Efectividad de la hipnosis en cantidad y calidad del sueño en pacientes con depresión post-COVID / Effectiveness of hypnotherapy on sleep quality and quantity in patients with post-COVID depression

Introducción: Se conocen diversos tratamientos para tratar y curar la depresión. Entre los más utilizados se encuentran la psicoterapia y la medicación. La hipnosis clínica utiliza un discurso basado en la sugestión y en los reflejos condicionados del sueño, para lograr la estabilidad en la desregulación del ciclo sueño / vigilia, lo cual es un factor esencial en el tratamiento de las personas deprimidas por la COVID-19. Objetivo: Comparar la evolución en la calidad y cantidad de sueño en pacientes con depresión post-COVID que fueron tratados con medicación e hipnosis. Métodos: Se realizó un estudio explicativo-comparativo, y un diseño cuasi-experimental. La muestra fue de 40 pacientes que fueron ingresados en el Hospital Universitario Clínico Quirúrgico «Cmdte. Manuel Fajardo Rivero», de Santa Clara, entre enero y marzo de 2021, con COVID-19. En un grupo de pacientes se empleó el inventario de depresión de Beck y un cuestionario para evaluar la cantidad y calidad del sueño antes y después de la intervención con medicación; en el otro grupo se empleó la hipnosis. Se utilizó la estadística descriptiva. Resultados: En ambos grupos la terapia empleada fue efectiva, redujo los niveles de depresión y eliminó las alteraciones del sueño. Conclusiones: Ambas formas de tratamiento se pueden emplear para tratar la depresión y los desórdenes propios del sueño. El método sugestivo de despertar de sueño hipnótico a sueño natural fue tan efectivo como los psicofármacos empleados.

Introduction: various treatments are known to treat and cure depression. Psychotherapy and medication are among the most used. Clinical hypnosis uses a discourse based on suggestions and conditioned sleep reflexes to achieve stability in sleep-wake cycle dysregulation, which is an essential factor in the treatment of people depressed by COVID-19. Objective: to compare the evolution in sleep quality and quantity in patients with post-COVID depression who were treated with medication and hypnotherapy. Methods: an explanatory comparative study with a quasi-experimental design was carried out. The sample consisted of 40 patients who were admitted due to COVID-19 at "Cmdte. Manuel Fajardo Rivero" Clinical and Surgical University Hospital from Santa Clara between January and March 2021. Beck Depression Inventory and a questionnaire were used in a group of patients to assess the sleep quality and quantity before and after the intervention with medication; hypnosis was used in the other group. Descriptive statistics was also used. Results: the used therapy was effective in both groups, reduced levels of depression and eliminated sleep disturbances. Conclusions: both forms of treatment can be used to treat depression and sleep disorders. The suggestive method of awakening from hypnotic sleep to natural sleep was as effective as the psychoactive drugs used.

False reports of an accomplice in a crime scene: conformity effects on memory confidence and accuracy / Relatos falsos sobre um cúmplice na cena do crime: efeitos da conformidade na confiança e na acurácia da memória / Informes falsos de un cómplice en la escena del crimen: efectos de conformidad en la confianza y precisión de la memoria

The memory reports of a given individual may be altered by preceding memory reports of another individual, a phenomenon termed memory conformity. To investigate this phenomenon, 58 undergraduate students were separated in two groups which watched one of two slightly different movies of a crime scene (one included an accomplice). Subsequently, pairs containing one participant from each group discussed the movie, and then participants responded individually whether there was an accomplice in the scene. The frequency of false reports and their confidence for the presence/absence of the accomplice were analyzed. Only false reports of seeing an accomplice were produced (by 31% of those who saw no accomplice), and confidence were as high for these responses as for correct "no-accomplice" responses. The data is consistent with prior findings, and show that confidence on false reports can be high when involving "insertion" of elements to witnessed events. (AU)

