Intimate Partner Violence and Women's Mental Health during the COVID-19 Pandemic in Brazil.

BACKGROUND: Intimate partner violence (IPV) increased extensively around the world during the pandemic, causing severe women's mental health damages. However, there are no studies showing these effects in Brazil. PURPOSE: To assess the perpetration of IPV and the presence of depression and suicidal ideation in women living in Brazil during the pandemic. METHODS: Cross-sectional online survey including women living in Brazil from July 2020 to Jun 2021. Participants answered a 43-item self-applied questionnaire exploring their characteristics and life changes due to the pandemic (CoRonavIruS Health Impact Survey), IPV (World Health Organization Violence Against Women) and depressive symptoms or suicidal ideation (Patient Health Questionnaire-9). We used multiple Poisson regression analyses with robust variance to model associations between IPV and mental health outcomes, considering as covariates aspects of social vulnerability. RESULTS: We found a high frequency of IPV (33.3%), depression (36.1%) and suicidal ideation (19.8%) among the participants. IPV was significantly associated with depression (PR=1.502, p=0.001 for one type of IPV; PR=2.702, p<0.001 for two or three types of IPV) and suicidal ideation (PR=2.264, p<0.001 for one type of VPI; PR=3.272, p<0.001 for two or three types of IPV). Food insecurity, being black, lower educational levels and being in a relationship with a person of the same gender were associated with one or both mental health outcomes. CONCLUSIONS: We demonstrated an association of IPV with higher frequencies of depression and suicidal ideation in women living in Brazil during the COVID-19 pandemic, highlighting the urgency of strengthening strategies to protect women during adversities.

O papel da remuneração na decisão de participar de pesquisa na saúde el papel de / El papel de la remuneración en la decisión de participar en la investigación en salud / The role of remuneration in the decision to participate in health research / El paper de la remuneració en la decisió de participar en la recerca en salut

O processo de consentimento informado para participação de pesquisa com seres humanos visa fornecer as informações adequadas ao indivíduo possibilitando que este tome a decisão de participar de maneira voluntária, livre de pressões externas. A possibilidade de remuneração poderia interferir na voluntariedade deste processo de consentir. O presente estudo objetivou avaliar percepção de influência da remuneração monetária por meio de simulações de pesquisa que variam em nível de risco (Bioequivalência e de Fase I) e tipo de remuneração monetária (com e sem). Participaram do estudo 80 voluntários. Os resultados sugerem que a remuneração não constituiu uma interferência na voluntariedade do processo de consentimento, visto que participantes aceitaram convite para participar da primeira pesquisa para a qual foram convidados e não se sentiram influenciados indebidamente

El proceso de consentimiento informado para la participación de sujetos humanos en investigación tiene por objeto dar la información adecuada al individuo, permitiendo que tome la decisión de participar de manera voluntaria y libre de presiones externas. La posibilidad de remuneración podría interferir en la voluntariedad de este proceso de consentir. El presente estudio evalúa la percepción de la influencia de la remuneración monetaria a través de simulaciones de investigación que varían en nivel de riesgo (Bioequivalencia y de Fase I) y tipo de remuneración monetaria (con y sin). Participaron del estudio 80 voluntarios. Los resultados sugieren que la remuneración no constituyó una interferencia en la voluntariedad del proceso de consentimiento, ya que los participantes aceptaron una invitación para participar en la primera encuesta a la que fueron invitados y no se sintieron influenciados incorrectamente

The process of informed consent for research participation with human beings aims to provide appropriate information to individuals enabling him or her to make the decision to participate voluntarily, free of external pressures. The possibility of remuneration could interfere in the willingness to consent. The present study aims to evaluate the perception of influence of the monetary payment through research simulations that vary in the level of risk (Bioequivalence and Phase I) and type of monetary payment (with and without). Eighty volunteers participated in the study. The results suggest that remuneration did not interfere with the willingness of the consent process, as participants accepted an invitation to participate in the first research option to which they were invited to and did not feel undue influence

