Post-Traumatic Stress Disorder in Brazilian Pregnant Women at the Beginning of the Coronavirus Disease Pandemic.

OBJECTIVE: Analyze the presence of PTSD symptoms and their risk among the pregnant women during the COVID-19 pandemic. METHODS: This is a cross-sectional study of pregnant women that received receiving prenatal care at two university hospitals in São Paulo, Brazil, during the COVID-19 pandemic, from April to June 2020. The sociodemographic and health data of the participants and their exposure to individuals suspected or confirmed to have COVID-19 were evaluated. The Impact of Event Scale-Revised and the State-Trait Anxiety Inventory were used to assess PTSD and anxiety symptoms, respectively. RESULTS: A total of 149 pregnant women were included in this study. The risk of PTSD among the participants was 55.1%. The independent risk factors for PTSD were state anxiety (ORadj = 2.6), trait anxiety (ORadj = 10.7), changes in routine due to the pandemic (ORadj = 4.7) and contact with a confirmed case of COVID-19 person (ORadj = 7.1). CONCLUSIONS: The COVID-19 pandemic had a significant negative impact on the mental health of pregnant women, more than half of the participants of the present study showed a risk of PTSD, exacerbated by anxiety symptoms and exposure to individuals with a confirmed case of COVID-19.

Prevalence of cognitive impairment in HIV patients: vertical and horizontal transmission.

Antiretroviral treatment has significantly increased the survival of patients infected with HIV-1. However, with increased survival, cognitive changes associated with HIV are frequently observed in this population. The clinical manifestations of HIV changes can vary as a result of several aspects, including the virus transmission route. Several studies have pointed out premature neurological changes in vertically infected patients, while the manifestation of cognitive damage in adults may take a longer time. Objective: The aim of this study was to verify the prevalence of cognitive changes in patients with HIV via vertical transmission after the highly active antiretroviral therapy and the cognitive performance of these patients compared to a group of sexually infected patients. Methods: A total of 48 patients were evaluated, 25 with vertical transmission and 23 with sexual transmission, between May 2013 and February 2015 at the Institute of infectology Emilio Ribas. Neuropsychological tests were applied to assess cognitive performance, scales to assess symptoms of anxiety and depression, and sociodemographic questionnaire. Results: The results demonstrate that the frequency of cognitive impairment in vertically transmitted patients was higher than in sexually transmitted patients. Conclusions: These findings suggest that the deleterious effects of the HIV virus on the development of the central nervous system reverberate more strongly than in patients who acquire it after adulthood.

O tratamento antirretroviral tem aumentado significativamente a sobrevida de pacientes contaminados pelo HIV-1. Entretanto, com o aumento da sobrevida, observam-se frequentemente alterações cognitivas associadas ao HIV nessa população. As manifestações clínicas das alterações do HIV podem variar em decorrência de diversos aspectos, entre eles a via de transmissão do vírus. Diversos estudos têm apontado alterações neurológicas prematuras em pacientes contaminados por via vertical, enquanto a manifestação de danos cognitivos em adultos pode levar um tempo maior. Objetivo: O objetivo deste estudo foi verificar a prevalência das alterações cognitivas em pacientes com HIV via transmissão vertical após a era da terapia antirretroviral altamente ativa e o desempenho cognitivo desses pacientes comparado ao de um grupo de pacientes contaminados por via sexual. Métodos: Foram avaliados 48 pacientes, sendo 25 com transmissão vertical e 23 com transmissão sexual no período entre maio de 2013 e fevereiro de 2015, no Instituto de Infectologia Emílio Ribas. Foram aplicados testes neuropsicológicos para avaliar o desempenho cognitivo, escalas para avaliar sintomas de ansiedade e depressão e questionário sociodemográfico. Resultados: Os resultados demonstraram que a frequência de comprometimento cognitivo em pacientes contaminados via transmissão vertical foi maior do que naqueles contaminados via transmissão sexual. Conclusões: Essas descobertas sugerem que os efeitos deletérios do vírus HIV na formação do sistema nervoso central repercutem de forma mais acentuada do que em pacientes que o adquiriram após a vida adulta.

Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir.

BACKGROUND: Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. OBJECTIVE: The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. METHODS: A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton's Scale, Beck's Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. RESULTS: Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). CONCLUSION: The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.

Family Conferences in Prenatal Palliative Care.