O relato sobre fatos vivenciados por um indivíduo pode ser alterado por relatos anteriores apresentados por outro indivíduo, fenômeno denominado conformidade de memória. Para investigar esse fenômeno, 58 estudantes de graduação foram separados em dois grupos, os quais assistiram cada um a um vídeo ligeiramente diferente de um mesmo crime (em um havia um cúmplice). Posteriormente, foram formados pares de discussão contendo participantes que assistiram às diferentes versões do vídeo, para, em seguida, responderem individualmente sobre se havia um cúmplice na cena testemunhada. A frequência de relatos incorretos e a confiança na presença/ausência do cúmplice foi analisada. Somente relatos falsos da presença do cúmplice foram verificados (por 31% daqueles que não viram o cúmplice no vídeo), e a confiança foi tão alta quanto as respostas corretas. Os resultados confirmam experimentos anteriores e mostram que a confiança em relatos falsos pode ser alta quando se trata de "inserção" de elementos em um evento testemunhado. (AU)

El informe de memoria sobre hechos vividos por un determinado individuo pueden ser modificados por informes de memoria de otro individuo, este fenómeno es denominado conformidad de memoria. Para investigar este fenómeno, 58 estudiantes universitarios fueron divididos en dos grupos, cada uno vio una película de una misma escena del crimen con sutiles diferencias (una de las versiones incluía un cómplice). Posteriormente, se conformaron parejas de discusión con un participante de cada grupo, y luego, de forma individual, cada persona contestó sí hubo un cómplice en la escena presenciada. Fue analizado la frecuencia de los informes falsos y su confianza en la presencia / ausencia del cómplice. Solo fueron analizados los informes falsos de la existencia del cómplice (por el 31% de los que no vieron el cómplice en el video), y la confianza fue tan alta para estas respuestas, como para las respuestas correctas de "no cómplices". Los resultados confirman los experimentos anteriores y muestran que la confianza en los informes falsos puede ser alta cuando se trata de "insertar" elementos en los eventos atestiguados. (AU)

Literatura de autoajuda, sugestão e contemporaneidade: uma leitura psicanalítica / Self-help literature, suggestion and contemporary times: a psychoanalytic reading / Literatura de autoayuda, sugestión y contemporaneidad: una lectura psicoanalítica

Um dos fenômenos da atualidade que merece destaque é a alta popularidade da literatura de autoajuda. As obras desse gênero propõem o cultivo de práticas de influência interpessoal, que incorrem geralmente no recurso à sugestão, criticada por Freud desde antes do século XX. Com efeito, utilizando como principal referencial teórico a psicanálise freudiana, privilegiando a noção de sugestão e, de maneira complementar, a análise de conteúdo de uma obra representativa da autoajuda, o presente estudo objetivou analisar alguns dos mecanismos presentes em tal modalidade literária e discutir os fatores que influenciam na sua ampla aceitação hoje. Em termos conclusivos, aponta que a relação estabelecida entre autor e leitor na autoajuda, pautada por processos psíquicos de identificação e transferência em favor da adesão às propostas do autor, permite que este renove continuamente a promessa de conduzir o leitor ao sucesso. (AU)

One of the phenomena of contemporary times that deserve mention is the high popularity of self-help literature. The works of this genre encourage practices of interpersonal influence, which usually incur in the use of suggestion, criticized by Freud since before the twentieth century. Indeed, using Freudian psychoanalysis as the main theoretical framework, focusing the notion of suggestion and, in a complementary way, the content analysis of a representative work of self-help, this study aimed to analyze some of mechanisms present in such literary genre and discuss the factors that influence its wide acceptance today. Thus, points out that the relationship between author and reader in self-help, guided by psychological processes of identification and transfer in favor of accession to the proposals of the author, allows him continually to renew this promise to lead the reader to success. (AU)

Las obras de la literatura de autoayuda proponen prácticas de cultivo de influencia interpersonal, que generalmente incurren en el uso de la sugestión, criticado por Freud desde antes del siglo XX. El psicoanálisis freudiano fue el principal recurso teórico y metodológico para revisión de la literatura, privilegiando la noción de la sugestión y, de manera complementaria, el análisis de contenido de una obra representativa de la autoayuda, este estudio tuvo como objetivo analizar algunos de mecanismos presentes en tal literatura y discutir los factores que influyen en su amplia aceptación en la actualidad. En términos concluyentes, señala que la relación entre el autor y el lector en la autoayuda, guiada por los procesos psicológicos de la identificación y la transferencia a favor de la adhesión a las propuestas del autor, permite renovar continuamente esta promesa de conducir al lector hacia el éxito. (AU)

