Configuración subjetiva del afrontamiento psicológico a la COVID-19 de adolescentes convalecientes del primer rebrote / Subjective configuration of psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth

Introducción: Para los adolescentes, enfermar de la COVID-19 constituye un acontecimiento estresante ante las demandas del ingreso hospitalario y la intervención médica. Objetivo: Reflejar la configuración subjetiva del afrontamiento psicológico a la COVID-19 de adolescentes convalecientes del primer rebrote de la enfermedad. Métodos: La investigación siguió un enfoque cualitativo constructivo interpretativo, a través de un estudio de casos múltiples. La muestra se seleccionó de forma intencional; se accedió a 13 adolescentes convalecientes de la COVID-19 en el período abril-octubre de 2020, que fueron incluidos para seguimiento por los servicios de Psicología y Psiquiatría infanto-juvenil, a partir de su permanencia en la provincia de Villa Clara. Se emplearon para la obtención de la información las técnicas composición y el rombo afectivo. El análisis de los contenidos se procesó con la herramienta ATLAS.ti. Resultados: El afrontamiento psicológico a la COVID-19 de adolescentes convalecientes del primer rebrote de la enfermedad, se caracterizó por malestares psicológicos como el miedo y la tristeza, la valoración positiva del trabajo del personal de la salud, la limitada movilización de recursos resilientes y la escasa percepción de apoyo social. Conclusiones: La rehabilitación en contextos de la vida cotidiana se afronta desde la preocupación por el proyecto de formación profesional, la necesidad de seguridad y protección encaminada a erradicar la pandemia, la preservación de la salud personal y familiar, y la compañía de los familiares que viven en el hogar(AU)

Introduction: For adolescent´s getting sick of COVID-19 constitute a stressful situation considering demands of being in hospital and due to the medical attention. Objective: Making known the subjective configuration of psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth of this illness trough a multi-case study. Methods: The research was carried out following an interpretative constructive qualitative approach trough a multi-case study. The sample was selected intentionally, having access to 13 convalescent adolescent´s suffering from COVID-19 over period of April-October, in 2020 that were included in order to be followed by infant and young psychiatric and psychology service from their stay on in our province of Villa Clara. Writing a composition and affective rhombus technique, were used to get some information. Content analysis was processed using the tool ATLAS.ti. Results: The psychological facing up to COVID-19 of convalescent adolescent´s for the first regrowth of this illness was characterized by psychological discomfort as fears and sadness, favorable assessment on the work of health staff, limited mobilization of tough resources and short of perception of social support. Conclusions: The rehabilitation on daily life context is faced from the concern for the Project of professional training, the protection and security needs putting into the end of pandemic, family and personal health preservation and the company of family that live at home(AU)

Translation and cultural adaptation of the mediterranean diet quality index in children and adolescents / Tradução e adaptação cultural do mediterranean diet quality index in children and adolescents

ABSTRACT Objective: To translate and culturally adapt the Mediterranean Diet Quality Index in Children and Adolescent (KIDMED) for the Brazilian population. Methods: The processes of translation and cultural adaptation followed internationally standardized methodological norms. We used the intraclass correlation coefficient and the Bland-Altman dispersion analysis to assess the reproducibility and calculated the internal consistency with Cronbach's alpha coefficient. Results: A total of 102 children and adolescents participated in the cross-cultural adaptation, of whom 58 (56.9%) were females, with a mean age of 9.8±4.9 years. The mean overall scores of adherence to the Mediterranean diet in the test and retest were similar (8.00 and 3.80 versus 8.01 and 3.84) for children and adolescents, respectively. The intraclass correlation coefficient for children and adolescents was 0.893 and 0.998, respectively. The internal consistency was 0.72. The Bland-Altman plot analysis showed good agreement between the final scores of the test and retest questionnaires, with no statistically significant difference. Conclusions: The KIDMED questionnaire was translated into Brazilian Portuguese and culturally adapted, presenting high reproducibility. This questionnaire can, therefore, be included and used in Brazilian studies that aim at evaluating the adherence to the Mediterranean diet among children and adolescents.

RESUMO Objetivo: Traduzir e adaptar culturalmente a escala do Mediterranean Diet Quality Index in Children and Adolescent (KIDMED) para a população brasileira. Métodos: Os processos de tradução e adaptação cultural seguiram normas metodológicas padronizadas internacionalmente. A reprodutibilidade foi avaliada pelo coeficiente de correlação intraclasse e pela análise de dispersão de Bland-Altman, e a consistência interna foi calculada pelo coeficiente de Cronbach. Resultados: Participaram da etapa de adaptação transcultural 102 crianças e adolescentes, sendo 58 (56,9%) meninas com idade média de 9,8±4,9 anos. Os escores totais médio de aderência à dieta mediterrânea no teste e no reteste foram semelhantes (8,00 e 3,80 versus 8,01 e 3,84) para as crianças e os adolescentes, respectivamente. O coeficiente de correlação intraclasse para as crianças e os adolescentes foi de 0,893 e 0,998, respectivamente. A consistência interna obtida foi de 0,72. A análise do gráfico de Bland-Altman demonstrou boa concordância entre os escores finais dos questionários de teste e de reteste, sem diferença estatisticamente significativa. Conclusões: O questionário KIDMED foi traduzido e adaptado culturalmente para a língua portuguesa do Brasil, apresentando alta reprodutibilidade. Esse questionário pode ser, portanto, incluído e utilizado em estudos brasileiros que visem avaliar a aderência à dieta mediterrânea de crianças e adolescentes.

Translation, cultural adaptation, and evidence of instrument validity for a morphological examination performed in children with autism spectrum disorder / Tradução, adaptação cultural e evidência de validade de instrumento para o exame morfológico aplicado a crianças com transtorno do espectro autista

ABSTRACT Objective: For every 100 random children diagnosed with autism, at least 20 have morphological abnormalities, often associated with syndromes. Brazil does not have a standardized and validated instrument for morphological physical examination. This study aimed to translate into Brazilian Portuguese and culturally adapt the clinical signs described in the Autism Dysmorphology Measure, as well as validate the instrument in a sample of children with autism. Methods: The original instrument was translated, culturally adapted, and published in full, following traditional procedures for translation, back-translation, and terminology adaptation according to the Nomina Anatomica. The sample included 62 children from a published multicenter study, with intelligence quotient between 50-69, of both genders, with chronological age between 3-6 years. Two clinical geneticists performed the morphological physical examination, which consisted of investigating 82 characteristics assessing 12 body areas. We used Cohen's Kappa coefficient to evaluate the agreement between the two observers. Results: The final version of the instrument - translated into Brazilian Portuguese and culturally adapted - showed high agreement between the two observers. Conclusions: The translated instrument meets all international criteria, and minor anomalies and their clinical descriptions were standardized and are recognizable for physicians not specialized in genetics.