Background: Fetal malformations are diagnosed prenatally in nearly 3% of pregnancies, and ∼1.2% are major malformations. After prenatal diagnosis, it is imperative to consider families' values and to support their decision-making process. Prenatal palliative care is a growing field mainly based on family conferences. The prenatal care setting is unique and differs from postnatal and adult care. There are no descriptions of family conferences in prenatal palliative care. The descriptions of themes that emerge from the prenatal care conference charts may guide professionals in this delicate task, and help determine the causes of suffering and identify family values before the birth of the infant. Aim: To perform a content analysis of medical records of family conferences and to describe the main themes observed during prenatal palliative care follow-up after the diagnosis of a life-limiting fetal condition. Design: This is a retrospective study of medical records of family conferences from a perinatal palliative care group, the GAI group, between May 2015 and September 2016. Setting/Participants: Families with estimated perinatal mortality >50% and eligibility for follow-up at our tertiary fetal medicine center were enrolled. We included women who participated in at least one family conference with the GAI group and who had given birth at the clinic or delivered at another center and returned for the postnatal family conference. Results: Fifty women met the inclusion criteria. Five main themes and 18 categories emerged from the charts and are described in detail. A model of follow-up in prenatal palliative care is proposed based on the themes and categories identified. Conclusions: This analysis may guide health professionals who seek to better identify family needs and values and organize follow-up during prenatal palliative care.

Emotional Distress in the Relationship of Caregivers and Institutionalized Babies.

Institutionalization is an exceptional and temporary measure that occurs when there is a violation of rights; lasting until the family reintegration or, in the impossibility of this, the placement in a substitute family through adoption. Among the main reasons for institutionalization in Brazil are the financial difficulties, abandonment, domestic violence, drug addiction, homelessness of the responsible for the child, sexual abuse, and the loss of parents by death or imprisonment. Although children and adolescents have their rights assured when they are institutionalized, the care provided in these spaces does not include all their needs and demands, which may damage their affective-relational development. Maternal deprivation in the first years of life can be detrimental to the development of these children, if not provided by adequate substitute care. Therefore, to understand which place the institutionalized baby occupies in the imaginary of the social caregivers and, from this, how is established the relationship regarding the care, is of fundamental importance to assess and address the risk factors in child development at this stage of life and in situation of institutionalization. This is an exploratory and descriptive study, developed in a childcare institution, located in the city of São Paulo, Brazil, capable of accommodating up to 20 babies between 0 and 2 years old. Data collection was performed with nine employees, eight social caregivers and one general service assistant who work directly in the care of the institutionalized babies. Drawing-Story with Theme (DS-T) procedures were used. Qualitative analysis was based on Interpretative Phenomenological Analysis. The appreciation of the nine applied Drawing-Story procedures allowed the establishment of three discussion axes representations of baby, baby care, and early separation process. This study concluded that the difficulties that permeate the context of caregivers' work are the high turnover of institutionalized children, as well as employees, the difficulty of dealing with processes of bonding and breaking bonds and no recognition of the profession. We highlight that the place that these babies occupy in the imaginary of these caregivers influences the bond they establish with the children hence the care offered to the babies. It is also noteworthy that these caregivers exhibited anguish and suffering from the reasons they believed led the children to be institutionalized.

Qualidade de vida profissional na saúde: um estudo em Unidades de Terapia Intensiva / Professional quality of life in health: A study in Intensive Care Units / Calidad de vida profesional en salud: un estudio en Unidades de Cuidados Intensivos

Objetivou-se avaliar a Qualidade de Vida Profissional por meio da análise de Satisfação por Compaixão, Burnout e Estresse Traumático Secundário em profissionais da saúde que atuam em Unidades de Terapia Intensiva, bem como verificar os fatores de risco para a ocorrência de Burnout e Estresse Traumático Secundário. O método adotado foi o estudo Survey em quatro UTIs de hospital universitário terciário da cidade de São Paulo. Foram utilizadas fichas de dados sociodemográficos e o instrumento ProQOL-BR. Verificou-se associação estatisticamente significativa entre Estresse Traumático Secundário e sexo (p = 0,03), e entre Satisfação por Compaixão, Burnout e Estresse Traumático Secundário (p < 0,01; p = 0,002). Constatou-se, ademais, que existe desequilíbrio da qualidade de vida profissional dos participantes, e que os fatores de risco para Burnout e Estresse Traumático Secundário não estão relacionados com a área de atuação profissional, idade, escolaridade, estado civil ou renda.

