Estudiantes universitarios en tiempos de covid-19: clases en línea y vida cotidiana / Being a college student in COVID-19 times: online classes and daily life / Ser um estudante universitário em tempos de Covid-19: aulas online e vida quotidiana

Resumen (analítico) Se abordan los ajustes que hicieron estudiantes de psicología en su vida cotidiana para continuar con sus clases en línea. Desde un enfoque de psicología cultural y una investigación de corte cualitativo, se analizan los significados que las y los estudiantes plasmaron en cuestionarios abiertos respondidos en línea. Los resultados muestran el trabajo de reelaboración práctico y simbólico que realizaron las y los participantes para redefinir qué significa ser estudiante en tiempos de pandemia. Se exponen las emociones que tuvieron, las estrategias empleadas para responder a las clases en línea y las experiencias con el servicio de psicología brindado a adolescentes de secundaria. Concluimos que durante la pandemia por covid-19 las clases en línea implicaron para las y los estudiantes retos nuevos en el reacomodo de sus vidas cotidianas.

Abstract (analytical) The paper addresses the adjustments made by psychology students in their daily lives to continue with their online classes. From a cultural psychology approach and a qualitative research approach, we analyze the meanings that students expressed in open questionnaires answered online. The results show the practical and symbolic elaboration work carried out by the participants to redefine what it means to be a student in times of pandemic. The emotions they had, the strategies used to respond to the online classes, and the experiences with the psychology service provided to secondary school adolescents are presented. We conclude that during the COVID-19 pandemic, the online classes implied new challenges for the students in the rearrangement of their daily lives.

Resumo (analítico) O artigo aborda os ajustamentos que os estudantes de psicologia fizeram na sua vida quotidiana para continuar com as suas aulas online. A partir de uma abordagem psicológica cultural e de uma investigação qualitativa, analisamos os significados que os estudantes expressaram em questionários abertos respondidos em linha. Os resultados mostram o trabalho prático e simbólico de reelaboração realizado pelos participantes para redefinir o que significa ser um estudante em tempos de pandemia. São apresentadas as emoções que tinham, as estratégias utilizadas para responder às aulas em linha e as experiências com o serviço de psicologia prestado aos adolescentes do ensino secundário. Concluímos que durante a pandemia de Covid-19, as aulas em linha proporcionaram aos estudantes novos desafios na reorganização da sua vida quotidiana.

Desarrollo de una bebida energizante con pulpa de maracuyá, cristales de aloe vera, panela y propiedades antioxidantes / Development of an energy drink with passion fruit pulp, aloe vera crystals, panela and antioxidant properties

RESUMEN En los últimos años, la demanda de productos saludables se ha venido incrementando, con lo cual, muchas investigaciones se han focalizado hacia la producción de alimentos y bebidas con potencial nutracéutico. El objetivo de este trabajo fue desarrollar una bebida energizante, a base de panela, jugo de maracuyá, cristales de aloe vera (AV), con propiedades antioxidantes. Se evaluó el contenido de compuestos fenólicos, ácido ascórbico y la capacidad antirradicalaria de las materias primas y las bebidas producidas. Se realizó un análisis sensorial, para verificar la aceptación del sabor, color, textura del AV y la aceptabilidad global de tres bebidas, seleccionadas de acuerdo con sus propiedades antioxidantes. Los resultados mostraron que la panela tenía el mayor contenido de compuestos fenólicos (59,4 ± 0,2mg AGE/g), mientras que el jugo de maracuyá, la mayor actividad antirradicalaria (657 ± 5µg eq AA/mL). Las bebidas analizadas dentro del diseño experimental variaron su actividad antioxidante, con la variación de los factores. De las tres bebidas seleccionadas, la bebida 2 presentó la mayor capacidad antirradicalaria (419 ± 1µg eq AA/mL) y contenido de vitamina C (15,75 ± 0,03µg/mL) y, además, un importante contenido de compuestos fenólicos (7,6 ± 2mg AGE/mL). Asimismo, los resultados del panel sensorial mostraron que la bebida 2 tenía una alta aceptabilidad global y una mayor aceptación del sabor, por lo cual, se puede concluir que esta bebida, es la que presenta mayor potencial antioxidante y comercial.

ABSTRACT In recent years, the demand for healthy products has been increasing, so much research has focused on the production of foods and beverages with nutraceutical potential. The aim of this work was to develop an energy drink, based on panela, passion fruit juice and aloe vera (AV) crystals with antioxidant properties. The content of phenolic compounds, ascorbic acid and the anti-radical capacity of the raw materials and beverages produced were evaluated. A sensory analysis was performed, to verify the acceptance of taste, color, AV texture and overall acceptability of three beverages, selected according to their antioxidant properties. The results showed that panela had the highest content of phenolic compounds (59.4 ± 0.2mg AGE/g), while passion fruit juice had the highest anti-radical activity (657 ± 5µg eq AA/mL). The beverages analyzed within the experimental design varied in their antioxidant activity with varying factors. Of the three drinks selected, drink 2 had the highest anti-radical capacity (419 ± 1µg AA eq/mL) and vitamin C content (15,75 ± 0,03µg/mL) and also a significant content of phenolic compounds (7,6 ± 2mg AGE/mL). Likewise, the results of the sensory panel showed that beverage 2 had a high overall acceptability and a greater acceptance of the taste, so it can be concluded that this drink is the one with the greatest antioxidant and commercial potential.