RESUMO Objetivo: Entre 100 crianças, não selecionadas, com diagnóstico de autismo, pelo menos 20 apresentam anomalias morfológicas, quase sempre associadas a síndromes. Não há no Brasil instrumento de exame físico morfológico padronizado e validado. O objetivo foi traduzir para o português do Brasil e adaptar culturalmente os sinais clínicos descritos no Autism Dysmorphology Measure, assim como procurar evidências de validade quando aplicado a uma amostra de crianças com autismo. Métodos: Foram feitas a tradução e a adaptação cultural do instrumento original, publicado na íntegra. Foram adotados os procedimentos tradicionais de tradução, retrotradução e adaptação da terminologia segundo a Nomina Anatomica. Foram incluídas na amostra 62 crianças com quociente de inteligência entre 50 e 69, de ambos os sexos, com idade cronológica entre três e seis anos, provenientes de estudo multicêntrico com os procedimentos metodológicos já publicados. O exame físico morfológico foi realizado por dois médicos geneticistas e consistiu na pesquisa de 82 características que avaliam 12 áreas corporais. Para avaliar a concordância entre os dois observadores foi utilizado o coeficiente Kappa de Cohen. Resultados: A versão final do instrumento traduzido e adaptado culturalmente ao português do Brasil mostrou alta concordância entre os dois observadores. Conclusões: O instrumento traduzido preenche todos os critérios propostos internacionalmente e o reconhecimento das anomalias menores e sua descrição clínica estão padronizados e são de fácil reconhecimento aos médicos não especialistas em genética.

El padecer como diagnóstico de la enfermedad / Suffering as a diagnosis of the disease

Introducción: La vivencias emocionales de las enfermedades y su cuidado reciben atención insuficiente en las condiciones actuales de una medicina altamente biologicista. Objetivo: Profundizar en el concepto del padecer como componente del diagnóstico con enfoque psicosocial en clínica. Métodos: Se realizó una búsqueda en las bases de datos PubMed, SciELO y Lilacs utilizando las palabras claves: padecer; afectación; enfermedad, illness, sickness, disease. Desarrollo: El diagnóstico médico se centra en la entidad nosológica que representa alteraciones estructurales y funcionales. La afectación se vincula a la vida de relaciones sociales del enfermo en la que supone determinado grado de invalidez y en el padecer, el cual es una expresión de la dimensión psicológica cuya complejidad se centra en la respuesta afectiva identificable por las emociones y sentimientos. El padecer tiene un carácter individual según los rasgos de personalidad, la biografía del paciente, las características de su enfermedad (aguda o crónica), el contexto en el que surge y se desarrolla el problema de salud y las cualidades del proceso de atención. El afrontamiento del padecer del paciente puede verse mejor desde una visión alostática. Conclusiones: El padecer de las enfermedades, también conocido como cuadro interno de la enfermedad, tiene como centro la respuesta emocional pero no se limita a ella. Exige conocer al enfermo como persona y su red de apoyo con vistas a facilitarle una respuesta adaptativa beneficiosa a su nueva condición(AU)

Introduction: The emotional experiences of diseases and their care receive insufficient attention in the current conditions of highly biologic oriented medicine. Objective: To deepen the concept of suffering as a component of diagnosis with a psychosocial approach in the clinic. Methods: A search in PubMed, SciELO and Lilacs databases was performed using suffering; affectation; disease, illness, sickness, disease as keywords. Discussion: The medical diagnosis focuses on the nosological entity that represents structural and functional alterations. Suffering is linked to the social relations of the patient in which certain degree of disability and suffering are supposed, which is an expression of the psychological dimension whose complexity focuses on the emotional response identifiable by emotions and feelings. Suffering has an individual character according to the personality traits, the patient´s history, the characteristics of the illness (acute or chronic), the context in which the health problem arises and advances and the qualities of the care process. Coping with the patient's suffering can be better understood from an allostatic view. Conclusions: Suffering from diseases, also known as internal symptoms of the disease, is centered on the emotional response but it is not just limited to it. Knowing the patient as a whole person and their support network is required to facilitating beneficial adaptive response to the new condition(AU)

Percepção e enfrentamento da dor em crianças e adolescentes com fibromialgia juvenil e artrite idiopática juvenil poliarticular / Pain perception and pain coping mechanisms in children and adolescents with juvenile fibromyalgia and polyarticular juvenile idiopathic arthritis

RESUMO Objetivo: Mensurar e comparar a dor musculoesquelética em pacientes com fibromialgia juvenil (FMJ) e em pacientes com artrite idiopática juvenil poliarticular (AIJ); e avaliar e comparar a percepção e o enfrentamento da dor. Métodos: Foram avaliados, em estudo transversal, 150 crianças e adolescentes (e seus respectivos pais), divididos em três grupos: FMJ, AIJ e controles saudáveis. A mensuração e o enfrentamento da dor foram realizados por meio de instrumentos específicos. Para a avaliação da percepção da dor, desenvolveram-se três vinhetas com simulação de situações que pudessem gerar dor: aplicação de injeção, queda de bicicleta e isolamento social. Os pais e os pacientes responderam individualmente quanto à percepção da dor em cada situação. Resultados: As maiores notas de dor, os menores escores de enfrentamento da dor, as maiores notas para a percepção da dor nas vinhetas e os piores índices de qualidade de vida relacionada à saúde foram observados nos pacientes com FMJ, quando comparados aos pacientes com AIJ e aos controles. O mesmo padrão foi observado com os respectivos pais. Conclusões: Pacientes com AIJ e FMJ se comportam diferentemente em relação à percepção da dor e ao desenvolvimento de técnicas para o enfrentamento da dor. A dor deve ser avaliada sob diferentes perspectivas para um planejamento mais individualizado e efetivo do tratamento desses pacientes.

