SUMMARY OBJECTIVES: This study aimed to identify the infrastructure (e.g., availability, resources, and staff), basic metrics, and problems (e.g., network, overcrowding, resources, and infrastructure) of the psychiatric emergency services in Brazil. METHODS: This is a cross-sectional study assessing psychiatric services (n=29) listed by the Brazilian Psychiatric Association in 2019. RESULTS: Almost all the units reported 24 h/7-day availability having psychiatrists, nurses, and social workers, with 8.8 (SE=2.2) and 2.8 (SE=0.3) consultations and hospitalizations per day, respectively. Separated room for contention was reported by the minority of the services (38%). The most commonly reported problems were insufficient structure for child/adolescent care (83%), increasing patient demand (72%), housing referral for homeless (72%), excessive prescription demand (69%), short-term room overcrowding (59%), court orders for inpatient treatment (59%), lack of vacancies for inpatients hospitalization (59%), and referral to primary care (56%). CONCLUSIONS: Similar to the United States, the Brazilian psychiatric emergency units are decreasing and encompass the shortcomings of the Brazilian mental health care network.

Resumo Contexto O consumo de crack é um dos grandes desafios em saúde pública, e o uso dessa droga tem efeitos diretos na saúde de seus usuários. Objetivos Avaliar o perfil das alterações vasculares em pacientes com dependência de crack em Centro de Atenção Psicossocial para Álcool e Drogas (CAPS-AD) e observar os possíveis efeitos vasculares periféricos. Métodos Trata-se de um estudo observacional, descritivo, de corte transversal. Os pacientes da amostra foram submetidos a um questionário objetivo para avaliar questões demográficas, padrão de uso da droga, coexistência de diabetes melito, hipertensão arterial ou tabagismo, exame físico e ecográfico. Os dados foram sumarizados e analisados estatisticamente com teste qui-quadrado ou teste exato de Fisher. Resultados A média de idade da amostra foi de 33,29 (±7,15) anos, e 74% eram do gênero masculino. A média de idade de início de uso da droga foi de 23,4 (±7,78) anos, com tempo médio de uso de 9,58 (±5,64) anos. O consumo médio diário de pedras de crack foi de 21,45 (±8,32) pedras. A alteração de pulsos em membros inferiores foi mais frequente em mulheres. A prevalência do espessamento da parede arterial nos membros inferiores foi de 94,8%. O tempo de uso da droga apresentou associação estatística (p = 0,0096) com alteração do padrão de curva espectral das artérias dos membros inferiores. Conclusões Há alterações vasculares periféricas em usuários de crack. O tempo de uso da droga exerceu um maior impacto nesse sistema, o que sugere associação entre o uso do crack e a diminuição de fluxo arterial.

Abstract Background Consumption of crack is one of the major challenges in public health and taking this drug has direct effects on the health of those who use it. Objectives To evaluate the profile of vascular abnormalities in patients receiving treatment for crack dependency at a Psychosocial Care Center for Alcohol and Drugs and to observe possible peripheral vascular effects. Methods The study design is observational, descriptive and cross-sectional. An objective questionnaire was administered to the patients in the sample to collect data on demographic details; drug use profile; and concomitant diabetes mellitus, arterial hypertension and/or smoking; and physical and ultrasound examinations were conducted. Data were summarized and analyzed statistically with the chi-square test or Fisher’s exact test. Results The mean age of the sample was 33.29 (±7.15) years, and 74% were male. Mean age at onset of drug use was 23.4 (±7.78) years and mean time since onset was 9.58 (±5.64) years. Mean consumption of crack rocks was 21.45 (±8.32) per day. The rate of abnormal lower limb pulses was higher among women. The prevalence of artery wall thickening in lower limbs was 94.8%. Time since starting to use crack exhibited a statistically significant association (p = 0.0096) with abnormalities in the spectral curve profiles of lower limb arteries. Conclusions Crack users exhibit peripheral vascular disorders. Length of time since starting to use the drug had the greatest impact on this system, suggesting an association between crack use and reduced arterial flow.