Genetics of dementia: insights from Latin America / Genética das demências: percepção a partir da América Latina

ABSTRACT. Alzheimer's disease (AD) and frontotemporal dementia (FTD) are neurodegenerative disorders that result in a significant burden to both patients and caregivers. By 2050, the number of people with dementia in Latin America will increase 4-fold. A deep understanding of the relevant genetic factors of AD and FTD is fundamental to tackle this reality through prevention. A review of different genetic variants that cause AD or FTD in Latin America was conducted. We searched Medline and PubMed databases using the keywords "Alzheimer's disease," "frontotemporal dementia," "mutation," "America," and "Latin America," besides specific Latin American countries. Forty-five items were chosen and analyzed. PSEN1 mutations are the commonest cause of genetic early-onset Alzheimer's disease (EOAD), followed by PSEN2 and APP mutations. Genetic FTD can be mainly explained by GRN and MAPT mutations, as well as C9orf72 G4C2 repeat expansion. APOE ε4 can modify the prevalence and incidence of late-onset Alzheimer's disease (LOAD), in addition to the cognitive performance in affected carriers.

RESUMO. A doença de Alzheimer (DA) e a demência frontotemporal (DFT) são distúrbios neurodegenerativos que causam uma sobrecarga significativa para pacientes e cuidadores. Em 2050, o número de pessoas com demência na América Latina aumentará 4 vezes. Uma compreensão profunda dos fatores genéticos relevantes da DA e da DFT é fundamental para enfrentar essa realidade por meio da prevenção. Foi realizada uma revisão de diferentes variantes genéticas que causam a DA ou a DFT na América Latina. Pesquisamos os bancos de dados Medline e PubMed usando as palavras-chave "doença de Alzheimer", "demência frontotemporal", "mutação", "América" e "América Latina", além de países latino-americanos específicos. Quarenta e cinco itens foram escolhidos e analisados. As mutações do PSEN1 são a causa mais comum da doença de Alzheimer genética de início precoce (DAIP), seguida pelas mutações do PSEN2 e da APP. A DFT genética pode ser explicada principalmente por mutações no GRN, MAPT e expansões repetidas da C9orf72 G4C2. O APOE ε4 pode modificar a prevalência e a incidência da doença de Alzheimer de início tardio (DAIT), mas também o desempenho cognitivo em portadores afetados.

Dyslipidemia in children with feeding difficulties - a cross-sectional study in a Brazilian reference center / Dislipidemia en niños con dificultades alimentares - estudio transversal en un centro de referencia brasileño

ABSTRACT This study aimed at describing the lipid profile of children with feeding difficulties (FD), as well as to verify the impact of clinical types of FD and other markers on the presence of dyslipidemias (DLP). It was a cross-sectional study with 61 children between 2 and 10 years old. The following data was collected from medical records: age, gender, duration of exclusive breastfeeding (months), dosages of total cholesterol, HDL, LDL, VLDL and triglycerides (according to recommendations for age), type of FD, BMI z-score, dietary intake of carbohydrates and lipids (% energy intake), and daily consumption of milk (ml), fiber (g) and sugar sweetened beverages (SSB, ml). T-Student-test and ANOVA test were used, with a 5% significance level. Children were mostly picky eaters (55.7%), and 47.5% had dyslipidemia, mostly low HDL-c (27.6%) and hypertriglyceridemia (21.9%). No significant relationship was found between DLP and duration of exclusive breastfeeding (p= 0.93), BMI (p> 0.40), type of FD (p> 0.26), or dietary characteristics (p> 0.12). Children with dyslipidemia tended to drink higher volumes of SSB when compared to recommended values (p= 0.044). The prevalence of DLP found was higher than the average shown in children. More studies are needed to prove if there is a true association between FD and dyslipidemia.

RESUMEN El objetivo de este estudio fue describir el perfil lipídico de niños con dificultades alimentares (DA) y verificar el impacto de los tipos clínicos de DA y otros marcadores sobre la presencia de dislipemias (DLP). Se trató de un estudio transversal con 61 niños de 2 a 10 años. Se obtuvieron los datos de edad, sexo, duración de la lactancia materna exclusiva (meses), colesterol total, HDL, LDL, VLDL y triglicéridos (según las recomendaciones para la edad), tipo de DA, índice-z del IMC, consumo dietético de carbohidratos y lípidos (% energético), consumo diario de leche (ml), fibra (g) y bebidas endulzadas (SSB, ml). Se usaron pruebas T-Student y ANOVA, con nivel de significancia del 5%. Los niños fueron selectivos (55,7%) y el 47,5% dislipidémicos, principalmente con HDL-c bajo (27,6%) y hipertrigliceridemia (21,9%). No se encontró relación significante entre DLP y la duración de la lactancia materna exclusiva (p= 0,93), el IMC (p> 0,40), el tipo de DA (p> 0,26) o las características dietéticas (p> 0,12). Los niños dislipidémicos tendieron a beber mayores volúmenes de SSB en comparación con los valores recomendados (p= 0,044). La prevalencia de DLP encontrada es más alta que el promedio que se muestra en niños. Se necesitan más estudios para demostrar asociaciones sólidas entre DA y dislipidemia.

O pediatra deve investigar sintomas de transtornos obsessivos compulsivos em crianças com dificuldades alimentares? / Should pediatricians investigate the symptoms of obsessive-compulsive disorder in children with feeding difficulties?

RESUMO Objetivo: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. Métodos: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação "transtorno obsessivo compulsivo" e "picky eating/dificuldade alimentar". Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. Resultados: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. Conclusões: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas.

ABSTRACT Objective: To review current evidence on the relationship between obsessive-compulsive disorder and feeding difficulties. Methods: Review the Science Direct and PubMed databases between 2007 and 2017 in English, Portuguese and Spanish. The search terms, used in association, were "obsessive compulsive disorder" and "picky eating/feeding difficulty". Cohort, case control and cross sectional studies were included that analyzed children, adolescents and/or adults of any sample size from any country in the world. Opinion articles were excluded. Results: Around 245 articles were selected, and only 4 were included in this review, according to previous criteria. Results from the studies essentially described that there is indeed a difference in "picky" behaviors between subjects with and without obsessive-compulsive disorder. Patients with obsessive-compulsive disorder tend to have exacerbated symptoms of disgust, anxiety and a higher eating behavior inflexibility score. Conclusions: Obsessive-compulsive disorder and feeding difficulties patients share common symptoms. The present study alerts health professionals who follow patients with feeding difficulties as to the importance of investigating possible psychiatric comorbidities.