El procés de consentiment informat per a la participació de subjectes humans en recerca té per objecte donar la informació adequada a l'individu, permetent que prengui la decisió de participar de manera voluntària I lliure de pressions externes. La possibilitat de remuneració podria interferir en la voluntarietat d'aquest procés de consentir. El present estudi avalua la percepció de la influència de la remuneració monetària a través de simulacions de recerca que varien en nivell de risc (Bioequivalencia I de Fase I) I tipus de remuneració monetària (amb I sense). Van participar de l'estudi 80 voluntaris. Els resultats suggereixen que la remuneració no va constituir una interferència en la voluntarietat del procés de consentiment, ja que els participants van acceptar una invitació per a participar en la primera enquesta a la qual van ser convidats I no es van sentir influenciats incorrectament

25 anos de Bioética Clínica no HCPA: um pioneirismo que se renova / 25 years of Clinical Bioethics at HCPA: a pioneering spirit that renews itself

25 anos de Bioética Clínica no HCPA.

25 years of Clinical Bioethics at HCPA.

Erros de medicação em hospitais: uma análise bioética dos aspectos jurídicos e de saúde / Medication errors in hospitals: a bioethical analysis of legal and health issues

Introdução: O tema dos erros de medicação envolve vários aspectos - éticos,morais, jurídicos, sociais, profissionais, assistenciais, entre outros - merecendo uma reflexão abrangente. Os aspectos éticos referem-se principalmente à adequação das ações frente aos erros e os aspectos jurídicos estão relacionados diretamente com a aferição da responsabilidade civil nos casos da ocorrência de danos. Este estudo busca estabelecer relações entre o Direito, a Saúde e a Bioética, em uma perspectiva interdisciplinar, por meio da avaliação dos acórdãos referentes a erros de medicação em hospitais na jurisprudência do Rio Grande do Sul.Método: Foi realizada uma pesquisa qualitativa, de análise de conteúdo documental, em acórdãos colhidos na base de dados eletrônica do Tribunal de Justiça do Estado do Rio Grande do Sul. O descritor utilizado para busca foi: erro de medicação em hospitais.Resultados e discussão: foram localizados 43 acórdãos na base de dados no período de 1995 a 2011. Destes, apenas seis referem-se a erros de medicação especificamente, sendo que dois não estão disponíveis na íntegra. Foram analisados os quatro acórdãos envolvendo erros de medicação. Nos quatroacórdãos os demandados foram: três hospitais, um município e um médico. Todas as decisões foram favoráveis aos demandantes.Considerações Finais: O conceito de erro de medicação, embora utilizado na área da saúde e por órgãos oficiais, não tem sido utilizado adequadamente no Poder Judiciário, o que demonstra que uma maior aproximação das áreas envolvidas, incluindo uma melhor comunicação, é necessária para uma adequada compreensão do tema.

Background: Medication errors involve several aspects - ethical, moral, legal, social, professional, welfare, among others -, deserving of a comprehensive reflection. The ethical aspects concern mainly the adequacy of actions related to errors and legal aspects directly involved in the assessment of civil liability in case of damage. This study aimed to establish relationships between law, health and bioethics, using an interdisciplinary perspective to verify the adequacy of legal proceedings about medication errors in hospitals of Rio Grande do Sul, Brazil. Method: We conducted a qualitative, documentary research on the electronic database of judgments of the State of Rio Grande do Sul Court of Justice. The descriptor used to perform the search was: medication error in hospitals.Results and discussion: we found 43 judgments in the database between 1995 and 2011. Only six judgments refer specifically to medication errors, and two are not fully accessible. Thus, we analyzed four judgments involving medicationerrors. In the four cases, the defendants were: three hospitals, one municipality, and one physician. All decisions were favorable to applicants. Final Considerations: The concept of medication error, though used in health care and by official organs, has not been appropriately used in the judiciary. This shows that an approximation of the involved areas, including a better communication,is necessary for proper understanding of the topic.