OBJECTIVES: To evaluate the Professional Quality of Life analizing Compassion Satisfaction, Burnout and Secondary Traumatic Stress among health professionals working in Intensive Care Units; to check the risk factors for the occurrence of Burnout and Secondary Traumatic Stress on those professionals. METHOD: Survey study conducted in four ICUs of tertiary university hospitals in São Paulo. Sociodemographic data was used along with the and ProQOL-BR tool. RESULTS: There was a statistically relevant association between Secondary Traumatic Stress and gender (p = 0.03) and between Compassion Satisfaction, Burnout and Secondary Traumatic Stress (p < 0.01; p = 0.002). CONCLUSION: It was found that there is instability in the professional quality of life of participants, and that the risk factors for Burnout and Secondary Traumatic Stress aren't related to professional area, age, education, marital status, or income.

Se objectiva evaluar la Calidad de Vida Profesional por medio del análisis de la Satisfacción por Compasión, Burnout y Estrés Traumático Secundario en el personal de la salud que trabajan en Unidades de Cuidados Intensivos y comprobar los factores de riesgo para la ocurrencia de burnout y estrés traumático secundario. El método adoptado es el estudio de encuesta en cuatro UCIs de hospital universitario terciario en Sao Paulo. Se utilizó datos sociodemográficos y ProQol-BR. Se confirmó la asociación estadísticamente significativa entre Estrés Traumático Secundario y sexo (p = 0,03) y entre Satisfacción por Compasión entre Burnout y Estrés Traumático Secundario (p < 0,01; p = 0,002). Se constató, además, que existe desequilibrio de la calidad de vida profesional de los participantes y que los factores riesgo para Burnout y Estrés Traumático Secundario no tiene relación con la práctica, edad, educación, estado civil o el ingreso profesional.

Neuropsychological Assessment of 412 HIV-Infected Individuals in São Paulo, Brazil.

HIV-associated neurocognitive disorders (HAND) remain frequent even among individuals receiving combined antiretroviral therapy (cART). In addition, HAND may adversely affect the quality of life and adherence to cART. There is scarce epidemiological information about HAND in Latin America. This cross-sectional study recruited HIV-infected patients from a tertiary teaching institution in São Paulo, Brazil, between May 2013 and February 2015. The patients were adults with at least 4 years of education and patients with current neurological or psychiatric diseases were excluded. HAND remain frequent even among individuals receiving cART, use of psychoactive substance, or inability to understand the content for neuropsychological evaluation. We used standardized tools to evaluate depression, use of psychoactive substances, and daily life activities, and we performed a comprehensive neuropsychological examination. HAND was classified using the Frascati criteria. Prevalence of HAND was estimated, and an associated variable of symptomatic HAND was identified by logistic regression. Four-hundred twelve HIV-infected patients were included [male: 281 (68%), mean age of 45.3 years]. Most of them [n = 340 (83.7%)] had an undetectable viral load. The prevalence of HAND was 73.6% (n = 303): 210 (50.9%) had asymptomatic neurocognitive involvement (ANI), 67 (16.2%) had mild neurocognitive disorder (MND), and 26 (6.3%) had HIV-associated dementia (HAD). The univariate logistic regression analysis showed that female gender, age older than 50 years, <11 years of schooling, CD4 count below 200 cells/mm3, presence of previous illnesses (e.g., diabetes, hypertension), opportunistic disease history, and a Beck Depression Inventory (BDI) score between 13 and 19 points were factors associated with symptomatic HAND (MND and HAD). However, a BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND. HAND was highly prevalent in São Paulo, Brazil, and ANI was the more frequent category of HAND. However, 22.5% of participants had symptomatic HAND. This finding constitutes a challenge in clinical practice. A BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND.

Transcranial Direct Current Stimulation for Post-Concussion Syndrome: Study Protocol for a Randomized Crossover Trial.

