Severe Mitral Valve Regurgitation in Infective Endocarditis: A Case Report.

We present a case report of a patient with infective endocarditis. He came to the emergency room with respiratory failure due to severe pneumonia and pulmonary edema. On 2D transesophageal echocardiography, vegetations were seen in both mitral and aortic valves, with mitral valve perforation and severe regurgitation. His clinical presentation and severity of the disease made him suitable for urgent valve repair. He was submitted to mitral valvuloplasty with closure of the valve perforation and insertion of a bioprosthetic aortic valve. Despite significant clinical improvement, a post-surgical complication was noted with new-onset lung injury after cardiopulmonary bypass. This is an interesting case of a patient with suspected retrograde valve involvement, affecting the aortic valve, the mitral-aortic intervalvular fibrosa, and the mitral valve, ending with mitral valve abscess with leaflet perforation and valvular regurgitation.

Impact of Psychosocial Factors on the Activity of Crohn's Disease: A Cross-Sectional Analysis of Social Support, Stress, and Flare-Up Incidence.

Background/Objectives: Crohn's disease is a chronic and debilitating intestinal disorder that alternates between remission and active flare-ups, often leading to hospitalization. Social support is known to enhance adaptation to the disease and modulate stress perception in patients, while stress may exacerbate symptoms. The aim of this study was to examine the roles of perceived stress and social support in Crohn's disease and their impact on the frequency of flare-ups. Methods: A cross-sectional observational study was conducted, assessing stress and social support in a cohort of 91 patients with Crohn's disease during flare-up and remission phases. The Perceived Stress Scale (PSS-14) and a Social Support Questionnaire were utilized for evaluation. We examined the relationship between stress and social support in Crohn's disease. The interaction between the variables studied was also observed, considering the stage of the disease. Finally, we carried out an analysis of the influence of these two variables on the development of flare-ups in Crohn's disease. Results: The study revealed that patients experience higher stress levels during flare-ups and that these levels are amplified by a lack of social support. A significant relationship was identified between the levels of social support and the occurrence of flare-ups, indicating that better social support is associated with fewer flare-ups. Conclusions: Patients with Crohn's disease in the flare-up phase are subject to considerable stress. A deficit in social support is linked to an increase in stress levels. The interaction between social support and stress plays a critical role in the development of flare-ups.

Adult Attachment Questionnaire: evidence of validity in a sample of IPVAW offenders.

Introduction: Adult attachment can be understood as a cognitive and emotional system concerning oneself and others, based on previous attachment experiences throughout life. This system automatically affects relationships with others. Because of its importance in the interpersonal domain, it has been studied on numerous occasions in research on intimate partner violence. The aim of this study was to obtain evidence of validity of the Adult Attachment Questionnaire (AAQ) in a sample of 331 men convicted of intimate partner violence against women (IPVAW). Methods: The AAQ assesses adult attachment style in four dimensions that, together, yield four attachment categories. A psychometric analysis was performed, including reliability analysis and confirmatory factor analysis of the items, which ratified the factorial structure of the questionnaire. For a correct fit of the model, it was necessary to eliminate 4 of the items from the original scale. Results: A latent profile analysis was also carried out, which identified four attachment styles: secure, preoccupied/anxious, avoidant/dismissing and fearful. Reliability indices were adequate. In general, the attachment profiles obtained ranges and means similar to those found in the general population study. The distribution of attachment styles was not equal: 50.57% of the participants presented secure attachment, 4.57% avoidant/dismissing attachment, 36.9% preoccupied/anxious, and 8.57% fearful. Discussion: In conclusion, a valid and reliable instrument was determined based on the original AAQ scale to measure attachment in men convicted of IPVAW.

Colorectal Cancer Surgery: Influence of Psychosocial Factors.

(1) Background: In the treatment of colorectal cancer, it is important to consider different psychosocial factors. Our first objective was to measure the levels of perceived stress in subjects diagnosed with colorectal cancer awaiting potentially curative surgery. Also, we aimed to analyse what coping styles these patients used, how they perceived their illness, and the subsequent influence of these factors on their levels of stress. (2) Methods: Stress, coping styles and illness perception were assessed in a sample of 107 patients. The instruments used were the Perceived Stress Scale (PSS-14), the Stress Coping Questionnaire (SCQ) and the Brief Illness Perception Questionnaire (BIPQ-R). (3) Results: Patients using active coping styles have lower levels of perceived stress (p = 0.000; p = 0.002) than patients making use of passive coping styles (p = 0.000; p = 0.032; p = 0.001). A multi-linear regression model found that the perception of illness and the use of the negative approach coping style (p = 0.000; p = 0.001) influence an increase in perceived stress, and that a decrease in stress levels was influenced by the problem solving coping style (p = 0.001). (4) Conclusions: Based on our results, we recommend preventive interventions in care patients undergoing colorectal cancer surgery.

