Acceptance and commitment therapy for chronic pain: a quasiexperimental study / Terapia de aceitação e compromisso em grupo para dor crônica: estudo quase-experimental

Objective Chronic pain is an important health problem and affects both quality of life and mental health. This study assessed psychological inflexibility, pain intensity, quality of life, anxiety and depression symptoms, self-efficacy, and social support among patients with chronic pain. Method A quasiexperimental design was used to assess six adult participants pre- and post-group intervention (eight sessions) based on acceptance and commitment therapy. Results After the intervention, the patients experienced a reduction in psychological inflexibility, pain, and depression and anxiety symptoms and improvements in quality of life and self-efficacy. The quality of life and depression symptoms and the domains of quality of life and psychological inflexibility were negatively correlated. Conclusion Acceptance and commitment therapy is a promising treatment for the interdisciplinary treatment of the Pain Clinic.

Objetivo Dor crônica é um problema de saúde prevalente que acarreta prejuízos para qualidade de vida e saúde mental. Este estudo avaliou inflexibilidade psicológica, intensidade da dor, qualidade de vida, sintomas de ansiedade e de depressão, autoeficácia e suporte social em pacientes com dor crônica. Método Utilizou delineamento quase-experimental e os seis participantes adultos foram avaliados por meio de instrumentos no pré e pós-intervenção em grupo (oito sessões) com Terapia de Aceitação e Compromisso. Resultados Após a intervenção houve redução da inflexibilidade psicológica e da dor, melhora da qualidade de vida, redução dos sintomas de ansiedade e de depressão e aumento da autoeficácia. Houve correlação inversa entre qualidade de vida e sintomas de depressão e entre domínios da qualidade de vida e inflexibilidade psicológica. Conclusão Conclui-se que a Terapia de Aceitação e Compromisso é um tratamento promissor a ser integrado no atendimento interdisciplinar da Clínica de dor.

Analysis of Progressive Muscle Relaxation on Psychophysiological Variables in Basketball Athletes.

The purpose of this study was to evaluate the effects of a progressive muscle relaxation program on psychological (stress levels, anxiety, and mood states) and physiological (blood pressure and heart rate) variables in basketball athletes. Fifty-nine basketball players, aged 14 to 19 years, and members of Bauru Basket team, were recruited for this study and grouped into control group (CG, n = 30) and intervention group (IG, n = 29). The participants were evaluated, before and after the intervention, by the following means: Competitive State Anxiety Inventory-2 (CSAI-2), to measure the pre-competitive anxiety state, i.e., how anxious each athlete felt just before the competition; Brunel Mood Scale (BRUMS), an instrument for early detection of overtraining syndrome; Recovery-Stress Questionnaire for Athletes (RESTQ-Sport), to identify the extent to which each athlete was physically or mentally stressed and the athlete's current capability for recovery; Athlete Burnout Questionnaire (ABQ), specifically developed for athletes. The IG athletes participated in 12 progressive muscle relaxation sessions, a practice for tensing or tightening a specific muscle until an ideal state of relaxation is reached. Each participant had blood pressure and heart rate measured before and after every session. The CG athletes were evaluated similarly to those in the IG but without relaxation. The results showed statistically significant differences in cognitive anxiety (p = 0.039) and specific stress (p = 0.016) between CG and IG before the intervention; in addition, a significant heart rate decrease (p < 0.01) between IG and CG was noted.

Estresse ocupacional e sintomas osteomusculares em Agentes Comunitários de Saúde / Occupational stress and musculoskeletal symptoms in Community Health Workers

Resumo Introdução Os Agentes Comunitários de Saúde (ACS) trabalham em condições de riscos ocupacionais e sobrecarga que podem causar adoecimento. Objetivos Avaliar a presença de estresse ocupacional e sintomas osteomusculares em Agentes Comunitários de Saúde e comparar os níveis de estresse ocupacional, segundo as características sociodemográficas. Método Estudo transversal, realizado em 2017, em um município do interior paulista. Foram utilizadas a Escala de Estresse no Trabalho e o Questionário Nórdico de Sintomas Osteomusculares. Resultados Participaram 44 ACS, sendo 70,5% do sexo feminino, 47,7% com 40 anos ou mais, 79,5% não exerciam outra atividade remunerada e 50,0% tinham de três a 10 anos de atuação profissional. Vinte e um (47,7%) profissionais apresentaram níveis importantes de estresse ocupacional (>2,5). Os principais fatores estressores foram: deficiência na divulgação de informações sobre decisões organizacionais (3,3;±1,1); deficiência nos treinamentos (3,4;±1,6); pouca valorização (3,2;±1,4); poucas perspectivas de crescimento na carreira (3,2;±1,6); discriminação/favoritismo no ambiente de trabalho (3,1;±1,5); falta de compreensão sobre as responsabilidades no trabalho (3,0;±1,5); tipo de controle (2,9;±1,1); forma como as tarefas são distribuídas (2,8;±1,4); realizar tarefas que estão além da capacidade (2,8;±1,2); falta de autonomia na execução do trabalho (2,7;±1,3); receber ordens contraditórias do superior (2,7;±1,4); tempo insuficiente para realizar o trabalho (2,7;±1,3). No último ano, 65,9% dos ACS referiram dor osteomuscular nas regiões lombar, 61,4% no pescoço, 47,7% nos ombros e 43,2% nos joelhos. Conclusão O estresse ocupacional e os sintomas osteomusculares são problemas presentes na prática laboral dos ACS, evidenciando que as organizações precisam incrementar recursos laborais para prevenir riscos psicossociais e amplificar a qualidade do trabalho destes profissionais.

