Effects of institutional rearing and foster care intervention on error monitoring and externalizing behaviors in adolescence.

Children raised in institutions display deficits in error monitoring and increased psychopathology. Deficits in error monitoring might be a pathway for the emergence of psychopathology in previously institutionalized adolescents. Here we investigate the impact of early psychosocial deprivation and a foster care intervention on error monitoring and its association with internalizing and externalizing behavioral problems in adolescence A modified Flanker task assessed error monitoring in 16-year-old adolescents from the BEIP. The ERN and mid-frontal theta power were computed as indices of neural responses of error monitoring. Adolescents who experienced early institutional rearing and were subsequently placed into foster care showed comparable behavioral (RT, accuracy) and neural (ERN, theta power) measures of error monitoring to their never institutionalized peers; whereas adolescents who received care as usual showed both perturbed behavioral performance and neural responses. Longer duration of institutional care was associated with a reduction in mid-frontal theta power. The results further demonstrated a link between error monitoring as measured by ERN and mid-frontal theta and externalizing-ADHD behavioral problems in adolescents who continued receiving care as usual. The results highlight the long-term positive impact of early foster care placement and perturbations due to prolonged institutional care in neural responses of error monitoring.

Longitudinal effects of early psychosocial deprivation on macaque executive function: Evidence from computational modelling.

Executive function (EF) describes a group of cognitive processes underlying the organization and control of goal-directed behaviour. Environmental experience appears to play a crucial role in EF development, with early psychosocial deprivation often linked to EF impairment. However, many questions remain concerning the developmental trajectories of EF after exposure to deprivation, especially concerning specific mechanisms. Accordingly, using an 'A-not-B' paradigm and a macaque model of early psychosocial deprivation, we investigated how early deprivation influences EF development longitudinally from adolescence into early adulthood. The contribution of working memory and inhibitory control mechanisms were examined specifically via the fitting of a computational model of decision making to the choice behaviour of each individual. As predicted, peer-reared animals (i.e. those exposed to early psychosocial deprivation) performed worse than mother-reared animals across time, with the fitted model parameters yielding novel insights into the functional decomposition of group-level EF differences underlying task performance. Results indicated differential trajectories of inhibitory control and working memory development in the two groups. Such findings not only extend our knowledge of how early deprivation influences EF longitudinally, but also provide support for the utility of computational modelling to elucidate specific mechanisms linking early psychosocial deprivation to long-term poor outcomes.

Psychosocial Risk in COVID Context: The Impact of Economic Factors and Labour Protection Policy (ERTEs) in Spain.

The pandemic and the current situation have caused working poverty and therefore social risk, which implies a deterioration in well-being, affecting mental health and anxiety. In this context, the employment situation tends to be regarded ignoring previous social differences, economic and mental components, which should be considered when establishing priorities to program a global action of various synergistic elements. The study involved 4686 people (3500 women and 1186 men). They all completed a questionnaire that evaluated their anxiety, employment situation, income, changes of working status, and fears of becoming infected at the workplace. The results show the need to take into account the social determinants of mental health in vulnerable groups due to socioeconomic factors, job changes, contractual changes, age, or gender, considering the need to generate strategies to manage mental health and deal with it at a structural level, therefore displacing individual focus policies and interventions. An example of these policies are ERTEs (record of temporary employment regulation), constituting a perceived measure of protection and acting as an effective buffer against the economic crisis, thus reducing anxiety.

Práticas psicológicas nos Creas do interior do RS: o olhar de trabalhadoras(es) / Psychological practices on CREAS in the countryside of the state of Rio Grande do Sul: perspectives of workers / Prácticas psicológicas en CREAS en el interior de Rio Grande do Sul: perspectiva de trabajadoras/es