O manejo transferencial em Freud: Uma análise da relação entre transferência e sugestão / Transference management in freud: an analysis of the relationship between transference and suggestion

Pretende-se elucidar a relação entre transferência e sugestão, tomando por referência a produção freudiana da primeira e segunda décadas, tendo por destaque os trabalhos sobre a técnica psicanalítica. Visa-se, assim, desvelar como o manejo da transferência impediria o método clínico psicanalítico de ter sua eficácia reduzida à sugestão. A partir da categoria neurose de transferência, é possível pensar estratégias epistemológicas para responder às críticas de outras áreas do conhecimento que alegam ser a psicanálise uma terapêutica que tem sua eficácia garantida pelo fenômeno da sugestibilidade do cliente na figura do analista.

Transference management in Freud: an analysis of the relationship between transference and suggestion. This article intends to elucidate the relationship between transference and suggestion taking Freud's production from the first and second decade as the reference, highlighting the work on psychoanalytic technique. The aim is to reveal how the management of transference would prevent the psychoanalytic clinical method from having its efficacy reduced by suggestion. From the category of transference neurosis, it is possible to think of epistemological strategies to respond to the criticisms from other areas of knowledge, which claim that psychoanalysis is a therapy that has its effectiveness guaranteed due to the phenomenon of client suggestibility faced with the figure of the analyst.

Uso de la sugestión en el manejo de la conducta del niño en odontología pediátrica / Use of suggestion in behavior management children in pediatric dentistry

La sugestión siempre ha sido utilizada por los seres humanos en otros seres humanos, tanto de forma consciente como inconsciente. Desde que la humanidad comenzó a ser consciente de si, comenzaron los intentos para influir en los demás. En la práctica clínica, muchos odontopediatras usan la sugestión de forma intuitiva en el manejo de la conducta del paciente. El objetivo de este articulo hacer una revisión bibliográfica sobre el uso de la sugestión en odontopediatria, los tipos de sugestión y algunas técnicas de sugestión usadas en el manejo de la conducta del niño...

The suggestion has always been used by humans over other human beings, both consciously and unconsciously. Since mankind began to be conscious of itself, began attempts to influence others. In clinical practice many pediatric dentists use intuitively suggestion in the management of the patient's behavior. The aim of this paper to review the literature on the use of suggestion in pediatric dentistry, types of suggestion and some suggestion techniques used in managing children's behavior...

Influência da idade, desejabilidade social e memória na sugestionabilidade infantil / Influence of age, social desirability and memory in children's suggestibility

A sugestionabilidade infantil é influenciada pela capacidade de memória, idade ou desejabilidade social. Este estudo teve como objetivo estudar estes fatores em três grupos de crianças com idades de 5/6 anos, 8/9 anos e 10/11 anos. Para tanto procedemos à construção de uma escala de avaliação da sugestionabilidade infantil baseada na Escala de Sugestionabilidade de Gudjonsson (GSS; Gudjonsson, 1997). Os resultados obtidos revelaram que as crianças mais novas foram as mais sugestionáveis, fenômeno que parece estar associado ao elevado grau de desejabilidade social das suas respostas. Relativamente à memória fonológica, verificamos que a sua menor amplitude esteve também relacionada com maior sugestionabilidade infantil. Sugere-se que as variáveis memória e desejabilidade social sejam cuidadosamente consideradas no momento de obtenção do testemunho de crianças. (AU)

Children's suggestibility is influenced by several factors such as memory, age or social desirability. The main objective of this study was to analyze how these factors are associated with the degree of suggestibility in 5/6 year-old, 8/9 year-old and 10/11 year-old children. For a suggestibility measure, a new scale based on the Gudjonsson Suggestibility Scale was developed (GSS; Gudjonsson, 1997). Results showed that: younger children are more suggestible than older children; a higher degree of social desirability is associated with stronger suggestibility responses; and a smaller memory span is related to greater children's suggestibility. Conclusions highlight that memory and social desirability should be analyzed carefully when eyewitness accounts of children are considered. (AU)

