Public prosecutor's office and social control in the National Unified Health System: a systematic review. / O Ministério Público e o controle social no Sistema Único de Saúde: uma revisão sistemática.

The 1988 Constitution increased the Public Prosecutor's Office attributions and facilitated social participation through management councils in the construction of public policies and in the implementation of social control. In this context, it is necessary to reflect critically on the Public Prosecutor's Office work and its interaction with Health Councils to strengthen social control in the National Unified Health System. We conducted a systematic literature review to identify the national panorama of the relationship between the Public Prosecutor's Office and Health Councils with a view to providing answers on this institution's contributions toward effective social control in the National Unified Health System (SUS). The following databases were consulted: PubMed, BVS, CAPES Journals and BDTD. We included 17 studies, papers and dissertations, which were selected in the period 2006-2015. Results summarize that the Public Prosecutor's Office should focus its activities on health, especially on the operative and extrajudicial matrix, in order to boost popular participation and overcome Health Councils' shortcomings. An essential dialogue between the Public Prosecutor's Office and Health Councils is in place and mutually benefits the strengthening and effectiveness of social control in the SUS.

A Constituição Federal de 1988 ampliou as atribuições do Ministério Público e possibilitou a participação popular por meio de conselhos gestores na construção de políticas públicas e na efetivação do controle social. Realizou-se uma revisão sistemática da literatura com o intuito de conhecer o panorama nacional sobre a interação entre o Ministério Público e os Conselhos de Saúde e a importância desse relacionamento para o fortalecimento do controle social no Sistema Único de Saúde, buscando refletir criticamente sobre a atuação do Ministério Público para o bom funcionamento desses instrumentos democráticos de poder. Consultaram-se as bases: PubMed, BVS, Periódicos CAPES e BDTD. Para a composição da amostra de 17 artigos e dissertações, selecionados entre 2006 e 2015, foram associados os descritores: Ministério Público, Controle Social, Participação Popular e Conselhos de Saúde. A análise dos resultados demonstra que existe diálogo entre Ministério Público e Conselhos de Saúde, e ele traz benefícios recíprocos que são imprescindíveis para o fortalecimento e efetivação do controle social no SUS. Na área da saúde, a atuação do Ministério Público sobre a matriz resolutiva e extrajudicial estimula a participação popular e a superação das deficiências enfrentadas pelos Conselhos de Saúde.

O Ministério Público e o controle social no Sistema Único de Saúde: uma revisão sistemática / Public prosecutor's office and social control in the National Unified Health System: a systematic review

Resumo A Constituição Federal de 1988 ampliou as atribuições do Ministério Público e possibilitou a participação popular por meio de conselhos gestores na construção de políticas públicas e na efetivação do controle social. Realizou-se uma revisão sistemática da literatura com o intuito de conhecer o panorama nacional sobre a interação entre o Ministério Público e os Conselhos de Saúde e a importância desse relacionamento para o fortalecimento do controle social no Sistema Único de Saúde, buscando refletir criticamente sobre a atuação do Ministério Público para o bom funcionamento desses instrumentos democráticos de poder. Consultaram-se as bases: PubMed, BVS, Periódicos CAPES e BDTD. Para a composição da amostra de 17 artigos e dissertações, selecionados entre 2006 e 2015, foram associados os descritores: Ministério Público, Controle Social, Participação Popular e Conselhos de Saúde. A análise dos resultados demonstra que existe diálogo entre Ministério Público e Conselhos de Saúde, e ele traz benefícios recíprocos que são imprescindíveis para o fortalecimento e efetivação do controle social no SUS. Na área da saúde, a atuação do Ministério Público sobre a matriz resolutiva e extrajudicial estimula a participação popular e a superação das deficiências enfrentadas pelos Conselhos de Saúde.

Abstract The 1988 Constitution increased the Public Prosecutor's Office attributions and facilitated social participation through management councils in the construction of public policies and in the implementation of social control. In this context, it is necessary to reflect critically on the Public Prosecutor's Office work and its interaction with Health Councils to strengthen social control in the National Unified Health System. We conducted a systematic literature review to identify the national panorama of the relationship between the Public Prosecutor's Office and Health Councils with a view to providing answers on this institution's contributions toward effective social control in the National Unified Health System (SUS). The following databases were consulted: PubMed, BVS, CAPES Journals and BDTD. We included 17 studies, papers and dissertations, which were selected in the period 2006-2015. Results summarize that the Public Prosecutor's Office should focus its activities on health, especially on the operative and extrajudicial matrix, in order to boost popular participation and overcome Health Councils' shortcomings. An essential dialogue between the Public Prosecutor's Office and Health Councils is in place and mutually benefits the strengthening and effectiveness of social control in the SUS.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance.

INTRODUCTION: User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. METHODS: This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. RESULTS: We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. CONCLUSION: Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance / Satisfação com o cuidado em uma unidade de internação psiquiátrica brasileira: diferenças nas percepções dos pacientes segundo tipo de plano de saúde

Abstract Introduction User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. Methods This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. Results We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. Conclusion Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.

