To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The nematode Angiostrongylus cantonensis is the most common cause of neuroangiostrongyliasis (manifested as eosinophilic meningitis) in humans. Gastropod molluscs are used as intermediate hosts and rats of various species are definitive hosts of this parasite. In this study, we identified several environmental factors associated with the presence and abundance of terrestrial gastropods in an impoverished urban region in Brazil. We also found that body condition, age and presence of co-infection with other parasite species in urban Rattus norvegicus, as well as environmental factors were associated with the probability and intensity of A. cantonensis infection. The study area was also found to have a moderate prevalence of the nematode in rodents (33% of 168 individuals). Eight species of molluscs (577 individuals) were identified, four of which were positive for A. cantonensis. Our study indicates that the environmental conditions of poor urban areas (presence of running and standing water, sewage, humidity and accumulated rain and accumulation of construction materials) influenced both the distribution and abundance of terrestrial gastropods, as well as infected rats, contributing to the maintenance of the A. cantonensis transmission cycle in the area. Besides neuroangiostrongyliasis, the presence of these hosts may also contribute to susceptibility to other zoonoses.
Fe-deficiency anaemia is considered an important public health problem both in wealthier countries and in those of medium and low income, especially in children under 5 years of age. The shortage of studies with national representativity in medium-income countries, such as Brazil, prevents the knowledge of the current situation and its associated factors. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of Fe-deficiency anaemia in Brazilian children under 5 years of age and determined the factors involved in the variability of the estimates of prevalence. We collected fifty-seven studies from the databases MEDLINE, LILACS and Web of Science, along with the reference lists of included articles. We contacted authors for unpublished data. We did not restrict publication timespan and language. This systematic review and meta-analysis was reported according to the guidelines by PRISMA. The pooled prevalence of anaemia in Brazil was 40·2 (95 % CI 36·0, 44·8) %. The age range of the child and the period of data collection were associated with the anaemia prevalence. The pooled prevalence of anaemia was higher in children under 24 months of age (53·5 v. 30·7 %; P < 0·001) and in studies with data collected before 2004 (51·8 v. 32·6 %; P = 0·001). The efforts made by the Brazilian government were successful in the reduction of anaemia in children under 5 years of age in Brazil in the evaluated period. However, prevalence remains beyond acceptable levels for this population group.
Either tobacco smoking or alcohol consumption during pregnancy sex-selectively increases susceptibility to drugs of abuse later in life. Considering that pregnant smoking women are frequently intermittent consumers of alcoholic beverages, here, we investigated whether a short-term ethanol exposure restricted to the brain growth spurt period when combined with chronic developmental exposure to tobacco smoke aggravates susceptibility to nicotine in adolescent and adult mice. Swiss male and female mice were exposed to tobacco smoke (SMK; research cigarettes 3R4F, whole-body exposure, 8 h/daily) or ambient air during the gestational period and until the tenth postnatal day (PN). Ethanol (ETOH, 2 g/Kg, 25%, i.p.) or saline was injected in the pups every other day from PN2 to PN10. There were no significant differences in cotinine (nicotine metabolite) and ethanol serum levels among SMK, ETOH and SMK + ETOH groups. During adolescence (PN30) and adulthood (PN90), nicotine (NIC, 0.5 mg/Kg) susceptibility was evaluated in the conditioned place preference and open field tests. NIC impact was more evident in females: SMK, ETOH and SMK + ETOH adolescent females were equally more susceptible to nicotine-induced place preference than control animals. At adulthood, SMK and SMK + ETOH adult females exhibited a nicotine-evoked hyperlocomotor profile in the open field, with a stronger effect in the SMK + ETOH group. Our results indicate that ethanol exposure during the brain growth spurt, when combined to developmental exposure to tobacco smoke, increases nicotine susceptibility with stronger effects in adult females. This result represents a worsened outcome from the early developmental dual exposure and may predispose nicotine use/abuse later in life.