O presente texto tem o objetivo de explanar ações desempenhadas por psicólogas(os) trabalhadoras(es) dos Centros de Referência Especializados de Assistência Social (Creas), em situações de violência intrafamiliar, identificadas a partir do estude empírico realizado por mim, psicóloga pesquisadora, também trabalhadora de um Creas. Participaram da pesquisa doze psicólogas(os), trabalhadoras(es) destes centros, em sete municípios do interior do Rio Grande do Sul, onde foram realizadas, presencialmente, as entrevistas. A análise dos dados apontou para uma compreensão metodológica a partir de três dimensões já apontadas na bibliografia, sendo elas: a) Acolhida Inicial, que demonstra que esses profissionais geralmente iniciam suas práticas com uma família ou indivíduo indo ao encontro destes, buscando a vinculação dos mesmos com o serviço; b) Acompanhamento Especializado, onde essas(es) trabalhadoras(es) desenvolvem suas práticas com diversidade e criatividade, a partir de visitas domiciliares, trabalhos com grupos, indivíduos ou famílias, geralmente em conjunto com outros profissionais, principalmente assistentes sociais; c) Articulação com a Rede, onde se identificou um importante movimento para o trabalho em conjunto com outros serviços disponíveis no território. Por fim, as considerações finais indicam que ainda há um caminho a ser trilhado com relação à definição das práticas dos psicólogos no Creas. Porém, há muito que se falar a respeito de práticas que já estão ocorrendo. Assim, tornam-se relevantes as pesquisas acadêmicas nesse contexto, pois ao inserir os profissionais psicólogos trabalhadores da política, eles podem promover uma articulação entre a produção do fazer cotidiano e a reflexão teórica e acadêmica sustentada pelas pesquisas.(AU)

This study aims to explore the activities developed by psychologists from the Centros de Referência de Atenção Especializada (CREAS - Brazilian Specialized Social Assistance Reference Centers), regarding situations of intrafamily violence identified by me, the author, a research psychologist and, CREAS worker. Participants include 12 psychologists who work on such centers from 7 cities in the countryside of Rio Grande do Sul, Brazil, where the interviews were conducted in person. The data analysis pointed toward a methodological comprehension based on 3 dimensions that have already been mentioned in the literature: the Initial Approach, which shows that these workers usually initiate their practices with a family or an individual by going after them, seeking bond development with the service. The Specialized Follow-up, in which these workers develop their practices with diversity and creativity, through home visits and activities with group, family or individual, often with other workers, such as social assistance workers. And the Network Articulation, in which a significant movement toward working with the public services available on each territory is identified. Finally, there is still a path to be taken regarding the definition of psychological practices on CREAS, however, there is much to be noticed of what has already been occurring. Thus, academic research on such context is relevant since the inclusion of psychologists who work in this policy may promote an articulation between daily activity and the theoretical and academic reflection, supported by the research.(AU)

Este texto tuvo por objetivo explicar las acciones desarrolladas por psicólogas/os trabajadoras/es en los "Centros de Referência Especializados de Assistência Social" (CREAS) (Centros de Referencia Especializados en Asistencia Social), respecto a las situaciones de violencia intrafamiliar, identificadas por un estudio empírico hecho por una psicóloga-investigadora que actúa en un CREAS. Participaron 12 psicólogas/os que trabajan en estos centros, en siete ciudades del interior de Rio Grande do Sul (Brasil), donde se llevó a cabo las entrevistas en persona. El análisis de datos apuntó a una comprensión metodológica de tres dimensiones ya destacadas en la bibliografía: la Acogida Inicial, que enseña que estos profesionales generalmente empiezan sus prácticas con una familia o individuo buscando el encuentro para la promoción de la vinculación con el servicio; El Seguimiento Especializado, en el que desarrollan sus prácticas con diversidad y creatividad desde visitas domiciliarias, trabajos con grupos, individuos o familias, generalmente junto a otros profesionales, sobre todo con trabajadores sociales; y Articulación con la Red de Servicios, en la cual se identificó un importante movimiento para el trabajo con otros servicios disponibles en el territorio. Por fin, se observa que todavía hay un camino por recorrer en relación a la definición de las prácticas de psicólogos en CREAS, aunque hay mucho que decir respecto a las prácticas que ya están ocurriendo. Así, se vuelven relevantes las investigaciones académicas en ese contexto por introducir a los profesionales psicólogos trabajadores de la política, las cuales pueden promover una articulación entre la producción del hacer cotidiano y la reflexión teórica y académica sustentada por las investigaciones.(AU)

Fatores de risco psicossociais no trabalho de gestores: revisão sistemática / Psychosocial Risk Factors in the Work of Managers: Systematic Review

