The relationship between general psychopathology in young people with family functioning and engagement with psychotherapy.

OBJECTIVE: to examine whether an underlying general psychopathology factor (p factor) existed in children and adolescents attending psychodynamic psychotherapy and whether this general psychopathology factor was associated with family functioning and engagement with psychotherapy. METHOD: Participants were 1976 children and adolescents, and their families, who sought psychodynamic psychotherapy from a community-based clinic in Southern Brazil. The Child Behavior Checklist and the Family Adaptability and Cohesion Evaluation Scales for assessing symptoms and family functioning were used, with treatment engagement data available through linked records. Confirmatory factor analytic methods examined psychopathology and regression models were constructed to examine associations. RESULTS: A general psychopathology factor and specific internalizing and externalizing factors were identified. Higher general psychopathology scores at assessment were associated with an increased likelihood of dropout and poorer attendance compared to completing treatment. Father's educational level, living with both parents, lack of family adaptability and cohesion, and maltreatment experience were related to increased p factor severity. CONCLUSION: General psychopathology severity seems to contribute to child and adolescent psychotherapy outcomes, increasing the risk of non-adherence and dropout. Family difficulties and traumatic experiences may increase p factor severity. Identifying general psychopathology routinely can be crucial for developing effective treatment plans.

Mortality, survival, and causes of death in mental disorders: comprehensive prospective analyses of the UK Biobank cohort.

BACKGROUND: The UK Biobank is a large middle-aged cohort recruited in 2006-2010. We used data from its participants to analyze mortality, survival, and causes of death associated with mental disorders. METHODS: Our exposures were mental disorders identified using (1) symptom-based outcomes derived from an online Mental Health Questionnaire (n = 157 329), including lifetime/current depression, lifetime/current generalized anxiety disorder, lifetime/recent psychotic experience, lifetime bipolar disorder, current alcohol use disorder, and current posttraumatic stress disorder and (2) hospital data linkage of diagnoses within the International Classification of Diseases, 10th revision (ICD-10) (n = 502 422), including (A) selected diagnoses or groups of diagnoses corresponding to symptom-based outcomes and (B) all psychiatric diagnoses, grouped by ICD-10 section. For all exposures, we estimated age-adjusted mortality rates and hazard ratios, as well as proportions of deaths by cause. RESULTS: We found significantly increased mortality risk associated with all mental disorders identified by symptom-based outcomes, except for lifetime generalized anxiety disorder (with hazard ratios in the range of 1.08-3.0). We also found significantly increased mortality risk associated with all conditions identified by hospital data linkage, including selected ICD-10 diagnoses or groups of diagnoses (2.15-7.87) and ICD-10 diagnoses grouped by section (2.02-5.44). Causes of death associated with mental disorders were heterogeneous and mostly natural. CONCLUSIONS: In a middle-aged cohort, we found a higher mortality risk associated with most mental disorders identified by symptom-based outcomes and with all disorders or groups of disorders identified by hospital data linkage of ICD-10 diagnoses. The majority of deaths associated with mental disorders were natural.

Etiology, management, and outcomes of pediatric telogen effluvium: A single-center study in the United States.

BACKGROUND/OBJECTIVES: Telogen effluvium (TE) is a diffuse, rapidly occurring non-scarring alopecia that can be a significant source of distress for patients and caregivers. To date, the disorder has not been extensively studied in a US pediatric patient population. This study aims to characterize the epidemiology, management, and disease course of pediatric TE. METHODS: A retrospective single-center analysis was conducted at the University of Miami including pediatric medical records from 2009 to 2021 with at least one clinic visit coded with the diagnosis of TE. RESULTS: 76 patients presented with a wide range of age at onset and hair loss duration. 67% of patients (n = 51) had an identified trigger, the most common being emotional stress and acute febrile illness, followed by nutritional deficiencies (specifically iron, ferritin, and vitamin D). Observation was the most common therapeutic approach. Of patients who had a follow-up evaluation (39%), different treatments resulted in similar rates of improvement. CONCLUSIONS: The results of this study demonstrate the variability in potential TE triggers, physical exam findings, and management in children, similar to what is currently observed and practiced in adult patients. Appropriate work-up for common triggers should be included during the initial visit. Greater evidence-based treatment approaches are needed for pediatric TE.

Topical application of a cream containing nanoparticles with vitamin E for radiodermatitis prevention in women with breast cancer: A randomized, triple-blind, controlled pilot trial.

