Cognitive performance during senescence in untreated congenital isolated GH deficiency.

Individuals with untreated isolated GH deficiency (IGHD) due to a mutation in the GHRH receptor gene from Itabaianinha Brazil have increased insulin sensitivity, normal life expectancy, and an extended health span, i.e. the period of life free from disabilities. We hypothesize that their prolonged health span is accompanied by a delayed cognitive decline in senescence. To test this hypothesis, we have administered the Literacy-Independent Cognitive Assessment (LICA) to 15 IGHD individuals aged over 50 years and 15 controls matched by age, sex, years of education, and percentage of illiteracy. All individuals were negative for HIV and syphilis serology, and there were no differences in serum levels of folate, vitamin B12 and TSH between the two groups, while free T4 was higher in the IGHD group. IGHD subjects had a higher total LICA score than controls, 215 (22.7) vs 204.2 (18.1), without reaching statistical significance. Scores of memory, visuoconstruction, language and calculation were similar between the two groups, with better attention (9.5 (1.4) vs 8.3 (1.1), P = 0.01) and executive function (38.3 (4.8) vs 35.1 (2.5), P = 0.03) scores in IGHD. MANCOVA revealed that group (but no age) had a significant effect on the LICA variables (partial eta squared of 0.455, power of 0.812, P = 0.02). This effect is verified on attention (partial eta squared 0.216, power of 0.749, P = 0.01) and executive function (partial eta squared 0.154, power of 0.570, P = 0.03. In conclusion, IGHD in senescence is associated with similar total cognitive performance but better attention and executive function than controls.

Fear of Covid-19, anxiety, and depression during the pandemic: A network analysis

Introduction: Covid-19 has generated several psychological impacts on people's lives and brought new challenges for dealing with the pandemic's repercussions. Objective: The objective was to analyse the relationship between the symptoms of fear of Covid-19, anxiety, and depression using different samples extracted at three distinct time-points. This study performed a network analysis of the fear of Covid-19 and anxiety- and depression -related symptoms based on data collected during the Covid-19 pandemic. Method: Three yearly cross-sectional surveys were conducted based on independent samples (2020-2022) of Brazilian adults (Time-point 1, Time-point 2, and Time-point 3 with 1,520, 1,523, and 1,517 participants, respectively). The Fear of Covid-19 Scale, the Generalised Anxiety Disorder Scale (7 items), and the Patient Health Questionnaire (9 items) were applied. The network structure invariance, the global strength invariance, and the strength of centrality index between the samples were compared. Results: Items from the three instruments had high values (>70%) in all samples (excluding the fear of Covid-19 at Time-point 3). Depression and anxiety symptoms increased, while fear-related behaviours decreased. Network analysis indicates that networks became progressively more parsimonious, and few edges connected different scales. Network comparisons revealed similar structures, but key differences were found: Time-point 1 showed significantly higher global connectivity, and changes in edge weights were observed only within the scales. Conclusions: Our findings suggest that the pandemic had a greater disorganising impact at its beginning, with a continuous increase in the mental health symptomatology and a reduction in the ratio between fear and anxiety and/or depression.

Introducción: El COVID-19 generó varios impactos psicológicos en la vida de las personas imponiendo nuevos desafíos para confrontar la pandemia. Objetivo: Analizar la relación entre los síntomas de miedo al COVID-19, ansiedad y depresión utilizando diferentes muestras extraídas durante tres períodos de tiempo distintos. Fueron analizadas redes del miedo y los síntomas de ansiedad y depresión usando datos recolectados durante la pandemia de COVID-19. Método: Tres encuestas transversales anuales basadas en muestras independientes (2020-2022) de adultos brasileños (punto temporal 1, punto temporal 2 y punto temporal 3 con 1520, 1523 y 1517 participantes, respectivamente). Se aplicaron la Escala de Miedo al COVID-19, la Escala de Trastorno de Ansiedad Generalizada (7 ítems) y el Cuestionario de Salud del Paciente (9 ítems). Se compararon la invariancia de la estructura de la red, la invariancia de la fuerza global y la fuerza del índice de centralidad entre los tres puntos temporales. Resultados: Los ítems de los tres instrumentos tuvieron valores altos (> 70 %) en todos los puntos temporales (excluyendo el miedo al COVID-19 en el punto temporal 3). A lo largo de los tres puntos temporales, los síntomas de depresión y ansiedad aumentaron, mientras que el miedo disminuyó. Las redes se volvieron progresivamente más parsimoniosas y pocas aristas conectaron diferentes escalas, con estructuras similares. Conclusiones: La pandemia tuvo un mayor impacto desorganizador en su inicio, con un aumento continuo de la sintomatología de salud mental y una disminución de la relación entre miedo y ansiedad o depresión.

