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Pierini MM, Boska GDA, Claro HG, Luz PDO, de Oliveira MAF. The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises. Rev Lat Am Enfermagem 2023; 31:e3848. [PMID: 37283417 PMCID: PMC10243431 DOI: 10.1590/1518-8345.6167.3848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/26/2022] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE (1) To our knowledge, this is the first study to evaluate CAPS AD's ability to handle crises. (2) The ability to handle crises of the CAPS AD from downtown São Paulo was 86.6%. (3) Of the nine users referred to other services, only one evolved to hospitalization. to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users' crises in comprehensive care. METHOD a quantitative, evaluative, and longitudinal study was conducted from February to November 2019. The initial sample consisted of 121 users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14 days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. RESULTS 67 users (54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. CONCLUSION both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.
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Affiliation(s)
- Marianna Martins Pierini
- Universidade Federal de São Paulo, Comissão de Residência Multiprofissional/COREMU, São Paulo, SP, Brasil
| | | | - Heloísa Garcia Claro
- Universidade Estadual de Campinas, Faculdade de Enfermagem, Campinas, SP, Brasil
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Mombelli JMR, Barbosa GC, Claro HG, Boska GDA, Oliveira MAFD. Predictors burden in mental health workers during the COVID-19 pandemic. Rev Bras Enferm 2022; 75Suppl 3:e20210762. [PMID: 35766748 DOI: 10.1590/0034-7167-2021-0762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze burden predictors in mental health workers during the COVID-19 pandemic. METHODS a quantitative study, collected between October and December 2020 through a sociodemographic questionnaire and Mental Health Service Burden Assessment Scale, in four services in a municipality in the state of São Paulo, Brazil, with 108 workers. Descriptive analysis and multiple linear regression of ordinary least squares were performed, in search of predictors for variation in the scale score. RESULTS it showed median work burden (2.03). Predictors: psychological or psychiatric follow-up; normal performance of activities during the pandemic; direct action with suspected or confirmed cases of COVID-19; and belonging to the risk group (people over 60 years of age, diabetics, hypertensive, cardiac, respiratory problems) (p<0.05). CONCLUSIONS working conditions observed during the pandemic, simultaneously with workers' mental health care needs predict burden at work in health.
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de Andrade Boska G, Carvalho Seabra PR, de Oliveira MAF, Garcia Claro H, de Almeida Lopes Fernandes IF. Cultural adaptation and Rasch psychometrics of the Substance Addiction Consequences scale. Nurs Forum 2022; 57:632-639. [PMID: 35383932 DOI: 10.1111/nuf.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
This study aims to adapt and evaluate the validity of the Substance Addiction Consequences scale for the Brazilian community-based addiction setting. This is a psychometric study, conducted in two stages: (1) cultural adaptation and (2) validation using the psychometric Rasch model. The Substance Addiction Consequences derived from the Nursing Outcome Classification comprises 16 items and four domains in the original instrument. We applied the original scale with 200 outpatients at two Psychosocial Care Centers for Alcohol and Drugs in São Paulo, Brazil. The four subscales are suitable for the Rasch model. In 13 of the 16 items, infits and outfits are between 0.5 and 1.5, corresponding to the model's optimal parameters. In addition, we removed one item that distorted the measurement. The psychometrics suggested that the SAC scale is valid with its 15 items and four domains. Therefore, it can be considered appropriate to use in the Brazilian community-based addiction setting.
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Affiliation(s)
| | - Paulo Rosário Carvalho Seabra
- Superior Nursing School of Lisbon and Nursing Research, Innovation and Development Center of Lisbon (CIDNUR), Lisbon, Portugal
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Silva CM, Oliveira VSD, Claro HG, Vargens OMDC. SOCIAL INTERACTION OF WOMEN EXPOSED TO HIV/AIDS: A REPRESENTATIVE MODEL. Texto contexto - enferm 2022. [DOI: 10.1590/1980-265x-tce-2021-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to present the representative model of the social interaction of women exposed to the Human Immunodeficiency Virus and AIDS based on the meanings attributed by them. Method: an interpretative and qualitative research study carried out in Rio de Janeiro, Brazil, from 2017 to 2018, through semi-structured interviews with 17 women who made up four sample groups, in the period between June 2017 and January 2018. The framework for data analysis is the Grounded Theory and Symbolic Interactionism, and the study was ethically approved as required by the National Health Council. Results: for women, the representative model of the social interaction process of exposure to the Human Immunodeficiency Virus and AIDS means “not protecting themselves” and “not being protected by the other”. It is seen as a sloppy, irresponsible and reckless act. The women know the measures to prevent exposure; however, they do not use condoms and acknowledge that they are both exposed and exposing others simultaneously. The central category entitled “Neglecting one's own life although being aware of exposure to the Human Immunodeficiency Virus and AIDS” stands out. Conclusion: understanding this social interaction can contribute to the apprehension of the main factors that influence the construction of these meanings by women, thus helping them to give a new meaning to this exposure and allowing them to modify their actions to protect themselves and others against AIDS. Consequently, effective assistance based on preservation of life is encouraged, with a view to comprehensive care to women and reducing their exposure to infection.
