Public Attention to Crime of Schizophrenia and Its Correlation with Use of Mental Health Services in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: This study was performed to examine the effects of the public attention to ‘crime of schizophrenia’ on the use of mental health services in patients with schizophrenia using big data analysis. METHODS: Data on the frequency of internet searches for ‘crime of schizophrenia’ and the patterns of mental health service utilization by patients with schizophrenia spectrum disorders by month were collected from Naver big data and the Health Insurance Review and Assessment Services in Korea, respectively. Their correlations in the same and following month for lagged effect were examined. RESULTS: The number of outpatients correlated negatively with public attention to ‘crime of schizophrenia’ in the same month. The lagged relationship between public attention and the number of admissions in psychiatric wards was also found. In terms of sex differences, the use of outpatient services among female patients correlated negatively with public attention in the same month while the number of male patients' admissions in both same and following month correlated positively with public attention. CONCLUSION: These findings suggested that public attention to ‘crime of schizophrenia’ could negatively affect illness behavior in patients with schizophrenia.

Exercise, illness and drug use: guiding principles for approaching a complex triad

Regular, low to moderate intensity exercise is considered beneficial to the human body, not only having ergogenic advantages, but also being anti-inflammatory, cardio- and neuroprotective.1 On the other hand, although high intensity training (HIT) is able to exaggerate cardiac conditions, e.g., hypertension2 as well as exacerbate inflammatory and oxidative stress responses,1,3 such exercise programs are becoming more popular as they too have shown demonstrable health benefits if performed appropriately. Indeed, various studies have reported on the superior beneficial cardiac and vascular effects of high intensity exercise programs over that of moderate intensity continuous training (MICT),4-7 contributing to the growing popularity of such time-efficient programs. As such, exercise can accurately be described as a double-edged sword ­ able to induce positive, beneficial physiological effects when performed chronically at lower intensities, but generating harmful effects when performed at high intensities without sufficient recovery periods. From a toxicological point of view, exercise mediates hormesis, i.e., the biphasic dose response to an environmental agent characterised by a low dose stimulation or beneficial effect and a high dose inhibitory or toxic effect.8

Evaluación de las diferencias de género en las estrategias de afrontamiento del dolor lumbar / Assessment of gender differences in strategies in coping with low back pain / Avaliação das diferenças de gênero nas estratégias de enfrentamento da dor lombar

El dolor lumbar puede ser visto como gran problema de salud pública. Las diferencias de género son importantes factores que influyen en los síntomas y en las respuestas del comportamiento. El objetivo de este estudio fue investigar las diferencias de género en los comportamientos de dolor y en el manejo del dolor lumbar crónico. La muestra estuvo conformada por 158 participantes (66,5% mujeres), con edades entre los 30 y 88 años que fueron diagnosticados con artrosis lumbar. Los instrumentos utilizados fueron la Escala Visual Analógica, el Cuestionario de Calidad de Vida y un cuestionario para evaluar las actividades de ocio y distracción del dolor. Los resultados del MANOVA demostraron que las mujeres presentaron mayor percepción del dolor que los hombres. También fue posible observar frecuencias más altas de actividades sociales en las mujeres, así como correlaciones significativas entre las actividades sociales y los dominios psicológicos, sociales y medio ambientales. En conclusión, las mujeres presentan mayor número de estrategias de afrontamiento para el dolor, lo cual puede tener influencia positiva en su calidad de vida.

Low-back pain is considered a serious public health problem. Gender differences are important factors that influence the symptoms and behavioral responses. This research aimed to investigate gender differences in pain behaviors and pain management of chronic low back pain. The sample consisted of 158 participants (66.5% female), aged 30-88 who were diagnosed with Lumbar Osteoarthritis. The instruments used were the Visual Analogue Scale, the Quality of Life Questionnaire and a questionnaire to assess leisure and distraction activities from pain. Results of MANOVA showed that women have significant greater pain perception than men. Higher frequencies of social activities were also observed for women, as well as significant correlations between social activities and psychological, social and environmental domains. In conclusion, women presented a greater number of coping strategies for pain than men, which probably tend to have a positive influence in their life quality.

A dor lombar pode ser vista como um grande problema de saúde pública. As diferenças de gênero são importantes fatores que influenciam nos sintomas e nas respostas do comportamento. O objetivo deste estudo foi pesquisar as diferenças de gênero nos comportamentos de dor e na gestão da dor lombar crônica. A amostra foi conformada por 158 participantes (66,5% mulheres), com idade entre 30 e 88 anos, que foram diagnosticadas com artrose lombar. Os instrumentos utilizados foram: a Escala Visual Analógica, o Questionário de Qualidade de Vida e um questionário para avaliar as atividades de lazer e distração da dor. Os resultados do MANOVA demonstraram que as mulheres apresentaram maior percepção da dor do que os homens. Também foi possível observar frequências mais altas de atividades sociais nas mulheres, bem como correlações significativas entre as atividades sociais e os domínios psicológicos, sociais e meio ambientais. Em conclusão, as mulheres apresentaram um maior número de estratégias de enfrentamento para a dor, o que pode influenciar positivamente em sua qualidade de vida.

