Abstract Objective: To evaluate acute and chronic changes seen on angiographic and histopathological studies of porcine rete mirabile, comparing those treated with the Menox liquid embolic system (LES) and those treated with the Onyx LES. Materials and Methods: Five pigs, each weighing approximately 35 kg, were submitted to rete mirabile embolization under general anesthesia and fluoroscopic guidance, with the Menox LES or Onyx LES. Four animals were treated with the Menox LES and underwent cerebral angiography, followed by euthanasia, at 1, 30, 60, and 90 days after embolization. One animal was treated with the Onyx LES underwent the same procedures at 30 days after embolization. In a subsequent histopathological analysis, we compared the Menox LES and Onyx LES in terms of the acute and chronic changes observed. Results: We observed no significant changes in blood pressure, heart rate, or electrocardiographic parameters that could be attributed to the super-selective infusion of dimethyl sulfoxide or the Menox embolic agent. Fluoroscopy showed adequate material opacity, appropriate progression to the center of the rete mirabile and complete unilateral embolization. Microcatheters were uneventfully detached from the embolized nidus. We observed mild to moderate intravascular and extravascular inflammatory responses, without histological evidence of necrotizing arteritis. There were no adverse neurovascular events. Conclusion: The Menox LES appears to be safe and effective, as well as being apparently equivalent to the Onyx LES in terms of the postprocedure angiographic and histopathological findings.

Resumo Objetivo: Avaliar as alterações angiográficas e histopatológicas agudas e crônicas em rete mirabile suína tratadas com o Menox liquid embolic system (LES) e comparar essas alterações com a embolização com Onyx LES. Materiais e Métodos: A embolização da rete mirabile com Menox LES e Onyx LES foi realizada em cinco suínos pesando cerca de 35 kg sob anestesia geral e orientação fluoroscópica. Quatro animais tratados com Menox LES foram submetidos a angiografia cerebral seguida de eutanásia após 1, 30, 60 e 90 dias e um animal tratado com Onix LES foi submetido ao mesmo procedimento após 30 dias. A análise histopatológica subsequente para alterações agudas e crônicas avaliou o desempenho do Menox LES comparado ao Onyx LES. Resultados: Não foram observadas alterações significativas atribuíveis à infusão superseletiva de dimetilsulfóxido ou Menox nos parâmetros de pressão arterial, frequência cardíaca ou eletrocardiograma. A fluoroscopia mostrou opacidade adequada do material, progressão adequada para o centro da rete mirabile e embolização unilateral completa. Os microcateteres foram retirados do nidus embolizado sem complicações. Observou-se resposta inflamatória intravascular e extravascular leve a moderada, sem indício histológico de arterite necrosante. Nenhum dos casos apresentou eventos neurovasculares adversos. Conclusão: A injeção de Menox LES mostrou-se segura e eficaz, além de ser equivalente ao Onyx LES em relação aos achados angiográficos e histopatológicos pós-procedimento.

ABSTRACT Objective: Choosing Wisely (CW) is an initiative that aims to advance the dialogue between physicians and patients about low-value health interventions. Given that thyroid conditions are frequent in clinical practice, we aimed to develop an evidence-based list of thyroid CW recommendations. Materials and methods: The Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) named a Task Force to conduct the initiative. The Task Force work was based on an electronic Delphi approach. The 10 recommendations that received the highest scores by the Task Force were submitted for voting by all SBEM associates. The 5 recommendations that received the highest scores by SBEM associates are presented herein. Results: The Task Force was composed of 14 thyroidologists from 10 tertiary-care, teaching-based Brazilian institutions. The brainstorming/ideation phase resulted in 69 recommendations. After the removal of duplicates and recommendations that did not adhere to the initiative's scope, 35 remained. Then the Task Force voted to attribute a grade (0 [lowest agreement] to 10 [highest agreement]) for each recommendation. The 10 recommendations that received the highest scores by the Task Force were submitted to all SBEM associates. A total of 683 associates voted electronically, attributing a grade (0 to 10) for each recommendation. The 5 recommendations that received the highest scores by the SBEM associates compose our final list. Conclusion: A set of recommendations to avoid unnecessary medical tests, treatments, or procedures for thyroid conditions are offered with a transparent methodology. This initiative aims to foster productive interactions between physicians and patients, stimulating shared decision-making.

Abstract Objective: To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach. Methods: Representative samples of the adult general population (n=13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated. Results: Health conditions explained a large proportion of full role limitation (PAF=62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability. Conclusion: The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation.