PURPOSE: Most topical agents for radiodermatitis prevention are not based on its pathophysiology, mainly caused by the indirect effects of radiation from reactive oxygen species release. Therefore, this study aimed to evaluate the effect of vitamin E-containing nanoparticle cream as an antioxidant for radiodermatitis prevention. METHOD: A randomized, triple-blind, parallel pilot study conducted in an Oncology Hospital including 40 adult women with breast cancer, and healthy skin, submitted to radiotherapy, divided into three groups: Intervention (12; 30%) receiving cream with nanoparticles containing vitamin E; Control 1 (14; 35%) cream without nanoparticles or vitamin E; Control 2 (14; 35%) cream with nanoparticles without vitamin E. Incidence, grade and time to onset of radiodermatitis were primary outcomes; health-related quality of life, reported symptoms, and breast temperature were secondary outcomes. RESULTS: All patients were followed until the end of the study. All had radiodermatitis. There were no significant differences between the study groups regarding radiodermatitis grade, health-related quality of life, and breast temperatures. A protective effect of vitamin E-containing nanoparticle cream was identified regarding the onset time of radiodermatitis in patients who did not receive a boosted radiation dose (p = .03) and the occurrence of mild inframammary erythema (p = .04). Itching was reported by 90% of the women. The definitive calculated sample is 108 volunteers. There were no identified side effects. CONCLUSIONS: A potential protective effect of a cream containing vitamin E nanoparticles was observed. This pilot study presents initial evidence about the role of a nanoencapsulated antioxidant in preventing radiodermatitis. TRIAL REGISTRATION: No. RBR-784F3Y; UTN-U1111-1201-5923.

The prevalence of skin tears and associated factors in hospitalised patients with cancer.

OBJECTIVE: Oncology patients are vulnerable to skin breakdown. The primary purpose of this study was to estimate the prevalence of skin tears (STs) in hospitalised patients with cancer and to explore related sociodemographic and clinical factors. METHOD: This was an observational, epidemiological, cross-sectional study conducted in an oncology hospital in the city of São Paulo. All STs were classified using the STAR Classification adapted and validated for Brazil. RESULTS: Of the 341 patients evaluated, 22 had STs, equating to a prevalence of 6.5%. A higher number of STs were noted on the lower limbs (26.9%) than on other body areas. The main factors associated with STs were the use of anticoagulants, the presence of ecchymosis and the use of incontinence briefs. CONCLUSION: This study contributed to a better understanding of the epidemiology of STs in hospitalised patients with cancer, as well as its associated factors. Results may inform nursing professionals with regard to the need to develop prevention strategies and early interventions.

Desenvolvimento e validação da versão em português da friends and family interview / Developing and validation the portuguese version of the friends and family interview / Desarrollo y validación de la versión portuguesa de la friends and family interview

O objetivo deste estudo foi a adaptação e validação da entrevista Friends and Family Interview que avalia o estilo de apego e a função reflexiva de crianças e adolescentes. Para adaptação, foram avaliadas a equivalência semântica, idiomática, experiencial e conceitual entre a versão traduzida e o instrumento original. A versão final da entrevista foi aplicada a uma amostra clínica de jovens entre 9 e 17 anos (M=13,12; DP=2,72) do sul do Brasil. Constatou-se que a versão em português apresentou uma consistência interna alta (α=0,79), assim como uma boa concordância entre avaliadores (α=0,89). A análise fatorial exploratória revelou dois componentes principais que melhor explicaram os dados, denominados Segurança nos Relacionamentos e Funcionamento Reflexivo (α=0,95) e Insegurança do Apego (α=0,72). Os resultados apoiaram a validade de construto e de critério da FFI e forneceram evidências de sua utilidade na avaliação do apego e da função reflexiva na infância e adolescência. (AU)

The study aimed to adapt and validate the Friends and Family Interview that assesses the attachment style and the reflective function in children and adolescents. The semantic, idiomatic, experiential and conceptual equivalences between the original and the translated version were analyzed. Then the final version was applied in a clinic sample of young people ranging from 9 to 17 years of age (M=13.12 SD=2.72 years), of southern Brazil. The statistical tests showed a high internal consistency (α=.79), as well as a good inter-evaluators reliability (α=.89) in the Portuguese version of the FFI. Exploratory factor analysis yielded two main factors, Relationships Security and Reflective Functioning (α=.95) and Attachment Insecurity (α=.72). The data supported the construct and criterion validities of the Portuguese version of the interview protocol. The FFI is a useful tool for the evaluation of attachment and reflective function in children and adolescents. (AU)

