Resiliência: avaliação de pacientes queimados em um hospital de urgência e emergência / Resilience: evaluation of burned patients in an urgency and emergency hospital / Resiliencia: evaluación de pacientes quemados en un hospital de urgencias y emergencias

A recuperação de vítimas de queimaduras é longa e dolorosa e afeta diversas esferas da vida do paciente. A resiliência, que se refere à capacidade humana de enfrentar e se adaptar a eventos adversos, exerce grande importância no processo de recuperação da queimadura. Logo, este trabalho objetiva avaliar a capacidade de resiliência de pacientes queimados, no momento da admissão e da alta hospitalar, em um hospital de emergência e urgência de Goiânia. Trata-se de um estudo descritivo, quantitativo e transversal que utiliza a Escala de Resiliência de Connor-Davidson (CD-RISC) como instrumento de mensuração. Na admissão hospitalar, a média da resiliência foi de 71,35, tendo sido observada uma relação significativa entre o fator Amparo da escala CD-RISC e a presença do(a) companheiro(a). O escore de resiliência encontrado nesta pesquisa é consistente com outros achados da literatura científica internacional e nacional referente à expressão da resiliência em vítimas de queimaduras e outros adoecimentos. A relação entre o fator Amparo e a presença de um(a) companheiro(a) enfatiza a importância da rede de apoio familiar na reabilitação do paciente queimado.(AU)

The recovery of burned patients is long and painful and impacts on different areas of people's lives. Resilience, which refers to the human capacity to face and adapt to adverse events, plays a major role in the process of recovery from burns. Therefore, the present study aims to assess the resilience of burned patients, on admission and hospital discharge, in an emergency and urgency hospital in Goiânia. This is a descriptive, quantitative and cross-sectional study that uses the Connor-Davidson Resilience Scale (CD RISC) as a measuring instrument. At hospital admission, the mean resilience was 71.35, with a significant association between the Support factor on the CD RISC scale and the presence of a partner. The resilience score found in the present study is consistent with other findings in the international and national scientific literature regarding the expression of resilience in victims of burns and other illnesses. The relationship between the Support factor and the presence of a partner emphasizes the importance of the family support network in the rehabilitation of the burned patient.(AU)

La recuperación de los pacientes quemados es larga y dolorosa e impacta en diferentes esferas de la vida de las personas. La resiliencia, que se refiere a la capacidad humana para enfrentar y adaptarse a eventos adversos, juega un papel importante en el proceso de recuperación de las quemaduras. Por tanto, el presente estudio tiene como objetivo evaluar la resiliencia de los pacientes quemados, en el momento del ingreso y el alta, en un hospital de emergencia y urgencia en Goiânia. Se trata de un estudio descriptivo, cuantitativo y transversal que utiliza la Escala de Resiliencia Connor-Davidson (CD RISC) como instrumento de medida. Al ingreso hospitalario, la resiliencia media fue de 71,35, con associación significativa entre el factor Amparo de la escala CD RISC y la presencia de pareja. El puntaje de resiliencia encontrado en el presente estudio es consistente con otros hallazgos en la literatura científica nacional e internacional sobre la expresión de resiliencia en víctimas de quemaduras y otras enfermedades. La relación entre el factor Amparo y la presencia de pareja enfatiza la importancia de la red de apoyo familiar en la rehabilitación del paciente quemado.(AU)

Presença de risco de transtorno do estresse pós-traumático em policiais militares feridos por arma de fogo / Presence of risk of posttraumatic stress disorder in military police officers wounded by firearms / Presencia de riesgo de trastorno de estrés postraumático en policías militares heridos por armamiento de fuego

Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)

This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)

Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)

Domestic violence against women in the brazilian media: study of social representations / Violencia doméstica contra las mujeres en los medios de comunicación brasileños: estudio de representaciones sociales / Violência doméstica contra as mulheres na mídia brasileira: estudo de representações sociais

This study examined the content published by the newspaper Folha de São Paulo regarding domestic violence before and after Law 11340/06, commonly known as Maria da Penha Law, came into force. A retrospective and comparative documentary research analyzed 3408 news reports published between 1994 and 2018. Divided into two corpora, '12 years before' and '12 years after' the Law, the material was analyzed using the IRaMuTeQ software and Descending Hierarchical Classification. The first corpus included news reports on cases involving celebrities and little about ordinary people. It also covered the feminist struggle to reduce domestic violence, focusing on specialized police stations and shelters. The second corpus included reports on the achievements generated by the Law and its challenges, pointing out the need to regard the law as more than a punitive instrument, addressing its preventive and care spheres. Problematizing how the media discloses such law is paramount, since the content divulged affects the construction of social representations.(AU)

