Teaching and mental health in medical students

SUMMARY OBJECTIVE: The objective of this study was to evaluate the relationship between quality of life, perceived stress, anxiety, and depression in medical students and the university teaching method: traditional method versus active methodology. METHODS: Four questionnaires were administered to volunteer students (n=361) enrolled in two institutions that employ active (Universidade Tiradentes) or traditional (Faculdade de Medicina do ABC) teaching methodology: socioeconomic level; brief quality of life (World Health Organization Quality of Life-Bref); perceived stress scale (PSS10); and depression and anxiety scale (hospital anxiety and depression scale). RESULTS: Of the students who responded to the questionnaires (226 UNIT and 135 FMABC), 70% were female and 67% were White. The majority did not use medication for depression (90%), anxiety (81%), and stress management (91%). Regarding anxiety, it was found: absence in the traditional method and moderate anxiety in the active methodology (26% UNIT×13% FMABC) (p<0.001). Regarding quality of life, it was found to be better quality of life in the environment domain at FMABC (78.12%) versus 71.88% at the UNIT (p<0.001). There was no difference between the institutions in relation to depression and perceived stress, and in quality of lifethere was only a difference in the environmental domain (p<0.001). In relation to gender, stress was higher in females (93.7%) than males (79.6%) with p<0.001. CONCLUSION: Differences were recorded between the groups regarding anxiety, with a predominance in UNIT students (active methodology), and no differences were recorded in relation to depression, perceived stress, and quality of life in all domains, except for the environment domain, which was higher in the traditional methodology, although about one-third of participants used medication for anxiety/depression.

Percepção de mulheres no momento do trabalho de parto no período da Pandemia de COVID-19 / Women's perception at the time of labor in the COVID-19 Pandemic's period

A Pandemia de COVID-19 trouxe prejuízos irreparáveis para toda a sociedade. Para as mulheres grávidas, além das dúvidas sobre a gravidez, surgiram mais questionamentos relacionados ao risco de exposição e contaminação pelo novo Coronavírus. Grávidas contaminadas pela COVID-19 podem ter manifestações clínicas leves até casos mais graves que, quando associados a algumas comorbidades, aumentam a possibilidade de um parto cesariano de emergência ou um parto prematuro. Diante disso, o presente estudo teve como objetivo conhecer a percepção de mulheres no momento do trabalho de parto no período da Pandemia de COVID-19. Trata-se de um estudo exploratório, descritivo, com abordagem qualitativa, realizado em Unidade de Saúde da Família, da cidade do Recife. Houve predominância de mulheres de raça/cor parda, primíparas, com renda mensal de até um salário mínimo, que estavam em uma união estável, com ensino médio completo e que não trabalhavam fora de casa. Observou-se a discrepância entre a expectativa para o momento do parto e a realidade como este de fato aconteceu; as repercussões emocionais, como medo, ansiedade e depressão, associadas aos distúrbios de imagem, também foram fatores abordados. Os resultados obtidos contribuem para que o processo de trabalho da Atenção Básica possa ser repensado e o conhecimento adquirido acerca desse tema possa ajudar a equipe de Saúde da Família a proporcionar uma assistência à saúde de qualidade e direcionada ao acompanhamento deste público.

The COVID-19 Pandemic has brought irreparable damage to the whole society. For pregnant women, in addition to doubts about pregnancy, more questions appeared regarding the risk of exposure and contamination by the new Coronavirus. Pregnant patients contaminated by COVID-19 can have mild clinical manifestations to more severe cases, which when associated with some comorbidities increase the possibility of an emergency cesarean or premature delivery. In light of this, the objective of the present study was to know the women's perception at the time of labor in the COVID-19 Pandemic's period. This is an exploratory and descriptive study, with a qualitative approach, carried out in a Family Health Unit in Recife city. There was a predominance of women of brown race/color, primiparous, with a monthly income up to one minimum wage, who were in a stable union, had completed high school and who did not work outside the home. It could be observed the discrepancy between the expectation for the moment of delivery and the reality as it actually happened. The emotional repercussions, such as fear, anxiety, depression, associated with image disorders were also factors addressed. The obtained results contribute so that the work process of Primary Health Care can be rethought and the knowledge acquired on this topic can help the Family Health Team to provide quality health care and directed to the follow-up of this public.

Estrés percibido y apoyo social percibido en cuidadores informales del adulto mayor / Perceived stress and social support in informal caregivers of the elderly

RESUMEN Objetivo: Predecir el estrés percibido con relación al apoyo social percibido en cuidadores informales (CI) de personas adultas mayores (PAM). Métodos: Estudio transversal correlacional predictivo realizado en hospitales de segundo y tercer nivel de Saltillo, Coahuila (México). Participando 150 CI, en el periodo diciembre 2021 - marzo de 2022, con muestreo no probabilístico intencional, aplicándoseles los instrumentos para la obtención de información que se analizó con estadística descriptiva y análisis estadístico inferencial. Resultados: La edad del CI es de M=51,7 años; 74,7 % son mujeres; la media de años de escolaridad de 10,93; son empleados (50,6 %); casado/unión libre (66,7 %); hija de la PAM (46 %); tienen una media de 32,13 meses de cuidado, M=13 horas al día y M=4 días a la semana; 80,7 % cuenta con ayuda para el cuidado. El PAM tiene una media de 72 años, 64,7 % son mujeres y 66.7 % tiene una enfermedad crónica. Los CI tienen un nivel medio de apoyo social percibido (43,3 %) y un nivel medio de estrés (87,3 %). La correlación muestra que a menor apoyo social mayor estrés (r=-0,485, p<0,001). El nivel de apoyo social percibido predice en un 21,4% el nivel de estrés percibido. Conclusión: El apoyo social juega un papel importante tanto en los pacientes que presentan estrés, ya que tiene el efecto de incrementar el bienestar emocional, la estabilidad y el control que impacta tanto en su salud como en la realización del cuidado, debido a que disminuye la probabilidad de efectos negativos que pueda presentar el cuidador.