Studies evaluating the occurrence of enteropathogenic bacteria in urban rats (Rattus spp.) are scarce worldwide, specifically in the urban environments of tropical countries. This study aims to estimate the prevalence of diarrhoeagenic Escherichia coli (DEC) and Salmonella spp. with zoonotic potential in urban slum environments. We trapped rats between April and June 2018 in Salvador, Brazil. We collected rectal swabs from Rattus spp., and cultured for E. coli and Salmonella spp., and screened E. coli isolates by polymerase chain reaction to identify pathotypes. E. coli were found in 70% of Rattus norvegicus and were found in four Rattus rattus. DEC were isolated in 31.3% of the 67 brown rats (R. norvegicus). The pathotypes detected more frequently were shiga toxin E. coli in 11.9%, followed by atypical enteropathogenic E. coli in 10.4% and enteroinvasive E. coli in 4.5%. From the five black rats (R. rattus), two presented DEC. Salmonella enterica was found in only one (1.4%) of 67 R. norvegicus. Our findings indicate that both R. norvegicus and R. rattus are host of DEC and, at lower prevalence, S. enterica, highlighting the importance of rodents as potential sources of pathogenic agents for humans.
The research described in this technical research communication examines the hypothesis that sublethal stress conditions can improve the survival of Lactococcus lactis subsp. lactis during drying and subsequent storage. After drying, the L. lactis that had adapted to acid or osmotic stresses did not differ statistically in terms of cell viability loss compared to the control samples tested (~0.38 log cycles). However, the cells that had adapted to oxidative conditions demonstrated a cell viability loss of only 0.01 log cycles. After 45 d of storage at temperatures of 4 and 25 °C, the final L. lactis sample populations were shown to be higher (112.5%) when they had been submitted to sublethal conditions of oxidative stress. When the cell samples were exposed to acid stress conditions, they exhibited a viability loss (0.82 log cycles) that was statistically different from the control sample (0.58 log cycles) after 45 d. Osmotic stress conditions did not demonstrate any influence over cell survival rates. Thus, submitting cells to oxidative stress conditions prior to storage has been shown to be a potential strategy for producing dehydrated cultures of L. lactis strains that are less sensitive to oxygen exposure.
This study aimed to examine the effects of re-ensiling time and Lactobacillus buchneri on the fermentation profile, chemical composition and aerobic stability of sugarcane silages. The experiment was set up as a repeated measure design consisting of four air-exposure periods (EP)(0, 6, 12, and 24 h) microbial additive (A) (L. buchneri; or lack of there), with five replicates. Sugarcane was ground through a stationary forage chopper and ensiled in four plastic drums of 200-L capacity. After 210 days of storage, the drums were opened and half of the silage mass was treated with L. buchneri at the concentration of 105 cfu/g of forage. Subsequently, the silages were divided into stacks. The re-ensiling process was started immediately, at 0, 6, 12 and 24-hour intervals, by transferring the material to PVC mini-silos. Silos were opened after 120 days of re-ensiling. The use of L. buchneri reduced butyrate concentration but did not change ethanol or acetic acid concentrations and aerobic stability. An interaction effect between L. buchneri and re-ensiling time was observed for dry matter (DM) losses and composition. Lactobacillus buchneri is not effective in improving aerobic stability in re-ensiled sugarcane silages. However, less DM is lost in silages treated with L. buchneri and exposed to air for 24 h. Re-ensiling sugar cane in up to 24 h of exposure to air does not change final product quality.
We evaluated the differences between the supplementation of urea in rumen and/or abomasum on forage digestion, N metabolism and urea kinetics in cattle fed a low-quality tropical forage. Five Nellore heifers were fitted with rumen and abomasum fistulas and assigned to a Latin square design. The treatments were control, continuous infusion of urea in the abomasum (AC), continuous infusion of urea in the rumen, a pulse dose of urea in the rumen every 12 h (PR) and a combination of PR and AC. The control exhibited the lowest (P < 0·10) faecal and urinary N losses, which were, overall, increased by supplementation. The highest urinary N losses (P < 0·10) were observed when urea was either totally or partially supplied as a ruminal pulse dose. The rumen N balance was negative for the control and when urea was totally supplied in the abomasum. The greatest microbial N production (P < 0·10) was obtained when urea was partially or totally supplied in the abomasum. Urea supplementation increased (P < 0·10) the amount of urea recycled to the gastrointestinal tract and the amount of urea-N returned to the ornithine cycle. The greatest (P < 0·10) amounts of urea-N used for anabolism were observed when urea was totally and continuously infused in the abomasum. The continuous abomasal infusion also resulted in the highest (P < 0·10) assimilation of microbial N from recycling. The continuous releasing of urea throughout day either in the rumen or abomasum is able to improve N accretion in the animal body, despite mechanism responsible for that being different.
