Collective efficacy and depressive symptoms in Brazilian elderly.

The objective was to investigate the association between depressive symptoms and collective efficacy among the elderly in a municipality in southern Brazil. A cross-sectional population-based design was carried out. Structured interviews were held at the homes of 1007 elderly individuals. The presence of depressive symptoms was measured using the Geriatric Depression Scale, exposures were a standard 8-item collective efficacy scale and a single item about elderly participation in groups. Data were analyzed using Poisson regression to obtain the crude and adjusted prevalence ratios (PRs). The sample consisted mostly of female (63%), white (96%) and married (64%) elderly individuals. The mean age, income and educational level were, respectively: 73 years (SD=4), R$ 1836 (SD=2170) and 5 years of education (SD=4). After controlling for demographic, socioeconomic, behavioral and health-related variables, participants who reported low collective efficacy at the places where they lived presented a prevalence of depressive symptoms that was twice as high as the prevalence among those who reported high collective efficacy. In the same way, elderly individuals who did not participate in groups presented prevalence of the outcome around 64% higher than among those who took part in one or more groups. The study suggests that creation of and participation in social networks and community groups may be an important strategy for promoting mental health among the elderly.

Correlates of lifetime alcohol misuse among older community residents in Brazil.

BACKGROUND: Little is known about the sociodemographic correlates and health effects associated with lifetime alcohol misuse in community dwelling elderly people in Brazil. METHOD: Data were obtained from a representative sample of 6961 residents aged 60+ in the state of Rio Grande do Sul, Brazil. The structured interview included a five-item lifetime alcohol use questionnaire addressing abuse and dependence, and questions regarding sociodemographic characteristics, lifestyle and social support, and health conditions. RESULTS: In the interview, 10.6% respondents (25.3% men, 2.9% women) endorsed at least one lifetime alcohol misuse question. Controlled analyses comparing a gradient of alcohol misuse (none, one or more than one item endorsed), found that men, people aged 60-69 (compared to older persons) and tobacco users were more likely to endorse alcohol misuse items. Persons reporting lower income and who were of non-white race/ethnicity did not differ from their comparison groups with respect to endorsing one item, but they were more likely to endorse two or more items. Endorsing more than one item was associated with impaired activities of daily living, the presence of respiratory problems and psychiatric disorders, but was protective against vascular conditions. CONCLUSIONS: Major lifetime alcohol misuse (defined as endorsing more than one of five items reflecting alcohol abuse or dependence) is more common in certain sociodemographic groups (men, younger elderly, lower income, non-whites). With the exception of vascular conditions, it is associated with smoking, poorer functional status, respiratory problems, and psychiatric disorder. Endorsing only one item has a reduced association, significant only for male gender, smoking, and psychiatric disorder.

The relationship between religiosity and tobacco, alcohol use, and depression in an elderly community population.

OBJECTIVE: The objective of this study is to examine the religious characteristics of older subjects and the associations of these characteristics to the use of tobacco, alcohol, and depression. METHODS: Data from a multistage random sample were used to examine associations between religiosity and health behaviors (tobacco use, alcohol) and depression among elderly house hold residents aged 60+ in Rio Grande do Sul, Brazil. Survey measures included sociodemographic characteristics, four aspects of religiosity, tobacco use, alcohol abuse and dependence, depression, life style, social context, functional status, and health conditions. RESULTS: After controlling for demographic, social connections, health behavior, functional status, and health conditions, evangelical affiliation reduced the odds of being a current tobacco user by 51%. Those reporting affiliation as Afro-Brazilian and not having a religion had, respectively, a 74% and 124% increased risk. All other religious domains protect against tobacco use. Not having a religion affiliation and the experience of a religious change increased the risk of alcohol misuse by 88% and 31%, respectively. In contrast, orienting-motivating force increased the odds of depression by 38%. Participating in social religious activities had reduced the risk of depression by 16%. CONCLUSION: Several aspects of religiosity reduced the odds of being a tobacco user. Not having a religion and the experience of a religious change increased the risk of alcohol misuse. However, the domain orienting-motivating force increased the odds, and participating in social religious activities had reduced the risk of a depressive state.

