RESUMO
Orofacial clefts are the most common congenital craniofacial anomalies worldwide, and if not managed in a timely manner, can lead to significant complications. We aim to examine surgical timing at one of the few cleft care centers in the North region of Brazil since its foundation in 2016. This retrospective, descriptive study analyzed medical records from 2016 to 2023. We calculated the age at surgery for each time period and each primary surgery performed. We also evaluated the number of procedures performed outside the recommended age . Of the 1439 procedures performed from 2016 to 2023, 713 procedures met our inclusion criteria. Among these, 66.67% (n=188) of primary cheiloplasties, 67.80% (n=40) of primary lip adhesions, and 54.57% (n=203) of palatoplasties were performed outside the recommended time frame. Of the surgeries performed, 45.16% (n=322) were between 2016 and 2019, while 54.84% (n=391) were from 2020 to 2023. Considering procedures performed within the ideal recommended age groups, only 32.92% (n=106) were done between 2016 and 2019, in contrast to 45.01% (n=176) between 2020 and 2023. In conclusion, since the inception of the specialized center, there has been an increase in surgical volume and an improvement in their timing. However, many surgeries are still being conducted outside the recommended time frame.
RESUMO
BACKGROUND: Orofacial clefts (OFC) are the most common congenital malformation of the craniofacial skeleton. Attempts have been made to correlate the components of maternal diet as triggers for the development or prevention of OFC. OBJECTIVE: To analyze nutritional status as a predictive factor for the development of cleft lip and palate in an Amazonian population. METHODS: A total of 152 mothers within 3 months of delivery were interviewed for comparison: 51 mothers of children with nonsyndromic cleft lip and palate (CLP) (study group) and 101 mothers of children without OFC (control group). A food frequency questionnaire was used to assess maternal nutrition and to analyze the influence of macro- and micronutrients on the possible predisposition or protection for CLP. RESULTS: The study group showed higher percentage of lipid intake than did the control group (p = 0.01). Among the participants with no family history of OFC, the study group had a higher percentage of lipid intake (p = 0.002) and lower vegetable intake (p = 0.037). Maternal micronutrient intake among the participants with a positive family history was lower in the study group for vitamins B2 (p = 0.03), B5 (p = 0.036), E (p = 0.03), and folate (p = 0.022). CONCLUSIONS: Nutritional analysis indicated that higher maternal lipid intake increased the likelihood of having offsprings with nonsyndromic CLP. Moreover, families with a history of OFC and low maternal folate intake showed heightened risk of nonsyndromic CLP in their offsprings.
Assuntos
Fenda Labial , Fissura Palatina , Estado Nutricional , Humanos , Fissura Palatina/epidemiologia , Fissura Palatina/etiologia , Fenda Labial/epidemiologia , Fenda Labial/etiologia , Feminino , Estudos de Casos e Controles , Fatores de Risco , Adulto , Brasil/epidemiologia , Masculino , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , GravidezRESUMO
Não é novidade para os cirurgiões plásticos, especialmente aos que se dedicam à cirurgia de face, que o nervo facial pode ser lesado virtualmente em qualquer cirurgia de ritidoplastia. Porém, apesar da importância contida nesse tema, não é tarefa simples encontrar na literatura artigos que abordem de forma objetiva a correlação entre lesão do nervo facial e cirurgia facial. Paralisias faciais, sejam elas completas ou não, podem se tornar situações potencialmente conflituosas na relação médicopaciente. Este artigo, portanto, visa propor de forma clara e sucinta, baseada na experiência dos autores, um guia de como evitar, identificar e tratar uma potencial lesão do nervo facial no contexto de uma cirurgia de face, em especial a ritidoplastia.
Is largely known that the facial nerve virtually can be injured in every facial lift. Even though its importance, it is difficult to find in the literature articles related to this theme. Complete or incomplete facial paralysis after a facial procedures, may become a very uncomfortable situation between the patient and the surgeon, that is why we propose in this article a guide which intends to help avoid, identify and manage a facial nerve injury in the event of a face lift. Identifying Facial palsy before the surgery: Intending to make the pre-op facial assessment as simple as possible, we suggest a systematic approach examination. Avoiding facial nerve injury during face lifting: Several technical details are discussed along the text aiming to minimize the risk of nerve damage during the surgical procedure. What to in the event of a post-operative facial palsy: The authors propose a logical approach to the facial palsy, suggesting a planning for diagnosis, classification of the lesion and a rational treatment for the injury. Conclusion: This article presents a guide showing some safe technical options to avoid nerve damage during rythidoplasty, how to identify the lesion and treat it if necessary.