BACKGROUND: Mild traumatic brain injury (MTBI) represents 70-80% of all treated brain injuries. A considerable proportion of MTBI patients experience post-concussion symptoms for a prolonged period after MTBI, and these symptoms are diagnosed as persistent post-concussion syndrome (PPCS). PPCS is defined as a range of physical, cognitive, and emotional symptoms. However, memory and executive dysfunction seems to be one of the most debilitating symptoms. Recently, non-invasive brain stimulation has been studied as a potential treatment method for traumatic brain injury (TBI) patients. Therefore, our primary goal is to verify the effects of transcranial direct current stimulation (tDCS) in patients with PPCS who demonstrate cognitive deficits in long-term episodic memory, working memory, and executive function following MTBI. METHODS/DESIGN: This is a randomized crossover trial of patients with a history of MTBI with cognitive deficits in memory and executive function. Thirty adult patients will be randomized in a crossover manner to receive three weekly sessions of anodal tDCS (2 mA) at left dorsolateral prefrontal cortex, left temporal cortex, and sham stimulation that will be performed at 7-day intervals (washout period). The clinical diagnosis of PPCS will be determined using the Rivermead Post-Concussion Symptoms Questionnaire. Patients who meet the inclusion criteria will be assessed with a neuropsychological evaluation. A new battery of computerized neuropsychological tests will be performed before and immediately after each stimulation. Statistical analysis will be performed to determine trends of cognitive improvement. DISCUSSION: There is paucity of studies regarding the use of tDCS in TBI patients, and although recent results showed controversial data regarding the effects of tDCS in such patients, we will address specifically patients with PPCS and MTBI and no brain abnormalities on CT scan other than subarachnoid hemorrhage. Moreover, due to the missing information on literature regarding the best brain region to be studied, we will evaluate two different regions to find immediate effects of tDCS on memory and executive dysfunction. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NCT02292589 (https://register.clinicaltrials.gov).

Presence of eating disorders and its relationship to anxiety and depression in pregnant women.

BACKGROUND: women who have inadequate nutrient intake are more likely to develop a risky pregnancy. The purpose of this study was to determine the presence of eating disorders and its association with anxiety and depression symptomatology in high-risk pregnancies. METHODS: this is a cross-sectional and prospective study conducted at the tertiary university hospital in the city of São Paulo, Brazil. 913 pregnant women waiting for the Obstetrics' outpatient appointment were invited to participate in the study on their 2nd and 3rd trimester of pregnancy. Structured interviews were carried out and the Structured Clinical Interview for DSM Disorders and Hospital Anxiety and Depression Scale were applied. FINDINGS: prevalence of eating disorder (ED) during pregnancy was 7.6% (n=69) (95% CI: 5.84% -9.28%), 0.1% (n=1) for anorexia nervosa; 0.7% (n=6) for bulimia nervosa; 1.1% (n=10) for binge eating disorder, and 5.7% (n=52) for pica. A statistically significant difference was found between the anxiety (p<0.01) and depressive symptoms (p<0.01). CONCLUSIONS: the prevalence of ED (7.6%) and its association with anxiety and depression symptoms during pregnancy highlights the need for specialist care for prevention, diagnosis and treatment. Given the importance of proper nutrition during pregnancy, both with regard to maternal health and fetal development, it is necessary to have specific predetermined evaluation protocols implemented by health care professionals for the diagnosis of ED during pregnancy.

Depression, stress and guilt are linked to the risk of suicide associated to ectopic pregnancy / Depressão, estresse e culpa ligam-se ao risco de suicídio associado à gestação ectópica

OBJECTIVE: To identify the risk for suicidal behavior in women who had a fetal loss resulting from ectopic pregnancy and verify the association of suicide risk with depression and psychosocial aspects. METHODS: Thirty-one women diagnosed with an ectopic pregnancy were interviewed. Major depression was identified using the Primary Care Evaluation of Mental Disorders questionnaire. The Prenatal Psychosocial Profile questionnaire was used to measure stress, social support and self-esteem. RESULTS: We found that 16% (n = 5) reported suicide risk behavior. The correlation between suicide risk and symptoms of major depression, stress and guilt was statistically significant. CONCLUSIONS: Depression and stress have been linked to the presence of suicide risk, further increasing the vulnerability of women with ectopic prgnancy, which generates intense emotional reactions as guilt.

OBJETIVO: identificar o risco de comportamento suicida em mulheres que apresentaram perda fetal resultante de gestação ectópica e verificar a associação entre risco suicida com depressão e aspectos psicológicos. MÉTODO: Trinta e uma mulheres diagnosticadas com gestação ectópica foram entrevistadas. Diagnóstico de Depressão maior foi identificado através do questionário Primary Care Evaluation of Mental Disorders. O questionário Prenatal Psychosocial Profile foi utilizado para avaliação de estresse, suporte social e auto-estima. RESULTADOS: Foi encontrado índice de 16% (n = 5) de mulheres que reportaram risco de comportamento suicida. A correlação entre risco suicida e sintomas de depressão maior, estresse e culpa foi estatisticamente significante. CONCLUSÃO: Depressão e estresse estiveram relacionados com a presença de risco suicida, aumentando a vulnerabilidade das mulheres com gestação ectópica, o que gera reações emocionais intensas como a culpa.