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Mombelli JMR, Barbosa GC, Claro HG, Boska GDA, Oliveira MAFD. Preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0762pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivos: analisar os preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19. Métodos: estudo quantitativo, coletado entre outubro e dezembro de 2020 por meio de questionário sociodemográfico e Escala de Avaliação da Sobrecarga de Profissionais em Serviços de Saúde Mental, em quatro serviços de um município do estado de São Paulo, Brasil, com 108 trabalhadores. Realizou-se análise descritiva e regressão linear múltipla de mínimos quadrados ordinários, em busca de preditores para a variação no escore da escala. Resultados: evidenciou-se mediana sobrecarga de trabalho (2,03). Preditores: acompanhamento psicológico ou psiquiátrico; desempenho normal das atividades durante a pandemia; atuação direta com casos suspeitos ou confirmados de COVID-19; e pertencer ao grupo de risco (pessoas acima de 60 anos, diabéticos, hipertensos, cardiopatas, problemas respiratórios) (p<0,05). Conclusões: condições de trabalho observadas durante a pandemia, simultaneamente com necessidades de cuidado à saúde mental dos trabalhadores, predizem sobrecarga no trabalho em saúde.
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Daley K, Hungerbuehler I, Cavanagh K, Claro HG, Swinton PA, Kapps M. Preliminary Evaluation of the Engagement and Effectiveness of a Mental Health Chatbot. Front Digit Health 2021; 2:576361. [PMID: 34713049 PMCID: PMC8521874 DOI: 10.3389/fdgth.2020.576361] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/10/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Mental health difficulties are highly prevalent, yet access to support is limited by barriers of stigma, cost, and availability. These issues are even more prevalent in low- and middle-income countries, and digital technology is one potential way to overcome these barriers. Digital mental health interventions are effective but often struggle with low engagement rates, particularly in the absence of human support. Chatbots could offer a scalable solution, simulating human support at a lower cost. Objective: To complete a preliminary evaluation of engagement and effectiveness of Vitalk, a mental health chatbot, at reducing anxiety, depression and stress. Methods: Real world data was analyzed from 3,629 Vitalk users who had completed the first phase of a Vitalk program (“less anxiety,” “less stress” or “better mood”). Programs were delivered through written conversation with a chatbot. Engagement was calculated from the number of responses sent to the chatbot divided by days in the program. Results: Users sent an average of 8.17 responses per day. For all three programs, target outcome scores reduced between baseline and follow up with large effect sizes for anxiety (Cohen's d = −0.85), depression (Cohen's d = −0.91) and stress (Cohen's d = −0.81). Increased engagement resulted in improved post-intervention values for anxiety and depression. Conclusion: This study highlights a chatbot's potential to reduce mental health symptoms in the general population within Brazil. While findings show promise, further research is required.
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Affiliation(s)
| | | | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Heloísa Garcia Claro
- Department of Preventive Medicine, Medical School, University of São Paulo, São Paulo, Brazil.,School of Nursing, University of Campinas, Campinas, Brazil
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
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Vera Cruz Dos Santos D, Coelho de Soárez P, Cavero V, U Rocha TI, Aschar S, Daley KL, Garcia Claro H, Abud Scotton G, Fernandes I, Diez-Canseco F, Brandt LR, Toyama M, Martins Castro HC, Miranda JJ, Araya R, Quayle J, Rossi Menezes P. A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru. JMIR Res Protoc 2021; 10:e26164. [PMID: 34643538 PMCID: PMC8552099 DOI: 10.2196/26164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/04/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
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 evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. Results The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. Conclusions We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. Trial Registration ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426 International Registered Report Identifier (IRRID) DERR1-10.2196/26164
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Affiliation(s)
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Victoria Cavero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Thaís I U Rocha
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Suzana Aschar
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Kate Louise Daley
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Heloísa Garcia Claro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, Brazil
| | - George Abud Scotton
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan Fernandes
- CECS Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, São Bernardo do Campo, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lena Rebeca Brandt
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mauricio Toyama
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Araya
- Centre for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Julieta Quayle
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Rossi Menezes
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Boska GDA, Seabra PRC, Oliveira MAFD, Fernandes IFDAL, Claro HG, Sequeira RMR. Consequences of psychoactive substance use: a comparative study of two services in Brazil and Portugal. Rev Esc Enferm USP 2021; 55:e20210138. [PMID: 34516604 DOI: 10.1590/1980-220x-reeusp-2021-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/01/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To compare the consequences of psychoactive substance use among users of mental health services in Brazil and Portugal. METHOD Cross-sectional, comparative, quantitative study, carried out with 362 users of two specialized treatment services in the cities of São Paulo (n = 200) and Lisbon (n = 162). Data collected in 2019 through the application of the Substance Addiction Consequences scale. A descriptive analysis and ordinary least squares and logistic regressions were performed. RESULTS All dimensions assessed by the scale were more severe for Brazilian users, with a difference for the physical domain and cognitive skills (p < 0.01). Brazilian participants were more likely to consume cocaine (p < 0.01) and have psychosis (p = 0.02) and Portuguese participants to have hepatitis (p < 0.01), personality disorders (p < 0.01), use benzodiazepines (p < 0.01) and tobacco (p < 0.01), and receive pharmacological support (p < 0.01). CONCLUSION It was found that Brazilian users have more serious consequences related to substance use, and Portuguese users have more comorbidities and exposure to risky consumption. It emerges that Portuguese responses minimize the consequences severity.