Oxford Cognitive Screen - Brazilian Portuguese version (OCS-Br): a pilot study / Oxford Cognitive Scale - versão em português do Brasil (OCS-BR): um estudo piloto

ABSTRACT Cognitive impairment is very common in stroke patients and underdiagnosed. Symptoms such as language, praxis, visuospatial, visuoconstructive and memory impairment are prominent. The screening cognitive tests available do not address some specific characteristics of stroke patients and have major limitations in relation to the most impaired cognitive domains. Objective: To test the applicability of a Brazilian version of the Oxford Cognitive Screen in a convenience sample of individuals with normal cognition. Methods: Thirty neurologically healthy participants underwent the OCS-Br in this pilot study. Results: The mean score on each task was: naming: 3.4 (SD=0.72) (maximum value of 4); semantics: 3 (SD=0) (maximum 3); orientation: 4 (SD=0) (maximum 4); visual field: 4 (SD=0) (maximum 4); sentence reading: 14.53 (SD: 1) (maximum 15); number writing: 2.86 (0.6) (maximum 3); calculation: 3.8 (SD=0.48) (maximum 4); and accuracy on the broken hearts test: 47.3 (3.3) (maximum 50). The scores obtained were similar to those of the English original sample. Conclusion: We observed similar values on each separate OCS task in comparison to the original test, confirming that the Brazilian Portuguese version is comparable to other studies.

RESUMO O comprometimento cognitivo é muito comum em pacientes com AVC e pouco diagnosticado. Déficits cognitivos envolvendo as funções de linguagem, praxia, habilidades visuoespaciais, visuoconstrutivas e memória são proeminentes. Os testes de avaliação cognitiva disponíveis não abordam algumas características específicas dos pacientes com AVC e apresentam limitação importante em relação aos domínios cognitivos mais comprometidos. Objetivo: Testar a aplicabilidade de uma versão brasileira do Oxford Cognitive Screen em uma amostra de conveniência com indivíduos sem prejuízo cognitivo. Métodos: Trinta participantes neurologicamente saudáveis foram submetidos ao OCS-Br neste estudo piloto. Resultados: O escore médio em cada tarefa foi: nomeação: 3,4 (DP=0,72) (valor máximo de 4); semântica: 3 (DP=0) (máximo de 3); orientação: 4 (DP=0) (máximo de 4); campo visual: 4 (DP=0) (máximo de 4); leitura de sentenças: 14,53 (DP: 1) (máximo de 15); número escrito: 2,86 (0,6) (máximo de 3); cálculo: 3,8 (DP=0,48) (máximo de 4); precisão no teste de corações partidos: 47,3 (3,3) (máximo de 50). Os escores foram semelhantes aos da amostra original. Conclusão: Observamos valores similares em cada tarefa separada do OCS em comparação ao teste original, o que torna a versão em português brasileiro comparável a outros estudos, e todos os itens foram bem compreendidos com potencial de usabilidade em nosso país.

Cambios en el EEG en reposo de exparticipantes en el conflicto armado colombiano con trastorno de personalidad antisocial / Changes in Resting EEG in Colombian Ex-combatants ith Antisocial Personality Disorder

RESUMEN Introducción: El conflicto armado colombiano, además de secuelas sociales y económicas en la población civil, ha implicado otras consecuencias. Los excombatientes, como la otra cara del conflicto, han sido objeto de interrogación sobre su estructura de personalidad y predisposición a conductas violentas. Se ha encontrado en parte de la población asociada al conflicto armado rasgos característicos del trastorno de personalidad antisocial (TPA) que se relacionarían con los comportamientos en contra de las convenciones sociales. Métodos: Mediante registros electrocardiográficos cuantitativos (qEEG), se evaluaron las diferencias en los patrones de actividad cortical entre un grupo de excombatientes, algunos de ellos con diagnóstico de TPA, y un grupo de control ajeno al conflicto armado y sin alteraciones psiquiátricas. Se empleó la Lista de Chequeo de Psicopatía Revisada (PCL-R) para determinar la presencia de criterios diagnósticos de TPA, así como la entrevista diagnóstica para estudios genéticos (DIGS) para clasificar la presencia de otros trastornos mentales incluidos en el CIE-10. Resultados: Se encontraron diferencias significativas en los niveles de psicopatía evaluados mediante la PCL-R. Con respecto al análisis de la potencia espectral, se observaron diferencias entre grupos en las ondas alfa-2 y beta, en regiones frontal y temporal izquierda y temporocentral izquierda respectivamente. Conclusiones: La técnica de qEEG permite evidenciarlas diferencias entre grupos en el potencial espectral en reposo, las cuales se relacionan con comportamientos desadaptativos característicos del TPA.

ABSTRACT Introduction: Although the social and economic consequences of Colombian internal conflicts mainly affected the civilian population, they also had other implications. The ex-combatants, the other side of the conflict, have been the subject of many studies that question their personality structures and antisocial features. Results suggest that ex-combatants usually have characteristics of an antisocial personality disorder (ASPD) that is related with their behavior. Methods: Quantitative EEG (qEEG) was used to evaluate differences in cortical activity patterns between an ex-combatants group and a control group. The Psychopathy Checklist-Revised (PCL-R) was used to assess the presence of ASPD in the ex-combatants group, as well as the Diagnostic Interview for Genetic Studies (DIGS) for other mental disorders classified in the DCI-10. Results: There are significant differences in psychopathy levels between groups, as well as in alpha-2 and beta waves, especially in left temporal and frontal areas for alpha-2 waves and left temporal-central regions for beta waves. Conclusions: qEEG measurements allow spectral resting potential to be differentiated between groups that are related with features typically involved in antisocial personality disorder, and to correlate them with patterns in the questionnaires and clinical interview.