Este artículo tuvo por objetivo identificar el contenido de la violencia doméstica transmitido en el periódico Folha de S. Paulo antes y después de la Ley 11.340/2006 (Ley Maria da Penha). La investigación fue de carácter documental retrospectivo y comparativa, realizada a partir de 3.408 noticias difundidas entre 1994 y 2018. El material se dividió en dos corpus: 12 años antes y 12 años después de la Ley, y se analizó con el software IRaMuTeQ. En el primer corpus, los medios informaron casos de celebridades y poco sobre la gente común. También abordaron la lucha feminista para reducir la violencia doméstica. Como no existe una legislación específica, la atención se centró en estaciones de policía especializadas y refugios. En el segundo corpus, se observaron los logros generados por la Ley y sus desafíos. Se identificó la necesidad de mirar la Ley desde un punto de vista no solo punitivo, sino también abordando las esferas preventivas y de asistencia. Se enfatiza la importancia de problematizar la difusión de la Ley en los medios, ya que los contenidos generalizados afectan la construcción de las representaciones sociales.(AU)

Este artigo pretende identificar o conteúdo sobre violência doméstica difundido no jornal Folha de S. Paulo antes e depois da Lei 11340/06 (Maria da Penha). A pesquisa foi documental, retrospectiva e comparativa; com 3408 reportagens entre 1994 e 2018. O material foi dividido em dois corpora: 12 anos antes e 12 anos depois da lei, e analisado com software IRaMuTeQ. No primeiro corpus, a mídia divulgava casos de celebridades e pouco acerca de pessoas do cotidiano. Também trouxe a luta feminista para diminuir a violência doméstica. Em virtude da então inexistência de uma legislação específica, os destaques eram as delegacias especializadas e as casas abrigo. No segundo corpus, observou-se as conquistas geradas pela lei e seus desafios. Identificou-se a necessidade de olhar para a lei por um viés não apenas punitivista, abordando as esferas preventivas e assistenciais. Destaca-se a importância de problematizar a difusão da lei na mídia, visto que os conteúdos perpassados afetam a construção de representações sociais.(AU)

Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: A 3-level network meta-analysis.

BACKGROUND: Anxiety, obsessive-compulsive, and stress-related disorders frequently co-occur, and patients often present symptoms of several domains. Treatment involves the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), but data on comparative efficacy and acceptability are lacking. We aimed to compare the efficacy of SSRIs, SNRIs, and placebo in multiple symptom domains in patients with these diagnoses over the lifespan through a 3-level network meta-analysis. METHODS AND FINDINGS: We searched for published and unpublished randomized controlled trials that aimed to assess the efficacy of SSRIs or SNRIs in participants (adults and children) with diagnosis of any anxiety, obsessive-compulsive, or stress-related disorder in MEDLINE, PsycINFO, Embase, and Cochrane Library from inception to 23 April 2015, with an update on 11 November 2020. We supplemented electronic database searches with manual searches for published and unpublished randomized controlled trials registered in publicly accessible clinical trial registries and pharmaceutical companies' databases. No restriction was made regarding comorbidities with any other mental disorder, participants' age and sex, blinding of participants and researchers, date of publication, or study language. The primary outcome was the aggregate measure of internalizing symptoms of these disorders. Secondary outcomes included specific symptom domains and treatment discontinuation rate. We estimated standardized mean differences (SMDs) with 3-level network meta-analysis with random slopes by study for medication and assessment instrument. Risk of bias appraisal was performed using the Cochrane Collaboration's risk of bias tool. This study was registered in PROSPERO (CRD42017069090). We analyzed 469 outcome measures from 135 studies (n = 30,245). All medications were more effective than placebo for the aggregate measure of internalizing symptoms (SMD -0.56, 95% CI -0.62 to -0.51, p < 0.001), for all symptom domains, and in patients from all diagnostic categories. We also found significant results when restricting to the most used assessment instrument for each diagnosis; nevertheless, this restriction led to exclusion of 72.71% of outcome measures. Pairwise comparisons revealed only small differences between medications in efficacy and acceptability. Limitations include the moderate heterogeneity found in most outcomes and the moderate risk of bias identified in most of the trials. CONCLUSIONS: In this study, we observed that all SSRIs and SNRIs were effective for multiple symptom domains, and in patients from all included diagnostic categories. We found minimal differences between medications concerning efficacy and acceptability. This three-level network meta-analysis contributes to an ongoing discussion about the true benefit of antidepressants with robust evidence, considering the significantly larger quantity of data and higher statistical power when compared to previous studies. The 3-level approach allowed us to properly assess the efficacy of these medications on internalizing psychopathology, avoiding potential biases related to the exclusion of information due to distinct assessment instruments, and to explore the multilevel structure of transdiagnostic efficacy.

Amplified neurobehavioral and hormonal alterations following the combination of prenatal and postnatal stress in first-time rats

In the present work, we sought to determine the effects of an individual application of prenatal stress and postnatal stress and their combination on the anxious and locomotor behavior of first-time mother rats. Indeed, three batches of rats were exposed to three types of daily repeated stress: one batch exposed to prenatal restraint stress (SC): 01h a day from day 11 to day 19 of gestation, one batch exposed to postnatal mother prenatal stress (SS): 03h a day from the third to the fourteenth postnatal day (JPN), and one batch exposed to combined restraint stress: 01h from day 11 to day 19 of gestation followed by a postnatal mother separation of 03h a day from the third to fourteenth JPN (CSS); a fourth control batch (T) of female rats that did not undergo any type of stress was also part of our study. At postnatal days 15 and 20, the behavior of the female rats in the four batches was assessed using the Open field Test along with the Plus Maze, and at JPN 30, the female rats were decapitated, the blood of which was collected for plasma adrenocorticotropic hormone (ACTH) level evaluation. Our findings show that all studied behaviors were very highly affected relative to the results of the control batch after individually applying prenatal restraint stress and mother separation. We noticed an intensified anxious behavior in CSS with a significant increase in plasma levels of ACTH.