Equity of access to outpatient care and hospitalization among older community residents in Brazil.

OBJECTIVE: To determine whether, as mandated by Brazilian law, health care (outpatient care, hospitalization) among older community residents is based on health-related criteria and not on other characteristics. RESEARCH DESIGN: Cross-sectional, population-representative. SUBJECTS: Multistage, random sample of 7040 household residents aged >or=60 years in the state of Rio Grande do Sul, Brazil. MEASURES: Structured in-person interviews to determine sociodemographic characteristics, self-reported health conditions, psychiatric status, outpatient service use within the previous 6 months, and number of hospitalizations within the previous 12 months. RESULTS: Seventy two percent reported an outpatient visit, 20% reported hospitalization. In controlled analyses, being female, older, unemployed, having private health insurance, increased the odds of an outpatient visit. Males, older persons, the insured, and more educated were more likely to report hospitalization. Race/ethnicity and religious affiliation were not associated with outpatient or hospital use. Pneumonia, heart disease, and urinary tract infection were particularly associated with both outpatient visits and hospitalization; diabetes, hypertension, and cancer with outpatient visit; stroke, cancer and psychiatric disorder with hospitalization; and heart disease, pneumonia, and psychiatric disorder with multiple hospitalizations. CONCLUSIONS: Use of health services did not differ by race/ethnicity or religion, but private health insurance facilitated outpatient access, and increased education facilitated hospitalization. Gender, age, and employment status likely reflected differential health needs. Improved access is needed for older persons lacking private health insurance, and those with little education. Patients with psychiatric problems merit increased attention to reduce excessive hospitalization.

Prevalence of self-reported sleep disturbance among older adults and the association of disturbed sleep with service demand and medical conditions.

OBJECTIVE: This cross-sectional study investigated the prevalence of disturbed sleep and the association of disturbed sleep with medical conditions and service use among older adults. METHODS: A sample of 6961 household residents aged 60 and over was recruited from a population-based random sample. Each subject was examined in a face-to-face interview. RESULTS: The overall prevalence of disturbed sleep was 33.7%, with the condition being more prevalent in women (37.2%) than in men (27.4%). The overall rate of medical consultations was 78%, and higher in those with sleep disturbance (males 73% vs 27%; females 80% vs 20%) compared to persons without disturbed sleep. The overall rate of hospitalizations was 20.2%. In logistic regression analyses, being female, of low income, low education, younger age, with psychiatric morbidity, pneumonia, urinary infection, dermatological problems and/or hypertension were significantly associated with self-reported sleep disturbance. Ethnicity, civil status or outpatient visits in the previous six months and hospitalizations in the previous year were not associated with self-reported sleep disturbance. CONCLUSION: Self-reported sleep disturbance was a frequent problem in the study population and was associated with gender, income, education, lower age and medical conditions. There was no association between sleep problems and use of medical services in the surveyed population.

Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: results from an elderly survey.

BACKGROUND: The main purpose of this study is to investigate the association of disturbed sleep, chronic physical pain and psychiatric morbidity in people aged 60 years and over. METHODS: A population-based random sample of 7040 household residents aged 60 years and over, was examined in a face-to-face interview. Painful medical conditions were assessed through questions evaluating medical treatment, hospitalizations, and consultations for medical problems. Disturbed sleep was assessed through questions concerning the presence of sleeping problems in the past 4 weeks. RESULTS: The overall prevalence of disturbed sleep is 33.7% (95% CI: 32.5-34.8) and the 6-month prevalence of any chronic pain was 76.2% (95% CI: 74.2-78.2%). A substantial burden of disturbed sleep is associated with the presence of physical pain morbidity, 42.5% for back pain to 49.7% for headaches. The prevalence of pain among persons with disturbed sleep ranges from 25.8% for gastrointestinal pain to 54.6% for joint pain. The presence of comorbid pain and disturbed sleep has an important disability impact as assessed by socioecomomic/professional data, health care utilization, self-rated health and physical activity. In logistic regression models, headaches, psychiatric morbidity, rural origin, Caucasians, self-rated health and number of chronic pain conditions were significantly associated with disturbed sleep after controlling for demographic variables and comorbidities. Age has a negative effect on sleep complaints. CONCLUSIONS: Disturbed sleep is highly comorbid with other pain conditions particularly headaches and psychiatric morbidity in later life. The combination of pain and disturbed sleep leads to important role disability and increased utilization of medical services.

