RESUMO
BACKGROUND: Despite the increasing burden of mental, neurological, and substance use (MNS) disorders, a significant treatment gap for these disorders continues to exist across the world, and especially in low- and middle-income countries. To bridge the treatment gap, the World Health Organization developed and launched the Mental Health Gap Action Programme (mhGAP) and the mhGAP Intervention Guide (mhGAP-IG) to help train non-specialists to deliver care. Although the mhGAP-IG has been used in more than 100 countries for in-service training, its implementation in pre-service training, that is, training prior to entering caregiver roles, is very limited. AIM OF THE STUDY: The aim of this study was to collect and present information about the global experience of academic institutions that have integrated WHO's mhGAP-IG into pre-service training. METHODS: A descriptive cross-sectional study was conducted using an electronic questionnaire, from December 2018 to June 2019. RESULTS: Altogether, eleven academic institutions across nine countries (Mexico, Nigeria, Liberia, Sierra Leone, Somaliland, Armenia, Georgia, Ukraine and Kyrgyzstan) participated in this study. Five of the institutions have introduced the mhGAP-IG by revising existing curricula, three by developing new training programmes, and three have used both approaches. A lack of financial resources, a lack of support from institutional leadership, and resistance from some faculty members were the main obstacles to introducing this programme. Most of the institutions have used the mhGAP-IG to train medical students, while some have used it to train medical interns and residents (in neurology or family medicine) and nursing students. Use of the mhGAP-IG in pre-service training has led to improved knowledge and skills to manage mental health conditions. A majority of students and teaching instructors were highly satisfied with the mhGAP-IG. CONCLUSIONS: This study, for the first time, has collected evidence about the use of WHO's mhGAP-IG in pre-service training in several countries. It demonstrates that the mhGAP-IG can be successfully implemented to train a future cadre of medical doctors and health nurses.
RESUMO
OBJECTIVE: to assess the influence of diabetes mellitus (DM) on cognitive functions of metabolic syndrome (MS) patients. 305 patients aged 45-89 years with chronic cerebrovascular disease and MS were enrolled into the study. All patients were divided into two groups: without DM (n=148) and with DM (n=1 57), comparable for age and level of education. Metabolic syndrome and its individual components were assessed. All patients underwent neurological examinations and the application of neuropsychological tests to assess cognitive functions as well as laboratory tests and MRI. Their blood pressure was measured and the body mass index (BMI) was calculated. The carotid intima-media thickness (IMT), plaque and degree of stenosis were measured by a high resolution B-mode ultrasound examination. Patients with metabolic syndrome and DM had more pronounced cognitive impairment (CI) according to MMSE, compared with the patients without DM. According to the neuropsychological test results, metabolic syndrome and hyperglycaemia were more strongly associated with information processing speed and mental flexibility (both including perceptual speed) rather than with memory (immediate and delayed recall). Therefore, prompt and adequate treatment of the existing metabolic syndrome and its individual components, in particular diabetes mellitus, will reduce the risk of both moderate CI and vascular dementia and improve the patients'quality of life.