Resumo Objetivo: analisar as características epidemiológicas de afastamentos do trabalho por Transtornos Mentais e de Comportamento (TMC) entre servidores públicos federais do Poder Executivo, no Tocantins, e investigar se variáveis pré-selecionadas influenciaram nos afastamentos. Métodos: foram avaliados dados de 103 servidores com pelo menos um registro de afastamento por transtornos mentais no período de abril de 2011 a dezembro de 2012. Os dados foram obtidos de prontuários eletrônicos e de informações do Portal da Transparência do Governo Federal Resultados: “Episódios depressivos”, “Reações ao stress grave e transtornos de adaptação”, e “Outros transtornos ansiosos” foram os mais frequentes causadores dos afastamentos. Diagnósticos de “Esquizofrenia, transtornos esquizotípicos e delirantes” apresentaram a maior média de afastamentos por servidor; os diagnósticos de “Transtornos devido ao uso de substância psicoativa” apresentaram a maior média de dias de afastamento por servidor. Na análise de correlação parcial, controlado o efeito da idade, os servidores com menos tempo de serviço público e de trabalho em órgão federal passaram mais dias afastados do trabalho do que aqueles que já trabalhavam nesses ambientes há mais tempo. Conclusão: os resultados reforçam a concepção de saúde mental e de trabalho como indissociáveis na conjuntura produtiva atual, incluindo o serviço público.

Abstract Objective: to analyze the epidemiological characteristics of the absence from work due to Mental Behavioral Disorders (MBD) among federal government workers in the state of Tocantins-Brazil and also to investigate whether pre-selected variables have influenced on the absence from work. Methods: we collected data from 103 federal government workers with at least one record of absence from work due to mental disorders from April 2011 to December 2012. Data were obtained from electronic medical records and information from Portal da Transparência of Brazilian Federal Government. Results: “depressive episodes”, “reaction to severe stress, and adjustment disorders” and “other anxiety disorders” were the most frequent causes of absence. Diagnosis of “schizophrenia, schizotypal and delusional disorders” had the highest average of medical leave per person, while “mental and behavioral disorders due to psychoactive substance use” had the highest average of days of absence per person. In the partial correlation analysis, the results indicated that workers with shorter employment time who have taken medical leaves due to mental disorders spent more days off work than those who were already working in these same environments before. Conclusion: the results reinforce the concept of “mental health” and “work” as inseparable in the current production environment, which includes the public sector work environment.

Introduction: This study aimed to describe the main features of visceral leishmaniasis (VL), both related to and independent of human immunodeficiency virus (HIV) infection, in patients who were registered in Tocantins, Brazil. Methods: Data from 1,779 new patients with VL, 33 of whom were also infected with HIV, were reviewed. Results: The incidence of VL/HIV coinfection increased from 0.32/100,000 inhabitants in 2007 to 1.08/100,000 inhabitants in 2010. VL occurred predominantly in children aged 10 years or younger, while VL/HIV was more common in patients aged between 18 and 50 years. There were more male patients in the VL/HIV group than in the VL group. Relapse rates were also considerably higher in the VL/HIV (9.1%) group than in the VL group (1.5%). Despite a similar clinical presentation, VL/HIV patients exhibited a higher proportion (24.2%) of concomitant infectious diseases and jaundice. Pentavalent antimonials were used for the initial treatment of VL and VL/HIV infections. However, amphotericin B deoxycholate and liposomal amphotericin B were also widely used in the treatment of VL/HIV coinfection. The mortality rate was higher in the VL/HIV coinfection group (19.4%) than in the VL group (5.4%). Furthermore, the mortality rate due to other causes was significantly higher in the VL/HIV group (12.9%) than in the VL group (0.7%). Conclusions: The study showed that the incidence, clinical characteristics and outcomes among the VL and VL/HIV patients in this state are similar to those from other endemic regions, indicating that both infections are emerging with increasing frequency in Brazil.