RESUMO Este artigo buscou analisar como as práticas de cuidado em saúde mental são percebidas pelos usuários de um Centro de Atenção Psicossocial (Caps) do estado do Pará. A metodologia utilizada foi de abordagem qualitativa, de cunho discursivo e etnográfico. Participaram do estudo 14 usuários cadastrados no Caps. As entrevistas foram analisadas de acordo com os eixos: Processo Saúde e Doença; Itinerário Terapêutico; Práticas de Cuidado em Saúde Mental; e Usuário e Autonomia. Nos discursos, o Caps foi o local em que os usuários se sentiram mais bem cuidados. Foi observada a coexistência de práticas de cuidado que corroboram os princípios da Reforma Psiquiátrica e outras que ainda reproduzem a lógica manicomial.

Acervo disponível em www.scielo.br/epsic Uma crítica à produção do TDAH e a administração de drogas para crianças

Background People with good health knowledge present a conceptual and objective appropriation of general and specific health topics, increasing their probability to express health protection and prevention measures. The main objective of this study was to conduct a rapid systematic review about the effects of health knowledge on the adoption of health behaviors and attitudes in populations under pandemic emergencies. Methods A systematic review was performed according to PRISMA checklist and the Cochrane method for rapid systematic reviews. Studies searches were performed in APA PsycNet, Embase, Cochrane Library and PubMed Central. Studies published between January 2009 and June 2020 and whose primary results reported a measure of interaction between health knowledge, health attitudes and behaviors in population groups during pandemics were included. A review protocol was recorded in PROSPERO (CRD42020183347). Results Out of a total of 5791 studies identified in the databases, 13 met the inclusion criteria. The included studies contain a population of 26099 adults, grouped into cohorts of health workers, university students, clinical patients, and the general population. Health knowledge has an important influence on the adoption of health behaviors and attitudes in pandemic contexts. Conclusions The consolidation of these preventive measures favors the consolidation of public rapid responses to infection outbreaks. Findings of this review indicate that health knowledge notably favors adoption of health behaviors and practices. Therefore, health knowledge based on clear and objective information would help them understand and adopt rapid responses to face a pandemic.

BackgroundThe effect of glycemic control on diabetic kidney disease (DKD) is well known. Recent evidence has suggested that Vitamin D (VD) may have a nephroprotective effect in diabetes, but the relationship between VD, glycemic control, and albuminuria has yet to be clarified.ObjectiveEvaluate the relationship between 25-hydroxy-vitamin D [25(OH)D], HbA1c, and albuminuria in Diabetes Mellitus (DM).Patients and MethodsCross-sectional study with 1576 individuals with DM who had 25(OH)D, HbA1c, and albuminuria levels measured. Patients with abnormal creatinine levels were excluded, in order to avoid interference on VD levels by impaired kidney function.ResultsPatients with HbA1c ≥7% had lower 25(OH)D when compared to patients with HbA1c <7% (29.7 ± 10.2 vs 28.1 ± 9.9 ng/ml, p = 0.003) and 25(OH)D levels seems to predict 1.5% of HbA1c behavior. The 25(OH)D concentrations in patients with normoalbuminuria were higher than the levels observed in those with micro or macroalbuminuria (29.8 ± 9.0 vs 26.8 ± 8.6 and 25.1 ± 7.6, respectively, p = 0.001), patients who had 25(OH)D <20 ng/ml and 25(OH)D <30 ng/ml were at a higher risk of presenting albuminuria [OR = 2.8 (95% CI = 1.6 – 4.9), p<0.001, and OR = 2.1 (95% CI = 1.3 - 4.6), p<0.001, respectively]. In our regression model, albuminuria was influenced by HbA1c (r² = 0.076, p<0.00001) and 25(OH)D (r² = 0.018, p = 0.002) independently.ConclusionOur study found an association between vitamin D levels, HbA1c and DKD. Additionally, our data suggest that the association between urinary albumin excretion and vitamin D levels is independent of glycemic control in patients with diabetes. Even though our patients presented normal creatinine levels, it is necessary further prospective studies to confirm if this association precedes or not the loss of renal function.

BackgroundThe role of repeated episodes of malaria on the cognitive development of children is a relevant issue in endemic areas since it can have a long-lasting impact on individual lifespan. The aim of the current paper was to investigate whether the history of malaria can impair the verbal and performance skills of children living in an endemic area with low transmission of Plasmodium vivax malaria.MethodsA cross-sectional study was conducted with children living in an endemic area of P. vivax malaria in Brazilian Amazon basin. The history of episodes of malaria was used as criteria for inclusion of children in the groups. The cognitive performance was assessed by the Wechsler intelligence scale for children-III edition (WISC-III), which was applied to the participants of study by two trained psychologists.ResultsA total of 17 cases and 26 controls was included in the study. A significant low score of verbal quotient was found in the cases (p = 0.005), however, the performance IQ was similar in both groups (p = 0.304). The full-scale IQ was significantly lower in the cases when compared to the controls (p = 0.042). The factorials index showed significant difference only in the subtest of verbal comprehension with the lower values in the cases (p = 0.0382), compared to the controls. The perceptual organization (p = 0.363), freedom from distractability (p = 0.180) and processing speed (p = 0.132) were similar in both groups.ConclusionsChildren with a history of vivax malaria has a significant impairment of verbal and full-scale quotients as well as a significant low index of verbal comprehension. These findings are likely due to the absenteeism caused by malaria and by the low parental education, which impairs an adequate response to the environmental stimulus.