Psychogenic non-epileptic seizures and psychoanalytical treatment: results / Crises não epilépticas psicogênicas e tratamento psicanalítico: resultados.

Background: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes. .

Introdução: estima-se que o número de casos de pacientes com crises não epilépticas psicogênicas (CNEP) seja de 2 a 33 por 100 mil habitantes. O índice de CNEP corresponde ainda a, aproximadamente, 19% dos pacientes tratados como epilépticos. Os pacientes com CNEP são tratados como portadores de epilepsia refratária, chegando ao limite máximo do tratamento medicamentoso e sem a obtenção de resultados satisfatórios. Objetivo: relatar os efeitos do tratamento psicanalítico individual em pacientes com CNEP de forma a avaliar a evolução do quadro clínico de CNEP e verificar sua associação com gênero, tempo de crise, prejuízos sociais, afetivos e profissionais, bem como término do tratamento. Métodos: a casuística foi composta por 37 pacientes com diagnóstico de CNEP feito por meio da monitoração por vídeo-EEG. Foram realizadas sessões de tratamento psicanalítico: atendimento clínico individual com frequência semanal, com duração aproximada de 50 minutos e duração total de 48 sessões em 12 meses. Resultados: este estudo constatou elevado índice de sucesso no tratamento dos pacientes com CNEP: 29,7% (n = 11) de cessação/cura dos sintomas e 51,4% (n = 19) de redução das crises convulsivas. Foi constatada associação entre cessar ou reduzir as crises e gênero (p<0,01), religião (p<0,01) e término do tratamento (p<0,01). Conclusão: este estudo apontou eficácia do tratamento psicanalítico individual realizado com pacientes com CNEP, podendo ser considerada uma forma de assistência essencial para que haja decréscimo ou cessação das crises. .

Abortion: a review of women's perception in relation to their partner's reactions in two Brazilians cities.

OBJECTIVE: to analyze women's perception in relation to their partner's reaction and behavior during the abortion process in two Brazilian capitals, associating the variables from women who suffered a spontaneous abortion with those from women who induced it. METHODS: semi-structured, questionnaire-based interviews were conducted with 285 women who underwent spontaneous abortion and 31 who reported having induced it. The data were analyzed using the thematic analysis technique, and, subsequently, by the IBM SPSS Statistics Standard Edition software program. The significance level was set at p < 0.05. RESULTS: in both capitals, the women who induced an abortion referred to the partner as the person who could not find out about the abortion (p<0.01 in Natal; p = 0.02 in São Paulo-SP) and, simultaneously, as the one who could have avoided it (p < 0.01 in Natal; p = 0.03 in São Paulo). In Natal-RN, induced abortion was associated with the partner's absence at the time pregnancy was confirmed (p = 0.02) and, in Sao Paulo-SP, with their negative reaction to news of the pregnancy (p = 0.04) and lack of participation in the abortion process (p < 0.01). CONCLUSION: despite having achieved independence, women still regard male participation in the abortion process as an important factor. The specifics of each capital denote the influence of the geographic and cultural dimension, indicating the need to take into account the particulars of each region in Brazil while considering a holistic approach to women's health.

Abortion: a review of women's perception in relation to their partner's reactions in two Brazilians cities / Abortamento: avaliação da percepção das mulheres relacionada às reações e às condutas do parceiro em duas cidades brasileiras

Objective: to analyze women's perception in relation to their partner's reaction and behavior during the abortion process in two Brazilian capitals, associating the variables from women who suffered a spontaneous abortion with those from women who induced it. Methods: semi-structured, questionnaire-based interviews were conducted with 285 women who underwent spontaneous abortion and 31 who reported having induced it. The data were analyzed using the thematic analysis technique, and, subsequently, by the IBM SPSS Statistics Standard Edition software program. The significance level was set at p < 0.05. Results: in both capitals, the women who induced an abortion referred to the partner as the person who could not find out about the abortion (p<0.01 in Natal; p = 0.02 in São Paulo-SP) and, simultaneously, as the one who could have avoided it (p < 0.01 in Natal; p = 0.03 in São Paulo). In Natal-RN, induced abortion was associated with the partner's absence at the time pregnancy was confirmed (p = 0.02) and, in Sao Paulo-SP, with their negative reaction to news of the pregnancy (p = 0.04) and lack of participation in the abortion process (p < 0.01). Conclusion: despite having achieved independence, women still regard male participation in the abortion process as an important factor. The specifics of each capital denote the influence of the geographic and cultural dimension, indicating the need to take into account the particulars of each region in Brazil while considering a holistic approach to women's health. .