Depression morbidity in later life: prevalence and correlates in a developing country.

OBJECTIVE: To investigate the one-month prevalence of depression morbidity and its association with sociodemographic characteristics, health and functional status, and use of health services in community residents aged 60 years and over in Brazil. METHODS: This study used a cross-sectional design of face-to-face interviews (N = 7,040) in Rio Grande do Sul State, Brazil. Participants were household residents aged 60 years and older. Measurements included the Short Psychiatric Evaluation Schedule (six-item version) and questionnaire that assessed sociodemographic characteristics, self-reported health status, systemic illnesses, activities of daily living (ADL), use of medical services, and social support. RESULTS: The overall prevalence of depression morbidity was 22% (men: 18%, women: 25.2%). In controlled analyses, younger age, low income, rural origin, never or no longer married, poor self-rated health, presence of systemic illnesses, visual, hearing, or ADL impairments, hospitalization in the past 12 months, and lack of exercise or employment were significantly associated with depression morbidity, whereas living alone was nearly so associated. Gender, education, minority race, or outpatient visits in the previous six months were not associated with depression morbidity. CONCLUSION: The overall prevalence of depression morbidity was among the highest previously reported for older persons. In controlled analyses, prevalence declined as age increased, and rates were higher for those with lower income and poorer social, health, and functional status, but did not differ significantly by gender, education, or race/ethnicity. Increased attention should be paid to identifying depression morbidity in those with adverse circumstances and to identifying ameliorating interventions.

Validity and limitations of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1).

OBJECTIVE: To study the concurrent validity of the Brazilian Composite International Diagnostic Interview 2.1 using as gold standard the clinical diagnoses based on the ICD-10 criteria and the Longitudinal, Expert, All Data (LEAD) procedure. METHOD: The sample was composed of 185 subjects selected at psychiatric hospitals, psychiatric outpatient units, the community, and primary care services. These individuals were intentionally selected according to 9 diagnostic groups. INSTRUMENTS: Composite International Diagnostic Interview (CIDI-core) version 2.1 (paper-and-pencil) administered by 16 trained interviewers. ANALYSIS: concurrent validity of diagnoses of the Composite International Diagnostic Interview 12-month. RESULTS: Values found for sensitivity and specificity in each diagnosis were: alcohol-related disorders (79.5%/97.2%); psychoactive substance-related disorders (77.3%/100%); schizophrenia and other psychotic disorders (28.6%/93.9%); manic episode and bipolar affective disorder (38.9%/96.4%); depressive disorder (82.5%/ 93.8%); phobic-anxiety disorder (80.6%/93.5%); obsessive-compulsive disorder (18.2%/98.9%); somatoform disorder (41.7%/90.8%); eating disorder (45.5%/100.0%). CONCLUSION: The Composite International Diagnostic Interview proved to be valid for diagnoses of alcohol-related disorders, psychoactive substance-related disorders, depressive disorder and phobic-anxiety disorder. The probable explanations for the poor performance for the other diagnoses were: necessity of some clinical judgement by the lay interviewer; difficulty to use the Probe Flow Chart; interviewees' difficulty of understanding; and lack of mechanisms to certify the veracity of the information.

