Emotion coaching skills as an augmentation to family-based therapy for adolescents with anorexia nervosa: A pilot effectiveness study with families with high expressed emotion.

OBJECTIVE: To examine the feasibility and acceptability of augmenting family-based treatment (FBT) for adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) with a parent emotion coaching intervention (EC) focused on reducing parent expressed emotion. METHOD: In this pilot effectiveness trial, families of adolescents with AN/AAN exhibiting high expressed emotion received standard FBT with either (1) EC group or (2) support group (an attention control condition focused on psychoeducation). RESULTS: Forty-one adolescents with AN or AAN were recruited (88% female, Mage = 14.9 ± 1.6 years, 95% White: Non-Hispanic, 1% White: Hispanic, 1% Bi-racial: Asian). Most study adolescents were diagnosed with AN (59%) while 41% were diagnosed with AAN. Participating parents were predominantly mothers (95%). Recruitment and retention rates were moderately high (76% and 71%, respectively). High acceptability and feasibility ratings were obtained from parents and interventionists with 100% reporting the EC intervention was "beneficial"-"very beneficial." The FBT + EC group demonstrated higher parental warmth scores at post-treatment compared to the control group (standardized effect size difference, d = 1.58), which was maintained at 3-month follow-up. Finally, at post-treatment, the FBT + EC group demonstrated higher rates of full remission from AN/AAN (40%) compared to FBT + support (27%), and were nine times more likely to be weight restored by 3-month follow-up. DISCUSSION: Augmenting FBT with emotion coaching for parents with high expressed emotion is acceptable, feasible, and demonstrates preliminary effectiveness. PUBLIC SIGNIFICANCE: Family based treatment for AN/AAN is the recommended treatment for youth but families with high criticism/low warmth are less likely to respond to this treatment. Adding a parent emotion coaching group (EC) where parents learn to talk to their adolescents about tough emotions is feasible and well-liked by families.

Expressed emotion and long-term outcome among adolescents with anorexia nervosa.

OBJECTIVE: The purpose of the current study is to examine expressed emotion (EE) and long-term treatment outcome among adolescents participating in a randomized controlled trial (RCT) for treatment of anorexia nervosa (AN). It was hypothesized that patients with high EE parents at baseline would show more severe symptoms at end-of-treatment, 12-month follow-up, and 4-year follow-up than patients from low EE families. METHOD: Secondary data analysis was conducted of original RCT data from a two-site eating disorder treatment trial conducted in the United States. Participants were 121 adolescents with AN who completed measures of EE, eating disorder psychopathology, depression, and self-esteem. RESULTS: Generalized estimating equations showed that participants who were in the Low EE group achieved a more accelerated drop in depression scores in the context of treatment (first 12 months) than participants in the High EE group. No other significant Group × Time interactions were found. DISCUSSION: Findings suggest that high parental EE at baseline does not indicate that adolescent patients with AN will fare poorly 4 years later.

Treatment dropout in a family-based partial hospitalization program for eating disorders.

Treatment dropout is a significant challenge in the treatment of eating disorders. In day hospital/partial hospitalization program settings, little is known about factors associated with treatment dropout. The purpose of the present study was to assess factors associated with treatment dropout in a partial hospitalization program for adolescents and young adults with anorexia nervosa. Patients and parents completed self-report and interview-based measures at baseline and at end of treatment in the partial hospitalization program. Few factors were found that differentiated the two groups. Those who dropped out had lower body weight at end of treatment, were less likely to have purged in the previous month, and had fathers who scored higher on the criticism subscale of expressed emotion. Patients who are purging may be seen as having more severe symptoms, thus possibly reducing the chances of parents prematurely discontinuing treatment. Parental criticism is a potentially modifiable factor in treatment. Further research is needed to identify effective ways to reduce parental criticism, and to identify additional modifiable factors associated with treatment dropout to reduce dropout rates in this population.Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.

Nursing staff's responses to thematic content of patients' expressed worries: observing communication in home care visits.