Influence of Coping and Self-Efficacy in Inflammatory Bowel Disease.

(1) Background: Coping includes the specific cognitive processes and behaviours that the patient uses when faced with the stress of living with a chronic disease. Self-efficacy is the knowledge that individuals have about their abilities and their confidence to face a problem or cope with a situation (disease). The aim of this study was to explore the role of coping and self-efficacy in inflammatory bowel disease. (2) Materials and Methods: A total of 92 participants were included (33 had been diagnosed with Crohn's disease, 23 with ulcerative colitis and 36 were healthy participants). The Coping Strategies Inventory was used to measure which coping strategies were employed, differentiating them as active or passive. The General Self-Efficacy Scale was used to measure self-efficacy. (3) Results: The results indicate that people with inflammatory bowel disease used strategies related to passive coping more than healthy people (mean of 36.39 ± 13.92 vs. 29.77 ± 10.70, p = 0.017). Additionally, people with inflammatory bowel disease used social withdrawal more than healthy participants (mean of 8.30 ± 5.07 vs. 4.47 ± 4.17, p < 0.001). In addition, there are significant differences in emotion-focused engagement coping strategies. People with inflammatory bowel disease used this strategy less than healthy people (mean of 21.77 ± 7.75 vs. 25.03 ± 7.00, p = 0.044). Finally, healthy participants used the emotion-focused disengagement strategy less than those diagnosed with inflammatory bowel disease (mean of 9.81 ± 7.74 vs. 15.61 ± 10.14, p = 0.004). (4) Conclusions: Actions aimed at the development of active coping strategies and patient socialisation must be included in the treatment of inflammatory bowel disease.

When prevention is the best remedy: HIV pre-exposure prophylaxis (PrEP) among adolescents gays and transgender women in Belo Horizonte, Minas Gerais State, Brazil.

Based on the incorporation of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy and considering the need to comprehend the use of medication among young people, this article analyzes narratives of gay men and transgender women from Belo Horizonte, Minas Gerais State, Brazil, participating in the PrEP1519 study. This is a qualitative research, based on the interpretative anthropology, developed by 10 in-depth interviews with PrEP users followed-up for at least three months between October and November 2019. The results showed that the drug was seen as the main motivation for participating in the study and as a strategy combined with the use of condoms, whether as additional prevention, or assuming the leading role. The medication revealed signs built by the gender performances and their relation to other medications, especially the experience of trans girls in hormonal therapy. Regarding the socialization of the use of PrEP, the narratives showed that there was no secret between the couples, which did not meant that stigmas on the association with HIV did not exist, mainly in the virtual context. In the family environment, they reported questions about the preventive function of the medication and the voluntary nature of the participation in the study. The youth's narratives revealed plural meanings of the medication and its social use, composing both the boys' and girls' performances. The signs attributed to the medication indicated that in addition to maintenance of health, the medication improves life and sexual freedom.

When prevention is the best remedy: HIV pre-exposure prophylaxis (PrEP) among adolescents gays and transgender women in Belo Horizonte, Minas Gerais State, Brazil / Quando a prevenção é o melhor remédio: profilaxia pré-exposição do HIV (PrEP) entre adolescentes gays e mulheres transgênero em Belo Horizonte, Minas Gerais, Brasil / Cuando la prevención es el mejor remedio: profilaxis previa a la exposición al VIH (PrEP) entre adolescentes gays y mujeres transgénero en Belo Horizonte, Minas Gerais, Brasil

Based on the incorporation of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy and considering the need to comprehend the use of medication among young people, this article analyzes narratives of gay men and transgender women from Belo Horizonte, Minas Gerais State, Brazil, participating in the PrEP1519 study. This is a qualitative research, based on the interpretative anthropology, developed by 10 in-depth interviews with PrEP users followed-up for at least three months between October and November 2019. The results showed that the drug was seen as the main motivation for participating in the study and as a strategy combined with the use of condoms, whether as additional prevention, or assuming the leading role. The medication revealed signs built by the gender performances and their relation to other medications, especially the experience of trans girls in hormonal therapy. Regarding the socialization of the use of PrEP, the narratives showed that there was no secret between the couples, which did not meant that stigmas on the association with HIV did not exist, mainly in the virtual context. In the family environment, they reported questions about the preventive function of the medication and the voluntary nature of the participation in the study. The youth's narratives revealed plural meanings of the medication and its social use, composing both the boys' and girls' performances. The signs attributed to the medication indicated that in addition to maintenance of health, the medication improves life and sexual freedom.