ABSTRACT Objective: Prediction of perceived stress in relation to perceived social support in IC of PAM. Methods: Cross-sectional correlational predictive study conducted in second and third level hospitals in Saltillo, Coahuila (Mexico). A total of 150 IC participated in the period December 2021-March 2022 with non-probabilistic intentional sampling, applying the instruments to obtain information that was analyzed with descriptive statistics and inferential statistical analysis. Results: The age of the IC is M=51.7 years; 74.7 % are women; mean years of schooling is 10.93; they are employed (50.6 %); married/free union (66.7 %); daughter of the PAM (46 %); they have a mean of 32.13 months of care, M=13 hours a day and M=4 days a week; 80.7 % have help for care. The PAM have an average age of 72 years old, 64.7 % are women and 66.7 % have a chronic disease. The IC have a medium level of perceived social support (43.3 %) and a medium level of stress (87.3 %). The correlation shows that the lower the social support the higher the stress (r=-0.485, p<0.001). The level of perceived social support predicted the level of perceived stress by 21.4 %. Conclusion: Social support plays an important role both in patients who present stress as it has the effect of increasing emotional well-being, stability and control that impacts both their health and the performance of care as it decreases the likelihood of negative effects that the caregiver may present.

Engagement and response to a psychoeducation program for family members of inpatients undergoing treatment for substance use disorder.

The goal of this study was to evaluate a sample of family members, among whom individuals were undergoing inpatient treatment for substance use disorder and identify predictors of engagement in a family support program. A total of 159 family nuclei were analyzed; 36 (22.6%) completed the program and 123 (77.4%) did not complete the program. Compared to nonparticipants, participants were majorly female (91.9%), younger (43.3 years old, SD = 16.5), unemployed, homemakers, and not financially independent (56.7%). The results showed the predominant participation of wives (29.7%) and offspring (mostly daughters, 27.0%). Participants also reported a higher rate of depressive symptoms (p = 0.003) and worse quality of life, primarily environmental. The frequency of domestic violence was higher among participants than among nonparticipants (27.9% vs. 9.0%, p = 0.005). Engagement in family support programs is the first challenge to overcome. The nonparticipants' profile shows the need to adopt engagement strategies that encompass males and facilitate the participation of breadwinning family members.

Neurogenic Background for Emotional Stress-Associated Hypertension.

PURPOSE OF REVIEW: The response to natural stressors involves both cardiac stimulation and vascular changes, primarily triggered by increases in sympathetic activity. These effects lead to immediate flow redistribution that provides metabolic support to priority target organs combined with other key physiological responses and cognitive strategies, against stressor challenges. This extremely well-orchestrated response that was developed over millions of years of evolution is presently being challenged, over a short period of time. In this short review, we discuss the neurogenic background for the origin of emotional stress-induced hypertension, focusing on sympathetic pathways from related findings in humans and animals. RECENT FINDINGS: The urban environment offers a variety of psychological stressors. Real or anticipatory, emotional stressors may increase baseline sympathetic activity. From routine day-to-day traffic stress to job-related anxiety, chronic or abnormal increases in sympathetic activity caused by emotional stressors can lead to cardiovascular events, including cardiac arrhythmias, increases in blood pressure and even sudden death. Among the various alterations proposed, chronic stress could modify neuroglial circuits or compromise antioxidant systems that may alter the responsiveness of neurons to stressful stimuli. These phenomena lead to increases in sympathetic activity, hypertension and consequent cardiovascular diseases. The link between anxiety, emotional stress, and hypertension may result from an altered neuronal firing rate in central pathways controlling sympathetic activity. The participation of neuroglial and oxidative mechanisms in altered neuronal function is primarily involved in enhanced sympathetic outflow. The significance of the insular cortex-dorsomedial hypothalamic pathway in the evolution of enhanced overall sympathetic outflow is discussed.

Angiotensinergic neurotransmission in the bed nucleus of the stria terminalis is involved in cardiovascular responses to acute restraint stress in rats.

The brain angiotensin II acting via AT1 receptors is a prominent mechanism involved in physiological and behavioral responses during aversive situations. The AT2 receptor has also been implicated in stress responses, but its role was less explored. Despite these pieces of evidence, the brain sites related to control of the changes during aversive threats by the brain renin-angiotensin system (RAS) are poorly understood. The bed nucleus of the stria terminalis (BNST) is a limbic structure related to the cardiovascular responses by stress, and components of the RAS system were identified in this forebrain region. Therefore, we investigated the role of angiotensinergic neurotransmission present within the BNST acting via local AT1 and AT2 receptors in cardiovascular responses evoked by an acute session of restraint stress in rats. For this, rats were subjected to bilateral microinjection of either the angiotensin-converting enzyme inhibitor captopril, the selective AT1 receptor antagonist losartan, or the selective AT2 receptor antagonist PD123319 before they underwent the restraint stress session. We observed that BNST treatment with captopril reduced the decrease in tail skin temperature evoked by restraint stress, without affecting the pressor and tachycardic responses. Local AT2 receptor antagonism within the BNST reduced both the tachycardia and the drop in tail skin temperature during restraint. Bilateral microinjection of losartan into the BNST did not affect the restraint-evoked cardiovascular changes. Taken together, these data indicate an involvement of BNST angiotensinergic neurotransmission acting via local AT2 receptors in cardiovascular responses during stressful situations.

