana de internações por paciente foi de 1,9 e a de tempo de internação por paciente foi de 29 dias. A taxa geral de pacientes internados foi reduzida à quase metade no período. O número de leitos por ano apresentou associação positiva com as taxas de pacientes internados, e o número de CAPS por ano teve associação negativa com algumas taxas de pacientes internados. CONCLUSÃO Verificou-se que, mesmo diante de um contexto de adversidades, a Política Nacional de Saúde Mental avançou em suas metas de reduzir progressivamente os leitos hospitalares e aumentar a oferta de serviços substitutivos de tal modo que ambas as estratégias foram associadas à redução das taxas de pacientes internados. Contudo, as mudanças foram percebidas com maior intensidade nos primeiros anos de implantação da política, tornando-se menos pujante nos últimos anos

DECOMPOSITION OF LEAF LITTER IN THE BRAZILIAN CERRADO, CERRADÃO AND FOREST ENVIRONMENTS IN THE AMAZON, BRAZIL

The soils of the Amazon region, despite being under one of the densest forests in the world, are mostly characterized by low nutrient availability, with litter being the main nutrient input route. The present work aimed to evaluate the litter decomposition in forest, Cerrado and Cerradão environments in the Amazon. The litter decomposition rate was estimated by mass loss analysis using litter bags. The collections were performed at intervals of 30, 60, 90, 120, 150, 180, 210, 240, 270 and 300 days, with four replications. Once collected, the material contained in each litter bag was placed to dry to obtain the dry mass. And so, the remaining mass percentage, the decomposition rates (k) and the half-life time (t1/2) are estimated. During the studied period, the Cerrado environment presented the lowest constant k (0.0017 g g-1 day-1) and consequently longer half-life (407 days). The monthly deposition in Cerrado input ranged from Mgha-1mother1 (June to September). Among the evaluated environments, the forest presented the highest decomposition speed and Cerrado presented the lowest one. It was evidenced that the decomposition process for all studied environments occurred with greater intensity in the rainy season

Care coordination in PMAQ-AB: an Item Response Theory-based analysis

OBJETIVO Analisar a qualidade das variáveis do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica para avaliar a coordenação na atenção básica do cuidado. MÉTODOS Estudo transversal baseado em dados de 17.202 equipes de atenção básica que participaram do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica em 2012. Baseado na Teoria de Resposta ao Item, o Modelo de Resposta Gradual de Samejima foi utilizado para estimação do escore relacionado ao nível de coordenação. Os coeficientes alfa de Cronbach, Spearman e ponto bisserial foram utilizados para análise da consistência interna e da correlação entre os itens e de itens com o escore total. Foram avaliadas as suposições de unidimensionalidade e de independência local dos itens. Gráficos do tipo nuvem de palavras auxiliaram na interpretação dos níveis de coordenação. RESULTADOS Os itens do Programa com maior discriminação do nível de coordenação foram: existência de telefone/internet, fluxos institucionais de comunicação e ações de apoio matricial. A frequência de contato de especialistas com a atenção básica e prontuário eletrônico integrado exigiram maior nível de coordenação das equipes. O coeficiente alfa de Cronbach total 0,8018. Os itens fluxos institucional de comunicação e telefone/internet tiveram maior correlação com o escore total. Os escores de coordenação variaram entre -2,67 (mínimo) e 2,83 (máximo). Maior grau de comunicação, troca de informações, apoio matricial, cuidado no território e domicílio tiveram peso relevante nos níveis de coordenação. CONCLUSÕES A capacidade de disponibilizar a informação e a frequência de contato entre os profissionais são elementos importantes para o cuidado abrangente, contínuo e de qualidade.OBJECTIVE Analyze the quality of the National Program for Primary Care Access and Quality Improvement variables to evaluate the coordination of primary care. METHODS A cross-sectional study based on data from 17,202 primary care teams that participated in the National Program for Primary Care Access and Quality Improvement in 2012. Based on the Item Response Theory, Samejima’s Gradual Response Model was used to estimate the score related to the level of coordination. The Cronbach’s alpha and Spearman’ coefficients and the point-biserial correlation were used to analyze the internal consistency and the correlation between the items and between the items and the total score. We evaluated the assumptions of unidimensionality and local independence of the items. Cloud-type word charts aided in the interpretation of coordination levels. RESULTS The Program items with the greatest discrimination in coordination level were: telephone/Internet existence, institutional communication flows, and matrix support actions. The specialists’ contact frequency with the primary care and integrated electronic medical record required a greater level of coordination among the teams. The Cronbach’ alpha was 0.8018. The institutional communication flows and telephone/Internet items had a higher correlation with the total score. Coordination scores ranged from -2.67 (minimum) to 2.83 (maximum). More communication, information exchange, matrix support, health care in the territory and the domicile had a significant influence on the levels of coordination. CONCLUSIONS The ability to provide information and the frequency of contact among professionals are important elements for a comprehensive, continuous and high-quality care