Behavioural alterations are independent of sickness behaviour in chronic experimental Chagas disease

The existence of the nervous form of Chagas disease is a matter of discussion since Carlos Chagas described neurological disorders, learning and behavioural alterations in Trypanosoma cruzi-infected individuals. In most patients, the clinical manifestations of the acute phase, including neurological abnormalities, resolve spontaneously without apparent consequence in the chronic phase of infection. However, chronic Chagas disease patients have behavioural changes such as psychomotor alterations, attention and memory deficits, and depression. In the present study, we tested whether or not behavioural alterations are reproducible in experimental models. We show that C57BL/6 mice chronically infected with the Colombian strain of T. cruzi (150 days post-infection) exhibit behavioural changes as (i) depression in the tail suspension and forced swim tests, (ii) anxiety analysed by elevated plus maze and open field test sand and (iii) motor coordination in the rotarod test. These alterations are neither associated with neuromuscular disorders assessed by the grip strength test nor with sickness behaviour analysed by temperature variation sand weight loss. Therefore, chronically T. cruzi-infected mice replicate behavioural alterations (depression and anxiety) detected in Chagas disease patients opening an opportunity to study the interconnection and the physiopathology of these two biological processes in an infectious scenario.

Illness perception, knowledge and self-care about cervical cancer / Percepção da doença, conhecimento e autocuidado sobre o câncer do colo do útero

Prevention plays a central role in early detection of cervical cancer. Common Sense Model proposes that the nature and organization of illness representations can guide actions related to health and how self-care is exercised. The aim of this study was to describe and compare illness perception, knowledge and self-care in women with and without cancer precursor lesions. Participants were 92 women (aged 18-59) from primary care unity divided into two groups: women with and without premalignant lesion. Measures for illness perception, knowledge and self-care were used. There was no statistically significant difference (t test e chi-square test) between groups in the variables analyzed. Despite the risk for cervical cancer, women with precursor lesions do not adjust their illness perceptions, knowledge and self-care to the situation. These data show the need to warn women against the cervical cancer risks, because their distorted perceptions and lack of knowledge about the disease may hamper the screening and control of cervical cancer.

A prevenção tem papel central na detecção precoce do câncer do colo do útero. O Modelo do Senso Comum propõe que a natureza e a organização das representações da doença podem orientar ações relacionadas à saúde e ao modo como o autocuidado é exercido. Este estudo buscou caracterizar e comparar a percepção da doença, o conhecimento e o autocuidado em mulheres com e sem lesões precursoras de câncer do colo do útero. Participaram 92 usuárias de uma Unidade Básica de Saúde (18-59 anos), dividas em dois grupos pareados por idade e escolaridade: com e sem lesões precursoras do colo do útero. Foram utilizados instrumentos de avaliação da percepção da doença, conhecimento sobre o câncer do colo do útero e autocuidado. Não houve diferenças estatisticamente significativas (teste t e qui-quadrado) entre os grupos quanto às variáveis investigadas. Apesar de estarem em risco para o câncer do colo do útero, as mulheres com lesões precursoras não ajustaram sua percepção da doença, conhecimento e autocuidado à situação. Esse dado alerta para a necessidade de sensibilizar as mulheres sobre o risco da doença, já que percepções errôneas e o desconhecimento sobre a doença podem dificultar o seu amplo rastreio e controle.

Theory of unpleasant symptoms: support for the management of symptoms in children and adolescents with cancer / Teoría de los síntomas desagradables: subvenciones para manejar síntomas en niños y adolescentes con câncer / Teoria dos sintomas desagradáveis: subsídios para o manejo de sintomas em crianças e adolescentes oncológicos

Objective: To present an overview of the clusters of neuropsychological symptoms in children and adolescents with cancer from the perspective of the Theory of Unpleasant Symptoms.Methods: A theoretical and reflective study based on international literature and the critical analysis of the authors.Results: In scientific literature, there is scarcity of international studies and an absence of studies in Brazil regarding the neuropsychological symptom clusters in children and adolescents with cancer. The theory of unpleasant symptoms is consistent because it emphasizes the complexity and interaction of the symptoms, the interrelationship between symptoms, the factors that influence symptoms, and the results and consequences of symptoms, thus supporting the planning of nursing interventions in paediatric oncology.Conclusion: It is essential to update knowledge on this subject and discuss the theories that support research and the clinical practice of symptom management in order to better qualify nursing care.