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Affiliation(s)
- Gabriella de Andrade Boska
- Universidade de São Paulo, Escola de Enfermagem, Grupo de Estudos em Álcool e outras Drogas, São Paulo, SP, Brazil
| | | | | | | | - Heloísa Garcia Claro
- Universidade Estadual de Campinas, Faculdade de Enfermagem, Campinas, SP, Brazil
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Silva CM, Toriyama ATM, Claro HG, Borghi CA, Castro TR, Salvador PICA. COVID-19 pandemic, emergency remote teaching and Nursing Now: challenges for nursing education. ACTA ACUST UNITED AC 2021; 42:e20200248. [PMID: 34037183 DOI: 10.1590/1983-1447.2021.20200248] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To discuss remote activities in nursing education in the context of the COVID-19 pandemic for strengthening nursing from the perspective of the "Nursing Now" campaign. METHOD Theoretical-reflective study based on literature and critical analysis. DISCUSSION Reflection about the measures to control the COVID-19 pandemic and suspend in-person classes, the adoption of alternative forms of teaching, especially online ones, and their repercussions on nursing teaching strategies. There were difficulties regarding the quality of education, unequal access, and lack of knowledge from professors. FINAL CONSIDERATIONS The negative impact that emergency distance teaching had on the education of nurses stands out, in contrast to the world movement for the valuing of nurses. The legacy of this crisis must be taken advantage of through the better use of technological resources and their incorporation in teaching, having as a certainty that the distance teaching model does not encompass the totality of nursing education.
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Affiliation(s)
- Carla Marins Silva
- Universidade de São Paulo (USP), Escola de Enfermagem, Departamento Materno-infantil e psiquiátrico. São Paulo, São Paulo, Brasil
| | - Aurea Tamami Minagawa Toriyama
- Universidade de São Paulo (USP), Escola de Enfermagem, Departamento Materno-infantil e psiquiátrico. São Paulo, São Paulo, Brasil
| | - Heloísa Garcia Claro
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Enfermagem. Campinas, São Paulo, Brasil
| | - Camila Amaral Borghi
- Universidade Municipal de São Caetano do Sul (USCS), Escola de Saúde, Faculdade de Medicina. São Paulo, São Paulo, Brasil
| | - Thaís Rojas Castro
- Universidade de São Paulo (USP), Escola de Enfermagem, Departamento Materno-infantil e psiquiátrico. São Paulo, São Paulo, Brasil
| | - Pedro Ivo Camacho Alves Salvador
- Universidade Federal do ABC (UFABC), Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas. São Bernardo do Campo, São Paulo, Brasil
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Araya R, Menezes PR, Claro HG, Brandt LR, Daley KL, Quayle J, Diez-Canseco F, Peters TJ, Vera Cruz D, Toyama M, Aschar S, Hidalgo-Padilla L, Martins H, Cavero V, Rocha T, Scotton G, de Almeida Lopes IF, Begale M, Mohr DC, Miranda JJ. Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru: Two Randomized Clinical Trials. JAMA 2021; 325:1852-1862. [PMID: 33974019 PMCID: PMC8114139 DOI: 10.1001/jama.2021.4348] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Importance Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. Objective To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. Design, Setting, and Participants Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). Interventions An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). Main Outcomes and Measures The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. Results Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. Conclusions and Relevance In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. Trial Registration ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima).
