RESUMO
Microplastics (MP) have been found in various environments worldwide. However, not many studies focus on the open ocean due to logistical restraints. Between January and May 2020, the NRP Sagres sampled 123 linear paths of subsurface water of the Atlantic Ocean, passing by Cape Verde, the east coast of South America, and the west coast of Africa. The water was sampled through the ship's water system. The membranes were analyzed by the Hydrographic Institute of Portugal and the Norwegian Institute for Water Research by micro-FTIR. The contamination levels were reported with uncertainty, for 99% confidence level (CL), normalized for filtered water volume and the distance traveled during sampling. Uncertainties were calculated through a detailed â³bottom-upâ³ evaluation. MP were found in about a third of the stations (48 out of 123), and most of those stations (43 out of 48) presented concentrations below 1 m-3 km-1. The sites where higher concentrations were registered were the port of the island of Santiago (Cape Verde) ((5.9 ± 5.2) m-3 km-1), the Guanabara Bay in Rio de Janeiro (Brazil) ((41 ± 27) m-3 km-1), and close to South Africa ((4.9 ± 2.4) m-3 km-1). Most MP found were polyamide, polyester, polyethylene, ethylene vinyl acetate, and poly(methyl methacrylate). The estimated contamination levels cannot be directly compared with information obtained in other studies due to differences in how MP were determined and the unknown uncertainty of their measured values. This article presents a relevant and reliable contribution to understanding the MP distribution in the Atlantic Ocean.
Assuntos
Microplásticos , Poluentes Químicos da Água , Plásticos , Incerteza , Brasil , Poluentes Químicos da Água/análise , Monitoramento Ambiental , ÁguaAssuntos
Reforma dos Serviços de Saúde , Política de Saúde , Brasil , Região do Caribe , América LatinaRESUMO
BACKGROUND AND AIMS: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. DESIGN: Cross-sectional household surveys. SETTING: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. PARTICIPANTS: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. MEASUREMENTS: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). FINDINGS: Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. CONCLUSIONS: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.
Assuntos
Alcoolismo/diagnóstico , Abuso de Maconha/diagnóstico , Alcoolismo/classificação , Alcoolismo/epidemiologia , Argentina/epidemiologia , Austrália/epidemiologia , Brasil/epidemiologia , Colômbia/epidemiologia , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Classificação Internacional de Doenças , Iraque/epidemiologia , Abuso de Maconha/classificação , Abuso de Maconha/epidemiologia , Irlanda do Norte/epidemiologia , Polônia/epidemiologia , Portugal/epidemiologia , Romênia/epidemiologia , Espanha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/classificação , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Organização Mundial da SaúdeRESUMO
CONTEXT: The scarcity of cross-national reports and the changes in Diagnostic and Statistical Manual version 5 (DSM-5) regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population. OBJECTIVE: To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions. DESIGN AND SETTING: Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0. PARTICIPANTS: Respondents (n = 142,949) from 25 high, middle, and lower-middle income countries across the world aged 18 years or older. MAIN OUTCOME MEASURES: PD and presence of single and recurrent PAs. RESULTS: Lifetime prevalence of PAs was 13.2% (SE 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; SE 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8-2.2) and their course (OR 1.3; 95% CI 1.2-2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9-1.3 and OR 0.7; 95% CI 0.6-0.8). Cross-national lifetime prevalence estimates were 1.7% (SE 0.0%) for PD with a median age of onset of 32 (IQR 20-47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder. CONCLUSIONS: We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology.
Assuntos
Inquéritos Epidemiológicos/estatística & dados numéricos , Internacionalidade , Transtorno de Pânico/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ásia/epidemiologia , Austrália/epidemiologia , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Nigéria/epidemiologia , Transtorno de Pânico/psicologia , Prevalência , América do Sul/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide. METHODS: Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided. RESULTS: Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings. CONCLUSIONS: The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers.
Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Pessoas com Deficiência/estatística & dados numéricos , Família/psicologia , Transtornos Mentais/enfermagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Medição de Risco , Fatores de Tempo , Organização Mundial da Saúde , Adulto JovemRESUMO
Objective: To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide. Methods: Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided. Results: Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings. Conclusions: The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers. .
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Pessoas com Deficiência/estatística & dados numéricos , Família/psicologia , Transtornos Mentais/enfermagem , Estudos Transversais , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , Medição de Risco , Fatores de Tempo , Organização Mundial da SaúdeRESUMO
[Introduction]. n the last quarter century, several projects emerged to reform mental health services in Latin American and Caribbean countries. Some did not survive the difficulties that inevitably arise in processes of change, and ended up disappearing before the intended changes could be introduced. Others, however, as shown in this publication, were able to overcome difficulties and meet intended objectives, effectively transforming the structure and quality of services. All these projects, including the many that did not survive, were part of one of the richest experiences in the transformation of mental health care worldwide - the experience of mental health reform in Latin America and the Caribbean...As proved by the experiences included in this book, a great deal can be learned from mental health reforms in Latin America and the Caribbean., On the one hand, each initiative developed truly original and innovative solutions for some of the problems usually encountered in the reform processes. Obviously, many of the innovative solutions can be applied in those countries that are at a similar stage of development as the Latin American and Caribbean countries where the reported experiences took place. However, many of these innovations also can be useful to any country interested in reforming its mental health services, regardless of the country’s degree of development. I also believe that the reform of mental health services in Latin America and the Caribbean―given specific aspects such as the dynamic following the Caracas Declaration and the impact of international cooperation―help us to better understand the real importance of some factors, such as social and political aspects and international cooperation, in implementing mental health service reforms.