Assuntos
Humanos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Ritidoplastia/efeitos adversos , Ritidoplastia/métodos , Guia de Prática Clínica , Face/cirurgia , Traumatismos Faciais/cirurgia , Traumatismos Faciais/complicações , Nervo Facial/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodosRESUMO
Ethnopharmacological relevance Senna septemtrionalis (Viv.) H.S. Irwin & Barneby (Fabaceae) is a shrub empirically used as diuretic, and for the treatment of neurological disorders. These pharmacological effects have not been previously evaluated. AIM OF THE STUDY: To evaluate the diuretic and CNS effects of a standardized ethanol extract of Senna septemtrionalis aerial parts (SSE). MATERIALS AND METHODS: Gas chromatography mass spectrometry was used to perform a chemical analysis with SSE. In all tests, SSE was evaluated from 10 to 100â¯mg/kg p.o. The diuretic activity of SSE was assessed in mice individually placed in metabolic cages. After 6â¯h, the urine volume and the electrolyte excretion (Na and K) were measured. The role of prostaglandins and nitric oxide was assessed administrating mice with indomethacin and N(ω)-nitro-L-arginine methyl ester (L-NAME), prior the administration of 100â¯mg/kg SSE. The sedative effects of SSE were analyzed with the pentobarbital-induced sleeping time test. The effects of SSE on motor coordination in mice were evaluated with the rotarod test. The antidepressant-like activity of SSE was analyzed with the forced swimming test (FST) and the tail suspension test (TST). The role of 5-HT2 receptor, α1-and α2-adrenoceptors, or muscarinic receptors was assessed administrating mice with cyproheptadine, prazosin, yohimbine, and atropine, respectively, prior the administration of 100â¯mg/kg SSE in the FST. The anxiolytic-like activity of SSE (10-100â¯mg/kg p.o.) was assessed using the light-dark test (LDB), the elevated plus maze test (EPM), the cylinder exploratory test, and the open field test (OFT). The anticonvulsant effect of SSE (1-100â¯mg/kg) was evaluated in mice administered with different convulsant agents: strychnine, pentylenetetrazol (PTZ), isoniazid (INH) or yohimbine. RESULTS: The main compound found in SSE was D-pinitol (42.2%). SSE (100â¯mg/kg) increased the urinary volume (2.67-fold), as well as the excretion of Na (5.60-fold) and K (7.2-fold). The co-administration of SSE with L-NAME or indomethacin reverted the diuretic activity shown by SSE alone. SSE lacked sedative effects and did not affect motor coordination in mice. SSE (100â¯mg/kg) showed higher and similar antidepressant-like effect, compared to 20â¯mg/kg fluoxetine, in the FST and TST, respectively. The co-administration of SSE with yohimbine reverted the antidepressant-like activity shown by SSE alone. SSE (100â¯mg/kg) showed anxiolytic-like activity in the four models of anxiety, with similar activity with 1.5â¯mg/kg clonazepam. The seizure-protective effect of SSE was ED50â¯=â¯73.9⯱â¯8.4â¯mg/kg (INH) and 40.4⯱â¯5.2â¯mg/kg (yohimbine). CONCLUSION: The diuretic effects of SSE involve the possible contribution of prostaglandins and nitric oxide. SSE showed moderate anxiolytic and anticonvulsant effects, whereas the participation of α2-adrenoceptors is probably associated in the antidepressant-like effects of SSE.