Percepção de profissionais de saúde sobre diretivas antecipadas de vontade / Advanced directives as perceived by healthcare professionals / Percepción de los profesionales de la salud sobre las voluntades anticipadas

Resumo Diretivas antecipadas de vontade são instrumentos que buscam garantir antecipadamente o cumprimento dos desejos do paciente em circunstâncias em que ele não consiga se manifestar livremente. Neste trabalho investigou-se a percepção de profissionais de saúde sobre o uso dessa ferramenta em cuidados paliativos, além dos principais dilemas éticos e ganhos ou prejuízos decorrentes de seu uso. Foi realizada entrevista semidirigida com nove profissionais, e os dados foram submetidos à análise de conteúdo. Evidenciaram-se cinco categorias, que apontaram para uma boa receptividade do recurso, por assegurar o exercício da autonomia do paciente, fortalecendo a percepção do cuidado, facilitando as decisões e propiciando conforto psicológico. Por sua vez, as adversidades ou desafios envolveram necessidade de melhor preparo técnico e maior integração da equipe, sobrecarga profissional, insegurança jurídica com eventual uso do instrumento, finitude como tabu e desconhecimento da sociedade acerca do tema.

Abstract Advance directives are instruments that aim to ensure the fulfillment of patients' will in circumstances where they are unable to express themselves freely. This study investigated how health professionals perceive the use of this tool in palliative care, as well as the main ethical dilemmas and gains or losses related to it. Semi-directed interviews were conducted with nine professionals and the data underwent content analysis. Five categories emerged, pointing to a good reception of the resource, as it ensures patient autonomy, strengthening the perception of care, facilitating decisions and providing psychological comfort. On the other hand, the adversities or challenges involved the need for better technical preparation and greater team integration, professional overload, legal uncertainty about its use, end-of-life as a taboo and society's lack of knowledge about the subject.

Resumen Las voluntades anticipadas son herramientas para garantizar el cumplimiento de las decisiones del paciente cuando estos ya no pueden expresarse. Este estudio evaluó las percepciones de los profesionales de la salud sobre el uso de esta herramienta en cuidados paliativos, así como los principales dilemas éticos y las ganancias o pérdidas derivadas de su uso. Se realizó una entrevista semidirigida a nueve profesionales, y los datos se sometieron a un análisis de contenido. Surgieron cinco categorías, que apuntan a una buena acogida del recurso, pues garantiza el ejercicio de la autonomía del paciente, reforzando la percepción de los cuidados, facilitando las decisiones y proporcionándole confort psicológico. Por otro lado, las adversidades o desafíos involucraron la necesidad de mejor preparación técnica y mayor integración del equipo, la sobrecarga profesional, la inseguridad jurídica sobre el posible uso del documento, la finitud como tabú y el desconocimiento de la sociedad sobre el tema.

Non-suicidal self-injury and suicidal behavior during the COVID-19 pandemic in Brazil.

This study sought to determine the explanatory variables behind suicidal behavior and non-suicidal self-injury during the early months of the COVID-19 pandemic in Brazil. The sample comprised 4797 adults, who filled out a series of standardized instruments and additional questions on COVID-19 exposure (self and others), self-injury, and suicidal behavior. One in 10 participants reported self-injury, and three in 10 had considered or attempted suicide. The factors associated with self-injury and suicidal behavior were lower educational level, younger age, chronic diseases, and anxiety. The factors associated with suicidal behavior were regular employment, living alone, and Black ethnicity.

Sociodrama como estratégia de promoção de saúde em um hospital universitário / Sociodrama as a health promotion strategy in a university hospital / Sociodrama como estrategia de promoción de la salud en un hospital universitario

RESUMO A residência multiprofissional qualifica profissionais para o serviço na saúde pública, mas o tipo de atuação e os desafios podem gerar impacto à saúde mental, desde sintomas ansiosos e depressivos a transtornos mentais. O objetivo deste trabalho foi apresentar uma estratégia de intervenção sociodramática com residentes de um hospital universitário. Realizou-se uma reflexão a partir da interlocução entre um relato de experiência e da literatura. Durante a intervenção, os residentes mostraram-se receptivos à proposta sociodramática e relataram experiências de crescimento pessoal, acolhimento e fortalecimento do vínculo entre os colegas. Com isso, evidencia-se o potencial de promoção de saúde do sociodrama no contexto hospitalar, alinhado à Política Nacional de Humanização, ao propiciar acolhimento, crescimento pessoal e relações de trabalho mais harmônicas.