Objetivo: Presentar el panorama actual de grupos de síntomas neuropsicológicos en niños y adolescentes con cáncer, en perspectiva de Teoría de Síntomas Desagradables.Métodos: Estudio teórico y reflexivo basado en la literatura internacional y el análisis crítico de los autores.Resultados: La literatura científica presenta internacionalmente escasos resultados y que faltan en Brasil con respecto a los grupos de síntomas neuropsicológicos en niños y adolescentes con cáncer. Esta es una teoría consistente, ya que hace hincapié en complejidad e interacción de los síntomas, las interrelaciones entre ellos, los factores que influyen y los resultados y las consecuencias de éstos, el apoyo a la planificación de las intervenciones de enfermería en oncología pediátrica.Conclusión: Actualizar el conocimiento sobre este tema, así como para discutir las teorías que apoyan la investigación y la práctica clínica en el manejo de los síntomas es fundamental para calificar el cuidado de enfermería.

Objetivo: Apresentar o panorama atual dos clusters de sintomas neuropsicológicos em crianças e adolescentes com câncer, na perspectiva da Teoria de Médio Alcance de Sintomas Desagradáveis.Métodos:Estudo teórico-reflexivo baseado na literatura internacional e na análise crítica dos autores.Resultados: A literatura científica apresenta resultados escassos internacionalmente e ausentes no Brasil, no que diz respeito aos clustersde sintomas neuropsicológicos em crianças e adolescentes com câncer. Esta é uma teoria consistente porque enfatiza a complexidade e a interação dos sintomas, as inter-relações entre os mesmos, os fatores que os influenciam e os resultados e consequências destes, corroborando o planejamento de intervenções de enfermagem em oncologia pediátrica.Conclusão: Atualizar o conhecimento desse tema, bem como discutir as teorias que dão suporte à pesquisa e à prática clínica no manejo de sintomas, é parte fundamental para qualificar o cuidado de enfermagem.

Teleaudiometry as a screening method in school children

OBJECTIVE: To compare the efficacy and feasibility of teleaudiometry with that of sweep audiometry in elementary school children, using pure-tone audiometry as the gold standard. METHODS: A total of 243 students with a mean age of 8.3 years participated in the study. Of these, 118 were boys, and 125 were girls. The following procedures were performed: teleaudiometry screening with software that evaluates hearing at frequencies of 1,000, 2000 and 4000 Hz at 25 dBHL; sweep audiometry screening in an acoustic booth (20 dBHL at the same frequencies); pure-tone audiometry thresholds in an acoustic booth (frequencies of 500, 1000, 2000 and 4000 Hz); and acoustic immittance measurements. RESULTS: The diagnostic capacities of the teleaudiometry/sweep audiometry screening methods were as follows: sensitivity  ϝ  58%/65%; specificity  ϝ  86%/99%; positive predictive value  ϝ  51%/91%; negative predictive value  ϝ  89%/92%; and accuracy  ϝ  81%/92%. Teleaudiometry and sweep audiometry showed moderate agreement. Furthermore, the use of these methods in series with immittance testing improved the specificity, whereas parallel testing improved the sensitivity. CONCLUSION: Teleaudiometry was found to be reliable and feasible for screening hearing in school children. Moreover, teleaudiometry is the preferred method for remote areas where specialized personnel and specific equipment are not available, and its use may reduce the costs of hearing screening programs. .

Calidad de vida del paciente con epilepsia. Instituto Nacional de Ciencias Neurológicas junio 2006 - diciembre 2007 / Quality of life of the patients with epilepsy. National Institute of Neurological Sciences, June 2006 - December 2007

La epilepsia es un problema de salud pública en toda Latinoamérica, no siendo el Perú ajeno a la existencia de un gran número de casos. El impacto de esta enfermedad en el ámbito cultural y socioeconómico es importante para el desarrollo de la vida del paciente con epilepsia, siendo necesario el conocimiento de su estándar de vida, en base a lo cual se determinarán las recomendaciones específicas destinadas al mejoramiento del nivel de vida. Objetivo General: Determinar la calidad de vida del paciente con epilepsia que acude al Instituto Nacional de Ciencias Neurológicas entre Junio 2006 y Diciembre 2007. Específicos: a) Determinar el nivel de bienestar físico, b) Determinar el nivel de bienestar psicológico, y c) Determinar el nivel de bienestar social del paciente con epilepsia. Material y método: Estudio de tipo no experimental, observacional, descriptivo, transversal, y retrospectivo. Muestreo no probabilístico. Aplicación del instrumento QOLIE-31 a un total de 120 pacientes admitidos al departamento de epilepsia en el servicio de consultorio externo. Resultados: El mayor número de pacientes correspondía al sexo masculino (57 por ciento), estando la mayoría en el grupo etario: 18-30 años (63 por ciento), tiempo de evolución menor de 10 años (63 por ciento), epilepsia sintomática (76 por ciento), y patrón de presentación de crisis epilépticas: mayor de 1 crisis por semana a 1 crisis al mes (38 por ciento). El 62 por ciento se hallaba en monoterapia antiepiléptica de primera línea. El puntaje global del QOLIE-31 en esta muestra fue de 50.08, bajo en comparación con otras poblaciones estudiadas. En relación a las tres dimensiones de la calidad de vida se evidenció la siguiente puntuación: bienestar físico: sensación de energía o fatiga (6.89) y efectos de la farmacoterapia (1.98); psicológico: preocupación por las crisis (2.83), valoración global de la calidad de vida (8.72), bienestar emocional (6.62), y funciones cognitivas (11.67)...