BACKGROUND: The aim of the study was to explore the thematic content of older persons' expressed worries in home care visits, and how nursing staff respond to different thematic contents. METHODS: The study had a descriptive, observational design, including 195 audio-recorded Norwegian home care visits with 33 nursing staff and 48 older persons. In all, 638 patient cues/concerns (worries) and subsequent nursing staff's responses were identified using Verona Coding Definitions of Emotional Sequences. A novel thematic coding scheme was used to label the thematic content of the cues/concerns. The nursing staff's responses were grouped based on communicative function as emotion-focused, content-focused or ignoring/blocking the cue/concern. Group difference was analysed using Pearson's chi-squared test, Fisher's exact test, and adjusted residuals. RESULTS: The theme of worries was associated with elicitation of the cue/concern, either elicited by the nursing staff or spontaneously expressed by the patient (Chi-square, p< 0.001). "Ageing and bodily impairment" was the most common theme (66%) and was equally elicited by patients and nursing staff. Worries about "Relationships with others" (9%), "Health care-related issues" (15%) and "Life narratives and value issues" (9%) were mainly elicited by nursing staff. The nursing staff response was associated with the theme of worries (p˂0.001). For the sub-themes of "Ageing and bodily impairment", Coping with existential challenges received more frequently emotion-focused responses (adjusted residuals: 3.2) and Expression of pain felt in the moment were more frequently ignored/blocked (adjusted residuals: 4.0, Fisher's exact test, p< 0.001). For the sub-themes of "Relationships with others", Being a burden more frequently received a content-focused response (adjusted residuals: 2.8), while Losing social ties more frequently received an emotion-focused response (adjusted residuals: 3.1, Fisher's exact test, p = 0.009). CONCLUSION: "Ageing and bodily impairment" was the most common theme and more frequently elicited by the older persons than other themes. Emotionally focused nursing staff responses were most common when addressing existential challenges and fear of losing social ties. Whereas nursing staff showed a tendency to ignore patients' spontaneous expressions of pain. Further research should explore the influence of nursing staff's responses on quality of care and patient satisfaction.

Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research.

Family-focused therapy (FFT) is an evidence-based intervention for adults and children with bipolar disorder (BD) and their caregivers, usually given in conjunction with pharmacotherapy after an illness episode. The treatment consists of conjoint sessions of psychoeducation regarding bipolar illness, communication enhancement training, and problem-solving skills training. This paper summarizes over 30 years of research on FFT and family processes in BD. Across eight randomized controlled trials with adults and adolescents with BD, FFT and mood-stabilizing medications have been found to hasten recovery from mood episodes, reduce recurrences, and reduce levels of symptom severity compared to briefer forms of psychoeducation and medications over 1-2 years. Several studies indicate that the effects of FFT on symptom improvement are greater among patients with high-expressed emotion relatives. New research focuses on FFT as an early intervention for youth at risk for BD, neuroimaging as a means of evaluating treatment mechanisms, and progress in implementing FFT in community mental health settings.

Development and Open Trial of a Technology-Enhanced Family Intervention for Adolescents at Risk for Mood Disorders.

AIM: Integrating psychosocial interventions with mobile apps may increase treatment engagement among adolescents. We examined the user experience, uptake, and clinical effects of a mobile-enhanced family-focused therapy (FFT) among adolescents at risk for mood disorders. METHOD: We created a mobile app containing 12 lesson plans corresponding to content of weekly FFT sessions, with modules concerning mood management, family communication and problem-solving. We pilot tested the app in an open trial of FFT (12 sessions in 18 weeks) for adolescents who had active depressive or hypomanic symptoms, a parent with mood disorder, and at least one parent who expressed high levels of criticism. Teens and parents made daily and weekly ratings of youths' moods, amount of parent/offspring criticism, and practice of FFT psychoeducational, communication or problem-solving skills. Independent evaluators interviewed adolescents at baseline and every 9 weeks over 27 weeks to measure symptom trajectories. RESULTS: Participants were adolescents (n=22; mean age 15.4 ± 1.8 years; 45.5% female) and their 34 parents. Completion of requested app assessment and skill practices averaged 46%-65% among adolescents and parents over 18 weeks of treatment. Adolescents showed significant improvement in clinician-rated depression scores over 27 weeks (Cohen's d=1.58, 95% CI, 0.83 to 2.32) and reported reductions in the amount of perceived criticism expressed by parents. LIMITATIONS: The uncontrolled design limits inferences about whether the mobile app augmented the effects of FFT on moods or family relationships. CONCLUSIONS: Mobile applications may enhance users' responses to family therapy and provide clinicians with information regarding clinical status. Clinicaltrials.gov NCT03913013.

Effects of family-focused therapy on suicidal ideation and behavior in youth at high risk for bipolar disorder.