Assuntos
Saúde Mental , Reforma dos Serviços de Saúde , América Latina , Região do CaribeRESUMO
OBJECTIVE: The growing burden of mental disorders in Latin America and the Caribbean has become too large to ignore. There is a need to know more about the prevelance of mental disorders and the gap between the number of individuals with psychiatric disorders and the number of those persons who remain untreated even though effective treatments exist. Having that knowledge would make it possible to improve advocacy, adopt better policies, formulate innovative intervention programs, and apportion resources commensurate with needs. METHODS: Data were extracted from the community-based psychiatric epidemiological studies published in Latin America and the Caribbean from 1980 through 2004 that used structured diagnostic instruments and provided prevalance rates. Estimates of the crude rates in Latin America and the Caribbean for the various disorders were determined by calculating the mean and median rates across the studies, by gender. In addition, data on service utilization were reviewed in order to calculate the treatment gap for specific disorders. RESULTS: Non affective psychosis (including schizophrenia) and an estimated mean one-year prevalence rate of 1.0 percent; major depression, 4.9 percent; and alcohol use abuse or dependence, 5.7 percent. Over one-third of individuals with nonaffective psychosis, over half of those with an anxiety disorder, and some three-fourths of those with alcohol use abuse or dependence did not receive mental health care from either specialized or general health services. CONCLUSIONS: The current treatment gap in mental health care in Latin America and the Caribbean remains wide. Further, current data likely greatly underestimate the number of untreated individuals. The epidemiological transition and changes in the population structure will further widen the treatment gap in Latin America and the Caribbean unless mental health policies are formulted or updated and programs and services are expanded (AU)
Assuntos
Humanos , Saúde Mental , Transtornos Mentais , Serviços de Saúde Mental , Região do Caribe , Recursos em Saúde , Política de Saúde , América LatinaRESUMO
La entrada en el nuevo milenio coincidió con el inicio de una nueva fase de la reforma de los servicios de salud mental en América Latina y el Caribe. Esta nueva fase ha impuesto nuevas prioridades e inspirado nuevas estrategias de cooperación técnica a escala internacional. En el presente artículo se mencionan las características principales de las primeras fases de la reforma de los servicios de salud mental en América Latina y el Caribe, se discuten los factores que llevaron a la fase iniciada en 2001 y se describen las estrategias y acciones de cooperación técnica desarrolladas por la Organización Panamericana de la Salud para enfrentar los desafíos surgidos en la etapa actual de la reforma. Además, se exponen algunas reflexiones sobre las perspectivas de la cooperación internacional en este campo, así como las ventajas de establecer un programa regional para la reforma de los servicios de salud mental que facilite el trabajo conjunto de los gobiernos y de las organizaciones internacionales en un plan de acción con objetivos definidos. Se recomienda aprovechar la celebración del decimoquinto aniversario de la Declaración de Caracas para lanzar un plan de acción regional que dé un nuevo impulso a la reforma de los servicios de salud mental
The beginning of the new millennium coincided with the start of a new phase in the reform of mental health services in Latin America and the Caribbean. This new phase has imposed new priorities and prompted new technical cooperation strategies at the international level. This piece points out the main characteristics of the first phases in the reform of mental health services in Latin America and the Caribbean, discusses the factors that led to the phase that started in 2001, and describes the strategies and the technical cooperation activities of the Pan American Health Organization to deal with the challenges that have arisen in the current stage of reform. The piece also considers the prospects for international cooperation in this field, as well as the advantages of establishing a program for the reform of mental health services in the Americas that would contribute to the combined efforts of governments and international organizations in an action plan with defined objectives. The piece recommends taking advantage of the celebration of the 15th anniversary of the Declaration of Caracas in order to launch an action plan that gives new impetus to mental health services reform in the Americas
Assuntos
Humanos , Reforma dos Serviços de Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Organização Pan-Americana da Saúde , Região do Caribe , Direitos Humanos , América LatinaRESUMO
