Actitudes de los profesionales de la Salud Mental hacia las personas con esquizofrenia / [Attitudes of mental health workers toward people with schizophrenia].

OBJECTIVE: Stigma is a social and universal phenomenon which constitutes the core of various social barriers. Stigmatizing attitudes of mental health workers influence the outcome of patients and affect their recovery. Our purpose was to determine some attitudes and social distance of mental health workers toward people with schizophrenia. METHODS: 517 mental health workers were surveyed at two national conferences in Argentina. RESULTS: More than 90

believed that patients have the right to know their diagnosis, but only 64

informed it. Psychiatrists and men professionals were more likely to inform the diagnosis. Eighteen per cent thought that the voting right of people with schizophrenia should be revoked, 13

believed that this group should not have children and 63.7

believed that people with schizophrenia can recover completely. There was a statistical difference in the social distance according to health workers’ gender, years of experience and the percentage of patients assisted. CONCLUSIONS: There exist social distance and stigmatizing attitudes toward people with schizophrenia among mental health workers. The contact could help to reduce social distance. Anti-stigmatizing education programs should be directed toward mental health workers since their initial training.

Psicoterapia ambulatoria en el Conurbano Bonaerense: tasa de su utilización, costo y características de las psicoterapias y sus usuarios / Outpatient psychotherapy in suburban Buenos Aires: rate of use, costs, practices and patient charac-teristics

Objetivo: El objetivo de este estudio fue conocer la frecuencia de tratamiento psicoterapéutico en la población adulta del Conurbano Bonaerense, su costo, particularidades de las terapias y características demográficas de los usuarios. Metodología: Se realizaran encuestas a 899 habitantes de 11 partidos del Gran Buenos Aires entre septiembre y noviembre del año 2007. Resultados: El 14,2 por ciento de los entrevistados había realizado psicoterapia en el último mes. El 42,8 por ciento de los encuestados había asistido alguna vez o asistía a tratamiento psicoterapéutico. La concurrencia es mayor entre las mujeres, viudos y personas de edad media y nivel educativo y socioeconómico elevado. Casi el 40 por ciento de los que están actualmente en psicoterapia realiza tratamiento psicoanalítico, 10 por ciento tratamiento cognitivo-conductual y 41 por ciento desconoce el tipo de psicoterapia que realiza. Los tratamientos son conducidos principalmente por psicólogos (85 por ciento), en su mayoría son de tipo individual y se realizan en forma privada. La duración promedio de la entrevista psicoterapéutica es de 52 minutos. Existe una relación positiva entre duración de la entrevista y su costo. No existen diferencias significativas en la frecuencia de uso de tratamiento psicoterapéutico entre las distintas zonas del Conurbano, como así tampoco con la frecuencia de la ciudad de Buenos Aires. Conclusiones: La asistencia a tratamiento psicoterapéutico en el Gran Buenos Aires es mayor que en otros países, sin embargo es menor en ciertos grupos sociales y etarios. Se necesitan estudios más detallados para dilucidar la adecuación de los tratamientos a los problemas mentales de la población.

Objective: The purpose of this study was to estimate the rate of use, costs and details of psychotherapeutic treatment in general population of suburban Buenos Aires along with patient demographic characteristics. Methods: A survey was conducted between September and November 2007 among 899 inhabitants of 11 districts in greater Buenos Aires. Results: During the previous month 14, 2 percent of the population received psychotherapy treatment. Lifetime prevalence of psychotherapy was 42, 8 percent. Use of psychotherapy was higher among women, the widowed, middle aged individuals and persons with higher socioeconomic status and levels of education. Almost 40 percent of the individuals in psychotherapy at the time of the survey reported receiving psychoanalytic treatment, 10 percent reported receiving cognitive-behavioral therapy while 41 percent was not aware of the type of psychotherapy received. Treatments were conducted mainly by psychologists (85 percent) and the majority consisted of individual psychotherapy in a private practice setting. Mean duration of a psychotherapy session was 52 minutes. A positive correlation was found between the duration of a session and its cost. There were no overall differences in the rate of use of psychotherapy between different areas of greater Buenos Aires, nor between these areas and previous estimates of prevalence in the city of Buenos Aires. Conclusions: Psychotherapy use in greater Buenos Aires is higher than in other countries. However, the rate of use is lower for certain socioeconomic and age groups. Further research is needed to determine whether the treatments observed are appropriate for the mental health needs of this population.

Estudio de efectividad en pacientes con esquizofrenia crónica: CATIE: ¿qué podemos aprender? / Effectiveness trials in chronic schizophrenic patients: CATIE. What can we learn?

La necesidad de contar con estudios clínicos prácticos en los pacientes esquizofrénicos llevó al desarrollo del estudio CATIE para estudiar la efectividad de los antipsicóticos en el "mundo real". Este estudio consta de distintas fases que se describen en este artículo, detallando su metodología, resultados y limitaciones. No hubo diferencias significativas en eficacia entre los antipsicóticos de primera y segunda generación. La olanzapina aparece como una droga de efectividad superior aunque con un perfil de efectos adversos metabólicos importantes. La clozapina tuvo eficacia superior en pacientes que no habían respondido al antipsicótico administrado en la fase anterior de este estudio. La risperidona parece ser más conveniente en pacientes que abandonan el tratamiento antipsicótico por intolerancia. Los antipsicóticos aún dejan muchas expectativas terapéuticas sin cumplirse. Se deben implementar otras medidas terapéuticas para lograr un tratamiento más integral. El tratamiento para cada paciente debe ser diseñado específica mente, siendo de enorme importancia lograr una mayor adherencia.