BACKGROUND: Youth who are at clinical and familial risk for bipolar disorder (BD) often have significant suicidal ideation (SI). In a randomized trial, we examined whether family-focused therapy (FFT) is associated with reductions in SI and suicidal behaviors in high-risk youth. METHODS: Participants (ages 9-17 years) met diagnostic criteria for unspecified BD or major depressive disorder with active mood symptoms and had at least one relative with BD type I or II. Participants were randomly allocated to 12 sessions in 4 months of FFT or 6 sessions in 4 months of psychoeducation (enhanced care, EC), with pharmacotherapy as needed. Clinician- and child-rated assessments of mood, suicidal thoughts and behaviors, and family conflict were obtained at baseline and 4-6 month intervals over 1-4 years. RESULTS: Participants (N=127; mean 13.2±2.6 yrs., 82 female) were followed over an average of 105.9±64.0 weeks. Youth with high baseline levels of SI who received FFT had lower levels of (and fewer weeks with) SI at follow-up compared to youth with high baseline SI who received EC. Participants in FFT had longer intervals without suicidal behaviors than participants in EC. Youths' ratings of family conflict significantly mediated the effects of treatment on SI at follow-up. LIMITATIONS: Family conflict was based on questionnaires rather than observer ratings of family interactions. CONCLUSIONS: Family psychoeducation with skill training can be an effective deterrent to suicidal thoughts and behaviors in youth at high risk for BD. Reducing parent/offspring conflict should be a central objective of psychosocial interventions for high-risk youth with SI.

Identifying Loss of Control Eating within Childhood Obesity: The Importance of Family Environment and Child Psychological Distress.

This study aims to examine the differences in family environment, psychological distress, and disordered eating symptomatology between children classified by weight status with or without loss of control (LOC) eating and to test a model of the role of emotional regulation of LOC eating based on a dysfunctional family environment. A cross-sectional study was conducted among 239 families. The assessment measured family expressed emotion, family adaptability and cohesion, child levels of depression and anxiety, body esteem, and disordered eating attitudes. The assessment was carried out in primary care centers and primary schools. Child body mass index (BMI) was associated with higher expressed emotion, psychological distress, and disordered eating symptomatology. Children with obesity and LOC presented higher BMI, poorer body esteem, and more disordered eating attitudes than children without LOC. Children with overweight/obesity, both with or without LOC, exhibited higher psychological distress and emotional overinvolvement than normal-weight children. A partial mediation of depression or anxiety and disordered eating attitudes between expressed emotion and LOC was found. Findings support that children with overweight/obesity show more family and psychological distress. Body esteem issues and disordered eating attitudes could alert the presence of LOC in children with obesity. The function of LOC might be to cope with psychological distress that may appear in a dysfunctional family environment.

The relationship of parental expressed emotion to co-occurring psychopathology in individuals with autism spectrum disorder: A systematic review.

Expressed emotion is a construct of the affective relationship between two people, with domains measuring criticism, hostility, warmth, relationship and emotional over-involvement. This review focuses on studies of Expressed Emotion in families of individuals with autism spectrum disorder and its association with co-occurring psychiatric disorders. A systematic search used the Psych-Info and Medline databases to identify articles available at or before September 2016. Eleven studies met the inclusion criteria. The included studies suggest that high levels of expressed emotion, including criticism, are associated with behavioural problems. However, the relationship between expressed emotion and emotional problems is presently unclear because findings were mixed. Also, there is presently little evidence regarding the impact of other components of expressed emotion on co-occurring disorders.

Communication between parents diagnosed with cancer and their children: study with data triangulation / Comunicación entre padres diagnosticados con cáncer y sus hijos: estudio con triangulación de datos / Comunicação entre pais diagnosticados com câncer e seus filhos: estudo com triangulação de dados

ABSTRACT Objective: To characterize the perceptions and feelings of parents diagnosed with cancer in relation to communication with their children between 3 and 12 years old. Method: A cross-sectional, multicenter, with data triangulation, through structured and semi-structured interviews, with a question with a Semantic Differential Scale, carried out with the father or mother with cancer undergoing outpatient treatment in two hospital institutions in the city of São Paulo, São Paulo, Brazil. Data were analyzed using descriptive statistics, content analysis, using the ATLAS.ti 8.0R software and the Social Representation Theory. Results: Forty-three respondents participated, 37 (86.0%) were female, 23 (53.5%) aged between 31 and 50 years old, 29 (67.5%) with only children between 7 and 12 years old. The experience was considered painful (73.1%), stressful (53.6%), clear (53.7%) and safe (51.2%). The feelings experienced generated two categories: Trial by fire; and Grateful rewards. Children's reactions from parents' perspective generated the categories: Sadness and suffering; Trust and support; Change of behavior; and Denial or insensitivity. Conclusion: Communication was assessed as negative and conflicting, positive and welcoming, and causing changes in children's behaviors.