Rationale Epilepsy is a public health problem in Latin America, and is considered to be a debilitating illness with impaired quality of life (QoL). This study was conducted with the aim to evaluate QoL in a cohort of individuals with epilepsy attending outpatient clinics at the Instituto Nacional de Ciencias Neurológicas (INCN) in Lima, Peru. Methods: We included consecutively patients seen in the outpatient epilepsy clinics at the INCN, between June 2006 and December of 2007. All patients were administered the Quality of Life in Epilepsy Inventory-31, already validated in Spanish. Results: Most of the patients in this cohort were males (57 per cent), most of them were between 18 and 30 years of age (63 per cent), with a 10 year history of epilepsy (63 per cent), diagnosed with symptomatic epilepsy (76 per cent), and with frequent seizures (1 per week to 1 per month, 38 per cent). Most patients (62 per cent) were on monotherapy. The mean score was 50.08 (48 in the female and 52 in the male group). The lowest scores were related to concern about seizures (2.83) and effects of pharmacological treatment (1.98). These scores were particularly seen in those with long history of epilepsy (longer than 10 years). Event though, in younger patients the lowest scores were seen in regards to concern about seizures and emotional behavior, the older patients scored lower in social relationships and emotional behavior. In terms of work, those without family support scored lower than those with it, and the areas that were most affected were the global quality of life, effects of pharmacotherapy, and concerns about seizures. Furthermore, lowest scores were seen in patients with symptomatic epilepsy and with frequent seizures (more than one seizure per week). The validity of the QOLIE-31 was found to be high (Cronbach's alpha=0.74). Conclusions: This preliminary study reveals a low QOL in Peruvian patients attending outpatient clinics at the INCN in Lima. The most compromised...

Experiences of Nurses Caring for Mental Health Care Users in an Acute Admission Unit at a Psychiatric Hospital in the Western Cape Province

Background: Caring for mental health care users (MHCUs) with mental illnesses is a major task that confronts nurses globally. It has been argued that caring for this group of patients is accompanied by unique challenges. Despite the available abundance of data about nursing patients suffering from mental illnesses; little is known about the lived experiences of nurses who care for MHCUs in acute admission units in the Western Cape province.Objectives: This study's aim is to explore and describe the lived experiences of nurses who care for MHCUs in an acute admission unit at a psychiatric hospital in the Western Cape province.Methods: A qualitative; descriptive; phenomenological study was conducted. A purposive sampling procedure was applied which resulted in a sample that comprised eight nurses. Indepth; individual; semi-structured interviews were conducted with these eight participants. Interviews were audio-recorded and transcribed verbatim and the researcher utilised Collaizzi's method to analyse collected data.Results: Both positive and negative experiences were reported. Positive experiences werethe recovery of patients; teamwork; and passion for caring. Negative experiences were the feelings of being unappreciated and unsupported by authorities. Physical assault by MHCUs;shortage of staff; increased workload and burnout was also reported.Conclusions: In-service training about management of aggression needs to be provided; debriefing sessions to deal with burnout needs to be arranged; and research to quantify levelsof burnout should be conducted

Impacto de la primera información de cáncer en el paciente en el Instituto de Enfermedades Neoplásicas / Impact of the first information of cancer in the patient at the Institute of Neoplastic Diseases

La presente tesis de investigación cualitativa tiene como objetivo comprender el impacto de la información del cáncer en el paciente afectado de esta enfermedad, estudio que da a conocer esencialmente cómo es que el paciente que tiene cáncer ha recibido la noticia de su diagnóstico, la manera de cómo se le informó, quién le comunicó, en qué circunstancias, cuál fue la respuesta emocional al enterarse de enfermedad y reacciones emocionales luego de haber tomado conocimiento de esta realidad. La ética utilizada fue la entrevista a profundidad realizada en diecisiete pacientes que fueron atendidos en el Instituto Nacional de Enfermedades Neoplásicas, los cuales fueron incluidos en el estudio, previa solicitud del investigador y aceptación del paciente, Luego del análisis del contenido de los datos de las entrevistas, se obtuvieron tres Categorías: Procurando el diagnóstico, Llegando el momento de la verdad y Sintiendo el Impacto de la Comunicación Sobre la Enfermedad. Del análisis de estas categorías, se obtuvieron dieciséis sub categorías con importantes resultados que se dan a conocer en el análisis temático del estudio. Lo resaltante de este análisis es que un número importante de entrevistados refirieron, luego de recibir la información de su enfermedad, haber sentido un fuerte impacto emocional. La reacción emocional luego de conocido el diagnóstico de cáncer fue variable; manifestaron sentimientos de tristeza, depresión, aislamiento, culpabilidad personal, entre otros. No todos aceptaron de inicio su diagnóstico...