The description of the growth of the Japanese quails is necessary to characterize the genetic potential of these birds raised in different countries. Thus, the aim of this study was to describe the genetic potential of Japanese quails by conducting a meta-analysis considering studies conducted in different countries. Only data about the subspecies Coturnix coturnix japonica were considered; studies regarding Coturnix coturnix coturnix were not examined. The criteria investigated were BW (W), age (t), year of publication and location of the study. Each set of genetic material within a publication was coded as one study. The Gompertz function was used to interpret the growth of laying quails; thus, each study was represented by Gompertz parameters. The W and t data were applied to estimate the values of Gompertz growth parameters, including BW at maturity (Wm), BW at birth (Wi), maturity rate (B) and inflection point (IP). The age at which the maximum growth rate was achieved (t*) was calculated considering the parameters Wm, Wi and B. To estimate these parameters, random regression was used to randomize the parameter Wm. The parameters estimated for each assay were used in exploratory, grouping, and principal component analyses. The values of Wi ranged from 4.1 to 11.6 g. The values of B ranged from 0.0393 to 0.1039/day, and consequently, the values of t* and IP ranged from 14 to 31 days and 9.21 to 31.03 g, respectively. These results show that there is considerable variability in the growth potential of Japanese quails. To better understand this variation, two groups were examined: Brazil and other countries, according to the grouping of Wi, Wm, B and t*; parameter B was the variable that presented the highest specificity, indicating that both groups modified the maturity rate. For the principal component analysis, the year of publication showed a relationship with the growth parameters but only for studies performed in Brazil. For studies carried out in other countries, the changes in growth parameters were not related to the year of publication. In Brazilian studies, there was a decrease in the maturity rate, but the weight at maturity was higher. Therefore, it appears that different strategies of genetic selection were adopted in Brazil compared to other countries.
Bipolar disorder (BD) is associated with social cognition (SC) impairments even during remission periods although a large heterogeneity has been described. Our aim was to explore the existence of different profiles on SC in euthymic patients with BD, and further explore the potential impact of distinct variables on SC.
Hierarchical cluster analysis was conducted using three SC domains [Theory of Mind (ToM), Emotional Intelligence (EI) and Attributional Bias (AB)]. The sample comprised of 131 individuals, 71 patients with BD and 60 healthy control subjects who were compared in terms of SC performance, demographic, clinical, and neurocognitive variables. A logistic regression model was used to estimate the effect of SC-associated risk factors.
A two-cluster solution was identified with an adjusted-performance group (N = 48, 67.6%) and a low-performance group (N = 23, 32.4%) with mild deficits in ToM and AB domains and with moderate difficulties in EI. Patients with low SC performance were mostly males, showed lower estimated IQ, higher subthreshold depressive symptoms, longer illness duration, and poorer visual memory and attention. Low estimated IQ (OR 0.920, 95% CI 0.863–0.981), male gender (OR 5.661, 95% CI 1.473–21.762), and longer illness duration (OR 1.085, 95% CI 1.006–1.171) contributed the most to the patients clustering. The model explained up to 35% of the variance in SC performance.
Our results confirmed the existence of two discrete profiles of SC among BD. Nearly two-thirds of patients exhibited adjusted social cognitive abilities. Longer illness duration, male gender, and lower estimated IQ were associated with low SC performance.