Family caregivers of older adults and physical and psychological health conditions and family support in care / Cuidadores familiares de ancianos y condiciones de salud física y psicológica y apoyo familiar en el cuidado / Cuidadores familiares de idosos e condições de saúde física, psicológica e apoio familiar no cuidado

ABSTRACT Objective: to analyze the existence of overload in family caregivers of older adults in the physical and psychological health and family support dimensions. Method: a qualitative study conducted with 23 participants from Dianópolis, Tocantins, Brazil. Data were collected through semi-structured interviews in September 2022. Data analysis was performed using content analysis in Minayo's thematic modality, which includes ordering, classification and final analysis of data. Results: the results show that the exercised role of caregiver is related to social representation, which is enhanced: by the context, cultural and family values; by the naturalization of the role of women as caregivers; by increasing the burden due to excessive responsibility and lack of support from other family members; and by the presence of psychological symptoms overlapping physical symptoms in caregivers. Conclusion: it is concluded that the support of professionals is essential to rethink new practices and ways of producing care through individual or collective activities, with a view to preventing caregivers from becoming ill.

RESUMEN Objetivo: analizar la existencia de sobrecarga de cuidadores familiares de ancianos en las dimensiones de salud física y psicológica y apoyo familiar. Método: estudio cualitativo, realizado con 23 participantes de Dianópolis, Tocantins, Brasil. Los datos fueron recolectados a través de entrevistas semiestructuradas en septiembre de 2022. El análisis de datos se realizó mediante análisis de contenido en la modalidad temática de Minayo, que incluye ordenamiento, clasificación y análisis final de datos. Resultados: los resultados muestran que el ejercicio del rol de cuidador está relacionado con la representación social, que se ve potenciada: por el contexto, los valores culturales y familiares; por la naturalización del rol de la mujer como cuidadora; al aumentar la carga por exceso de responsabilidad y falta de apoyo de otros miembros de la familia; y por la presencia, en los cuidadores, de síntomas psicológicos superpuestos a los físicos. Conclusión: se concluye que el apoyo de los profesionales es fundamental para repensar nuevas prácticas y formas de producir cuidado, a través de actividades individuales o colectivas, con miras a prevenir que los cuidadores se enfermen.

RESUMO Objetivo: analisar a existência de sobrecarga de cuidadores familiares de idosos nas dimensões de saúde física, psicológica e apoio familiar. Método: estudo qualitativo, realizado com 23 participantes de Dianópolis, Tocantins, Brasil. Os dados foram coletados mediante entrevistas semiestruturadas em setembro de 2022. A análise dos dados foi efetuada utilizando-se a análise de conteúdo na modalidade temática de Minayo, que abrange a ordenação, a classificação e a análise final dos dados. Resultados: os resultados evidenciam que o exercício da função de cuidador está relacionado à representação social, a qual é potencializada: pelo contexto, valores culturais e familiares; pela naturalização da função da mulher como cuidadora; pela potencialização da sobrecarga em razão do excesso de responsabilidade e falta de apoio de outros membros da família; e pela presença, nos cuidadores, de sintomas psicológicos sobrepondo-se aos físicos. Conclusão: conclui-se que o apoio dos profissionais é essencial para repensar novas práticas e formas de produzir o cuidado, por meio de atividades individuais ou coletivas, com vistas a prevenir o adoecimento dos cuidadores.

NMDA receptors in the insular cortex modulate cardiovascular and autonomic but not neuroendocrine responses to restraint stress in rats.

The insular cortex (IC) is a brain structure involved in physiological and behavioural responses during stressful events. However, the local neurochemical mechanisms involved in control of stress responses by the IC are poorly understood. Thus, this study aimed to investigate the involvement of glutamatergic neurotransmission within the IC in cardiovascular, autonomic and neuroendocrine responses to an acute session of restraint stress. For this, the selective NMDA glutamate receptor antagonist LY235959 (1 nmol/100 nL) or the selective non-NMDA glutamate receptor antagonist NBQX (1 nmol/100 nL) were microinjected into the IC 10 min before the onset of the 60 min session of restraint stress. We observed that the antagonism of NMDA receptors within the IC enhanced the restraint-evoked increase in arterial pressure and heart rate, while blockade of non-NMDA receptors did not affect these cardiovascular responses. Spontaneous baroreflex analysis demonstrated that microinjection of LY235959 into the IC decreased baroreflex activity during restraint stress. The decrease in tail skin temperature during restraint stress was shifted to an increase in animals treated with the NMDA receptor antagonist. Nevertheless, the blockade of either NMDA or non-NMDA glutamate receptors within the IC did not affect the increase in circulating corticosterone levels during restraint stress. Overall, our findings provide evidence that IC glutamatergic neurotransmission, acting via local NMDA receptors, plays a prominent role in the control of autonomic and cardiovascular responses to restraint stress, but without affecting neuroendocrine adjustments.

O uso das estratégias de coping por pacientes e seu impacto no controle do estresse / El uso de estrategias de afrontamiento por pacientes y su impacto en manejo del estrés / The use of coping strategies by patients and their impact on stress management

Objetivo: avaliar o efeito das estratégias de Coping sobre o estresse de pacientes hospitalizados com Covid. Métodos: A pesquisa aconteceu no período de março a outubro de 2021 e foram utilizados 3 instrumentos de coletas de dados, inicialmente e após 30 dias da alta do paciente. Aplicou-se um questionário para caracterizar os participantes, depois utilizamos a versão em português da Escala de Estresse Percebido e o Inventário de Estratégias de Coping de Folkmann e Lazarus. Foram realizadas orientações sobre o uso das estratégias de coping aos pacientes hospitalizados. Resultados: Após as orientações sobre o uso das estratégias de coping, os pacientes passaram a utilizá-las e também diminuíram a percepção do estresse. Conclusão: A aplicação das estratégias de coping no momento da internação de pacientes com covid-19, contribuíram de forma impar para recuperação dos internados, modificando de forma significativa o estresse, possibilitando o manejo da ansiedade no período de internação e possivelmente colaborando para uma abreviação no período de internação(AU)