ABSTRACT Objective: To measure and compare musculoskeletal pain in patients with juvenile fibromyalgia (JFM) and polyarticular juvenile idiopathic arthritis (JIA), and to evaluate and compare pain perception and pain coping mechanisms in these patients. Methods: In this cross sectional study, we evaluated 150 children and adolescents, and their respective parents, from 3 different groups: JFM, polyarticular JIA, and healthy controls. Pain intensity and pain coping mechanisms were measured using specific questionnaires. Pain perception was evaluated according to three illustrations simulating situations that might cause pain: a shot, a bicycle fall, and social isolation. The patients' parents also filled out the questionnaires and provided a pain score that matched their child's perception of pain for each illustration. Results: The highest pain scores, the lowest pain coping strategy scores, the highest pain perception scores for all three illustrations, and the worse health related to quality of life indicators were observed in the JFM group, when compared to the JIA and control groups. The same pattern was observed with their parents. Conclusions: Patients with JIA and JFM behave differently in relation to pain perception and the development pain coping mechanisms. Pain should be evaluated from different perspectives for an individualized and efficient treatment of patients.

Funcionamiento Cognitivo Global y Conducta Adaptativa en dos Niñas con Neuropatía Sensitiva Autonómica Hereditaria Tipo IV / Global cognitive and adaptive functioning in two girls with hereditary sensory and autonomic neuropathy type IV

La neuropatía sensitiva autonómica hereditaria tipo IV (HSAN-IV) es una condición neurológica de origen genético extremadamente rara que puede cursar con discapacidad intelectual, sin embargo, hay escasas publicaciones sobre las características del funcionamiento cognitivo global y la conducta adaptativa de los afectados. En este estudio se describe la capacidad cognitiva global y el funcionamiento adaptativo de dos niñas de 12 y 14 años diagnosticadas con HSANIV, incluyendo una caracterización de los procesos de comprensión verbal, razonamiento perceptual, memoria de trabajo y velocidad de procesamiento. Las menores fueron evaluadas mediante la Escala de Inteligencia para niños de Wechsler cuarta edición (WISC-IV) encontrándose en ambos casos un bajo índice de comprensión verbal, una medida del desarrollo cognitivo alcanzado a través de la historia de aprendizaje de las niñas; así como un bajo índice de razonamiento perceptivo, indicador de su capacidad para adaptarse y afrontar situaciones nuevas de forma flexible. Esto se acompaña de dificultad en la manipulación de información en la memoria para la resolución de problemas y enlentecimiento en la velocidad de procesamiento de la información. Adicionalmente, se evaluó su funcionamiento adaptativo mediante el sistema de evaluación de la conducta adaptativa ABAS-II, el cual se caracterizó por fortalezas en habilidades comunicativas, uso de recursos comunitarios y vida en el hogar; con limitaciones en habilidades académicas y de autocuidado. En conclusión, la HSAN-IV es una condición que cursa con discapacidad intelectual con necesidades de apoyo variables en intensidad. En los casos estudiados se encontró discapacidad intelectual con necesidad de apoyo limitado, es decir, los apoyos se requieren de forma regular durante un periodo de tiempo corto pero definido.

Hereditary sensory autonomic neuropathy type IV (HSAN-IV) is a neurological condition of extremely rare genetic origin that may be associated with intellectual disability; however, there are few publications about the characteristics of global cognitive functioning and adaptive behaviour of these patients. In this study we describe the global cognitive function and the adaptive behavior of two girls aged 12 and 14 diagnosed with HSAN-IV, including a characterization of the processes of verbal comprehension, perceptual reasoning, working memory and processing speed. The children were assessed using the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV), finding in both cases a low level of verbal comprehension, a measure of cognitive development achieved through the girls' learning history; as well as a low rate of perceptual reasoning, indicator of their ability to adapt and face new situations in a flexible way. This is accompanied by difficulty in manipulating information in the memory to solve problems and slow down the speed of information processing. Additionally, its adaptive functioning was evaluated through the Adaptive Behavior Assessment System ABAS-II, which was characterized by strengths in communication skills, use of community resources and life at home; with limitations in academic and self-care skills. In conclusion, HSAN-IV is a condition related with intellectual disability with varying support needs in intensity. In the cases studied, intellectual disability was found with limited need for support, that is, supports are required on a regular basis for a short but defined period.

Afrontamiento y adaptación de mujeres con cáncer de mama / Confrontation and women's adaptation with cancer of he/she suckles

RESUMEN Introducción: el cáncer de mama es uno de los tumores malignos de mayor frecuencia y una de las principales causas de muerte por cáncer en las mujeres en el mundo. Objetivo: describir la capacidad de afrontamiento y adaptación de mujeres que presentan cáncer de mama y se encuentran en tratamiento en Hematooncologos SA de la ciudad de Cali. Métodos: estudio descriptivo transversal, desarrollado durante los meses de septiembre del 2013 y febrero del 2014, incluyó 175 mujeres. Para la recolección de la información se utilizó el instrumento Escala de Medición del Proceso de Afrontamiento y Adaptación de Callista Roy (ECAPS) traducido y validado para Colombia. Para el análisis de los datos se hizo uso de estadística univariada. Resultados: la edad de los participantes osciló entre 30 a 84 años. Dentro de los tipos de tratamiento que recibieron se observó que el 74,3 por ciento se habían realizado cirugía, 53 por ciento radioterapia, 86 por ciento quimioterapia. La capacidad de afrontamiento y adaptación fue alta en 173 (98.9 por ciento) y baja en 2 (1,1 por ciento). Conclusiones: las estrategias de afrontamiento y adaptación utilizadas por las mujeres con cáncer de mama fueron altas en comportamientos personales, reacciones físicas dadas en los factores 1-2-3 y baja en las estrategias empleadas para sobre llevar la situación los factores 4 y 5. Sin embargo utilizan varias estrategias simultáneamente(AU)