Feeding difficulties are not associated with higher rates of iron deficiency anemia in Brazilian children and adolescents: cross-sectional study

Background: Iron deficiency anemia and feeding difficulties (FD) are common issues in childhood, reinforcing the concern about the risk of micronutrient deficiencies. FD do not necessarily reflect nutritional deficiencies, since they may or may not relate to specific nutrient sources. The objective of the study is to describe the prevalence of iron depletion and iron deficiency anemia in children with FD and to seek associations with diagnosis and its markers. Methods: This is a cross-sectional study with 68 patients (convenience sample). The following data were assessed through medical records: age (months), gender, exclusive breastfeeding duration (months), birth weight (kg), iron supplementation, hemoglobin (Hb), ferritin, and C-reactive protein (CRP) levels, repertory of foods consumed (food inventory and 3-day food record analysis), and diagnosis of FD. Data were classified according to references for age and were analyzed using correlation tests, Student's t test, ANOVA and chi-square test, or its nonparametric equivalents. A significance level of 5% was considered. Results: Iron depletion and anemia were identified in 10.1 and 6% of children, respectively. Picky eating was diagnosed in 35.3%. Food repertory consisted on average of 21 foods, with null correlation to Hb and ferritin. The average fortified milk intake was 517 ml/day, with null correlation to Hb. There was no effect of diagnosis of FD on Hb (p = 0.18) or ferritin (p = 0.52). The same was verified in the children without supplementation, to both Hb (p = 0. 54) and ferritin (p = 0.08). Conclusions: No evidence of association between diagnosis of FD or repertory of foods to anemia or iron depletion was found, which could be a reassuring factor for caregivers. Reproduction in large scale as well as inclusion of dietary intake variables is suggested for further research.

Does family mealtime have a protective effect on obesity and good eating habits in young people? A 2000-2016 review / Fazer refeições em família tem efeito protetor para a obesidade e bons hábitos alimentares na juventude? Revisão de 2000 a 2016

Abstract Objectives: to review the prevalence of family meals and its impact on BMI and eating habits during childhood and adolescence. Methods: reviews are from Bireme / Lilacs / Scielo / Cochrane and Pubmed, between 2000-2016 with descriptors "family meal or mealtime", "behavior", "nutrition or diet or consumption or eating", and "child or children or adolescence"; performed by two independent examiners, according to the systematic steps in English and Portuguese. The articles were selected based on prevalence and/ or discussion between nutritional variables. 2,319 articles were found, which 15 were selected all in English: systematic reviews (n=2), cross-sectional studies (n=8), longitudinal studies (n=8); all related to children (n=5), adolescents (n=6) and both (n=5). Results: the mean of shared meals was 1x/day, with a prevalence of 27 to 81%. Most studies (n=13) reported the beneficial impact on BMI, higher consumption of fruit and vegetables, protein, calcium and a lower consumption of sweets and sugar sweetened beverages, family union and self-regulation of appetite. Conclusions: having daily family mealtime has beneficial effect on the nutritional status and children and adolescents' eating behavior.

Resumo Objetivos: revisar a prevalência da prática de refeições em família e seu impacto no IMC e no comportamento alimentar durante a infância e adolescência. Métodos: revisão nas bases Bireme / Lilacs / Scielo / Cochrane e Pubmed, entre 2000 a 2016, com descritores "refeição em família", "comportamento", "alimentação ou dieta ou ingestão alimentar" e "criança/adolescentes"; realizada por dois examinadores independentes e segundo etapas sistemáticas, em inglês e português. Foram selecionados trabalhos que apresentassem a prevalência e/ou discussão de relações entre variáveis nutricionais. Foram encontrados 2319 artigos, dos quais 15 foram selecionados, todos na língua inglesa: revisões sistemáticas (n=2), estudos transversais (n=8), estudos longitudinais (n=8); todos com crianças (n=5), adolescentes (n=6) e ambos (n=5). Resultados: a média de compartilhamento de refeições foi de 1x/dia, com prevalência de 27 a 81%. A maioria dos estudos (n=13) descreveu impacto benéfico sobre o IMC, maior consumo de FLV, proteínas, fontes de cálcio e menor consumo de doces e bebida adoçadas, união familiar e auto regulação do apetite. Conclusões: a realização das refeições em família diariamente exerce efeito benéfico sobre o estado nutricional e comportamento alimentar de crianças e adolescentes.

Perfil psiquiátrico, cognitivo y de reconocimiento de características emocionales de un grupo de excombatientes de los grupos armados ilegales en Colombia / Psychiatric, Cognitive and Emotional Profile in Ex-combatants of Illegal Armed Groups in Colombia

Introducción: La exposición al conflicto armado produce adaptaciones biológicas y psicológicas orientadas a hacer frente al entorno de guerra. Las condiciones particulares del conflicto colombiano hacen un escenario especial en la exploración del comportamiento humano posterior a la exposición al combate. Objetivo: Describir las características psiquiátricas, cognitivas y del procesamiento emocional de un grupo de excombatientes del conflicto armado colombiano. Métodos: Se evaluó a 63 excombatientes y 22 controles en diferentes dominios a través del WAIS (coeficiente intelectual), el INECO Frontal Screening (función ejecutiva), el Interpersonal Reactivity Index (empatía), el reconocimiento de características emocionales y la MINI (perfil psiquiátrico). Resultados: En comparación con los controles, los excombatientes mostraban con mayor frecuencia trastorno de personalidad antisocial (p = 0,031) y trastorno disocial de la conducta (p = 0,017). En el dominio cognitivo, se evidenció peor desempeño en la función ejecutiva de los excombatientes (Me = 18,50; RQ = 4,00) que entre los controles (Me = 23,00; RQ = 5,25), acompanado de un pobre distrés personal en el componente empático (Me = 10,00; RQ = 5,00) respecto al grupo control (Me = 37,00; RQ = 7,25). Conclusiones: Las diferencias en función ejecutiva, distrés personal y perfil psiquiátrico de los excombatientes podrían estar asociadas a los comportamientos adaptativos de los individuos en el entorno de guerra.