RESUMEN Objetivo: Caracterizar las percepciones y sentimientos de padres diagnosticados con cáncer en relación a la comunicación con sus hijos entre 3 y 12 años. Método: Transversal, multicéntrico, con triangulación de datos, mediante entrevistas estructuradas y semiestructuradas, con una pregunta con Escala Diferencial Semántica, realizadas con el padre o la madre con cáncer en tratamiento ambulatorio en dos instituciones hospitalarias de la ciudad de São Paulo, São Paulo, Brasil. Los datos fueron analizados mediante estadística descriptiva, análisis de contenido, utilizando el software ATLAS.ti 8.0R y la Teoría de las Representaciones Sociales. Resultados: Participaron 43 encuestados, 37 (86,0%) eran del sexo femenino, 23 (53,5%) con edades entre 31 y 50 años, 29 (67,5%) con hijos únicos entre 7 y 12 años. La experiencia fue considerada dolorosa (73,1%), estresante (53,6%), clara (53,7%) y segura (51,2%). Los sentimientos vividos generaron dos categorías: Prueba de fuego; y recompensa agradecida. Las reacciones de los niños, desde la perspectiva de los padres, generaron las categorías: Tristeza y sufrimiento; Confianza y apoyo; Cambio de comportamiento; y Negación o insensibilidad. Conclusión: La comunicación fue evaluada como negativa y conflictiva, positiva y acogedora, y provoca cambios en las conductas de los niños.

RESUMO Objetivo: Caracterizar as percepções e os sentimentos dos pais diagnosticados pelo câncer em relação à comunicação com seus filhos entre 3 e 12 anos. Método: Transversal, multicêntrico, com triangulação de dados, por meio de entrevistas estruturadas e semiestruturadas, com uma pergunta com Escala de Diferencial Semântico, realizadas com o pai ou a mãe com câncer em tratamento ambulatorial em duas instituições hospitalares da cidade de São Paulo, São Paulo, Brasil. Os dados foram analisados por meio da estatística descritiva, análise de conteúdo, utilizando o software ATLAS.ti 8.0R e a Teoria das Representações Sociais. Resultados: Participaram 43 respondentes, sendo 37 (86,0%) do sexo feminino, 23 (53,5%) com idades entre 31 e 50 anos, 29 (67,5%) com filho único entre 7 e 12 anos. A experiência foi considerada dolorosa (73,1%), estressante (53,6%), clara (53,7%) e segura (51,2%). Os sentimentos vivenciados geraram duas categorias: Prova de fogo; e Grata recompensa. As reações dos filhos, na perspectiva dos pais, geraram as categorias: Tristeza e sofrimento; Confiança e apoio; Mudança de comportamento; e Negação ou insensibilidade. Conclusão: A comunicação foi avaliada como negativa e conflituosa, positiva e acolhedora, e causadora de mudanças nos comportamentos dos filhos.

Parental Outcomes Following Participation in Cognitive Behavior Therapy for Children with Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) benefit from parent involvement in their therapy, and there is evidence that this involvement may improve parent functioning as well. We examined changes in parent mental health, parenting, and expressed emotion, following participation in a randomized controlled trial of cognitive behavior therapy for 57 children with ASD. Post-intervention, improvements occurred in the treatment group in parent depression and emotion regulation, compared to waitlisted parents. Treatment effects also occurred across all parents in depression, emotion regulation, perceptions of their children and mindful parenting. Though preliminary, these results have implications for intervention development and evaluation by focusing on parent outcomes in child treatment.

Therapeutic alliance, expressed emotion, and treatment outcome for anorexia nervosa in a family-based partial hospitalization program.

Adolescent therapeutic alliance has been found to be associated with improvements in eating disorder cognitions and with early weight gain. The current study assessed patient and parent therapeutic alliance, correlates of parent alliance, and relationship between alliance and treatment outcome. Fifty-six patients with anorexia nervosa completed measures of therapeutic alliance and eating disorder symptoms. Patients' parents completed measures of therapeutic alliance, expressed emotion, and psychopathology. Patients' alliance predicted cognitive and behavioral symptomatology at end of treatment (ß=-0.39, p=0.001), though it was not related to changes in weight (ß=0.12, p=0.377). Maternal hostility was associated with lower maternal alliance (r=-0.34, p=0.05). Findings suggest that maternal hostility should be addressed in treatment, and that patient alliance may be important in achieving psychological recovery from disordered eating.

Familial expressed emotion among heroin addicts in methadone maintenance treatment: does it matter?