ABSTRACT Introduction: Breast cancer is one of the most frequent malignant tumors and one of the leading causes of cancer death in women in the world. Objective: To describe the coping skills and adaptation of women with breast cancer and undergoing treatment in Hematooncologos SA city of Cali. Methods: Cross-sectional descriptive study, developed during the months of September 2013 and February 2014, included 175 women. Measuring the Scale tool Process Coping and Adaptation of Callista Roy (Ecaps) translated and validated for Colombia was used for data collection. For data analysis was done using univariate statistics. Results: The age of participants ranged from 30 to 84 years. Among the types of treatment they received it was observed that 74.3 percent had performed surgery, 53 percent radiotherapy, 86 percent chemotherapy. Coping capacity and adaptation was high in 173 (98.9 percent) and low in 2 (1.1 percent). Conclusions: Coping and adaptation strategies used by women with breast cancer were high in personal behaviors, physical reactions given in 1-2-3 and low factors in the strategies used to bring the situation on factors 4 and 5. However several strategies used simultaneously(AU)

Symptoms of anxiety and depression are related to cardiovascular responses to active, but not passive, coping tasks

Objective: Anxiety and depression have been linked to blunted blood pressure (BP) and heart rate (HR) reactions to mental stress tests; however, most studies have not included indices of underlying hemodynamics nor multiple stress tasks. This study sought to examine the relationships of anxiety and depression with hemodynamic responses to acute active and passive coping tasks. Methods: A total of 104 participants completed the Hospital Anxiety and Depression Scales and mental arithmetic, speech, and cold pressor tasks while BP, HR, total peripheral resistance, and cardiac output (CO) were assessed. Results: After adjustment for traditional risk factors and baseline cardiovascular activity, depression scores were negatively associated with systolic BP, HR, and CO responses to the mental arithmetic task, while anxiety scores were inversely related to the systolic BP response to mental arithmetic. Conclusion: High anxiety or depression scores appear to be associated with blunted cardiac reactions to mental arithmetic (an active coping task), but not to the cold pressor test or speech tasks. Future research should further examine potential mechanisms and longitudinal pathways relating depression and anxiety to cardiovascular reactivity. Clinical trial registration number: TCTR20160208004

Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain / Pacientes com endometriose que utilizam estratégias positivas de enfrentamento apresentam menos depressão, estresse e dor pélvica

ABSTRACT Objective To determine the correlations between coping strategies, depression, stress levels and pain perception in patients with endometriosis. Methods This prospective and exploratory study included 171 women undergoing treatment for endometriosis between April and August 2014. The questionnaires used were Brief COPE, Beck Depression Inventory, Lipp’s Stress Symptom Inventory for Adults and Visual Analogue Scale. Clinical data were collected from electronic medical records. Results Patients with endometriosis who used positive coping strategies had better adaptation to stress (p<0.004) and less depression (p<0.004). The presence and intensity of depression, stress and acyclic pelvic pain were directly associated (p<0.05). The intensity of dysmenorrhea was associated with the degree of depression (p<0.001), whereas acyclic pelvic pain was associated with the degree of depression (p<0.001), stress level (p<0.001) and stress type (p<0.001). Conclusion We found a positive association between coping, depression levels, type and levels of stress and pain intensity in patients with endometriosis. The use of maladaptive coping strategies focused on emotion is correlated with increase in depression and stress.

RESUMO Objetivo Observar a correlação entre estratégias de enfrentamento, depressão, níveis de estresse e percepção de dor em pacientes com endometriose. Métodos Estudo prospectivo e exploratório, que incluiu 171 mulheres em tratamento por endometriose entre abril e agosto de 2014. Foram utilizadas as escalas: COPE Breve, Inventário de Depressão de Beck, Inventário de Sintomas de Stress para Adultos de Lipp e a Escala Visual Analógica. Os dados clínicos foram coletados do prontuário eletrônico. Resultados Pacientes com endometriose que utilizaram estratégias positivas de enfrentamento apresentaram melhor adaptação ao estresse (p<0,004) e menos depressão (p<0,004). A presença e a intensidade da depressão, do estresse e da dor pélvica estiveram diretamente associadas (p<0,05). A intensidade da dismenorreia foi associada com o grau de depressão (p<0,001), enquanto a intensidade da dor pélvica acíclica esteve associada com o grau de depressão (p<0,001), nível de estresse (p<0,001) e tipo de estresse (p<0,001). Conclusão Houve associação positiva entre coping, níveis de depressão, tipo e níveis de estresse e intensidade da dor nas pacientes com endometriose. A utilização de estratégias de coping desadaptativa focada na emoção está correlacionada com o aumento da depressão e do estresse.

Sensory processing patterns, coping strategies, and quality of life among patients with unipolar and bipolar disorders

Objective: To compare sensory processing, coping strategies, and quality of life (QoL) in unipolar and bipolar patients; to examine correlations between sensory processing and QoL; and to investigate the relative contribution of sociodemographic characteristics, sensory processing, and coping strategies to the prediction of QoL. Methods: Two hundred sixty-seven participants, aged 16-85 years (53.6±15.7), of whom 157 had a diagnosis of unipolar major depressive disorder and 110 had bipolar disorder type I and type II, completed the Adolescent/Adult Sensory Profile, Coping Orientations to Problems Experienced, and 12-item Short-Form Health Survey version 2. The two groups were compared with multivariate analyses. Results: The unipolar and bipolar groups did not differ concerning sensory processing, coping strategies, or QoL. Sensory processing patterns correlated with QoL independently of mediation by coping strategies. Correlations between low registration, sensory sensitivity, sensation avoidance, and reduced QoL were found more frequently in unipolar patients than bipolar patients. Higher physical QoL was mainly predicted by lower age and lower sensory sensitivity, whereas higher mental QoL was mainly predicted by coping strategies. Conclusion: While age may predict physical QoL, coping strategies predict mental QoL. Future studies should further investigate the impact of sensory processing and coping strategies on patients’ QoL in order to enhance adaptive and functional behaviors related to affective disturbances.

