Bridging the mental health treatment gap: Effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city

OBJECTIVE: To analyse temporal trends in diagnosis and treatment of mental disorders in primary care following implementation of a collaborative care intervention (matrix support). DESIGN: Dynamic cohort design with retrospective time-series analysis. Structured secondary data on medical visits to general practitioners of all study clinics were extracted from the municipal electronic records database. Annual changes in the odds of mental disorders diagnoses and antidepressants prescriptions were estimated by multiple logistic regression at visit and patient-year levels with diagnoses or prescriptions as outcomes. Annual changes during two distinct stages of the intervention (stage 1 when it was restricted to mental health (2005-2009), and stage 2 when it was expanded to other areas (2010-2015)) were compared by adding year-period interaction terms to each model. SETTING: 49 primary care clinics in the city of Florianópolis, Brazil. PARTICIPANTS: All adults attending primary care clinics of the study setting between 2005 and 2015. RESULTS: 3 131 983 visits representing 322 100 patients were analysed. At visit level, the odds of mental disorder diagnosis increased by 13% per year during stage 1 (OR 1.13, 95% CI 1.11 to 1.14, p<0.001) and decreased by 5% thereafter (OR 0.95, 95% CI 0.94 to 0.95, p<0.001). The odds of incident mental disorder diagnoses decreased by 1% per year during stage 1 (OR 0.99, 95% CI 0.98 to 1.00, p=0.012) and decreased by 7% per year during stage 2 (OR 0.93, 95% CI 0.92 to 0.93, p<0.001). The odds of antidepressant prescriptions in patients with a mental disorder diagnosis increased by 7% per year during stage 1 (OR 1.07, 95% CI 1.05 to 1.20, p<0.001); this was driven by selective serotonin reuptake inhibitor prescriptions which increased 14% per year during stage 1 (OR 1.14, 95% CI 1.12 to 1.18, p<0.001) and 9% during stage 2 (OR 1.09, 95% CI 1.08 to 1.10, p<0.001). The odds of incident antidepressant prescriptions did not increase during stage 1 (OR 1.00, 95% CI 0.97 to 1.02, p=0.665) and increased by 3% during stage 2 (OR 1.03, 95% CI 1.00 to 1.04, p<0.001). Changes per year were all significantly greater during stage 1 than stage 2 (p values for interaction terms <0.05), except for antidepressant prescriptions during visits (p=0.172). CONCLUSION: The matrix support intervention may increase diagnosis and treatment of mental disorders when inter-professional collaboration is adequately supported. Competing demands to the primary care teams can subsequently reduce these effects. Future studies should assess clinical outcomes and identify active components and factors associated with successful implementation

Maternal and Fetal Complications Due to Decreased Nitric Oxide Synthesis during Gestation

Nitric oxide (NO) is synthesized from L-arginine by the constitutive NO synthase in vascular endothelial cells and plays an important role in the regulation of blood pressure and coronary vasomotion. Normal pregnancy is associated with major adaptations in maternal cardiovascular function, which help the woman to accommodate the growing fetus. The vascular endothelium is stimulated during pregnancy to release increased amounts of NO, and the abnormality in the L-arginine NO pathway may play a role in the etiology of preeclampsia. The objective of this study is to discuss the importance of nitric oxide during gestation and the maternal and fetal complications associated with decreased NO synthesis during this period. Maternal arterial hypertension due to inhibition of nitric oxide synthesis during pregnancy impairs fetal development, mainly the reduction of the wall/lumen ratio of the cardiac and renal microvasculature as well as the reduction in the number of nephrons. These changes may contribute to the development of hypertension. Despite these findings, more studies are needed to understand the programming of fetal development, and the intrauterine environmental factors. influence this process

The importance of the slaughterhouse in surveilling animal and public health : a systematic review

From the point of public health, the objective of the slaughterhouse is to guarantee the safety of meat in which meat inspection represent an essential tool to control animal diseases and guarantee the public health. The slaughterhouse can be used as surveillance center for livestock diseases. However, other aspects related with animal and human health, such as epidemiology and disease control in primary production, control of animal welfare on the farm, surveillance of zoonotic agents responsible for food poisoning, as well as surveillance and control of antimicrobial resistance, can be monitored. These controls should not be seen as a last defensive barrier but rather as a complement to the controls carried out on the farm. Regarding the control of diseases in livestock, scientific research is scarce and outdated, not taking advantage of the potential for disease control. Animal welfare in primary production and during transport can be monitored throughout ante-mortem and post-mortem inspection at the slaughterhouse, providing valuable individual data on animal welfare. Surveillance and research regarding antimicrobial resistance (AMR) at slaughterhouses is scarce, mainly in cattle, sheep, and goats. However, most of the zoonotic pathogens are sensitive to the antibiotics studied. Moreover, the prevalence at the slaughterhouse of zoonotic and foodborne agents seems to be low, but a lack of harmonization in terms of control and communication may lead to underestimate its real prevalence.Portuguese Foundation for Science and Technology (FCT).https://www.mdpi.com/journal/vetsciParaclinical Science