Objetivo. Este estudo objetiva sistematizar e avaliar a produção científica nacional e internacional acerca dos fatores de risco psicossociais presentes no trabalho de gestores e como estes afetam sua saúde. Método. Realizou-se uma revisão sistemática da literatura. Foram seguidas as diretrizes do Protocolo PRISMA - Preferred Reporting Items for Systematic reviews and Meta-Analyses. Resultados. Verificou-se que os gestores estão expostos a riscos psicossociais relacionados às categorias tipo e produção de tarefas e saúde e bem-estar. A exposição a estes fatores de risco pode desencadear alterações físicas e mentais na saúde. Foram identificadas ações de intervenção e seus resultados, bem como a necessidade de desenvolvimento de ações de prevenção e promoção de saúde mental voltadas para gestores.

Objective. This study aims to systematize and evaluate the national and international scientific production about the psychosocial risk factors present in the work of managers and how these affect their health. Method. A systematic review of the literature was done. For its development, the guidelines for conducting a systematic review proposed by the PRISMA Protocol - Preferred Reporting Items for Systematic reviews and Meta-Analyses were followed. Results. After the process of refining the results, it was found that managers are exposed to psychosocial risks related to the categories types, and production of tasks and health and well-being. The exposure to these risk factors can trigger physical and mental changes in the health of these workers, requiring prevention and mental health promotion actions.

Early deprivation alters structural brain development from middle childhood to adolescence.

Hypotheses concerning the biologic embedding of early adversity via developmental neuroplasticity mechanisms have been proposed on the basis of experimental studies in animals. However, no studies have demonstrated a causal link between early adversity and neural development in humans. Here, we present evidence from a randomized controlled trial linking psychosocial deprivation in early childhood to changes in cortical development from childhood to adolescence using longitudinal data from the Bucharest Early Intervention Project. Changes in cortical structure due to randomization to foster care were most pronounced in the lateral and medial prefrontal cortex and in white matter tracts connecting the prefrontal and parietal cortex. Demonstrating the causal impact of exposure to deprivation on the development of neural structure highlights the importance of early placement into family-based care to mitigate lasting neurodevelopmental consequences associated with early-life deprivation.

Foster care leads to sustained cognitive gains following severe early deprivation.

This study examined longitudinal data from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care following exposure to severe psychosocial deprivation. We report data from 135 participants assessed in early adulthood (age 18 y). We find that 16 y after randomization occurred, those who had been randomized to high-quality foster care had significantly higher IQ scores (9 points, 0.6 SD) than those randomized to care as usual. Mediation analyses provide evidence that the causal effect of the intervention on cognitive ability in early adulthood could be explained, in part, by higher-quality caregiving and attachment security. These findings indicate that early investment in family care as an alternative to institutional care leads to sustained gains in cognitive ability. Fostering caregiving relationships is a likely mechanism of the intervention. In addition, exploratory analyses indicate that stable placements throughout childhood are associated with the greatest long-term gains in cognitive ability. Whether early interventions for infants and young children lead to lasting change has significant implications for decisions to invest in programs aimed at improving children's developmental outcomes.

Recorte temporal dos desafios para implementação da Rede de Atenção Psicossocial (RAPS) no Brasil: revisão sistemática / Temporal review of the challenges for the implementation of the Psychosocial Attention Network (RAPS) in Brazil: systematic review

A RAPS integra um dos eixos prioritários da Rede de Atenção à Saúde no Brasil. Objetiva-se apontar um panorama referente aos desafios para implementação da RAPS no Brasil. Realizou-se uma revisão sistemática da literatura por meio de buscas nas bases: Google Acadêmico, Scielo, BDENF, Portal da CAPES, Medline e Lilacs, utilizando-se a associação "Rede de Atenção Psicossocial" e "desafios". Os desafios foram: articulação da rede/efetivação do apoio matricial; recursos materiais e humanos; gestão; assistência tradicional/manicomial e outros. Conclui-se que é primordial que as práticas assistenciais em saúde mental sejam revistas, que profissionais e poder público busquem integrar suas ações e que familiares possam também compor e se reconhecerem como parte importante para o processo do cuidado.