Amplified neurobehavioral and hormonal alterations following the combination of prenatal and postnatal stress in first-time rats

In the present work, we sought to determine the effects of an individual application of prenatal stress and postnatal stress and their combination on the anxious and locomotor behavior of first-time mother rats. Indeed, three batches of rats were exposed to three types of daily repeated stress: one batch exposed to prenatal restraint stress (SC): 01h a day from day 11 to day 19 of gestation, one batch exposed to postnatal mother prenatal stress (SS): 03h a day from the third to the fourteenth postnatal day (JPN), and one batch exposed to combined restraint stress: 01h from day 11 to day 19 of gestation followed by a postnatal mother separation of 03h a day from the third to fourteenth JPN (CSS); a fourth control batch (T) of female rats that did not undergo any type of stress was also part of our study. At postnatal days 15 and 20, the behavior of the female rats in the four batches was assessed using the Open field Test along with the Plus Maze, and at JPN 30, the female rats were decapitated, the blood of which was collected for plasma adrenocorticotropic hormone (ACTH) level evaluation. Our findings show that all studied behaviors were very highly affected relative to the results of the control batch after individually applying prenatal restraint stress and mother separation. We noticed an intensified anxious behavior in CSS with a significant increase in plasma levels of ACTH.(AU)

Mental disorders in the context of trauma and violence in a population study. / Trastornos mentales desde la perspectiva del trauma y la violencia en un estudio poblacional.

INTRODUCTION: Traumatic events and violence are widespread public health problems. They do not have limits related to age, sex or socioeconomic level. The prevalence of mental disorders and sociodemographic characteristics were compared in the context of traumatic events and types of violence in the general population. MATERIALS AND METHODS: Observational prevalence study with a secondary information source, in the general population aged 13 to 65 years, selected at random. The interview was conducted using the Compositum International Diagnosis Interview which generates psychiatric diagnoses according to the DSM-IV. The variables included were traumatic events grouped into five categories: related to armed conflict, sexual violence, interfamily violence, other types of violence, traumas and some mental disorders. The prevalence of mental disorders was compared in the five categories of traumatic events. Statistical significance was defined as a p value of <0.05. RESULTS: Sexual and interfamily violence were more prevalent in women (p <0.05). In those under age 13, major depression related to armed conflict had a prevalence of 48.3%, with a significant difference from the other trauma groups (p=0.015). All prevalences for childhood-onset disorders showed significantly different prevalences compared with the group for violence related to armed conflict (p <0.05) and suicidal ideation was higher in the sexual violence group (p=0.006). DISCUSSION: High prevalences of mental disorders were found in people who had been exposed to traumatic events and violence. In those who experienced traumatic events related to armed conflict and sexual violence, higher prevalences of certain mental disorders were detected.

Masaje frente a musicoterapia para reducir el estrés en prematuros de una unidad crítica neonatal, una revisión sistemática / Massage versus music therapy to reduce stress in prematures of a neonatal critical unit, a systematic review

Introducción: en la Unidad de Cuidados Intensivos Neonatales (UCIN) los prematuros son expuestos e circunstancias estresantes, esto trae consecuencias que se ven reflejadas a nivel cardiovascular, respiratorio, inmunológico, hormonal y conductual. Existen tratamientos no farmacológicos para disminuir el estrés y minimizar el dolor como: la terapia táctil kinestésica a base de masajes y la musicoterapia. Objetivo: identificar entre la terapia táctil kinestésica y musicoterapia, la más efectiva para reducir el estrés en prematuros de la unidad crítica neonatal. Metodología: revisión sistemática. Búsqueda en inglés, español y portugués de artículos sobre prematuros que han recibido musicoterapia o terapia táctil kinestésica en las bases de datos: Scielo, Pubmed, Elsevier, Cochrane, Lilacs y Google Académico. Evaluada la calidad metodológica seleccionamos 30 artículos para el análisis. Resultados: la musicoterapia trae consigo una amplia lista de beneficios además de reducir niveles de cortisol. Conclusión: ambas terapias fueron aplicadas a prematuros de 32 a 37 semanas de gestación. Un total de 15 artículos avalan mejores resultados cuando los masajes duran de 10-15 minutos y se aplican tres veces al día, contribuyendo a la ganancia de peso. Un total de 14 artículos demostró tener mejores resultados con musicoterapia durante 15-10 minutos, de 1 a 3 veces al día, ayudando a mejorar la saturación de oxígeno, los signos vitales y la disminución de los días de uso de respirador artificial.