Revelação de diagnóstico de AIDS para terceiros: aspectos éticos, morais, legais e sociais / AIDS diagnostic disclosure to third parties: ethical, moral, legal and social issues

Os serviços de saúde, compostos por equipes multiprofissionais, desenvolvem um importante papel de reduzir a vulnerabilidade do portador de HIV/AIDS. Isto é, mais do que diagnosticar e medicar seus pacientes torna-se preciso ter um cuidado quanto às ações não justificáveis de revelação do diagnóstico do paciente para terceiros. Essa preocupação é relevante na medida em que diferentes aspectos éticos, morais, legais e sociais estão associados a essa notícia. O reconhecimento do envolvimento desses múltiplos fatores auxilia a equipe multiprofissional a ponderar determinadas práticas e posições frente aos problemas éticos gerados pelas questões de revelação diagnóstica (AU)

Health services, comprising multidisciplinary teams, develop an important role in reducing individuals' vulnerability with HIV / AIDS diagnosis. More than just diagnose and medicate patients, it becomes necessary to pay attention to disclosure actions that are not justifiable, revealing the patient's diagnosis to third parties. This concern is relevant in so far as many ethical, moral, legal and social aspects are associated with such news. The acknowledgment of these multiple factors involvement supports the multidisciplinary team to consider some practices and adopt positions facing ethical problems raised by diagnostic disclosure issues (AU)

Role of TRPV1 in consolidation of fear memories depends on the averseness of the conditioning procedure.

Despite the fact that TRPV1 receptors are widely expressed in brain structures such as the hippocampus, its functions remain largely unknown. In the present study, we have investigated the possible modulatory role of the hippocampal endovanilloid system upon memory consolidation of two different behavioral tasks in rats. Post-training infusion of the TRPV1 antagonist capsazepine disrupted memory consolidation with a strong training protocol, but not with a weak one in the contextual fear conditioning or in the step-down inhibitory avoidance task. These results provide evidence that the modulation of the hippocampal memory consolidation through TRPV1 receptors takes place only in presence of a strong emotional experience, suggesting that a certain aversiveness level is required in order to recruit endovanilloids to exert this function. A possible synergic role of hippocampal endovanilloid and endocannabinoid system on memory consolidation is discussed.

Acreditação hospitalar e o processo de consentimento informado / Hospital accreditation and informed consent process

O Hospital de Clínicas de Porto Alegre (HCPA) está passando, no presente momento, pelo processo de acreditação pela Joint Commission International (JCI), e um tema relevante abordado nas avaliações de Acreditação é o processo de consentimento. O objetivo deste artigo é avaliar, desde o ponto de vista ético e de forma independente, os conteúdos do Manual Padrões de Acreditação da Joint Commission International para Hospitais que se referem direta ou indiretamente a questões envolvendo o consentimento, através da análise documental baseada na leitura e análise dos conteúdos do Manual da JCI, no que se refere aos temas relativos ao consentimento. Foi verificado que a Acreditação Hospitalar não acrescenta novas exigências éticas e legais, apenas detalha formas e modos de registrar e verificar a obtenção dos consentimentos envolvendo os pacientes de uma instituição. As diferentes possíveis formas de obtenção do consentimento, seja ele verbal ou obtido por meio de Termos de Consentimento, devem ser sempre registradas no prontuário do paciente, que é o documento que consolida todas as informações a ele relacionadas.

The Hospital de Clínicas de Porto Alegre (HCPA) is undergoing the process of accreditation by the Joint Commission International (JCI). A relevant topic addressed in the accreditation evaluation is the consent process. Based on an ethical standpoint and in an independent manner, the objective of this study was to evaluate the contents of the Joint Commission International Accreditation Standards for Hospitals directly or indirectly related to issues involving consent. We conducted document analysis by means of reading and analysis of the content of the JCI Manual about issues involving consent. We found that Hospital Accreditation does not add new ethical and legal requirements. It only provides detailed description on how to register and check the consents obtainment involving patients from an institution. The possible different ways of obtaining consent, whether verbal or written, must be registered on the patient’s medical record, which is the document that consolidates all patient-related informationbe identified, such as the amendment to the Code of Medical Ethics and the approval of the Resolution of the Federal Medical Board on Advance Directives. This recognition of the patient’s autonomy has a direct impact on the doctor-patient, doctor-patient’s family, and doctor-medical team relationships.

