http://hdl.handle.net/10362/2884 2013-06-19T14:37:27Z http://hdl.handle.net/10362/8861 Title: Prevalência do consumo do álcool em dois Centros de Saúde da Praia e num centro numa zona rural, Picos - Ilha de Santiago Authors: Varela, Maria Francisca Tavares Alvarenga Abstract: RESUMO: Conhecer a prevalência e perfil de consumo das populações revela-se como elementos importantes para o estabelecimento de Planos e Programas de intervenção na atenção aos problemas relacionados com o consumo do álcool. Este estudo transversal numa amostra de utentes dos cuidados primários de saúde teve por objectivo conhecer a prevalência do consumo do álcool em dois centros de saúde numa zona urbana, (Achada de Santo António e Achadinha) na capital do país e um centro de saúde numa zona rural (Picos), no interior da ilha de Santiago. O instrumento utilizado para avaliar os consumos de médio e alto risco do álcool foi o ASSIST. Foram entrevistados 302 utentes nos 3 centros de saúde. Os resultados mostraram uma prevalência ao longo da vida de 86,4% e nos últimos 3 meses de 62,3%. Mostrou que os homens tinham consumo superior às mulheres no centro de saúde de Achadinha (p value= 0.002 ) e Picos (p value=0.003). Em Achada de Santo António a diferença entre homens e mulheres não se mostrou estatisticamente significativa (p value= 0.397). Os resultados mostraram também nos dois centros associação significativa entre consumo de risco de tabaco e consumo de risco do álcool (p value=0.000 e 0.003) o que não se verificou em ASA (p value= 0.962). As variáveis idade, ocupação profissional, nível de escolaridade, não mostraram associação significativa ao consumo de risco do álcool mas mostraram associação significativa ao consumo do álcool nos últimos 3 meses. Mas o consumo do álcool nos últimos 3 meses não mostrou associação significativa ao consumo do tabaco nos últimos 3 meses. Espera-se que os resultados possam subsidiar a política de luta contra o álcool, no sentido de implementar acções que possam prevenir os danos à saúde e outras consequências resultantes do consumo abusivo do álcool. --------- ABSTRACT: To determine the prevalence and consumption profile of populations revealed as important elements for establishing plans and intervention programs in attention to problems related to alcohol consumption. This cross-sectional study on a sample of users of primary health care was aimed to determine the prevalence of alcohol consumption in two health centers in an urban area, (Achada de Santo António and Achadinha) in the capital and a health center in a rural area (Picos), in the island of Santiago’s contryside. The instrument used to assess the intake of medium and high risk alcohol was the ASSIST. We interviewed 302 users in three health centers. The results showed lifetime prevalence of 86.4% and in the last 3 months of 62.3%. It showed that men were superior to women in consumption in both health centers of Achadinha (p value=0.002) and Picos (p value=0.000). In Achada de Santo António, the difference between men and women was not statistically significant (p value = 0397). The results also showed the two centers had a significant association between risk of tobacco consumption and risk consumption of alcohol (p value = 0.000 and 0.003) which was not found in ASA (p value = 0.962). There was no association between the variables (age, professional occupation, and educational level) and risk of alcohol consumption, but they showed a significant association with alcohol consumption in the last 3 months. On the other hand, the consumption of alcohol in the last three months showed no significant association with the consumption of tobacco in the last 3 months. It is hoped that the results may support the policy against alcohol, may implement actions that can prevent damage to the health and other consequences resulting from alcohol abuse. 2013-01-01T00:00:00Z http://hdl.handle.net/10362/8860 Title: Analysis of mental health service financial models with a particular emphasis of Ireland Authors: Datta, Anna Abstract: ABSTRACT: Financing is a critical factor in ensuring the optimal development and delivery of a mental health system. The primary method of financing worldwide is tax-based. However many low income countries depend on out-of-pocket payments. There is a report on Irish Health Care funding but none that deals exclusively with mental health care. This paper analyses the various financial models that exist globally with respect to financing the mental health sector, examines the impact of various models on service users, especially in terms of relative ‘financial burden’ and provides a more detailed examination of the current mental health funding situation in Ireland After extensive internet and hardcopy research on the above topics, the findings were analysed and a number of recommendations were reached. Mental health service should be free at the point of delivery to achieve universal coverage. Government tax-based funding or mandatory social insurance with government top-ups, as required, appears the optimal option, although there is no one funding system applicable everywhere. Out-of-pocket funding can create a crippling financial burden for service users. It is important to employ improved revenue collection systems, eliminate waste, provide equitable resource distribution, ring fence mental health funding and cap the number of visits, where necessary. Political, economic, social and cultural factors play a role in funding decisions and this can be clearly seen in the context of the current economic recession in Ireland. Only 33% of the Irish population has access to free public health care and the number health insurance policy holders has dramatically declined, resulting in increased out-of-pocket payments. This approach risks negatively impacting on the social determinants of health, increasing health inequalities and negatively affecting economic productivity. It is therefore important the Irish government examines other options to provide funding for mental health services. 