Brinquedo terapêutico no procedimento de punção venosa: estratégia para reduzir alterações comportamentais / Juguete terapéutico durante el procedimiento de punción venosa: estrategia para reducir alteraciones de comportamiento / Therapeutic toy during the procedure of venipuncture: a strategy to reduce behavioral changes

Introdução: A enfermagem pediátrica deve estar atenta aos subsídios da assistência que tornem possível um melhor manejo da dor e da ansiedade oriundas da hospitalização infantil, geralmente, causadas pela realização de procedimentos invasivos como a punção venosa. O uso do Brinquedo Terapêutico Instrucional (BTI) pode representar uma intervenção eficaz para lidar com os efeitos negativos da hospitalização. Objetivo: Comparar as reações manifestadas pela criança frente ao preparo para punção venosa antes e após o uso do BTI. Materiais e Métodos: A pesquisa é analítica, exploratória e de abordagem quantitativa. Para análise dos dados foi utilizado o teste de McNemar. A amostra consistiu de 21 crianças hospitalizadas, pré-escolares e escolares, a coleta deu-se entre junho e agosto de 2012, em unidade de internação pediátrica do Crato, CE (Brasil). Resultados e Discussão: Após o uso do BTI, observou-se uma redução na frequência de variáveis comportamentais que indicam menor adaptação ao procedimento, com significância estatística em especial para: “Solicita a presença Materna” e “Evita olhar para o Profissional” (p<0,001). A realização das sessões também potencializou a frequência de, praticamente, todos os comportamentos associados a uma melhor aceitação ao preparo ou realização da punção venosa, com destaque para “Observa o Profissional” (p<0,001) e “Sorri” (p<0,005). Conclusões: O BTI constitui relevante intervenção para a enfermagem pediátrica, sendo necessário, para sua aplicação sistematizada, articular ações que visem uma maior sensibilização dos órgãos gestores dos serviços de pediatria, maior capacitação dos profissionais envolvidos e melhor abordagem do ensino do brinquedo terapêutico nos cursos de graduação de enfermagem.

Introducción: La enfermería pediátrica debe conocer los recursos de asistencia que permitan mejor manejo del dolor y la ansiedad ocasionada de una hospitalización infantil, generalmente, causadas por realización de procedimientos invasivos, como la punción venosa. El uso del Juego Terapéutico Instruccional (JTI) puede representar una intervención eficaz para hacer frente a efectos negativos de la hospitalización. Objetivo: Comparar las reacciones manifestadas por el niño sometido a punción venosa antes y después del uso del JTI. Materiales y Métodos: El estudio es analítico, exploratorio y cuantitativo. Para el análisis de datos se empleó el test de McNemar. La muestra consistió en 21 niños hospitalizados, pre-escolares y escolares, la recolección de datos ocurrió entre junio y agosto de 2012 en unidad pediátrica de Crato, CE (Brasil). Resultados y Discusión: Después del uso del JTI, se observó una reducción en la frecuencia de las variables de comportamiento que indican una adaptación menor al procedimiento de punción venosa, estadísticamente significativo: “Solicita la presencia Materna” y “Evita mirar el Profesional” (p <0,001). La realización de las sesiones también potencializó la frecuencia de prácticamente todos los comportamientos asociados a una mejor aceptación a la preparación o realización de la punción venosa: “Observa el Profesional” (p <0,001) y “Sonríe” (p <0,005). Conclusiones: El JTI constituye una intervención relevante para la enfermería pediátrica, siendo necesario para su aplicación, articular acciones destinadas a aumentar la sensibilización entre los administradores de los servicios de pediatría, mayor capacitación de los profesionales y un mejor abordaje en la educación del juguete terapéutico en los pregrados de enfermería.

Introduction: Pediatric nurses should always be attentive to the care subsidies that make possible a better control of pain and anxiety generated by infant hospitalization. Generally, these adverse feeling in children are caused by the realization of intrusive procedures, such as venipuncture. The use of the Therapeutic Toy Instructional (TTI) may represent an effective intervention to deal with the negatives effects of hospitalization. Objective: To compare the reactions expressed by the child, exposed to venipuncture, before and after the use of TTI. Materials and Methods: The research is analytical, exploratory and quantitative approach. For analysis of the data was employed the McNemar test. The sample consisted of 21 hospitalized children, pre-school and school ages, the process of data was collected between June and August of 2012 in a pediatric unit from Crato, CE (Brazil). Results and Discussion: After using the TTI, there was a reduction in frequency of behavioral variables that indicate less adaptation to the procedure, particularly for “Require the presence of mother" and "Try not to look for the Professional" (p <0.001). The realization of the sessions also increased the frequency of many behaviors associated with better acceptance of the procedure, especially: "Look for the Professional" (p <0.001) and "Smile" (p <0.005). Conclusions: The TTI is a relevant intervention for pediatric nursing; to use it in a systematic way is needed: planning actions aimed at increasing awareness among managers of pediatric services, better training of professionals and the inclusion of teaching of therapeutic toy in nursing courses.

A Predictive Model on North Korean Refugees' Adaptation to South Korean Society: Resilience in Response to Psychological Trauma

PURPOSE: This study investigated prediction of North Korean refugees' adaptation to the South Korean society and verified the goodness of fit between a hypothetical model and actual data in order to suggest the best model. METHODS: This survey was conducted with 445 North Korean refugees living in a metropolitan area. Data were collected from September 1st to November 20th, 2012, and analyzed using SPSS Windows 18.0 and AMOS 17.0. RESULTS: Traumatic experiences of North Korean refugees increased self-efficacy and psychological trauma. Acculturation stress decreased self-efficacy and increased passive coping. Self-efficacy affected active and passive coping, decreased psychological trauma, and increased resilience. Resilience is successful adaptation and refers to North Korean refugees' abilities to adapt effectively to stress. In particular, self-efficacy as the main parameter affecting resilience was confirmed. CONCLUSIONS: The results suggest that resilience can be improved through self-efficacy. It was the most significant factor decreasing psychological trauma and increasing resilience. Therefore, we need to develop programs for self-efficacy. The results also provide basic data for policy making for North Korean refugees.