Introduction: Exposure to armed conflict produces biological adaptations oriented to handle the highly stressful conditions in war environments. The special features of The Colombian armed create a special scenario to evaluate the human behavior. Objective: In this study, psychiatric, cognitive and emotional processing characteristics of a group of Colombian armed illegal forces of excombatants are described. Methods: Sixty-three ex combatants and 22 controls were assessed with WAIS (IQ), INECO frontal screening (executive functions), Interpersonal Reactivity Index (empathy), emotional features recognition and MINI (psychiatric profile). Results: When compared to the control group, ex-combatants showed higher frequency of antisocial personality disorder (P=.031) and behavioral dissocial disorder (P=.017). In cognitive profile, the ex-combatants showed a lower score in the executive function test (Me = 18.50; RQ=4.00), control (Me = 23.00; RQ=5.25), with a poor personal distress in emphatic profile (Me = 10.00; RQ= 5.00) compared to control group (Me = 37.00; RQ= 7.25). Conclusions: We found differences in cognitive and psychiatric profile in ex-combatants in comparison with controls.

Como acompanhar a criança com dificuldade alimentar em escopo multidisciplinar?: Protocolo de atendimento multiprofissional na infância e adolescência - estudo piloto / How to monitor children with feeding dif fi culties in a multidisciplinary scope?: Multidisciplinary care protocol for children and adolescents ­ pilot study

OBJECTIVES: To present the results of the implementation of a multidisciplinary approach to feeding difficulties in childhood and adolescence in a reference service METHODS: The protocol was designed for outpatient patients aged from zero to 19 years old, with complaints of feeding difficulties and without psychiatric diagnoses, with signed parental consent. The protocol consists of paediatrician, speech therapist and nutritionist assessment in the same appointment, with common observation of evaluations and following multidisciplinary discussion. Diagnoses were categorized according Kerzner et al , and parenting styles according to Hughes20. Statistical analysis was conducted via SPSS v21 through frequency distribution (%), mean ± standard deviation, Chi-square test and ANOVA. Significance level was considered at 5% RESULTS: Sample consisted of 56 children, 67.9% of males, most (75%) younger than 5 years old. The most frequent diagnosis was selectivity (30%). There was association between diagnoses and organic diseases in 30%. Start of complaints occurred at 18 months old. Speech-therapy alterations were detected mostly in speech (29%) and oral-motor skills (32%). Anthropometric assessment showed average normal growth patterns and average dietary assessment of protein intake derived from dairy products was above recommendations (18g/day CONCLUSIONS: Results herein justify the presence of the multidisciplinary team in monitoring feeding difficulties in childhood and adolescence, and highlight the importance of longitudinal research nationwide

OBJETIVO: Apresentar os resultados da implantação do serviço de referência em atendimento multidisciplinar exclusivo para dificuldades alimentares na infância e adolescência MÉTODO: Protocolo idealizado para assistência ambulatorial de pacientes entre zero e 19 anos com queixas de dificuldades alimentares, sem diagnósticos psiquiátricos e com consentimento dos pais por escrito. O protocolo consiste no atendimento de pediatra, fonoaudióloga e nutricionista na mesma consulta, com observação dos atendimentos e discussão multiprofissional posterior. Os diagnósticos foram categorizados segundo Kerzner et al, e estilos parentais segundo Hughes et al20. A análise estatística foi realizada via SPSS v21, através de frequência de distribuição (%), média ± desvio padrão, teste Qui-quadrado e ANOVA. Foi considerado nível de significância em 5% RESULTADOS: Obteve-se amostra final de 56 crianças, 67,9% do sexo masculino, menores de 5 anos (75%). O diagnóstico mais frequente foi o de seletividade alimentar (30%). Em 30% dos casos houve associação a alterações orgânicas. O aparecimento da queixa ocorreu, em média, aos 18 meses. Foram detectadas alterações fonoaudiológicas na fala (29%) e motricidade oral (32%). A avaliação antropométrica revelou média de eutrofia, e a dietética identificou ingestão de proteínas lácteas acima das recomendações (18g/dia CONCLUSÕES: Os resultados justificam a necessidade da equipe multiprofissional no acompanhamento da dificuldade alimentar na infância e adolescência, e evidenciam a importância da continuidade do tema em pesquisas longitudinais em âmbito nacional

Análisis de la aproximación de Alcohólicos Anónimos a los pacientes hospitalizados / Analysis of Alcoholics Anonymous' approach to hospitalized patients