2012-01-01T00:00:00Z http://hdl.handle.net/10362/8401 Title: Analysis of the pathway of developing a national mental health plan for Suriname Authors: Jintie, Herman Alwin Abstract: ABSTRACT: The aim of this analysis was to analyze and describe the steps that have been taken in the development of the mental health policy in Suriname after the WHO AIMS. The objectives are: 1.To review the steps to be taken in developing a mental health policy and plan for a country 2.To gather information and data concerning mental health policy and plan development in Suriname 3.To draw conclusion from the experience gained that can be applied to other countries. In general, the information that was gathered from the four countries Guyana, Barbados, Trinidad & Tobago and Suriname, was compared with the WHO steps for developing a mental health policy and plan. Were these steps taken into consideration, when developing their mental health policy and plan? If not, what were the reasons why it did not happen? The checklist for evaluating a mental health plan was used in Suriname. This checklist assisted to see if the results of the recommendations given by the WHO AIMS to develop a effective and balanced mental health plan were taken into consideration. The mayor findings of the analysis are that Suriname as well as Guyana used the steps in developing their mental health policy and plan. Barbados and Trinidad & Tobago did not develop a mental health policy and plan. Suriname and Guyana have a mental health coordinating body at the Ministry of Health. Trinidad & Tobago as well as Barbados have a mental health focal person at the Ministry of Health of the respective countries. It can be concluded that successfully improving of health systems and services for mental health is combining theoretical concepts, expert knowledge and cooperation of many stakeholders. The appointment of a mental health coordinating unit at the Ministry of Health is crucial for the development of mental health in a country. Furthermore, mental health is everyone’s business and responsibility. Implementing the steps to be taken when developing a mental health policy and plan as recommended by WHO may be a slow process requiring the mobilization of political will. That’s why it is crucial that persons responsible for this process work close with all stakeholders in relevant sectors, taking their needs into consideration and try to translate that in clear objectives. It is common knowledge that improving the quality of mental health must be accompanied by the availability of financial and human resources. Finally, a mental health policy and plan should be one document tackling all aspects of mental health of a community. 2012-01-01T00:00:00Z http://hdl.handle.net/10362/7740 Title: Income and mental health  Authors: Silva,  Maria Manuela Correia Vieira da Abstract: RESUMO: A enorme carga e o sofrimento provocado pelas doenças mentais no mundo tornam imperioso conhecer melhor os seus determinantes. Combater as desigualdades em saúde tornou-­‐se uma prioridadade de saúde pública, mas é necessário estabelecer as suas vias causais para ser possível implementar intervenções e políticas efetivas. A literatura científica tem sugerido a importância dos determinantes sociais na etiologia e evolução das principais doenças mentais e do suicídio, com especial ênfase no papel da desvantagem social. Ainda assim, o papel dos fatores psicossociais na saúde mental, e especificamente o papel do rendimento e da sua distribuição, não tem sido investigado no meu país, Portugal. No meu projeto de investigação proponho-­‐me a estudar se em Portugal existe uma associação entre as doenças mentais e o rendimento absoluto e relativo. Pretendo usar os dados do primeiro inquérito epidemiológico sobre saúde mental realizado em Portugal, um inquérito nacional transversal no domicílio que foi conduzido em 2009,integrado no WHO World Mental Health Survey Consortium. Nesta tese de mestrado apresento os resultados da minha revisão da literatura sobre a relação entre o estatuto socio-­‐económico e a saúde mental e esboço uma proposta de pesquisa para continuar a investigar este tema. A evidência que apresento mostra que a exposição a um vasto leque de riscos psicossociais, como o baixo rendimento, a educação limitada e o estatuto ocupacional baixo,aumenta a probabilidade de desenvolver problemas de saúde mental. As diferenças em saúde seguem um gradiente social, com piores resultados de saúde à medida que a posição na hierarquia social diminui. Também sumarizo a literatura sobre o papel do contexto na produção de desigualdades em saúde para além das características individuais. Tem especial interesse o potencial efeito na saúde do rendimento relativo e a importância da distribuição dos rendimentos como determinante de saúde. Finalmente,delineio os possíveis mecanismos através dos quais o estatuto socio-­económico contribui para as disparidades em saúde. 2012-01-01T00:00:00Z