Objective: to assess the effect of Coping strategies on the stress of hospitalized patients with Covid. Methods: Three data collection instruments were used, initially and after 30 days of patient discharge. A questionnaire was applied to characterize the participants, after that the Portuguese version of the Perceived Stress Scale and the Folkmann and Lazarus' Coping Strategies Inventory was used. The hospitalized patients were provided with guidelines on the use of coping strategies. Results: After guidance on the use of coping strategies, patients began to use them and also reduced the perception of stress. Conclusion: The application of coping strategies in patients with Covid-19 at the time of hospitalization contributed in a unique way to their recovery, significantly modifying stress, enabling anxiety management during the hospitalization period and possibly contributing to an abbreviation of the hospitalization period(AU)

Objetivo: evaluar el efecto de las estrategias de Coping sobre el estrés de pacientes hospitalizados con Covid. Métodos: Se utilizaron tres instrumentos de recolección de datos, inicialmente y después de 30 días del alta del paciente. Se aplicó un cuestionario para caracterizar a los participantes, posteriormente se utilizó la versión en portugués de la Escala de Estrés Percibido y el Inventario de Estrategias de Afrontamiento de Folkmann y Lazarus. Los pacientes hospitalizados recibieron orientaciones sobre el uso de estrategias de afrontamiento. Resultados: Después de la orientación sobre el uso de estrategias de afrontamiento, los pacientes comenzaron a utilizarlas y también redujeron la percepción de estrés. Conclusión: La aplicación de estrategias de afrontamiento en pacientes con Covid-19 en el momento de la hospitalización contribuyó de manera única a su recuperación, modificando significativamente el estrés, posibilitando el manejo de la ansiedad durante el período de hospitalización y posiblemente contribuyendo a una abreviación del período de hospitalización.(AU)

"Pegar" ou "passar ": medos entre profissionais da linha de frente da COVID-19 / "To Catch" or "to give": fears among frontline professionals at COVID-19

OBJETIVO: Investigar a relação entre a realização de testes para detectar COVID-19 e indícios de sofrimento psíquico, estresse e burnout entre profissionais de saúde da linha de frente da pandemia em um hospital geral. MÉTODOS: Estudo prospectivo de abordagem mista usando SRQ-20, PSS, OBI e entrevistas em profundidade em série de três entrevistas em 2020. RESULTADOS: Prevalências preocupantes de escores elevados de SRQ20, Burnout e Estresse Percebido ocorreram nas três entrevistas, e o registro de testes realizados foi crescente no período estudado, mas não houve associação entre desfechos e realização de testes para detectar COVID-19. Os temores de contrair a doença e de ser transmissor do vírus apareceram como os principais estressores para profissionais de saúde, mantidos apesar da realização de testes. CONCLUSÃO: Nesse grupo, testes realizados não se mostraram suficientes para modificar os efeitos psicossociais da atividade em linha de frente sobre profissionais de saúde.

OBJECTIVE: To investigate the relationship between the performance of tests to detect COVID-19 and signs of psychological distress, perceived stress and burnout among health professionals on the frontline of the pandemic in a general hospital. METHODS: Prospective mixed-approach study using SRQ-20, PSS, OBI and in-depth interviews in a series of 3 interviews throughout 2020. RESULTS: Worrying prevalences of high scores of SRQ20, Burnout and Perceived Stress occurred on the three interviews and the number of tests performed increased during the study period, but there was no association between outcomes and testing to detect COVID- 19. Fear of contracting the disease or being a transmitter of the virus appeared as the main stressors for health professionals, maintained despite testing. CONCLUSION: In this group, tests performed were not sufficient to modify the psychosocial effects of the front line activity on health professionals.

Differential roles of prelimbic and infralimbic cholinergic neurotransmissions in control of cardiovascular responses to restraint stress in rats.

Previous studies showed a prominent role of the medial prefrontal cortex (mPFC), especially the prelimbic (PL) and infralimbic (IL) subregions, in behavioral and physiological responses to stressful stimuli. Nevertheless, the local neurochemical mechanisms involved are not completely understood. In this sense, previous studies identified cholinergic terminals within the mPFC, and stressful stimuli increased local acetylcholine release. Despite these pieces of evidence, the specific role of cholinergic neurotransmission in different subregions of the mPFC controlling the cardiovascular responses to stress has never been systematically evaluated. Therefore, the purpose of this study was to investigate the involvement of cholinergic neurotransmission present within PL and IL in cardiovascular responses to an acute session of restraint stress in rats. For this, rats received bilateral microinjection of the choline uptake inhibitor hemicholinium-3 before exposure to restraint stress. The arterial pressure and heart rate (HR) increases and the decrease in tail skin temperature as an indirect measurement of sympathetically-mediated cutaneous vasoconstriction were recorded throughout the restraint stress session. The results showed that the depletion of acetylcholine within the PL caused by local microinjection of hemicholinium-3 decreased the tachycardia to restraint stress, but without affecting the pressor response and the drop in tail skin temperature. Conversely, IL treatment with hemicholinium-3 decreased the restraint-evoked pressor response and the sympathetically-mediated cutaneous vasoconstriction without interfering with the HR response. Taken together, these results indicate functional differences of cholinergic neurotransmission within the PL and IL in control of cardiovascular and autonomic responses to stressful stimuli.