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Affiliation(s)
- Ricardo Araya
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Paulo Rossi Menezes
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Heloísa Garcia Claro
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- School of Nursing, Universidade Estadual de Campinas, Campinas, Brazil
| | - Lena R. Brandt
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kate L. Daley
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Julieta Quayle
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tim J. Peters
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Daniela Vera Cruz
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Mauricio Toyama
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Suzana Aschar
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Liliana Hidalgo-Padilla
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hellen Martins
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Victoria Cavero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Thais Rocha
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - George Scotton
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan F. de Almeida Lopes
- Federal University of ABC, Engineering, Modeling and Applied Social Sciences Center (CECS), Santo André, Brazil
| | - Mark Begale
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Hungerbuehler I, Daley K, Cavanagh K, Garcia Claro H, Kapps M. Chatbot-Based Assessment of Employees' Mental Health: Design Process and Pilot Implementation. JMIR Form Res 2021; 5:e21678. [PMID: 33881403 PMCID: PMC8100879 DOI: 10.2196/21678] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/10/2020] [Accepted: 03/17/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Stress, burnout, and mental health problems such as depression and anxiety are common, and can significantly impact workplaces through absenteeism and reduced productivity. To address this issue, organizations must first understand the extent of the difficulties by mapping the mental health of their workforce. Online surveys are a cost-effective and scalable approach to achieve this but typically have low response rates, in part due to a lack of interactivity. Chatbots offer one potential solution, enhancing engagement through simulated natural human conversation and use of interactive features. OBJECTIVE The aim of this study was to explore if a text-based chatbot is a feasible approach to engage and motivate employees to complete a workplace mental health assessment. This paper describes the design process and results of a pilot implementation. METHODS A fully automated chatbot ("Viki") was developed to evaluate employee risks of suffering from depression, anxiety, stress, insomnia, burnout, and work-related stress. Viki uses a conversation style and gamification features to enhance engagement. A cross-sectional analysis was performed to gain first insights of a pilot implementation within a small to medium-sized enterprise (120 employees). RESULTS The response rate was 64.2% (77/120). In total, 98 employees started the assessment, 77 of whom (79%) completed it. The majority of participants scored in the mild range for anxiety (20/40, 50%) and depression (16/28, 57%), in the moderate range for stress (10/22, 46%), and at the subthreshold level for insomnia (14/20, 70%) as defined by their questionnaire scores. CONCLUSIONS A chatbot-based workplace mental health assessment seems to be a highly engaging and effective way to collect anonymized mental health data among employees with response rates comparable to those of face-to-face interviews.
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Affiliation(s)
| | | | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Heloísa Garcia Claro
- School of Nursing, University of Campinas, Campinas, Brazil.,Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil
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Rocha TIU, Aschar SCDAL, Hidalgo-Padilla L, Daley K, Claro HG, Martins Castro HC, dos Santos DVC, Miranda JJ, Araya R, Menezes PR. Recruitment, training and supervision of nurses and nurse assistants for a task-shifting depression intervention in two RCTs in Brazil and Peru. Hum Resour Health 2021; 19:16. [PMID: 33546709 PMCID: PMC7863440 DOI: 10.1186/s12960-021-00556-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. METHODS We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. RESULTS We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other's experiences. CONCLUSION Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).
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Affiliation(s)
- Thais Izabel Ugeda Rocha
- Faculty of Medicine of Sao Paulo University-Preventive Medicine Department, Av. Dr. Arnaldo, 455-Cerqueira César, sala 2364, Sao Paulo, SP 01246-903 Brazil
| | | | - Liliana Hidalgo-Padilla
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima, Peru
| | - Kate Daley
- Faculty of Medicine of Sao Paulo University-Preventive Medicine Department, Av. Dr. Arnaldo, 455-Cerqueira César, sala 2364, Sao Paulo, SP 01246-903 Brazil
| | - Heloísa Garcia Claro
- Faculty of Medicine of Sao Paulo University-Preventive Medicine Department, Av. Dr. Arnaldo, 455-Cerqueira César, sala 2364, Sao Paulo, SP 01246-903 Brazil
| | - Hellen Carolina Martins Castro
- Faculty of Medicine of Sao Paulo University-Preventive Medicine Department, Av. Dr. Arnaldo, 455-Cerqueira César, sala 2364, Sao Paulo, SP 01246-903 Brazil
| | - Daniela Vera Cruz dos Santos
- Faculty of Medicine of Sao Paulo University-Preventive Medicine Department, Av. Dr. Arnaldo, 455-Cerqueira César, sala 2364, Sao Paulo, SP 01246-903 Brazil
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima, Peru
| | - Ricardo Araya
- Centre for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 18 De Crespigny Park, London, SE5 8AF UK