Resumen Objetivo: Describir la distribución de la discapacidad en población europea de 18 a 64 años de edad y analizar la contribución de los trastornos físicos y mentales con una perspectiva de salud pública. Métodos: Se analizaron muestras representativas de población general adulta (n=13.666) de 10 países europeos participantes en la Iniciativa Mundial de Encuestas para la Salud Mental (World Mental Health Surveys Initiative), agrupados en tres regiones: Centro-Oeste, Sur y Centro-Este. La Entrevista Diagnóstica Internacional Compuesta (CIDI 3.0) se utilizó para evaluar seis trastornos mentales, y siete trastornos físicos fueron autorreportados a partir de una lista estandarizada. Se contabilizaron los días con discapacidad parcial y total del mes previo a la entrevista utilizando una versión modificada de la escala WHO-DAS. Se calcularon las fracciones de riesgo atribuible (PAF). Resultados: Los trastornos mentales y físicos fueron importantes contribuyentes a la discapacidad total (PAF=62,6%) y en menor medida a la discapacidad parcial (46,6%). El dolor crónico fue el único trastorno que ha contribuido a explicar tanto la discapacidad total como la parcial en las tres regiones europeas. Los trastornos mentales son los que contribuyen más a la discapacidad total y parcial en los países del Centro-Oeste y del Sur. En los países del Centro-Este, donde los trastornos mentales fueron poco prevalentes, la enfermedad cardiovascular fue la principal contribuyente a la discapacidad. Conclusión: La contribución de los trastornos físicos y mentales a la discapacidad en las tres regiones europeas estudiadas es importante. Los trastornos mentales están asociados con una gran discapacidad en la mayoría de las regiones. Es necesario incorporar el estudio del impacto de las enfermedades comunes en discapacidad a la agenda de salud pública. Se necesitan estudios adicionales que profundicen en las diferencias regionales encontradas.

Abstract Objective: To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach. Methods: Representative samples of the adult general population (n=13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated. Results: Health conditions explained a large proportion of full role limitation (PAF=62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability. Conclusion: The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation.

Resumen Objetivo: Describir la distribución de la discapacidad en población europea de 18 a 64 años de edad y analizar la contribución de los trastornos físicos y mentales con una perspectiva de salud pública. Métodos: Se analizaron muestras representativas de población general adulta (n=13.666) de 10 países europeos participantes en la Iniciativa Mundial de Encuestas para la Salud Mental (World Mental Health Surveys Initiative), agrupados en tres regiones: Centro-Oeste, Sur y Centro-Este. La Entrevista Diagnóstica Internacional Compuesta (CIDI 3.0) se utilizó para evaluar seis trastornos mentales, y siete trastornos físicos fueron autorreportados a partir de una lista estandarizada. Se contabilizaron los días con discapacidad parcial y total del mes previo a la entrevista utilizando una versión modificada de la escala WHO-DAS. Se calcularon las fracciones de riesgo atribuible (PAF). Resultados: Los trastornos mentales y físicos fueron importantes contribuyentes a la discapacidad total (PAF=62,6%) y en menor medida a la discapacidad parcial (46,6%). El dolor crónico fue el único trastorno que ha contribuido a explicar tanto la discapacidad total como la parcial en las tres regiones europeas. Los trastornos mentales son los que contribuyen más a la discapacidad total y parcial en los países del Centro-Oeste y del Sur. En los países del Centro-Este, donde los trastornos mentales fueron poco prevalentes, la enfermedad cardiovascular fue la principal contribuyente a la discapacidad. Conclusión: La contribución de los trastornos físicos y mentales a la discapacidad en las tres regiones europeas estudiadas es importante. Los trastornos mentales están asociados con una gran discapacidad en la mayoría de las regiones. Es necesario incorporar el estudio del impacto de las enfermedades comunes en discapacidad a la agenda de salud pública. Se necesitan estudios adicionales que profundicen en las diferencias regionales encontradas.

Os processos de implementação de um Modelo de Gestão de Cuidados são um dos melhores exemplos de como uma prática baseada na evidência pode influenciar a organização dos serviços de saúde. Esta prática ajudou a moldar as equipas de saúde mental nas últimas décadas, aumentando a sua multidisciplinaridade e o trabalho interdisciplinar. Os exemplos de vários países mostram como a investigação sobre a efectividade se harmoniza com o desenvolvimento de políticas de saúde para fazer face às diferentes necessidades de cada sistema de saúde, influenciando a implementação da gestão de cuidados e a melhoria de cuidados. Portugal seguiu o seu próprio caminho na implementação da gestão de cuidados, determinado maioritariamente pela organização de serviços associada à capacidade de implementar uma política nacional de saúde mental, nos últimos anos.