The present qualitative research thesis allows to evaluate the impact of the information of cancer in patients affected with this illness, which announces essentially how it is that the patient who has cancer has received the news of the diagnosis from his doctor, the way how there was informed, who informed, the circumstances, likewise how the patient received the information and the emotional impact after having taken knowledge of the his disease. The depth interviews technique was the utilized in seventeen patients of the Instituto Nacional de Enfermedades Neoplásicas, who previously have been requested and accepted to be included in this study. After the analysis of the collected data results, the outcomes of the interview were systematized in three categories: procuring the diagnosis, coming the true moment and feeling the impact of communication. The complementary evaluation of the subcategories shown interesting results in the contents of all the interviews between the physician and the patient. The analysis of this categories demonstrated a very strong emotional impact in almost all cases, accepting it in most of them, but not easily accepted in others and the emotional reaction was variable as feelings of sadness, depression, isolation, guilt, etc...

Does the previous diagnosis of arterial hypertension affect one s daily life? Pro-Saude Study / Conhecimento de diagnostico previo de hipertensao arterial tem impacto sobre o cotidiano do individuo? Estudo Pro-Saude

In addition to damaging several target organs, arterial hypertension may negatively impact patients' activities of daily living. Biological and behavioral mechanisms underlying such limitations have yet to be clarified. The objectives of this study were to investigate whether having been previously told of a hypertension diagnosis is associated with the frequency and duration of temporary limitations in activities of daily living, and whether these relationships differ by gender, age, or socioeconomic position. We analyzed sectional data from 2,666 participants (56% women; 55% with high school or lower schooling) at the baseline phase (1999 - 2001) of a longitudinal investigation of university employees in Rio de Janeiro, Brazil (Pró-Saúde Study), asking participants whether they had ever been diagnosed with hypertension by a health professional, if they had been unable to perform any activities of daily living due to a health problem in the previous 2 weeks, and for how many days that had occurred. Multinomial logistic regression models were fitted for the overall study population and for age, gender, educational level, and per capita household income strata. Associations between hypertension diagnosis and temporary limitations were not observed in the overall study population and in gender, education and income strata. However, there were higher odds of temporary limitations among participants aged 55 years old or more with hypertension diagnosis (adjusted OR = 9.5; 95%CI 1.5 - 58.6), regardless of blood pressure levels and use of antihypertensive medication. Elderly people may keep an attitude of higher vigilance regarding conditions or events potentially worsening their health status.

Além de lesões em vários órgãos-alvo, a hipertensão arterial pode determinar outras consequências negativas no cotidiano do portador, mas os mecanismos biológicos e comportamentais possivelmente envolvidos ainda não foram esclarecidos. Os objetivos deste estudo foram investigar se o histórico autorrelatado de hipertensão associa-se com freqüência e duração de incapacidade temporária para atividades habituais, e se esta relação modifica-se de acordo com sexo, idade ou posição socioeconômica. Analisamos dados seccionais relativos a 2666 participantes (56% mulheres; 55% ensino médio ou menos) da linha de base (1999 - 2001) de uma investigação longitudinal de funcionários de universidade no Rio de Janeiro (Estudo Pró-Saúde): se o indivíduo alguma vez havia sido informado por profissional de saúde que tinha hipertensão, se nas duas semanas anteriores havia ficado impedido de realizar alguma de suas atividades habituais por problema de saúde, e por quantos dias isso ocorrera. Modelos de regressão logística multinomial foram utilizados para a população total e em estratos de sexo, idade, renda e escolaridade. Não observamos associação entre histórico autorrelatado de hipertensão e ocorrência de incapacidade temporária na população total e em estratos de sexo, escolaridade e renda. Entretanto, essa associação foi evidenciada entre os participantes com 55 ou mais anos de idade (OR ajustada = 9,5; IC95% 1,5 - 58,6), independentemente dos níveis de pressão arterial e do uso de medicação anti-hipertensiva, o que pode expressar uma atitude de maior vigilância desses indivíduos mais idosos em relação a sintomas que possam representar piora de seu estado de saúde.

Conhecimento da equipe de enfermagem sobre avaliação comportamental de dor em paciente crítico / Conocimiento del equipo de enfermería en la evaluación del comportamiento del dolor en el paciente crítico / Nursing team knowledge on behavioral assessment of pain in critical care patients

Estudo transversal prospectivo que teve como objetivo descrever o conhecimento da equipe de enfermagem sobre uma avaliação comportamental de dor. Realizado em hospital privado da cidade de São Paulo, Brasil, em novembro de 2011, com profissionais de enfermagem de uma UTI geral adulto. Estes responderam a um questionário com dados sociodemográficos e questões referentes ao conhecimento sobre uma avaliação comportamental de dor. A análise dos dados foi descritiva e a média de acertos por categoria profissional foi comparada por teste Mann-Whitney. Dos 113 participantes, mais de 70% demonstraram ter conhecimento sobre os principais aspectos dessa avaliação e não houve diferença estatisticamente significativa entre as categorias profissionais. Concluiu-se que o conhecimento dos profissionais foi satisfatório, mas pode ser aprimorado.