Background: Some authors evaluated the effect of VD on hyperglycemia in T1DM, but the results remain controversial. This study aims to analyze the effects of high-dose VD supplementation on T1DM patients’ glycemic levels, maintaining stable doses of insulin. Methods: Prospective, 12-week clinical trial including 67 T1DM patients, who were supplemented with high doses of cholecalciferol according to participants' VD value. Patients with VD levels below 30 ng/mL received 10,000 IU/day; those with levels between 30-60 ng/mL received 4,000 IU/day. Patients who had not achieved 25(OH)D levels > 30 ng/ml or presented insulin dose variation during the study were not analyzed. Results: Only 46 out of 67 patients accomplished the criteria at the end of the study. There was no general improvement in the glycemic control evaluated by HbA1c (9.4 ± 2.4 vs 9.4 ± 2.6, p=NS) after VD supplementation. However, a posthoc analysis, based on HbA1c variation, identified patients who had HbA1c reduced at least 0.6% (group 1, N = 13 (28%)). In addition, a correlation between 25(OH)D levels with HbA1c and total insulin dose at the end of the study was observed (r = -0.3, p<0.05; r=-0.4, p<0.05, respectively) and a regression model demonstrated that 25(OH)D was independent of BMI, duration of T1DM and final total insulin dose, being capable of determining 9.2% of HbA1c final levels (Unstandardized B coefficient = −0.033 (CI 95%: −0.064 to −0.002), r² = 0.1, p <0.05). Conclusion: Our data suggests that VD is not widely recommended for glycemic control. Nevertheless, specific patients might benefit from this approach.

BackgroundCardiovascular autonomic neuropathy (CAN) is associated with diabetes mellitus, increasing morbidity and mortality. Some cross-sectional studies associated CAN with low 25-hydroxyvitamin D levels. The aim of our study was to evaluate the effect of high-dose vitamin D (VD) supplementation on CAN in Type 1 Diabetes Mellitus (T1DM) patients.MethodsWe performed a prospective study with 23 patients diagnosed with T1DM and CAN. Subjects with VD levels &lt;30 ng/ml received 10,000 IU/day; the ones with VD levels between 30–60 ng/ml were given 4,000 IU/day for 12 weeks.ResultsThere was an improvement in CAN parameters related to resting heart rate variability, such as time domain parameters [Maximum RR interval (0.77 ± 0.11 vs 0.94 ± 0.51 s, p &lt;0.05), Mean length of regular RR intervals (0.71 ± 0.10 vs 0.76 ± 0.09 s, p &lt;0.05) and Standard deviation of all NN intervals (0.02 ± 0.01 vs 0.03 ± 0.02 s; p &lt;0.01)] and frequency domain parameters [Low Frequency (1.9 ± 0.5 vs 2.5 ± 0.9 s, p &lt; 0.001), Total Power (2.5 ± 0.4 vs 2.8 ± 0.6 s, p &lt;0.05)]. In addition, there was a correlation between absolute VD level variation and posttreatment High Frequency (%), as well as among percent variation in VD level and end-of-study Low Frequency/High Frequency ratio (r=0.6, p&lt;0.01; r= -0.5, p&lt;0.05, respectively).ConclusionOur pilot study is the first to suggest a strong association between high-dose vitamin D supplementation and improved cardiovascular autonomic neuropathy in T1DM patients. It occurred without any variation in HbA1C, blood pressure levels, lipids, and insulin dose.Clinical Trial Registrationhttp://www.isrctn.com/ISRCTN32601947, identifier ISRCTN32601947.

Objective: Investigate the prevalence of vitamin D deficiency in an equatorial population through a large-sample study. Methods: Cross-sectional study with 30,224 healthy individuals from the North Region, in Brazil (Amazônia, state of Pará), who had 25-hydroxy-vitamin D (25(OH)D) and intact parathyroid hormone (PTH) serum levels measured by immunoassay method. Those with history of acute or chronic diseases were excluded. Abnormal levels of calcium, creatinine, glycemia and albumin were also exclusion criteria. Results: 25(OH)D levels were 29.1 ± 8.2ng/mL and values <12.7 ng/mL were equal to < -2 SD below average. Hypovitaminosis D was present in 10% of subjects according to the Institute of Medicine (values <20ng/mL) and in 59%, in consonance with Endocrine Society criteria (values 20-30 ng/mL as insufficiency and <20 ng/mL as deficiency). Individuals were divided according to four age brackets: children, adolescents, adults and elderly, and their 25(OH)D levels were: 33±9; 28,5±7,4; 28.3±7,7; 29.3±8,5ng/mL, respectively. All groups differed in 25(OH)D, except adolescents vs adults. Regression model showed BMI, sex, living zone (urban or rural) and age as independent variables to 25(OH)D levels. Comparing subjects with vitamin D deficiency (<20 ng/mL) to those with vitamin D insufficiency (20-30 ng/mL), a difference between PTH levels in these two groups was observed (95.9 ± 24.7pg/mL vs 44.2 ± 64.5pg/mL; p<0.01). Additionally, the most accurate predictive vitamin D level for subclinical hyperparathyroidism in ROC curve was 26ng/mL. Conclusion: Our equatorial population showed low prevalence of vitamin D hypovitaminosis ranging with age bracket. The insufficient category by Endocrine Society was corroborated by our PTH data.