Objetivo: analisar a percepção das mulheres quanto às reações e às condutas do parceiro no processo do abortamento, associando as variáveis entre mulheres que sofreram abortamento espontâneo e que o provocaram, nas cidades de Natal (RN) e de São Paulo (SP). Métodos: foram realizadas entrevistas semidirigidas com 285 mulheres que sofreram abortamento espontâneo e 31 mulheres que referiram tê-lo provocado. Os dados foram analisados pela Técnica de Análise Temática e, posteriormente, utilizou-se o programa IBM SPSS. O nível de significância utilizado foi p < 0,05. Resultados: em ambas as capitais, as mulheres que provocaram o abortamento referiram o parceiro como alguém que não poderia saber do abortamento (p < 0,01 em Natal; p = 0,02 em São Paulo) e, ao mesmo tempo, como aquele que poderia tê-lo evitado (p < 0,01 em Natal; p = 0,03 em São Paulo). Em Natal, o abortamento provocado foi associado à ausência do parceiro no momento da confirmação da gestação (p = 0,02) e, em São Paulo, a reações negativas quando noticiada a gravidez (p=0,04) e a não participação no processo do abortamento (p < 0,01). Conclusão: apesar da independência feminina conquistada, os resultados obtidos indicam que as mulheres que provocaram o abortamento percebem a participação masculina como importante no processo. As particularidades de cada capital denotam influência da dimensão geográfica e cultural, demonstrando a necessidade de uma assistência integral à saúde da mulher que respeite as especificidades de cada região do Brasil. .

Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test / Desempenho de uma amostra de adultos Brasileiros no Traill making test e Stroop Test

OBJECTIVE: The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C. METHODS: We recruited 1447 healthy subjects aged ?18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C. RESULTS: Among the participants, mean intellectual efficiency was 103.20 (SD:12.0), age 41.0 (SD:16.4) years and education 11.9 (SD:5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference. CONCLUSION: Gender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples.

OBJETIVO: Os testes de atenção Trail Making Test (TMT) e Stroop Test (ST) são largamente usados na prática clínica e em pesquisas. O objetivo deste estudo foi fornecer informação normativa para a população brasileira de adultos e estudar a interferência de gênero, idade e educação no TMT parte A e B e no ST cartão A, B e C. MÉTODOS: Recrutamos 1447 sujeitos saudáveis com idade ?18 anos, nível educacional de 0-25 anos, falantes nativos do Português (Brasil). Os sujeitos foram avaliados pelos subtestes do Wechsler Adult Intelligence Scale-III Raciocínio Matricial e Vocabulários, além do TMTA, TMTB e ST A, B e C. RESULTADOS: Entre os participantes a média de eficiência intelectual foi de 103,20 (SD:12,0), de idade 41,0 (SD:16,4) anos e de escolaridade 11,9 (SD: 5,6) anos. Houve diferenças significantes por gênero em TMTA (p=0,002), TMTB (p=0,017) e STC (p=0,024). Idade se correlacionou de modo positivo com todos os testes de atenção, enquanto a escolaridade correlacionou-se de modo negativo. Após o modelo de regressão linear múltipla o gênero não manteve correlação significativa, mas idade e escolaridade mantiveram sua interferência. CONCLUSÃO: O gênero não mostrou grande impacto nas tarefas atencionais como a idade e escolaridade que devem, portanto, ser consideradas na estratificação de amostras normativas.

Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test.

OBJECTIVE: The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C. METHODS: We recruited 1447 healthy subjects aged ≥18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C. RESULTS: Among the participants, mean intellectual efficiency was 103.20 (SD: 12.0), age 41.0 (SD: 16.4) years and education 11.9 (SD: 5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference. CONCLUSION: Gender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples.

OBJETIVO: Os testes de atenção Trail Making Test (TMT) e Stroop Test (ST) são largamente usados na prática clínica e em pesquisas. O objetivo deste estudo foi fornecer informação normativa para a população brasileira de adultos e estudar a interferência de gênero, idade e educação no TMT parte A e B e no ST cartão A, B e C. MÉTODOS: Recrutamos 1447 sujeitos saudáveis com idade ≥18 anos, nível educacional de 0-25 anos, falantes nativos do Português (Brasil). Os sujeitos foram avaliados pelos subtestes do Wechsler Adult Intelligence Scale-III Raciocínio Matricial e Vocabulários, além do TMTA, TMTB e ST A, B e C. RESULTADOS: Entre os participantes a média de eficiência intelectual foi de 103,20 (SD: 12,0), de idade 41,0 (SD: 16,4) anos e de escolaridade 11,9 (SD: 5,6) anos. Houve diferenças significantes por gênero em TMTA (p=0,002), TMTB (p=0,017) e STC (p=0,024). Idade se correlacionou de modo positivo com todos os testes de atenção, enquanto a escolaridade correlacionou-se de modo negativo. Após o modelo de regressão linear múltipla o gênero não manteve correlação significativa, mas idade e escolaridade mantiveram sua interferência. CONCLUSÃO: O gênero não mostrou grande impacto nas tarefas atencionais como a idade e escolaridade que devem, portanto, ser consideradas na estratificação de amostras normativas.