BACKGROUND: Expressed emotion (EE) is the quality of the atmosphere between a relative and a family member with mental illness. Substantial research has focused on the relationship between the level of EE and the outcomes of mental illness. However, no prior study has explored the role of EE relative to heroin addicts. AIM: The aims of this study were to investigate the influence of EE on patient outcome in methadone maintenance treatment (MMT) and the relationship between the EE of heroin addicts and other demographic and psychological variables. METHODS: A total of 117 heroin addicts who entered MMT were enrolled. Each subject underwent a comprehensive interview to record demographic data and drug use history. The Family Emotional Involvement Scale (FEICS), Beck Depression Inventory (BDI), and Beck Anxiety Depression Inventory (BAI) were used at baseline. All subjects were followed for 12 months. The results of monthly urine tests and the treatment retention were recorded for further analysis. RESULTS: Perceived criticism was correlated with depression (r=0.20, P<0.01). The overall retention rate in 12-month MMT was 54.70%. Lower perceived criticism (OR=1.84, 95% CI=1.20-3.60, P<0.01) and lower depression (OR=1.24, 95% CI=0.65-1.80, P=0.02) predicted longer retention in MMT. CONCLUSION: EE, especially perceived criticism, has its influences on outcomes among heroin addicts in MMT. This suggested the potential benefits of family therapy among high EE heroin addicts in MMT. Furthermore, the mechanism how EE affects the outcome of MMT needs to be further investigated.

Validação de conteúdo e aparência de manual educativo para promoção da saúde mental infantil / Validation of content and appearance of an educational manual to promote children's mental health

RESUMO Objetivo validar o conteúdo e a aparência de um manual educativo para promoção da saúde mental infantil. Métodos trata-se de estudo metodológico, do qual participaram 16 especialistas (profissionais da saúde e educação) e seis do público-alvo (enfermeiros). O Índice de Validade de Conteúdo e o Índice de Concordância foram calculados conforme resposta ao instrumento, que avaliava objetivos, aparência, estrutura, organização, relevância e didática do manual. Resultados o Índice de Validade de Conteúdo foi de 0,984 para o público-alvo, e o Índice de Concordância foi de 100,0%. As principais modificações foram no título, nos objetivos e no referencial teórico, com exclusão de oficinas e revisão ortográfica e gramatical. Conclusão o manual apresentou Índices de Validade de Conteúdo e de Concordância satisfatórios. Ele pode auxiliar o enfermeiro e demais profissionais da saúde na promoção da saúde mental de crianças, difundindo o desenvolvimento da inteligência emocional.

ABSTRACT Objective to validate the content and appearance of an educational manual to promote children's mental health. Methods this is a methodological study, in which 16 specialists (health and education professionals) and six of the target audience (nurses) participated. The Content Validity Index and the Agreement Index were calculated according to the response to the instrument, which assessed the objectives, appearance, structure, organization, relevance and didactics of the manual. Results the Content Validity Index was 0.984 for the target audience, and the Agreement Index was 100.0%. The main changes were in the title, objectives and theoretical framework, excluding workshops and spelling and grammatical revision. Conclusion the manual presented satisfactory Content Validity and Agreement indexes. It can assist nurses and other health professionals in promoting children's mental health, promoting the development of emotional intelligence.

Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia / Emoción expresada de familiares y recaídas de pacientes con diagnóstico de esquizofrenia / Expressed emotion of family members and psychiatric relapses of patients with a diagnosis of schizophrenia

RESUMO Objetivo: Avaliar a relação entre recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia, níveis de emoção expressa de seus familiares e fatores relacionados. Método: Estudo prospectivo, realizado em um serviço ambulatorial de saúde mental e em dois Centros de Atenção Psicossocial, com pacientes e familiares que responderam ao Family Questionnaire − Versão Português do Brasil, um formulário contendo as variáveis sociodemográficas e clínicas e um roteiro estruturado para avaliação de recaídas. Para a análise, utilizou-se do modelo de regressão logística. Resultados: Participaram do estudo 89 díades. Dos pacientes investigados, 31% apresentaram recaídas, e 68% dos familiares, elevada emoção expressa. A relação entre a emoção expressa e as recaídas não foi significativa. A análise de regressão logística mostrou que quanto maior o número de internação nos 2 anos precedentes ao estudo, a chance de o paciente apresentar recaídas no período de 24 meses é de 1,34. Conclusão: A emoção expressa foi insuficiente para predizer recaídas. Assim, as recaídas devem ser compreendidas como um fenômeno multifatorial. Esses resultados fornecem subsídios para intervenções e investigações sobre os múltiplos fatores envolvidos na evolução do paciente com esquizofrenia, acompanhado em serviços de saúde mental de base comunitária.