Introduction: In the Neonatal Intensive Care Unit (NICU), premature infants are exposed to stressful circumstances, this has cardiovascular, respiratory, immune, hormonal and behavioral consequences. There are non-pharmacological treatments to reduce stress and minimize pain such as: Kinesthetic Tactile Therapy and Music Therapy. Objective: To identify between kinesthetic tactile therapy and music therapy, the most effective for reducing stress in premature infants of the NICU. Methods: Systematic review. Search in English, Spanish and Portuguese of arricies on premature infants who have received music therapy or kinesthetic tactile therapy in the databases: Scielo, Pubmed, Elsevier, Cochrane, Lilacs and Google Scholar. Evaluated the methodological quality we selected 30 arricies for the analysis. Results: Music therapy brings with ¡t an extensive list of benefits in addition to reducing cortisol levels. Conclusión: Both therapies were applied to premature infantsfrom 32 to 37 weeks of gestation. A total of 15 arricies guarantee better results when massages last 10-15 minutes and are applied three times a day, contributingto weight gain. A total of 14 arricies were shown to have better results with music therapy for 15-10 minutes, 1 to 3 times a day, helping to improve oxygen saturation, vital signs and decrease the days of use of an artificial respirator.

Impact of Season of Birth on Psychiatric Disorder Susceptibility and Drug Abuse Incidence in a Population from the Köppen Tropical Savanna Region of Brazil.

BACKGROUND: Despite much evidence that season of birth (SOB) my influence the vulnerability to psychiatric disorders, divergence has been reported, in particular between populations born in the northern and southern hemispheres. We analyzed the potential modified risk by SOB to psychiatric disorder or drug addiction comorbidity in a population born in the Triângulo Mineiro region, a southern hemisphere Köppen tropical savanna region in Brazil. METHOD: We accessed the records of 98,457 of patients and healthy controls of the National Datacenter of Medical Promptuary to evaluate the influence of SOB as a modifying factor on the occurrence of mental disorders and drug abuse conditions among individuals born from the year 2000 to 2016. RESULTS: The data revealed significant modification of the relative incidence of major depressive disorder (MDD) (F11, 72 = 2.898; p = 0.003; eta-squared, ES = 0.313; ⍺ = 0.97), anxiety-related disorder (ARD) (F11, 81 =2.389; p = 0.013; ES = 0.241; ⍺ = 0.932), and schizophrenia (SZ) (F11, 83 = 2.764; p = 0.005; ES = 0.303; α = 0.963), while there was no increase in the number of healthy controls born in any month of the year (F11, 71 = 1.469; p = 0.163). Post hoc analyses indicated a significant higher vulnerability to MDD or ARD if the patient was born in August, or October to December, respectively. A relative increase in the incidence of SZ was also observed in patients born from August to October, compared to patients born from November to January. CONCLUSIONS: SOB may influence the risk for psychiatric disorders in the TMR population. Regional particularities associated with the climatic regime may account for the apparent divergence between studies.

O conceito de introjeção e sua evolução na teoria de Ferenczi / The concept of introjection and its evolution in Ferenczi's theory / El concepto de introyección y su evolución en la teoría de Ferenczi

Para Ferenczi, em grande sintonia com o pensamento de Freud, a introjeção foi inicialmente um conceito fundamental no desenvolvimento psíquico da criança e indispensável para diferenciar o funcionamento neurótico de outras patologias. Além disso era uma noção essencial para teorizar a dinâmica transferencial na relação analítica. No entanto, ao final de sua obra, ao reavaliar a importância do trauma, da confusão de línguas entre o adulto e a criança e entre o analista e o paciente, ao conceitualizar as noções de identificação com o agressor e de introjeção do sentimento de culpa nas síndromes pós-traumáticas e, principalmente, ao sublinhar a importância decisiva que adquire a desmentida e a cisão do Ego na dinâmica do trauma, Ferenczi modifica e enriquece enormemente sua primeira contribuição. Justamente sua última contribuição à psicanálise, refletida nas derradeiras notas do Diário clínico, é um neologismo interessante que Ferenczi define como intropressão, consistindo na tentativa de conjugar a introjeção com os efeitos violentos suscitados na mente da criança em decorrência da irrupção inesperada do Superego parental e dos adultos em geral. Esta dinâmica, além disso, lamentavelmente não deixa de estar presente em algumas modalidades patológicas da relação analítica. Esta última concepção de Ferenczi foi continuada e completada de maneira brilhante por Abraham e Torok em seu conceito do crime da introjeção, a que se dedica a última parte do presente trabalho (AU)

To Ferenczi, whose thinking was largely in line with that of Freud, introjection was initially a fundamental concept in the psychic development of the child and was necessary to distinguish the neurotic functioning from other pathologies. Furthermore, introjection was a crucial notion for the theorization of the transference dynamics in the analytic relationship. However, in his final works, Ferenczi modified and expanded his first contribution, since he reassessed the importance of trauma and the confusion of tongues between the adult and the child and between the analyst and the patient; he conceptualized the notions of identification with the aggressor and of introjection of the guilt feeling in posttraumatic disorders and also underlined the decisive importance that disavowal and ego-splitting have in the dynamics of trauma. In his last contribution to psychoanalysis, condensed in the notes of his Clinical Diary, Ferenczi presented indeed an interesting neologism that he defined intropression, consisting in the attempt to combine introjection with the violent effects arisen in the child's mind after the unexpected irruption of the parental Superego and of adults in general. That dynamics is unfortunately present in some pathological modalities of the analytic relationship. The latter notion introduced by Ferenczi was brilliantly developed and completed by Abraham and Torok in their concept of crime of introjection to which the last part of this paper is dedicated