Validity and limitations of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

OBJECTIVE: To study the concurrent validity of the Brazilian Composite International Diagnostic Interview 2.1 using as gold standard the clinical diagnoses based on the ICD-10 criteria and the Longitudinal, Expert, All Data (LEAD) procedure. METHOD: The sample was composed of 185 subjects selected at psychiatric hospitals, psychiatric outpatient units, the community, and primary care services. These individuals were intentionally selected according to 9 diagnostic groups. Instruments: Composite International Diagnostic Interview (CIDI-core) version 2.1 (paper-and-pencil) administered by 16 trained interviewers. Analysis: concurrent validity of diagnoses of the Composite International Diagnostic Interview 12-month. RESULTS: Values found for sensitivity and specificity in each diagnosis were: alcohol-related disorders (79.5 percent/97.2 percent); psychoactive substance-related disorders (77.3 percent/100 percent); schizophrenia and other psychotic disorders (28.6 percent/93.9 percent); manic episode and bipolar affective disorder (38.9 percent/96.4 percent); depressive disorder (82.5 percent/ 93.8 percent); phobic-anxiety disorder (80.6 percent/93.5 percent); obsessive-compulsive disorder (18.2 percent/98.9 percent); somatoform disorder (41.7 percent/90.8 percent); eating disorder (45.5 percent/100.0 percent). CONCLUSION: The Composite International Diagnostic Interview proved to be valid for diagnoses of alcohol-related disorders, psychoactive substance-related disorders, depressive disorder and phobic-anxiety disorder. The probable explanations for the poor performance for the other diagnoses were: necessity of some clinical judgement by the lay interviewer; difficulty to use the Probe Flow Chart; interviewees' difficulty of understanding; and lack of mechanisms to certify the veracity of the information.

OBJETIVO: Validação concorrente da versão brasileira do Composite International Diagnostic Interview 2.1, utilizando como padrão ouro o diagnóstico médico baseado nos critérios diagnósticos da CID-10 e critérios Longitudinal, Experts Clinicians, All Data (LEAD). MÉTODO: Amostra composta por 185 indivíduos procedentes de hospitais psiquiátricos, ambulatórios de especialidades psiquiátricas, serviços comunitários e atenção primária à saúde, selecionados intencionalmente segundo nove grupos diagnósticos. Instrumentos: CIDI 2.1 (lápis e papel), versão para diagnósticos ao longo da vida, aplicado por 16 entrevistadores treinados. Análise: validade concorrente dos diagnósticos do Composite International Diagnostic Interview no último ano. RESULTADOS: Os valores encontrados de sensibilidade e especificidade foram: transtornos decorrentes do uso de álcool (79,5 por cento/97,2 por cento); transtornos decorrentes do uso de substâncias psicoativas (77,3 por cento/100 por cento); esquizofrenia e outros transtornos psicóticos (28,6 por cento/93,9 por cento); episódio maníaco e transtorno afetivo bipolar (38,9 por cento/96,4 por cento); transtorno depressivo (82,5 por cento/93,8 por cento); transtorno fóbico-ansioso (80,6 por cento/93,5 por cento); transtorno obsessivo-compulsivo (18,2 por cento/98,9 por cento); transtorno somatoforme (41,7 por cento/90,8 por cento); e transtorno alimentar (45,5 por cento/100,0 por cento). CONCLUSÃO: O Composite International Diagnostic Interview mostrou-se válido para os diagnósticos de transtornos decorrentes do uso de álcool e substâncias psicoativas, transtorno depressivo e transtorno fóbico-ansioso. As prováveis explicações para o pior desempenho nos demais diagnósticos foram: necessidade de algum julgamento clínico do entrevistador leigo; dificuldade no manuseio do Diagrama de Especificação de Resposta; dificuldade de compreensão dos entrevistados; e falta de mecanismos para atestar a veracidade das informações.

Co-occurrence of chronic physical pain and psychiatric morbidity in a community sample of older people.