RESUMEN Objetivo: Evaluar la relación entre recaídas psiquiátricas de pacientes con diagnóstico de esquizofrenia, niveles de emoción expresada de sus familiares y factores relacionados. Método: Estudio prospectivo, llevado a cabo en un servicio de ambulatorio de salud mental y en dos Centros de Atención Psicosocial, con pacientes y familiares que respondieron al Family Questionnaire − Versión Portugués de Brasil, un formulario conteniendo las variables sociodemográficas y clínicas y un guión estructurado para evaluación de recaídas. Para el análisis, se utilizó el modelo de regresión logística. Resultados: Participaron en el estudio 189 pares. De los pacientes investigados, el 31% presentaron recaídas, y el 68% de los familiares, elevada emoción expresada. La relación entre la emoción expresada y las recaídas no fue significativa. El análisis de regresión logística mostró que cuanto mayor el número de estancias hospitalarias en los dos años precedentes al estudio, la probabilidad de que el paciente presente recaídas en el período de 24 meses es de 1,34. Conclusión: La emoción expresada fue insuficiente para predecir recaídas. De esa manera, las recaídas deben comprenderse como un fenómeno multifactorial. Dichos resultados brindan subsidios para intervenciones e investigaciones acerca de los múltiples factores involucrados en la evolución del paciente con esquizofrenia, acompañado en servicios de salud mental de base comunitaria.

ABSTRACT Objective: Assess the relationship between psychiatric relapses of patients with a diagnosis of schizophrenia, the levels of expressed emotion among their relatives and related factors. Method: Prospective study carried out at a mental health outpatient clinic and two Psychosocial Care Centers, with patients and relatives responding to the Family Questionnaire - Brazilian Portuguese Version, a form containing socio-demographic and clinical variables and a structured script to assess relapses. A logistic regression model was used for the analysis. Results: A total of 89 dyads participated in the study. Of the patients investigated, 31% presented relapses and, among the relatives, 68% presented elevated levels of expressed emotion. The relationship between expressed emotion and the relapses was not significant. The logistic regression analysis demonstrated that when there were a higher number of hospital admissions in the two years preceding the study, the chance of the patient relapsing in the 24-month period is 1.34. Conclusion: Expressed emotion was insufficient to predict relapses. Thus, a relapse should be understood as a multifactorial phenomenon. These results provide support for interventions and investigations on the multiple factors involved in the evolution of schizophrenia patients in follow-up at community-based health services.

Influência da iluminação nas expressões emocionais de parturientes: ensaio clínico randomizado / Lighting impact on the emotional expression of pregnant women: a randomized clinical trial

Resumo Objetivo Identificar e comparar as expressões emocionais das parturientes no período expulsivo sob iluminação comum e usual e com baixa luminosidade. Métodos Ensaio clínico, controlado e randomizado de abordagem pragmática. Selecionado 95 parturientes, divididas em dois grupos: iluminação comum e usual e baixa luminosidade da sala de parto. Resultados A emoção mais presente no período expulsivo é a raiva (33,9%). As diferenças entre os grupos do estudo quanto à presença de emoções são significativas: medo (p< 0,0001), nojo (p = 0,0091) e tristeza (p = 0,0060) estiveram mais presentes no grupo de iluminação comum e usual. Já o grupo de baixa luminosidade apresentou mais alegria (p< 0,0001) e raiva (p< 0,0001). Todas as parturientes terminaram seus partos com a emoção alegria. Conclusão O ambiente com baixa luminosidade promove uma sequência de emoções que respeita e auxilia a fisiologia do período expulsivo do trabalho de parto.

Abstract Objective To identify and compare the emotional expression of pregnant women during the stage of expulsion under common and regular lighting and low lighting. Methods Pragmatic, randomized controlled clinical trial. Ninety-five pregnant women were selected, and divided into two groups: common and regular lighting and low lighting in the delivery room. Results The most evident emotion during the stage of expulsion is anger (33.9%). The differences between the study groups regarding the presence of emotions are significant: fear (p< 0.0001), disgust (p = 0.0091), and sadness (p = 0.0060) were more evident for the group under common and regular lighting. The group under low lighting expressed more joy (p< 0.0001) and anger (p< 0.0001). All pregnant women finished their deliveries feeling joy. Conclusion Low lighting provides a series of emotions that respect and help women's physiology during the stage of expulsion in labor.

Emoções vivenciadas por coordenadores de transplantes nas entrevistas familiares para doação de órgãos / Emotions experienced by transplant coordinators in family interviews for organ donation

The process of organ donation consists in different stages among which the family interview that is conducted by advanced transplant coordinators. This moment holds high emotional complexity, because it informs about encephalic death and the possibility of donation. In this context, the objective is to know the emotions experienced by transplant coordinators in the family interview for organ donation. Method: qualitative research, descriptive-interpretative norm; approved by the Ethics Committee of UFF/HUAP. Data was collected by semi-structured interviews with 24 advanced coordinators of Central of Transplants from the Rio de Janeiro State, from January to May of 2012. Results: the emotions were: negative ­ anger, fear and sadness; positive ­ love; impartial ­ surprise; and the denial ­ emotionless at the interview. Was conclude that different types of emotions permeate the family interview, with a predominance of those negatives. Not all coordinators were able to denominate their emotions, demonstrating the difficulty of dealing with the emotional issues in the workplace. It was observed that by identifying the emotions felt, they initiated the awareness of their own emotions.