The Psychosocial Attention Network (RAPS) integrates one of the priority axes of the Health Care Network in Brazil. Aim to give an overview of the challenges for implementing RAPS in Brazil. A systematic review of the literature was carried out, by the searching at the bases: Google Academic, Scielo, BDENF, Portal of the CAPES, Medline and Lilacs, using the association "Psychosocial Care Network" and "challenges". The challenges were: articulation of the network/implementation of matrix support; material and human resources; management; traditional/asylum assistance and others. It was concluded that is essential that mental health care practices be reviewed, that professionals and public authorities seek to integrate their actions and that family members can also compose and recognize themselves as an important part of the care process.

Moral injury related to immigration detention on Nauru: a qualitative study.

Background: Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role. Objective: Our aim was to explore moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru. Methods: In this retrospective study, we conducted in-depth interviews with 13 individuals who had sought refuge in Australia and, due to arriving by boat, had been transferred to immigration detention on Nauru. At the time of the study, they lived in Australia following medical transfer. We used reflexive thematic analysis to develop themes from the data. Results: Major themes included 1) how participants' home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, lack of agency, violence, and dehumanization after arrival, with the Australian government seen as the driving force behind these experiences; and 3) how these experiences led to feeling irreparably damaged. The participant statement 'In my country they torture your body but in Australia they kill your mind.' conveyed these three key themes in our analysis. Conclusion: Our findings suggest that moral injury may be one of the processes by which mandatory immigration detention can cause harm. Although refugees returned to Australia from offshore detention may benefit from interventions that specifically target moral injury, collective steps are needed to diminish deterioration of refugee mental health. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one's moral frameworks. Policy makers should incorporate moral injury considerations to prevent eroding refugee mental health.

Antecedentes: La detención de inmigrantes está asociada con resultados perjudiciales en la salud mental, pero se conoce poco acerca de los procesos psicológicos subyacentes. El daño moral y la experiencia de transgredir las creencias morales pueden desempeñar un rol importante.Objetivos: Nuestro objetivo fue explorar las evaluaciones de daño moral y los resultados asociados a la salud mental relacionados con la detención de inmigrantes en Nauru.Métodos: En este estudio retrospectivo, realizamos entrevistas en profundidad a 13 individuos que habían solicitado refugio en Australia y, debido a que llegaron en barco, habían sido transferidos a centros de detención de inmigrantes en Nauru. En el momento del estudio, se encontraban viviendo en Australia tras un traslado médico. Utilizamos un análisis temático reflexivo para desarrollar temas a partir de los datos.Resultados: Los temas principales incluyeron 1) cómo la experiencia del país de origen de los participantes y la expectativa de obtener protección los llevaron a buscar seguridad en Australia; 2) cómo experimentaron la privación, la falta de acción, la violencia, la deshumanización posterior a su llegada, con el gobierno australiano visto como la fuerza impulsora detrás de estas experiencias; y 3) cómo estas experiencias los llevaron a sentirse irreparablemente dañados. La declaración de los participantes 'En mi país torturan tu cuerpo, pero en Australia matan tu mente', transmitió estos tres temas en nuestro análisis.Conclusiones: Nuestros hallazgos sugieren que el daño moral puede ser uno de los mecanismos por los cuales la detención migratoria obligatoria puede causar daño. Sin embargo, los refugiados retornados de la detención en alta mar a Australia pueden beneficiarse de las intervenciones que se enfocan específicamente en el daño moral, se necesitan pasos colectivos para disminuir el deterioro de la salud mental de los refugiados. Nuestros resultados resaltan el impacto potencialmente deletéreo en la salud mental de experimentar múltiples transgresiones sutiles y sustanciales de los marcos morales de uno. Los diseñadores de políticas públicas deberían incorporar consideraciones relacionadas al daño moral para prevenir la erosión de la salud mental de los refugiados.

El tratamiento de las personas con problemas de salud mental en la normativa penal y penitenciaria. Reflexiones y propuestas / The treatment of people with mental health problems in criminal and penitentiary regulations. Reflections and proposals

