Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. (13,5%). O tempo médio de permanência hospitalar dos pacientes com infecção hospitalar foi maior, quando comparados àqueles sem infecção hospitalar (16,2±16,2 dias e 33,2±22,9 dias, p<0,001). Observou-se relação entre escore de 16 a 42 pontos, na National Institute of Health Stroke Scale, e a ocorrência de infecção hospitalar (rico relativo 4,4; intervalo de confiança 95% 1,8 a 11,0). A mortalidade intra-hospitalar foi de 15,9%, sendo maior entre pacientes considerados muito graves à admissão, quando comparados com aqueles com gravidade moderada a leve pela National Institute of Health Stroke Scale, (34,6% e 1,6% respectivamente, p<0,001) e também entre aqueles que desenvolveram infecção hospitalar quando comparados aos que não apresentaram esta complicação (37,5% e 10,1% respectivamente, p=0,003). Conclusões: As infecções hospitalares foram complicações importantes entre os pacientes idosos com acidente vascular cerebral agudo e estiveram associadas com maior gravidade do déficit neurológico, maior grau de dependência, tempo de hospitalização mais prolongado e taxa de mortalidade mais alta. DESCRITORES: acidente vascular cerebral; infecção hospitalar; epidemiologia; mortalidade; idosos. ABSTRACT Aims:To evaluate the association between severity of neurological deficit/degree of functional disability and incidence of nosocomial infections, length of hospital stay, and mortality, in elderly patients with acute stroke. Methods: A prospective cohort study evaluated elderly patients with acute stroke, hospitalized at the Hospital of the Marilia Medical School, in Marilia, SP, Brazil. Inclusion criteria were patients aged 60 years or more and diagnosed with acute stroke. Patients were stratified according to the severity of the stroke by the National Institutes of Health Stroke Scale and the degree of dependence by the modified Rankin scale. All patients were followed from the time of admission to discharge or death. Results: We studied 113 patients with a mean age of 70.8 years, 63 (55.7%) men. The main underlying diseases were hypertension (77.9%) and type 2 diabetes mellitus (30.1%). Seventy-eight (69%) patients were affected for the first time and 86 (76.1%) had ischemic stroke. Nosocomial infection occurred in 24 patients (21.2%) and pneumonia was the most frequent (13.5%). The average length of hospital stay among patients with nosocomial infection was higher when compared to those without nosocomial infection (16.2±16.2 days and 33.2±22.9 days, p<0.001). There was association between score 16-42 points on the National Institute of Health Stroke Scale and the occurrence of nosocomial infection (risk ratio 4.4; 95% confidence interval 1.8 to 11.0). In-hospital mortality was 15.9%, higher among patients considered severe at admission compared to those with moderate to mild severity by t...

Schizophrenia is the most severe mental disorder that may affect the individual. Among the proposed treatments it is included the use of medication for symptom control in addition to other therapies and psychoeducation. Often, individuals with schizophrenia suffer numerous hospitalizations when not adhering to the treatment proposed, in these cases depot antipsychotic injections are indicated. The objective of this study was to investigate the demographic and epidemiological profile of outpatients taking antipsychotic injections in a mental health clinic of a teaching hospital in Mar¡lia - SP, Brazil. It is a documentary research with a quantitative approach approved by the Ethics Committee in Research of the institution studied. It was observed that most of these individuals are male, young, white, education level less than 8 years, Catholic, single, unemployed. The drug of choice for treating most of these individuals was the haloperidol decanoate, and only one of the 26 patients studied showed extrapyramidal symptoms, who was also treated with biperiden injections. After the introduction of the treatment with depot medication there was a decrease in the number of rehospitalizations, shorter hospitalizations and bigger spacing between one hospitalization and another after the use of injectable medication. We conclude that these changes provide positive consequences for the patient, family and health sector in the country.

History of madness in Brazil is marked by a disease-centered care and asylum model. With the onset of the psychiatric reform in Brazil, new public health policies that intend to replace the current hospital-centered model for people with mental disorders are being considered and articulated with other substitute services. Until recently the responsible for these individuals have been mental health experts in Ambulatory Health Services, with the new policies primary care professionals are also responsible. Studies show that not all primary care professionals have the same perception and understanding in relation to the care of the person with mental disorder, demonstrating resistance to care for these individuals.ObjectivesTo assess the knowledge produced in Brazilian literature on the social representations of madness on the part of health professionals in primary care.MethodIntegrative review. The question that guided this study was: what are the health professionals’ social representations about madness in primary care?ResultsSix articles were selected; the articles were written by nurses, psychologists and psychiatrists and published in refereed journals. All articles were qualitative and published between 2005 and 2012.ConclusionProfessionals are centered in an organicist model, on the doctor, on medicalization, and have ambiguous and often unscientific concepts about mental illness. Some believe there is no cure or improvement for mental illness, relate aggression and violence to mental illness, and admit to having little knowledge about mental health and feel unprepared to work with these individuals. Social reintegration practices were not identified.

There is a significant increase in the use of multiple drugs. The use and abuse is a current and alarming phenomenon. The use of this substance is a challenge to public health.ObjectivesTo describe the epidemiology and clinical care of the emergency department by use of licit and illicit drugs in 2001 and 2011. Compare if there was a change in profile over the past 10 years.MethodologyEpidemiological descriptive study. We analyzed 1982 medical records in 2001 and 2465 in 2011. The study was approved by the Ethics Committee.ResultsRegarding sex, remained unchanged; the male is responsible for most of the medical care. Regarding age, there was no change over the last ten years, being individuals between 20-39 years old the highest rate of attendance. As the etiologic profile, there has been a change over the last 10 years. In 2001 the diagnosis of ICD-10-F10 (Mental and behavioral disorders due to use of alcohol) was predominant. In 2011 the ICD-10 and ICD-10-F19 (mental disorder and behavior due to multiple drug use and use of other psychoactive substances). As for the number of attendances, in 2001 there was a large concentration in the first quarter, while in 2011 it was better distributed throughout the year. There was an increase in the number of visits in 2011 compared to 2001.ConclusionWe believe educational and preventive actions are necessary to minimize the increase in drug use. It is also necessary to have measures to reduce damage.

The “Programa de Educação pelo Trabalho - PET” (Education through Work Program) is one of the intersectoral actions designed to strengthen strategic areas of the “Sistema Único de Saúde - SUS” (Unified Health System) in Brazil. This program's goal is to prepare undergraduates to real local necessities so they will be fully prepared professionals when they graduate. Brazilian Ministry of Health has funded 80 PETs nationwide, focusing alcohol, crack and other drugs issues. Each PET team had a tutor, mentors and students, all of them receiving scholarships. The program lasted one year (with the possibility of being extended for one more). FAMEMA - Medicine School of Marília, was one of the 80 institutions selected nationwide for the development of this program. The program consists of weekly meetings, tutorial-based learning, study questions, discussions, analytical summaries, field practice and literature. All knowledge acquired during tutorial activity allowed students and mentors to approach the drugs topic, learn the related national policies and know local, Brazilian and global realities. From this experience several scientific searches were developed such as the “Waiting Room Program” at the Psychosocial Care Center - Alcohol and Drugs. As patients tend to be more spontaneous while waiting in a non-therapeutic room they could reveal service flaws such as inefficient reception, bond, patient-therapist relationship. The Waiting Room Project aims to turn downtime into a moment of awareness, acceptance, strengthen ties and improve treatment adherence. We emphasize that the project was discussed between service professionals and they are responsible for its implementation.