Para Ferenczi, muy en sintonía con el pensamiento de Freud, la introyección fue inicialmente un concepto fundamental en el desarrollo psíquico del niño e indispensable para diferenciar el funcionamiento neurótico de otras patologías. Además resultaba una noción esencial para teorizar la dinámica transferencial en la relación analítica. Sin embargo, al final de su obra, al revalorizar la importancia del trauma, de la confusión de lenguas entre el adulto y el niño y entre el analista y el paciente, al conceptualizar las nociones de identificación con el agresor y de introyección del sentimiento de culpa en los síndromes post-traumáticos y sobre todo al subrayar la importancia decisiva que adquiere el desmentido y la escisión del yo en la dinámica del trauma, Ferenczi modifica y enriquece enormemente su primera aportación. Precisamente, su última contribución al psicoanálisis, reflejada en las postreras notas del Diario clínico es un neologismo interesante que Ferenczi define como intropresión y que era el intento de conjugar la introyección con los efectos violentos que suscita en la irrupción inesperada del super yo parental y de los adultos en general en la mente del niño. Esta dinámica además, no deja de estar presente lamentablemente en algunas modalidades patológicas de la relación analítica. Esta última concepción de Ferenczi fue continuada y completada brillantemente por Abraham y Torok en su concepto del crimen de la introyección, al que se dedica la última parte del presente trabajo

Prevención de la depresión posparto en madres adolescentes atendidas en el Hospital General Ambato; 2017 / Prevention of postpartum depression in adolescent mothers treated at the Ambato General Hospital; 2017

Introducción: La depresión posparto es un trastorno depresivo que puede empezar en cualquier momento después del parto que puede durar de semanas a meses, se acompaña de síntomas como: fatiga, pérdida de energía, incomodidad, problemas para conciliar el sueño, entre otros. Objetivo: Diseñar una estrategia que contribuya a la prevención de la depresión posparto en madres adolescentes atendidas en el servicio de Gineco-obstetricia del Hospital General Ambato. Métodos: La investigación responde a una modalidad cuantitativa; no experimental con desarrollo de diagnóstico transversal, descriptivo con una muestra de 50 madres adolescentes. Resultados: Las madres adolescentes más propensas a sufrir una depresión posparto están comprendidas entre los 14-16 años en un 58% y son solteras en un 72%, la relación que mantienen con la familia es buena en un 38%, la violencia física y psicológica intrafamiliar si existe rara vez demostrándose en un 48%, existe un desconocimiento sobre la depresión posparto manifestándose en un 98%. Conclusiones: Los factores predisponentes para desencadenar en una depresión posparto son las madres adolescentes solteras por la falta de apoyo de la pareja, la relación afectiva y de dependencia que tienen con la familia, la falta de apoyo proporcionado por la familia durante el embarazo y en la crianza del bebé y lo más relevante el desconocimiento sobre la depresión posparto por ende no estarían en capacidad de reconocer la sintomatología

Introduction: Postpartum depression is a depressive disorder that can start at any time after delivery that can last from weeks to months, is accompanied by symptoms such as fatigue, loss of energy, discomfort, trouble falling asleep, among others. Objective: To design a strategy that contributes to the prevention of postpartum depression in adolescent mothers assisted in the Obstetrics and Gynecology service of the Ambato General Hospital. Methods: The research responds to a quantitative modality; non-experimental with development of cross-sectional diagnosis, descriptive with a sample of 50 adolescent mothers. Results: Adolescent mothers more prone to suffer postpartum depression are between 14-16 years old in 58% and are single in 72%, their relationship with the family is good in 38%, physical violence and intrafamilial psychological if it is rarely demonstrated by 48%, there is a lack of knowledge about postpartum depression manifested in 98%. Conclusions: The predisposing factors to trigger postpartum depression are single teenage mothers due to the lack of support from the couple, the affective and dependent relationship they have with the family, the lack of support provided by the family during pregnancy and in the upbringing of the baby and most relevant the ignorance about the postpartum depression therefore they would not be able to recognize the symptomatology

Impactos da Síndrome de Burnout na qualidade de vida dos profissionais de enfermagem da atenção básica à saúde / Impacts of burnout syndrome on the quality of life of basic health care nursing professionals

Objetivo: Identificar o impacto da Síndrome de Burnout (SB) na qualidade de vida dos profissionais de enfermagem da Atenção Básica à Saúde. Métodos: Estudo exploratório e descritivo, com caráter quanti-qualitativo, desenvolvido com 52 profissionais da Rede de Atenção Básica à Saúde da Cidade de Bayeux, região metropolitana de João Pessoa-PB. Resultados: 13,5% das pro-fissionais estudadas manifestaram características relacionadas à SB e 30,8% apresentaram predisposição para o desenvolvi-mento da mesma. Conclusão: O profissional acometido pela SB tende a apresentar diminuição em seu rendimento de trabalho e dificuldades na relação com a equipe de trabalho, refletindo o impacto negativo que a síndrome traz para a qualidade de vida. (AU)