Com base na incorporação da profilaxia pré-exposição (PrEP) como estratégia para a prevenção do HIV, e considerando a necessidade de compreender o uso da medicação entre jovens, o artigo analisa as narrativas de homens gays e mulheres transgênero da cidade de Belo Horizonte, Minas Gerais, Brasil, participantes no estudo PrEP1519. A pesquisa qualitativa, baseada na antropologia interpretativa, foi desenvolvida através de 10 entrevistas em profundidade com usuários de PrEP acompanhados durante pelo menos três meses entre outubro e novembro de 2019. Os resultados mostraram que o medicamento era visto como a principal motivação para participar no estudo e como estratégia combinada com o uso de preservativos, seja como prevenção adicional ou assumindo o papel principal. A medicação revelou sinais elaborados pelas performances de gênero e sua relação com outros medicamentos, principalmente a experiência de meninas trans em uso de hormonioterapia. Quanto à socialização do uso da PrEP, as narrativas mostraram que não havia segredo entre os casais, o que não significava a inexistência de estigma em relação à associação com HIV, principalmente no contexto virtual. No ambiente familiar, os participantes relatavam questões sobre a função preventiva da medicação e a natureza voluntária da participação no estudo. As narrativas dos jovens revelaram sentidos plurais atribuídos à medicação e ao seu uso social, compondo as performances tanto dos meninos quanto das meninas. Os sinais atribuídos à medicação indicaram que além da manutenção da saúde, a medicação melhora a vida e a liberdade sexual dos usuários.

Basado en la incorporación de la profilaxis previa a la exposición (PrEP) como una estrategia de prevención contra el VIH, y considerando la necesidad de entender el uso de medicación entre gente joven, este artículo analiza narrativas de hombres gais y mujeres transgénero de Belo Horizonte, Minas Gerais, Brasil, que participan en el estudio PrEP1519. Esta es una investigación cualitativa, basada en la antropología interpretativa, desarrollada por 10 entrevistas en profundidad con usuarios de PrEP, a quienes se les realizó un seguimiento durante al menos tres meses entre octubre y noviembre de 2019. Los resultados mostraron que la medicación fue considerada como la principal motivación de participar en el estudio y como una estrategia combinada con el uso de condones, ya sea como prevención adicional, o asumiendo el papel principal. La medicación reveló signos de estar construida por el desempeño del género y su relación con otros medicamentos, especialmente la experiencia de las chicas trans en la terapia hormonal. Respecto a la socialización del uso del PrEP, las narrativas mostraron que no había secretos entre las parejas, lo cual no significó que no existieran estigmas en la asociación con el VIH, principalmente en contexto virtual. En el ambiente familiar, se informó de cuestiones sobre la función preventiva de la medicación y la naturaleza voluntaria de participar en el estudio. Las narrativas de ellos jóvenes revelaron significados plurales de la medicación y su uso social, formando parte del desempeño tanto de los chicos como de las chicas. Los signos atribuidos a la medicación indicaron que además de mantener la salud, la medicación mejora la vida y la libertad sexual.

When prevention is the best remedy: HIV pre-exposure prophylaxis (PrEP) among adolescents gays and transgender women in Belo Horizonte, Minas Gerais State, Brazil / Quando a prevenção é o melhor remédio: profilaxia pré-exposição do HIV (PrEP) entre adolescentes gays e mulheres transgênero em Belo Horizonte, Minas Gerais, Brasil / Cuando la prevención es el mejor remedio: profilaxis previa a la exposición al VIH (PrEP) entre adolescentes gays y mujeres transgénero en Belo Horizonte, Minas Gerais, Brasil