Ecotourism and primate habituation: Behavioral variation in two groups of white-faced capuchins (Cebus capucinus) from Costa Rica / Ecoturismo y habituación de primates: variación en comportamiento de dos grupos de monos carablanca (Cebus capucinus) en Costa Rica

The increase of ecotourism operations within Costa Rica during the last 20yrs has brought more and more humans into close, direct contact with several wildlife species. One of these species is the white-faced capuchin (Cebus capucinus), highly gregarious, and with exposure over time, willing to come into close vicinity of humans and their developments. Such contact has its advantages and disadvantages for the ecotourism industry. We observed white-faced monkeys in order to assess the impact of human presence and development on monkey behavior, with a focus on aggressive, affiliative, and foraging behaviors in Curú Wildlife Refuge (CWR), located in Puntarenas, Costa Rica, and to ascertain the degree of over-habituation of capuchin populations at CWR. Though there exists no discrete behavioral parameters that measure over-habituation, it can be defined as an extreme state of habituation in which non-human primates not only lose fear of humans, but also actively include humans in social interactions or treat them as a food resource. We used instantaneous focal animal and group scan sampling during 8wks in March and April 2012. Two groups (approximately 20-30 individuals each) of capuchins were observed; the first near the tourist development at the Southwestern area of CWR, representing a habituated population that regularly foraged, rested, and groomed in the presence of humans. The second, was observed in the Northeastern area of CWR, did not visit the center of human activity and exhibited fear of humans. The habituated group exhibited significantly fewer instances of threatened behavior in response to human presence (p<0.0001) than the non-habituated group, and spent significantly more time eating and foraging (p<0.0001). While the habituated monkeys at CWR may not be over-habituated, they could become that way as development, especially ecotourism, increases. Over-habituation is a problem that affects capuchins in certain ecotourism sites in Costa Rica. It is critical that the consequences of habituation be studied more carefully, primarily in areas where ecotourism operations draw visitors to wildlife habitats. Rev. Biol. Trop. 62 (3): 909-918. Epub 2014 September 01.

El aumento de actividades ecoturísticas en Costa Rica durante los últimos 20 años ha ocasionado que más y más personas entren en contacto directo y cercano con varias especies de vida silvestre. Una de estas especies es el mono carablanca (Cebus capucinus), que es muy gregario y, al pasar el tiempo, tiende a acercarse a los humanos y sus instalaciones. Tal contacto tiene ventajas y desventajas para la industria del ecoturismo. Observamos monos carablanca con el fin de evaluar el impacto de la presencia humana y la infraestructura en el comportamiento de estos animales, enfocando los comportamientos de agresión, acicalamiento y forrajeo para determinar el grado de habituación excesiva de las poblaciones de monos capuchinos en el Refugio de Vida Silvestre Curú, Puntarenas, Costa Rica. Aunque no existen parámetros específicos de comportamiento para medir la habituación excesiva, se puede definir esta condición como un estado en que los primates no humanos no solamente pierdan su temor a los humanos, sino que también incluyen a las personas activamente en sus interacciones sociales o las consideran como una fuente de alimentación. Los monos carablanca fueron observados a través del muestreo instantáneo focal y por escaneo grupal durante ocho semanas de marzo y abril de 2012. Dos grupos (aproximadamente 20-30 individuos cada uno) fueron observados; uno cerca del desarrollo turístico en la parte suroeste del refugio, que representó una población habituada que de manera regular comía, descansaba y se acicalaba en presencia de humanos; el segundo grupo, que se observó en el noreste del refugio, no visitaba el centro de actividad humana y mostraba temor hacia los humanos. El grupo habituado mostró significativamente menos ocasiones de comportamiento amenazante ante la presencia humana (p<0.0001) y empleó más tiempo comiendo y buscando alimento (p<0.0001). Aunque el grupo de habituados en Curú probablemente no tenga habituación excesiva, esta condición podría surgir más adelante, especialmente si aumenta el desarrollo, y en particular el ecoturismo. La habituación excesiva es un problema que afecta a los monos carablanca en ciertos sitios secoturísticos de Costa Rica. Es de suma importancia que las consecuencias de la habituación excesiva se estudien más a fondo, principalmente en las áreas donde las actividades ecoturísticas atraen visitantes a los hábitats de la vida silvestre.

Afrontamiento al distrés relacionado con la disfunción eréctil en varones con diabetes mellitus tipo 2 / Coping with erectile dysfunction-related distress in men with type 2 diabetes mellitus

Introducción: los estudios sobre afrontamiento al distrés generado por las dificultades sexuales en personas con diabetes mellitus son escasos. Objetivos: identificar las estrategias de afrontamiento que emplea un grupo de varones con diabetes mellitus tipo 2 frente al distrés generado por la disfunción eréctil, y explorar la relación entre estas estrategias y sus necesidades percibidas y referidas. Métodos: estudio descriptivo, transversal, que combinó metodología cualitativa y cuantitativa, en el que participaron 10 varones con diabetes mellitus tipo 2 y disfunción eréctil secundaria. Los instrumentos utilizados fueron: Escala de Modos de Afrontamiento, de RS Lazarus y S Folkman, Técnica de los 10 Deseos y Entrevista Semi-estructurada. La información cuantitativa se procesó a través de valores absolutos, porcentajes y medias (según dato e instrumento), y la cualitativa a través de la extracción de temas generales, categorías y contenidos. Se realizó triangulación teórica y de fuentes. Los aspectos éticos fueron considerados. Resultados: los sujetos tenían edad media de 51,6 años, nivel escolar superior y medio-superior, y todos fueron residentes en La Habana. Aparecieron divergencias entre las estrategias referidas a través del cuestionario y la entrevista: en el primero los sujetos refirieron con mayor frecuencia la búsqueda de apoyo social (media 1,8), mientras en las entrevistas refirieron mayormente la huida-evitación, a través de estrategias emergentes y coadyuvantes como: el desinterés informacional, la búsqueda de causas externas y la búsqueda de nuevas experiencias. Las necesidades y motivaciones fundamentales se expresaron en el área sexual-marital. Conclusiones: los sujetos utilizaron el manejo emocional como estilo de afrontamiento fundamental frente al distrés relacionado con la disfunción eréctil, a través de la estrategia de huida-evitación. Este hecho, la relevancia otorgada a la sexualidad y otros aspectos discutidos en el artículo, condicionan importantes vulnerabilidades psicosexuales en los sujetos estudiados(AU)