Estudio transversal prospectivo que tuvo como objetivo describir el conocimiento del equipo de enfermería con relación a evaluación del comportamiento del dolor. Realizado en un hospital privado de la ciudad de São Paulo, Brasil en noviembre de 2011 con profesionales de enfermería de una UTI general adulto. La población estudiada respondió a un cuestionario con datos demográficos y preguntas relacionadas al conocimiento sobre una evaluación de comportamiento del dolor. El análisis de datos fue descriptivo y el promedio de aciertos por categoría profesional fue comparado por el test de Mann-Whitney. De los 113 participantes, el 70% demostró el conocimiento de los principales aspectos de esta evaluación y no hubo diferencia estadísticamente significativa entre las categorías profesionales. Se concluye que el conocimiento de los profesionales era satisfactorio, pero se puede mejorar.

This investigation consisted on a prospective cross-sectional study that aimed to describe the nursing team knowledge on behavioral assessment of pain. The study was conducted in a private hospital in the city of São Paulo, Brazil, in November 2011, with nursing professionals from a general adult intensive care unit. They answered a questionnaire that contained sociodemographic data and questions related to knowledge about a behavioral assessment of pain. Descriptive data analysis was carried out and the average positive score was compared among categories using the Mann-Whitney test. Out of the 113 participants, over 70% have demonstrated knowledge of the main aspects of this assessment and there was no statistical significant difference among the professional categories. It was concluded that the knowledge of the professionals was satisfactory, but it can be improved.

Children's Mental Health in Multicultural Family and North Korean Defectors in South Korea

South Korea is changing into a multi-cultural society, due to an increase in international marriage, foreign workers and transcultural immigration. In addition, the number of North Korean defectors entering South Korea has increased and now, there are approximately 25000. Therefore, this review have focused on a research that pertains to adaptation and mental health concerns of their children. Children who have immigrated themselves or whose parents have immigrated, might experience language barriers, difficulties in school adjustment, identity confusion and mental health problems. However, their academic performance and developmental status are known to be variable and be affected by socioeconomic status and their parents' educational level. Studies that evaluated the psychological problems of North Korean adolescent refugees' indicated the need for interests in both emotional and behavioral problems. The risk factors of North Korean adolescent refugees' mental health are suggested to be past traumatic experiences, long duration of defection and short period of adaptation. When mental health professionals provide assessment and treatment, they should consider the pre- and post-migration experiences & cultural background that affect the illness behaviors and attitudes toward mental illnesses. Lastly, the majority of children with multi-cultural background are still under an adolescent period and we should follow up with long-term perspectives.

Depression as an Inflammatory Disease / 대한정신약물학회지

Inflammation is an immune response engaged with the reciprocal interactions among the neural, endocrine and immune system. From this psychoneuroimmunological view, inflammation is one of important allostatic loads contributory to depression. Sickness behaviors in the inflammatory state share many parts of depressive symptoms and patients treated with cytokines for various illnesses are at increased risk of developing depression. The dysfunctions of cytokines and hypothalamic-pituitary-adrenal axis have been widely investigated to find out inflammatory responses. Inflammatory mediators such as cytokines, glucocorticoid and C-reactive protein affect the etiopathogenesis of depression via altered monoamine and glutamate neurotransmission, glucocorticoid receptor resistance and neurogenesis. Although inflammation is subtle and not easy to be detected in the wide population, it is basal pathophysiology and plays an important role at least to the vulnerable patients. From this perspectives, inflammatory markers may be useful in the diagnosis and prediction of treatment response, leading to the possibility of tailored treatments. Understanding depression as a kind of inflammatory disease would provide new opportunities for the psychiatry beyond monoamine theory.

Medicalização dos desvios de comportamento na infância: aspectos positivos e negativos / Medicalization of deviant behavior in children: positive and negative features / Medicalización de los desvíos de comportamiento en la infancia: aspectos positivos y negativos

A medicalização dos comportamentos desviantes na infância é apresentada como uma estratégia eficaz para lidar com crianças que apresentam algum tipo de dificuldade, sem que, no entanto, as dificuldades desse processo sejam claramente expostas. O processo de medicalização, porém, é complexo e apresenta muitos resultados negativos. Dentro desse contexto, nosso objetivo é refletir sobre essas dificuldades. Primeiramente, apresentamos como se dá a relação entre medicalização e infâcia. Em seguida, discutimos alguns aspectos considerados positivos e negativos da medicalização. Para finalizar, consideramos que enquadrar uma criança em um diagnóstico psiquiátrico apresenta sérias consequências indesejáveis, e acaba sendo mais útil para a sociedade e para o entorno da criança do que para a própria criança.