BACKGROUND: Knowledge about co-occurrence of the most frequent chronic pain symptoms with psychiatric morbidity in older people is very limited. OBJECTIVE: To study the association of psychiatric morbidity and painful physical conditions in people aged 60 years and over. METHOD: Population-based random sample of 7,040 household residents, aged 60 years and over, in Brazil. RESULTS: The overall prevalence of pain conditions is 76%. Age-sex specific prevalence of chronic pain conditions such as back pain, joint, abdominal, chest, headaches, reported by respondents ranged from 11.6% up to 51.1%. In logistic regression models, chest pain, head pain, back pain, joint pain and abdominal pain emerged as predictors of psychiatric morbidity. The odds of psychiatric morbidity are also affected by income, ethnicity, origin (urban/rural), and marital status. CONCLUSION: The association of chronic painful conditions and psychiatric morbidity in late life is statistically strong in this surveyed population.

Reforma psiquiátrica no Rio Grande do Sul: uma análise histórica, econômica e do impacto da legislação de 1992 / Psychiatric reform in Rio Grande do Sul: an analysis of history, economy and the impact of 1992 legislation

Os autores apresentam uma análise da reforma psiquiátrica do Rio Grande do Sul, utilizando uma perspectiva histórica e uma abordagem por três vertentes: a psiquiatria institucional; os desenvolvimentos na área extra-hospitalar; e as políticas de saúde implementadas ao longo dos anos. A partir do referencial adotado, foi revisada a experiência brasileira e a do Rio Grande do Sul em particular, tendo como fontes: os bancos de dados MEDLINE e Lilacs e documentos oficiais do Ministério da Saúde e da Secretaria Estadual de Saúde do Rio Grande do Sul. Hoje, após 14 anos da promulgação da Lei Estadual n° 9716, que dispõe sobre a reforma psiquiátrica no Rio Grande do Sul e determina a substituição progressiva dos hospitais psiquiátricos por uma rede de atenção integral em saúde mental, nota-se que o número de leitos psiquiátricos foi reduzido em 35 por cento, e a proposta de implantação da rede "alternativa" de assistência ao doente mental não foi implementada da forma preconizada, tampouco de maneira igualitária. Tendo em vista que os atuais desafios, tais como o fenômeno da "porta giratória" e o paciente crônico, refletem a necessidade de extensão dos cuidados primários e secundários, a experiência do Rio Grande do Sul permite pôr em discussão a possibilidade de modificação da estratégia, de tal modo que, ao invés de tentar estruturar um "sistema dentro do sistema", como hoje está colocado, possa-se tirar melhor proveito da integração da saúde mental aos programas-eixo do SUS, como o Programa de Saúde da Família e o Programa de Agentes Comunitários de Saúde.

The authors present an analysis of the psychiatric reform in Rio Grande do Sul, Brazil, using a historical perspective and an approach by three trends: institutional psychiatry; developments in the extra-hospital area; and policies of health implemented along the years. Based on the references adopted, the experience in Brazil and in Rio Grande do Sul was reviewed using the following sources: MEDLINE and Lilacs databases and official documents from the Brazilian Health Ministry and from the Health State Secretary. Nowadays, 14 years after the promulgation of State Law 9716, which refers to the psychiatric reform in Rio Grande do Sul and determines the progressive replacement of psychiatric hospitals by a network of full mental health care, the number of psychiatric beds was reduced in 35 percent and the proposal of an "alternative" care network to the mentally ill was not implemented as recommended, neither in an equal form. Bearing in mind that the present challenges, such as the phenomenon of the "revolving door" and the chronicle patient, show the necessity of extending primary and secondary care. The experience in Rio Grande do Sul brings into debate the possibility of changing the strategy, so that, instead of trying to structure "a system inside the system," as is placed today, more benefits can be drawn from the integration of mental health with the main programs in the Brazilian Unified Health System (SUS), such as Family Health Program (PSF) and Community Health Agents Program (PACS).