Objective: To identify the impact of the Burnout Syndrome (SB) on the quality of life of nursing professionals in Basic Health Care. Methods: An exploratory and descriptive study, with quantitative and qualitative character, developed with 52 professionals from the Network of Basic Attention to Health of the city of Bayeux, metropolitan region of João Pessoa-PB. Results: 13.5% of the professionals studied showed character-istics related to SB, and 30.8% presented a predisposition for its development. Conclusion: the professional affected by SB tends to present a decrease in his work income and difficulties in the relationship with the work team, reflecting the negative impact that the syndrome brings to the quality of life. (AU)

Diferenças de percepção de estressores de acordo com o tipo de rota no trabalho de caminhoneiros / Differences of perception of stressors according to the route type on truck drivers work

A profissão de caminhoneiro está sujeita a inúmeros estressores ocupacionais. O presente estudo objetivou verificar diferença na percepção de estressores laborais em caminhoneiros que realizam rotas curtas e aqueles que percorrem rotas longas no seu trabalho. A amostra se constituiu de 445 caminhoneiros atuantes em diferentes regiões do estado do Rio Grande do Sul, Brasil. Como instrumentos de pesquisa, foram utilizados questionários de dados sociodemográficos, laborais e estressores ocupacionais, elaborados para esse estudo. Os dados foram analisados por meio da prova t de student. A análise evidenciou associação significativa dos estressores: condições de estradas e repouso, postos de atendimento, locais para alimentação, possibilidade de assalto e roubo, jornada de trabalho, remuneração e sistemas eletrônicos de controle aos caminhoneiros de rota longa, quando comparados aos de rota curta. Os resultados apontam para a necessidade de se considerar a variável rota longa no processo de adoecimento dessa categoria profissional.(AU)

The profession of truck driver is exposed to several occupational stressors. This study aimed to evaluate the existence of differences between short and long run distances truck drivers, regarding stressors perception. The sample was composed by 445 Brazilian truck drivers from different zones of the state of Rio Grande do Sul. As instruments, we used socio-demographic, labor, and occupational stressors questionnaires especially created for this research. The data was analyzed trough student t-tests. The analysis highlighted that long distance drivers, compared to short distance drivers, have higher stressors levels about: roads pavement and rest conditions, services area, food court services, lack of security, working hours, salary, and electronic control systems. The results indicate that the variable long driven distance should be considered for the illness process analysis of this profession category.(AU)

Rebirthing-Breathwork, activation of the autonomic nervous system, and psychophysiological defenses / Rebirthing-Breathwork, ativação do sistema nervoso autónomo, e defesas psicofisiológicas / Rebirthing-Breathwork, activación del sistema nervioso autónomo, y defensas psicofisiológicas

Rebirthing-Breathwork can be described as a technique that uses the breathing rhythm to activate a somaticcognitive cycle. When allowed to unfold, this cycle spontaneously brings unresolved issues to consciousness and leads to their resolution. This is an analytic and interpretative study with the goal to present a theoretical basis for a processing model that the authors are developing to use Rebirthing-Breathwork in the treatment of traumatic stress-related disorders. In this essay we discuss Rebirthing-Breathwork in the light of a theory and an approach developed by Peter Levine and address the role psychophysiological defenses and the autonomic nervous system play in accessing suppressed and traumatic memories. Based on personal and clinical evidence we describe how Rebirthing-Breathwork activates suppressed and traumatic memories; how these activated memories activate one of two types of psychophysiological defenses; and how these defenses can be negotiated by means of mindfulness, embodiment and empowerment, so that the activated memories can be processed.(AU)

Rebirthing-Breathworkpode ser descrito como uma técnica que utiliza o ritmo respiratório para ativar um ciclo cognitivo-somático. Quando permitido o seu desenvolvimento, este ciclo traz questões não resolvidas à consciência, conduzindo-as à sua resolução. Este artigo é um estudo analítico-interpretativo com o objetivo de apresentar a base teórica para um modelo de processamento que está sendo desenvolvido pelos autores para utilização do trabalho respiratório - Rebirthing-Breathwork - no tratamento de transtornos traumáticos relacionados ao estresse. Neste ensaio discutimos o Rebirthing-Breathwork à luz de uma teoria e uma abordagem desenvolvida por Peter Levine e tratamos sobre o papel que as defesas psicofisiológicas e o sistema nervoso autônomo desempenham no acesso a memórias reprimidas e traumáticas. Com base em evidências pessoais e clínicas, descrevemos como o trabalho de Rebirthing-Breathworkativa memórias reprimidas e traumáticas e como essas memórias ativadas, por sua vez, provocam um dos dois tipos de defesas psicofisiológicas. Descrevemos, ainda, como se pode lidar com essas defesas através de mindfulness, de uma melhor conexão com o corpo e empoderamento, a fim de que essas memórias ativadas possam ser processadas.(AU)