El objetivo de este estudio fue la adaptación y la validación de la entrevista Friends and Family Interview (FFI) que evalúa el estilo de apego y la función reflexiva de niños y adolescentes. Para la adaptación se evaluó la equivalencia semántica, idiomática, experiencial y conceptual entre la versión traducida y el instrumento original. La versión final de la entrevista se aplicó a una muestra clínica de jóvenes entre 9 y 17 años (M=13,12; DS=2,72) del sur de Brasil. Se encontró que la versión portuguesa tenía una alta consistencia interna (α=0,79), así como una buena concordancia entre evaluadores (α=0,89). El análisis factorial exploratorio reveló dos componentes principales, denominados Seguridad en las Relaciones y Funcionamiento Reflexivo (α=0,95) e Inseguridad del Apego (α=0,72). Los resultados apoyaron la validez de criterio y constructo de la FFI y proporcionaron evidencias de su utilidad para evaluar el apego y la función reflexiva en la niñez y en la adolescencia. (AU)

Intervenções para a prevenção e o tratamento de feridas cutâneas em pacientes com câncer

Os tratamentos oncológicos evoluíram nos últimos anos, possibilitando ao paciente com câncer maior chance de cura e sobrevida. Mas, também, trazendo desafios no cuidado oferecido a esse paciente. Compilamos nesse vídeo os resultados de três pesquisas sobre o cuidado de feridas cutâneas no paciente oncológico, desenvolvidas no Programa de Pós-Graduação na Saúde do Adulto-PROESA pela Escola de Enfermagem da Universidade de São Paulo-EEUSP sob a supervisão da Profa. Dra. Vera Lucia Conceição de Gouveia Santos.

Intervenções para a prevenção e o tratamento de feridas cutâneas em pacientes com câncer

Os tratamentos oncológicos evoluíram nos últimos anos, possibilitando ao paciente com câncer maior chance de cura e sobrevida. Mas, também, trazendo desafios no cuidado oferecido a esse paciente. Compilamos nesse vídeo os resultados de três pesquisas sobre o cuidado de feridas cutâneas no paciente oncológico, desenvolvidas no Programa de Pós-Graduação na Saúde do Adulto-PROESA pela Escola de Enfermagem da Universidade de São Paulo-EEUSP sob a supervisão da Profa. Dra. Vera Lucia Conceição de Gouveia Santos.

Provider perceptions and practices for appearance-related psychosocial distress caused by dermatologic disease in children.

BACKGROUND/OBJECTIVES: Differences in appearance are often stigmatized in society, and dermatologic disease can lead to psychological and social sequelae that significantly impact patient quality of life. However, discrepancy between patient-reported and physician-assessed psychological distress raises a question of how clinicians are prepared in recognizing and managing the psychosocial impact of a child's skin condition. We aim to identify current practices among healthcare providers toward properly addressing appearance-related psychosocial distress in pediatric dermatology patients. METHODS: Surveys assessing provider attitude and practices to appearance-related distress were distributed to members of the Society of Pediatric Dermatology via the Pediatric Dermatology Research Alliance, and Florida Chapter of American Academy of Pediatrics. RESULTS: Over half of respondents report encountering appearance-related psychosocial distress on a daily basis and believe screening to be important. However, only 14% use a validated screening tool and 18% screen all patients. Major obstacles to generalized screening were limited time and staffing. Self-reported knowledge and management of appearance-related psychosocial distress includes direct counseling and referrals to local support groups, mental health providers, specialized summer camps, and school-affiliated resources. Nevertheless, 86% expressed interest in learning more about appearance-related psychosocial distress, particularly about patient education and resources. CONCLUSIONS: Although clinicians frequently encounter appearance-related distress with pediatric dermatology patients, screening is selective and lacks standardization. Self-reported knowledge and management is comprehensive, but there is a need for increased training in patient education and resources.

Topical cream containing nanoparticles with vitamin E to prevent radiodermatitis in women with breast cancer: a clinical trial protocol.

OBJECTIVE: Little is known about the efficacy of products aiming to prevent radiodermatitis, which affects between 90-95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidenceon their effectiveness. Here, the authors present a clinical trial protocol to evaluate the effects of applying a cream containing nanoparticles with vitamin E to prevent radiodermatitis in patients with breast cancer. METHOD: The protocol recommends that 108 women with breast cancer, receiving radiotherapy, are included in this triple-blinded, randomized, controlled study at an oncology hospital. Patients will be divided in three groups of 36 individuals each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will receive a cream without nanoparticles nor vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree, and time of onset of radiodermatitis. The secondary endpoints will focus on the quality of life, symptoms, and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved and registered on an international trials database.