OBJETIVO: La creciente carga de trastornos mentales que afecta a las poblaciones de América Latina y el Caribe es demasiado grande para hacer caso omiso de ella. Por lo tanto, es una necesidad impostergable conocer la prevalencia de los trastornos mentales y la brecha de tratamiento, que está dada por la diferencia entre las tasas de prevalencia verdadera y las de las personas que han sido tratadas, que en algunos casos es grande pese a la existencia de tratamientos eficaces. Si se dispone de mayor informacion, se hace más factible 1) abogar mejor por los intereses de las personas que necesitan atención, 2) adoptar políticas más eficaces, 3) formular programas de intervención innovadores y 4) adjudicar recursos en conformidad con las necesidades observadas. MÉTODOS: Los datos se obtuvieron de estudios comunitarios publicados en América Latina y el Caribe entre 1980 y 2004. En esas investigaciones epidemiológicas se usaron instrumentos diagnósticos estructurados y se estimaron tasas de prevalencia. Las tasas brutas de diversos trastornos psiquiátricos en América Latina y el Caribe se estimaron a partir de las tasas media y mediana extraídas de los estudios, desglosadas por sexo. También se extrajeron los datos correspondientes al uso de servicios de salud mental para poder calcular la brecha en el tratamiento según trastornos específicos. RESULTADOS: Las psicosis no afectivas (entre ellas la esquizofrenia) tuvieron una prevalencia media estimada durante el año precedente de 1,0 por ciento; la depresión mayor, de 4,9 por ciento; y el abuso o la dependencia del alcohol, de 5,7 por ciento. Más de la tercera parte de las personas afectadas por psicosis no afectivas, más de la mitad de las afectadas por trastornos de ansiedad, y cerca de tres cuartas partes de las que abusaban o dependían del alcohol no habían recibido tratamiento psiquiátrico alguno, sea en un servicio especializado o en uno de tipo general. CONCLUSIONES: La actual brecha en el tratamiento de los trastornos mentales en América Latina y el Caribe sigue siendo abrumadora. Además, las tasas actuales probablemente subestiman el número de personas sin atención. La transición epidemiológica y los cambios en la composición poblacional acentuarán aun más la brecha en la atención en América Latina y el Caribe, a no ser que se formulen nuevas políticas de salud mental o que se actualicen las existentes, procurando incluir en ellas la extensión de los programas y servicios.
Objective. The growing burden of mental disorders in Latin America and the Caribbean has become too large to ignore. There is a need to know more about the prevalence of mental disorders and the gap between the number of individuals with psychiatric disorders and the number of those persons who remain untreated even though effective treatments exist. Having that knowledge would make it possible to improve advocacy, adopt better policies, formulate innovative intervention programs, and apportion resources commensurate with needs. Methods. Data were extracted from community-based psychiatric epidemiological studies published in Latin America and the Caribbean from 1980 through 2004 that used structured diagnostic instruments and provided prevalence rates. Estimates of the crude rates in Latin America and the Caribbean for the various disorders were determined by calculating the mean and median rates across the studies, by gender. In addition, data on service utilization were reviewed in order to calculate the treatment gap for specific disorders. Results. Nonaffective psychosis (including schizophrenia) had an estimated mean one-year prevalence rate of 1.0%; major depression, 4.9%; and alcohol use abuse or dependence, 5.7%. Over one-third of individuals with nonaffective psychosis, over half of those with an anxiety disorder, and some three-fourths of those with alcohol use abuse or dependence did not receive mental health care from either specialized or general health services. Conclusions. The current treatment gap in mental health care in Latin America and the Caribbean remains wide. Further, current data likely greatly underestimate the number of untreated individuals. The epidemiological transition and changes in the population structure will further widen the treatment gap in Latin America and the Caribbean unless mental health policies are formulated or updated and programs and services are expanded
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prioridades em Saúde , Transtornos Mentais/epidemiologia , Transtornos Mentais/prevenção & controle , Saúde Pública , Região do Caribe/epidemiologia , América Latina/epidemiologia , PrevalênciaAssuntos
Prioridades em Saúde , Transtornos Mentais , Saúde Pública , Região do Caribe , Prevalência , América LatinaRESUMO
[Prólogo - Mirta Roses, Directora]. La reforma psiquiátrica ha sido y sigue siendo una prioridad en la agenda de salud pública de la Región de las Américas. Para apoyar su implantación y ejecución, durante los últimos 20 años la Organización Panamericana de la Salud (OPS) ha promovido innumerables acciones de cooperación técnica destinadas a reforzar las capacidades de los países, en particular los de América Latina y el Caribe, en el desarrollo de políticas y planes nacionales de salud mental. En seguimiento a la Declaración de Caracas, realizada en 1990, tanto la OPS como el Departamento de Salud Mental y Abuso de Sustancias de la Organización Mundial de la Salud (OMS), los gobiernos de varios países y expertos de diversas partes del mundo llevaron a cabo iniciativas que abrieron el camino a transformaciones importantes en las políticas y en los servicios de muchas naciones de la Región. Sin embargo, como se demostró en la evaluación realizada en 2001 en el ámbito de las iniciativas de la OMS en salud mental, a pesar del progreso realizado, aún quedaba mucho por hacer y había que buscar nuevas estrategias, capaces de responder a los desafíos de la reforma psiquiátrica...Espero que esta publicación pueda ser un instrumento útil para todos los que trabajan en pro de la mejoría de la atención a las personas con enfermedades mentales severas en América Latina y el Caribe: responsables políticos, profesionales, usuarios, familiares e investigadores.