El Rebirthing-Breathwork se puede describir como una técnica que usa el ritmo respiratorio para activar un ciclo cognitivo-somático. Cuando el ciclo se desarrolla, espontáneamente lleva a la consciencia problemas no resueltos y los conduce a su resolución. Este es un estudio analítico-interpretativo con el objetivo de presentar una base teórica para el modelo de procesamiento que los autores están desarrollando, cuya finalidad es la utilización del trabajo respiratorio - Rebirthing Breathwork - en el tratamiento de los trastornos traumáticos relacionados con el estrés. En este ensayo discutimos el Rebirthing Breathwork con base en una teoría y un enfoque desarrollado por Peter Levine, y abordamos el papel que desempeñan las defensas psicofisiológicas y el sistema nervioso autónomo en el acceso a memorias reprimidas y traumáticas. Con base en evidencias personales y clínicas, describimos cómo el trabajo de Rebirthing-Breathwork activa memorias reprimidas y traumáticas; cómo estos recuerdos activados, a su vez, activan uno de los dos tipos de defensas psicofisiológicas; y cómo podemos tratar esas defensas por medio del mindfulness, de una mejor conexión con el cuerpo y del empoderamiento, con la finalidad de procesar las memorias activadas.(AU)

Transtornos relacionados a traumas e a estressores / Trauma and stressor-related disorders

Os Transtornos relacionados a traumas e a estressores são quadros psiquiátricos relacionados a exposi- ção a um evento traumático ou estressante, resultando em sofrimento psicológico relevante, prejuízo social, profissional e em outras áreas importantes da vida do indivíduo. A apresentação clínica de tais transtornos é caracterizada por sintomas de ansiedade e de medo, anedonia, disforia, externalizações da raiva, agressividade e sintomas dissociativos. De acordo com a 5ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5), as categorias diagnósticas inclusas nesse espectro são Transtorno de Apego Reativo, Transtorno de Interação Social Desinibida, Transtorno de Estresse PósTraumático, Transtorno de Estresse Agudo e os Transtornos de Adaptação. O objetivo desta revisão é introduzir o debate sobre a conceituação clínica e as diretrizes terapêuticas dos Transtornos Relacionados a Traumas e a Estressores, direcionando a escolha do profissional pelas práticas terapêuticas adequadas relacionadas a tais categorias diagnósticas. Além disso, os autores discutem as consequências do Estresse Precoce (situações traumáticas ocorridas na infância e adolescência) na vida adulta. (AU)

Trauma and Stressor-Related Disorders are psychiatric conditions related to exposure to a traumatic or stressful event, resulting in significant psychological distress social, professional and other relevant areas of the individual's life. The clinical presentation of these disorders is characterized by symptoms of anxiety and fear, anhedonia, dysphoria, externalizations of anger, aggressiveness and dissociative symptoms. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic categories included in this spectrum are Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder and Adjustment Disorders. The objective of this review is to introduce the debate on clinical conceptualization and therapeutic guidelines of Trauma and Stressor-Related Disorders, directing professional's choice for proper therapeutic practices related to such diagnostic categories. Also, the authors discuss the consequences of early life stress (traumatic situations that occur in childhood and adolescence) in adulthood. (AU)

Attachment-Based Family Therapy: A Review of the Empirical Support.

Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT.

Propiedades psicométricas del Test de Cribado de Demencias Pesotest en muestras clínica y no clínica de adultos mayores / Psychometric properties of a Screening Test for Dementia Pesotest in clinical and non-clinical samples of elderly people / Propriedades psicométricas do teste de rastreio de demências pesoteste em amostras clínica e não clínica de idosos

El objetivo de este estudio instrumental fue determinar las propiedades psicométricas del test de cribado de demencias Pesotest en muestras clínica y no clínica de adultos mayores de Bogotá. Los participantes fueron 213 adultos mayores de 65 años. Los instrumentos utilizados fueron el Pesotest, el Mini Mental State Examination (MMSE), la Encuesta Sociodemográfica y la Escala de Depresión Geriátrica de Yesavage (GDS). La consistencia interna del Pesotest obtenida con el Alpha de Cronbach fue de 0.86. Se usó el MMSE para establecer la validez convergente y se encontró una correlación significativa de 0.596. Se hallaron diferencias estadísticamente significativas entre las muestras clínica y no clínica. El análisis factorial arrojó cuatro factores: mediante la curva ROC se encontró que la sensibilidad o proporción de personas diagnosticadas con demencia que dieron positivo fue de 0.83; la especificidad o proporción de personas sanas que según la prueba puntúan sin demencia fue de 0.78, y el punto de corte fue 18. El análisis con el modelo de Rasch evidenció que solo un ítem no se ajustó al modelo, y que el ítem con mayor dificultad era el que evaluaba memoria y cálculo, cuya alteración indica evolución a demencia. Con base en los resultados favorables del análisis psicométrico, adecuada consistencia interna, validez convergente, validez de criterio y validez de constructo, se recomienda utilizar el Pesotest en servicios de atención primaria.