Introduction: the studies on the coping with distress generated by sexual difficulties in diabetes mellitus persons are scanty. Objectives: to identify the coping strategies of a group of men with type 2 diabetes mellitus against the distress generated by erectile dysfunction and to explore the relationship between these strategies and their perceived and referred requirements. Methods: cross sectional and descriptive study combining qualitative and quantitative methods. Ten men with type 2 diabetes mellitus and secondary erectile dysfunction participated in it. The instruments were Coping Modes Scale of RS Lazarus and S. Folkman, Ten-desire technique and semi-structured interview. The quantitative information was processed by using absolute values, percentages and means (according to data or instrument used) and the qualitative one through extracting general topics, categories and contents. Theoretical and source triangulation was carried out. Ethical aspects were taken into consideration. Results: the subjects were 51.6 years-old as average, higher and middle-higher education and all were living in Havana. There were divergences among the strategies mentioned in the questionnaire and the interview in the former, the subjects stated the search for social support more frequently (mean of 1.8) whereas in the latter, they mostly mentioned runaway-avoidance, through emerging and coadjutant strategies such as lack of interest in information, search of external causes and search of new experiences. Fundamental needs and motivations were expressed in the sexual-marital area. Conclusions: the participants used emotional management as a fundamental way of coping with erectile dysfunction distress, through the runaway-avoidance strategy. This event, the importance given to sexuality and other discussed aspects in the article give rise to important psychosexual vulnerabilities in the studied subjects(AU)

Central pain due to stroke: cognitive representation and coping according to gender / Dor central em acidente vascular encefálico: representação cognitiva e enfrentamento conforme o gênero

OBJECTIVE: To identify and compare perceptions of pain and how it is faced between men and women with central post-stroke pain. METHODS: The participants were 25 men and 25 women of minimum age 30 years-old and minimum schooling level of four years, presenting central post-stroke pain for at least three months. The instruments used were: Mini-Mental State Examination; structured interview for the Brief Psychiatric Scale; Survey of Sociodemographic and Clinical Data; Visual Analogue Scale (VAS); Ways of Coping with Problems Scale (WCPS) in Scale; Revised Illness Perception Questionnaire (IPQ-R); and Beck Depression Inventory (BDI). RESULTS: A significantly greater number of women used the coping strategy "Turn to spiritual and religious activities" in WCPS. They associated their emotional state with the cause of pain in IPQ-R. "Distraction of attention" was the strategy most used by the subjects. CONCLUSION: Women used spiritual and religious activities more as a coping strategy and perceived their emotional state as the cause of pain.

OBJETIVO: Identificar e comparar a percepção e o enfrentamento da dor entre homens e mulheres com dor central por acidente vascular cerebral (AVC). MÉTODOS: Participaram do estudo 25 homens e 25 mulheres com dor central por AVC há pelo menos três meses, maiores de 30 anos, escolaridade mínima de 4ª série. Os instrumentos utilizados foram: Mini-exame do Estado Mental; Entrevista Estruturada para Escala Psiquiátrica Breve; Inquérito de Dados Sociodemográficos e Clínicos; Escala Visual Analógica (EVA); Escala dos Modos de Enfrentamento de Problemas (EMEP); Questionário de Percepção da Doença Revisado (QPD-R) e Inventário de Depressão de Beck (IDB). RESULTADOS: Um número significativamente maior de mulheres revelou usar a estratégia de enfrentamento "Realizar atividades espirituais e religiosas" na EMEP e associou o estado emocional à causa de suas dores no QPD-R. "Distração da atenção" foi a estratégia mais utilizada pelos sujeitos. CONCLUSÃO: As mulheres utilizaram mais atividades espirituais e religiosas como estratégia de enfrentamento e perceberam mais o estado emocional como causa da dor.

Experimental assessment of the effects of a Neotropical nocturnal piscivore on juvenile native and invasive fishes

We experimentally examined the predator-prey relationships between juvenile spotted sorubim Pseudoplastystoma corruscans and young-of-the-year invasive and native fish species of the Paraná River basin, Brazil. Three invasive (peacock bass Cichla piquiti, Nile tilapia Oreochromis niloticus, and channel catfish Ictalurus punctatus) and two native (yellowtail tetra Astyanax altiparanae and streaked prochilod Prochilodus lineatus) fish species were offered as prey to P. corruscans in 300 L aquaria with three habitat complexity treatments (0%, 50% and 100% structure-covered). Prey survival was variable through time and among species (C. piquiti < O. niloticus < A. altiparanae < P. lineatus < I. punctatus), depending largely on species-specific prey behavior but also on prey size and morphological defenses. Habitat complexity did not directly affect P. corruscans piscivory but some prey species changed their microhabitat use and shoaling behavior among habitat treatments in predator's presence. Pseudoplatystoma corruscans preyed preferentially on smaller individuals of those invasive species with weak morphological defensive features that persisted in a non-shoaling behavior. Overall, our results contrast with those in a companion experiment using a diurnal predator, suggesting that nocturnal piscivores preferentially prey on different (rather diurnal) fish species and are less affected by habitat complexity. Our findings suggest that recovering the native populations of P. corruscans might help controling some fish species introduced to the Paraná River basin, particularly C. piquiti and O. niloticus, whose parental care is expected to be weak or null at night.

A relação predador-presa entre juvenis de pintado Pseudoplatystoma corruscans (piscívoro nativo) e jovens do ano de espécies nativas e invasoras de peixes da bacia do rio Paraná, Brasil, foi testada experimentalmente. Três espécies de peixe invasoras (o tucunaré Cichla piquiti, a tilápia do Nilo Oreochromis niloticus e o bagre do canal Ictalurus punctatus) e duas nativas (o lambari do rabo amarelo Astyanax altiparanae e o curimbatá Prochilodus lineatus) foram oferecidas como presa para P. corruscans em microcosmos, com três tratamentos de complexidade de habitat (0%, 50% e 100% de cobertura por estruturas submersas). A sobrevivência de presas variou ao longo do tempo e entre espécies (C. piquiti < O. niloticus < A. altiparanae < P. lineatus < I. punctatus), sendo governada, em grande parte, por diferenças espécies-específicas no comportamento das presas, mas também pelo tamanho e defesas morfológicas das mesmas. A complexidade de habitat não afetou diretamente a piscivoria de P. corruscans, mas, na presença do predador, algumas espécies-presa alteraram seu comportamento quanto ao uso de micro-habitat e grau de agregação entre os níveis de complexidade de habitat. Pseudoplatystoma corruscans predou preferencialmente sobre os indivíduos menores das espécies invasoras que apresentaram estruturas morfológicas defensivas pouco desenvolvidas e que não formavam cardume. Em geral, os resultados obtidos contrastam com os de um experimento análogo, no qual foi usado um piscívoro diurno, sugerindo que piscívoros noturnos predam preferencialmente sobre espécies de peixes diferentes (de hábitos mais diurnos) e que são menos afetados pela complexidade estrutural de habitats. Os resultados obtidos sugerem que a recuperação de populações nativas de P. corruscans poderia contribuir para o controle de algumas espécies de peixes introduzidas no rio Paraná, especialmente C. piquiti e O. niloticus, dos quais se espera que o cuidado parental seja reduzido ou nulo à noite.