Abstract Introduction Community health workers (CHWs) work under conditions of occupational risks and overload that can cause illness. Objectives To evaluate the presence of occupational stress and musculoskeletal symptoms in community health workers, and compare the levels of occupational stress, according to sociodemographic characteristics. Method Cross-sectional study, conducted in 2017, in a municipality in the interior of São Paulo state. The Work Stress Scale and the Nordic Musculoskeletal Questionnaire were used. Results Forty-four CHWs participated, 70.5% were female, 47.7% were 40 years old or older, 79.5% had no other paid activity and 50.0% had three to 10 years of professional experience. Twenty-one (47.7%) professionals presented important levels of occupational stress (>2.5). The main stressors were: deficiency in disclosure of information about organizational decisions (3.3;±1.1); deficiency in training (3.4;±1.6); little appreciation (3.2;±1.4); few prospects for career growth (3.2;±1.6); discrimination/favoritism in the work environment (3.1;±1.5); lack of understanding about job responsibilities (3.0; ±1.5); type of control (2.9;±1.1); how tasks are distributed (2.8;±1.4); performing tasks that are beyond one's capacity (2.8;±1.2); lack of autonomy in performing the work (2.7;±1.3); receiving contradictory orders from the superior (2.7;±1.4); insufficient time to perform the work (2.7;±1.3). In the last year, 65.9% of CHWs reported musculoskeletal pain in the lower back, 61.4% in the neck, 47.7% in the shoulders, and 43.2% in the knees. Conclusion Occupational stress and musculoskeletal symptoms are problems present in the CHWs' work practice, showing that organizations need to increase labor resources to prevent psychosocial risks and enhance the quality of work of these professionals.

Comparative Analysis of Psychology Responding to COVID-19 Pandemic in Brics Nations.

The BRICS Forum, an independent international organization encouraging commercial, political, and cultural cooperation between Brazil, Russia, India, China, and South Africa, was formed in 2011, and these countries have a significant influence on their regional affairs. These nations were hit by COVID-19 at different times, and all adopted home quarantine to reduce the spread of the virus. We present a comparative analysis of actions of psychology and potential outcomes during the COVID-19 pandemic in BRICS nations regarding five aspects: psychology in health policies, social roles of psychology, socioeconomic context, actions for the general population, and health professionals during stage 1 of the pandemic, and possible actions in stage 2. Various types of actions were taken by psychologists in BRICS, with different levels of coordinated cooperation with respective governmental and non-governmental organizations, multiple and parallel efforts from different scientific societies, and professional regulatory agencies. Scientific societies have had an important role in coordinating some of these efforts, especially because they congregate the psychologists from different parts of these countries, improving communication and access to key information. The aim of these actions varies from improving situational skills and competences to increase the accessibility of psychological services and provide psychoeducation and telepsychology. We will consider the social importance of these actions within these countries as a global opportunity for psychology to stage in a complex context involving human health. The way psychology in BRICS will face this challenging situation is likely to produce important regional influence, stimulate scientific contribution, and increase the accessibility of psychology.

Burden, Stress, and Depression in Informal Caregivers of Patients Pre and Post Liver Transplant.

BACKGROUND: Caring for a patient with chronic liver disease involves exposure to factors that increase family caregivers' vulnerability to developing mental disorders. This study reassessed the scores of burden, stress, and depression in informal (family) caregivers of patients with liver disease after liver transplant. METHODS: In this observational and descriptive study, the caregivers were reassessed for the same outcomes 4 to 10 years following the initial assessment pre-transplant. The data were obtained from the identification card, the interview script, the Brazilian version of the Caregiver Burden Scale, the Lipp Inventory of Stress Symptoms for Adults, and the Beck Depression Inventory. Descriptive statistics of pre- and post-liver transplant phases were calculated, and the Wilcoxon signed rank test was used to compare the burden scores. RESULTS: The 5 caregivers were women, with a mean age of 51.6 (SD, 8.38) years. All of the caregivers' (100%) burden score increased, 2 caregivers needed to seek some form of help, and 3 caregivers showed an indication of burden risk. Regarding stress symptoms, 3 caregivers (60%) maintained a score indicating no stress, 2 caregivers (40%) presented increased scores, and the predominant symptoms changed from psychological to physical. Regarding depression, 3 caregivers (60%) maintained the minimum level of symptoms for depression, and 2 caregivers (40%) presented increased scores. CONCLUSION: After liver transplant, caregivers' burden scores increased, and levels of stress and depression increased for caregivers who already showed symptoms in the pre-transplant phase.

Pandemia do Coronavírus e Ensino Remoto Emergencial: Percepção do Impacto no Bem Estar de Universitários

Resumo: Jovens em ensino superior são mais vulneráveis ao aparecimento de sintomas psicológicos diante do contexto de COVID-19. Não só a pandemia, como a adaptação à realidade do ensino remoto e demais dificuldades podem afetar o bem estar dos universitários. Por isso, esse estudo buscou investigar a percepção de bem-estar e saúde mental de universitários que realizaram ensino remoto durante a quarentena. Trata-se de um estudo transversal, exploratório e descritivo. Utilizou-se o instrumento "Questionário sobre percepção do isolamento social por universitários durante quarentena da COVID-19". Por meio da técnica por amostragem de referência os universitários divulgaram o link de acesso ao questionário online a seus pares. Participaram 497 estudantes, a maioria mulheres (74,69%) com média de idade 21,71 (DP=2.85), matriculados em Instituição de Ensino Superior pública (IES) (72.89%). Encontrou-se correlação positiva e significante (p<0.0001) para prejuízo no desempenho acadêmico pela adesão ao Ensino Remoto Emergencial e a percepção negativa na saúde mental e no bem-estar. Nos dados qualitativos, foram identificados percepção de maior ansiedade (15.35%), estresse (7.3%) e alteração do sono (7.67%) nos participantes. Cerca de 91.96% dos participantes estão engajados em práticas de auto cuidado e gerenciamento emocional. Portanto, os resultados convergem com a literatura e implicam que o ensino remoto pode impactar negativamente sobre o bem-estar e gerar insegurança quanto à qualidade e solidez da formação acadêmica. Os dados desse estudo sugerem que as instituições implementem atividades preventivas em relação à saúde mental dos estudantes e adequem o ensino remoto a fim de reduzir o sofrimento identificado.