Conformidade entre testemunhas oculares: efeitos de falsas informações nos relatos criminais / Conformity among eyewitnesses: effect of false information on criminal reports / Conformidad entre testigos oculares: efectos de falsas informaciones en testimonios criminales

Este estudo investigou como informações falsas fornecidas a testemunhas oculares podem afetar a fidedignidade de seus relatos. Os participantes foram divididos em duas condições experimentais. Todos assistiram ao vídeo de um crime e responderam a um questionário sobre informações nele descritas. Em uma condição, os participantes preencheram o questionário individualmente e, em seguida, discutiram suas respostas com um confederado, que fornecia informações falsas ao participante. Após discutirem tais informações, os participantes eram requisitados a fazer um novo relato. Em outra condição, os participantes realizaram todo o procedimento individualmente, sem receberem informações falsas. O número de erros na presença do confederado foi maior quando comparado com a condição sem o confederado. São discutidos possíveis fatores que envolvem a distorção da memória por meio de conformidade, assim como implicações práticas dos resultados encontrados...

The current study investigated how misinformation presented to eyewitnesses can affect the reliability of their reports. An experiment was conducted with 54 participants, divided in two conditions. All participants watched a video of a crime scene, and then answered a questionnaire about the content of the video. In one condition participants filled the questionnaire individually and then discussed their answers with a confederate, instructed to provide misinformation to participants. After the discussion participants were required to provide a new report. In another condition participants made the whole procedure individually, without receiving any misinformation. Mistakes in the presence of the confederate were higher when compared to the condition with no confederate. Potential factors underlying the distortion of memories through conformity, as well as practical implications of the results are discussed...

Este estudio investigó cómo información falsa proporcionada a testigos oculares puede afectar la veracidad de los testimonios. Los participantes fueron divididos en dos condiciones experimentales, y todos asistieron el video de un delito y luego respondieron a un cuestionario sobre la información contenida en el mismo. En un grupo los participantes completaron el cuestionario de forma individual y luego discutieron sus respuestas con un asociado que les proporcionaba informaciones falsas. Después de discutir esas informaciones se les solicitaba hacer un nuevo testimonio. En el otro grupo los participantes realizaron todo el procedimiento individualmente, sin recibir información falsa. El número de errores fue mayor en la presencia del asociado. Se discuten los posibles factores implicados en la distorsión de la memoria mediante la conformidad, así como las implicaciones prácticas de los resultados...

Social, cultural and economic factors associated with self-medication / Factores económicos, sociales y culturales asociados con la automedicación

Introduction: Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. Objective: To determine the prevalence of self-medication and its related factors in a Colombian city. Materials and methods: Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. Results: Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. Conclusion: Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

Introducción. La automedicación es un fenómeno cada vez más frecuente a nivel mundial. Los estudios en este campo sugieren que hay una relación entre la automedicación y diversos factores sociodemográficos y económicos. Objetivo. Determinar la prevalencia de la automedicación y los factores relacionados en Pereira, Colombia. Materiales y métodos. Estudio descriptivo de corte transversal llevado a cabo en la población de Pereira. Se hizo un muestreo aleatorio por afijación proporcional en 414 adultos, y se desarrolló y aplicó la encuesta IRIS-AM ( Instrument for Systematic Data Collection of Self-Medication ). Resultados. Se encuestaron 414 personas, 62,6 % de las cuales eran mujeres; el promedio de edad fue de 44 años. La prevalencia de la automedicación fue de 77,5 % a lo largo de la vida y de 31,9 % en los 30 días previos. Los medicamentos más comúnmente utilizados fueron los analgésicos y antipiréticos (44,3 %), los antiinflamatorios no esteroideos (36,4 %), y los antihistamínicos (8,5 %). Los síntomas que llevaron a la automedicación con mayor frecuencia fueron la cefalea (55,7 %), el resfriado (16,2 %) y el dolor muscular (13,2 %). Los análisis multivariados mostraron asociación entre la automedicación a lo largo de la vida y guardar medicamentos en casa, así como entre tener un nivel superior de escolaridad y estar a favor de la automedicación. Los factores referentes a almacenar medicamentos y recomendarlos a otros se asociaron con la automedicación en los 30 días previos. Conclusiones. La prevalencia de la automedicación hallada en este estudio fue similar a la reportada previamente a nivel mundial; aun así, no existe un patrón establecido para esta práctica. Se evidenciaron las variables sociodemográficas asociadas con la automedicación, las cuales requieren una mejor caracterización. La intención de recurrir a la automedicación ha sido poco estudiada y podría ser un indicador importante para la medición y comprensión de este fenómeno.