Terapias complementares no enfrentamento do estresse no período puerperal: revisão integrativa da literatura / Terapias complementarias en el afrontamiento del estrés en el período puerperal: una revisión integrador de la literatura / Complementary therapies facing stress in the puerperal period: integrative literature review

Objetivo: Identificar evidências científicas na literatura sobre o uso de terapias complementares no enfrentamento do estresse no período puerperal. Método : A coleta de dados foi realizada de janeiro a março de 2021.Trata-se de uma revisão integrativa da literatura, utilizou-se estratégia PICO para elaboração da pergunta de pesquisa: Quais são as evidências científicas encontradas na literatura sobre o uso de terapias complementares como benefício para enfretamento de estresse no período puerperal? Utilizou-se as bases de dados: SciELO; LILACS; MEDLINE; CINAHL e EMBASE. Os descritores utilizados segundo DESC/ MESH foram: Período Pós-Parto, Terapias Complementares, Estresse Emocional e Estresse Psicológico. Resultados: Encontrados 49 artigos, dos quais 6 selecionados, dentre as práticas utilizadas 6 terapias complementares distintas foram identificadas: biofeedback ou bioenergética; acupressão; reflexologia; musicoterapia e yoga. Conclusão: Os resultados dos estudos confirmaram a existência de evidências de que terapias complementares são benéficas para o enfrentamento do estresse no período puerperal.(AU)

To identify scientific evidence in the literature on the use of complementary therapies in coping with stress in the puerperal period. Method: Data collection was carried out from January to March 2021. This is an integrative literature review, using the PICO strategy to prepare the research question: What is the scientific evidence found in the literature on the use of therapies supplements as a benefit for coping with stress in the puerperal period? The following databases were used: SciELO; LILACS; MEDLINE; CINAHL and EMBASE. The descriptors used according to DESC/MESH were: Postpartum Period, Complementary Therapies, Emotional Stress and Psychological Stress. Results: 49 articles were found, 6 of which were selected, among the practices used, 6 distinct complementary therapies were identified: biofeedback or bioenergetics; acupressure; reflexology; music therapy and yoga. Conclusion: The results of the studies(AU)

Objetivo: Identificar evidencia científica en la literatura sobre el uso de terapias complementarias en el afrontamiento del estrés en el puerperio. Método: La recolección de datos se realizó de enero a marzo de 2021. Se trata de una revisión integradora de la literatura, utilizando la estrategia PICO para preparar la pregunta de investigación: ¿Cuál es la evidencia científica encontrada en la literatura sobre el uso de terapias complementarias como beneficio para el afrontamiento? con estrés en el puerperio? Se utilizaron las siguientes bases de datos: SciELO; LILACS; MEDLINE; CINAHL y EMBASE. Los descriptores utilizados según DESC / MESH fueron: Posparto, Terapias complementarias, Estrés emocional y Estrés psicológico. Resultados: se encontraron 49 artículos, de los cuales se seleccionaron 6, entre las prácticas utilizadas, se identificaron 6 terapias complementarias distintas: biofeedback o bioenergética; acupresión reflexología; musicoterapia y yoga. Conclusión: Los resultados de los estudios confirmaron la existencia de evidencia de que las terapias complementarias son beneficiosas para afrontar el estrés en el puerperio.(AU)

Liver proteome alterations in psychologically distressed rats and a nootropic drug.

BACKGROUND: Chronic psychological distress is considered today a pandemic due to the modern lifestyle and has been associated with various neurodegenerative, autoimmune, or systemic inflammation-related diseases. Stress is closely related to liver disease exacerbation through the high activity of the endocrine and autonomic nervous systems, and the connection between the development of these pathologies and the physiological effects induced by oxidative stress is not yet completely understood. The use of nootropics, as the cognitive enhancer and antioxidant piracetam, is attractive to repair the oxidative damage. A proteomic approach provides the possibility to obtain an in-depth comprehension of the affected cellular processes and the possible consequences for the body. Therefore, we considered to describe the effect of distress and piracetam on the liver proteome. METHODS: We used a murine model of psychological stress by predatory odor as a distress paradigm. Female Sprague-Dawley rats were distributed into four experimental groups (n = 6 - 7/group) and were exposed or not to the stressor for five days and treated or not with piracetam (600 mg/kg) for six days. We evaluated the liver proteome by one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis (1D-SDS-PAGE) followed by liquid chromatography-tandem mass spectrometry (GeLC-MS/MS). Besides, we analyzed the activity of liver antioxidant enzymes, the biochemical parameters in plasma and rat behavior. RESULTS: Our results showed that distress altered a wide range of proteins involved in amino acids metabolism, glucose, and fatty acid mobilization and degradation on the way to produce energy, protein folding, trafficking and degradation, redox metabolism, and its implications in the development of the non-alcoholic fatty liver disease (NAFLD). Piracetam reverted the changes in metabolism caused by distress exposure, and, under physiological conditions, it increased catabolism rate directed towards energy production. These results confirm the possible relationship between chronic psychological stress and the progression of NAFLD, as well as we newly evidenced the controversial beneficial effects of piracetam. Finally, we propose new distress biomarkers in the liver as the protein DJ-1 (PARK7), glutathione peroxidase 1 (GPX), peroxiredoxin-5 (PRDX5), glutaredoxin 5 (GLRX5), and thioredoxin reductase 1 (TXNDR1), and in plasma as biochemical parameters related to kidney function such as urea and blood urea nitrogen (BUN) levels.