El presente trabajo analiza el tratamiento que la normativa penal y penitenciaria española ofrece a las personas con problemas de salud mental (o con discapacidad psicosocial) que son acusadas de un delito y entran en contacto con el medio penitenciario. El análisis revela que este colectivo es víctima de una discriminación y un maltrato institucional cuya erradicación exige cambios relevantes en la legislación, las políticas públicas y la mentalidad social, a la luz de la Convención Internacional sobre los Derechos de las Personas con Discapacidad. Estos cambios se orientan a cuatro objetivos básicos: 1) evitar situaciones de desatención que aboquen a las personas con problemas de salud mental a entrar en el ciclo delictivo; 2) potenciar su desviación del medio penitenciario hacia respuestas más resocializadoras; 3) garantizar que quienes entren en prisión puedan ejercer sus derechos en igualdad de condiciones que todas las personas internas; 4) erradicar prejuicios y estereotipos promoviendo la formación de profesionales y la toma de conciencia por parte de la sociedad de la situación de desventaja de este colectivo. (AU)

This paper analyzes the treatment that Spanish penal and penitentiary regulations offer to people with mental health problems (or with psychosocial disabilities) who are accused of a crime and come into contact with the penitentiary environment. The analysis reveals that this group is the victim of discrimination and institutional abuse, whose eradication requires significant changes in legislation, public policies and social mentality, in the light of the International Convention on the Rights of Persons with Disabilities. These changes are aimed at four basic objectives: 1) to avoid situations of neglect that lead people with mental health problems to enter the criminal cycle; 2) to enhance their diversion from the prison environment towards more resocializing responses; 3) to ensure that those who have to enter prison can exercise their rights on an equal basis with other inmates; 4) to eradicate prejudices and stereotypes by promoting the training of professionals and raising the awareness of society regarding the situation of disadvantage in this group. (AU)

Autonomic reactivity to social rejection, peer difficulties, and the buffering effects of adolescent friendships following early psychosocial deprivation.

Autonomic nervous system reactivity has been posited to be a mechanism contributing to social and emotional problems among children exposed to early adversity. Leveraging data from the Bucharest Early Intervention Project, a longitudinal randomized controlled trial of foster care versus institutional care of abandoned children in Romania, we assessed whether altered sympathetic reactivity to peer rejection feedback in early adolescence mediated the relation between early institutional rearing and peer problems in later adolescence. We also assessed whether adolescent friendship quality or randomized placement in foster care early in life moderated these associations. Participants include 68 institutionalized children randomized to care as usual, 68 institutionalized children randomized to foster care, and 135 never-institutionalized children. At age 12, participants reported friendship quality with respect to a best friend and completed a social rejection task while electrocardiogram and impedance cardiography were recorded. Sympathetic nervous system reactivity to rejection feedback was assessed using preejection period (PEP). At ages 12 and 16, peer problems were reported by parents. Mediation analysis revealed that less PEP reactivity to social rejection at age 12 partially mediated the association between early institutionalization and greater peer problems at age 16. Further moderated mediation analysis revealed that this indirect effect was evidenced among previously institutionalized youths with low, but not high, quality friendships. We did not observe foster care intervention effects. These findings suggest that altered sympathetic reactivity to social rejection might be a mechanism linking early institutionalization to social difficulties into adolescence, however, positive adolescent friendships may buffer these effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations between Early Psychosocial Deprivation, Cognitive and Psychiatric Morbidity, and Risk-taking Behavior in Adolescence.

OBJECTIVE: Early psychosocial deprivation increases the risk of later cognitive and psychiatric problems, but not all deprived children show these difficulties. Here, we examine the extent to which psychosocial deprivation increases the risk of later cognitive and psychiatric difficulties and the downstream consequences of this for risk-taking behavior in adolescence. METHOD: Children abandoned to institutions early in life were randomly assigned to care-as-usual or a foster care intervention during infancy. A separate group of never-institutionalized children was recruited as a comparison sample. The current follow-up study included 165 children (51% female), 113 with a history of institutionalization and 52 with no such history. At age 12, caregivers reported on children's psychiatric difficulties, and their IQ was assessed by standardized testing. At 16 years, risk-taking behavior was assessed from youth self-reports. RESULTS: Latent profile analysis revealed three subgroups of children with varying levels of cognitive and psychiatric difficulties: Low-Morbidity (n = 104, 62.7%), Medium-Morbidity (n = 46, 27.9%), and High-Morbidity (n = 15, 9.4%). Nearly half of the institutionalized children belonged to the High- or Medium-Morbidity subgroups; and institutionally-reared children were significantly more likely to belong to one of these profiles than never-institutionalized children. Compared to the Low-Morbidity subgroup, membership in the Medium-Morbidity profile was associated with higher levels of risk-taking behavior at age 16 years. CONCLUSIONS: Children who experience psychosocial deprivation are considerably more likely to present with elevated cognitive and psychiatric difficulties in early adolescence and, for some children, this elevation is linked to heightened risk-taking behavior in later adolescence.

