International Journal of Mental Health Systems, 2019
Background: Emerging researchers in low-and middle-income countries (LMIC) face many barriers, in... more Background: Emerging researchers in low-and middle-income countries (LMIC) face many barriers, including inadequacies in funding, international exposure and mentorship. In 2012, the National Institute of Mental Health (NIMH) funded five research hubs aimed at improving the research core for evidence-based mental health interventions, enhancing research skills in global mental health, and providing capacity building (CB) opportunities for early career investigators in LMIC. In this paper emerging researchers contextualize their experiences. Case presentation: Each of the five hubs purposively selected an emerging researcher who had experienced more than one hub-related CB opportunity and actively participated in hub-related clinical trial activities. The five 'voices' were invited to contribute narratives on their professional backgrounds, CB experience, challenges and successes as an emerging mental health researcher, and suggestions for future CB activities. These narratives are presented as case studies. CB activities provided broader learning opportunities for emerging researchers. Benefits included the receipt of research funding, hands-on training and mentorship, as well as exposure to networks and collaborative opportunities on a global scale. To overcome ongoing challenges of access to funding, mentoring, networking and global exposure, the emerging voices recommend making mentorship and training opportunities available to a wider range of emerging mental health researchers. Conclusions: Investing in CB is not enough to ensure sustainability and leave a legacy unless it is accompanied by ongoing mentorship and international exposure. Financial investment in building research capacity, promotion of mentorship and supervision, and international networking are essential to yield well-prepared young investigators in LMIC as experienced by these rising stars. Governments and policymakers should prioritize educational policies to support the continuous development and international engagement of emerging researchers. This can advance strategies to deal with one of most important and costly problems faced by healthcare systems in LMIC: the mental health treatment gap.
Summary— One hundred patients who presented with symptoms of prostatism had both intravenous urog... more Summary— One hundred patients who presented with symptoms of prostatism had both intravenous urography (IVU) and ultrasound examinations. Ultrasound gave as much useful information on the upper urinary tracts as IVU, whilst preliminary results suggested that it is a reliable way of assessing bladder wall thickness and residual urine. The use of this non-invasive, cheap and quick investigation may be more appropriate in many patients who present with symptoms of prostatism.
Background. Latin America Treatment and Innovation Network in Mental Health (LATIN-MH) is a resea... more Background. Latin America Treatment and Innovation Network in Mental Health (LATIN-MH) is a research hub located in Brazil and Peru that conducts a research project to help reduce the treatment gap in mental health in Latin America (LA). Besides its research core, LATIN-MH has a Capacity Building (CB) component that aims to help young researchers receive the specific training to contribute to the growing scientific production in mental health in LA. Methods. LATIN-MH proposal in CB includes a series of actions to prepare professionals in the research area. The main proposals are described here, which include online study groups, promotion of scientific meetings, hands-on training in different levels and sharing of information. Results. LATIN-MH CB activities are at its initial stages but the proposed activities were well evaluated by the participants. The first participating fellows who finished their fellowships are contributing elsewhere in the mental treatment and human resources formation area. Conclusion. The repercussion of LATIN-MH actions in CB and its evaluation, particularly on the formation of human resources and dissemination of information, show that the hub is contributing to the critic formation of young researchers and the circulation of important information.
A utilização das técnicas de reprodução assistida vem possibilitando, nas últimas décadas, a real... more A utilização das técnicas de reprodução assistida vem possibilitando, nas últimas décadas, a realização da vontade de exercer a parentalidade em diferentes contextos e situações, muito além da infertilidade. Aqui são elaboradas reflexões associadas à monoparentalidade buscada, não acidental, considerando contingências específicas, tais como a utilização de sêmen post mortem e a denominada produção independente, seja em indivíduos hetero ou homossexuais. Tais reflexões são eliciadas em virtude da prática clínica à luz da revisão de literatura e debruçam-se sobre as condições que favorecem essa busca, muitas vezes de caráter narcísico e que necessitam de uma escuta e uma interlocução privilegiada no atendimento clínico. Palavras-chave: monoparentalidade; parentalidade póstuma, reprodução assistida, narcisismo.