Efeito das essências florais na redução do estresse em estudantes de enfermagem: ensaio clínico randomizado / Effect of flower essences in the reduction of nursing students stress: randomized clinical trial

Introdução: Dentre os estudantes acadêmicos da área da saúde, os da enfermagem são os que apresentam maiores manifestações psicológicas e fisiológicas de estresse. Em função da formação, durante o período acadêmico, algumas situações podem ser consideradas estressoras como aulas práticas, avaliações de aprendizado, diferenças entre teoria e a realidade da prática assistencial, situações de limites humanos (doenças/morte), horas intensivas de aula, entre outros. A terapia floral, por sua atuação sutil, pode auxiliar a trazer o equilíbrio emocional ajudando na redução dos sinais e sintomas psicoemocionais do estresse. É uma prática integrativa, não farmacológica e de fácil acesso. Objetivo: Analisar o efeito do buquê de essências florais composto pelas essências: Impatiens, Cerato, Elm, White Chestnut, Olive, Cherry Plum, Larch na redução de sinais e sintomas de estresse dos estudantes de enfermagem medidos pelo Teste de Baccaro, Escala de Estresse Percebido e Instrumento de Avaliação de Estresse de Estudantes de Enfermagem. Método: Ensaio clínico randomizado, triplo cego, com dois grupos: Floral (GF) que recebeu um buquê de essências florais composto por: Impatiens, Cerato, Elm, White Chestnut, Olive, Cherry Plum, Larch e grupo Placebo (GP) que recebeu uma fórmula composta somente do veículo sem essência floral. Os grupos utilizaram a fórmula por 60 dias na dosagem de 4 gotas 4 vezes ao dia. A amostra foi composta por 101 estudantes de enfermagem de duas instituições públicas e duas privadas (49 GP e 52 GF) com pontuação acima de 20 pontos pelo Teste de Baccaro. O desfecho primário foi avaliado pelas escalas: Teste de Baccaro, Escala de Estresse Percebido e Avaliação de Estresse em Estudantes de Enfermagem. O desfecho secundário foi avaliado pela percepção do uso da fórmula pelos estudantes ao final do estudo. As escalas de estresse foram aplicadas no início e no final da intervenção. A escala de COPE Breve e o Questionário de Senso de Coerência de Antonovsky foram utilizadas como variáveis moderadoras. A análise utilizou a estatísitca descritiva, comparação dos grupos pelo t-student, teste de Fisher, qui-quadrado e teste Wilcoxon-Mann-Whitney de acordo com o tipo de variável e tamanho de efeito pelo teste d-Cohen. Adotou-se nível de significância =5%. Resultados: Não houve diferença significativa entre os GF e GP na redução do estresse medido pelo Teste de Baccaro e Escla de Estresse Percebido (p>0,05), ambos os grupos tiveram redução nas pontuações das escalas (p<0.001) com tamanho de efeito grande nos dois grupos. Na Avaliação de Estresse do Estudante de Enfermagem não houve redução significativa entre os grupos e para os dois grupos ao longo do tempo. A analise de interação mostrou que houve interferência ao longo do estudo do ano do curso na Escala de Estresse Percebido e o fato de ser aluno USP na Avaliação de Estresse em Estudantes de Enfermagem, e nesta escala também houve uma influência do ano de curso e pandemia. A análise da percepção sobre a utilização do efeito floral mostrou nos relatos do GF efeito terapêutico na mudança de padrões de comportamento, não observados no GP. Conclusão: A intervenção com terapia floral não foi mais efetiva que o placebo na redução de sinais e sintomas de estresse O efeito da terapia floral se evidenciou nos relatos dos estudantes. A fórmula floral contribuiu para a melhora da qualiade do sono, autoconfiança e padrão de comportamento frente a determinadas situações.

Introduction: Among healthcare college students, the nursing ones are those demonstrate the biggest psychological and physiological stress manifestations. On account of the daily academic life, some situations can be considered stressors such as practical classes, learning assessments, differences between theory and reality of care practice, human boundary situations (disease/death), intensive class hours, amongst others. The floral therapy, for its subtle action, can help bring the emotional balance by helping to reduce the psycho-emotional signs and symptoms of stress. It s an integrative practice, no pharmacological and with easy access. Objective: To analyse the effect of a flower essence bouquet composed by the essences: Impatiens, Cerato, Elm, White Chestnut, Olive, Cherry Plum, Larch in the reduction of nursing students signs and symptoms of stress measured by Baccaro s Test, Perceived Stress Scale and Scale of Assessment of Stress Among Nursing Students. Method: Randomized clinical trial, triple blind, with two groups Floral (FG) that received a flower essence bouquet composed of: Impatiens, Cerato, Elm, White Chestnut, Olive, Cherry Plum, Larch and Placebo group (PG) that received a formula composed only of the vehicle without flower essence. The groups used the formula for 60 days in the dosage of 4 drops 4 times a day. The sample was composed of 101 nursing students from two public and two private institutions (49 PG e 52 FG) with score above 20 points by the Baccaro s Test. The primary outcome was rated by the scales: Baccaro s Test, Perceived Stress Scale and Scale of Assessment of Stress Among Nursing Students. The secondary outcome was rated by the students perception of the formula use by the end of the study. The stress scales were applied in the beginning and at the end of the intervention. The Brief COPE scale and the Antonovsky s Sense of Coherence Scale were used as moderators variables. Descriptive analysis of the data was performed, comparing the groups by t-student test, Fisher test, chi-square and Wilcoxon-Mann-Whitney test according to variable type and size effect by d-Cohen test. The significance level = 5% was adopted. Results: There was no significant difference between GF and GP in the stress reduction measured by Baccaro s Test and Perceived Stress Scale (p>0,05), both groups had scale scores reductions (p<0.001) with large effect size in the two groups. In the Scale of Assessment of Stress Among Nursing Students there was no significant reduction between the groups and for the two groups in the long term. The interaction analysis showed that there was interference throughout the academic year study in the Perceived Stress Scale and the fact of being USP student in the Scale of Assessment of Stress Among Nursing Students, and this scale had also an influence in the academic year and pandemic. The perception analysis about the use of the floral effect showed in the FG reports therapeutic effects in the changing behavior patterns, not observed in the PG. Conclusion: The floral therapy intervention was not more effective than placebo in reducing signs and symptoms of stress. The effect of flower essence therapy was evident in the students' reports. The floral formula contributed to an improvement in sleep quality, self-confidence, and behavioral patterns when faced with certain situations.