Estrés laboral: una revisión de las principales causas consecuencias y estrategias de prevención / Work Stress: A Review of the Main Causes, Consequences, and Prevention Strategies / O estresse no trabalho: uma revisão das principais causas, consequências e estratégias de prevenção

Introducción: El estrés laboral es una enfermedad peligrosa que altera el estado psicológico de la persona, porque genera reacciones y respuestas de tipo emocional, cognitivo, fisiológico y del comportamiento frente a situaciones con alta demanda laboral que sobrepasa los recursos personales y del trabajo. Se considera una problemática de tipo social y económica asociada con factores de riesgo psicosocial y con desencadenantes. Por ello, es fundamental su detección precoz, para evitar sus secuelas y para emplear estilos de afrontamiento. Objetivo: Analizar los referentes teóricos del estrés laboral, teniendo en cuenta sus principales causas, consecuencias y estrategias de prevención en el ámbito laboral. Metodología: Revisión documental disponible en las bases de datos Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Biblioteca Digital, Elsevier, Redalyc, Dialnet, SciELO y Science Direct, de estudios publicados entre 2015 y 2020 que incluyeran conceptos de estrés laboral, causas, consecuencias y estrategias de prevención. Se revisaron 60 artículos, y para seleccionar la información se aplicó búsqueda, organización, categorización y análisis de 5554 documentos electrónicos. Se excluyeron 6 estudios relacionados con temas específicos del síndrome de burnout. Conclusiones: El estrés es una problemática prevalente en el contexto organizacional que se genera por múltiples factores asociados con las condiciones laborales y personales y origina en el individuo consecuencias fisiológicas y mentales que afectan su desempeño y productividad. De ahí que sea necesario incentivar una cultura preventiva que fomente la salud de los colaboradores.

Introduction: The labor stress is dangerous disease that alters the psychological state of the person, by generating emotional, cognitive, physiological and behavioral reactions and responses to situa-tions with high work demand that exceeds personal and work resources. It is considered as a social and economic problem associated with psychosocial risk factors and triggers, which, it is essential to attach importance to its early detection and thus avoid its consequences, as well as the use of coping styles. Objective: To analyze the theoretical references of work stress, considering the main causes, conse-quences and prevention strategies in the workplace. Methodology: Documentary review available in the databases Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Bibliotheca Digital, Elsevier, Redalyc, Dialnet, SciELO and Science Direct. Inclusion criteria: works published between 2015 and 2020 that include concepts of work stress, causes, consequences and prevention strategies. 60 articles were reviewed to select the information, a search, organization, categorization and analysis of 5554 electronic documents were applied, 6 studies related to specific topics of Burnout syndrome were excluded. Conclusions: Stress is a prevalent problem in the organizational context that is generated by multiple factors associated with the work and personal conditions, originating in the individual consequences of physiological and mental type affecting the performance and the productivity, being necessary to stimulate a preventive culture that promotes the health of the collaborators.

Introdução: O estresse relacionado ao trabalho é uma doença perigosa que altera o estado psicoló-gico da pessoa, pois gera reações emocionais, cognitivas, fisiológicas, comportamentais e respostas a situações com altas exigências de trabalho que excedem os recursos pessoais e de trabalho. É conside-rado um problema social e econômico associados a fatores de risco psicossociais e desencadeadores. É, portanto, essencial detectá-lo cedo, para evitar suas consequências e usar estilos de enfrentamento. Objetivo: Analisar as referências teóricas do estresse relacionado ao trabalho, levando em conta suas principais causas, consequências e estratégias de prevenção no local de trabalho. Metodologia: revisão documental disponível nas bases de dados Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Digital Library, Elsevier, Redalyc, Dialnet, SciELO e Science Direct, de estudos publicados entre 2015 e 2020 que incluíam conceitos de estresse relacionado ao trabalho, causas, consequências e estratégias de prevenção. Sessenta artigos foram revisados, e para selecionar as informações, foi aplicada uma pesquisa onde foram organizados, categorizados e analisados 5554 documentos eletrônicos. Foram excluídos seis estudos relacionados a questões específicas da Síndro-me de Burnout. Conclusões: O estresse é um problema predominante no contexto organizacional que é gerado por múltiplos fatores associados às condições de trabalho e pessoais, e causa consequências fisiológicas e mentais no indivíduo que afetam seu desempenho e produtividade. Portanto, é necessário incentivar uma cultura preventiva que promova a saúde dos funcionários.Palavras-chave: estresse ocupacional; psicossocial; saúde ocupacional; trabalhadores.