Doença mental, mulheres e transformação social: um perfil evolutivo institucional de 1931 a 2000 / Mental health, women and social change: a progressive institutional profile from 1931 to 2000

INTRODUÇÃO: No século XX, as mulheres vivenciaram inúmeras transformações e alcançaram uma participação mais ativa na sociedade.O estudo visa descrever o perfil da clientela feminina, admitida em um serviço de internação psiquiátrica com as transformações históricas, sociais e demográficas.Oferece um retrato comparativo das condições epidemológicas existentes no decorrer da série histórica e os aspectos do meio da condição sociocultural das mulheres do estado. MATERIAIS E MÉTODOS: Estudo epidemiológico descritivo, longitudinal, tipo série histórica de dados, baseado na coleta de dados efetuada no serviço de arquivo médico e de estatísticas de um hospital. Foram analisadas as seguintes variáveis: idade, estado civil, cor, setor profissional, ocupação, classe social e diagnóstico psiquiátrico, todos padronizados conforme os critérios da Classificação Internacional de Doenças, edições 9 e 10. Para identificação dos casos, utilizaram-se todas as primeiras internações de mulheres. RESULTADOS: No decorrer de 70 anos, obteve-se um total de 9.629 indivíduos/casos. Observou-se o predomínio de mulheres na faixa etária de 26 a 45 anos (47,9 por cento), brancas (91,3 por cento), pertencentes ao subproletariado (86,8 por cento), fora da população economicamente ativa (96,7 por cento) e com diagnóstico de transtornos afetivos (28,6 por cento) e psicoses esquizofrênicas (25,2 por cento). Quanto ao estado civil, verificou-se maior presença de mulheres casadas (44,9 por cento). Todavia, na década de 90, as mulheres solteiras representaram 54,4 por cento, enquanto que as casadas perfizeram 39,7 por cento das pacientes. CONCLUSÃO: Foram detectadas mudanças significativas nos motivos para admissão de mulheres nos últimos anos. Sugere-se que as variações tenham sido influenciadas pelos determinantes biológicos das doenças mentais graves e, também de maneira significativa, pelas pressões sociais advindas do novo papel da mulher na sociedade.

INTRODUCTION: Along the 20th century, women underwent numerous changes and reached a more active participation in society. This study aims at describing the profile of the female patients admitted to a service of psychiatric hospitalization from May 1931 to December 2000. In addition, it relates the profile of psychiatric morbidity with the historical, social and demographic changes. It also offers a comparison between the epidemiological conditions throughout the historical series and the aspects regarding the environment and the sociocultural status of women from a Southern Brazilian state. MATERIALS AND METHODS: Descriptive, longitudinal, epidemiological study including historical data and based on data collected from the medical files and statistics of a hospital. The following variables were assessed: age, marital status, race, professional area, occupation, social class and psychiatric diagnosis, all standardized according to the International Classification of Diseases (ICD-9 and ICD-10) criteria. To identify the cases, all first hospitalizations of women were used. RESULTS: Along 70 years, a total of 9,629 individuals/cases was obtained. There was a predominance of women in the age group between 26-45 years (47.9 percent), white (91.3 percent), belonging to the subproletariat (86.8 percent), not belonging to the economically active part of the population (96.7 percent) and with diagnosis of affective disorders (28.6 percent) and schizophrenic psychoses (25.2 percent). With regard to marital status, married women were prevalent (44.9 percent). However, in the 1990's, single women represented 54.4 percent, whereas married women accounted for 39.7 percent of the patients. CONCLUSION: Significant changes were detected in the reasons for admitting women to psychiatric services over the past years. It is suggested that the variations might have been influenced by biological determinants of severe mental diseases, and especially by the ...