Background: Mobile health interventions provide significant strategies for improving access to he... more Background: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. Methods: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top-down and bottom-up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic
Two randomized controlled trials (RCTs) in Brazil and Peru demonstrated the effectiveness of CONE... more Two randomized controlled trials (RCTs) in Brazil and Peru demonstrated the effectiveness of CONEMO, a digital intervention supported by trained nurses or nurse assistants (NAs), to reduce depressive symptoms in people with diabetes and/or hypertension. This paper extends the RCTs findings by reflecting on the conditions needed for its wider implementation in routine care services. A qualitative study using semi-structured interviews and content analysis was conducted with nurses/NAs, clinicians, healthcare administrators, and policymakers. Informants reported that CONEMO would be feasible to implement in their health services, but some conditions could be improved before its scale-up: reducing workloads of healthcare workers; raising mental health awareness among clinicians and administrators; being able to inform, deliver and accompany the intervention; assuring appropriate training and supervision of nurses/NAs; and supporting the use of technology in public health services and b...
ASPECTOS HISTÓRICOS E MÍTICOS "O feto é uma criatura viva que se nutre e se move nas cavidad... more ASPECTOS HISTÓRICOS E MÍTICOS "O feto é uma criatura viva que se nutre e se move nas cavidades do corpo materno". Platão (429-347 AC) Durante muito tempo se acreditou que o útero humano era para o feto o equivalente do paraíso, do Éden perdido: ali ele estaria totalmente protegido, na vivência humana mais próxima possível do nirvana, enquanto preparava-se para nascer -e ser. Aparentemente, tudo que acontecia neste período associava-se a experiências agradáveis , de calor e aconchego, penumbra, silêncio, proteção e prazer. O embrião e o feto são considerados símbolos da potencialidade: um estado de não manifestação mas, ao mesmo tempo, a soma de todas as possibilidades do ser . Na mitologia hindu, Hiranyagarbha é o embrião de ouro do Veda, o próprio princípio da vida levado sobre as águas primordiais: é o fogo, o germe da luz que brilha no seio de sua mãe a semente e origem do mundo.
A pesquisa caracterizou-se como estudo transversal com o objetivo de investigar a avaliação auto-... more A pesquisa caracterizou-se como estudo transversal com o objetivo de investigar a avaliação auto-referida da imagem corporal de pacientes idosos com diagnóstico de câncer fora de perspectivas terapêuticas de cura, em tratamento no Ambulatório de Cuidados Paliativos do ICHC-FMUSP e a associação com a representação da doença. Os instrumentos foram: Entrevista semi-dirigida; Produção Gráfica eEscala de Imagem Corporal. Os dados foram analisados quantitativamente por freqüência de conteúdo e qualitativamente pela EDAO, com referencial psicanalítico. Os resultados demonstraram que a amostra não teve inviabilizada sua percepção das possibilidades de adaptação às limitações do quadro clínico nem sua qualidade de vida. Por ser amostra idosa, por si só em momento de crise para muitos indivíduos e ter prognóstico fechado, os dados surpreenderam, o que se justifica pela relação com a equipe, cuja boa assistência interferiu na qualidade de vida e na utilização dos recursos de enfrentament
Considerações Gerais O abortamento espontâneo é um processo que se inscreve no ciclo gravídico-pu... more Considerações Gerais O abortamento espontâneo é um processo que se inscreve no ciclo gravídico-puerperal e que se traduz em aspectos físicos, psicológicos e socioculturais interdependentes. Intercorrência freqüente e de etiologia controversa, é particularmente discutida a participação de variáveis psicológicas em sua ocorrência, numa perspectiva psicossomática. As repercussões emocionais do abortamento espontâneo na vida da mulher e do casal tendem a ser minimizadas culturalmente, especialmente no momento em que a sociedade parece estar mais mobilizada para discutir aspectos concernentes ao controle da natalidade, inclusive através da indução do abortamento, ou se maravilha face às novas técnicas de fertilização assistida, panacéia da esterilidade. Nesse contexto, parece haver pouco espaço para se atentar às vivências associadas à ausência de maternidade/paternidade, quando esta não decorre de uma escolha consciente do casal mas se lhes é imposta através do abortamento espontâneo. Os recentes avanços relacionados à fertilização assistida e seus elevados índices de sucesso vem estimulando diferentes autores a estudarem os aspectos emocionais associados à utilização das diferentes técnicas e suas conseqüências na dinâmica do casal, antes estéril. Esta maternidade, o filho e
The development of assisted reproductive techniques poses important challenges to the work of cli... more The development of assisted reproductive techniques poses important challenges to the work of clinical psychologists. Due to its singularity, posthumous assisted reproduction, exponentially increases these challenges and engages the assisted reproduction team with social representations related to the process, bringing out ethical, important legal and moral issues. There are few studies related to this subject in Portuguese. The authors present data from some research that explore either the opinions about posthumous assisted reproduction or the difficulties inherent to this process, which is inscribed in a serious grief process. The risks related to the process are also presented. They discuss data they collected in a survey developed in social media (Facebook) and among students of a face to face assisted reproduction course, in order to get a grip on society's perceptions on the subject. They suggest guidelines to support the psychologist's work in this context with candidates to posthumous reproduction.