Assuntos
Ansiolíticos/farmacologia , Anticonvulsivantes/farmacologia , Antidepressivos/farmacologia , Antioxidantes/farmacologia , Diuréticos/farmacologia , Extratos Vegetais/farmacologia , Senna , Animais , Ansiolíticos/química , Anticonvulsivantes/química , Antidepressivos/química , Antioxidantes/química , Comportamento Animal/efeitos dos fármacos , Diuréticos/química , Etanol/química , Dose Letal Mediana , Masculino , Camundongos Endogâmicos BALB C , Componentes Aéreos da Planta , Extratos Vegetais/química , Convulsões/tratamento farmacológico , Sono/efeitos dos fármacos , Solventes/químicaRESUMO
Low-carbohydrate diets are considered to be an effective approach to weight loss and have, subsequently, grown in popularity. Despite the apparent health benefits that these diets may provide for insulin resistance, hypertension, and dyslipidemia, their implications on cardiomyocyte oxidative capacity have yet to be investigated. To evaluate the adaptations induced by a 6-week low-carbohydrate, high-fat (LCHF) diet on mitochondrial respiration, two groups of male mice were investigated: Apolipoprotein E-deficient mice on a LCHF diet (L-DIET) and apolipoprotein E-deficient mice on a regular rodent diet (CON). Heart tissue was extracted and used for high-resolution respirometry (HRR), while immunoblotting was performed to quantify mitochondrial density and complexes. The results demonstrate increased expression of all five mitochondrial subunits in the L-DIET group compared to control condition. Furthermore, HRR revealed increased efficiency of substrate consumption, implying augmented oxidative capacity in the L-DIET group. These findings further support the notion that cardiomyocytes prefer lipids as a primary fuel source, by demonstrating that the shift in metabolism caused by a LCHF diet facilitates such an environment. This provides important information regarding the effects of a LCHF on cardiomyocytes, especially when considering free radical production and heart dysfunction.
Assuntos
Apolipoproteínas E/genética , Carboidratos da Dieta/farmacologia , Gorduras na Dieta/farmacologia , Complexo de Proteínas da Cadeia de Transporte de Elétrons/genética , Mitocôndrias/efeitos dos fármacos , Miócitos Cardíacos/efeitos dos fármacos , Animais , Apolipoproteínas E/deficiência , Dieta com Restrição de Carboidratos/métodos , Dieta Hiperlipídica/métodos , Carboidratos da Dieta/metabolismo , Gorduras na Dieta/metabolismo , Complexo de Proteínas da Cadeia de Transporte de Elétrons/agonistas , Complexo de Proteínas da Cadeia de Transporte de Elétrons/metabolismo , Expressão Gênica/efeitos dos fármacos , Masculino , Camundongos , Camundongos Knockout , Mitocôndrias/metabolismo , Miocárdio/citologia , Miocárdio/metabolismo , Miócitos Cardíacos/citologia , Miócitos Cardíacos/metabolismo , Fosforilação Oxidativa/efeitos dos fármacosRESUMO
BACKGROUND: Treatment of facial paralysis in the older population is often relegated to static rather than dynamic reanimation for fear of poor outcomes. This pervasive approach lacks physiologic foundation and is not evidence based. Thus, the authors present an extensive literature review demonstrating weak evidence supporting this misguided concept, followed by detailed outcomes from three centers of the largest reported series to date of patients older than 60 years after reanimation performed using three techniques-lengthening temporalis myoplasty, free functional muscle, and nerve transfers. METHODS: A PubMed search spanning over 40 years identified all reports on reanimation in patients older than 60 years. In addition, detailed demographics, surgical techniques, and outcomes of 30 patients older than 60 years were analyzed. RESULTS: Of 629 articles, only 45 patients were identified, described in case reports or small series, lacking details or consistent long-term follow-up. In the clinical series, average age, preoperative House-Brackmann score, and comorbidities were similar among the groups. Highest excursion was observed in the free functional muscle group, followed by nerve transfer and temporalis myoplasty, averaging 10.4, 6.8, and 3.1 mm, respectively. The most notable philtral deviation correction was in the lengthening temporalis myoplasty group, followed by the free muscle and nerve transfer groups, averaging 5.6, 2.2, and 1.13 mm, respectively. Complication rates were highest in the free functional muscle group. CONCLUSIONS: Facial palsy patients should not be denied dynamic restoration based on age alone. Although surgical technique may vary based on duration of palsy, surgeon experience, and preference, with each presenting advantages and disadvantages, dynamic restoration is feasible regardless of age. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Assuntos