Psychogenic non-epileptic seizures and psychoanalytical treatment: results.

BACKGROUND: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. METHODS: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. RESULTS: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). CONCLUSION: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes.

"Graças a deus vomito, senão morria": o sintoma bulímico e a clínica psicanalítica em um hospital público / "Thank god I can throw up, otherwise I'd die": symptoms of bulimia and psychoanalytic clinic at a public hospital / "Heureusement que je vomis, sinon je mourrais": le symptôme boulimique et la clinique psychanalytique dans un hôpital public / "Gracias a dios vomito, si no moría": el sintoma bulímico y la clinica psicoanalítica

Os manuais de classificação e diagnóstico são bastante objetivos ao descreverem a etiologia, o diagnóstico diferencial e o tratamento para todos aqueles que padecem dos chamados transtornos alimentares. Todavia, se a Medicina, como área do saber científico, deve generalizar, a psicanálise tem como campo de pesquisa o inconsciente, o sujeito como efeito de linguagem. Com isso, a partir de observações sobre as entrevistas preliminares de um caso, no qual se evidenciava o sintoma bulímico, o presente artigo coloca em relevo algumas questões: as especificidades do sintoma para a psicanálise, a diferença radical entre instinto e pulsão e a particularidade da produção de saber em psicanálise.

Manuals of classification and diagnosis are highly objective when describing the etiology, differential diagnosis and treatment for persons suffering from the so-called eating disorders. But whereas medicine as a science must seek generalizations, psychoanalysis has the unconscious as its field of research and the subject as an effect of language. This paper deals with issues based on observations of preliminary interviews in a clinical case where the symptom of bulimia was present. The observations refer to specific aspects of the symptom in psychoanalysis, the radical difference between the concepts of "instinct" and "drive" and the particular production of knowledge in psychoanalysis.

Les manuels de classification et diagnostique font une description bien objective de l'étiologie, du diagnostic différentiel et du traitement destiné aux personnes souffrant des dits troubles de l'alimentation. Toutefois, si la Médecine, comme champ de connaissance scientifique, opère par la généralisation, le domaine de recherche de la Psychanalyse porte sur l'inconscient, sur le sujet comme effet du langage. Ainsi, à partir des observations sur les entretiens préliminaires d'un cas de boulimie, cet article met en relief quelques questions, telles que : les spécificités du symptôme dans la psychanalyse, la différence radicale entre l'instinct et la pulsion, ainsi que la particularité de la production du savoir en psychanalyse.

Los Manuales de clasificación y diagnostico son bastante objetivos y o describen la etiología, el diagnostico diferencial y el tratamiento para todos aquellos que padecen los llamados trastornos alimenticios. Todavía, la medicina como área del saber científico debe generalizar, el psicoanálisis tiene como campo de pesquisa el inconsciente y el sujeto como un efecto del lenguaje. Con esto a partir de observaciones sobre las entrevistas preliminares de un caso en la cual se evidenciaba el síntoma Bulímico, el presente articulo revela algunas reflexiones:las especificaciones de síntomas para el psicoanálisis la diferencia radical entre instinto e pulsión yla particularidad de la producción de saber en psicoanálisis.

[Preference in the process of parturition: a comparison between primiparous and nulliparous women]. / Preferência pela via de parto: uma comparação entre gestantes nulíparas e primíparas.