The formation of psychotherapists in our country is done at different levels and in different way... more The formation of psychotherapists in our country is done at different levels and in different ways, as a reflection of a fragmented scientific and professional field. Nowadays, it is considered adequate to refer to this activity in its plural form: psychotherapies, to contemplate the diversity of this field. Considering the particularities of psychotherapies and the fact that different professions are allowed to exercise it, from various theoretical approaches and techniques, the field of psychotherapies presents specific problems and difficulties to be mapped and, accordingly, to propose guidelines to the profession and the formation of psychotherapists. The present paper aims at mapping this situation and proposing guidelines for the main
International Journal of Mental Health Systems, 2019
Background: Emerging researchers in low-and middle-income countries (LMIC) face many barriers, in... more Background: Emerging researchers in low-and middle-income countries (LMIC) face many barriers, including inadequacies in funding, international exposure and mentorship. In 2012, the National Institute of Mental Health (NIMH) funded five research hubs aimed at improving the research core for evidence-based mental health interventions, enhancing research skills in global mental health, and providing capacity building (CB) opportunities for early career investigators in LMIC. In this paper emerging researchers contextualize their experiences. Case presentation: Each of the five hubs purposively selected an emerging researcher who had experienced more than one hub-related CB opportunity and actively participated in hub-related clinical trial activities. The five 'voices' were invited to contribute narratives on their professional backgrounds, CB experience, challenges and successes as an emerging mental health researcher, and suggestions for future CB activities. These narratives are presented as case studies. CB activities provided broader learning opportunities for emerging researchers. Benefits included the receipt of research funding, hands-on training and mentorship, as well as exposure to networks and collaborative opportunities on a global scale. To overcome ongoing challenges of access to funding, mentoring, networking and global exposure, the emerging voices recommend making mentorship and training opportunities available to a wider range of emerging mental health researchers. Conclusions: Investing in CB is not enough to ensure sustainability and leave a legacy unless it is accompanied by ongoing mentorship and international exposure. Financial investment in building research capacity, promotion of mentorship and supervision, and international networking are essential to yield well-prepared young investigators in LMIC as experienced by these rising stars. Governments and policymakers should prioritize educational policies to support the continuous development and international engagement of emerging researchers. This can advance strategies to deal with one of most important and costly problems faced by healthcare systems in LMIC: the mental health treatment gap.
Summary— One hundred patients who presented with symptoms of prostatism had both intravenous urog... more Summary— One hundred patients who presented with symptoms of prostatism had both intravenous urography (IVU) and ultrasound examinations. Ultrasound gave as much useful information on the upper urinary tracts as IVU, whilst preliminary results suggested that it is a reliable way of assessing bladder wall thickness and residual urine. The use of this non-invasive, cheap and quick investigation may be more appropriate in many patients who present with symptoms of prostatism.
Background. Latin America Treatment and Innovation Network in Mental Health (LATIN-MH) is a resea... more Background. Latin America Treatment and Innovation Network in Mental Health (LATIN-MH) is a research hub located in Brazil and Peru that conducts a research project to help reduce the treatment gap in mental health in Latin America (LA). Besides its research core, LATIN-MH has a Capacity Building (CB) component that aims to help young researchers receive the specific training to contribute to the growing scientific production in mental health in LA. Methods. LATIN-MH proposal in CB includes a series of actions to prepare professionals in the research area. The main proposals are described here, which include online study groups, promotion of scientific meetings, hands-on training in different levels and sharing of information. Results. LATIN-MH CB activities are at its initial stages but the proposed activities were well evaluated by the participants. The first participating fellows who finished their fellowships are contributing elsewhere in the mental treatment and human resources formation area. Conclusion. The repercussion of LATIN-MH actions in CB and its evaluation, particularly on the formation of human resources and dissemination of information, show that the hub is contributing to the critic formation of young researchers and the circulation of important information.