Effects of non-invasive respiratory support on sleep in preterm infants evaluated by actigraphy.

OBJECTIVE: Few studies have evaluated sleep in preterm infants under non-invasive ventilatory support in neonatal intensive care units (NICU). The main objective of this study was to evaluate the influence of continuous positive airway pressure (CPAP) in the sleep of premature babies. MATERIAL AND METHODS: Crossover study in a NICU. We selected preterm infants with gestational age between 28 and 37 weeks using nasal CPAP. Eighteen preterm were included. Patients were monitored with actigraphy and with the Neonatal Behavioral Assessment Scale (NBAS). RESULTS: Results showed a reduction in sleep effciency, total sleep time and total sleep period during the CPAP period when compared to the non-CPAP. NBAS demonstrated significantly greater time of deep sleep and light sleep in the period without CPAP. CONCLUSION: Our data suggests that the use of CPAP, during the first week of life, in preterm neonates, is associated with transitory alterations of sleep organization.

Acute urticaria preceding other COVID-19-associated manifestations-A case report.

The novel coronavirus SARS-CoV-2 has been associated with a variety of dermatologic manifestations, often the predominant finding in otherwise asymptomatic or oligosymptomatic patients. Urticarial eruption is one example, but few cases have been reported among pediatric patients. We present a case of acute urticaria in a 6-month-old boy preceding other COVID-19 symptoms. The suspicion of a possible COVID-19-associated cutaneous manifestation prompted timely testing and diagnosis of SARS-CoV-2 infection.

Hydrolysed formula, delayed food introduction and fatty acids for atopic dermatitis prevention in infancy.

AIM: The role of nutrition in preventing atopic diseases including atopic dermatitis has recently gained interest in the medical community. Caregivers of infants and children at an increased risk for developing atopic dermatitis often employ exclusion diets or other measures in hopes of preventing the development of this burdensome disease. This paper reviews the current literature in regard to the role of preventative dietary measures in the context of atopic dermatitis, with a special focus on the topics of hydrolysed formula, early vs. delayed introduction of certain foods and fatty acid supplementation. METHODS: Literature pertaining to preventative dietary measures for infants at risk for atopic dermatitis was reviewed. RESULTS: Analysis of the literature suggests that hydrolysed formula should not be routinely offered to infants for prevention of atopic dermatitis. Formulas utilised should contain concentrations of polyunsaturated fatty acids similar to that in breast milk. Finally, infant caregivers should not delay or restrict introduction of food, which can be more harmful than helpful to the patient. CONCLUSION: Recommendations to caretakers providing for infants at risk for atopic dermatitis should include infant consumption of breast milk and avoid delayed introduction of foods.

Topical cream containing nanoparticles with vitamin E to prevent radiodermatitis in women with breast cancer: a clinical trial protocol.

OBJECTIVE: Little is known about the efficacy of products aiming to prevent radiodermatitis, which affects between 90-95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidenceon their effectiveness. Here, the authors present a clinical trial protocol to evaluate the effects of applying a cream containing nanoparticles with vitamin E to prevent radiodermatitis in patients with breast cancer. METHOD: The protocol recommends that 108 women with breast cancer, receiving radiotherapy, are included in this triple-blinded, randomized, controlled study at an oncology hospital. Patients will be divided in three groups of 36 individuals each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will receive a cream without nanoparticles nor vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree, and time of onset of radiodermatitis. The secondary endpoints will focus on the quality of life, symptoms, and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved and registered on an international trials database.

Nursing team knowledge on care for patients with fungating wounds.

OBJECTIVE: to evaluate the nursing team knowledge of a cancer hospital on care for patients with Malignant Fungating Wounds (MFW) and to analyze associated sociodemographic and educational factors. METHOD: an observational and cross-sectional study, conducted between September and October 2015, after approval by the Research Ethics Committee. A questionnaire was applied containing sociodemographic, educational and related components to the accomplishment of dressings, dressings choice and orientation. Data were analyzed by using Chi-square, Fisher's exact test, Student's t-Test and Pearson's correlation. RESULTS: 37 professionals participated in the study, most of whom were technicians (56.8%), women (91.9%) and with a mean age of 32 years. The professionals presented 56.5% of correct answers. There were no statistically significant associations between sociodemographic/educational variables and number of correct answers. CONCLUSION: there was a lack of important knowledge about care for patients with MFW, which should guide strategies for the oncology staff training.

Clinical protocol for the topical use of a cream with nanoparticles and vitamin E to prevent radiodermatitis in patients with breast cancer]. / Aplicación tópica de crema con nanopartículas con vitamina E para prevenir radiodermatitis en cáncer de mama: protocolo de ensayo clínico.