Antecedentes: El porcentaje de dependientes alcohólicos que acude a los grupos de autoayuda aumentó del 33.4% en 2008 al 43.7% en 2011 según las Encuestas Nacionales de Adicciones. Alcohólicos Anónimos (AA) y su programa de Doce Pasos representa el principal modelo de autoayuda en México. El 12° Paso o llevar el mensaje es una estrategia común para atraer nuevos miembros a los grupos de AA y se realiza frecuentemente en salas hospitalarias.Objetivo: Describir la actividad de llevar el mensaje en un contexto hospitalario para identificar los significados implicados y la manera de relacionarse con los pacientes.Método: Se utilizó una aproximación etnográfica para observar la actividad de nueve miembros de AA en un hospital de tercer nivel de la Ciudad de México a lo largo de diez meses. Se aplicó el modelo del sistema de actividad para la organización e interpretación de los datos.Resultados: La actividad de llevar el mensaje tiene seis momentos principales: 1. Autopresentación del alcohólico en recuperación; 2. Definición del alcoholismo como una enfermedad sin cura; 3. Los Doce Pasos de AA como una alternativa; 4. Autodiagnóstico; 5. Preguntar sobre el consumo; 6. Invitación a las juntas del grupo de AA en el hospital. Los miembros de AA utilizan sus relatos personales para comunicar la visión de AA sobre el alcoholismo y la recuperación.Discusión y conclusión:Llevar el mensaje se orienta principalmente por el significado de la negación del alcoholismo. Las acciones de los AA están diseñadas para evitar la negación y promover la aceptación de la enfermedad. Además, el mismo contexto hospitalario legitima la presencia de AA y sus Doce Pasos. Llevar el mensaje nos presenta una estrategia para disminuir el estigma asociado con la dependencia alcohólica, el cual es uno de los principales obstáculos para solicitar ayuda.

Background: The percentage of alcohol dependents who attend self-help groups increased from 33.4% in 2008 to 43.7% in 2011 according to the National Surveys of Addictions. Alcoholics Anonymous (AA) and their Twelve Steps program represent the main model for self-help in Mexico. The 12th Step or carrying the message is a common strategy to attract new members into AA groups and it is done frequently at hospital wards.Objective: To describe the activity of carrying the message in a hospital context in order to identify the meanings involved and how AA members relate to the patients.Method: An ethnographic approach was used to observe the activity of nine AA's members in a third level hospital in Mexico City over a ten-month period. The activity system model was used for data organization and interpretation.Results: The carrying the message activity consists of six core moments: 1. Self-introduction of the recovering alcoholic; 2. Defining alcoholism as an incurable disease; 3. AA's Twelve Steps as an alternative; 4. Self-diagnosis; 5. Ask about consumption; 6. Invitation to hospital AA's group meetings. The AA's member uses personal experience's stories to convey AA vision about alcoholism and recovering.Discussion and conclusion: The carrying the message activity is mainly oriented by the meaning of alcoholism-denial. The AA's actions are designed to avoid denial and to promote disease acceptance. Furthermore, the hospital setting itself legitimizes the AA presence and their Twelve Steps. Carrying the message presents a strategy to diminish stigma related to alcohol dependency which is one of the main obstacles for seeking help.

O papel do fonoaudiólogo no diagnóstico e tratamento multiprofissional da criança com dificuldade alimentar: uma nova visão / The role of the speech language pathologist in the diagnosis and multidisciplinary treatment of children with feeding difficulties: a new vision

O presente artigo relata o caso clínico de paciente de dois anos e seis meses atendida por equipe multidisciplinar. A paciente apresentou dificuldades alimentares caracterizadas por recusa alimentar, tempo prolongado das refeições, defesa sensório-oral, reflexo de vômito anteriorizado e dificuldade mastigatória. Não se alimentava sozinha, nem participava das refeições em família. Apresentava refluxo gastroesofágico, alergia a proteína do leite de vaca e tosse seguida por vômito. Não apresentou comprometimento pondero-estatural. Foi utilizado o Programa de Refeição Compartilhada. Após acompanhamento médico, a conduta de trabalho foi definida e iniciada pelo trabalho sensório-oral, seguido do trabalho com a mastigação, associados ao trabalho de orientação familiar. A paciente passou a realizar as refeições com a família e participar das rotinas sociais de alimentação. O tempo de refeição foi reduzido e a recusa alimentar eliminada. Os aspectos sensório-motores-orais melhoraram significantemente. Após a alta e reavaliação em três meses, apresentou melhora no refluxo gastro-esofágico e a medicação foi suprimida. A nutricionista iniciou a introdução de derivados do leite, com boa aceitação por parte da paciente. O programa utilizado mostrou-se eficaz para o diagnóstico e tratamento da dificuldade alimentar apresentada pela paciente. A equipe multidisciplinar foi capaz de ter uma visão ampliada da dificuldade alimentar apresentada pela paciente, compreendendo as questões motoras, orais, orgânicas e nutricionais da alimentação da criança inseridas no seu contexto familiar.

The article reports the case study of a two year and six month old female patient, attended by a multidisciplinary team. Patient presented feeding difficulties such as food refusal, long lasting meals, oral-sensory defensiveness, anterior vomiting reflex and difficulties in chewing. She did not feed herself nor took part in family mealtimes. Presented gastro esophageal reflux, allergy to cow's milk protein and coughs followed by vomiting, without impairment of weight or height. The Mealtime Partners Program was method of treatment choice. After treatment of medical issues, the working method was established and initiated with oral sensory development, followed by chewing development and associated to family counseling. Patient started having meals with the family and taking part in social mealtime routines. Duration of meals diminished and food refusal was eliminated. Motor-oral system patterns improved significantly. Reassessment in 3 months showed reduction in gastroesophageal reflux symptoms and medication was removed. The nutritionist introduced dairy products with good acceptance. The Mealtime Partners Program, proved to be effective in the diagnosis and treatment of the feeding difficulties presented. The multidisciplinary team had a broad view of feeding difficulties presented by the patient, comprising motor, oral, organic and nutritional issues of feeding regarding the child's family background.