Médicos, enfermeras y pacientes: entre las contradicciones, la incertidumbre y las carencias en tiempo de covid-19 en México / Doctors, nurses and patients: dealing with contradictions, uncertainty and shortages during covid-19 in Mexico

Resumen La pandemia de covid-19 puso al descubierto las innumerables carencias que durante décadas han formado parte del inequitativo y fragmentado sistema nacional de salud. Las siguientes reflexiones tienen como propósito central enunciar la fragilidad en la que labora el personal de salud en México, al igual que las contradictorias declaraciones que han acompañado el desarrollo de la pandemia en el país, una conjunción de elementos que han acentuado la incertidumbre frente a la nueva enfermedad y su manejo.

Abstract The covid-19 pandemic revealed the innumerable shortages that have characterized the nation's inequitable and fragmentary health care system for decades. The main goal of the following reflections is to outline the precarity of working conditions for health care personnel in Mexico, as well as the contradictory statements issued as the epidemic developed in the country, a combination of factors that magnified uncertainty about the new disease and how to deal with it.

Children and Adolescent Mental Health in a Time of COVID-19: A Forgotten Priority.

Globally, 10-20% of children and adolescents experience mental health conditions, but most of them do not receive the appropriate care when it is needed. The COVID-19 deaths and prevention measures, such as the lockdowns, economic downturns, and school closures, have affected many communities physically, mentally, and economically and significantly impacted the already-neglected children and adolescents' mental health. As a result, evidence has shown that many children and adolescents are experiencing psychological effects such as depression and anxiety without adequate support. The consequences of not addressing the mental health conditions in children and adolescents extend through adulthood and restrict them from reaching their full potential. The effects of COVID-19 on children and adolescents' mental health highlight the urgent need for multisectoral home-grown solutions to provide early diagnosis and treatment and educate caregivers on home-based interventions and community outreach initiatives to address children and adolescents' mental health challenges during this pandemic and beyond.

Evaluating the impact of social deprivation on Press Ganey® Outpatient Medical Practice Survey Scores.

BACKGROUND: Social deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). METHODS: We retrospectively reviewed unique new adult patient (≥ 18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status). RESULTS: Univariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70-0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94-0.96; p < 0.001). CONCLUSIONS: Social deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups.

Estimating an individual-level deprivation index for HIV/HCV coinfected persons in Canada.

BACKGROUND: HIV-HCV coinfected individuals are often more deprived than the general population. However, deprivation is difficult to measure, often relying on aggregate data which does not capture individual heterogeneity. We developed an individual-level deprivation index for HIV-HCV co-infected persons that encapsulated social, material, and lifestyle factors. METHODS: We estimated an individual-level deprivation index with data from the Canadian Coinfection Cohort, a national prospective cohort study. We used a predetermined process to select 9 out of 19 dichotomous variables at baseline visit to include in the deprivation model: income >$1500/month; education >high school; employment; identifying as gay or bisexual; Indigenous status; injection drug use in last 6 months; injection drug use ever; past incarceration, and past psychiatric hospitalization. We fitted an item response theory model with: severity parameters (how likely an item was reported), discriminatory parameters, (how well a variable distinguished index levels), and an individual parameter (the index). We considered two models: a simple one with no provincial variation and a hierarchical model by province. The Widely Applicable Information Criterion (WAIC) was used to compare the fitted models. To showcase a potential utility of the proposed index, we evaluated with logistic regression the association of the index with non-attendance to a second clinic visit (as a proxy for disengagement) and using WAIC compared it to a model containing all the individual parameters that compose the index as covariates. RESULTS: We analyzed 1547 complete cases of 1842 enrolled participants. According to the WAIC the hierarchical model provided a better fit when compared to the model that does not consider the individual's province. Values of the index were similarly distributed across the provinces. Overall, past incarceration, education, and unemployment had the highest discriminatory parameters. However, in each province different components of the index were associated with being deprived reflecting local epidemiology. For example, Saskatchewan had the highest severity parameter for Indigenous status while Quebec the lowest. For the secondary analysis, 457 (30%) failed to attend a second visit. A one-unit increase in the index was associated with 17% increased odds (95% credible interval, 2% to 34%) of not attending a second visit. The model with just the index performed better than the model with all the components as covariates in terms of WAIC. CONCLUSION: We estimated an individual-level deprivation index in the Canadian Coinfection cohort. The index identified deprivation profiles across different provinces. This index and the methodology used may be useful in studying health and treatment outcomes that are influenced by social disparities in co-infected Canadians. The methodological approach described can be used in other studies with similar characteristics.