Apresentação em pôster: inadequações éticas e metodológicas / Pôster presentation: ethical and methodological inadequacies

A apresentação de temas livres na forma de pôster é uma maneira frequente de divulgar resultados de uma pesquisa. Foram avaliados os aspectos éticos e metodológicos dos pôsteres e resumos submetidos em um encontro científico. Foram verificadas inadequações em diferentes aspectos, tais como identificação do tema livre, autoria, preservação de informações, método, questões regulatórias.

Poster presentation is a common way to disseminate research results. We evaluated ethical and methodological issues presented in posters and in abstracts submitted to a scientific meeting. Inadequacies were found in different aspects such as project identification, authorship, information, methods and regulatory issues.

M4 muscarinic receptors are involved in modulation of neurotransmission at synapses of Schaffer collaterals on CA1 hippocampal neurons in rats.

All five subtypes of muscarinic acetylcholine receptors (mAChR; M(1)-M(5)) are expressed in the hippocampus, where they are involved both in cognitive functions and in synaptic plasticity, such as long-term potentiation (LTP). Muscarinic toxins (MTs) are small proteins from mamba snake venoms that display exquisite discrimination between mAChRs. MT1 acts as an agonist at M(1) and an antagonist at M(4) receptors, with similar affinities for both. MT3, the most selective antagonist available for M(4) receptors, infused into the CA1 region immediately after training caused amnesia in the rat, indicating the participation of M(4) receptors in memory consolidation. Our goal was to investigate the participation of M(4) receptor in neurotransmission at the hippocampal Schaffer collaterals-CA1 synapses. Two different preparations were used: 1) field potential recordings in freshly prepared rat hippocampal slices with high-frequency stimulation to induce potentiation and 2) whole-cell voltage clamp in cultured hippocampal organotypic slices with paired stimuli. In preparation 1, a dose of MT3 that was previously shown to cause amnesia blocked LTP; the nonselective antagonist scopolamine blocked LTP without affecting basal transmission, although it was depressed with higher concentration. In preparation 2, basal transmission was decreased and LTP induction was prevented by an MT3 concentration that would bind mainly to M(4) receptors. Although M(1) receptors appeared to modulate transmission positively at these excitatory synapses, M(1) activation concomitant with M(4) blockade (by MT1) only allowed a brief, short-term potentiation. Accordingly, M(4) blockade by MT3 strongly supports a permissive role of M(4) receptors and suggests their necessary participation in synaptic plasticity at these synapses.

Differential role of the hippocampal endocannabinoid system in the memory consolidation and retrieval mechanisms.

CB1 cannabinoid receptors are abundantly expressed in the brain, with large concentrations present in the hippocampus, a brain structure essential for memory processing. In the present study, we have investigated the possible modulatory role of the endocannabinoid system in the dorsal hippocampus upon the different phases of memory processing of an aversive task. AM251, a selective antagonist of CB1 receptors, and anandamide, an endogenous agonist of cannabinoid receptors, were bilaterally infused into the dorsal hippocampus of male Wistar rats either before training, immediately after training, or before test in the step-down inhibitory avoidance (IA) task. Results showed that pre-training infusion of CB1 drugs did not influence the acquisition of the task. In contrast, post-training infusion of the CB1 antagonist disrupted while the antagonist facilitated memory consolidation of IA. The post-training results demonstrate that memory consolidation depends on the integrity of the endocannabinoid system in the CA1 region of the dorsal hippocampus. While we still have no direct proof of endocannabinoids released there after an aversive task such as IA, these results suggests that (a) AM251 acts blocking the binding of endogenously released cannabinoids and (b) exogenously supplemented anandamide may be adding its contribution to the action of the endogenously released pool. Considering our data and the higher density of CB1 receptors present in the GABAergic interneurons, we propose them as the putative target of the endocannabinoid modulation of memory, a hypothesis that needs to be proven. In addition, pre-test infusion of the CB1 receptor antagonist facilitated while infusion of the agonist did not affect memory retrieval of IA. The completely opposite action of the same drug upon memory at the post-training (consolidation) and pre-test (recall) contexts suggests that some durable change took place in the CA1 region during the consolidation process that modified the logical attributes of the pharmacological response, i.e., the drug response changed from memory disruption to memory facilitation. A similar phenomenon was previously described by us in the M4 cholinergic muscarinic subsystem in the hippocampus for the same task (Diehl, F., Fürstenau, L. O., Sanchez, G., Camboim, C., de Oliveira Alvares, L., Lanziotti, V. B., et al. (2007). Facilitatory effect of the intra-hippocampal pretest administration of MT3 in the inhibitory avoidance task. Behavioral Brain Research, 177(2), 227-231), but the biological nature of such change in the local neural circuitry remains to be investigated.