The medicalization of deviant behaviors during childhood is usually presented as an effective strategy to deal with troublesome children, but the problems associated with medicalization are not frequently exposed. Even so, the process of medicalization is complex and may present many negative results. In this context, our aim is to discuss these difficulties. First, we present an overview of the relationship between medication and childhood. After that, we discuss some positive and negative aspects of medicalization. Finally, we conclude that framing a child under a psychiatric diagnosis is often more beneficial for the society and the child's surroundings than it is for the child herself.

La medicalización de los comportamientos desviantes en la infancia es presentada como una estrategia eficaz para manejar niños que presentan algún tipo de dificultad, sin que, sin embargo, las dificultades de ese proceso sean claramente expuestas. El proceso de medicalización, sin embargo, es complejo y presenta muchos resultados negativos. En ese contexto, nuestro objetivo es reflexionar sobre esas dificultades. Primero, presentamos como se da la relación entre medicalización e infancia. Enseguida, discutimos algunos aspectos considerados positivos y negativos de la medicalización. Para finalizar, consideramos que encuadrar un niño en un diagnóstico psiquiátrico presenta serias consecuencias indeseables, y acaba siendo más útil para la sociedad y para el entorno del niño de lo que para el propio niño.

As representações sociais sobre a doença renal crônica / The social representations about chronic kidney disease

Trata-se de pesquisa de abordagem qualitativa, do tipo descritiva que teve por objetivo descrever as representações sociais dos doentes renais sobre o processo de adoecimento. Os dados foram coletados em uma instituição hospitalar, no setor de Terapia Renal Substitutiva (TRS) do município de Ponta Grossa - PR, no período de janeiro e fevereiro de 2012. Fizeram parte da pesquisa 23 doentes renais crônicos, com idade entre 18 e 60 anos, que realizam hemodiálise no mínimo um ano. Os dados foram obtidos mediante entrevista semiestruturada, gravada e após os depoimentos foram transcritos e analisados pelo método de Análise de Conteúdo, que permitiu identificar quatro categorias temáticas: Constatação da finitude e ruptura da normalidade, Inimiga oculta que seca o rim, Máquina como garantia de vida, Rim novo: Esperança de cura. A representação social do processo de adoecimento está ancorada na constatação da finitude da vida, representa a aproximação da morte, que surge como possibilidade na vida desses indivíduos, que provoca medo, insegurança e mudança de comportamento, quando percebem a introdução uma nova realidade, ser doente crônico. A doença surge silenciosa e seca os rins entendida pelos doentes renais, também como a representação de fracasso em consequência da perda do emprego, mudança no papel social. Por outro lado, alguns entrevistados revelaram abertura de um nível de sensibilidade para aquilo que está no cotidiano, permitiram criar novas opções de vida diante do sofrimento. O tratamento para a doença representa a dependência da máquina da hemodiálise que traz a garantia da vida, mesmo sendo ela a causadora da perda da liberdade. A fístula necessária para a sobrevivência na máquina gera marcas pelo corpo, alterando a autoestima do doente renal. Com todo esse sofrimento, a esperança nasce quando percebe que o transplante renal possibilita uma nova chance de vida sem a dependência da máquina. A espera do rim novo representa a cura, e a fé é essencial para manter viva a esperança, além do apoio familiar que influência no processo de adoecimento. Compreende-se que a representação social é individual, e pode ser influenciada por outras pessoas e pela realidade em que vive. Na prática profissional, essas representações influenciam o modo de gerir os cuidados prestados aos doentes renais crônicos submetidos à hemodiálise.

This is qualitative study, the descriptive type that aimed to describe the representations of chronic renal failure patients about the disease process. Data were collected in a hospital, in the sector of Renal Replacement Therapy (RRT) in the city of Ponta Grossa - PR, between January and February 2012. The participants were 23 patients with chronic renal failure, aged 18 to 60 years who undergo hemodialysis at least one year. Data were collected through semi-structured interviews and after the interviews were transcribed and analyzed using content analysis, which identified four themes: Finding the finiteness and rupture of normality, hidden enemy that dries the kidney machine warranty life, new Kidney: Hope. The social representation of the disease process is anchored on the observation of the end of life, is the approach of death, which arises as a possibility in the lives of these individuals, causes fear, insecurity, and perceived behavioral change when introducing a new reality, be patient chronic. The disease appears silent and dry kidneys by renal patients also understood as representing failure as a result of job loss, change in social roles and social restrictions as much food. On the other hand, some interviewees said opening a level of sensitivity to what is in the everyday, creating new options allowed life to suffering. Treatment for the disease is the dependence of the hemodialysis machine that brings the guarantee of life, even though she is causing the loss of freedom. The fistula necessary for survival in the machine generates marks the body, altering the patient's renal esteem. With all this suffering, hope arises when you realize that kidney transplantation provides a new chance of life without dependence on the machine. The hope of the new kidney is healing, and faith is essential to keep hope alive beyond the family support that influences the disease process. It is understood that social representation is individual and may be influenced by other people and the reality in which he lives. In practice, these representations influence the way we manage the care of patients with chronic renal failure undergoing hemodialysis.

