National Policy for Comprehensive Health Care for Adolescents Deprived of Liberty: an analysis of its implementation

Paths and inter-mediations between Brazilian Health Services and Youth Detention Centers

Socio-education is an educational and (re)socialization proposal for young people having troubles with the law, a law which also includes the right to health care guaranteed by the Unified Health System (SUS). This study aims to investigate the relationship between health services and socio-educational units in Paraná state, from the perspective of service workers and managers. The qualitative and exploratory research consisted of sixteen semi-structured interviews in five municipalities in the state, with subsequent categorization of the narratives based on hermeneutic analysis. As a result, there was considerable weakness in the coordination between the network's facilities to promote overall health care, specifically the mental health of young people. Security issues have a strong influence on the regulation of actions, even health actions, in socio-education. The current policy of comprehensive health care in socio-education, implemented in Brazil in 2014, is, however, an important counterpoint for the reordering and nudging policies in this area.

From Social Rejection to Welfare Oblivion: Health and Mental Health in Juvenile Justice in Brazil, Colombia and Spain

(1) Background: This study aims to examine and describe the policies of three Latin American countries: Colombia, Brazil, and Spain, and identify how they implement their support systems for health, mental health, mental health for children and adolescents, and juvenile justice systems that support judicial measures with treatment and/or therapeutic approaches specialized in mental health. (2) Methods: Google Scholar, Medline, and Scopus databases were searched to identify and synthesize of the literature. (3) Results: Three shared categories were extracted to construct the defining features of public policies on mental health care in juvenile justice: (i.) models of health and mental health care, (ii.) community-based child and adolescent mental health care, and (iii.) mental health care and treatment in juvenile justice. (4) Conclusions: Juvenile justice in these three countries lacks a specialized system to deal with this problem, nor have procedures been designed to specifically address these situations within the framework of children's rights.

[Validation of the logical model of the National Policy for Comprehensive Health Care for Adolescents in Socio-Educational Care (Pnaisari)]

This research involves a descriptive and exploratory study, using documentary analysis, application of a questionnaire and focus group activity for elaboration and validation of a logical model of the National Policy for Comprehensive Health Care for Adolescents in Socio-Educational Care (Pnaisari). The implementation of the policy aims to guarantee access to health care for this population group. Thus, the scope of this study is to describe the stages of development and the results of the process of elaboration and validation of the logical model of Pnaisari. In terms of results, the validated Logic Model exalted the inter-sectoral and inter-federative articulation as a central and fundamental element for the implementation of the policy. As a way to improve the model, the recommendation is to insert the inputs involved in the actions, highlight mental health actions, describe the actors involved in the stages and organize the products and results into tangible goals, separating the result from the impact. Despite the challenges facing its implementation, all municipalities of the country should implement Pnaisari, since it is the Unified Health System's policy for adolescents and young people deprived of liberty.

Feeding practices and early weaning in the neonatal period: a cohort study

OBJECTIVE

To describe feeding practices and the risk factors for the mixed breastfeeding and early weaning in the neonatal period.

METHODS

Cohort study, which we collected socioeconomic, demographic, health care and feeding data from 415 mother/child binomials born in four public maternity hospitals in Natal/Brazil. They were followed-up at 48 hours, 7 and 28 days after birth. The association was established using Pearson's Chi-square test and Poisson's regression, after adjusting it to other variables.

RESULTS

The prevalence of mixed breastfeeding in the first 2 days was 47,2% and early weaning in 7 and 28 days was 8,4% and 16,2% in that order. The main reasons for mixed breastfeeding and early weaning were: colostrum deficiency (33.8%), difficulty in latching/sucking (23.5%) and "little milk" (70.0%). The use of formula/milk/porridge remained associated with maternal age ≤ 20 years (RR = 0.64; 95%CI: 0.47-0.86), age 20-29 years (RR = 0,70; 95%CI: 0,57-0,87), primiparity (RR = 1.37; 95%CI: 1.11-1.60) and cesarean delivery (RR = 1.20; 95%CI: 1.00-1.45) at 2 days; absence of paternal support (RR = 4.98; 95%CI: 2.54-9.79) and pacifier use (RR = 3.21; 95%CI: 1.63-6.32) at 7 days; and only pacifier use (RR = 2.48; 95%CI: 1.53-4.02) at 28 days.

CONCLUSIONS

Early weaning was associated with maternal and health care factors, thus suggesting the need to readjust good practices and educational actions to achieve the exclusive offer to the maternal breast in the neonatal period.

Prevalence of the five newborn screening tests

Neonatal screening is essential for child health and has the following purposes: (1) pulse oximetry screening to evaluate congenital heart diseases; (2) red reflex examination to investigate eye diseases; (3) newborn hearing screening test to evaluate congenital hearing diseases; (4) tongue test to evaluate the lingual frenulum and identify communication and feeding problems; (5) the Guthrie test to screen for metabolic diseases. This study investigated the prevalence of the five neonatal screening tests and its associated institutional and socio-cultural factors using a cross-sectional study with 415 mother and baby binomials from public maternity hospitals in Natal, RN, Brazil in 2019. Pearson's chi-squared, Mann-Whitney and Poisson regression tests were used, with a significance of p ≤ 0.05 and a 95% confidence interval. The sample loss was 71 mothers (17%). The prevalence in the first week and at the end of 28 days was 93% and 99.5% (pulse oximetry screening), 60% and 97.6% (red reflex examination), 71.9% and 93.6% (Guthrie test), 35.5% and 68.2% (hearing screening test), and 19% and 48.9% (tongue test). Only 152 newborns (36.6%) underwent all five tests. The performance of the tests was associated in the final model (p ≤ 0.05) with the residence of the mothers in the state capital (PR = 1.36; 95% CI = 1.18-1.56) and the provision of guidance for mothers about the five tests in maternity hospitals (PR = 1.30; 95% CI = 1.08-1.67). None of the tests met full coverage, and regional inequities were identified indicating the need to restructure the institutions, training and qualification procedures to improve of the work processes and longitudinal care.

Depression, anxiety, and drug usage history indicators among institutionalized juvenile offenders of Brasilia

INTRODUCTION

One of the most serious socio-educational measures for children and adolescents in conflict with the law in Brazil is their internment. This measure may represent an additional source of stress to this population and present significant impacts in the mental health context. This study aims to describe anxiety levels, depression, and addictive consumption, as well as to estimate the causalities and interactions of these variables.

METHODS

Herein, we report a study in which 175 male juveniles from youth detention institutions of the Federal District voluntarily completed the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and a short self-rating questionnaire asking whether and how often they had experienced cannabis, alcohol, and other "hard" psychotropic drugs (e.g., crack, cocaine, amphetamine) 1 year prior to institutionalization.

RESULTS

Of the total participants, 28.00% showed moderate to severe depression scores and 34.28% showed moderate to severe anxiety scores. In addition, the vast majority of participants also reported some antecedent drug abuse, including cannabis, alcohol, and other "hard drugs." The BDI scores moderately correlated with BAI, but none of these parameters considerably correlated with the antecedent drug abuse.

CONCLUSIONS

The data indicate potentially concerning levels of emotional distress in these institutionalized juveniles which seem to be independent of addictive behaviors. These data deserve attention and further investigation. Thus, a need for preventative mental health for the general population and socio-educational intervention aimed at interned youth which can decrease levels of emotional stress is emphasized.