Based on the incorporation of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy and considering the need to comprehend the use of medication among young people, this article analyzes narratives of gay men and transgender women from Belo Horizonte, Minas Gerais State, Brazil, participating in the PrEP1519 study. This is a qualitative research, based on the interpretative anthropology, developed by 10 in-depth interviews with PrEP users followed-up for at least three months between October and November 2019. The results showed that the drug was seen as the main motivation for participating in the study and as a strategy combined with the use of condoms, whether as additional prevention, or assuming the leading role. The medication revealed signs built by the gender performances and their relation to other medications, especially the experience of trans girls in hormonal therapy. Regarding the socialization of the use of PrEP, the narratives showed that there was no secret between the couples, which did not meant that stigmas on the association with HIV did not exist, mainly in the virtual context. In the family environment, they reported questions about the preventive function of the medication and the voluntary nature of the participation in the study. The youth's narratives revealed plural meanings of the medication and its social use, composing both the boys' and girls' performances. The signs attributed to the medication indicated that in addition to maintenance of health, the medication improves life and sexual freedom.

Com base na incorporação da profilaxia pré-exposição (PrEP) como estratégia para a prevenção do HIV, e considerando a necessidade de compreender o uso da medicação entre jovens, o artigo analisa as narrativas de homens gays e mulheres transgênero da cidade de Belo Horizonte, Minas Gerais, Brasil, participantes no estudo PrEP1519. A pesquisa qualitativa, baseada na antropologia interpretativa, foi desenvolvida através de 10 entrevistas em profundidade com usuários de PrEP acompanhados durante pelo menos três meses entre outubro e novembro de 2019. Os resultados mostraram que o medicamento era visto como a principal motivação para participar no estudo e como estratégia combinada com o uso de preservativos, seja como prevenção adicional ou assumindo o papel principal. A medicação revelou sinais elaborados pelas performances de gênero e sua relação com outros medicamentos, principalmente a experiência de meninas trans em uso de hormonioterapia. Quanto à socialização do uso da PrEP, as narrativas mostraram que não havia segredo entre os casais, o que não significava a inexistência de estigma em relação à associação com HIV, principalmente no contexto virtual. No ambiente familiar, os participantes relatavam questões sobre a função preventiva da medicação e a natureza voluntária da participação no estudo. As narrativas dos jovens revelaram sentidos plurais atribuídos à medicação e ao seu uso social, compondo as performances tanto dos meninos quanto das meninas. Os sinais atribuídos à medicação indicaram que além da manutenção da saúde, a medicação melhora a vida e a liberdade sexual dos usuários.

Basado en la incorporación de la profilaxis previa a la exposición (PrEP) como una estrategia de prevención contra el VIH, y considerando la necesidad de entender el uso de medicación entre gente joven, este artículo analiza narrativas de hombres gais y mujeres transgénero de Belo Horizonte, Minas Gerais, Brasil, que participan en el estudio PrEP1519. Esta es una investigación cualitativa, basada en la antropología interpretativa, desarrollada por 10 entrevistas en profundidad con usuarios de PrEP, a quienes se les realizó un seguimiento durante al menos tres meses entre octubre y noviembre de 2019. Los resultados mostraron que la medicación fue considerada como la principal motivación de participar en el estudio y como una estrategia combinada con el uso de condones, ya sea como prevención adicional, o asumiendo el papel principal. La medicación reveló signos de estar construida por el desempeño del género y su relación con otros medicamentos, especialmente la experiencia de las chicas trans en la terapia hormonal. Respecto a la socialización del uso del PrEP, las narrativas mostraron que no había secretos entre las parejas, lo cual no significó que no existieran estigmas en la asociación con el VIH, principalmente en contexto virtual. En el ambiente familiar, se informó de cuestiones sobre la función preventiva de la medicación y la naturaleza voluntaria de participar en el estudio. Las narrativas de ellos jóvenes revelaron significados plurales de la medicación y su uso social, formando parte del desempeño tanto de los chicos como de las chicas. Los signos atribuidos a la medicación indicaron que además de mantener la salud, la medicación mejora la vida y la libertad sexual.

Flare-Ups in Crohn's Disease: Influence of Stress and the External Locus of Control.