| | - Paulo Rossi Menezes
- Faculty of Medicine of Sao Paulo University-Preventive Medicine Department, Av. Dr. Arnaldo, 455-Cerqueira César, sala 2364, Sao Paulo, SP 01246-903 Brazil
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Silva IFD, Boska GDA, Oliveira MAFD, Claro HG, Araújo RDA, Souza MRCF. NURSING CARE IN ALCOHOL WITHDRAWAL SYNDROME: CARE FLOWCHART. REME 2021. [DOI: 10.5935/1415.2762.20210032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Smith DC, Davis JP, Shen S, Garcia Claro H. The Emerging Adult Reasons for Substance Use (EARS): Preliminary Support for Multidimensionality, Validity and Reliability. Subst Use Misuse 2021; 56:297-307. [PMID: 33380243 DOI: 10.1080/10826084.2020.1862233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Substance use peaks during the transition to adulthood, beckoning additional research on its developmental influences. This article reports initial findings on the validity and reliability of the Emerging Adult Reasons for Substance use (EARS), a new measure of substance use motives based on Arnett's (2000) proposed emerging adult dimensions. Method: Content experts in emerging adulthood theory generated EARS items and collected data from a large online sample. We completed exploratory (EFA) and confirmatory factor analyses (CFA) on split halves of the total sample (n = 750). Then, we tested for invariance across genders and age cohorts, as well as examined cross-correlations with the Inventory of Dimensions of Emerging Adulthood (IDEA), Drinking Motives Questionnaire (DMQ-Revised), and measures of substance use. Results: The EFA identified three internally consistent factors: Normative Expectancy, Developmental Strain, and Subjective Invulnerability. Confirmatory factor analyses supported the three factor model, but fit indices were slightly below published standards (RSMEA = .82, CFI = .85, TLI = .83, SRMR = .07). For Normative Expectancy and Developmental Strain, intercepts varied across age cohorts, with higher intercepts for emerging relative to older adults. The patterns of correlations generally supported the construct validity of the EARS subscales. Conclusion: The EARS is reliable and valid, and appears to measure developmentally specific motives for substance use. Additional studies may further validate this promising instrument.
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Affiliation(s)
- Douglas C Smith
- School of Social Work, The University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Center for Prevention Research and Development, Champaign, IL, USA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society; USC Center for Mindfulness Science; USC Institute of Addiction Science; University of Southern California, Los Angeles, CA
| | - Sa Shen
- Center on Health Aging and Disability, The University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Silva NND, Oliveira MAFD, Oliveira MSRD, Claro HG, Fernandes IFDAL, Boska GDA, Bosque RM. Satisfaction of black and non-black individuals assisted at the Alcohol and Drugs Psychosocial Care Center. Saúde debate 2020. [DOI: 10.1590/0103-1104202012719i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este artigo objetivou analisar comparativamente a satisfação de indivíduos negros e não negros assistidos por Centros de Atenção Psicossocial em Álcool e Outras Drogas de três estados brasileiros. É um estudo quantitativo, transversal e avaliativo, cujos dados foram coletados por meio de entrevistas seguidas de análise inferencial. Participaram do estudo 707 indivíduos, a maioria homens, autodeclarados negros, com média de idade de 44 anos. Os resultados mostraram que indivíduos negros e não negros estavam igualmente satisfeitos com a assistência ofertada, sobretudo com a competência e compreensão dos profissionais, acolhimento e ajuda recebida, o que contradiz a literatura tradicional que desvela racismo nos serviços de saúde. A avalição é a de que os Centros de Atenção Psicossocial em Álcool e Outras Drogas são locais potentes e diferenciados do sistema de saúde, mais acolhedores e inclusivos, para o cuidado de qualquer tipo de população com necessidades decorrentes do uso de substâncias. Esse resultado é coerente com a história desses dispositivos de saúde em nosso país, sendo serviços centrais da rede substitutiva aos cuidados hegemônicos e asilares.
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Silva NND, Oliveira MAFD, Oliveira MSRD, Claro HG, Fernandes IFDAL, Boska GDA, Bosque RM. Satisfação de negros e não negros assistidos por Centros de Atenção Psicossocial em Álcool e Outras Drogas. Saúde debate 2020. [DOI: 10.1590/0103-1104202012719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este artigo objetivou analisar comparativamente a satisfação de indivíduos negros e não negros assistidos por Centros de Atenção Psicossocial em Álcool e Outras Drogas de três estados brasileiros. É um estudo quantitativo, transversal e avaliativo, cujos dados foram coletados por meio de entrevistas seguidas de análise inferencial. Participaram do estudo 707 indivíduos, a maioria homens, autodeclarados negros, com média de idade de 44 anos. Os resultados mostraram que indivíduos negros e não negros estavam igualmente satisfeitos com a assistência ofertada, sobretudo com a competência e compreensão dos profissionais, acolhimento e ajuda recebida, o que contradiz a literatura tradicional que desvela racismo nos serviços de saúde. A avalição é a de que os Centros de Atenção Psicossocial em Álcool e Outras Drogas são locais potentes e diferenciados do sistema de saúde, mais acolhedores e inclusivos, para o cuidado de qualquer tipo de população com necessidades decorrentes do uso de substâncias. Esse resultado é coerente com a história desses dispositivos de saúde em nosso país, sendo serviços centrais da rede substitutiva aos cuidados hegemônicos e asilares.