Valoración de la efectividad del soporte nutricional por sonda nasogástrica en sala general / Assessment of the efficacy of nasogastric nutritional support in a general ward / Valorização da efetividade do suportenutricional por sonda nasogástricaem enfermaría

La interrupción de la alimentación enteral conduce a un aporte calórico inadecuado, circunstancia que se agrava debido al estado catabólico que presentan los pacientes internados, contribuyendo ambas situaciones al deterioro de su estado nutricional. La malnutrición calóricoproteica se asocia con un mayor número de complicaciones, con un incremento de la estadía hospitalaria y, por lo tanto, con mayores costos. Objetivos. Evaluar la calidad del soporte nutricional por sonda y cuáles son los factores que influyeron en las diferencias entre la cantidad de nutrientes administrados, pautados y teóricamente requeridos. Material y métodos. Pacientes adultos a quienes se les prescribía nutrición enteral por sonda nasogastro/enteral. Se calcularon diariamente las calorías pautadas y las administradas, mientras que los requerimientos calóricos teóricos se calcularon según la ecuación de Harris-Benedict a la que se le aplicaba un factor de estrés y actividad. Asimismo, se evaluaron las causas por las que se interrumpió la nutrición enteral. Resultados. De un total de 40 pacientes consecutivos que recibieron soporte nutricional enteral un 95% presentó administración inadecuada. Hubo una inadecuación de la prescripción médica de la alimentación enteral en un 70% relacionado con el requerimiento calórico total. El bajo ratio de calorías administradas-pautadas afectaban a la Nutrición Enteral, debido a las causas más importantes de interrupción (que acumulan el 80% de las interrupciones):a) relacionadas al personal de enfermería (32.5%), b) incumplimiento en el horario de entrega del alimento (20%), c) problemas mecánicos (12.5%), d) procedimientos diagnósticos (10%) y e) disfunción gastrointestinal(10%). Conclusiones. En nuestra unidad se observó una diferencia importante entre los requerimientos calóricos teóricos y la cantidad efectivamente administrada. El conocimiento de esta situación permitirá ...

Background. The interruption of enteral feeding leads to inappropriate caloric intake, circumstance aggravated by the catabolic state of inpatients and both factors contributing to the deterioration of their nutritional status.Protein-energy malnutrition is associated with more complications, increased hospital stay, and therefore higher costs.Objective. To evaluate the quality of enteral nutritional support and the factors influencing the differences between the amounts of nutrients managed, scheduled and theoretically required.Materials y methods. Adult patients prescribed enteral nutrition by nasogastric/enteral tube. The calories administered and estimated were daily calculated, while theoretical caloric requirements were calculated according to the Harris-Benedict equation with an applied factor of stress and activity. The reasons leading to enteral nutrition cessationwere also evaluated.Results. Of the 40 consecutive patients who received enteral nutritional support, 95% reported inadequate administration. There was an inadequate medical prescription of enteral feeding by 70%, related to total caloric requirements. The low ratio of calories prescribed-administered affected enteral nutrition due to the following main causes of interruption (which accumulate 80% of interruptions): nurses/' work (32.5%), failure in the delivery of the scheduled food (20%), mechanical problems (12.5%), diagnostic procedures (10%) and gastrointestinal dysfunction (10%). Conclusions. In our unit we could observe an important difference between the theoretical energy requirements and the amounts effectively administered. Acknowledging...

A interrupção da alimentação enteral conduza uma contribuição calórica inadequada, circunstância que se agrava devido o estado catabólico que apresentamos pacientes internados, contribuindo ambas as situaçõespara a deterioração do seu estado nutricional. A má nutriçãocalórica-proteica é associada a um maior número decomplicações, com um incremento da estadia hospitalariae, portanto, com maiores custos.Objetivos. Avaliar a qualidade do suporte nutricional porsonda e quais são os fatores que influenciaram nas diferençasentre a quantidade de nutrientes administrados, determinadose teoricamente requeridos.Material e métodos. Pacientes adultos que recebiam prescriçãonutricional enteral por sonda nasogastroenteral. Foramcalculadas diariamente as calorias determinadas e asadministradas enquanto que os requerimentos calóricoseram calculados segundo a equação de Harris-Benedictna qual se aplicava um fator de estresse e atividade. Alémdisso, foram avaliadas as causas pelas quais a nutriçãoenteral foi interrompida.Resultados. De um total de 40 pacientes ...

Dermatitis liquenoide anular de la juventud en un adulto: presentación de un caso clínico / Annular lichenoid dermatitis of youth (ALDY) in an adult patient: a clinic case

La dermatitis liquenoide anular es una entidad clínica recientemente descrita que se presenta como placas circularesceritematosas con centro hipopigmentado y evolución crónica. A pesar de que los diagnósticos diferenciales puedencser diversos la histopatología es muy característica. Siendo la mayor parte de los casos descritos en niños, se le dio el nombre de ALDY, aunque se han visto casos en la adultez. Presentamos el caso de un paciente varón adulto, de 41 años, como aporte al conocimiento de esta patología.

Annular lichenoid dermatitis of youth is a clinical entity recently described that presents as circular plaques hipopigmented centre and chronic evolution. Despite of several differential diagnoses, this pathology is characterized by its histopathology. As most cases has been described in children, it was named as ALDY;but has seen cases in adults. A case of a 41 years old male is presented as a contribution for the knowledge of this pathology.