A utilização das técnicas de reprodução assistida vem possibilitando, nas últimas décadas, a real... more A utilização das técnicas de reprodução assistida vem possibilitando, nas últimas décadas, a realização da vontade de exercer a parentalidade em diferentes contextos e situações, muito além da infertilidade. Aqui são elaboradas reflexões associadas à monoparentalidade buscada, não acidental, considerando contingências específicas, tais como a utilização de sêmen post mortem e a denominada produção independente, seja em indivíduos hetero ou homossexuais. Tais reflexões são eliciadas em virtude da prática clínica à luz da revisão de literatura e debruçam-se sobre as condições que favorecem essa busca, muitas vezes de caráter narcísico e que necessitam de uma escuta e uma interlocução privilegiada no atendimento clínico. Palavras-chave: monoparentalidade; parentalidade póstuma, reprodução assistida, narcisismo.
Background: Mobile health interventions provide significant strategies for improving access to he... more Background: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. Methods: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top-down and bottom-up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic
Two randomized controlled trials (RCTs) in Brazil and Peru demonstrated the effectiveness of CONE... more Two randomized controlled trials (RCTs) in Brazil and Peru demonstrated the effectiveness of CONEMO, a digital intervention supported by trained nurses or nurse assistants (NAs), to reduce depressive symptoms in people with diabetes and/or hypertension. This paper extends the RCTs findings by reflecting on the conditions needed for its wider implementation in routine care services. A qualitative study using semi-structured interviews and content analysis was conducted with nurses/NAs, clinicians, healthcare administrators, and policymakers. Informants reported that CONEMO would be feasible to implement in their health services, but some conditions could be improved before its scale-up: reducing workloads of healthcare workers; raising mental health awareness among clinicians and administrators; being able to inform, deliver and accompany the intervention; assuring appropriate training and supervision of nurses/NAs; and supporting the use of technology in public health services and b...
ASPECTOS HISTÓRICOS E MÍTICOS "O feto é uma criatura viva que se nutre e se move nas cavidad... more ASPECTOS HISTÓRICOS E MÍTICOS "O feto é uma criatura viva que se nutre e se move nas cavidades do corpo materno". Platão (429-347 AC) Durante muito tempo se acreditou que o útero humano era para o feto o equivalente do paraíso, do Éden perdido: ali ele estaria totalmente protegido, na vivência humana mais próxima possível do nirvana, enquanto preparava-se para nascer -e ser. Aparentemente, tudo que acontecia neste período associava-se a experiências agradáveis , de calor e aconchego, penumbra, silêncio, proteção e prazer. O embrião e o feto são considerados símbolos da potencialidade: um estado de não manifestação mas, ao mesmo tempo, a soma de todas as possibilidades do ser . Na mitologia hindu, Hiranyagarbha é o embrião de ouro do Veda, o próprio princípio da vida levado sobre as águas primordiais: é o fogo, o germe da luz que brilha no seio de sua mãe a semente e origem do mundo.