Traducción y comentario de un documento freudiano de 1892: análisis del informe de la conferencia de Sigmund Freud sobre hipnosis y sugestión / Translation and commentary of a Freudian document of 1892: analysis of the report of Sigmund Freud's lecture on hypnosis and suggestion

Este artículo ofrece la primera traducción al español del informe que reproduce fielmente el contenido de una conferencia dictada por Sigmund Freud en 1892, titulada ¡Über Hypnose und Suggestion¡ [Sobre hipnosis y sugestión]. Ese documento aporta elementos muy valiosos para una mejor comprensión de los inicios del pensamiento freudiano, particularmente de su relación con el terreno de la hipnosis. En este texto se reconstruyen los primeros pasos de Freud en el campo del hipnotismo, y se detalla el modo en que se posicionó respecto de los debates que dos escuelas francesas de medicina sostenían sobre aquellos problemas. El análisis de la exposición de 1892 tiene como resultado, primero, una mejor intelección de la perspectiva asumida por Freud hacia las doctrinas de Charcot y Bernheim, y segundo, la demostración de la importancia que la obra de Jospeph Delbœuf tuvo para el creador del psicoanálisis en ese momento capital de su recorrido profesional.

Confiabilidad intraevaluador del cuestionario para limitaciones en la actividad y restricciones en la participación de niños con TDAH / Intra-rater Reliability for the Questionnaire on Activity Limitations and Participation Restrictions of Children With ADHD

Introducción: Los cuestionarios para la evaluación de limitaciones en la actividad y restricciones en la participación de niños con TDAH (CLARP-TDAH) se han desarrollado recientemente en Colombia, basados en las sugerencias hechas por la Organización Mundial de la Salud (OMS) desde la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF), lo cual permite trascender de la evaluación clínica a una evaluación desde la funcionalidad y el funcionamiento de los niños en su contexto familiar y escolar. En este estudio se determinó el grado de confiabilidad intraevaluador para los cuestionarios CLARP TDAH Padres y Profesores. Métodos: En una muestra no probabilística de 203 niños y niñas colombianos escolarizados y diagnosticados con TDAH, se determinó la confiabilidad intraevaluador a través del índice kappa; los informantes fueron los padres y los profesores. Resultados: Se encontró que la confiabilidad intraevaluador de los dominios del cuestionario CLARP-TDAH para padres obtuvo κ > 0,7, mientras que para los dominios del CLARP-TDAH Profesores resultaron > 0,8. Conclusiones: Los cuestionarios CLARP-TDAH son una herramienta con buen nivel de confiabilidad intraevaluador, lo cual permite realizar una evaluación confiable de las limitaciones en la actividad y las restricciones en la participación para determinar el funcionamiento en los entornos familiar y escolar.

Introduction: Questionnaires for evaluating activity limitations and participation restrictions in children with ADHD (CLARP-TDAH) has recently been developed in Colombia, based on the suggestions made by the WHO from the International Classification of Functioning, Disability and Health (ICF), allowing clinical evaluation beyond an evaluation of the functionality and functioning of children in their family and school environments. Previous research with the questionnaire proved useful in the multidisciplinary approach of Colombian children with ADHD. This study determines the level of intra-rater reliability for questionnaires CLARP-TDAH Parents and Teachers. Methods: The study included a non-random sample of 203 Colombian children attending school and diagnosed with ADHD. Intra-rater reliability and the reproducibility of the results was determined using the Kappa index. The informants were parents and teachers. Results: Kappa values >0.7 were obtained for the intra-rater reliability of the questionnaire domains of CLARP-TDAH Parents, while for CLARP-TDAH Teachers domains these values were >0.8. Conclusions: CLARP-TDAH questionnaires are a tool with a good level of intra-rater reliability, which allows a reliable assessment of activity limitations and participation restrictions in order to determine the level of functioning at home and school.