A evolução histórica em um hospital psiquiátrico: assistência médica tradicional ao gerenciamento pela qualidade total / The hystorical evolution in a psychiatric hospital: from tradicional medical assistance to total quallity management

O presente estudo tem por objetivo apresentar o processo histórico desenvolvido ao longo de setenta anos por uma instituição psiquiátrica de Pelotas/Rio Grande do Sul, bem como demonstrar a importância e a necessidade de articulação adequada entre a tecnologia médica e a tecnologia de gestão de modo a aoferecer aos clientes serviços melhor estruturados, mais acolhedores e mais eficazes em seu processo terapêutico. A Clínica Olivé Leite é o segundo mais antigo hospital psiquiátrico do Estado, fundado em 01 de maio de 1931. De 1931 a 1950, o modelo de administração e atecnologia terapêutica médica estavam baseados no paradigma médico e terapêutico clássico francês, no tratamento moral, na molarioterapia, no choque insulínico, no cardiazol e na eletroconvulsoterapia (ECT). Depois de 1950, com a introdução e massificação do uso da penicilina e dos neurolépticos fenotiazínicos a situação epidemiológica teve importante modificação tendendo à deshospitalização. Nos anos 60, foi implantado o modelo assistencial de Comunidade Terapêutica, voltado para a reintegração social do paciente. Nos anos 80, iniciou-se o processo de implantação da avaliação institucional e da informatização das informações clínicas. Nos anos 90, o hospital apresentou as condições propícias para a implementação da filosofia do gerenciamentpela Qualidade Total.

Effectiveness of time-limited psychotherapy for minor psychiatric disorders: randomised controlled trial evaluating immediate v. long-term effects.

BACKGROUND: Psychotherapy research rarely has studied outcome in the longer term. AIMS: To evaluate the effectiveness of brief group dynamic psychotherapy (BGDP) intervention in patients with minor psychiatric disorders compared with the usual clinical management shortly after treatment termination and to investigate whether intervention would show a differential effect at 2-year follow-up. METHOD: Patients were allocated randomly to an experimental or control group. The General Health Questionnaire (GHQ) was used as a primary outcome measure. RESULTS: Based on improvement in the GHQ, at termination of treatment the BGDP group showed a significant improvement in 23 out of 42 (54.8%) compared with 11 out of 41 (26.8%) in the clinical management group. The difference in the total improvement rate is 28% (95% C18-48) (chi(2)=6.7; d.f.=1; P=0.009). In contrast, no differential follow-up effects were found between the BGDP and clinical management groups. CONCLUSIONS: Psychotherapy appears to have beneficial effects at termination of treatment but the changes attained were not stable.

A saúde e seus custos: como passar do caos à qualidade? / Brazilian health care system and related costs: how to move from chaos to quality

O caos vivenciado pelo sistema de saúde no país é de conhecimento público. A resoluçäo para esse problema passa, indubitavelmente, pelas questões de gestäo. Entretanto, essas afirmações näo säo novidade; por isso, já existem paradigmas de gestäo para instituições vinculadas à saúde. Sobre esses säo feitas algumas considerações no presente Ensaio, a respeito dos princípios da Qualidade e da Metodologia para análise de custos chamada ABC - Custeio Baseado em Atividades

Tratamento etiológico em psiquiatria: o modelo da neurossífilis / Etiological treatment in psychiatry: the neurosyphilis model

Este trabalho tem como objetivo estudar a evolução histórica, durante 60 anos, das admissões por diagnóstico de neurossífilis em um hospital psiquiátrico e descrever o impacto da moderna antibioticoterapia. Foi baseado nos dados e planilhas do hospital psiquiátrico em estudo, de 1931 a 1991. O banco de dados do hospital contém informações do tipo: nome, sexo, idade, estado civil, nacionalidade, procedência, profissão, classe social, número de admissões por neurossífilis e outros diagnósticos, data de admissão, data de alta e diagnóstico pelo CID 9/WHO. A análise estatística envolveu todas as admissões até o último registro de paciente com diagnóstico de neurossífilis e comparado com resultados por outros tipos de admissões. Observou-se que antes da introdução da penicilina, nos serviços de saúde de Pelotas, em 1948, 19 por cento das admissões eram por neurossífilis. Depois, os registros hospitalares descrevem uma tendência decrescente até a última admissão em 1968. O impacto da antibioticoterapia na história natural da neurossífilis foi o maior até hoje e nunca antes visto com outros recursos terapêuticos (biológicos, psicofarmacológicos e psicoterápicos), para outras doenças psiquiátricas.