(1) Background: The aim of this study was to explore the role of perceived stress and the health locus of control in Crohn's disease and their influence upon the development of flare-ups of this disease. (2) Methods: Stress and the external locus of control were evaluated in a sample of 64 Crohn's patients (flare-up phase versus latency phase). The perceived stress scale (PSS-14) and the multidimensional health locus of control scale were the measurement instruments used. (3) Results: The results indicate that the patients have high stress levels during a flare-up (26.13; 27.44; 28.79; 29.67); high stress levels (28.07; 29.67; 27.44; 28.07) if they have a high external locus of control; and that the external locus of control and stress levels have a significant influence upon the existence of flare-ups in those patients with low external locus of control levels (χ2 = 11.127; df = 1: p < 0.001). (4) Conclusions: Actions aimed at reducing stress and external locus of control levels are necessary in Crohn's disease.

Influencia de los factores psicosociales en la enfermedad de Crohn / Influence of psychosocial factors in Crohn's disease / Influência de fatores psicossociais na doença de Crohn

OBJETIVO: Conocer la influencia de los factores psicosociales en la enfermedad de Crohn. METODOLOGÍA: Se utilizó la Escala de Estrés Percibido, la Escala de Apoyo Social Percibido y la Escala Multidimensional de Locus de Control. Se recopilaron los datos de pacientes con enfermedad de Crohn - en fase de brote y quiescencia - y sanos. Los niveles de estos factores se compararon para conocer su impacto en la enfermedad de Crohn. RESULTADOS: Diferencias estadísticamente significativas se encontraron en las tres variables en los grupos. Los pacientes con enfermedad de Crohn en fase de brote percibieron los niveles de estrés más altos. Los pacientes con enfermedad de Crohn que estaban en fase de recidiva presentaron los mayores niveles de apoyo social, identificándose el efecto modulador que tiene esta variable sobre el estrés. Y, por último, los pacientes con enfermedad de Crohn con brote presentaron mayor nivel de locus de control externo. CONCLUSIÓN: Son necesarias intervenciones enfermeras en la enfermedad de Crohn relacionadas con mayor manejo del estrés, aumento del apoyo social y disminución del locus de control externo

OBJECTIVE: To know the influence of psychosocial factors in the Crohn ́s disease. METHODOLOGY: The Perceived Stress Scale, Scale of Social Support Perceived and Multidimensional Scale of Locus of Control was used. Data was collected from patients with Crohn ́s disease -in outbreak and quiescence phase- and healthy. The levels ofthese factors were compared to know its impact in the Crohn ́s disease. RESULTS: Statistically significant differences found in the three variables in the groups. Patients with Crohn's disease outbreak phase perceived the highest stress levels. Patients with Crohn's disease who were in the relapse phase had the highest levels of social support, identifying the modulating effect that this variable has on stress. And finally, patients with Crohn's disease with outbreak had a higher level of external control locus. CONCLUSIONS:Nurse interventions are necessary in the Crohn ́s disease therapy in order to better manage the stress, increase the social support network and change the locus of control, decreasing the external locus of control

OBJETIVO: Conhecer a influência de fatores psicossociais na doença de Crohn. METODOLOGIA: Utilizou-se a Escala de Estresse Percebido, Escala de Apoio Social Percebido e Escala Multidimensional de Lócus de Controle. Os dados foram coletados de pacientes com doença de Crohn - em fase de cessação e quiescência - e saudáveis. Os níveis desses fatores foram comparados para conhecer seu impacto na doença de Crohn. RESULTADOS: Diferenças estatisticamente significantes foram encontradas nas três variáveis nos grupos. Pacientes com doença de Crohn na fase de exacerbação perceberam os maiores níveis de estresse. Pacientes com doença de Crohn em fase de remissão apresentaram os maiores níveis de suporte social, identificando o efeito modulador dessa variável no estresse. E finalmente, os pacientes com doença de Crohn exacerbaçao tinham um nível mais alto de locus de controle externo. CONCLUSÃO: As intervenções do enfermeiro são necessárias na terapia da doença de Crohn para melhor manejo do estresse, aumento da rede de apoio social e mudança do locus de controle, diminuindo o locus de controle externo

Afrontamiento de la muerte en estudiantes de Ciencias de la Salud / Coping with death by students of Health Sciences