A pesquisa caracterizou-se como estudo transversal com o objetivo de investigar a avaliação auto-... more A pesquisa caracterizou-se como estudo transversal com o objetivo de investigar a avaliação auto-referida da imagem corporal de pacientes idosos com diagnóstico de câncer fora de perspectivas terapêuticas de cura, em tratamento no Ambulatório de Cuidados Paliativos do ICHC-FMUSP e a associação com a representação da doença. Os instrumentos foram: Entrevista semi-dirigida; Produção Gráfica eEscala de Imagem Corporal. Os dados foram analisados quantitativamente por freqüência de conteúdo e qualitativamente pela EDAO, com referencial psicanalítico. Os resultados demonstraram que a amostra não teve inviabilizada sua percepção das possibilidades de adaptação às limitações do quadro clínico nem sua qualidade de vida. Por ser amostra idosa, por si só em momento de crise para muitos indivíduos e ter prognóstico fechado, os dados surpreenderam, o que se justifica pela relação com a equipe, cuja boa assistência interferiu na qualidade de vida e na utilização dos recursos de enfrentament
Considerações Gerais O abortamento espontâneo é um processo que se inscreve no ciclo gravídico-pu... more Considerações Gerais O abortamento espontâneo é um processo que se inscreve no ciclo gravídico-puerperal e que se traduz em aspectos físicos, psicológicos e socioculturais interdependentes. Intercorrência freqüente e de etiologia controversa, é particularmente discutida a participação de variáveis psicológicas em sua ocorrência, numa perspectiva psicossomática. As repercussões emocionais do abortamento espontâneo na vida da mulher e do casal tendem a ser minimizadas culturalmente, especialmente no momento em que a sociedade parece estar mais mobilizada para discutir aspectos concernentes ao controle da natalidade, inclusive através da indução do abortamento, ou se maravilha face às novas técnicas de fertilização assistida, panacéia da esterilidade. Nesse contexto, parece haver pouco espaço para se atentar às vivências associadas à ausência de maternidade/paternidade, quando esta não decorre de uma escolha consciente do casal mas se lhes é imposta através do abortamento espontâneo. Os recentes avanços relacionados à fertilização assistida e seus elevados índices de sucesso vem estimulando diferentes autores a estudarem os aspectos emocionais associados à utilização das diferentes técnicas e suas conseqüências na dinâmica do casal, antes estéril. Esta maternidade, o filho e
The development of assisted reproductive techniques poses important challenges to the work of cli... more The development of assisted reproductive techniques poses important challenges to the work of clinical psychologists. Due to its singularity, posthumous assisted reproduction, exponentially increases these challenges and engages the assisted reproduction team with social representations related to the process, bringing out ethical, important legal and moral issues. There are few studies related to this subject in Portuguese. The authors present data from some research that explore either the opinions about posthumous assisted reproduction or the difficulties inherent to this process, which is inscribed in a serious grief process. The risks related to the process are also presented. They discuss data they collected in a survey developed in social media (Facebook) and among students of a face to face assisted reproduction course, in order to get a grip on society's perceptions on the subject. They suggest guidelines to support the psychologist's work in this context with candidates to posthumous reproduction.
The formation of psychotherapists in our country is done at different levels and in different way... more The formation of psychotherapists in our country is done at different levels and in different ways, as a reflection of a fragmented scientific and professional field. Nowadays, it is considered adequate to refer to this activity in its plural form: psychotherapies, to contemplate the diversity of this field. Considering the particularities of psychotherapies and the fact that different professions are allowed to exercise it, from various theoretical approaches and techniques, the field of psychotherapies presents specific problems and difficulties to be mapped and, accordingly, to propose guidelines to the profession and the formation of psychotherapists. The present paper aims at mapping this situation and proposing guidelines for the main
Is any pregnancy low risk?" Wilson Schifrin,1980 ( 2 ) O ciclo gravídico-puerperal tem sido descr... more Is any pregnancy low risk?" Wilson Schifrin,1980 ( 2 ) O ciclo gravídico-puerperal tem sido descrito como uma das "crises normativas" no desenvolvimento psicossexual da mulher (BENEDECK,1970; MALDONADO,1976; QUAYLE, 1985;. Como ocorre na adolescência e no climatério, a gestação apresenta à mulher e sua família novos desafios, intimamente relacionados às mudanças corporais em andamento, provocando alterações no equilíbrio psíquico e social previamente existentes. Essa "crise normativa" possibilita a busca de outras formas adaptativas, bem como o desenvolvimento de papéis e funções associados à maternidade. Paralelamente às adaptações físicas exigidas pela gravidez, sobejamente descritas, outras ocorrem, a preparar a mulher para o desempenho de seu papel maternal. A partir da elaboração de conflitos e perdas associados aos diferentes momentos do ciclo gravídicopuerperal e à própria história de uma determinada mulher, em particular, novas configurações adaptativas se estabelecem, favorecendo o desenvolvimento psicológico da gestante, a formação e/ou renovação do núcleo familiar e o fortalecimento do vínculo afetivo do casal..
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