An understanding of the processes involved in grazing behaviour is a prerequisite for the design of efficient grassland management systems. The purpose of managing the grazing process is to identify sward structures that can maximize animal forage daily intake and optimize grazing time. Our aim was to evaluate the effect of different grazing management strategies on foraging behaviour and herbage intake by sheep grazing Italian ryegrass under rotational stocking. The experiment was carried out in 2015 in southern Brazil. The experimental design was a randomized complete block with two grazing management strategies and four replicates. The grazing management treatments were a traditional rotational stocking (RT), with pre- and post-grazing sward heights of 25 and 5 cm, respectively, and a ‘Rotatinuous’ stocking (RN) with pre- and post-grazing sward heights of 18 and 11 cm, respectively. Male sheep with an average live weight of 32 ± 2.3 kg were used. As intended, the pre- and post-grazing sward heights were according to the treatments. The pre-grazing leaf/stem ratio of the Italian ryegrass pasture did not differ between treatments (P > 0.05) (~2.87), but the post-grazing leaf/stem ratio was greater (P < 0.001) in the RN than in the RT treatment (1.59 and 0.76, respectively). The percentage of the non-grazed area was greater (P < 0.01) in post-grazing for RN compared with RT treatment, with an average of 29.7% and 3.49%, respectively. Herbage nutritive value was greater for the RN than for the RT treatment, with greater CP and lower ADF and NDF contents. The total time spent grazing, ruminating and resting did not differ between treatments (P > 0.05), with averages of 439, 167 and 85 min, respectively. The bite rate, feeding stations per min and steps per min by sheep were greater (P < 0.05) in the RN than in the RT treatment. The grazing time per hour and the bite rate were greater (P < 0.05) in the afternoon than in the morning in both treatments. The daily herbage intake by sheep grazing Italian ryegrass was greater (P < 0.05) in the RN than in the RT treatment (843.7 and 707.8 g organic matter/sheep, respectively). Our study supports the idea that even though the grazing time was not affected by the grazing management strategies when the animal behaviour responses drive management targets, such as in ‘Rotatinuous’ stocking, the sheep herbage intake is maximized, and the grazing time is optimized.
Ageing leads to a progressive loss of muscle function (MF) and quality (MQ: muscle strength (MS)/lean muscle mass (LM)). Power training and protein (PROT) supplementation have been proposed as efficient interventions to improve MF and MQ. Discrepancies between results appear to be mainly related to the type and/or dose of proteins used. The present study aimed at determining whether or not mixed power training (MPT) combined with fast-digested PROT (F-PROT) leads to greater improvements in MF and MQ in elderly men than MPT combined with slow-digested PROT (S-PROT) or MPT alone. Sixty elderly men (age 69 (sd 7) years; BMI 18–30 kg/m2) were randomised into three groups: (1) placebo + MPT (PLA; n 19); (2) F-PROT + MPT (n 21) and (3) S-PROT + MPT (n 20) completed the intervention. LM, handgrip and knee extensor MS and MQ, functional capacity, serum metabolic markers, skeletal muscle characteristics, dietary intake and total energy expenditure were measured. The interventions consisted in 12 weeks of MPT (3 times/week; 1 h/session) combined with a supplement (30 g:10 g per meal) of F-PROT (whey) or S-PROT (casein) or a placebo. No difference was observed among groups for age, BMI, number of steps and dietary intake pre- and post-intervention. All groups improved significantly their LM, lower limb MS/MQ, functional capacity, muscle characteristics and serum parameters following the MPT. Importantly, no difference between groups was observed following the MPT. Altogether, adding 30 g PROT/d to MPT, regardless of the type, does not provide additional benefits to MPT alone in older men ingesting an adequate (i.e. above RDA) amount of protein per d.
This study presents two years of characterization of a warm temperate rhodolith bed in order to analyse how certain environmental changes influence the community ecology. The biomass of rhodoliths and associated species were analysed during this period and in situ experiments were conducted to evaluate the primary production, calcification and respiration of the dominant species of rhodoliths and epiphytes. The highest total biomass of rhodoliths occurred during austral winter. Lithothamnion crispatum was the most abundant rhodolith species in austral summer. Epiphytic macroalgae occurred only in January 2015, with Padina gymnospora being the most abundant. Considering associated fauna, the biomass of Mollusca increased from February 2015 to February 2016. Population densities of key reef fish species inside and around the rhodolith beds showed significant variations in time. The densities of grouper (carnivores/piscivores) increased in time, especially from 2015 to 2016. On the other hand, grunts (macroinvertebrate feeders) had a modest decrease over time (from 2014 to 2016). Other parameters such as primary production and calcification of L. crispatum were higher under enhanced irradiance, yet decreased in the presence of P. gymnospora. Community structure and physiological responses can be explained by the interaction of abiotic and biotic factors, which are driven by environmental changes over time. Biomass changes can indicate that herbivores play a role in limiting the growth of epiphytes, and this is beneficial to the rhodoliths because it decreases competition for environmental resources with fleshy algae.