Opposing relationships of childhood threat and deprivation with stria terminalis white matter.

While stress may be a potential mechanism by which childhood threat and deprivation influence mental health, few studies have considered specific stress-related white matter pathways, such as the stria terminalis (ST) and medial forebrain bundle (MFB). Our goal was to examine the relationships between childhood adversity and ST and MFB structural integrity and whether these pathways may provide a link between childhood adversity and affective symptoms and disorders. Participants were young adults (n = 100) with a full distribution of maltreatment history and affective symptom severity. Threat was determined by measures of childhood abuse and repeated traumatic events. Socioeconomic deprivation (SED) was determined by a measure of childhood socioeconomic status (parental education). Participants underwent diffusion spectrum imaging. Human Connectome Project data was used to perform ST and MFB tractography; these tracts were used as ROIs to extract generalized fractional anisotropy (gFA) from each participant. Childhood threat was associated with ST gFA, such that greater threat was associated with less ST gFA. SED was also associated with ST gFA, however, conversely to threat, greater SED was associated with greater ST gFA. Additionally, threat was negatively associated with MFB gFA, and MFB gFA was negatively associated with post-traumatic stress symptoms. Our results suggest that childhood threat and deprivation have opposing influences on ST structural integrity, providing new evidence that the context of childhood adversity may have an important influence on its neurobiological effects, even on the same structure. Further, the MFB may provide a novel link between childhood threat and affective symptoms.

Adapting breastfeeding support in areas of socio-economic deprivation: a case study approach.

BACKGROUND: There are inequalities in breastfeeding initiation and continuation rates, whereby socio-economically disadvantaged mothers are least likely to breastfeed. Breastfeeding peer support (BPS) interventions are recommended as a solution, and in the UK non-profit organisations are commissioned to deliver BPS services in areas of socio-economic deprivation. BPS interventions have a mixed evidence base, offering limited knowledge about the interaction between context and intervention and how this affects women's experiences. METHODS: This interpretive study used a case study methodology to explore how and why two BPS services developed their services in socio-economically deprived contexts. Methods aimed to generate holistic understanding of BPS service development. Data collected across both cases comprised; observation (n = 1), and semi-structured interviews with: mothers who had (n = 10) and had not (n = 9) engaged with the BPS services, peer supporters (PSs) (n = 9), community health professionals (n = 5), infant feeding co-ordinators (n = 2), non-profit organisation managers (n = 3), and public health commissioners (n = 2). Inductive grounded theory analytic techniques of open coding and constant comparisons, followed by cross case comparisons, were used to analyse the data. RESULTS: The over-arching theme - 'the transcending influence of society' - offers insights into the underlying context and drivers impacting service development. It reflects how funding and data sharing arrangements determined service operation and the peer's access to women. Four underpinning themes explain how: peer supporters were resourceful in adapting their services ('adapting and modifying the support'); BPS organisations worked to enable women's access to supportive breastfeeding environments, but did not necessarily focus service development on the needs of women living in areas of deprivation ('supporting women's journeys to access'); the BPS-professional connections for supporting access and how BPS could result in more supportive community environments ('embedding within healthcare practice'); and how management practices precluded meaningful use of data to provide context led service development ('ways of using knowledge'). CONCLUSIONS: Findings suggest that while PSs are commissioned to focus on those most in need, there is limited discussion, collection, or use of knowledge about women's lives to develop needs-led service delivery. The key recommendation is the development of a social ecological tool to facilitate the use and application of contextual knowledge.