Aportes del Hospital de Día para la atención de niños/as y adolescentes con patologías mentales graves, en la formación de residentes de Psiquiatría Pediátrica / Contributions from the Day Hospital for the care of children and adolescents with serious mental pathologies, in the training of Pediatric Psychiatry residents

Cerca del 20 % de niños en todo el mundo experimentan trastornos mentales, independientemente de su procedencia o cultura. La manifestación de un trastorno mental durante la infancia puede ocasionar alteraciones en el desarrollo, impactando negativamente en la calidad de vida, la dinámica familiar, y en el progreso académico y social. En nuestro país los problemas de salud mental en la infancia y adolescencia están entre los principales problemas de salud en este grupo de edades, y las consultas y hospitalizaciones de niños, niñas y adolescentes se encuentran con una oferta de servicios limitada. En 2017, se aprueba la Ley de Salud Mental, que promueve la atención de los problemas en el ámbito comunitario, y la implementación de distintos dispositivos de atención alternativos a la hospitalización a tiempo completo. Uno de los dispositivos intermedios es el hospital de día, para la atención de trastornos mentales en forma ambulatoria diurna, como alternativa a la hospitalización. En el 2021 se abre el primer Hospital de Día para niños, niñas y adolescentes con trastornos psiquiátricos severos en el Centro Hospitalario Pereira Rossell. Con un equipo interdisciplinario con recursos de la Administración de los Servicios de Salud del Estado y la Facultad de Medicina, brinda la oportunidad de pasantías para estudiantes de distintas disciplinas. El Hospital de Día enriquece la formación de residentes de Psiquiatría Pediátrica para enfrentar desafíos clínicos y desarrollar estrategias de tratamiento interdisciplinarias, complementarias al abordaje tradicional, una atención de mayor calidad y una oportunidad de aprendizaje en trabajo en equipo.

About 20% children experience mental disorders worldwide, regardless of background or culture. Mental disorders appearing during childhood can cause developmental changes, with negative impact on quality of life, family dynamics, as well as on academic and social progress. In our country, Mental Health problems in childhood and adolescence are among the main health problems in this age group, increasing consultations and hospitalizations of children and adolescents, stressing a limited supply of services. In 2017, the Mental Health Law was passed, which promotes mental health care at the community level, and the implementation of different care strategies as alternatives to fulltime hospitalization. One of the intermediate strategies is the day hospital, for the care of mental disorders on a daytime outpatient basis, as an alternative to conventional hospitalization. In 2021, the first day hospital for children and adolescents with severe psychiatric disorders was opened in Uruguay at the Pereira Rossell Hospital Center. With an interdisciplinary team with resources from ASSE and the Faculty of Medicine, it provides opportunity for internships for students from different disciplines. The Day Hospital enriches the training of Pediatric Psychiatry residents. They learn how to cope with clinical challenges, have a teamwork learning opportunity, and develop interdisciplinary treatment strategies, complementary to the traditional approach, providing higher quality care in the management of serious childhood mental disorders.

Clinical impact and cost analysis of the use of either the Xpert MTB Rif test or sputum smear microscopy in the diagnosis of pulmonary tuberculosis in Rio de Janeiro, Brazil

Abstract INTRODUCTION: The molecular test Xpert MTB/RIF (Xpert) has been recommended for use in the diagnosis of pulmonary tuberculosis (PTB); however, data on the cost of incorporating it under routine conditions in high-burden countries are scarce. The clinical impact and costs incurred in adopting the Xpert test in routine PTB diagnosis was evaluated in a prospective study conducted from November 2012 to November of 2013, in the City of Rio de Janeiro, Brazil. METHODS: The diagnostic and therapeutic cascade for TB treatment was evaluated using Xpert in the first stage (S1), and sputum smear microscopy (SSM) in the second stage (S2). The mean costs associated with each diagnostic test were calculated including equipment, human resources, supplies, and infrastructure. RESULTS: We included 232 subjects with probable TB (S1 = 87; S2 = 145). The sensitivities of Xpert and SSM were 91.7% (22/24) and 79.1% (34/43), respectively. The median time between triage and TB treatment initiation in S1 (n = 24) was 14.5 days (IQR 8-28.0) and in S2 (n = 43) it was 8 days [interquartile range (IQR) 6-12.0]. The estimated mean costs per examination in S1 and S2 were US$24.61 and US$6.98, respectively. CONCLUSIONS: Compared with SSM, Xpert test showed a greater sensitivity, but it also had a time delay with respect to treatment initiation and a higher mean cost per examination.