Insects in the subfamily Ischnorhininae (Hemiptera: Auchenorrhyncha: Cercopidae), known as spittlebugs or froghoppers, are mainly distributed in the Neotropical region. A few genera include pest species of economic relevance, including Prosapia Fennah, 1949. Two new species from Mexico and Costa Rica are now described for this genus, and a key to species is proposed for the P. inferens (Walker, 1858) species group.
Clinical history, neuroimaging and lab investigations, and neuropsychological assessments.
A 66-year-old married man was admitted to an Old Age psychiatric ward presenting with a two-year history of desinhibited behaviour, hetero-aggression and a gradual loss of his ability cope with activities of daily living. His Mini Mental State Examination (MMSE) score was 20/30 on admission. The symptoms described above raised the working diagnosis of a frontotemporal dementia. Computerized axial tomography was normal. Laboratory and additional examinations were performed. Serological tests for syphilis were positive for both the Venereal Disease Research Laboratory test (VDRL) and Treponema pallidum hemaglutination test (TPHA). Cerebrospinal fluid (CSF) revealed a positive VDRL (cytology: 2 erythrocytes/μl, 30 leucocytes/μl with 24 mononuclear cells/ μl). Additional tests including human immunodeficiency virus (HIV) test were negative. Based on these findings the patient was treated for neurosyphilis according to the IUSTI 2008 European Guidelines on the management of Syphilis: Benzyl penicillin 18 million units i.v. daily, as 3 million units every four hours during 21 days. Two months later, he scored 28/30 at the MMSE but showing only slight improvement at the executive function battery.
Neurosyphilis remains a differential diagnosis for a wide variety of psychiatric syndromes, including dementia. However, the incidence of neurosyphilis presenting initially with frontotemporal impairment is unclear. High-risk groups such as patients with neuropsychiatric diseases should be routinely screened with serological tests in order to prevent morbidity and help to eliminate syphilis.
Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables.
In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning.
One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed and verbal memory.
The reliability of the PSP was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared to high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance.
The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.
Metabolic Syndrome (MS) is constituted by a set of specific metabolic alterations being postulated that the main dysfunction is insulin resistance. Estimates point to higher prevalence of MS in bipolar patients, between 30 to 35%. Cost-effective screening methods, not recurring to blood test, have been researched.
Analyse knowledge and importance given to MS in bipolar patients. Test the viability of MS screening without blood tests.
Observational, cross-sectional study. Random sample of 15 adult bipolar patients, in euthymic phase. Semi-structured interview, YMRS, HAMD were applied. MS diagnosis investigated according to the International Diabetes Federation (IDF) criteria. MS screening was defined positive if blood pressure ≥ 130/85 or anti-hypertensive medication and abdominal perimeter > 90 in males or > 80 in females. A questionnaire about knowledge, attitudes and concerns on MS was applied.
14 patients completed the investigation protocol. Five (36%) met IDF criteria for metabolic syndrome. Screening sensitivity was 80% and specificity 78%. Twelve patients (80%) were overweigh or obese. Mean IMC in patients that met IDF criteria for MS was 30 while in the other group mean IMC was 26. Only 3 (20%) have ever heard about MS, but the majority of the patients were concerned, in decreasing order, about weight gain, blood pressure cholesterol and hyperglycemia control.
Although limited by small sample size, this study strengthens the idea that MS screening can be effective in clinical practice, it also indicates the need to educate BP patients about MS and to prevent overweight.
Studying inpatient clinical population's features allows a better understanding of readmissions. Factors associated with higher levels of readmission may give clues concerning better treatment planning and follow-up.
To detect psychosocial and clinic factors associated with readmissions in an inpatient general psychiatric population.
107 patients consecutively admitted to an inpatient unit were characterized in terms of psychosocial, clinical, treatment and discharge plan features. Readmission was defined as the number of previous admittances in the last two years.
Patients characteristics: Average age 44 (SD: 16); 58% female; 10 (SD:5) years of education; average disease duration of 128 (SD:115) months. Main diagnosis: 30,8% schizophrenia; 14% bipolar I disorder; 13,1% major depression; 11,2% recurrent major depression; 5,6% cluster B personality; 3,8% bipolar II disorder and 2,9% schizoaffective disorder. From more to less frequent diagnosis implicated in readmissions were schizophrenia, schizoaffective disorder, recurrent major depression, bipolar I, bipolar II and major depression episode. Readmissions were not associated with inpatient treatment or disease duration, nor toxics or axis II diagnosis. Nonetheless, beginning a depot antipsychotic medication was related to an increase in previous admissions.