The aim of this instrumental study was to establish the psychometric properties of the screening test for dementia Pesotest in clinical and non-clinical samples of elderly people. The participants of this study were 213 elderly people over 65 years old. The instruments used were the Pesotest, the Mini Mental State Examination (MMSE), the Sociodemographic Survey and the Geriatric Depression Scale Yesavage (GDS). A Cronbach's alpha of 0.86 for internal consistency of the Pesotest was found. The MMSE was used to establish convergent validity, finding a significant correlation of 0.596. Statistically significant differences were also found between the clinical and nonclinical samples. The factor analysis yielded four factors and using the ROC curve it was found that the sensitivity, or the proportion of people diagnosed with dementia, was 0.83; and the specificity, or the proportion of healthy people that were diagnosed with dementia by the test, was 0.78, with a cut-off point of 18. The analysis with the Rasch Model showed that only one item was not fit and that the most difficult item was the one which assessed calculation and memory, whose alteration indicates an evolution towards dementia. Based on the favorable results of the psychometric analysis, suitable internal consistency, convergent and construct validity and reliability, the use of the Pesotest in primary care services is recommended.

O objetivo deste estudo instrumental foi determinar as propriedades psicométricas do Teste de Rastreio de Demências Pesoteste em amostras clínica e não clínica de idosos de Bogotá (Colômbia). Participaram do estudo 213 adultos maiores de 65 anos. Os instrumentos utilizados foram o Pesoteste, o Mini Mental State Examination (MMSE), a Pesquisa Sociodemográfica e a Escala de Depressão Geriátrica de Yesavage (GDS). A consistência interna do Pesoteste obtida com o Alpha de Cronbach foi de 0,86. Foi usado o MMSE para estabelecer a validade convergente e constatou-se uma correlação significativa de 0,596. Acharam-se diferenças estatisticamente significativas entre as amostras clínicas e as não clínicas. A análise fatorial demonstrou quatro fatores: mediante a curva ROC, constatou-se que a sensibilidade ou a proporção de pessoas diagnosticadas com demência que deram positivo foi de 0,83; a especificidade ou a proporção de pessoas saudáveis que, segundo o teste pontuam sem demência, foi de 0,78, e o ponto de corte foi 18. A análise com o modelo de Rasch evidenciou que somente um item não se ajustava ao modelo, e que o item com maior dificuldade era o que avaliava memória e cálculo, cuja alteração indica evolução a demência. Com base nos resultados favoráveis da análise psicométrica, na adequada consistência interna, na validade convergente, na validade de critério e na validade de construto, recomenda-se utilizar o Pesoteste em serviços de atenção primária.

Childhood trauma and dimensions of depression: a specific association with the cognitive domain

Objective: To investigate associations between a history of childhood trauma and dimensions of depression in a sample of clinically depressed patients. Methods: A sample of 217 patients from a mood-disorder outpatient unit was investigated with the Beck Depression Inventory, the Hamilton Depression Rating Scale, the CORE Assessment of Psychomotor Change, and the Childhood Trauma Questionnaire. A previous latent model identifying six depressive dimensions was used for analysis. Path analysis and Multiple Indicators Multiple Causes (MIMIC) models were used to investigate associations between general childhood trauma and childhood maltreatment modalities (emotional, sexual, and physical abuse; emotional and physical neglect) with dimensions of depression (sexual, cognition, insomnia, appetite, non-interactiveness/retardation, and agitation). Results: The overall childhood trauma index was uniquely associated with cognitive aspects of depression, but not with any other depressive dimension. An investigation of childhood maltreatment modalities revealed that emotional abuse was consistently associated with depression severity in the cognitive dimension. Conclusion: Childhood trauma, and specifically emotional abuse, could be significant risk factors for the subsequent development of cognitive symptoms of major depression. These influences might be specific to this depressive dimension and not found in any other dimension, which might have conceptual and therapeutic implications for clinicians and researchers alike.

Childhood trauma and dimensions of depression: a specific association with the cognitive domain.

OBJECTIVE: To investigate associations between a history of childhood trauma and dimensions of depression in a sample of clinically depressed patients. METHODS: A sample of 217 patients from a mood-disorder outpatient unit was investigated with the Beck Depression Inventory, the Hamilton Depression Rating Scale, the CORE Assessment of Psychomotor Change, and the Childhood Trauma Questionnaire. A previous latent model identifying six depressive dimensions was used for analysis. Path analysis and Multiple Indicators Multiple Causes (MIMIC) models were used to investigate associations between general childhood trauma and childhood maltreatment modalities (emotional, sexual, and physical abuse; emotional and physical neglect) with dimensions of depression (sexual, cognition, insomnia, appetite, non-interactiveness/retardation, and agitation). RESULTS: The overall childhood trauma index was uniquely associated with cognitive aspects of depression, but not with any other depressive dimension. An investigation of childhood maltreatment modalities revealed that emotional abuse was consistently associated with depression severity in the cognitive dimension. CONCLUSION: Childhood trauma, and specifically emotional abuse, could be significant risk factors for the subsequent development of cognitive symptoms of major depression. These influences might be specific to this depressive dimension and not found in any other dimension, which might have conceptual and therapeutic implications for clinicians and researchers alike.