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Menezes P, Quayle J, Garcia Claro H, da Silva S, Brandt LR, Diez-Canseco F, Miranda JJ, Price LN, Mohr DC, Araya R. Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru. JMIR Ment Health 2019; 6:e11698. [PMID: 31025949 PMCID: PMC6658291 DOI: 10.2196/11698] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/21/2018] [Accepted: 01/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders. OBJECTIVE This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs). METHODS Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up. RESULTS The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings. CONCLUSIONS The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants' depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings.
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Affiliation(s)
- Paulo Menezes
- Population Mental Health Research Centre, Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil.,Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil
| | - Julieta Quayle
- Population Mental Health Research Centre, Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Heloísa Garcia Claro
- Population Mental Health Research Centre, Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Simone da Silva
- Population Mental Health Research Centre, Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | - Lena R Brandt
- Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - LeShawndra N Price
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Ricardo Araya
- Centre for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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da Silva ATC, Hanlon C, Susser E, Rojas G, Claro HG, Quayle J, Habtamu K, Burrone MS, Cavalcanti MT, Sharma M, Schneider M, Adhikari RP, van de Water T, Mohammed Y, Ordóñez AE, Seedat S. Enhancing mental health research capacity: emerging voices from the National Institute of Mental Health (NIMH) global hubs. Int J Ment Health Syst 2019; 13:21. [PMID: 30988696 PMCID: PMC6446384 DOI: 10.1186/s13033-019-0276-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/19/2019] [Indexed: 01/06/2023] Open
Abstract
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.
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Affiliation(s)
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ezra Susser
- Columbia University, New York State Psychiatric Institute, New York City, New York USA
| | - Graciela Rojas
- Faculty of Medicine, University of Chile, Santiago, Chile
| | - Heloísa Garcia Claro
- Departmente of Preventive Medicine, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Julieta Quayle
- Departmente of Preventive Medicine, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Kassahun Habtamu
- School of Psychology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Mona Sharma
- Center for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
| | - Marguerite Schneider
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Tanya van de Water
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yasmin Mohammed
- Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anna E. Ordóñez
- Office of Clinical Research, National Institute of Mental Health, NIH in the United States, Bethesda, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Boska GDA, Oliveira MAFD, Claro HG, Araujo TSGD, Pinho PH. Night beds in psychosocial attention care centers for alcohol and drugs: analysis and characterization. Rev Bras Enferm 2018; 71:2251-2257. [PMID: 30365791 DOI: 10.1590/0034-7167-2018-0149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/09/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze and characterize the use of night beds in a Psychosocial Attention Care Center for Alcohol and Drugs (Centro de Atenção Psicossocial Álcool e Drogas - CAPS ad). METHOD It is a quantitative, documental, descriptive and retrospective study. Data were gathered from 565 medical records. An analysis of continuous variables was performed. RESULTS When admitted to the beds, most users (87.6%) consumed multiple substances daily and were vulnerable, specially in street situation (68.3%). These users were admitted on an average of two times, undergoing a previous evaluation by the nurse (85.8%), usually for detoxication or due to the vulnerable condition. They stayed in the center for an average of seven days and 31.1% did not finish what was proposed. For a few cases, hospital support was needed. Overall, discharges were planned, but the return happened without booking. CONCLUSION Social issues cut through the use of night beds, however, it is a therapeutic resource that meets significant demands and is present in the daily lives of vulnerable users as a comprehensive care.
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Affiliation(s)
| | | | | | | | - Paula Hayasi Pinho
- Universidade Federal do Recôncavo da Bahia. Santo Antônio de Jesus, Bahia, Brazil
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Claro HG, de Oliveira MAF, Bourdreaux JT, Fernandes IFDAL, Pinho PH, Tarifa RR. Drug use, mental health and problems related to crime and violence: cross-sectional study. Rev Lat Am Enfermagem 2018; 23:1173-80. [PMID: 26626010 PMCID: PMC4664019 DOI: 10.1590/0104-1169.0478.2663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 07/04/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: to investigate the correlation between disorders related to the use of alcohol
and other drugs and symptoms of mental disorders, problems related to crime and
violence and to age and gender. Methods: cross-sectional descriptive study carried out with 128 users of a Psychosocial
Care Center for Alcohol and other Drugs, in the city of São Paulo, interviewed by
means of the instrument entitled Global Appraisal of Individual Needs - Short
Screener. Univariate and multiple linear regression models were used to verify the
correlation between the variables. Results: using univariate regression models, internalizing and externalizing symptoms and
problems related to crime/violence proved significant and were included in the
multiple model, in which only the internalizing symptoms and problems related to
crime and violence remained significant. Conclusions: there is a correlation between the severity of problems related to alcohol use
and severity of mental health symptoms and crime and violence in the study sample.
The results emphasize the need for an interdisciplinary and intersectional
character of attention to users of alcohol and other drugs, since they live in a
socially vulnerable environment.