Introducción: La muerte es un proceso que está presente en la vida. Los estudiantes de Ciencias de la Salud están especialmente expuestos al mismo, así como al hecho de estar presentes y acompañar en el proceso de morir a los pacientes. Objetivos: Conocer los niveles de afrontamiento ante la muerte en estudiantes de Ciencias de la Salud. Conocer la influencia de otras variables tales como el género, edad, año académico, religión y experiencias previas ante la muerte en relación al afrontamiento de la muerte. Métodos: Se llevó a cabo un estudio descriptivo de corte transversal. La muestra estuvo compuesta por 227 estudiantes de la Universidad Alfonso X el Sabio (Madrid-España). Para medir el afrontamiento de la muerte se utilizó la Escala Bugen de Afrontamiento de la Muerte-EBAM. Resultados: Los estudiantes de enfermería presentaron mayores niveles de afrontamiento de la muerte que los estudiantes de farmacia y Actividad Física y Deporte. La prueba de Chi Cuadrado mostró que existía relación entre la titulación cursada y el nivel de afrontamiento de la muerte (p< 0,01). La t de student también constató que no existían diferencias estadísticamente significativas al considerar el Afrontamiento de la muerte y haber tenido experiencias previas con moribundos (p< 0,01). No se constató influencia del género, edad, año académico y religión con el nivel de afrontamiento. Conclusiones: De este estudio se deduce la necesidad de incluir en los planes formativos asignaturas que traten el proceso de la muerte de manera que se puedan manejar de forma adecuada aspectos psicológico-emocionales del profesional, cuestión que repercutirá en el aumento de la calidad asistencial(AU)

Introduction: Death is a process that is present in life. Health science students are particularly exposed to it, as well as to the fact of being present and accompanying dying patients in such process. Objectives: To know the levels of coping with death in students of health sciences. To know the influence of other variables such as gender, age, academic year, religion and previous experiences with death in association to coping with death. Methods: A descriptive, cross-sectional study was carried out. The sample consisted of 227 students from Alfonso X el Sabio University in Madrid, Spain. For measuring coping of death, Bugen's Coping with Death Scale was used. Results: Nursing students showed higher levels of coping with death than Pharmacy or Physical Activity and Sport students. The chi-square test showed a relation between the degree completed and the level of coping with death (p< 0,01). The Student's t-test also showed no statistically significant differences when considering coping with death together with having previous experiences with dying (p< 0,01). No influence of gender, age, academic year and religion was found in association with the level of coping. Conclusions: This study shows the need to include, in the syllabuses, subjects that treat the process of death, so that psychological-emotional aspects of the professional can be handled appropriately, as it is an issue that will have an impact on the increase in the quality of healthcare(AU)

Estrés y enfermedad de Crohn: diferencias entre enfermos de Crohn con brote, sin brote y personas sanas / Stress and Crohn’s disease: differences among outbrake and quiescence patients and healthy persons

Distintas investigaciones han puesto de manifiesto la relación entre estrés y numerosas patologías. Este estudio pretende explorar su relación con la enfermedad de Crohn. Se compararon los niveles de estrés, medidos mediante la escala de estrés percibido, de 37 pacientes en brote con 27 en fase de quiescencia y 40 personas sanas. De los resultados obtenidos parece derivarse que los enfermos de Crohn en fase de brote poseen mayores niveles de estrés que las personas sanas, además se constatan diferencias significativas en dicha variable entre enfermos de Crohn con brote y sin brote y enfermos de Crohn con brote y personas sanas. No se observan diferencias estadísticamente significativas entre enfermos de Crohn sin brote y personas sanas. El trabajo concluye planteando algunas explicaciones plausibles a dichos resultados y, en particular, que el estrés pueda entenderse más como una de las consecuencias que como uno de los antecedentes de la enfermedad de Crohn (AU)

Research has shown the relationship between stress and many diseases. The aim of this study is to investigate its effect on Crohn’s disease. Using the Perceived Stress Scale we compared the stress levels of three different groups: 37 patients in the outbreak phase, 27 in quiescence, and 40 healthy controls. Results show that Crohn’s sufferers in outbreak phase have higher stress levels than both quiescence patients and healthy persons. However, no significant differences were observed between those in quiescence and healthy persons. The paper concludes by suggesting plausible explanations for these results, particularly that stress may be better understood as a consequence rather than a cause/precursor of Crohn’s disease (AU)

Recusa de via natural de alimentação após reabilitação funcional da disfagia em contexto hospitalar: implicações biopsíquicas / Refusal of a natural way of feeding after functional rehabilitation of dysphagia in a hospital context: biopsychic implications