These are preliminary results of a small sample, but they point towards the usefulness of a systematic evaluation of inpatient populations, mainly in what concerns complex clinical situations like major pathology readmissions.
The literature recognizes differences in the prevalence, eating disorders (ED) symptoms and eating habits/behaviours by sex, but few studies in Portugal considered this subject.
To explore associations between sex, Body Mass Index (BMI), Eating Attitudes Test-25 (EAT-25) dimensions and items, the EAT-25 score dichotomized by the cutoff of 19 (a score equal/above 19 indicates “possible” ED) and, finally, some items about eating habits/behaviors; to verify possible associations between sociodemographic variables and items assessing eating habits/behaviours.
308 adolescents (M = 14,5 years; DP = 1,67; girls, n = 184, 59,7%) answered a sociodemographic questionnaire and the EAT-25.
There were no significant associations between sex, categorized and dimensional BMI, EAT-25 dimensions, categorized EAT-25 (cutoff of 19) and items assessing eating habits/behaviors. However, some items of the EAT-25 revealed a significant association with sex. Most adolescents from both sexes presented a score below the cutoff of 19. The frequency with which young people drink sodas and eat vegetables is associated with father's educational level. The frequency with which adolescents eat vegetables and fast food is associated with the school area they attend.
Eating habits/behaviours are not as much negative as documented in some literature. There does not seem to exist significant sex differences regarding eating attitudes, “possible” ED, BMI and eating habits/behaviours. However, there are sex differences regarding some of the specific symptoms of EAT-25. It is good to verify that both sexes reveal a low prevalence of “possible” eating behaviour disorder, although girls reveal a higher value.
In 2007 the Government launched a new Mental Health Plan (MHP), written in the spirit of international principles, including the WHO 2001 Global Mental Health Report and the Helsinki European Declaration. The new MHP includes a special section with guidelines for Child and Adolescent Mental Health Services (CAMHS) development. This is relevant, given that, according to WHO, 2 million young people in Europe suffer from mental disorders, sometimes receiving no care.
Regarding mental health needs of the children and youth, the MHP focus on i. how to develop new CAMHS in public general hospitals, across the country, and ii. how to integrate CAMHS in the general health system (including primary care), in order to promote access and decrease stigma.
A national task force has been empowered by the Government to assure the implementation of the MHP, with external monitoring from WHO. This task force includes a team of child and adolescent mental health experts, belonging to different administrative catchment areas throughout the country.
Relevant advances have been: appraisal of current resources, development of new CAMHS, planning of residential and day unit facilities for adolescents, mental health promotion and domestic violence prevention programmes, advocacy and stigma.
Despite several positive outcomes, CAMHS evaluation detected significant problems (access, equity and quality of care). Special attention should be given to CAMHS, namely through the increase of new services and new teams. Nevertheless, given the present crisis context, broad policies can negatively influence and restraint the mental health plan implementation.
Although some improvements during the last decade, Portuguese mental health services still bear substantial shortages, in terms of accessibility, equity and quality of care. A new National Mental Health Plan with a community model has been launched in 2007.
To assess unmet needs at public mental health services in Portugal.
Cross-sectional study, steering all the public mental health services throughout the country, both for adults (39 units) and children/adolescents (11 units). Evaluation was done by means of the WHO “Quality Assurance in Mental Health Care” tool, which includes dimensions such as physical environment, administrative arrangements, care process, interaction with families, outreach, discharge and follow-up.
The quality of services, according to the assessment made with the participation of professionals, did not reach the “Good level” (> 80% met needs). Level of unmet needs was worse in adult outpatient services (35%) than in inpatient units (27%, despite the relevance of the former. Most critical areas of unmet needs included human resources (only 44% met needs, concerning provision, distribution, interdisciplinary composition of the staff) and administrative arrangements (66% met needs). Regarding the child/adolescent units, the weighted level of quality of outpatient services (67% met needs) was similar to that of inpatient units (68%).
The implementation of the mental health plan has to tackle some of the unmet needs present in mental health services in Portugal. Special attention should be given to the outpatient facilities, in order to undertake with the community philosophy of the National Mental Health Plan.