A cirurgia cardíaca pediátrica sob o olhar dos pais: um estudo qualitativo / Pediatric cardiac surgery under the parents sight: a qualitative study

INTRODUÇÃO: As cardiopatias congênitas podem muitas vezes ser corrigidas por meio de cirurgia, assegurando para os pais a expectativa de uma vida normal, entretanto, a vivência da hospitalização, muitas vezes precoce, ocasiona maior sofrimento, sendo a operação o pior momento. OBJETIVO: O objetivo deste estudo foi analisar a vivência de famílias de crianças submetidas à cirurgia cardíaca, identificando os recursos de enfrentamento utilizados pelos familiares. MÉTODOS: A abordagem qualitativa foi a opção metodológica deste estudo, onde realizou-se seis entrevistas semi-estruturadas e 100 horas de observação participante. Foi utilizada a análise temática para a compreensão dos dados. RESULTADOS: Os resultados foram categorizados em quatro núcleos temáticos: sentimentos e emoções frente ao adoecimento do filho; a doença do coração sob o olhar materno; mãe e filho na dinâmica da unidade de terapia intensiva e recursos de enfrentamento. A fala das mães demonstrou a importância do coração devido a seu simbolismo que, por sua vez, potencializa sua fragilidade emocional diante do adoecimento. A religiosidade e uma consistente rede social de apoio foram fatores contribuintes para a manutenção de comportamentos adaptativos. A presença da mãe em todas as etapas do tratamento da criança contribuiu para a minimização do sofrimento gerado pela internação. CONCLUSÕES: A vivência das famílias foi caracterizada por sentimentos ambivalentes, como medo da morte, culpa e impotência frente às diferentes etapas do tratamento. A angústia e a ansiedade prevaleceram diante de situações desconhecidas, necessidade de informações frente às condutas terapêuticas, rotinas hospitalares e da própria situação de vida das famílias entrevistadas.

INTRODUCTION: Congenital heart defects can often be corrected through surgery, providing for parents to expect a normal life, but the hospitalization experience often early, causes more pain, for which surgery is the worst moment. OBJECTIVE: The aim of this study was to analyze the experience of families of children undergoing cardiac surgery and to identify the coping resources used by the families. METHODS: A qualitative approach was the metodology of choice for this study, which took place with six semi-structured interviews and 100 hours of observation. Thematic analysis was used to understand the data. RESULTS: The results were categorized into four themes: feelings and emotions facing the illness of the child; heart disease under the watchful mother, mother and child on the ICU and coping resources. The speech of mothers demonstrated the importance of the heart due to its symbolism that enhances their emotional fragility in the face of illness. Religiosity and a solid social network of support were contributing factors for the maintenance of the adaptive behaviors. The presence of mothers in all stages of the child's treatment contributed to minimizing the suffering generated by hospitalization. CONCLUSION: The experience of families was characterized by ambivalent feelings such as fear of death, guilt and helplessness against the different stages of treatment. The anguish and anxiety prevailed in the face of unknown situations when information were required before therapeutic procedures, hospital routines and the actual life situation of the families.

El anciano diabético y la respuesta adaptativa a la enfermedad / The diabetes elderly and its adaptive response to disease

La diabetes mellitus es la quinta enfermedad más frecuente en la senectud y una de las entidades que genera mayores demandas psicológicas y conductuales por parte del paciente, ya que gran parte de su manejo es conducido por este. En el paciente diabético, la calidad de vida está relacionada con el control metabólico, el que a su vez depende de múltiples factores psicosociales y conductuales. En el paciente geriátrico, en particular, a la depresión, la ansiedad y sentimientos de indefensión, se suman temores por su condición de diabético, lo que puede incidir negativamente en su estado psíquico y conducirlo al descontrol metabólico. Es necesario, entonces, el estudio de la respuesta adaptativa a la enfermedad en este segmento poblacional, lo que permitirá identificar tempranamente hábitos y conductas de riesgo que pudieran interferir con el adecuado cumplimiento del tratamiento y el control metabólico. Son varias las áreas que conforman la respuesta adaptativa: la percepción de la severidad de la enfermedad, su repercusión psicológica, las molestias asociadas, las barreras para el cumplimiento del tratamiento y la conducta de salud. Entre los factores capaces de modificar la expresión de dicha respuesta se destacan: la edad avanzada, el deterioro cognitivo, la comorbilidad, el deterioro de la capacidad funcional, la depresión y el apoyo social. El estudio de la respuesta adaptativa a la diabetes constituye un reto para los interesados en el tema y una necesidad impostergable, afín de comprender el papel del comportamiento humano en el proceso salud-enfermedad y perfeccionar las prácticas de salud

The diabetes mellitus is the fifth disease more frequent in old age and one of the entities generating more psychological and behavioral requests by patient, since most of its management is handled by itself. In diabetic patient, quality of life is related to the metabolic control, which in it turn depends of multiple psychosocial and behavioral factors. In elderly patient, in particular at the depression, the anxiety and feelings of defencelessness are added the fairs due its diabetic status, lapsing negatively in its psychic state and provoking a metabolic lack of control. Thus, it is necessary the study of the adaptive response to disease in this population segment, allowing to identify early the risky habits and behaviors that may to interfere with the appropriate treatment fulfillment of and the metabolic control. There are some areas related to the adaptive response: the perception of disease severity, its psychological repercussion, associate nuisances, barriers for treatment fulfillment and the health behavior. Among the factors able to modify the expression of such response are included: old age, cognitive deterioration, comorbid process, functional ability deterioration, depression and social support. The study of the adaptive response to diabetes is a challenge for those interested in this subject matter and a unpostponable to understand the human behavior role in health-disease process and to improve the health practices