Expressão Facial , Paralisia Facial/cirurgia , Transferência de Nervo/métodos , Procedimentos de Cirurgia Plástica/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Músculos Faciais/inervação , Músculos Faciais/cirurgia , Estudos de Viabilidade , Humanos , Músculo Temporal/transplante , Fatores de Tempo , Resultado do TratamentoRESUMO
The authors performed cadaveric dissections to investigate the existence of an anatomical structure creating and maintaining the cervical mental angle, aiming to understand the anatomical bases of the cervico-mental angle and its modifications over time. Six fresh cadaver dissections were performed; four were done in the Caen University anatomy laboratory one in Paris XV University and one in the Coventry University hospital, England. At the end of this investigation, the authors were able to demonstrate the existence of an anatomical structure in the neck, the cervico-mental angle suspensory ligament. This ligament that fixates the platysma and skin to deeper structures originated from the second branchial arch and seems to play a key role in the formation of the cervico-mental angle and in the anatomical alterations in the ageing process. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Pescoço/cirurgia , Rejuvenescimento , Envelhecimento da Pele/fisiologia , Sistema Musculoaponeurótico Superficial/cirurgia , Cirurgia Plástica/métodos , Idoso , Pontos de Referência Anatômicos/cirurgia , Cadáver , Dissecação , Estética , Feminino , Seguimentos , Humanos , Ligamentos/anatomia & histologia , Ligamentos/cirurgia , Pessoa de Meia-Idade , Pescoço/anatomia & histologia , Medição de Risco , Sistema Musculoaponeurótico Superficial/fisiopatologia , Resultado do TratamentoRESUMO
A number of genes that confer resistance to coffee leaf rust (SH 1-SH 9) have been identified within the genus Coffea, but despite many years of research on this pathosystem, the complementary avirulence genes of Hemileia vastatrix have not been reported. After identification of H. vastatrix effector candidate genes (HvECs) expressed at different stages of its lifecycle, we established an assay to characterize HvEC proteins by delivering them into coffee cells via the type-three secretion system (T3SS) of Pseudomonas syringae pv. garcae (Psgc). Employing a calmodulin-dependent adenylate cyclase assay, we demonstrate that Psgc recognizes a heterologous P. syringae T3SS secretion signal which enables us to translocate HvECs into the cytoplasm of coffee cells. Using this Psgc-adapted effector detector vector (EDV) system, we found that HvEC-016 suppresses the growth of Psgc on coffee genotypes with the SH 1 resistance gene. Suppression of bacterial blight symptoms in SH 1 plants was associated with reduced bacterial multiplication. By contrast, HvEC-016 enhanced bacterial multiplication in SH 1-lacking plants. Our findings suggest that HvEC-016 may be recognized by the plant immune system in a SH 1-dependent manner. Thus, our experimental approach is an effective tool for the characterization of effector/avirulence proteins of this important pathogen.
Assuntos
Basidiomycota/fisiologia , Coffea/genética , Coffea/microbiologia , Resistência à Doença/genética , Proteínas Fúngicas/metabolismo , Genes de Plantas , Doenças das Plantas/microbiologia , Pseudomonas syringae/patogenicidade , Adenilil Ciclases/metabolismo , Sequência de Aminoácidos , Sistemas de Secreção Bacterianos , Basidiomycota/genética , Éxons/genética , Proteínas Fúngicas/química , Regulação da Expressão Gênica de Plantas , Genes Fúngicos , Genótipo , Íntrons/genética , Pseudomonas syringae/crescimento & desenvolvimento , Alinhamento de SequênciaRESUMO
This article reviews the literature on political participation of social workers and the variables that promote or impede political advocacy. Early research in the 1980s and 1990s most often reported education, feelings of efficacy, having a macro-type job, and being a member of a national association as factors that determine greater political participation. Since the late 1990s, organizational and legal issues have surfaced more prominently as barriers to political participation by social workers. This article addresses barriers to participation, such as not feeling competent to perform policy-related tasks and perceived legal barriers.It then analyzes the actual restrictions that nonprofit 501(c)(3) organizations and publicly employed social workers face in lobbying and partisan politics. The article summarizes the activities that are legally allowed in these areas and concludes that social workers can be more politically active than they often realize.