Liquen estriado del adulto: experiencia en un servicio de Dermatología / Adult lichen striatus: experience in dermatology service

Introducción. El liquen estriado es una dermatosis que sigue el trayecto de las líneas de Blaschko, se presenta característicamente en población pediátrica y es rara en pacientes adultos. Objetivo. Describir las características epidemiológicas y clínicas de los pacientes adultos con diagnóstico de liquen estriado diagnosticados en el período 1998-2010 en el Hospital Nacional Daniel Alcides Carrión (HNDAC). Material y Métodos. Estudio descriptivo de tipo serie de casos. Se revisó las historias clínicas de los casos de liquen estriado y se obtuvo datos epidemiológicos (edad, sexo), antecedentes de importancia (comorbilidad) y aspectos clínicos de los pacientes (tiempo de enfermedad, características de las lesiones, síntomas asociados). Los datos obtenidos fueron registrados en un instrumento de recolección de datos. Resultados. Ingresaron al estudio un total de 10 casos, el promedio de edad fue de 27 años (rango 16-48 años), 80% de los casos fueron de sexo femenino. Las lesiones clínicas eran placas formadas por pápulas milimétricas levemente descamativas de color piel, eritematosas o ligeramente hipopigmentada de distribución lineal y que seguían las líneas de Blaschko. Las lesiones se presentaron con mayor frecuencia en miembros inferiores (60%) y tronco (40%). El síntoma más frecuentemente referido porlos pacientes fue prurito (70%). La comorbilidad más frecuente fue atopía que se presentó en 40% de los pacientes. Conclusión. Los pacientes adultos con diagnóstico de liquen estriado del HNDAC presentan características clínicas similares a las descritas en pacientes pediátricos. La atopía constituye la comorbilidad más frecuente.

Back ground. Lichen adult is a dermatosis that follows the Blaschko lines, tipically it present in pediatrics population and is rare in adult patients. Objective. Describe the epidemiological and clinical characteristics with diagnosis of lichen striatus that were diagnosed between1998-2010 at National Hospital Daniel Alcides Carrion (HNDAC). Material and methods. Descriptive study of a case series. Clinical records were reviewed, obtaining epidemiological data (age, genre), background of importance (comorbidity) and clinical aspects of the patients ( time of illness , characteristics of the injuries, associated symptoms) that were recorded in a data collection instrument. Results. Ten cases were enrolled, the age average was 27 years old (range 16-48 years), 80% of cases corresponded to females. Clinical injuries were plates formed by millimeter papules slightly descamatives of skin color, eritematoses or slightly hypopigmentated od linear distribution and that followed the blaschko lines. Injuries were presented with more frequency at the lower limbs (60%) andin trunk (40%). The most frequent symptom was the pruritus (70%).The most frequent comorbidity was the atopy, presents in 40% of the patients. Conclusion. Adult patients with diagnosis of lichen striatus atthe HNDAC present clinical characteristics similar to pediatrics patients. The comorbility more frequent is the atopy.

La promoción della salud en la primera infancia evolución del concepto y su applicación en el contexto internacional y nacional / The evolution of the concept of health promotion during early childhood and its international and national application

Sin duda alguna la primera infancia ha sido considerada la fase de desarrollo más importante de todo el ciclo vital. Es un período fundamental en la constitución del ser humano, de sus competencias, habilidades y de su manera de relacionarse con el mundo. Durante la niñez se llevan a cabo importantes procesos de maduración y aprendizaje que son los que le permiten interactuar, integrarse y desarrollar al máximo como persona, por lo tanto, el sano desarrollo infantil se ha relacionado con la disminución de problemas tales como: la obesidad, el sedentarismo, las dificultades en el desarrollo psicomotor, entre otros. En este sentido, las estrategias de promoción de la salud en la primera infancia pretenden lograr un impacto positivo en la salud de los niños y niñas, adaptándose a las necesidades y posibilidades en lo local, con participación activa de padres, madres, cuidadores, docentes y de la comunidad. La presente revisión, que surge del trabajo final de la Especialización en alimentación y nutrición en promoción de la salud, se centró en investigar la evolución del concepto de promoción de la salud, las experiencias y acciones de promoción de la salud en la primera infancia, las bases conceptuales más importantes que enmarcan la promoción de la salud en este grupo de población y la relación entre la normatividad que propende por la garantía de los derechos de los niños(as) y la promoción de la salud en busca de su desarrollo integral.

Without doubt, early childhood has been considered the most important developmental phase in the whole lifecycle. It is a fundamental period in human constitution, skills, abilities and way of relating to the world. Important learning and maturation occur during childhood which allows one to interact, integrate and develop to the maximum as a person; healthy child development has been related to a reduction of problems such as obesity, sedentary behaviour and psychomotor development difficulties. Early childhood health promotion strategies are aimed at making a positive impact on boys' and girls' health, being adapted to local needs and possibilities, involving the active participation of fathers, mothers, caretakers, teachers and the community. This review (arising from work done at the end of the specialisation in food and nutrition in health promotion course) has been focused on investigating the evolution of the health promotion concept, health promotion experience and action during early childhood, the most important conceptual bases framing health promotion in this group of the population and the relationship between regulations aimed at guaranteeing children's rights and promoting health in the search for their integral development.

Psoriasis en pacientes con VIH: presentación de nueve casos / Psoriasis in HIV patient: presentation of nine cases

La psoriasis es una enfermedad inflamatoria crónica multifactorial y de base genética, cuya incidencia se estima entre 0,5% y 2% en nuestra población. El VIH es una infección cada vez más frecuente, cuyos pacientes se afectan también de psoriasis antes o después de su diagnóstico, siendo una interrogante frecuente si la enfermedad influye de alguna manera en la presentación o severidad de esta última, como lo hace en otras dermatosis. Siendo la comorbilidad VIH y psoriasis un reto terapéutico, sobre todo en pacientes con cuadros más severos por la polifarmacia que estos reciben. Se presentan y analizan nueve casos, con ambos diagnósticos, evaluados en el Servicio de Dermatología del Hospital Daniel A. Carrión del Callao, entre 2007 y 2011.

Psoriasis is a chronic, multifactorial, genetic and inflammatory disease which incidence is estimated between 0,5 and 2% in our population. HIV is now a more frequent infection, this patient can be affected by psoriasis before or after the diagnosis, been frequent question if HIV change in any way in presentation or severity like HIV does in other dermatosis. Comorbidity HIV-psoriasis is otherwise a therapeutic challenge, especially in the most critical cases due to polypharmacy. Nine cases attended in the Service of Dermatology of the Hospital Daniel A. Carrión arepresented and analized.