Iohexol Clearance for Determination of Glomerular Filtration Rate in Rats Induced to Acute Renal Failure

IntroductionThe glomerular filtration rate (GFR) is considered an especially important tool for the measurement of renal function. Inulin clearance (InCl) is the classic reference method for this purpose, although it is associated with a number of disadvantages; thus, other markers have been proposed, including iohexol. Determination of iohexol clearance (IoCl) has been established for clinical use; however, its application as a GFR marker in experimental rat models has not been reported.ObjectivesThis study aims to standardize a methodology for the measurement of iohexol clearance and to evaluate its applicability as a marker of GFR in rats with induced toxic acute renal failure (ARF), using InCl as the gold standard.Materials and MethodsTwenty-six Wistar male rats (200-300 g) were divided into the following two groups: a control group (n=7) and an ARF group (n=19). ARF was induced by the subcutaneous administration of cisplatin (5 mg/kg); IoCl and InCl were determined simultaneously, and plasma creatinine (pCreat) dosage was measured colorimetrically.ResultsThe pCreat, InCl and IoCl levels were consistent with the expected values for the renal function ranges of the evaluated animals, and the IoCl and InCl levels were significantly correlated (r=0.792). An inverse moderate linear correlation between the IoCl and pCreat measurements (r=-0.587) and between the InCl and pCreat measurements (r=-0.722) were observed.ConclusionThese results confirm a correlation between IoCl and the gold standard of GFR, InCl measurement. IoCl offers a relevant advantage over InCl because determination of the former allows the animal to live after the procedure.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, SP, BrazilUniv São Paulo, Inst Biomed Sci, Dept Immunol, São Paulo, SP, BrazilUniv São Paulo, Sch Med, Dept Nephrol, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, SP, BrazilWeb of Scienc

Evaluation of welfare during transport and lairage through the occurrence of lesions in slaughtered pig carcasses

Animal welfare is the state of the animal in its attempts to cope with its environment, and it can be measured and improved by the action of man. Recently, the topic “Animal Welfare” has become more important, resulting from the discovery that the management of animals in life has impact on the post mortem meat quality. This study aimed to determine the effect of transport batch number of pigs transported by batch, type of route and the time elapsed between the exploration and slaughter in the occurrence of lesions, considered as indicators of animal welfare at the slaughterhouse. At one slaughterhouse of pigs located in the northern of Portugal, 834 animals were monitored in order to check the occurrence of lesions consistent with lacerations, erythema, bruising and fractures, from a total of five different transport batches. The global analysis of the data showed that lacerations were present in 72% of animals and was the most common type of lesion, followed by erythema, bruises and broken bones presented in 20%, 11% and 1% respectively. The size of each batch, the duration of the journey and the time spent in the lairage significantly influenced the occurrence of observed lesions, particularly, lacerations, erythema and bruising. Bem-Estar Animal consiste no estado do animal em sua tentativa de adaptação ao meio ambiente envolvente, podendo ser medido e melhorado com a ação do ser humano. Nos últimos anos o tema “Bem-Estar Animal” tem adquirido importância, resultante das grandes preocupações com o manejo dos animais em vida e constatação da influência que este tem na qualidade da carne post mortem. Este trabalho teve como objetivo determinar o efeito do lote de suínos transportados, respectivo tamanho, tipo de trajeto e do tempo decorrido entre a origem e o abate na ocorrência de lesões, consideradas indicadores mínimos de bem-estar animal em matadouro. Nos matadouros de suínos da região norte de Portugal, foram monitorados 834 animais com relação à ocorrência de lesões compatíveis com lacerações, eritemas cutâneos, hematomas e fraturas, em cinco diferentes lotes. Pela análise global dos dados, verificou-se que as lacerações estavam presentes em 72% dos animais e foi o tipo de lesão mais frequentemente observado. Seguiram-se os eritemas cutâneos em 20%, os hematomas em 11% e as fraturas em apenas 1% dos animais. O tamanho do lote de animais transportados, a duração da viagem e o tempo de permanência no matadouro influenciaram significativamente a ocorrência das lesões monitoradas, nomeadamente lacerações, eritemas e hematomas.