Adaptación transcultural de la escala Daily Spiritual Experience Scale para su uso en Colombia / Cross-cultural adaptation of the Daily Spiritual Experience Scale for its use Spirituality in Colombia

Objetivo: Realizar la adaptación transcultural de la escala Daily Spiritual Experience Scale para su uso en Colombia. Método: Se obtuvo el permiso para el uso de la escala y se siguieron las siguientes etapas a partir del algoritmo de la European Organisation for Research and Treatment of Cancer: traducciones directas e independientes de la escala por 2 traductores hablantes nativos del español colombiano, obtención de una versión preliminar a partir de las anteriores versiones, traducciones inversas e independientes de la escala por 2 traductores hablantes nativos de inglés, revisión del proceso por la autora de la escala e inclusión de sugerencias y realización de una prueba piloto. Resultados: Las traducciones directas fueron similares en las instrucciones, opciones de respuesta y 11 de los 16 items de la escala; en 4 items se requirió una reunión de consenso para escoger la mejor opción de traducción; las traducciones inversas fueron similares entre si, y con la versión original de la escala, la autora sugirió emplear algunos términos más adecuados en 6 items, luego de aclarar el propósito del item; estas sugerencias fueron incluidas en la versión preliminar de la escala; en la prueba piloto, realizada con pacientes con cáncer, no se observaron dificultades de comprensión, confusión, molestia, y tampoco se sugirió un nuevo parafraseo. Conclusión: Se cuenta con la versión en español colombiano de la escala Daily Spiritual Experience Scale, para ser sometida a un estudio de validación previo a su uso en la evaluación de experiencias espirituales diarias en población clínica y general.

Objective: To make a cross-cultural adaptation of the Daily Spiritual Experience Scale for its use in Colombia. Method: Permission was obtained to use the scale and the stages of the EORTC organization were followed: direct and independent translations of the Scale by two native Colombian Spanish speaking translator. A preliminary version was obtained from these two versions, followed by independent back-translations of the Scale by two native English speaking translators, a review of the process by the author of the Scale, as well as including suggestions, and finally the performing of a pilot test. Results: The direct translations were similar as regards the instructions, response options, and 11 of the 16 items of the Scale. Four of the items required a consensus meeting to choose the best translation option. The back-translations were similar between themselves and with the original version of the Scale. The author suggested some more suitable terms in 6 items after clarifying the intention of the item. These suggestions were included in the preliminary version of the Scale. In the pilot test, performed with cancer patients, no difficulties in comprehension were observed, nor confusion or discomfort. No new paraphrasing was suggested. Conclusion: There is now a version of the Daily Spiritual Experience Scale in Colombian Spanish to be subjected to a validation study prior to its use in the evaluation of the spiritual experiences in the clinical and general population.

Dimensiones y alternativas del diagnosticar en la medicina y la psiquiatría: I parte / Dimensions and alternatives in the act of diagnose in medicine and psychiatry: part I

En esta primera de un trabajo concebido en dos partes, se indaga sobre el papel que la sugestión del médico tiene en el acto de diagnosticar, y en el ejercicio de la medicina. Lo que hoy llamamos sugestión será expuesto con más detalle en la segunda parte; en el actual se pretende asimilarla con los que los hipocráticos llamaban la magia, actitud frente a la medicina que repudiaron explícita y reiteradamente, lo que es aprehensible en los textos que nos legaron, porque el médico, y secundariamente el paciente, estaban, a su juicio, particularmente expuestos a caer en sus redes.

In this first, of a work conceived in two parts, it is investigated the role that have the suggestion in the physician in the act of diagnose and in the practice of medicine. What we now call suggestion will be presented in more detail in the second part; the current aims to assimilate with that the clubbing called the magic, attitude toward hipocratic medicine repudiated explicitly and repeatedly, what is apprehensible in the texts that we have bequeathed us, because the doctor, and secondarily secondarily the patient, were, in his view, particularly liable to fall into their networks.