Associação entre eventos estressores e citocinas inflamatórias e anti-inflamatórias em pessoas idosas longevas / Association between stressor events and inflammatory and anti-inflammatory cytokines in long-lived older people

Resumo Objetivo investigar a associação entre a frequência de eventos estressores e citocinas em pessoas idosas longevas. Métodos os participantes responderam a um questionário constituído de variáveis sociodemográficas, indicaram quais eventos estressores constantes no Inventário de Eventos Estressores de vida ocorreram nos últimos cinco anos e responderam a escala de depressão geriátrica (GDS). Foram dosados por citometria de fluxo: interleucina (IL) 10, IL-6, IL-4, IL-2, fator de necrose tumoral (TNF-α) e interferon gama (IFN-γ). A análise descritiva foi realizada para a caracterização da amostra. Para investigar a associação entre as variáveis foi desenvolvido um modelo de regressão linear múltipla, utilizando o método Backward. Resultados Participaram da pesquisa 91 pessoas idosas com média de idade de 82 anos. Mais da metade da amostra relatou morte de ente querido como o evento estressor mais prevalente (61%). Nessa amostra foi possível perceber que quanto mais eventos estressores foram relatados, menor o nível de IL-4 (p=0,046), da mesma forma que o estado civil viuvez, onde os dados mostraram que quem é viúvo tem menos eventos estressores em comparação a quem é casado (p=0,037). Conclusão Evidenciou-se a importância de um olhar mais cuidadoso dos profissionais de saúde na avaliação multidimensional da pessoa idosa, de forma que se obtenham subsídios para a implementação de programas e intervenções específicos que possam amenizar a percepção dos eventos estressores vivenciados, colaborando com menores danos decorrentes da imunossenescência.

Abstract Objective To investigate the association between the frequency of stressor events and cytokines in long-lived older people. Methods The participants answered a questionnaire consisting of sociodemographic variables, indicated which stressor events included in the Stressor Life Events Inventory occurred in the last five years and answered the Geriatric Depression Scale (GDS). The following were measured by flow cytometry: interleukin (IL) 10, IL-6, IL-4, IL-2, tumor necrosis factor (TNF-α) and interferon gamma (IFN-γ). We carried out a descriptive statistical analysis in order to characterize the sample. To investigate the association between the variables, a multiple linear regression model was developed, using the Backward method. Results 91 older people with an age average of 82 years participated in the research. More than half of the sample reported the death of a loved one as the most prevalent stressor event (61%). In this sample, it was possible to notice that the more stressor events were reported, the lower the level of IL-4 (p=0.046), as well as the marital status of widowhood, where data showed that those who are widowed have fewer stressor events in comparison to who is married (p=0.037). Conclusion The importance of a more careful look by health professionals in older people multidimensional assessment was evidenced, so that subsidies are obtained for the implementation of specific programs and interventions that can ease the perception of the stressor events experienced, collaborating with less resulting damage of immunosenescence.

Social and health-related predictors of family function in older spousal caregivers: a cross-sectional study.

Given the benefits of adequate family function for the health and well-being of older adults, it is important to understand what factors predict adequate family function in older people who care for their spouses. OBJECTIVE: Analyse predictors of family function in older spousal caregivers. METHODS: A cross-sectional study design was used to investigate a non-probabilistic sample of 298 older spousal caregivers. Home-based face-to-face interviews were used to evaluate sociodemographic variables and care context, family function (Family APGAR), cognitive function, perceived stress, and depressive symptoms. Data were analysed using multiple logistic regression with stepwise forward method for variable section. RESULTS: Older caregivers having some degree of cognitive impairment (OR=-0.160, 95%CI 0.444-0.579), depressive symptoms (OR=-0.848, 95%CI 0.726-0.992) or high levels of stress (OR=-0.955, 95%CI 0.914-0.999) had overall lower levels of family function. Having more children was linked to approximately 1.3 times higher family function (95%CI 1.080-1.057). CONCLUSION: Stress, depression, cognitive decline, and number of children are predictors of family function and should be considered in social and health care strategies within the family caregiving context.

Dados os benefícios da função familiar adequada para a saúde e o bem-estar de pessoas idosas, é importante compreender quais fatores predizem o funcionamento familiar adequado em pessoas idosas que cuidam de seus cônjuges. OBJETIVO: Analisar preditores de funcionamento familiar em idosos cuidadores de cônjuges idosos. MÉTODOS: Um estudo transversal foi usado para investigar uma amostra não probabilística de 298 cuidadores cônjuges idosos. Foram realizadas entrevistas domiciliares para avaliar variáveis sociodemográficas e situação de cuidado, funcionamento familiar (APGAR familiar), função cognitiva, percepção de estresse e sintomas depressivos. Os dados coletados foram analisados por meio de regressão logística múltipla com método stepwise forward para seleção das variáveis. RESULTADOS: Idosos cuidadores com algum grau de comprometimento cognitivo (OR=-0,160, IC95% 0,444­0,579), sintomas depressivos (OR=-0,848, IC95% 0,726­0,992) ou altos níveis de estresse (OR=-0,955, IC95% 0,914-0,999) tiveram menores níveis de funcionamento familiar. Ter mais filhos esteve relacionado a maiores níveis de funcionamento familiar em aproximadamente 1,3 vez (IC95% 1,080­1,057). CONCLUSÃO: A presença de estresse, depressão, declínio cognitivo e número de filhos são preditores do funcionamento familiar e devem ser considerados como parte de estratégias sociais e de saúde no contexto de cuidado familiar.