Case management implementation processes are one of the best examples on how an evidence-based practice can influence health services organisation. This practice helped shaping mental health teams, increasing their multidisciplinarity and interdisciplinary work in the last decades. Examples from several countries show how effectiveness research blends into health policy development to meet different needs in each health system, thus influencing case management inception and improvement of care. Portugal followed its own path in case management implementation, determined mostly by mental health services organisation and closely linked with the capacity to implement a national mental health policy in the last years.

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.

A recent debate has taken place in International Human Resource Management (IHRM) theory and practice between the so-called functionalists and the critical approaches. This paper reviews the literature on mainstream, functionalist IHRM and the critical approaches, and theoretically discusses their fit to emerging countries' realities and multilatinas experience. The essay's main objectives and contributions are: (a) to argue that this debate, overly typical of the American-European context, may not be fully applicable to ambiguous and contradictory contexts, such as most developing countries and, particularly, Latin America; (b) to argue that the disputes between both functionalist and critical IHRM theorists, in equally richer countries, is inadequate for other (non-rich-involving) contexts; and (c) to propose redirection possibilities for this debate, particularly, in Latin America.

A podridão ácida é uma patologia das videiras, de alta freqüência nos períodos quentes e chuvosos, em conseqüência do desenvolvimento de fungos e bactérias em seus frutos. Um dos gêneros de fungos responsáveis por esta doença é o Penicillium spp., que poderá levar à produção de micotoxinas, como a patulina. Neste trabalho, foi realizada uma investigação sobre a podridão ácida e a ocorrência de patulina em uvas Itália (Vitis vinifera L. cv. Rubi) cultivadas no município de Marialva, Brasil. Foram avaliados os seguintes tratamentos: (I) testemunha sem sintomas de podridão ácida; (II) amostras com sintomas, sem a remoção das bagas infectadas; (III) amostras com sintomas, com a remoção das bagas infectadas, (IV) amostras com sintomas da doença, com a remoção das bagas infectadas e desinfecção com hipoclorito. A cromatografia em camada delgada foi utilizada para a determinação de patulina. Nas amostras analisadas, não foi detectada contaminação por esta micotoxina.

Sour rout is a pathology of bunch grapes occurring in hot and rainy periods. Several fungi and bacteria are associated with this disease, including Penicilium spp. In the present study it was carried out an investigation to determine the incidence of sour rout and patulin in grapes (Vitis vinifera L. cv. Rubi) cultivated in Marialva, Brazil. The treatments studied were the following: (I) samples without symptoms of sour rout, (II) samples with symptoms and without cleaning stage, (III) samples with symptoms and with cleaning stage and (IV) samples with symptoms, cleaning stage and washing with hypochlorite. The thin-layer chromatography was utilized to determine the presence and quantification of patulin. Patulin was not detected in any samples.

The authors evaluated the mental health systems of El Salvador, Guatemala, and Nicaragua, using a group of select indicators. The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was used to collect data from the nations. The national mental health systems of Nicaragua, Guatemala, and El Salvador have serious limitations, especially in primary care, and a marked lack of qualified human resources. Budget allocations for mental health care are barely 1% of the total health care budgets; and the psychiatric hospitals located in the national capitals consume at least 90% of those funds. The limited human and material resources available are concentrated in the respective country capital cities. National mental health policies and legislation have not been adopted; however, all three countries do have national plans in progress. Furthermore, all three have designed and implemented programs for mental health care in case of disaster. Agreements must be reached with offices for the defense of human rights to raise awareness and protection of rights for the mentally ill. In recent years, new experiences have been gained and these should be distributed more widely. The Pan American Health Organization (PAHO/WHO) and the WHO-AIMS project have contributed toward developing community models for mental health services. Lastly, priorities have been identified and action items recommended.