Abstract: Young people in higher education are more vulnerable to the appearance of psychological symptoms in the context of COVID-19. Also, the adaptation to remote education and other difficulties can affect the well-being of university students. Therefore, this study sought to investigate the perception of well-being and mental health of university students who underwent remote education during quarantine. This is a cross-sectional, exploratory, and descriptive study. The instrument used was "Questionnaire on the perception of social isolation by university students during quarantine of COVID-19". Using the reference sampling technique, university students released the link to access the online questionnaire to their peers. 497 students participated, most of them women (74.69%), with mean age of 21.71 (SD = 2.85), enrolled in a public higher education institution (HEI) (72.89%). A positive and significant correlation was found (p <0.0001) for academic performance impaired by the adhesion of Emergency Remote Education and the negative perception of mental health and well-being. In the qualitative part, participants noticed anxiety (15.35%), stress (7.3%) and altered sleep (7.67%). About 91.96% of the participants are engaged in self-care and emotional management practices. Therefore, the results converge with the literature and imply that online education can impact well-being and generate insecurity regarding the quality and solidity of academic training. Data from this study suggest that institutions should implement preventive activities regarding students' mental health and adapt remote learning in order to reduce student's distress.

Resumen: Los jóvenes en educación superior son más vulnerables a la aparición de síntomas psicológicos en el contexto de COVID-19. La pandemia, la adaptación a la educación a distancia y otras dificultades afectan el bienestar de los estudiantes universitarios. Este estudio buscó investigar la percepción de bienestar y salud mental de los que realizaron educación remota durante la cuarentena. Esto es un estudio transversal, exploratorio y descriptivo. El instrumento utilizado fue "Cuestionario sobre la percepción de aislamiento social de estudiantes universitarios durante la cuarentena de COVID-19". Utilizando la técnica de muestreo de referencia, los estudiantes lanzaron el enlace para acceder al cuestionario en línea a sus compañeros. Participaron 497 estudiantes, la mayoría mujeres (74,69%) con una media de edad de 21,71 (DE = 2,85) matriculados en una institución pública de educación superior (72,89%). Se encontró una correlación positiva y significativa (p<0,0001) para el rendimiento académico deteriorado por este modelo de enseñanza y la percepción negativa de salud y bienestar mental. En el resultado cualitativo se identificaron percepcíon de mayor ansiedad (15,35%), estrés (7,3%) y alteración del sueño (7,67%). Aproximadamente el 91,96% realiza prácticas de autocuidado y manejo emocional. Por tanto, los resultados convergen con la literatura e implican que la educación remota puede impactar el bienestar y generar inseguridad en cuanto a la calidad y solidez de la formación académica. Los datos de este estudio sugieren que las instituciones deben implementar actividades preventivas relacionadas con la salud mental de los estudiantes y adaptar el aprendizaje a distancia para reducir la angustia de los universitarios.

Characterization and psychological aspects of patients with erectile dysfunction / Caracterização e aspectos psicológicos de pacientes com disfunção erétil / Caracterización y aspectos psicológicos de pacientes con disfunción eréctil

This study aimed to characterize patients with erectile dysfunction (ED) evaluated by the psychologist who participates in the Urology team of a teaching hospital. The following data from medical records of patients treated between January / 2011 and April / 2015 were analyzed: 1) the urologist's referral, with diagnosis and the reason for the request for psychological evaluation; 2) the patient's psychological records, filed at the Psychology Service. Data of 233 male patients were analyzed, who had a mean age of .34 ± 1.18 and a high prevalence of ED of organic cause (72.1%). Organic, psychological factors and lifestyle associated with the etiology of ED were identified: behavioral (smoking and alcohol consumption.), advanced age, prostate cancer, premature ejaculation, depression, and anxiety. Data pointed out the importance of psychological assessment associated with the medical diagnosis of ED to provide proper treatment.

Este estudo teve como objetivo caracterizar pacientes com disfunção erétil (DE) avaliados pelo psicólogo que participa da equipe de urologia de um hospital de ensino. Foram analisados os seguintes dados dos prontuários de pacientes atendidos entre janeiro de 2011 e abril de 2015: 1. encaminhamento do urologista, com diagnóstico e motivo da solicitação para avaliação psicológica e 2. prontuário psicológico do paciente, arquivado no ambulatório de psicologia. Analisaram-se dados de 233 pacientes do sexo masculino, com média de idade 57,34 ± 1,18 e alta prevalência da DE de causa orgânica (72,1%). Fatores orgânicos, psicológicos e estilo de vida associados à etiologia da DE foram identificados: comportamentais (tabagismo e etilismo), idade avançada, câncer de próstata, ejaculação precoce, depressão e ansiedade. Os dados indicam a importância da avaliação psicológica associada ao diagnóstico médico da DE para fornecer o tratamento adequado.