Educational aspects and parenting in adolescence

Objective: To describe the educational profile of adolescents who experienced parenting. Method: It is a descriptive study with quantitative approach developed between 2008 and 2009, with 204 adolescents, of both sexes who experienced parenting. The data collecting took place from a questionnaire referring to social and demographic variables and was organized and tabulated using the software EPI-INFO 6.04. Results: The age average was between 17 and 19 years old, 80% of adolescents did not attend school and 58,3% had not finished primary school, the reasons were due to their jobs and pregnancy. Conclusion: The adolescents have demonstrated low schooling due to conciliation of parenting and studies. It is evident the necessity of new ways of orientating these adolescents to return and/or keep educational activities as an example of human dignity for themselves and their children

EDUCATIONAL ASPECTS AND PARENTING IN ADOLESCENCE

RESUMO OBJETIVO: descrever o perfil educacional de adolescentes que vivenciaram a parentalidade. MÉTODO: trata-se de um estudo descritivo com abordagem quantitativa, desenvolvido entre 2008 e 2009, com 204 adolescentes, de ambos os sexos que vivenciaram a parentalidade. A coleta de dados ocorreu a partir de um questionário referente a variáveis sóciodemográficas e foram organizados e tabulados usando o software EPI-INFO 6.04. RESULTADOS: A concentração de idade apresentou-se entre 17 e 19 anos, 80% dos adolescentes não freqüentavam a escola e 58,3% não haviam completado o ensino fundamental, os motivos do abandono escolar foram o trabalho e a própria gestação. CONCLUSÃO: Os adolescentes demonstraram baixa escolaridade devido à conciliação da parentalidade e dos estudos. Evidencia-se a necessidade de novas formas de direcionar esses adolescentes ao retorno e/ou manutenção das atividades educativas como exemplo de dignidade humana para seus filhos e para si

EDUCATIONAL ASPECTS AND PARENTING IN ADOLESCENCE

RESUMO OBJETIVO: descrever o perfil educacional de adolescentes que vivenciaram a parentalidade. MÉTODO: trata-se de um estudo descritivo com abordagem quantitativa, desenvolvido entre 2008 e 2009, com 204 adolescentes, de ambos os sexos que vivenciaram a parentalidade. A coleta de dados ocorreu a partir de um questionário referente a variáveis sóciodemográficas e foram organizados e tabulados usando o software EPI-INFO 6.04. RESULTADOS: A concentração de idade apresentou-se entre 17 e 19 anos, 80% dos adolescentes não freqüentavam a escola e 58,3% não haviam completado o ensino fundamental, os motivos do abandono escolar foram o trabalho e a própria gestação. CONCLUSÃO: Os adolescentes demonstraram baixa escolaridade devido à conciliação da parentalidade e dos estudos. Evidencia-se a necessidade de novas formas de direcionar esses adolescentes ao retorno e/ou manutenção das atividades educativas como exemplo de dignidade humana para seus filhos e para si

The nature and activity of liaison mental services in acute hospital settings: a multi-site cross sectional study

Background: To describe the clinical activity patterns and nature of interventions of hospital-based liaison psychiatry services in England. Methods: Multi-site, cross-sectional survey. 18 acute hospitals across England with a liaison psychiatry service. All liaison staff members, at each hospital site, recorded data on each patient they had face to face contact with, over a 7 day period. Data included location of referral, source of referral, main clinical problem, type of liaison intervention employed, staff professional group and grade, referral onto other services, and standard assessment measures. Results: A total of 1475 face to face contacts from 18 hospitals were included in the analysis, of which approximately half were follow-up reviews. There was considerable variation across sites, related to the volume of Emergency Department (ED) attendances, number of hospital admissions, and work hours of the team but not to the size of the hospital (number of beds). The most common clinical problems were co-morbid physical and psychiatric symptoms, self-harm and cognitive impairment. The main types of intervention delivered were diagnosis/formulation, risk management and advice. There were differences in the type of clinical problems seen by the services between EDs and wards, and also differences between the work conducted by doctors and nurses. Almost half of the contacts were for continuing care, rather than assessment. Eight per cent of all referrals were offered follow up with the LP team, and approximately 37% were referred to community or other services. Conclusions: The activity of LP services is related to the flow of patients through an acute hospital. In addition to initial assessments, services provide a wide range of differing interventions, with nurses and doctors carrying out distinctly different roles within the team. The results show the volume and diversity of LP work. While much clinical contact is acute and confined to the inpatient episode, the LP service is not defined solely by an assessment and discharge function; cases are often complex and nearly half were referred for follow up including liaison team follow up

Uso de contraceptivos por puérperas adolescentes

Objetivo: Averiguar a utilização dos métodos contraceptivos pelas puérperas adolescentes a fim de relacionar o seu (des)uso com a gravidez na adolescência.Método: Estudo transversal, descritivo, realizado por meio de instrumento estruturado com 181 puérperas adolescentes que tiveram seus partos no hospital participante da pesquisa. Os dados foram coletados no período de dezembro de 2008 a dezembro de 2009.Resultados: 64,1% das puérperas faziam uso de algum método contraceptivo antes de ficarem grávidas e os métodos mais utilizados foram anticoncepcional oral 51% e o preservativo masculino 29%. Para 75% das adolescentes a gravidez foi planejada e justificada pelo desejo e a vontade própria de vivenciar a maternidade.Conclusão: Considerando que quase metade das adolescentes entrevistadas desejavam a gestação, aponta-se que pesquisar e discutir apenas o uso ou não dos métodos contraceptivos não é adequado. É necessário aprofundar as investigações acerca dos significados de ser mãe na adolescência