Los autores realizaron una evaluación de los sistemas de salud mental en El Salvador, Guatemala y Nicaragua, por medio de un grupo de indicadores seleccionados. Para recopilar la información en los países se utilizó el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (WHO-AIMS, por su sigla en inglés). Nicaragua, Guatemala y El Salvador tienen serias limitaciones en sus sistemas nacionales de salud mental, en especial en la atención primaria, así como una marcada insuficiencia de recursos humanos calificados. El presupuesto dedicado a la salud mental apenas representa 1% del presupuesto general de salud y los hospitales psiquiátricos situados en la capital de los países consumen más de 90% de los fondos de salud mental. Los limitados recursos (materiales y humanos) existentes se concentran en las respectivas capitales de los países. No se han formulado políticas ni legislaciones nacionales de salud mental. Sin embargo, las tres naciones cuentan con planes nacionales en ejecución. Asimismo, se ha avanzado en el diseño e implementación de programas de protección de la salud mental en situaciones de desastre. Es necesario establecer acuerdos con las procuradurías de los derechos humanos para incrementar la vigilancia y protección de los derechos humanos en las personas afectadas por enfermedades mentales. En los últimos años se han logrado impulsar algunas experiencias innovadoras que requieren ser generalizadas. La Organización Panamericana de la Salud (OPS/OMS) y el proyecto WHO-AIMS han contribuido al desarrollo de modelos comunitarios de servicios de salud mental. También se identificaron prioridades y se plantean recomendaciones para la acción.

OBJETIVO: Estudar o efeito do 1.8 cineol, componente do Cróton nepetaefolius (planta do Nordeste) comumente usada na medicina popular para distúrbios do trato gastrintestinal (TGI), sobre o comportamento motor do TGI de ratos Wistar anestesiados. MÉTODOS: Utilizamos 16 animais machos, pesando entre 300 a 350g. Os estudos de complacência gástrica foram conduzidos em animais sob jejum de 24h. As variações do volume gástrico (VG), foram medidas por pletismografia, enquanto a PA, FC e PVC foram monitoradas continuamente por um sistema digital de aquisição de dados. RESULTADOS: Observamos diminuição do VG, o qual foi significativo aos 30, 40, 50 e 60min após o tratamento com 1.8 cineol quando comparado ao perído basal (2,0±0,1; 1,9±0,1; 1,8±0,1 e 1,7±0,1mL, vs 2,1±0,2mL). A PA apresentou queda significativa após a administração de 1.8 cineol, mantendo-se assim durante os 60min de monitoração (87,9±7,7; 87,6±7,1; 87,9±6,4; 87,8±5,7; 86,0±5,5 e 87,7±6,0mmHg, respectivamente vs 94,4±6,2; mmHg), bem como a FC (366,3±13,4; 361,7±11,5; 357,3±10,4; 353,0±10,4; 348,3±11,1 e 350,4±13,7bpm respectivamente vs 395,2±11,1bpm). Já a PVC não sofreu variações significativas durante após o tratamento. CONCLUSÃO: O 1.8 cineol diminui a complacência gástrica em ratos anestesiados além de apresentar efeitos hipotensor e bradicárdico; provavelmente por ação direta sobre a musculatura lisa gastrintestinal e vascular e modulação do sistema nervoso autônomo.

PURPOSE: To study the effect of 1,8 cineoleee components of the essencial oil of Croton nepetaefolius - plant of North-East of Brasil, used in the popular medicine for riots of the gastrointestinal tract - on the motor behavior of the gut of Wistar rats. METHODS: Used 16 male animals under jejun of 24h weighing 300-350g. The effect of 1.8 cineoleee (1 or 3mg/Kg) on gastric compliance had been lead in anaesthetized rats. The variations of the gastric volume (GV), had been measured by plethysmography, while AP, HR and CVP had been monitored continuously by a digital system of data acquisition. RESULTS: Observe reduction of the GV, which was significant on 30, 40, 50 and 60min after treatment (2.0±0.1; 1.9±0.1; 1.8±0.1 and 1.7±0.1mL, versus 2.1±0.2mL). The AP presented significant fall after the administration of 1.8 cineoleee, remaining thus during 60min of monitorization (87.9±7.7; 87.6±7.1; 87.9±6.4; 87.8±5.7; 86.0±5.5 and 87.7±6.0mmHg, respectively versus 94.4±6.2 mmHg), as well as the HR (366.3±13.4; 361.7±11.5; 357.3±10.4; 353.0±10.4; 348.3±11.1 and 350.4±13.7bpm, respectively versus 395.2±11.1bpm). The CVP did not suffer significant variations after treatment. CONCLUSION: Observe the 1.8 cineoleee reduces the gastric compliance in anaesthetized rats besides presenting effect hipotensor and bradicardic; probably for direct action on the gastrointestinal and vascular smooth muscel and moduling the autonomic nervous system.

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.

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.

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.

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%; la depresión mayor, de 4,9%; y el abuso o la dependencia del alcohol, de 5,7%. 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.