Estudo descritivo do perfil ocupacional da clientela admitida em serviço de internaçäo psiquiátrica da Regiäo Sudeste do RS, período 1931-1992 / Descriptive study of admitted patients in a psychiatric impatient service, from 1931 to 1992 - The occupational profile

O presente estudo visa descrever o perfil ocupacional da clientela admitida em um serviço de internaçäo psiquiátrica, no período de 1931-1992, relacionando com outras variáveis sócio-demográficas. Os dados da pesquisa säo provenientes dos registros clínicos de toda a clientela admitida no período estudado. Foram catalogadas mais de 34.000 admissöes e levantado o perfil ocupacional. As ocupaçöes foram classificadas, de acordo com os critérios operacionais de Bronfman por Victora e Barros, em oito categorias: 1)Propietários; 2)Administradores; 3)Profissionais de nível superior; 4)Funçöes d escritório; 5)Técnicos; 6)Trabalhadores semi-especializados; 7)Trabalhadores manuais näo-qualificados; 8)Ocupaçöes fora da populaçäo economicamente ativa. Para a caracterizaçäo descritiva das informaçöes, os dados ocupacionais foram organizados em tabelas, relacionando a variável em estudo com sexo, edade e tempo médio de permanência da internaçäo. A análise preliminar permite informar que, com a evoluçäo histórica, houve um aumento da participaçäo na clientela admitida dos seguintes segmentos ocupacionais: Ocupaçöes fora da populaçäo economicamente ativa e Trabalhadores manuais näo-qualificados. No sexo masculino predominou em todas as décadas, o número de trabalhadores näo-qualificados, enquanto que , no sexo feminino predominou, em todas as décadas, Ocupaçöes fora da populaçäo economicamente ativa. A partir dos anos 60, houve um umento no número de mulheres com ocupaçöes dentro da populaçäo economicamente ativa, comprovando seu ingresso no mercado de trabalho. Comclui-se que a clientela admitida num serviço de internaçäo psiquiátrica reflete, historicamente, o perfil sócio-ocupacional da sociedade em que está inserida

Estudo descritivo do perfil ocupacional da clientela admitida em servico de internacao psiquiatrica da regiao Sudeste do RS, periodo 1931-1992

O presente estudo visa descrever o perfil ocupacional da clientela, admitida em um servico de internacao psiquiatrica, no periodo de 1931-1992, relacionando com outras variaveis socio-demograficas. Os dados da pesquisa sao provenientes dos registros clinicos de toda a clientela admitida no periodo estudado. Foram catalogadas mais de 34.000 admissoes e levantado o perfil ocupacional. As ocupacoes foram calssificadas, de acordo com criterios operacionais de Bronfman por Victoria e Barros, em oito categorias: 1) Proprietarios; 2) Administradores; 3) Profissionais de nivel superior; 4) Funcoes de escritorio; 5) Tecnicas; 6) Trabalhadores semi-especializados; 7) Trabalhadores normais nao-qualificados; 8) Ocupacoes fora da populacao economicamante ativa. Para a caracterizacao descritiva das informacoes, os dados ocupacionais foram organizados em tabelas, relacionando a variavel em estudo com sexo, idade e tempo medio de permanencia da internacao. A analise preliminar permite informar que, com a evolucao historica, houve um aumento da participacao na clientela admitida dos seguintes segmentos ocupacionais: Ocupacoes fora da populacao economicamente ativa e Trabalhadores manuais nao-qualificados. No sexo masculino predominou em todas as decadas, o numero de trabalhadores nao-qualificados, enquanto que, no sexo feminino predominou, em todas as decadas, Ocupacoes fora da populacao economicamente ativa. A partir dos anos 60, houve um aumento no numero de mulheres com ocupacoes dentro da populacao economicamente ativa, comprovando seu ingresso no mercado de trabalho. Conclui-se que a clientela admitida num servico de internacao psiquiatrica reflete, historicamente, o perfil socio-ocupacional da sociedade em que esta inserida.