O processo de doação de órgãos é composto por diferentes etapas, dentre as quais a entrevista familiar que é realizada por coordenadores avançados de transplantes. Este momento comporta grande complexidade emocional, pois se informa sobre a morte encefálica e a possibilidade da doação. Neste contexto, objetiva-se: conhecer as emoções vivenciadas pelos coordenadores de transplantes na entrevista familiar para doação de órgãos. Método: pesquisa qualitativa, descritivo-interpretativa; aprovado pelo Comitê de Ética UFF/HUAP.Coletaram-se dados por entrevista semiestruturada com 24 coordenadores avançados da Central de Transplantes do Estado do Rio de Janeiro, no período de janeiro a maio de 2012. Resultados: As emoções foram: negativas - raiva, medo e tristeza; positivas - amor; imparciais - surpresa; e, negação - não sentir emoções na entrevista. Conclui-se que diferentes tipos de emoções permeiam a entrevista familiar, havendo uma predominância daquelas negativas. Nem todos os coordenadores conseguiram nomear suas emoções, demonstrando a dificuldade de lidarem com as questões emocionais no ambiente laboral. Observou-se que ao identificarem as emoções sentidas, iniciou-se a tomada de consciência das próprias emoções nos participantes.

Mood State of Women with Breast Cancer and that of Their Spouses / Estado de ânimo em mulheres com câncer de mama e seus esposos / Estado de ánimo en mujeres con cáncer de mama y en sus parejas

Abstract Objectives. This work sought to determine mood levels of women subjected to treatments for breast cancer and of their spouses. Methods. Descriptive cross-sectional study with non-probabilistic sampling. The profile of mood states (POMS) instrument, Spanish version, was applied to a sample of 103 couples from five Colombian cities. Results. The mood level in women reported a mean of 61.4 ± 5.7 and 60.7 ± 4.9 in their spouses, without being statistically significant. Upon analyzing the score of the mood subscales, statistically significant differences were only noted in tension (higher score in spouses) and fatigue (higher score in women). Conclusion. The emotional area was moderately affected in the study couples, which could be consequential of late effects of the treatments for breast cancer. Nursing must develop care actions that promote the emotional wellbeing of women with breast cancer and include participation from the spouses.

Resumo Objetivos. Determinar o nível do estado de ânimo das mulheres submetidas a tratamentos por Câncer de mama e o dos seus esposos. Métodos. Estudo descritivo de corte transversal com amostragem não probabilístico. Se aplicou o instrumento Perfil de estados de ânimo - POMS, versão espanhola, a uma amostra de 103 casais de cinco cidades colombianas. Resultados. O nível de estado de ânimo nas mulheres reportou média de 61.4±5.7 e nos seus esposos 60.7±4.9, sem ser estatisticamente significativas. Quando se analisou a pontuação das sub-escalas de Estado de Ânimo se apreciaram diferenças estatisticamente significativas tão só as de tensão (pontuação maior em esposos) e fatiga (pontuação maior em mulheres). Conclusão. A área emocional se afetou moderadamente nos casais do estudo, o que poderia ser consequência dos efeitos tardios dos tratamentos por Câncer de mama. A enfermagem deve desenvolver ações de cuidado nas quais se promovam o bem-estar emocional das mulheres com câncer de mama e inclua a participação dos esposos.

Resumen Objetivos. Determinar el nivel del estado de ánimo de las mujeres sometidas a tratamientos por cáncer de mama y el de sus parejas. Métodos. Estudio descriptivo de corte transversal con muestreo no probabilístico. Se aplicó el instrumento Perfil de estados de ánimo - POMS, versión española, a una muestra de 103 parejas de cinco ciudades colombianas. Resultados. El nivel de estado de ánimo en las mujeres reportó media de 61.4±5.7; en sus parejas, 60.7±4.9, sin ser estadísticamente significativas. Cuando se analizó el puntaje de las subescalas de Estado de Ánimo se apreciaron diferencias estadísticamente significativas tan solo las de tensión (puntaje mayor en esposos) y fatiga (puntaje mayor en mujeres). Conclusión. El área emocional se afectó moderadamente en las parejas de estudio, lo que podría ser consecuencia de los efectos tardíos de los tratamientos por cáncer de mama. Enfermería debe desarrollar acciones de cuidado en las que se promuevan el bienestar emocional de las mujeres con cáncer de mama e incluyan la participación de sus parejas.