AM251, a selective antagonist of the CB1 receptor, inhibits the induction of long-term potentiation and induces retrograde amnesia in rats.

Long-term potentiation (LTP) has a long history as putative mechanism of memory formation, specially in the hippocampus, a structure essential for memory formation. Endocannabinoids are one of the endogenous systems that modulate this plasticity event: the activation of hippocampal CB1 receptors may inhibit local GABA release. Here, we have studied both (1) the role of the selective CB1 antagonist AM251 upon LTP induction in a hippocampal slice preparation, and (2) the effect of its intrahippocampal administration in the step-down inhibitory avoidance (IA) and the open field habituation tasks (OF). Standard extracellular electrophysiology techniques were used to record field excitatory postsynaptic potentials from the dendritic region of CA1 neurons in response to a high frequency stimulation of Schaffer's collaterals; a micropipette ejected 0.2 microM of AM251 (in DMSO/PBS) 2 min before the stimulus: LTP was induced and lasted more than 30 min in the control, but not in the AM251-treated group. Immediately after training, either in IA (footshock, 0.5 mA) or OF, animals received a bilateral infusion of 0.55 or 5.5 ng/side of AM251 or its vehicle in the CA1 region, and test was performed 24 h later. AM251 has caused a significative decrease in the test step-down latency when compared to the control group, but no differences were detected in the OF task, including the number of crossings, i.e., there were no motor effects. The LTP supression could be caused by AM251 acting over GABAergic interneurons that modulate the LTP-bearing glutamatergic neurons. Endocanabinoids would then be the natural dis-inhibitors of local plasticity in the dorsal hippocampus, and the amnestic action of AM251 would be due to a disruption of this endogenous modulatory system.

Amnestic effect of intrahippocampal AM251, a CB1-selective blocker, in the inhibitory avoidance, but not in the open field habituation task, in rats.

CB1 is the most abundant metabotropic receptor of the brain, being found in areas classically involved in learning and memory and present at higher density at presynaptic terminals. Different sets of evidence support the idea that endogenous ligands (endocannabinoids) to the CB1 receptors act as modulators of neurotransmission. In hippocampus, endocannabinoids seem to act as retrograde messengers mediating down-regulation of GABA release. Previous reports have described a cognitive impairment effect of cannabinoid agonists, or facilitation by antagonists. The scope of the present study is to investigate the effect of intrahippocampal administration of the CB1-selective antagonist, AM251, in two behavioral tasks. One hundred and twelve male Wistar rats with bilateral cannulae implanted in the CA1 region of the dorsal hippocampus were trained in a step-down inhibitory avoidance task (IA, footshock, 0.5 mA) or an open field habituation task (OF). Immediately, after training, animals received an infusion of 0.55, 5.5, and 55.5 ng/side of AM251 (Tocris), or its vehicle (DMSO/saline), via these cannulae. Our results show that AM251 disrupted memory consolidation of the IA task, but not the OF task, an effect that seems to be purely mnemonic since the drug showed no motor performance effects. Only the intermediate dose (5.5 ng/side) of AM251 was effective in IA and the absence of effect with the larger dose may be the consequence of non-specific binding. The fact that OF was not affected raises the possibility that this endogenous system requires some degree of aversiveness to be recruited. We propose that increased levels of endogenous cannabinoids in the hippocampus, following a training session, contribute to facilitate memory consolidation, a process that may have been disrupted with AM251.