Este estudio tuvo como objetivo caracterizar a pacientes con disfunción eréctil (DE) evaluados por el psicólogo que participa del equipo de urología de un hospital de enseñanza. Se analizaron los siguientes datos de los prontuarios de pacientes atendidos entre enero/2011 y abril/2015: 1. encaminamiento del urólogo, con diagnóstico y motivo de la solicitud para evaluación psicológica y 2. prontuario psicológico del paciente, archivado en el ambulatorio de psicología. Se analizaron datos de 233 pacientes del sexo masculino, con media de edad 57,34 ± 1,18 y alta prevalencia de la DE de causa orgánica (72,1%). Los factores orgánicos, psicológicos y estilo de vida asociados a la etiología de la DE fueron identificados: comportamentales (tabaquismo y etilismo), edad avanzada, cáncer de próstata, eyaculación precoz, depresión y ansiedad. Los datos indican la importancia de la evaluación psicológica asociada al diagnóstico médico de la DE, para proporcionar el tratamiento adecuado.

Variáveis psicossociais e adesão ao tratamento antirretroviral para HIV/Aids / Psychosocial variables and adherence to antiretroviral treatment for HIV/Aids / Variables psicosociales y adhesión al tratamiento antirretroviral para el VIH/Sida

A terapia antirretroviral, tratamento padrão para HIV/aids, requer taxas de adesão da ordem de 95% para ser efetiva. O objetivo deste estudo foi avaliar adesão, suporte social, transtornos mentais, sintomas de depressão e percepção de autoeficácia para aderir ao tratamento em pacientes vivendo com HIV. Trata-se de estudo descritivo transversal com pacientes em tratamento antirretroviral, que responderam a instrumentos de autorrelato. Participaram 66 pacientes, 34 homens e 32 mulheres. A maioria apresentou excelente controle da carga viral e sintomas mínimos de depressão; a média do suporte social percebido foi alta, especialmente para os homens. Verificou-se menor pontuação de autoeficácia em mulheres e níveis baixos/insuficientes de adesão em 24 pacientes (17 mulheres). A adesão apresentou correlação significativa com as variáveis autoeficácia, gênero masculino, escolaridade, carga viral e suporte social.

To be effective, the highly active antiretroviral therapy, the standard treatment for HIV/aids, requires adherence rates close to 95%. The objective of this study was to assess adherence, social support, mental disorders, depressive symptoms, and self-efficacy perception for adherence. It is a cross-sectional descriptive study with patients on antiretroviral treatment for HIV/aids, who filled self-report measures. Participants were 34 men and 32 women (n = 66). The majority had excellent viral control and minimal symptoms of depression. The average social support score was high, especially for men. Lower scores on self-efficacy were observed among women, and low/insufficient levels of adherence were observed in 24 patients (17 were women). Adherence was significantly correlated with self-efficacy, male gender, education, viral load, and social support.

La terapia antirretroviral, el tratamiento estándar para el VIH/sida, requiere tasas de adherencia cercanas al 95% para ser efectiva. El objetivo de este estudio fue evaluar la adherencia, el apoyo social, los trastornos mentales, los síntomas de depresión y la percepción de autoeficacia para adherirse al tratamiento en pacientes que viven con VIH/sida. Se trata de un estudio transversal descriptivo con pacientes en tratamiento antirretroviral para el VIH/sida, que respondieron a los instrumentos de autoinforme. Participaron 66 pacientes, 32 mujeres y 34 hombres. La mayoría tenía excelente control viral y síntomas mínimos de depresión. El apoyo social promedio fue alto, especialmente para los hombres. Hubo una puntuación de autoeficacia más baja en mujeres y niveles de adherencia bajos/insuficientes en 24 pacientes (17 eran mujeres). La adherencia mostró una correlación significativa con las variables autoeficacia, género masculino, educación, carga viral y apoyo social..

Validation of the Adapted Social Assessment Instrument for Liver Transplantation Candidates.

BACKGROUND AND AIMS: Assessment is considered a duty, as well as a part of the tasks of social workers; in addition, they have an ethical commitment to improve their working tools. This study aimed at validating the Adapted Social Assessment Instrument used in a transplant center in the state of São Paulo, Brazil, for liver transplantation candidates, requiring its improvement and strengthening. METHODS: The methodology was based on both Marxian dialectics and the method of content validation. The content validation analysis was performed by 5 social workers from 3 Brazilian transplant centers. They evaluated the 5 domains of the instrument: identification, socio-demographic profile, eligibility criteria, evaluation, and social interventions. Descriptive statistics of data were performed, and qualitative analysis was associated to the participant observation. RESULTS: The 5 professionals (100%) assigned the scores 3 and 4, which have demonstrated clarity, relevance, and feasibility, pointing out suggestions for improvement, some of which were considered. CONCLUSIONS: The instrument was evaluated with an approval percentage of above 80%; therefore, the instrument is a valid measure.

Medicina defensiva: uma prática em defesa de quem? / Defensive medicine: a practice in whose defense? / Medicina defensiva: ¿una práctica en defensa de quién?

Resumo Casos de litígio contra médicos têm aumentado no Brasil: já são três novas ações por hora em decorrência de suposto erro médico. Este estudo objetivou analisar se o médico processado e o profissional que conhece outro colega de profissão que também passou por tal situação alteram a conduta clínica com receio de figurar como réu em ação indenizatória por erro médico. Foi aplicado questionário a 104 médicos de 28 especialidades, 53 mulheres (51%) e 51 homens (49%). Analisou-se a relação entre variáveis como estado civil, tempo médio de formado, vínculos empregatícios, entre outras, e a prática cotidiana da medicina defensiva. O estudo busca promover o debate sobre a alteração da conduta clínica por interesse do médico em não ser processado, desvinculando sua prática e a hipótese diagnóstica do paciente.