Dimensiones y alternativas del diagnosticar en la medicina y la psiquiatría: II Parte / Dimensions and alternatives in the act of diagnose in medicine and psychiatry: Part II

En esta investigación se explora el elemento sugestivo que opera en el que diagnostica en el ejercicio de hacer diagnósticos, asunto del que fueron conscientes y pusieron en claro los médicos griegos del siglo V a.C. según lo expusimos en la primera parte de este trabajo. Se discute el origen, alcance y uso del término sugestión en la medicina moderna, y se muestran ejemplos de esta constante de la práctica médica moderna, tanto en la psiquiatría como en la cirugía. Por último, se estudian los ingredientes sugestivos sobre lo que al parecer se monta la clasificación diagnóstica conocida como DSM., de amplio uso en la psiquiatría.

In this research is explored the suggestive element that operates in diagnosing exercise in making diagnosis. Greek physicians were conscious about that in the 5thcentury B.C., as we discussed in the first part of this work. We discuss the origin, scope and use of the term suggestion in modern medicine, with examples of this constant of the medical modern practice, both in psychiatry and in surgery. Finally, the suggestive ingredients are studied in what apparently is based the diagnostic classification known as DSM, widely used in psychiatry.

Circumcision Weeks: Making Circumcision Part of Routine Training and Service Delivery at District-Level Hospitals in South Africa

"Background: Medically safe; elective male circumcision supports traditional and cultural rites of passage by reducing the risk of adverse events and death among men undergoing initiation. It is a way of preventing penile conditions that arise from being uncircumcised. It also protects against various sexually transmitted infections; playing a particularly important role in human immunodeficiency virus (HIV) prevention; as it protects against HIV infection in men by up to 60. It also helps reduce herpes simplex virus type 2; a key biological co-factor thought to account for some human susceptibility to HIV infection and human papillomavirus. To address these needs and to meet the World Health Organization's call to upscale male circumcision to 80in HIV/AIDS epidemic-gripped sub-Saharan Africa; there is a need to provide male circumcision as standard care in district health. Method: A retrospective review of three years of circumcision services; using the sleeve method; and not the high-volume; forceps-guided method; and training at a Level 1 district hospital in South Africa. Results: Two hundred and twenty-one medical circumcisions were performed; increasing significantly in each successive year. Mostly; they were carried out under local anaesthetic; and there were only four complications; all of which were successfully resolved. The average age of the patients was 20; and generally; they elected to have medical circumcision carried out for cultural reasons. Some 60 students and clinicians were trained in safe medical male circumcision. Conclusion: To meet the growing demand for male medical circumcision; especially among teenagers and young adult men at district-level hospitals; there is a need to significantly expand the surgical competency of clinicians in this field. ""Circumcision weeks"" are one way of routinely upscaling surgical skill levels; while simultaneously responding to increased patient demand for safe medical circumcision."

Proposal of managerial standards for new product portfolio management in Brazilian pharmaceutical companies / Proposta de normas gerenciais para a gestão de portfólio de novos produtos em empresas brasileiras de produtos farmacêuticos

New Product Portfolio Management is aimed at helping decision-makers better select projects for new products based on key criteria for the manufacturer. The Brazilian pharmaceutical industry has been undergoing change due to stricter sanitary requirements following the enactment of the Generic Law in 1999. This paper presents the results of a research study aimed at clarifying the rationale employed by national pharmaceutical companies in selecting and prioritizing their new product development projects. Consequently, proposals for an analytical structure that could help these companies better select their products were produced. The research was carried out using case study methodology in which four different companies were investigated. The results of the field study confirmed that these companies had a non-structured Product Development System and that the selection of new product development projects was made on a non-systematic basis. The research also identified key criteria for the selection of projects of new pharmaceutical products, which provided the basis for the preparation of a proposal for a managerial standard for application of New Product Portfolio Management.

