Tropical stream microcosms of isolated fungal species suggest nutrient enrichment does not accelerate decomposition but might inhibit fungal biomass production.

Terrestrial leaf litter is an essential energy source in forest streams and in many tropical streams, including Cerrado, litter undergoes biological decomposition mainly by fungi. However, there is a limited understanding of the contribution of isolated fungal species to in-stream litter decomposition in the tropics. Here we set a full factorial microcosms experiment using four fungal species (Aquanectria penicillioides, Lunulospora curvula, Pestalotiopsis submerses, and Pestalotiopsis sp.) incubated in isolation, two litter types (rapid and slow decomposing litter) and two nutrient levels (natural and enriched), all characteristics of Cerrado streams, to elucidate the role of isolated fungal species on litter decomposition. We found that all fungal species promoted litter mass loss but with contributions that varied from 1% to 8% of the initial mass. The fungal species decomposed 1.5 times more the slow decomposing litter and water nutrient enrichment had no effect on their contribution to mass loss. In contrast, fungal biomass was reduced by nutrient enrichment and was different among fungal species. We showed fungal contribution to decomposition depends on fungal identity and litter type, but not on water nutrients. These findings suggest that the identity of fungal species and litter types may have more important repercussions to in-stream decomposition than moderate nutrient enrichment in the tropics.

Community health services and risk of readmission in public psychiatric hospitals of Belo Horizonte, Brazil, 2005-2011.

INTRODUCTION: The readmission phenomenon in psychiatry not only reflects the severity and chronicity of the underlying disorders, but also indicates the quality of mental healthcare. In the context of the Brazilian mental healthcare reform, no study has included the availability of outpatient care among the potential determinants for psychiatric readmission. OBJECTIVE: To correlate the availability of community healthcare resources at the place of residence with the risk of psychiatric readmission. METHODS: All admission records from 2005 to 2011 in the two public psychiatric hospitals of Belo Horizonte were included (n=19,723). Variables related to patients and characteristics of hospitalization were collected, and indicators of community healthcare coverage were calculated for each place of residence yearly. The outcome of interest was early (<7 days), medium-term (8-30 days) and late (31-365 days) readmissions. The analysis was based on Cox regressions. RESULTS: The coverage of basic health units and of psychiatrists was associated with lower readmission risks. Coverage of specialized centers for psychosocial attention (Centros de Atenção Psicossocial [CAPS]) and psychologists did not show any protective effects. Young, male patients and those residing outside the capital had greater risk of early readmission. Compared to other psychotic disorders, mood disorders and neurotic disorders were seen as protective factors for readmission. CONCLUSION: Regionalized attention offered by the CAPS did not result in reduced readmission risks.

Community health services and risk of readmission in public psychiatric hospitals of Belo Horizonte, Brazil, 2005-2011 / Cobertura de serviços extra-hospitalares e risco de reinternação nos hospitais psiquiátricos públicos de Belo Horizonte, 2005 a 2011

Abstract Introduction The readmission phenomenon in psychiatry not only reflects the severity and chronicity of the underlying disorders, but also indicates the quality of mental healthcare. In the context of the Brazilian mental healthcare reform, no study has included the availability of outpatient care among the potential determinants for psychiatric readmission. Objective To correlate the availability of community healthcare resources at the place of residence with the risk of psychiatric readmission. Methods All admission records from 2005 to 2011 in the two public psychiatric hospitals of Belo Horizonte were included (n=19,723). Variables related to patients and characteristics of hospitalization were collected, and indicators of community healthcare coverage were calculated for each place of residence yearly. The outcome of interest was early (<7 days), medium-term (8-30 days) and late (31-365 days) readmissions. The analysis was based on Cox regressions. Results The coverage of basic health units and of psychiatrists was associated with lower readmission risks. Coverage of specialized centers for psychosocial attention (Centros de Atenção Psicossocial [CAPS]) and psychologists did not show any protective effects. Young, male patients and those residing outside the capital had greater risk of early readmission. Compared to other psychotic disorders, mood disorders and neurotic disorders were seen as protective factors for readmission. Conclusion Regionalized attention offered by the CAPS did not result in reduced readmission risks.

Resumo Introdução O fenômeno da reinternação psiquiátrica reflete não apenas a gravidade e cronicidade da doença de base, mas também a qualidade dos serviços de saúde. Ainda não há estudos incluindo a disponibilidade de recursos assistenciais extra-hospitalares como preditor da readmissão psiquiátrica, no contexto da reforma da assistência à saúde mental brasileira. Objetivo Correlacionar a disponibilidade de recursos de assistência extra-hospitalar das localidades de residência com o risco de readmissão psiquiátrica. Métodos Foram analisados todos os registros de internações ocorridas de 2005 a 2011 nos dois hospitais psiquiátricos públicos de Belo Horizonte (n=19.723). Foram coletadas variáveis relativas aos pacientes e às características da internação, e calculados indicadores de cobertura em saúde extra-hospitalar para cada localidade de residência e ano. O desfecho de interesse foi a reinternação precoce (<7 dias), de médio prazo (8-30 dias) e tardia (31-365 dias). A análise se deu por regressões de Cox. Resultados A cobertura de unidades básicas de saúde e de psiquiatras se associou a menores riscos de reinternação. A cobertura de Centros de Atenção Psicossocial (CAPS) e de psicólogos não apresentou efeitos protetores. Pacientes jovens e do sexo masculino, assim como os residentes fora da capital, tiveram risco maior de reinternação precoce. Em comparação com outros transtornos psicóticos, os transtornos de humor e os transtornos neuróticos se apresentaram como fatores protetores para a reinternação. Conclusão A atenção regionalizada oferecida pelos CAPS não resultou em riscos reduzidos de reinternação.