Abstract Cases of litigation against physicians have been growing in Brazil: there are currently three new lawsuits filed per hour related to alleged medical error. The purpose of this study was to analyze if both the physician who is sued and the physician who knows another physician who has been sued change their clinical behavior due to the fear of appearing as a defendant in a lawsuit seeking compensation for medical error. In all, 104 questionnaires were answered by physicians of 28 different specialties, 53 (51%) being women and 51 (49%) being men. The relationship between variables such as marital status, the average time since graduation, employment links, among others, and the daily practice of defensive medicine. The study aims to promote the debate about the change in clinical behavior due to the physician's interest in not being sued by removing the link between their conduct and the patient's diagnostic hypothesis.

Resumen Los casos de litigio contra médicos han aumentado en Brasil: ya son tres nuevas acciones por hora, como consecuencia de un supuesto error médico. Este estudio tuvo como objetivo analizar si el médico procesado y el profesional que conoce a otro colega de profesión que pasó por tal situación modifican su conducta clínica ante el temor de figurar como reo en una acción indemnizatoria por error médico. Se aplicó un cuestionario a 104 médicos de 28 especialidades, siendo 53 mujeres (51%) y 51 hombres (49%). Se analizó la relación entre variables como estado civil, tiempo promedio de egreso, vínculos laborales, entre otras, y la práctica cotidiana de la medicina defensiva. El estudio procura promover el debate sobre la alteración de la conducta clínica por interés del médico en no ser procesado, desvinculando su práctica y la hipótesis diagnóstica del paciente.

Motociclistas acidentados: caracterização, perfil comportamental e sintomas de transtornos mentais / Crashed motorcycle riders: characterization, behavioral profile, and mental disorders symptoms

Introdução: Acidentes de trânsito (AT) são uma das principais causas de trauma no mundo. No Brasil, a taxa de mortalidade de motociclistas envolvidos em AT aumentou de forma significante entre 2004 e 2014: de 2,8 para 6,2 óbitos respectivamente por 100 mil habitantes. Objetivos: caracterizar o perfil sociodemográfico e clínico de motociclistas vítimas de Acidentes de Trânsito atendidos no Hospital de Base de São José do Rio Preto (2016 a 2018); identificar o perfil comportamental desses pacientes e rastrear sintomas de transtornos mentais. Métodos: pacientes envolvidos em acidentes com motocicleta (motoristas), atendidos no Pronto Atendimento da Cirurgia do Hospital de Base de São José do Rio Preto, SP, Brasil, foram convidados a participar do estudo e responderam aos seguintes instrumentos: Mini International Neuropsychiatric Interview (MINI) e Inventário de Auto-Avaliação para Adultos (ASR). O Banco de Dados da Unidade de Trauma do Hospital de Base forneceu as infomações do prontuário para a construção do perfil sociodemográfico e clínico (referentes às lesões do trauma) do paciente. Resultados: Os participantes (n = 40) eram principalmente do sexo masculino, com média de idade de 33,83 anos (± 12,95) e baixa escolaridade; 13 relataram dirigir após ingestão de bebida alcoólica. A maioria apresentou lesões leves. Foram identificados (ASR e MINI) problemas externalizantes e internalizantes, violação de regras, queixas somáticas, abuso de álcool e de crack. Conclusão: Entre os motociclistas acidentados houve predominância de jovens do sexo masculino com baixa escolaridade, maior prevalência de lesões nas extremidades e no abdomem, uso de álcool associado à direção e presença de sintomas de transtornos mentais internalizantes e externalizantes.

Introduction: Motorcycle accidents are the main causes of trauma in the world. In Brazil, death rates of motorcyclists involved in traffic accidents have increased significantly from 2004 to 2014, going from 2.8 to 6.2 deaths per 100 thousand inhabitants. Objectives: To characterize the sociodemographic and clinical profile of traffic accidents victims involved in motorcycle accidents referred to Hospital de Base, São José do Rio Preto, S.P., Brazil, from 2016 to 2018; To identify the behavioral profile of these patients, and trace symptoms of mental disorders. Methods: Patients involved in a motorcycle accident (riders) who received medical attention at the emergency surgery service at Hospital de Base were invited to participate the study. All participants signed the informed consent form. We used the following instruments: Mini International Neuropsychiatric Interview (MINI) and the Adult Self-Assessment Inventory (ASAI). Patients' files were retrieved from the Trauma Unit registries in order to build a sociodemographic and clinical profile of the patient, as well as any medical information. Results: We included 40 participants, mainly men with a mean of age 33.83±12.95 years and lower scholar degree; 13 participants reported driving after drinking alcohol. Most had mild injuries. Externalizing and internalizing problems, infringement of rules, somatic complaints, as well as alcohol and crack abuse were identified. Conclusion: Among crashed motorcycle riders, there was a predominance of young men with low education and higher prevalence of injuries to the extremities and abdomen. We also concluded that the participants presented the use of alcohol associated with motorcycle riding, as well as the presence of symptoms of internalizing and externalizing mental disorders.