PURPOSE: It was to describe and compare the preference of nulliparous and primiparous women for a particular mode of delivery and to determine whether the previous experience of childbirth influences the delivery process. METHODS: We conducted a prospective cross-sectional study. One-hundred interviews were held with 56 nulliparous and 44 primiparous women using previously prepared questionnaires. The quantitative and categorical data were evaluated by the chi-square or Fisher's Exact Test. RESULTS: 60.7% of nulliparous women and 70.5% of primiparous women reported to prefer vaginal delivery. When analyzing the answers about receiving sufficient information about the type of delivery, the presence or absence of influence on the choice of route of delivery and the preferred route of delivery by the partner, there were no statistically significant differences between the two groups. The level of significance used for the tests was 0.05. CONCLUSIONS: This study permitted us to conclude that the previous experience of delivery does not influence the expectation of the delivery process or the choice for a specific mode of delivery. When choosing the route of delivery, women seek to ensure the health of mother and neonate, as well as to avoid the process of pain and suffering.

Preferência pela via de parto: uma comparação entre gestantes nulíparas e primíparas / Preference in the process of parturition: a comparison between primiparous and nulliparous women

OBJETIVO: Foi descrever e comparar a preferência pela via de parto entre gestantes nulíparas e primíparas, e verificar se a vivência anterior do parto exerce influência no processo de parturição. MÉTODOS: Foi realizado um estudo transversal prospectivo. Foram realizadas 100 entrevistas com questionários previamente elaborados com 56 gestantes nulíparas e 44 primíparas. Os dados categóricos e quantitativos foram avaliados pelo qui-quadrado ou Teste Exato de Fisher. O nível de significância utilizado para os testes foi de 0,05. RESULTADOS: Das gestantes, 60,7% das nulíparas e 70,5% das primíparas relataram preferir o parto por via vaginal. Ao se analisar as respostas sobre ter recebido informações suficientes sobre o tipo de parto, a existência ou não de influências na escolha pela via de parto e a preferência da via de parto pelo parceiro, não foram evidenciadas diferenças significativas entre os dois grupos (p>0,05). CONCLUSÃO: O presente estudo permitiu concluir que a vivência anterior do parto não exerce influência na expectativa do processo de parturição nem na escolha por determinada via de parto. As mulheres, ao optarem pela via de parto, buscam garantir a saúde materna e do neonato, bem como evitar o processo de dor e sofrimento.

PURPOSE: It was to describe and compare the preference of nulliparous and primiparous women for a particular mode of delivery and to determine whether the previous experience of childbirth influences the delivery process. METHODS: We conducted a prospective cross-sectional study. One-hundred interviews were held with 56 nulliparous and 44 primiparous women using previously prepared questionnaires. The quantitative and categorical data were evaluated by the chi-square or Fisher's Exact Test. RESULTS: 60.7% of nulliparous women and 70.5% of primiparous women reported to prefer vaginal delivery. When analyzing the answers about receiving sufficient information about the type of delivery, the presence or absence of influence on the choice of route of delivery and the preferred route of delivery by the partner, there were no statistically significant differences between the two groups. The level of significance used for the tests was 0.05. CONCLUSIONS: This study permitted us to conclude that the previous experience of delivery does not influence the expectation of the delivery process or the choice for a specific mode of delivery. When choosing the route of delivery, women seek to ensure the health of mother and neonate, as well as to avoid the process of pain and suffering.

[Abortion in women living in the outskirts of São Paulo: experience and socioeconomic aspects]. / Aborto provocado em mulheres da periferia da cidade de São Paulo: vivência e aspectos socioeconômicos.

PURPOSE: To compare and analyze socioeconomic aspects and the emotional experience of women with spontaneous or induced abortion and in women living in the outskirts of São Paulo. METHODS: A prospective case-control study carried out from July 2008 to March 2010, involving semi-structured interviews with women who presented a previous diagnosis of abortion and who had been admitted to two public hospitals in the outskirts of São Paulo. The study included 100 women with diagnosis of abortion and were hospitalized for curettage. Eleven women who reported induced abortion (11%) represented the case group. The control group (n=22) was selected at a 2:1 ratio according to the following procedure: for every case of induced abortion, the next two cases of spontaneous abortion at the same hospital. A semistructured interview was conducted with questions regarding emotional aspects and family, social and economic context. RESULTS: The women with induced abortion compared to the group with spontaneous abortion had lower educational level, with more frequent elementary level (82 versus 36%, p=0.04), lower income (median, R$ 1,000.00 versus R$ 1,400.00, p=0.04), lower personal income (median, R$ 200.00 versus R$ 333.00, p=0.04), higher frequency of negative feelings upon suspicion (82 versus 22%, p=0.004) and confirmation (72 versus 22%, p=0.03) of pregnancy. CONCLUSION: Among women looking for health care in hospitals in the outskirts of São Paulo, induced abortion is related to unfavorable socioeconomic conditions, which affects the emotional experiences of suspicion and confirmation of pregnancy.