A gestão de portfólio de projetos de novos produtos visa a auxiliar os tomadores de decisão a selecionar projetos de novos produtos considerando critérios importantes para a organização. A indústria farmacêutica brasileira tem passado por transformações devido ao aumento das exigências sanitárias após a Lei de Genéricos, de 1999. O objetivo deste trabalho foi entender como as indústrias farmacêuticas brasileiras selecionam seus projetos de desenvolvimento de novos produtos e propor uma estrutura que possa auxiliar estas empresas a selecionar seus projetos de produtos. Foi utilizada a metodologia de estudo de caso e uma mostra de quatro organizações foi investigada. Os resultados indicam que essas empresas apresentam um desenvolvimento de produtos não estruturado e que a seleção de projetos de novos produtos é realizada de forma não-sistemática. Critérios importantes para a seleção de projetos de novos produtos foram identificados e utilizados para elaboração de um padrão gerencial para aplicação da gestão de portfólio de projetos de novos produtos.

Comparison of four ways in treatment of acute conversion disorder

In spite of high prevalence of conversion disorder, there is no widely acceptable effective treatment for it. In this study, we compared four ways of treatment in acute conversion disorder and it's recurrent after one month. In a clinical trial study, we selected 80 patients with acute conversion disorder using simple sampling method. They were divided randomly into four treatment groups. [Suggestion, simple muscle relaxation, hypnosis, and diazepam injection] The speed of syndrome elimination, recovery frequency, and one month's recurrence were compared. The results were analyzed with chi-square, Fisher's exact test and ANOVA. Mean recovery time was significantly less in muscle relaxation group compared to the hypnosis and diazepam injection groups [P < 0.05]. In patients with co-morbidity, the mean recovery time was shorter than the mean recovery time in none co-morbidity [P < 0.05]. There was no significant relation between one month recurrent and way of treatment or other variables. All four ways of treatments bring significant recovery, but in muscle relaxation, recovery is faster than hypnosis and diazepam infusion

De placebos y nocebos: la sanación por las palabras / About placebos and nocebos: healing through words

El concepto de efecto placebo, aplicado principalmente al manejo terapéutico del dolor, ha sido extensamente estudiado y se refiere a la posibilidad de obtener efectos analgésicos mediante la administración de sustancias inertes. La evidencia opuesta, es decir la inducción del dolor mediante sugestión verbal, ha dado lugar al concepto de nocebo, que implica que la expectativa de un hecho negativo puede llevar, de por si, al empeoramiento de un síntoma. La propuesta neuroquímica del fenómeno placebo-nocebo implica la presencia de sistemas neuronales opuestos, activados por las expectativas con respecto al dolor. Los opioides mediarían la analgesia placebo mientras que la colecistokinina sería la responsable del aumento del dolor. La sanación por la palabra, a la luz de los conocimientos actuales, implicaría que hay un nexo entre los efectos psicosociales y farmacológicos, importante desde el punto de vista del manejo terapéutico del dolor.

The concept of "the placebo effect", mainly applied to the therapeutic management of pain, has been extensively studied and refers to the possibility to obtain analgesic effects through the administration of inert substances. The opposite evidence, i.e. the induction of pain through verbal suggestions, has validated the concept of nocebo effect, that implies that the expectative of a negative event could cause, per se, the worsening of a symptom. The neurochemical approach of the placebo-nocebo phenomenon involves the existence of opposite neuronal systems, activated for expectations regarding pain. Opioids would mediate placebo analgesia whereas cholecystokinin would account for the increase in pain. Healing through words, under the light of the present knowledge, would imply that a link exists between psychosocial and pharmacologic effects, important from the point of view of the therapeutic management of pain.

Comparison of four different treatment options in the management of acute conversion disorder

Patients with conversion disorder may be seen by different specialists in various clinics and emergency situations. However, there are not sufficient studies on the most effective treatment for this disabling illness. In a clinical trial, we compared four treatment strategies; muscle relaxation, suggestion, hypnosis and intravenous diazepam infusion, in 80 patients with acute conversion disorder. Speed of recovery and number of the recurrences in a month following different treatment options were compared among groups. Recovery was significantly quicker with muscle relaxation compared to hypnosis and diazepam infusion. In patients with comorbidity of major depressive disorder, recovery was even faster. There was no statistically significant differences in the number of remissions or relapses among the four groups. All the four different treatment strategies brought about significant recovery. However, after treating patients with muscle relaxation, recovery was faster compared to other treatment methods