Fibromialgia: atividade física, depressão e qualidade de vida / Fibromyalgia: physical activity, depression and quality of life

A fibromialgia (FM), doença caracterizada por dor musculoesquelética difusa acompanhada de outros sintomas não relacionados ao aparelho locomotor, apresenta prevalência no Brasil de 2,5%. Objetivo: avaliar a prática de atividade física, os sintomas de depressão e a qualidade de vida em pacientes com FM. Tipo de estudo: Estudo observacional retrospectivo. Método: Participaram do estudo 50 pacientes adultos com diagnóstico de FM de acordo com os critérios de classificação do American College of Rheumatology (ACR), sendo excluídos os que apresentaram comorbidades. Após aprovação do projeto pelo Comitê de Ética em Pesquisa, pacientes que compareceram à consulta de rotina em consultório privado de reumatologia e atenderam aos critérios de inclusão foram convidados a participar do estudo. A análise dos dados foi realizada por meio dos testes Kruskal-Wallis, Mann-Whitney e coeficiente de correlação de Pearson. Valores de P<0,05 foram considerados significantes. Resultados: Houve predominância do sexo feminino, idade média de 47 anos, etnia branca, estado civil casado e com filhos. O resultado da EVA variou entre 0 (n=9) a 8 (n=6). O FIQ variou entre 0 e 86,7 e o BDI total entre 0 e 26. A BDI-13 variou entre 0 e 22. Houve correlação positiva do escore do BDI-13 com o FIQ-total e do BDI-13 com o escore EVA. Conclusão: Os dados não sugerem impacto significativo da atividade física na melhora dos sintomas de dor, qualidade de vida e depressão em pacientes com fibromia (AU)

Fibromyalgia (FM) is a disease characterized by widespread musculoskeletal pain that can be accompanied by several other symptoms not related to the musculoskeletal system and its predominance in Brazil is of 2,5%. Objective: Evaluate the performance in physical activity, symptoms of depression and life quality in patients with FM. Type of study: Retrospective observational study. Method: fifty adult patients that were diagnosed with FM according to the American College of Rheumatology (ACR) criteria. Patients who presented comorbidities were excluded of the study. After the project being approved by the research ethics committee, patients with fibromyalgia that attended a routine doctor's visit in a private rheumatologic office and met the inclusion criteria were invited to take part in the study. The data analysis was done with the Kruskal­Wallis test, Mann-Whitney e coefficient and correlation Person test. Values of P< 0,05 were considered significant. Results: Female predominance, white ethnicity, average age of 47 (±13) years old, married, and with children. Physical activity (56% of participants), physical activity measured by IPAQ short version showed that 24% of participants presented low level, 42% moderate and 24% high. VAS varied score between 0 (n=9) and 8 (n=6). Significant statistic (p=0,44) was not observed when compared with VAS and IPAQ. The FIQ score varied between 0 and 86,7. The total BDI score varied between 0 and 26. The Affective-cognitive subscale (BDI-13) varied between 0 and 22. Statistic difference was not observed when compared with BDI total and BDI-13 with IPAQ. There was positive correlation of BDI-13 score with the total FIQ and the BDI13 with VAS score. Conclusion: Benefit of physical activity was not demonstrated in the symptoms of pain relief, neither life quality nor depression in patients with fibromyalgia. This result might be related to the inaccuracy of the IPAQ method used to quantify the intensity of physical activity self-reported by the patients. (AU)

Rheumatoid arthritis: profile of patients and burden of caregivers / Artrite reumatoide: perfil de pacientes e sobrecarga de cuidadores

Abstract Objective: to describe the profile of patients with Rheumatoid Arthritis (RA) and their caregivers receiving care at the Rheumatology Outpatient Clinic of a teaching hospital, and evaluate the burden of the caregivers. Method: a cross-sectional study was performed with 41 patients with RA and their caregivers using a questionnaire to identify sociodemographic variables; the Burden Interview Scale and the Stanford Health Assessment Questionnaire. Descriptive analyzes and comparison between clinical-demographic variables and the functional status of patients were performed and the correlation between sociodemographic variables and levels of burden of caregivers was tested. Results: there was a prevalence of female patients (87.8%); a mean age of 64.4 years (±12.9); a mean time for the diagnosis of RA of 13.5 years (±8.5), a prevalence of moderate disability (39.0%); lower disability in the Hygiene domain (1.6; ±0.5) and greater disability in the Other Activities of Daily Life (2.1; ±0.6), Reach (2.0; ±0.7) and Grip (2.0; ±0.7) domains. The caregivers were women (73.2%); aged between 17 and 81 years (mean: 46.8; ±15.1); with a high school education (41.4%). The degree of kinship was 56.2% offspring and 36.6% spouses. Eighteen (44.0%) caregivers suffered burden, nine (22.0%) of whom had mild burden and nine (22.0%) of whom suffered intense burden. There was a higher incidence of intense burden among spouses (12.2%) and mild burden among children (12.2%). Conclusion: the low occurrence of burden among caregivers may be related to the profile of the patients, who presented good levels of independence for self-care. The profile of caregivers and the prevalence of overburdened spouses and offspring shows the need and importance of the implementation of caregiver training by health service professionals to improve care for RA patients. AU