Introdução: Este artigo discute aspectos orgânicos e psíquicos em quadros disfágicos, que influenciam no processo terapêutico fonoaudiológico realizado em ambiente hospitalar. Tanto o fonoaudiólogo quanto a equipe hospitalar, conforme determinam políticas de saúde atuais, devem buscar aportes teóricos e técnicos que permitam escuta clínica atenta às questões e ao sofrimento dos pacientes, tornando-os ativos no processo terapêutico, humanizando o atendimento. Assim, deve-se tratar o sujeito e não apenas os aspectos miofuncionais da disfagia. Olhar humanizado não implica em desconsiderar questões orgânicas importantes ao prognóstico e ao tratamento da disfagia. Significa reconhecer a singularidade dos sujeitos, utilizando estratégias necessárias em cada caso, respeitando o tempo e os modos pelos quais os pacientes significam e enfrentam suas demandas.Objetivo: Responder a seguinte indagação: Por que alguns pacientes em condições para iniciar uma dieta via oral (VO) não conseguem fazê-lo ou resistem a ela? Método: O design é de um estudo de caso clínico. Foram estudados dois pacientes adultos que, entre outros agravos, tinham disfagia e que, após reabilitação funcional da alimentação por VO, seguiram recusando a via natural de alimentação. Resultados/Discussão: Com apoio da equipe do hospital, abriu-se espaço aos pacientes para falarem de suas representações e sentimentos, o que permitiu compreender a recusa alimentar, bem como constituir condições para superarem tal dificuldade de alimentação. Conclusão: O fonoaudiólogo deve articular as dimensões orgânicas e psíquicas no tratamento de pacientes disfágicos, pois a oralidade depende também de determinação simbólica: a boca é lugar de alimentação, mas também de palavras e afetos.

Introduction: This article discusses physical and mental aspects in dysphagia which influence the therapeutic process in a hospital. Both the therapist and hospital staff, as determined in current health policies, should seek theoretical and technical devices for careful clinical listening to the questions and the suffering of patients, making them more active in the therapeutic process, and thus, humanizing care. Therefore, one should treat the subject and not only his/her myofunctional dysphagia. Humanized care does not imply in disregarding important organics issues to prognosis in treatment of dysphagia. It means recognizing the uniqueness of each subject, using strategies required in each case, respecting the time and different ways in which patients face their demands. Aim: To respond to the question: Why is it that some patients are considered able to start an oral diet but can not do so or resist to it? Method: The design is a case study. We studied two adult patients who, among other illnesses, had dysphagia and, after functional rehabilitation of oral feeding, refused to follow the natural route of feeding. Results: With support from hospital staff, the opportunity appeared for patients to talk about their ideas and feelings. This enabled the understanding of the refusal to eat, and enabled patients to overcome this difficulty in feeding. Conclusion: The Speech-Language Pathologist should articulate both organic and psychological treatment for patients with dysphagia, as orality also depends on symbolical determination: the mouth is a place for food, but also of words and affections.

Introducción: Este artículo aborda aspectos físicos y mentales en la disfagia, que influyen en el proceso terapéutico realizado en un ambiente hospitar. Tanto el fonoaudiólogo como el personal del hospital, según lo determinado en las políticas actuales de salud, deben buscar los dispositivos teóricos y técnicos que permitan una escucha clínica atenta a las preguntas y al sufrimiento de los pacientes, haciendolos activos en el proceso terapéutico, humanizando el atendimiento. Asi, se debe tratar el sujeto y no solamente los aspectos miofuncionales de la disfagia. Significa reconocer la singularidad de los sujetos, utilizando lãs estrategias necesárias a cada caso, respetando el tiempo y los modos como los pacientes dan significado y enfrentan a sus demanda Objetivo: Contestar a la siguiente pregunta: ¿Por qué algunos pacientes que pueden iniciar una dieta via oral (VO) no pueden hacerlo o se oponen a ella? Método: El design es de estudio de caso clínico. Se estudiaron dos pacientes adultos que, entre otros problemas tenian disfagia y que, después de la rehabilitación funcional de la alimentación por VO, siguieron negando la vía natural de alimentación. Resultados/Discusión: Con el apoyo del personal del hospital se abrió espácio a los pacientes para hablar sobre sus representaciones y sentimientos, lo que permitió entender la negativa a alimentarse, y también construir condiciones para que superen tal dificultad de alimentacion. Conclusión: El fonoaudiólogo debe articular las dimensiones orgânicas y psíquicas en el tratamiento de pacientes con disfagia, porque la oralidad depende también de la determinación simbólica: la boca es lugar de alimentación, pero también de palabras y afectos.