Resumo Introdução A avaliação da satisfação do usuário nos serviços de saúde mental é um importante indicador da qualidade do tratamento. O objetivo deste estudo foi avaliar a satisfação com o tratamento em uma amostra de pacientes internados com transtornos mentais e as associações entre os níveis de satisfação e variáveis clínicas/sociodemográficas. Métodos Este estudo exploratório investigou 227 pacientes psiquiátricos internados que responderam a Escala de Satisfação do Paciente com os Serviços de Saúde Mental (SATIS-BR) e a Escala de Percepção da Mudança (EMP). Os escores SATIS-BR foram analisados segundo associações com dados clínicos e sociodemográficos. Correlações de Pearson foram usadas para correlacionar escores SATIS com outras variáveis. Resultados Encontramos alto grau de satisfação com o atendimento na unidade de internação psiquiátrica avaliada. Em geral, os pacientes atribuíram satisfação máxima para a maioria dos itens. Os maiores escores de satisfação foram associados a pacientes em tratamento pelo Sistema Único de Saúde (SUS) e com menor escolaridade. A SATIS mostrou uma correlação positiva moderada com EMP. A pior dimensão avaliada foi associada às instalações físicas e conforto da enfermaria. Conclusão Pacientes com cobertura pelo SUS podem estar mais satisfeitos do que pacientes com planos privados de saúde quando tratados na mesma unidade. A avaliação da satisfação com o tratamento pode ser usada para reorganizar serviços em unidades de internação psiquiátrica.

Evaluation of DSM-5 and ICD-11 personality traits using the Personality Inventory for DSM-5 (PID-5) in a Brazilian sample of psychiatric inpatients.

OBJECTIVE: The objective of this study was to test if the Personality Inventory for DSM-5 (PID-5) is an adequate instrument to evaluate psychiatric inpatients' pathological personality traits. METHODS: Inpatients (n = 130; mean age: 38.5 years; 62.3% female; 63.9% single) answered the PID-5 after clinical improvement of their psychiatric symptoms. The mean scores of the DSM-5 personality domains, facets and profiles, and ICD-11 domain traits were compared with the mean scores of a Brazilian normative sample (n = 656). We investigated the diagnostic performance of the scales to identify individuals with and without psychopathology. RESULTS: The final sample included mainly diagnoses of mood disorders. Except for Antagonism and Disinhibition, all DSM-5 personality domains and most facets as well as almost all DSM-5 personality disorder profiles (except Narcissist) and ICD-11 trait domains (except Detachment and Dissociality) of the inpatients presented high differences compared with the normative sample. In general, the PID-5 scales presented a high negative predictive value and a low positive predictive value to identify individuals with severe psychopathology. DISCUSSION: This study found high scores of pathological personality traits in a sample of Brazilian psychiatric inpatients. The PID-5 may be a promising instrument to measure pathological personality traits among psychiatric inpatients. Methodological and sample size limitations may have influenced the results. © 2018 John Wiley & Sons, Ltd.

Psychopathology and impairment of quality of life in offspring of psychiatric inpatients in southern Brazil: a preliminary study.

OBJECTIVE: To evaluate the quality of life and risk of psychopathology in the infant and adolescent offspring of psychiatric inpatients from a general hospital unit. METHODS: Offspring (4-17 years old) of psychiatric inpatients were interviewed face-to-face and assessed with the Strengths and Difficulties Questionnaire (SDQ). Interviews with caregivers and the hospitalized parents were also performed. The quality of life of the offspring, psychopathology of their hospitalized parents, and their current caregivers were investigated in order to evaluate any associations between these aspects and psychopathology in the offspring. RESULTS: Thirty-four children of 25 patients were evaluated, 38.2% of which presented high risk for some type of psychopathology including hyperactivity or attention deficit disorder (38.2%), behavioral disorders (20.6%), and emotional disorders (17.6%). While only the minority of these children (17.6%) were already receiving mental health treatment, another 41.2% of them exhibited some degree of symptoms and were only referred for specialized assessment. Additionally, 61.8% of the children were reported to be suffering from some impairment in their quality of life. CONCLUSION: This preliminary study found a high rate of psychopathology in children of psychiatric inpatients. These results corroborate previous evidence that children and adolescents with parents with severe psychopathology are at high risk for developing mental disorders. Public policies and standard protocols of action directed to this population are urgently needed, especially for offspring of parents that are hospitalized in psychiatric in-patient units of general hospitals.

Por onde anda a histeria? / Where is the hysteria?

O termo histeria foi suprimido das classificações diagnósticas vigentes. Este artigo cita e descreve os diagnósticos que estão agora abrigados no guarda-chuva da histeria, além de discutir algumas implicações sobre essa mudança.