Medicina y estrés: antecedentes históricos y evidencias científicas / Medicine and stress: historic antecedents and scientific evidence

El estrés puede alterar la capacidad inmunológica de una persona, ya sea a través de neurotransmisores o a través de hormonas. El cambio hormonal que se produce como consecuencia del estrés afectará el desarrollo de cualquier enfermedad. Esto implica que el médico no debe considerar al paciente sólo como portador de una enfermedad sino también como un ser sufriente tanto física como emocionalmente, teniendo en cuenta que esas emociones pueden modificar el curso de su enfermedad. En este trabajo pretendemos llamar la atención sobre un tema que, si bien suele estar presente en el pensamiento médico, no siempre lo está como conocimiento fundamentado. Comenzamos con una breve referencia histórica y describimos las evidencias científicas que avalan la relación que nos ocupa.

Stress can alter a person's immune capacity, eíther through neurotransmitters or through hormones. Hormonal change that occurs as a results of stress affects the development of any disease. This implies that the physician should consider the patient not only as a carrier of a disease but also a suffering being, both physically and emotionally, bearing in mind that these emotions can alter the course of the disease. In this paper, we draw attention to an issue that, while often present in medical thinking, is not always as knowledge based. We begin with a brief historical reference and describe the scientific evidence that supports the relationship in question.

Creencias sobre la enfermedad y estrategias de afrontamiento como predictores de la calidad de vida en pacientes en rehabilitación cardiovascular / Beliefs about illness and coping strategies as predictors of quality of life in patients in cardiovascular rehabilitation / Crenças sobre a doença e estratégias de enfrentamento como predictores de qualidade de vida em pacientes em reabilitação cardiovascular

La percepción de enfermedad y los estilos de afrontamiento se relacionan con la percepción de calidad de vida en la enfermedad crónica. El presente estudio tuvo como objetivo la identificación de las creencias sobre la enfermedad y las estrategias de afrontamiento predictoras de la calidad de vida relacionada con la salud en una muestra de 80 pacientes (68.6% hombres y 31.3% mujeres) asistentes al programa de rehabilitación cardiovascular de la Fundación Cardiovascular de Colombia, con sede en Bucaramanga. Para ello se aplicaron el Illness Behavior Questionnaire (IBQ), la Escala de Estrategias de Coping Modificada (EEC-M) y el Cuestionario de Calidad de Vida Relacionada con la Salud SF-36. Los resultados estadísticos evidencian la influencia del empleo de las estrategias de afrontamiento pasivas sobre la baja calidad de vida en la muestra valorada, así como de las creencias focalizadas en las limitaciones que conlleva la patología; asimismo, muestra a la religión como una estrategia protectora en el afrontamiento de la enfermedad cardiovascular.

Illness perception and coping styles are related to the perceived quality of life in chronic illness. This study aimed at identifying beliefs about illness and coping strategies as predictors of health related quality of life in a sample of 80 patients (68.6% men and 31.3% women) who were attending the cardiac rehabilitation program at the Fundación Cardiovascular de Colombia, based in Bucaramanga. In order to achieve this objective, the Illness Behavior Questionnaire (IBQ), the Coping Strategies Scale- Modified (CSS-M) and the Health Related Quality of Life Questionnaire SF-36 were administered to the participants. The statistical results show the influence of passive coping strategies and of beliefs focused on the constraints inherent to their pathology on the poor quality of life of the assessed sample. They also show religion as a protective strategy for coping with cardiovascular disease.

A percepção da doença e os estilos de enfrentá-la estão relacionados à qualidade de vida percebida em doenças crônicas. Neste estudo se identificaram as crenças sobre a doença e as estratégias predictoras da qualidade de vida relacionada à saúde em uma amostra de 80 pacientes (68,6% homens e 31,3% mulheres) participarem do programa de reabilitação cardíaca na Fundação Cardiovascular da Colômbia, com sede em Bucaramanga. Se aplicaram o Questionário de Comportamento Doença (IBQ), a Escala de Estratégias de Enfrentamento Modificada (CSE-M) e o Questionário de Qualidade de Vida Relacionada à Saúde SF-36. Os resultados estatísticos mostram a influência do uso de estratégias de enfrentamento passivo na má qualidade de vida nos valores da amostra e as crenças focadas nos constrangimentos inerentes à patologia. Também mostra a religião como uma estratégia de proteção ao lidar com a doença cardiovascular.