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Pinho PH, Oliveira MAF, Pereira MO, Claro HG, Soares RH, Gonçalves RMDA. Atitudes das equipes dos serviços de atenção psicossocial em álcool e drogas. Psipesq 2018. [DOI: 10.24879/201800120010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Considerando que as atitudes dos profissionais de saúde influenciam suas práticas assistenciais, objetivou-se mensurar as atitudes desses profissionais frenteao álcool, alcoolismo e alcoolista. Foram entrevistados 288 profissionais de 12 Centros de Atenção Psicossocial Álcool/Drogas por meio da Escala de AtitudesFrente ao Álcool, Alcoolismo e Alcoolista. Apontou-se tendência a atitudes positivas, sobretudo dos profissionais com nível superior e que desenvolviamintervenções dirigidas a alertar os riscos do consumo do álcool e a desenvolver consciência crítica dos problemas. Entretanto, os trabalhadores apresentaramatitudes negativas frente à etiologia do alcoolismo e aqueles que desenvolviam intervenções dirigidas à abstinência apresentaram atitudes menos positivas.
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Garcia Claro H, Ferreira de Oliveira MA, de Almeida Lopes Fernandes IF, Titus JC, Ribeiro Tarifa R, Fernandes Rojas T, Hayasi Pinho P. Internal Consistency and Convergent Validity of the Portuguese Versions of the Global Appraisal of Individual Needs-Initial and Short Screener: Validity of the Portuguese GAIN-I and SS. J Addict Nurs 2017; 27:241-246. [PMID: 27922475 PMCID: PMC5145254 DOI: 10.1097/jan.0000000000000143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of this article is to present evidence on the internal consistency and convergent validity of the Brazilian Portuguese versions of the Global Appraisal of Individual Needs-"Initial" and "Short Screener" versions. METHODS One hundred sixty-eight individuals from an inpatient service and/or a community-based outpatient service located in São Paulo were interviewed using the Brazilian Portuguese versions of the instruments. The internal consistency of the instruments scales was computed, along with evidence for the convergent validity between corresponding subscales of the Initial and Short Screener instruments. RESULTS Cronbach's alpha values for both instruments' total scale scores were greater than .7. The Short Screener scales showed strong-to-moderate correlations with corresponding subscales of the Initial. The General Individual Severity Scale from the Initial and Total Disorder Screener from the Short Screener have convergent validity with each other (ρ = 0.801). CONCLUSIONS The Brazilian Portuguese instrument scales showed evidence for internal consistency and convergent validity performing similarly to the American English versions.
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Affiliation(s)
- Heloísa Garcia Claro
- Heloísa Garcia Claro, BSN, MSc, PhD, Márcia Aparecida Ferreira de Oliveira, BSN, MSc, PhD, Rosana Ribeiro Tarifa, BSN, MSc, Thais Fernandes Rojas, BSN, and Paula Hayasi Pinho, PhD, School of Nursing, University of São Paulo, Brazil. Ivan Filipe de Almeida Lopes Fernandes, MSc, PhD, Federal University of ABC, São Bernardo do Campo, São Paulo, Brazil. Janet C. Titus, PhD, Chestnut Health Systems, Normal, Illinois
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Pereira MO, Oliveira MAFD, Pinho PH, Claro HG, Gonçalves AM, Reinaldo AMDS. What is the emphasis of Brazilian drug policy: resocialization or internment? Esc Anna Nery 2017. [DOI: 10.1590/2177-9465-ean-2017-0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To analyze the discourses of public managers, at the municipal and state levels of the city of São Paulo - Brazil and of community services that serve users dependent on drugs with mental disorders, in order to confront them with the current public policies of the Brazilian Ministry of Health and Check whether they have advanced or receded. Methods: Cross-sectional, interpretive qualitative study was carried out with four public managers and community service providers who attend drug users. Data were collected through semi-structured interviews. Results: The speeches indicated that despite the fact that despite participant health managers indicate which direction should be given the care to drug users, under some aspects, public policies in the last six years have receded. Conclusion: The Policy advanced with the structuring of the psychosocial care network and articulation with a single network of social assistance, among others, but fell back when it introduced the therapeutic communities in the health network and promoted hospitalizations with public funding.
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Garcia Claro H, Ferreira de Oliveira MA, Almeida Lopes Fernandes IFD, Titus JC, Ribeiro Tarifa R, Fernandes Rojas T, Hayasi Pinho P. Rasch model of the GAIN substance problem scale among inpatient and outpatient clients in the city of São Paulo, Brazil. Addict Behav Rep 2015. [PMID: 29531994 PMCID: PMC5845976 DOI: 10.1016/j.abrep.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction This study used the Rasch model to evaluate the psychometric properties of the Portuguese version of the Substance Problem Scale (SPS) of the “Global Appraisal of Individual Needs - Initial” for use in Brazil. The SPS measures alcohol and drug problem severity within a DSM-IV-TR framework. The goal of the Rasch analysis was to assess scale dimensionality, item severity, and differential item functioning (DIF). Methods Data was collected from 40 inpatients and 70 outpatients in São Paulo, Brazil. The Rasch model fit and DIF by gender and level of care were examined. Results The SPS fit the Rasch model, with no items distorting the measure. Only three of the sixteen items performed differently between men and women and three performed differently by level of care. Conclusions The results were compatible with those from Rasch analyses of the American English and Canadian English versions of the scale. The Portuguese version of the SPS is, thus, valid for use in Brazil, both with men and women in inpatient and outpatient programs.