Resumo Objetivo: Descrever o perfil de pacientes com Artrite Reumatoide (AR) e seus cuidadores, atendidos no Ambulatório de Reumatologia de um hospital de ensino, e avaliar sobrecarga dos cuidadores. Método: Estudo transversal com 41 pacientes e seus cuidadores, utilizando-se questionário de identificação com variáveis clínico-demográficas; Escala de Sobrecarga do Cuidador de Zarith e Health Assessment Questionnaire. Realizaram-se análises descritivas, comparação entre variáveis clínico-demográficas e estado funcional dos pacientes, correlação entre variáveis sociodemográficas e níveis de sobrecarga dos cuidadores. Resultados: Prevalência de pacientes do sexo feminino (87,8%); média de idade de 64,4 anos (±12,9); tempo médio de diagnóstico da AR de 13,5 anos (±8,5); predomínio de deficiência moderada (39,0%); menor deficiência no domínio Higiene (1,6;±0,5) e maior deficiência nos domínios Outras atividades do dia a dia (2,1;±0,6), Alcance (2,0;±0,7) e Pegada (2,0;±0,7). Os cuidadores eram mulheres (73,2%); faixa etária entre 17 e 81 anos (média: 46,8; ±15,1); ensino médio completo (41,4%); grau de parentesco: 56,2% filhos e 36,6% cônjuges. Dezoito (44,0%) cuidadores apresentaram sobrecarga, sendo 9 (22,0%) com sobrecarga ligeira e 9 (22,0%) com sobrecarga intensa. Maior incidência de sobrecarga intensa entre cônjuges (12,2%) e sobrecarga ligeira entre filhos (12,2%). Conclusão: A baixa ocorrência de sobrecarga entre cuidadores pode estar relacionada ao perfil dos doentes, que apresentaram bons níveis de independência para o autocuidado. O perfil dos cuidadores e prevalência de cônjuges e filhos com sobrecarga evidencia a necessidade e a importância de os profissionais do serviço implementarem ações de capacitação dos cuidadores, para melhorar a assistência aos pacientes com AR. AU

Quality of Life, Depression, Anxiety and Coping Strategies after Heart Transplantation.

INTRODUCTION:: Heart transplantation is the therapeutic procedure indicated to increase the survival of patients with refractory heart failure. Improvement in overall functioning and quality of life are expected factors in the postoperative period. OBJECTIVE:: To identify and evaluate mental disorders and symptoms, such as depression and anxiety, quality of life and coping strategies in the post-surgical situation of heart transplantation. METHODS:: A cross-sectional, quantitative study with patients who have undergone heart transplantation. Participants answered to the Sociodemographic Questionnaire, Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), MINI International Neuropsychiatric Interview, Escala Modos de Enfrentamento de Problemas (Ways of Coping Scale) (EMEP) and World Health Organization Quality of Life-BREF (WHOQOL-BREF). For data analysis, the significance level was considered P≤0.05. RESULTS:: A total of 33 patients participated in the study. The BDI-II results indicated that 91% (n=30) of the patients presented a minimal level. In BAI, 94% (n=31) of the patients demonstrated minimal level of anxiety symptoms. WHOQOL-BREF showed a perception of quality of life considered good in all domains. The EMEP data have registered a problem-focused coping strategy. According to MINI, a single case of major depressive episode, current and recurrent was recorded. CONCLUSION:: Although most participants in the sample had symptoms of depression and anxiety, only one patient was identified with moderate symptoms in both domains. The most used strategy was coping focused on the problem. Patients have classified the perceptions of quality of life as 'good', pointing out satisfaction with their health.

Quality of life, depression, anxiety and coping strategies after heart transplantation

Abstract Introduction: Heart transplantation is the therapeutic procedure indicated to increase the survival of patients with refractory heart failure. Improvement in overall functioning and quality of life are expected factors in the postoperative period. Objective: To identify and evaluate mental disorders and symptoms, such as depression and anxiety, quality of life and coping strategies in the post-surgical situation of heart transplantation. Methods: A cross-sectional, quantitative study with patients who have undergone heart transplantation. Participants answered to the Sociodemographic Questionnaire, Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), MINI International Neuropsychiatric Interview, Escala Modos de Enfrentamento de Problemas (Ways of Coping Scale) (EMEP) and World Health Organization Quality of Life-BREF (WHOQOL-BREF). For data analysis, the significance level was considered P≤0.05. Results: A total of 33 patients participated in the study. The BDI-II results indicated that 91% (n=30) of the patients presented a minimal level. In BAI, 94% (n=31) of the patients demonstrated minimal level of anxiety symptoms. WHOQOL-BREF showed a perception of quality of life considered good in all domains. The EMEP data have registered a problem-focused coping strategy. According to MINI, a single case of major depressive episode, current and recurrent was recorded. Conclusion: Although most participants in the sample had symptoms of depression and anxiety, only one patient was identified with moderate symptoms in both domains. The most used strategy was coping focused on the problem. Patients have classified the perceptions of quality of life as 'good', pointing out satisfaction with their health.

Validity and reliability evidence of the questionnaire for illness representation, the impact of epilepsy, and stigma (QIRIS) / Evidências de validade e confiabilidade do questionário de representação da doença, impacto da epilepsia e estigma (QIRIS)

ABSTRACT The objective of this study was to obtain reliability and validity evidence for the questionnaire of illness representation, the impact of epilepsy, and stigma (QIRIS) for use with adolescents and adults in Brazil. QIRIS consists of 14 questions grouped in three domains (attribution of meaning, impact of disease, and stigma) and was applied to 57 adults with epilepsy. QIRIS internal consistency was satisfactory (Cronbach’s α = 0. 866). Significant and strong correlation was found between issues belonging to the same domain, as expected. Three domains have highly significant and positive correlations with the instrument’s total score, indicating evidence of content validity. We conclude that QIRIS has psychometric properties and can facilitate a systematic evaluation of the patient’s representation according to a biopsychosocial approach that may contribute to clinical practice based on scientific evidence.

RESUMO Este estudo buscou evidências de confiabilidade e validade para o questionário de representação da doença, impacto da epilepsia e estigma (QIRIS), para uso em adolescentes e adultos no Brasil. O QIRIS consiste de 14 questões agrupadas em 3 domínios (atribuição de significados, impacto da doença e estigma) e foi aplicado em 57 adultos com epilepsia. A consistência interna do QIRIS foi satisfatória (α de Cronbach = 0,866). Foi encontrada forte e significante correlação entre as questões com o mesmo domínio.Os três domínios têm correlações altamente significativas e positivas com a pontuação total do instrumento, indicando evidências de validade de conteúdo. Concluímos que o QIRIS tem propriedades psicométricas que facilitam uma avaliação sistemática de representação do paciente de acordo com uma abordagem biopsicossocial, além de contribuir para uma prática clínica baseada em evidências científicas.