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Defesa do Paciente , Política , Serviço Social/estatística & dados numéricos , Humanos , Manobras Políticas , Comportamento Social , Apoio SocialRESUMO
JUSTIFICATIVA E OBJETIVOS: A endocardite é uma doença em que agentes infecciosos invadem as superfícies endocárdicas, produzindo inflamação e lesões. Sendo muito discutida após a publicação das diretrizes da American Heart Association de 2007. Tais diretrizes têm causado muitas controvérsias na literatura atual, com reflexo na decisão quanto à conduta a ser adotada para sua profilaxia. Dessa forma, este estudo teve por objetivo contribuir na prática clínica, no tocante a real indicação e custo efetividade da profilaxia antimicrobiana para a prevenção da endocardite bacteriana. CONTEÚDO: Este estudo versa sobre a profilaxia da endocardite bacteriana, através de uma revisão da literatura e seus conceitos mais relevantes, discutindo o consenso americano e sua aplicabilidade na realidade brasileira. Para tanto foram feitas duas pesquisas na base de dados da PubMed, Sociedade Brasileira de Cardiologia e Sociedade Brasileira de Odontologia. CONCLUSÃO: A escolha da profilaxia antibiótica deve levar em conta os aspectos atuais de nossa população, bem como a classificação de risco para endocardite e a evolução clínica de cada paciente na prática diária, para uma correta indicação do antibiótico e melhora de seu custo efetividade.
Assuntos
Antibacterianos , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologiaRESUMO
Os autores fazem uma revisão sobre o uso da tomografia computadorizada e da ressonância magnética no estadiamento do câncer de colo do útero.
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Humanos , Feminino , Espectroscopia de Ressonância Magnética , Estadiamento de Neoplasias , Tomografia , Neoplasias do Colo do ÚteroRESUMO
Derrame pleural é o acúmulo anormal de líquido no espaço entre as pleuras parietal e visceral. Para tanto, deve haver um descompasso entre a produção e a reabsorção do líquido pleural, normalmente presente nesse espaço (cavidade pleural), com a finalidade de facilitar o deslizamento pulmonar e, finalmente as trocas gasosas. Nesse artigo, os autores fazem uma abordagem simplificada e diagnóstica dos diferentes tipos de derrame pleural.
Assuntos
Humanos , Masculino , Feminino , Derrame Pleural/diagnósticoRESUMO
A novel chemical class of potent chemoattractant receptor-homologous expressed on Th2 lymphocytes (CRTH2 or DP2) antagonists is reported. An initial and moderately potent spiro-indolinone compound ( 5) was found during a high-throughput screening campaign. Structure-activity relationship (SAR) investigation around the carboxylic acid group revealed that changes in this part of the molecule could lead to a reversal of functional activity, yielding weakly potent agonists. SAR investigation of the succinimide functional group led to the discovery of several single-digit nanomolar antagonists. The potency of these compounds was confirmed in a human eosinophil chemotaxis assay. Moreover, compounds ( R)- 58 and ( R)- 71 were shown to possess pharmacokinetic properties suitable for development as an orally bioavailable drug.
Assuntos
Hipersensibilidade/tratamento farmacológico , Indóis/classificação , Indóis/farmacologia , Receptores Imunológicos/antagonistas & inibidores , Receptores de Prostaglandina/antagonistas & inibidores , Compostos de Espiro/classificação , Compostos de Espiro/farmacologia , Animais , Sítios de Ligação , Células CACO-2 , Permeabilidade da Membrana Celular/efeitos dos fármacos , Cristalografia por Raios X , Inibidores das Enzimas do Citocromo P-450 , Cães , Desenho de Fármacos , Humanos , Indóis/química , Inflamação/tratamento farmacológico , Masculino , Microssomos/efeitos dos fármacos , Microssomos/metabolismo , Modelos Moleculares , Estrutura Molecular , Ratos , Ratos Sprague-Dawley , Compostos de Espiro/química , Estereoisomerismo , Relação Estrutura-AtividadeRESUMO
The application of the evolutionary fragment-based de novo design tool TOPology Assigning System (TOPAS), starting from a known CB1R (CB-1 receptor) ligand, followed by further refinement principles, including pharmacophore compliance, chemical tractability, and drug likeness, allowed the identification of benzodioxoles as a novel CB1R inverse agonist series. Extensive multidimensional optimization was rewarded by the identification of promising lead compounds, showing in vivo activity. These compounds reversed the CP-55940-induced hypothermia in Naval Medical Research Institute (NMRI) mice and reduced body-weight gain, as well as fat mass, in diet-induced obese Sprague-Dawley rats. Herein, we disclose the tools and strategies that were employed for rapid hit identification, synthesis and generation of structure-activity relationships, ultimately leading to the identification of (+)-[( R)-2-(2,4-dichloride-phenyl)-6-fluoro-2-(4-fluoro-phenyl)-benzo[1,3]dioxol-5-yl]-morpholin-4-yl-methanone ( R)-14g . Biochemical, pharmacokinetic, and pharmacodynamic characteristics of ( R)-14g are discussed.