Contenção física no hospital psiquiátrico: estudo transversal das práticas e fatores de risco / Physical restraint in a Brazilian psychiatric hospital: cross-sectional study of practice and risk factors

RESUMO Objetivos Descrever a utilização da contenção física em um hospital psiquiátrico público e analisar os fatores de risco associados com seu uso, no contexto da implantação de um protocolo clínico. Métodos Em um hospital psiquiátrico público de Belo Horizonte-MG, os formulários de registro e monitoramento de contenção física (2011-2012) foram analisados e comparados com os registros das demais internações englobadas no mesmo período. Neste estudo transversal, além das análises descritivas das características clínicas e demográficas dos pacientes contidos, das técnicas utilizadas e das complicações reportadas, os fatores de risco associados com o uso da contenção foram analisados por meio de regressão logística múltipla. Resultados A contenção foi utilizada em 13,4% das internações, sendo mais comum em pacientes jovens, do sexo masculino, portadores de psicoses não orgânicas, apresentando agitação/agressividade. A técnica foi geralmente de quatro pontos, durando entre 61-240 minutos. Os únicos fatores de risco significativos para o uso da contenção incluíram a idade (OR = 0,98; p = 0,008) e o tempo de permanência (OR = 1,01; p < 0,001). Conclusões A contenção física foi utilizada usualmente na abordagem aguda do paciente agitado/agressivo inabordável verbalmente, no contexto de um transtorno psicótico. O registro dos dados vitais e dos efeitos adversos foram os itens menos aderentes aos protocolos vigentes.

ABSTRACT Objectives To describe the use of physical restraint in a public psychiatric hospital and analyze the risk factors associated with its use in the context of the implementation of a clinical protocol. Methods In a public psychiatric hospital of Belo Horizonte-MG, registration forms for monitoring physical restraint (2011-2012) were analyzed and compared with the records of other admissions in the same period. In this cross-sectional study, the clinical and demographic characteristics of the restrained patients, the techniques used and the reported complications were described. Also, risk factors associated with the use of physical restraints were analyzed using multiple logistic regression. Results Physical restraint was used in 13.4% of admissions, was more common in young male patients, with a non-organic psychoses diagnosis, presenting agitation/aggressive behavior. Usually, a four-points restraint technique was performed, lasting between 61-240 minutes. The only significant risk factors for the use of restraints included age (OR = 0.98, p = 0.008) and length of stay (OR = 1.01, p < 0.001). Conclusions Physical restraint was used in the approach of the acutely agitated, aggressive, and non-responsive to verbal de-escalation patient, in the context of a psychotic disorder. The registration of vital signs and adverse effects were the items less frequently compliant to current protocols.

O PET-Saúde no Centro de Saúde Cafezal: promovendo hábitos saudáveis de vida / The Educational Program for Health Work at the Cafezal Health Center: promoting healthy life habits

Trata-se de um de relato de experiência dos monitores bolsistas e voluntários de alguns cursos da área de saúde da Universidade Federal de Minas Gerais (UFMG) no projeto PET-Saúde, sob supervisão de cinco preceptores e de um tutor do projeto realizado na Unidade Básica de Saúde (UBS) Cafezal. O objetivo é descrever a experiência desse grupo tutorial do PET-Saúde Cafezal na promoção de hábitos saudáveis de vida. Os monitores puderam vivenciar a rotina do serviço de Atenção Primária, através do acompanhamento de diferentes atividades em diversos setores da UBS Cafezal e perceberam que os aspectos mais relevantes do projeto foram o trabalho interdisciplinar e multiprofissional, de acordo com os princípios de respeito e ética, a observação da rotina e do funcionamento da UBS, bem como a oportunidade de aplicarem seus conhecimentos acadêmicos adquiridos previamente. O modelo utilizado como estratégia de ensino-aprendizagem permitiu-lhes um meio de aprendizado teórico-prático dos preceitos adotados pelo SUS, uma vez que, devido ao princípio da indissociabilidade entre extensão, ensino e pesquisa, são realizados diversos trabalhos em campo e desenvolvidas pesquisas com equipes multidisciplinares.

This is an experience report of the scholarship students and volunteers of health science courses of the Federal University of Minas Gerais (UFMG) who participated in the PET-Health project, under the supervision of five preceptors and one tutor. The project was carried out at the Primary Health Care Unit (PHCU) Cafezal in the city of Belo Horizonte. The objective of the project was the diffusion of healthy lifestyle concerning physical activity and nutrition. The aim of this report is the characterization of the experiences of this tutorial group. The monitors were able to experience the service routines of primary care by monitoring different activities in all sectors of the PHCU-Cafezal. The most relevant aspects of the project were multidisciplinary and interdisciplinary cooperation, in accordance with the principles of respect and ethics, the routine observation and operation of PHCU, as well as the opportunity to apply the recently acquired academic knowledge. This teaching and learning strategy enabled the students to practice the updated principles of preventive health care adopted by SUS, due to the principle of indivisibility of university extension projects, innovative teaching strategies and research.