Validity and reliability evidence of the questionnaire for illness representation, the impact of epilepsy, and stigma (QIRIS).

The objective of this study was to obtain reliability and validity evidence for the questionnaire of illness representation, the impact of epilepsy, and stigma (QIRIS) for use with adolescents and adults in Brazil. QIRIS consists of 14 questions grouped in three domains (attribution of meaning, impact of disease, and stigma) and was applied to 57 adults with epilepsy. QIRIS internal consistency was satisfactory (Cronbach's α = 0. 866). Significant and strong correlation was found between issues belonging to the same domain, as expected. Three domains have highly significant and positive correlations with the instrument's total score, indicating evidence of content validity. We conclude that QIRIS has psychometric properties and can facilitate a systematic evaluation of the patient's representation according to a biopsychosocial approach that may contribute to clinical practice based on scientific evidence.

Caracterização da supervisão em um centro formador de Psicologia da Saúde / Characterization of supervision in a Health Psychology teaching center

Este estudo tem por objetivo aprofundar o conhecimento sobre a formação do psicólogo na área de Psicologia da Saúde, caracterizando o supervisor e a experiência de supervisão, com base em pesquisa desenvolvida em um centro de formação em Psicologia da Saúde localizado no interior do estado de São Paulo. Como instrumento, foi utilizado o Inventário de Levantamento de Atividades de Supervisão, em uma versão para os supervisores e outra para os super-visionandos. Participaram do estudo 21 supervisores e 21 aprimorandos. Os supervisores, em sua maioria, eram mulheres com ampla experiência e com titulação de especialização ou mestrado. A análise das respostas indicou que a avaliação do processo de supervisão foi positiva para os participantes nos aspectos: empatia e atenção à experiência afetiva, aprendizagem e autoexpressão, compreensão das dificuldades, e responsividade às necessidades dos aprimorandos.(AU)

To deepen the knowledge about the training of psychologists in the field of Health Psychology, the goal of this study is to characterize the supervisor and supervisory experience in a training center in Health Psychology located in São Paulo. The instrument used was the Inventory Survey of Supervisory Activities (one version for supervisors and one for supervisees). A total of 21 supervisors and 21 supervisees participated in the study. Most supervisors were women with a broad experience and a specialization course and a Master's degree in Psychology. The analysis of the responses in the inventories indicated that the evaluation of the supervision process is positive for participants in the following aspects: empathy and attention to affective experience. learning and self-expression, understanding of difficulties and responsiveness to the needs of supervisees by their supervisors.(AU)

Caracterização da supervisão em um centro formador de psicologia da saúde / Characterization of supervision in a health psychology teaching center

Este estudo tem por objetivo aprofundar o conhecimento sobre a formação do psicólogo na área de Psicologia da Saúde, caracterizando o supervisor e a experiência de supervisão, com base em pesquisa desenvolvida em um centro de formação em Psicologia da Saúde localizado no interior do estado de São Paulo. Como instrumento, foi utilizado o Inventário de Levantamento de Atividades de Supervisão, em uma versão para os supervisores e outra para os super-visionandos. Participaram do estudo 21 supervisores e 21 aprimorandos. Os supervisores, em sua maioria, eram mulheres com ampla experiência e com titulação de especialização ou mestrado. A análise das respostas indicou que a avaliação do processo de supervisão foi positiva para os participantes nos aspectos: empatia e atenção à experiência afetiva, aprendizagem e autoexpressão, compreensão das dificuldades, e responsividade às necessidades dos aprimorandos.

To deepen the knowledge about the training of psychologists in the field of Health Psychology, the goal of this study is to characterize the supervisor and supervisory experience in a training center in Health Psychology located in São Paulo. The instrument used was the Inventory Survey of Supervisory Activities (one version for supervisors and one for supervisees). A total of 21 supervisors and 21 supervisees participated in the study. Most supervisors were women with a broad experience and a specialization course and a Master's degree in Psychology. The analysis of the responses in the inventories indicated that the evaluation of the supervision process is positive for participants in the following aspects: empathy and attention to affective experience. learning and self-expression, understanding of difficulties and responsiveness to the needs of supervisees by their supervisors.

Psychological assessment of patients undergoing cardiac transplant in a teaching hospital (2004 to 2012).

OBJECTIVE: To analyze the psychological evaluations of patients with heart failure waiting for heart transplantation. METHODS: The data were obtained from patient records containing pre-surgery psychological evaluations performed by psychologists from the multidisciplinary cardiology team. The evaluation protocol included the Quality of Life Questionnaire (SF-36), Beck Depression Inventory, and an interview script. RESULTS: The results of psychological evaluations performed between 2004 and 2012 for 60 candidates for heart transplantation were analyzed: 43 men and 17 women aged between 16 and 66 years (Mean=45.18; SD=11.91), predominantly from the São José do Rio Preto area (São Paulo state, Brazil) (83%), with incomplete elementary education (68%), and who were in stable relationships (73%). Although women presented higher mean scores for depression (21.41) than men (14.61), there was no significant difference between genders. Women's quality of life was impaired in all domains compared to men (below 50%) and was significantly poorer in the physical functioning (P=0.01), vitality (P=0.00), emotional role functioning (P=0.04), and mental health (P=0.02) domains. CONCLUSION: Patients with psychosocial vulnerability (e.g., depression) identified before transplantation should receive psychological treatment.