Assuntos
Fármacos Antiobesidade/administração & dosagem , Fármacos Antiobesidade/farmacologia , Benzodioxóis/administração & dosagem , Benzodioxóis/farmacologia , Obesidade/tratamento farmacológico , Receptor CB1 de Canabinoide/agonistas , Animais , Fármacos Antiobesidade/química , Benzodioxóis/síntese química , Benzodioxóis/química , Peso Corporal/efeitos dos fármacos , Cristalografia por Raios X , Cicloexanóis/antagonistas & inibidores , Cicloexanóis/farmacologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Desenho de Fármacos , Humanos , Hipotermia/induzido quimicamente , Ligantes , Masculino , Camundongos , Microssomos/efeitos dos fármacos , Modelos Moleculares , Estrutura Molecular , Ratos , Ratos Sprague-Dawley , Receptor CB1 de Canabinoide/química , Relação Estrutura-AtividadeRESUMO
Replacement of the N-butyl side-chain of lead 5-HT4 receptor antagonist 2 with propanesulfonylpiperidinyl, morpholinyl, and piperazinyl groups led to higher affinity analogs 4-6. In vitro drug metabolism screens and cassette pharmacokinetic studies in the dog led to identification of the N-methylpiperazinyl analog (6b), which displayed pharmacokinetic, selectivity, and safety parameters sufficient for advancement to the clinic for the treatment of urinary incontinence.
Assuntos
Compostos Heterocíclicos com 2 Anéis/química , Compostos Heterocíclicos com 2 Anéis/farmacologia , Antagonistas do Receptor 5-HT4 de Serotonina , Animais , Cães , Compostos Heterocíclicos com 2 Anéis/farmacocinética , Camundongos , Modelos Químicos , Estrutura Molecular , Ratos , Relação Estrutura-Atividade , Suínos , Porco MiniaturaRESUMO
R1481 is a sub-type selective muscarinic receptor antagonist with the potential treatment of overactive bladder. R1481 presents two challenges for drug development. The first is the viscous semi-solid nature of the active pharmaceutical ingredient (API). The second challenge is the poor oral bioavailability of this water soluble, metabolically stable compound due to low intestinal permeability, and the P-glycoprotein (P-gp) efflux mechanism. Vitamin E TPGS is reported by others to enhance bioavailability by increasing the solubility of active compounds and by inhibiting P-gp in the intestine. In this report, compatibility of R1481 in Capmul MCM-based formulations with and without vitamin E TPGS is summarized. Review of accelerated stability studies of oral formulations led to the identification of a soft gelatin capsule formulation using neat Capmul MCM as an acceptable formulation for Phase 1 clinical studies. Soft gelatin capsules (5 mg strength) were manufactured with and without the addition of vitamin E TPGS. Clinical data show that vitamin E TPGS does not improve systemic exposure of R1481 in humans.
Assuntos
Gelatina/sangue , Antagonistas Muscarínicos/sangue , Soluções Farmacêuticas/farmacocinética , Adulto , Animais , Biofarmácia , Cápsulas , Fenômenos Químicos , Química Farmacêutica , Físico-Química , Estudos Cross-Over , Avaliação Pré-Clínica de Medicamentos/métodos , Feminino , Gelatina/administração & dosagem , Gelatina/química , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/administração & dosagem , Antagonistas Muscarínicos/química , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/química , Suínos , Porco Miniatura , Vitamina E/administração & dosagem , Vitamina E/sangue , Vitamina E/químicaRESUMO
A review of the literature revealed mixed reviews on the impact of managed care on mental health service delivery. Research supports that managed care contributes to a reduction in inpatient costs and an increase in outpatient service use. Other studies suggest that there are problems with access and quality of care. An additional issue is whether or not, and to what extent, mental health services are "carved out" from physical health for patients. This study discusses the findings of a qualitative analysis of Medicaid managed care recipients on the barriers and enabling factors to obtaining mental health services in a full carve-out managed care model. Results indicate that reduced access, quality of care problems, and a lack of integration of care exist. Additionally, recipients' interactions with managed care, service providers, and caseworkers affect their mental health care. The results also report on the tactics used by recipients to cope with service problems. Implications for social work practice and research are discussed and recommendations for service delivery and evidence-based education are delineated.