ABSTRACT The multiprofessional residency qualifies professionals for acting in public health system, but the kind of activities and challenges can have an impact on mental health, from anxious and depressive symptoms to mental disorders. This paper aimed to present a sociodramatic intervention strategy with residents in a university hospital. A reflection based on the interlocution between an experience report and literature was conducted. During the intervention, the residents were receptive to the sociodramatic proposal and reported experiences of personal development, welcoming, and strengthening of bonds among colleagues, culminating with a collective catharsis. Thus, the health-promoting potential of sociodrama in the hospital context, aligned with the National Humanization Politics, is evidenced by providing welcoming, personal development and more harmonious work relationships.

RESUMEN La residencia multiprofesional cualifica a los profesionales para la acción en sistema de la sanidad pública, pero el tipo de actuación y los desafíos pueden repercutir en la salud mental, desde los síntomas ansiosos y depresivos hasta los trastornos mentales. El objetivo de este trabajo fue presentar una estrategia de intervención sociodramática con residentes de un hospital universitario. Se realizó una reflexión a partir de la interlocución entre un relato de experiencia y la literatura. Durante la intervención, los residentes se mostraron receptivos a la propuesta sociodramática y relataron experiencias de crecimiento personal, acogiendo y fortaleciendo el vínculo entre compañeros. Con esto, se destaca el potencial de promoción de la salud del sociodrama en el contexto hospitalario, en línea con la Política Nacional de Humanización, al brindar acogida, crecimiento personal y relaciones laborales más armoniosas.

Prática psicodramática no contexto hospitalar / Psychodramatic practice in the hospital context / Práctica psicodramática en el contexto hospitalario

RESUMO A hospitalização, essencial para recuperação da saúde, costuma ampliar o sofrimento psíquico dos pacientes, na medida em que impõe uma rotina de cuidados, afasta o paciente da família e do meio social. O objetivo deste estudo é apresentar a compreensão psicodramática desse contexto e possibilidades de intervenção. Foi realizada uma articulação teórica com a experiência psicoterapêutica de enfoque psicodramático. Observou-se que a existência de conservas culturais hospitalares e limitações impostas pelo adoecimento gera perda da espontaneidade e cristalização no papel de doente, aumentando o sofrimento e prejudicando a recuperação do indivíduo. O estabelecimento de uma relação télica e o uso de técnicas psicodramáticas mostraram-se relevantes no resgate da espontaneidade e na promoção da saúde mental dos pacientes.

ABSTRACT Hospitalization, essential for health recovery, usually increases the psychic suffering of patients, as it imposes a care routine, distances the patient from the family and the social environment. The aim of this study is to present possibilities for psychodramatic intervention in this context. A theoretical articulation was carried out with a report of professional experience in Psychology with a psychodramatic approach. It was observed that the existence of hospital cultural preserves and the limitations imposed by illness generates loss of spontaneity and crystallization in the sick role, resulting in suffering and impairing the individual's recovery. The establishment of a telic relationship and the use of psychodramatic techniques proved to be relevant in rescuing spontaneity and promoting the mental health of patients.

RESUMEN La hospitalización, fundamental para la recuperación de la salud, suele aumentar el sufrimiento psíquico de los pacientes, ya que impone una rutina de cuidados, aleja al paciente de la familia y del entorno social. El objetivo de este estudio es presentar posibilidades de intervención psicodramática en este contexto. Se realizó una articulación teórica con un relato de experiencia profesional en Psicología con enfoque psicodramático. Se observó que la existencia de cotos culturales hospitalarios y las limitaciones impuestas por la enfermedad generan pérdida de espontaneidad y cristalización en el rol de enfermo, resultando en sufrimiento y perjudicando la recuperación del individuo. El establecimiento de una relación télica y el uso de técnicas psicodramáticas demostraron ser relevantes para rescatar la espontaneidad y promover la salud mental de los pacientes.