The need for practical clinical trials on schizophrenic patients led to the development of the CATIE to study the effectiveness of antipsychotics in the "real world". This study has different phases that are described in this article, detailing their methodology, results and limitations. There were no significant differences between the antipsychotics of first and second generation. Olanzapine appeared as a drug of higher effectiveness but with important metabolic side effects. Clozapine had higher efficacy in patients that had not responded to an antipsychotic administered in a previous phase of this study. Risperidone appeared to be more convenient for patients that abandoned their antipsychotic treatment because of intolerability. Antipsychotics still leave a lot of therapeutic expectations without fulfillment. Other therapeutic measures should be carried out to accomplish a more comprehensive treatment. The treatment for each patient must be specifically designed and the achievement of compliance must be considered of great importance.

Prevalencia de tratamiento psicoterapéutico en los habitantes de la ciudad de Buenos Aires / Prevalence of psychotherapeutic treatments in citizens of Buenos Aires City

Introducción: existen escasos datos acerca de la prevalencia de psicoterapia realizada por la población general en la ciudad de Buenos Aires. El objetivo de nuestro estudio fue determinar dicha prevalencia, las características demográficas de la población que la realiza, así como también conocer el tipo y las particularidades de las psicoterapias empleadas. Método: se realizaron encuestas a 1510 transeúntes en distintos barrios de la ciudad de Buenos Aires. Resultados: el 15,6 de la población encuestada concurrió a un tratamiento psicoterapéutico en el último mes, el 21 en el último año y el 41,6 asistió hace más de un año. El tratamiento psicoterapéutico es más prevalente en mujeres y en personas de mayor nivel educativo y socioeconómico, y menos frecuente en ancianos. No existen diferencias según estado civil. El 44 de los que están actualmente en tratamiento no conocen el tipo de psicoterapia que reciben, el 41,3 hace terapia psicoanalítica y el 8 psicoterapia cognitivo-conductual. En el 82 de los casos el profesional que efectúa el tratamiento es psicólogo y en el 11 es médico. Conclusiones: el uso de la psicoterapia está muy extendido en la ciudad de Buenos Aires.

Introduction: Little data exist about the prevalence of psycotherapy used by the general population of the city of Buenos Aires. The aim of our study was to determine this prevalence, the demographic characteristics of the population that receives psychotherapy, as well as types and characteristics of these psycotherapies. Method: A survey was conducted among 1510 inhabitants in different neighbourhoods of the city of Buenos Aires. Results: During the month previous to the survey, 15.6 of the population received psychotherapy treatment, 21 during the last year and 41.6 had received before. Psychoterapy treatment is more prevalent among women and people with higher educational and social-economic level, and it is less frequent in the elderly group. No differences in the use of psychotherapy exist according to marital status. Forty four percent of the patients under treatment at the moment of the survey were unaware of the type of psychotherapy received, 41.3 knew that they were receiving psychoanalytic therapy and 8 cognitive-behavioral psychotherapy. Eighty-two percent of the treatments were conducted by psychologists and 11 by physicians. Conclusions: The use of the psychotherapy is very extended among the general population of the city of Buenos Aires.

Aplicação dos conceitos atuais do marketing para o mercado hospitalar / The application of present marketing concepts for the hospital market

Nas condições atuais de constantes, rápidas e profundas modificações de mercado, da tecnologia e da sociedade, as organizações hospitalares são forçadas a modificar seu relacionamento com os clientes e com o ambiente competitivo de maneira geral. No esforço para conquistar e manter clientes, os hospitais americanos têm adotado uma nmova visão de marketing, que vem atender às exigências deste ambiente mutável e competitivo. Estamos vivendo a era do marketing voltado para o valor e do hospital orientado ao marketing, ou seja, as organizações hospitalares passam a ter, de fato, o cliente como principal foco de seu negócio. A aplicação dos conceitos do marketing chegou tardiamente à área da saúde, no final dos anos 70. Este mercado reveste-se de características próprias, devido as quais somente nos últimos anos as organizações de saúde, inclusive as sem fins lucrativos, passaram a acolher de forma mais generalizada os conceitos de marketing de serviços, se estruturando e investindo no planejamento e nas ações de marketing. O marketing de valor pressupõe uma organização atenta às mudanças ambientais e preconiza uma postura ética diante da sociedade, exigindo uma integração do marketing com as diferentes áreas da organização, trabalhando em conjunto, colocando o cliente no centro das atenções da empresa, que deve responder, servir e satisfazê-lo. Diversos estudos estrangeiros confirmaram o relacionamento entre uma forte orientação de marketing com o desempenho dos hospitais. Como inexistem trabalhos analisando a possível orientação de marketing nos hospitais do Brasil, não se pode afirmar que haja hospitais orientados ao marketing no país.

Lesiones de los tejidos blandos causadas por Mycobacterium Fortuitum-chelonei / Soft tissue lesions caused by M. Fortuitum-chelonei

Se presentan 3 pacientes con lesiones de los tejidos blandos, causadas por microorganismos acido - alcohol resistentes, del complejo M. Fortuitum Chelenoid. Se senala el antecedente traumatico, la cronicidad de la infeccion y las dificultades encontradas tanto para el diagnostico como para el tratamiento