Como você se sente? Emoções de estudantes após praticarem bullying / How do you feel? Students' emotions after practicing bullying

Objetivou-se identificar e analisar as emoções geradas em estudantes envolvidos em situações de bullying como agressores. Trata-se de estudo transversal descritivo realizado com 232 estudantes do sexto ao nono ano do ensino fundamental que responderam a um questionário autoaplicável. Os dados foram analisados no Statistical Analysis Software, mediante estatística descritiva e Teste Exato de Fisher. Do total de estudantes, 17,4% foram identificados como agressores. Prevaleceu não sentir nenhuma emoção após a prática de agressões contra colegas para meninos (36,7%) e meninas (25,0%). Os meninos demonstraram sentirem ainda raiva (26,7%) e tristeza (23,3%) em menor proporção, ao passo que as meninas também demonstraram sentir culpa (25,0%), tristeza (16,7%) e vergonha (8,3%). O estudo indica que os agressores investigados apresentam emoções que não concorrem para compreensão dos efeitos negativos da violência que praticam, bem como não colaboram para a interrupção das agressões.

Our objective was to identify and analyze emotions generated in students involved in bullying situations as aggressors. This is a cross-sectional descriptive study, conducted with 232 students from the sixth to ninth year of middle school, who answered a self-reported questionnaire. We analyzed the data with the Statistical Analysis Software, through descriptive statistics and Fisher's exact test. Of all students, 17.4% were identified as aggressors. Not feeling any emotion after practicing aggression against friends was prevalent for boys (36.7%) and girls (25.0%). Boys demonstrated to feel anger (26.7%) and sadness (23.3%) in smaller proportions, while girls also demonstrated to feel guilt (25.0%), sadness (16.7%) and shame (8.3%). The study indicates investigated aggressors presenting emotions that do not compete to comprehend negative effects of the practiced violence, as well as it does not collaborate to interrupt aggressions.

O preparo emocional dos profissionais de saúde na entrevista familiar: estudo hermenêutico / Emotional preparedness of health professionals in family interviews: a hermeneutic study / La preparación emocional de los profesionales de salud en la entrevista familiar: estudio hermenéutico

A entrevista familiar para doação de órgãos comporta grande carga emocional e é realizada por coordenadores avançados em transplantes. OBJETIVO: compreender como se dá o preparo emocional dos coordenadores avançados em transplantes para realizar a entrevista familiar. MÉTODO: abordagem qualitativa, estudo hermenêutico; aprovado pelo Comitê de Ética UFF/HUAP nº 321/11. Os dados foram obtidos por entrevista semiestruturada contendo oito questões abertas com 24 sujeitos no período de janeiro a maio de 2012. RESULTADOS: a maioria dos entrevistados não faz qualquer preparo para a entrevista familiar e reconhece a necessidade da implantação de um serviço de suporte para as demandas emocionais advindas do trabalho. CONCLUSÃO: Embora não realizem preparação emocional, os profissionais entendem a relevância do suporte que promova seu autoconhecimento e os faça sentir mais seguros e aptos para as entrevistas familiares.

Approaching families in order to convince them to donate organs is always a conversation filled with a heavy emotional load, and it is performed by experienced transplant coordinators. AIM: to understand the emotional preparedness of experienced transplant coordinators when approaching families of possible donors. METHOD: This study has a qualitative approach, in a hermeneutic method; the Committee of Ethics at UFF/HUAP approved it of under protocol #321/11. The data was obtained through semi-structured interviews, with eight open questions and 24 individuals, between January and May 2012. RESULTS: The majority of the interviewees do not prepare themselves before approaching families and they also recognize the necessity to implement a support system to assist the emotional demands generated by their workload. CONCLUSION: Despite the fact they do not prepare themselves emotionally, professionals see the relevance of support to promote their own self-understanding and that makes them feel safer and prepared to approach families at such a sensitive moment.

La entrevista familiar para donación de órganos implica gran carga emocional y es realizada por coordinadores avanzados en trasplantes. OBJETIVO: comprender como se da la preparación emocional de los coordinadores avanzados en transplantes para realizar la entrevista familiar. MÉTODO: enfoque cualitativo, estudio hermenéutico; aprobado por el Comité de Ética UFF/HUAP nº 321/11. Los datos fueron obtenidos por entrevista semiestructurada conteniendo ocho cuestiones abiertas con 24 individuos en el período de enero a mayo de 2012. RESULTADOS: la mayoría de los entrevistados no hace ninguna preparación para la entrevista familiar y reconoce la necesidad de la implantación de un servicio de apoyo para las demandas emocionales que surjan del trabajo. CONCLUSIÓN: Aunque no realicen preparación emocional, los profesionales entienden la relevancia del apoyo que promueve su autoconocimiento y los hace sentir más seguros y aptos para las entrevistas familiares.