The term hysteria was suppressed from the current diagnostic classifications. This article cites and describes the diagnoses that are now housed under the umbrella of hysteria, in addition to discussing some implications on this change.

Psicose: diagnóstico e manejo inicial / Psychosis: diagnosis and initial management

Este artigo visa esclarecer a abordagem inicial e o tratamento das psicoses enquanto ainda em sala de emergência.

This article aims to clarify the initial approach and treatment of psychosis while still in the emergency room.

Factors related to positive and negative outcomes in psychiatric inpatients in a general hospital psychiatric unit: a proposal for an outcomes index

Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS), Global Assessment of Functioning (variation and at discharge) and Clinical Global Impression (severity and improvement) were used to build a ten-point improvement index (I-Index). Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes) were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

Atendimento ao paciente psiquiátrico: manejo em urgências e emergências / Care of the psychiatric patient: urgency and emergency management

O trabalho a seguir visa orientar e guiar médicos que se deparam com o primeiro atendimento a um paciente psiquiátrico.

The paper that follows has the intention to guide doctors that will face with the first assessment of a psychiatric patient.

History of childhood abuse and neglect and suicidal behavior at hospital admission.

Suicide is a major public health problem. Preventive measures have been sought by identifying risk factors. This study evaluates the association of childhood abuse and neglect with suicidal behavior at the time of psychiatric hospital admission. A total of 120 subjects (72 females; mean age 42.5 +/- 15.6 years old) admitted from August 2006 to July 2007 completed the Childhood Trauma Questionnaire (CTQ) to assess severity of exposure to childhood maltreatment. Thereof 62 (51.6%) patients presented with suicidal behavior at admission. Patients who had attempted suicide had significantly higher CTQ scores. Regression analysis indicated that shorter illness duration and severity of childhood maltreatment were predictors of suicidal behavior at admission. The study showed that inpatients of a psychiatric unit of a general hospital who experienced severe childhood abuse or neglect were significantly more likely to present with suicidal behavior. History of childhood maltreatment should be evaluated as an associated risk factor of suicidal behavior at admission of psychiatric inpatients.

Quando indicar internação para um paciente com sintomas psiquiátricos? / When do you indicate hospitalization for a patient with psychiatric symptoms?

A internação psiquiátrica constitui um importante aspecto da abordagem terapêutica e do manejo de um paciente com sintomas psiquiátricos, na prática médica. Um clínico não psiquiatra deve cogitar a internação psiquiátrica em casos onde os sintomas a justifiquem, muito mais do que o diagnóstico psiquiátrico em si. O objetivo deste trabalho é tentar exemplificar e esclarecer quando devemos indicar internação psiquiátrica para um paciente, independentemente de qual seja a especialidade médica a que o paciente esteja buscando auxílio

Aspectos do funcionamento de uma unidade de internação psiquiátrica de um hospital geral / Functioning aspects of a general hospital psychiatric unit

O objetivo deste trabalho é descrever o funcionamento de uma unidade de internaçäo psiquiátrica (UIP) em um hospital geral em seus aspectos eminentemente práticos. Reunir vários pacientes psiquiátricos graves e manejá-los é uma tarefa desafiadoramente árdua. A farmacologia ainda é empírica e paliativa, a despeito dos grandes esforços e avanços científicos alcançados nos últimos anos. Tentar discutir o embasamento que respalda cientificamente as condutas e manejos dentro de uma UIP poderá lançar luz ao nosso conhecimento, principalmente daqueles que estão iniciando a prática psiquiátrica, sejam estudantes estagiários ou residentes.

Diseño optimo de una vivienda en tierra "Lak'auta"

El principal objetivo del proyecto, es la optimizacion de una vivienda lak'auta, fabricada en tierra, a traves de estudios tecnologicos y experimentales, mediante ensayos de laboratorio y calculo estructural, que permitan poner en practica, la construccion en areas rurales, de estas viviendas de caracter social, de bajo costo y utilizando exclusivamente material del lugar. La vivienda denominada "Lak'auta" casa de tierra, tiene la principal caracteristica de tener la arquietctura de Nubia, es decir que tiene la forma de boveda, donde los muros y techo son exclusivamente construidos con adobe. Para realizar los estudios y ensayos de laboratorio se eligieron cuatro localidades que pertenecen al area rural de nuestro departamento, las cuales son: Lahuachaca, viacha, huarina, laja. Con la recoleccion del material y adobes de las regiones en estudio se procedio a la ejecucion de ensayos fisico-mecanicos para determinar sus propiedades. Con los ensayos de granulometria, hidrometria, limites de Aterberg, pesos especifico, se determino el primer parametro comparativo que es la Clasificacion de Suelos. Paralelamente se realizaron los ensayos de Resistencia a Compresion de adobes como unidad, cubos labrado Norma Peruana y prismas o muretes de adobes construidos para modelar lo mas aproximado posible al comportamiento real de un muro de adobe.