Social and health-related predictors of family function in older spousal caregivers: a cross-sectional study / Variáveis sociais e de saúde preditoras da função familiar em cuidadores cônjuges idosos: um estudo transversal

ABSTRACT. Given the benefits of adequate family function for the health and well-being of older adults, it is important to understand what factors predict adequate family function in older people who care for their spouses. Objective: Analyse predictors of family function in older spousal caregivers. Methods: A cross-sectional study design was used to investigate a non-probabilistic sample of 298 older spousal caregivers. Home-based face-to-face interviews were used to evaluate sociodemographic variables and care context, family function (Family APGAR), cognitive function, perceived stress, and depressive symptoms. Data were analysed using multiple logistic regression with stepwise forward method for variable section. Results: Older caregivers having some degree of cognitive impairment (OR=-0.160, 95%CI 0.444-0.579), depressive symptoms (OR=-0.848, 95%CI 0.726-0.992) or high levels of stress (OR=-0.955, 95%CI 0.914-0.999) had overall lower levels of family function. Having more children was linked to approximately 1.3 times higher family function (95%CI 1.080-1.057). Conclusion: Stress, depression, cognitive decline, and number of children are predictors of family function and should be considered in social and health care strategies within the family caregiving context.

RESUMO. Dados os benefícios da função familiar adequada para a saúde e o bem-estar de pessoas idosas, é importante compreender quais fatores predizem o funcionamento familiar adequado em pessoas idosas que cuidam de seus cônjuges. Objetivo: Analisar preditores de funcionamento familiar em idosos cuidadores de cônjuges idosos. Métodos: Um estudo transversal foi usado para investigar uma amostra não probabilística de 298 cuidadores cônjuges idosos. Foram realizadas entrevistas domiciliares para avaliar variáveis sociodemográficas e situação de cuidado, funcionamento familiar (APGAR familiar), função cognitiva, percepção de estresse e sintomas depressivos. Os dados coletados foram analisados por meio de regressão logística múltipla com método stepwise forward para seleção das variáveis. Resultados: Idosos cuidadores com algum grau de comprometimento cognitivo (OR=-0,160, IC95% 0,444-0,579), sintomas depressivos (OR=-0,848, IC95% 0,726-0,992) ou altos níveis de estresse (OR=-0,955, IC95% 0,914-0,999) tiveram menores níveis de funcionamento familiar. Ter mais filhos esteve relacionado a maiores níveis de funcionamento familiar em aproximadamente 1,3 vez (IC95% 1,080-1,057). Conclusão: A presença de estresse, depressão, declínio cognitivo e número de filhos são preditores do funcionamento familiar e devem ser considerados como parte de estratégias sociais e de saúde no contexto de cuidado familiar.

Angiotensin-converting enzyme 2 activator, DIZE in the basolateral amygdala attenuates the tachycardic response to acute stress by modulating glutamatergic tone.

The basolateral amygdala (BLA) is critical in the control of the sympathetic output during stress. Studies demonstrated the involvement of the renin-angiotensin system components in the BLA. Angiotensin-(1-7) [Ang-(1-7)], acting through Mas receptors, reduces stress effects. Considering that angiotensin-converting enzyme 2 (ACE2) is the principal enzyme for the production of Ang-(1-7), here we evaluate the cardiovascular reactivity to acute stress after administration of the ACE2 activator, diminazene aceturate (DIZE) into the BLA. We also tested whether systemic treatment with DIZE could modify synaptic activity in the BLA and its effect directly on the expression of the N-methyl-d-aspartate receptors (NMDARs) in NG108 neurons in-vitro. Administration of DIZE into the BLA (200 pmol/100 nL) attenuated the tachycardia to stress (ΔHR, bpm: vehicle = 103 ± 17 vs DIZE = 49 ± 7 p = 0.018); this effect was inhibited by Ang-(1-7) antagonist, A-779 (ΔHR, bpm: DIZE = 49 ± 7 vs A-779 + DIZE = 100 ± 15 p = 0.04). Systemic treatment with DIZE attenuated the excitatory synaptic activity in the BLA (Frequency (Hz): vehicle = 2.9 ± 0.4 vs. DIZE =1.8 ± 0.3 p < 0.04). NG108 cells treated with DIZE demonstrated decreased expression of l subunit NMDAR-NR1 (NR1 expression (a.u): control = 0.534 ± 0.0593 vs. DIZE = 0.254 ± 0.0260) of NMDAR and increases of Mas receptors expression. These data demonstrate that DIZE attenuates the tachycardia evoked by acute stress. This effect results from a central action in the BLA involving activation of Mas receptors. The ACE2 activation via DIZE treatment attenuated the frequency of excitatory synaptic activity in the basolateral amygdala and this effect can be related with the decreases of the NMDAR-NR1 receptor expression.

Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile: Protocol for a Randomized Controlled Trial.

BACKGROUND: Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age. OBJECTIVE: The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms. METHODS: This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised. RESULTS: Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021. CONCLUSIONS: This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up. TRIAL REGISTRATION: ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17943.

Cardiovascular reactivity to emotional stress: The hidden challenge for pets in the urbanized environment.

Emotional stress is currently considered an important risk factor for cardiovascular diseases. Experimental evidence clearly shows robust autonomic cardiovascular effects in animals exposed to stress stimuli. Considering the remarkable variability of stressors, the urban environment can pose a severe challenge to cardiovascular control. Interestingly, pet ownership is indicated as an efficient non-pharmacological therapy to attenuate stress effects that can reduce the risk of cardiovascular disease. However, the risk of cardiovascular diseases in pets themselves living in urban environment has not received attention it deserves. Here, we review the central mechanisms involved in the autonomic cardiovascular response to emotional stress. Next, we discuss experimental evidence showing the cardiovascular effects produced by emotional stressors in animals, aiming to establish a parallel with common urban stressors. Association of additional risk factors such as sedentarism, obesity and ambient temperature are also considered. Our aim is to identify and raise awareness of the risk of cardiovascular disease in pets exposed to quotidian emotional stressors present in the urban environment.