Suchergebnisse

Da sempre le società crescono e si evolvono sotto la pressione dei nuovi rapporti di potere che de-costruiscono le proprie istituzioni per poi costruirne di nuove, affinché gli individui possano convivere nonostante valori e interessi contrastanti. Le società si possono dire tali nel momento in cui costituiscono uno spazio pubblico. Nella società industriale tale spazio pubblico era costruito intorno all'istituzione dello Stato-Nazione che sotto la spinta del sindacato e della lotta di classe, hanno dato vita ad uno spazio pubblico istituzionale basato sul legame con il sistema politico democratico, una magistratura indipendente e una società civile legata allo Stato. Con il passare del tempo e dopo i processi di globalizzazione e lo sviluppo delle nuove tecnologie è stato messo in discussione lo Stato-Nazione come espressione di spazio pubblico. Con ciò non si vuole affermare che lo Stato-Nazione sia scomparso ma che la sua legittimità è andata scemando mettendo in luce una governance globale, mentre i governi continuano a restare nazionali. Il risultato è una crisi della legittimità politica che vede il principio di cittadinanza entrare in conflitto con quello dell'auto-determinazione. Le società continuano a funzionare sotto il profilo sociale e politico, spostando il processo di formazione dell'opinione pubblica dalle istituzioni politiche all'universo della comunicazione, che è incentrato principalmente intorno ai mass-media. Si tratta di una prospettiva che è estesa anche alle dinamiche storiche di contro-potere, dato che emergono nuove forme di cambiamento sociale e una politica alternativa che utilizza le opportunità offerte dai mass-media. In conclusione lo spazio pubblico viene definito nello spazio della comunicazione. Quest'ambito è sempre più contrastato, in quanto apre una nuova era che vede il fiorire di un nuovo modello di società, dove i detentori del potere stanno cercando di riaffermare il proprio dominio, a seguito del riconoscimento della sempre minore capacità, da parte delle istituzioni di recepire progetti e istanze dei cittadini di tutto il mondo; si tratta di fissare nuove forme di dominio che utilizzano principalmente i media. In queste circostanze si assiste a una nuova fase di costruzione del potere nello spazio della comunicazione, dove i potenti sono sempre più spinti dall'esigenza di raccogliere la sfida lanciata dai network di comunicazione orizzontale. Lo spazio pubblico emergente, fondato sulla comunicazione rispetta l'esito di un episodio della più antica battaglia: quella per la nostra libertà di pensiero.

Background: Despite major advancements in understanding of the factors associated with mental health in older adults, studies assessing positive behaviours, attitudes and virtues are still scarce in the literature. Aims: This study aims to investigate whether factors related to positive behaviours, attitudes and virtues are associated with mental health (i.e. depression, anxiety and stress) and satisfaction with life in Brazilian community-dwelling older adults. Methods: A population-based, cross-sectional study of Brazilian older adults who were users of the public health system and seen by Family Health teams was conducted in 2017. Instruments were applied to assess cognition, physical activity, sleep, quality of life, social support, religiousness, spirituality, satisfaction with life, resilience, altruism, volunteerism, loneliness, meaning in life and mental health (i.e. depression, anxiety and stress). Analyses were carried out using linear and logistic regression models. Results: A total of 534 (93.5%) older adults were included. Positive behavioural factors and values including volunteerism, meaning in life, resilience, peace, loneliness, faith and religiousness were associated with mental health outcomes (i.e. depression, anxiety and stress), as were traditional factors, such as sleep, gender, social support and cognitive state. Conclusions: Aspects related to positive behaviour, attitudes and virtues can impact the mental health of the older population. These results can serve to alert health professionals on the importance of addressing these factors and help guide the implementation of preventive measures and interventions for this age group.

ABSTRACT In light of the high cost of dementia treatment, there is legislation authorizing free distribution of cholinesterase inhibitors to those suffering from Alzheimer's disease in Brazil. However, the existence of this free distribution does not guarantee adequate distribution. Objectives The present study aimed to investigate the trends of prescriptions and the coverage of Alzheimer's disease treatment using cholinesterase inhibitors from public pharmacies dispensing high-cost drugs in Brazil. Methods This was a retrospective study that collected data from the Brazilian public Unified Health System. All cholinesterase inhibitors distributed at no cost to Brazilians during the year 2014, as well as the estimated number and percentages of patients who used these medications, were evaluated and compared to data from the year 2008. Results Our estimates indicated that 9.7% of the population having dementia syndromes used cholinesterase inhibitors, as well as 16.1% of those with Alzheimer's disease in Brazil. A clear disparity was noted between the use and distribution of cholinesterase inhibitors, depending on the region in which they were found. Over time, an increase in the distribution of cholinesterase inhibitors has been noted. In 2008, that use was 12.0% whereas, in 2014, it was 16.1%, an increase of 34% in six years. Conclusion It was estimated that 16.1% of patients with Alzheimer's disease in Brazil use cholinesterase inhibitors. These values have increased and, in spite of not being satisfactory, they indicate a potential for improvement. However, there is still a significant disparity among the regions.

Background: Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training. Objective: To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years. Methods: This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses. Results: The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [ SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels. Conclusion: Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

Background: Different stages of a physician's career may be associated with different types of mental health impairment. Aims: This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians. Methods: A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale – DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models. Results: The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students. Conclusion: Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career.

Objective: To review the most common mental health strategies aimed at alleviating and/or preventing mental health problems in individuals during the coronavirus disease 2019 (COVID-19) and other coronavirus pandemics. Methods: We conducted a systematic review of the literature assessing three databases (PubMed, SCOPUS, and PsycINFO). A meta-analysis was performed with data from randomized controlled trials (RCTs). For non-RCT studies, a critical description of recommendations was performed. Results: From a total of 2,825 articles, 125 were included. Of those, three RCTs were included in the meta-analysis. The meta-analysis revealed that the interventions promoted better overall mental health outcomes as compared to control groups (standardized mean difference [SMD] = 0.87 [95%CI 0.33-1.41], p 0.05; I2 = 36.8%). Concerning the systematic review, we found a large body of scientific literature proposing recommendations involving psychological/psychiatric interventions, self-care, education, governmental programs, and the use of technology and media. Conclusions: We found a large body of expert recommendations that may help health practitioners, institutional and governmental leaders, and the general population cope with mental health issues during a pandemic or a crisis period. However, most articles had a low level of evidence, stressing the need for more studies with better design (especially RCTs) investigating potential mental health interventions during COVID-19. PROSPERO registration: CRD42020190212.