Purification of a lectin from Cratylia mollis crude extract seed by a single step PEG/phosphate aqueous two-phase system

The partitioning and purification of lectins from the crude extract of Cratylia mollis seeds (Cramoll 1,4) was investigated in aqueous two-phase systems (ATPS). A factorial design model (24) was used to evaluate the influence of polyethylene glycol (PEG) molar mass (15008000g/mol), PEG concentration (12.517.5% w/w), phosphate (1015% w/w) concentration, and pH (68) on the differential partitioning, purification factor, and yield of the lectin. Polymer and salt concentration were the most important variables affecting partition of lectin and used to find optimum purification factor by experimental BoxBehnken design together with the response surface methodology (RSM). ATPS showed best conditions composed by 13.9% PEG1500, 15.3% phosphate buffer at pH 6, which ensured purification factor of 4.70. Sodium dodecyl sulfatepolyacrylamide gel electrophoresis showed a single band of protein with 26.1kDa. Furthermore, results demonstrated a thermostable lectin presenting activity until 60°C and lost hemagglutinating activity at 80°C. According to the obtained data it can be inferred that the ATPS optimization using RSM approach can be applied for recovery and purification of lectins.We are grateful to the following bodies for the grants awarded: CAPES (Coordination for the Improvement of Level Personnel Superior); FACEPE (Pernambuco Science and Technology Foundation): Researcher's scholarship grant: BFP-0017-5.05/18 CNPq (National Council for Scientific Development and Technological) process: 427153/2016-6 and we also thank the reviewers for their valuable comments and suggestions as these helped us to improve the manuscript.info:eu-repo/semantics/publishedVersio

Comparison of Anthropometric Profile and Cognitive Performance of Elite and Non-Elite Beach Volleyball Athletes

To compare the anthropometric profile and cognitive performance of elite and non-elite beach volleyball athletes. Comparative and descriptive study. The sample was composed by 8 athletes, divided in 2 groups: elite (n = 4) and non-elite (n = 4). They were evaluated in anthropometric parameters age, weight and height, and the variables of the cognitive performance evaluated by the battery of computerized tests CogState® (Brief Battery): Detection (Simple Reaction Time); Identification (Choice Reaction Time); One Back Speed (Working Memory); One Back Acuracy (Short Term Memory). Data were classified as non-parametric with the dispersion curve analysis performed by the Shapiro Wilk test. Anthropometric profile and cognitive performance variables were compared with the Mann Whitney U test between the groups. The procedures were performed with a significance level of p < 0.05 using the Statistical Package for the Social Science - SPSS®, Version 25.0. It was observed that there was significant difference in the anthropometric profile in the variable age (sig = 0.029) and in the cognitive performance significant differences occurred in the variables Detec (sig = 0.029) and Indent (sig = 0.029) of elite and not elite athletes of the beach volleyball modality. Elite and non-elite beach volleyball athletes present significant differences in the anthropometric variable (Age) and in the variables of cognitive performance (Detection and Identification) where elite athletes have a better cognitive performance than the non- elite athletes

Pesca do apaiari, Astronotus ocellatus (Agassiz, 1831), e perfil socioeconômico dos pescadores artesanais de uma região da Amazônia brasileira

The artisanal fishery is an important economic and subsistence activity among traditional populations in the Amazon Region. Therefore, the aim of this study was to characterize the fishery of apaiari, Astronotus ocellatus (Agassiz, 1831), and to present a socioeconomic profile of artisanal fishermen in the region lakes of Pracuúba, Amapá, Brazil. From May to August 2011 interviews were conducted using standardized forms with fishermen selected by "snowball" method and aged above 18 years old. A total of 68 fishing workers were interviewed, of which 55 were men and 13 women. It was possible to observe that fishing workers have a wide knowledge of fishery in the Region, including apaiari fishery, and that social and economic lives of the Pracuúba population depend totally of the artisanal fishery

BRSMG Realce: Common bean cultivar with striped grains for the state of Minas Gerais

The common bean cultivar “BRSMG Realce”, recommended for the state of Minas Gerais, has high yield potential and resistance to powdery mildew, bacterial wilt and to anthracnose pathotypes 65, 73, 77, 81, 91, 475 and 479. The plants and pods are high, resulting in lower loss during mechanical harves