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Affiliation(s)
- Heloísa Garcia Claro
- University of São Paulo, School of Nursing, EEUSP, Av. Dr. Enéas de Carvalho Aguiar, 419, 05403-000 São Paulo, Brazil
- Corresponding author.
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Oliveira MAFD, Cestari TY, Pereira MO, Pinho PH, Gonçalves RMDDA, Claro HG. Processos de avaliação de serviços de saúde mental: uma revisão integrativa da literatura. Saúde em Debate 2014. [DOI: 10.5935/0103-1104.20140034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Claro HG, Oliveira MAFD, Paglione HB, Soares RH, Okazaki C, Vargas DD. Estratégias e possibilidades da entrevista motivacional na adolescência: revisão integrativa. Texto contexto - enferm 2013. [DOI: 10.1590/s0104-07072013000200033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Observa-se o aumento de uso de drogas por adolescentes e o surgimento de estudos que apresentam a Entrevista Motivacional como possibilidade terapêutica para esta população. Este estudo objetiva revisar na literatura informações acerca da eficácia da Entrevista Motivacional para uso com adolescentes usuários de álcool e outras drogas. Foi realizada uma revisão integrativa da literatura nacional e internacional, utilizando-se os descritores motivational interviewing e adolescents, e foram incluídos na análise um total de 22 artigos. Estudos apontam a Entrevista Motivacional como técnica promissora, revelando diminuição do padrão de uso de drogas pelos adolescentes estudados. Esta técnica mostrou-se eficaz para uso com adolescentes, entretanto estudos sobre esta temática são muito recentes e escassos, o que sugere novas investigações.
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Claro HG, Oliveira MAFD, Paglione HB, Pinho PH, Pereira MO, Vargas DD. Tradução e adaptação cultural do global appraisal of individual needs - initial. Rev Esc Enferm USP 2012; 46:1148-55. [PMID: 23223731 DOI: 10.1590/s0080-62342012000500016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 02/17/2012] [Indexed: 11/22/2022] Open
Abstract
Este estudo objetivou traduzir e adaptar culturalmente o instrumento Global Appraisal of Individual Needs - Initial e calcular seu Índice de Validade de Conteúdo. Trata-se de estudo metodológico, de adaptação cultural do instrumento. O instrumento foi traduzido para o português em duas versões que deram origem à síntese das traduções, submetida à avaliação de quatro juízes experts na área de álcool e outras drogas. Após modificações, foi retraduzido e ressubmetido aos juízes e autores do instrumento original, resultando na versão final do instrumento, Avaliação Global das Necessidades Individuais - Inicial O Índice de Validade de Conteúdo do instrumento foi de 0,91, considerado válido pela literatura. O instrumento Avaliação Global das Necessidades Individuais - Inicial é um instrumento adaptado culturalmente para o português falado no Brasil; entretanto, não foi submetido a testes com a população-alvo, o que sugere que sejam realizados estudos que testem sua confiabilidade e validade.
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Barros S, Claro HG. Processo ensino aprendizagem em saúde mental: o olhar do aluno sobre reabilitação psicossocial e cidadania. Rev Esc Enferm USP 2011; 45:700-7. [DOI: 10.1590/s0080-62342011000300022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 09/06/2010] [Indexed: 11/22/2022] Open
Abstract
As políticas de Saúde Mental vigentes no país confirmam necessidade de estimular práticas de ensino, pesquisa e extensão que favoreçam novas atitudes profissionais. Estudo anterior revelou que a representação de alunos sobre competências necessárias na saúde mental, conforma categorias sobre conceitos de competência, recursos cognitivos, sentimentos expressos e conceito de saúde e doença, não se depreendendo temas relacionados à Cidadania ou à Reabilitação Psicossocial dos usuários, conceitos centrais no ensino da disciplina. Neste estudo, analisou-se a representação sobre estes conceitos, sobre os saberes e habilidades identificados como necessários para a prática da Reabilitação. Os entrevistados cursaram a disciplina de Enfermagem em Saúde Mental de uma universidade pública e os resultados mostram valorização das demandas dos usuários, no entanto, as representações sobre cidadania e reabilitação psicossocial sustentam-se no senso comum relacionado à periculosidade e à direitos básicos como à saúde e lazer.
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