Objetivo: Poco se conoce sobre la eficacia de productos para la prevención de radiodermatitis, que afecta al 90­95% de las mujeres con cáncer de mama. El uso de antioxidantes es promisorio, sin embargo, poco estudiado. Los autores desarrollaron un protocolo de ensayo clínico para evaluar el efecto potencial de la aplicación de crema con nanopartículas con vitamina E para prevenir radiodermatitis aguda en mujeres con cáncer de mama. Método: El protocolo sugiere que 108 mujeres adultas con cáncer de mama, que estén recibiendo radioterapia, sean incluidas en este ensayo clínico, controlado, aleatorizado y triple ciego, en un hospital oncológico. Se prevé la distribución de pacientes en tres grupos de 36 personas: el grupo A recibirá una crema con nanopartículas lipídicas con vitamina E, el grupo B obtendrá una crema sin nanopartículas ni vitamina E, y el grupo C usará una crema con nanopartículas sin vitamina E. Los resultados primarios evaluarán la incidencia, el grado y el tiempo de surgimiento de la radiodermatitis. Los resultados secundarios se centrarán en la calidad de vida, los síntomas y la temperatura local. Las pacientes serán evaluadas tres veces por semana, desde el inicio de la radioterapia hasta dos semanas después de la última sesión. El presente proyecto fue aprobado por el comité de ética en investigación de las instituciones involucradas.Objective: Little is known about the efficacy of products that aim to prevent radiodermatitis, which affects between 90­95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidence on their effectiveness. Here, the authors present a clinical trial protocol to evaluate the potential effects of applying a nanoparticle cream with vitamin E to prevent radiodermatitis in patients with breast cancer. Method: The protocol recommends that 108 women with breast cancer, who are receiving radiotherapy, be included in a triple-blinded, randomised, controlled study in an oncology hospital. Patients will be divided in three groups of 36 people each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will obtain a cream without nanoparticles or vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree and time of onset of radiodermatitis. The secondary endpoints will focus on quality of life, symptoms and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved.

Nursing team knowledge on care for patients with fungating wounds / Conocimiento del equipo de enfermería sobre cuidados con pacientes con úlceras neoplásicas / Conhecimento da equipe de enfermagem sobre cuidados com pacientes com feridas neoplásicas

ABSTRACT Objective: to evaluate the nursing team knowledge of a cancer hospital on care for patients with Malignant Fungating Wounds (MFW) and to analyze associated sociodemographic and educational factors. Method: an observational and cross-sectional study, conducted between September and October 2015, after approval by the Research Ethics Committee. A questionnaire was applied containing sociodemographic, educational and related components to the accomplishment of dressings, dressings choice and orientation. Data were analyzed by using Chi-square, Fisher's exact test, Student's t-Test and Pearson's correlation. Results: 37 professionals participated in the study, most of whom were technicians (56.8%), women (91.9%) and with a mean age of 32 years. The professionals presented 56.5% of correct answers. There were no statistically significant associations between sociodemographic/educational variables and number of correct answers. Conclusion: there was a lack of important knowledge about care for patients with MFW, which should guide strategies for the oncology staff training.

RESUMEN Objetivo: evaluar el conocimiento del equipo de enfermería de un hospital oncológico sobre el cuidado de pacientes con Úlceras Neoplásicas Malignas (UNM) y analizar factores sociodemográficos y educativos asociados. Método: estudio observacional y transversal, realizado entre septiembre y octubre de 2015, tras la aprobación por el Comité de Ética en Investigación. Se aplicó un cuestionario que contenía componentes sociodemográficos, educativos y relacionados con la realización de curativos, elección de coberturas y orientación. Los datos fueron analizados a través del Test Qui-Cuadrado, Exacto de Fisher, Test t de Student y correlación de Pearson. Resultados: en el estudio 37 profesionales, siendo la mayoría técnicos (56,8%), mujeres (91,9%) y con edad media de 32 años. Los profesionales presentaron un 56,5% de aciertos. No hubo asociaciones estadísticamente significativas entre variables sociodemográficas/educativas y número de aciertos. Conclusión: se observó déficit de conocimientos importantes sobre el cuidado de pacientes con UNM, lo que debió orientar estrategias para capacitación de los equipos actuantes en Oncología.

RESUMO Objetivo: avaliar o conhecimento da equipe de enfermagem de um hospital oncológico sobre o cuidado de pacientes com Feridas Neoplásicas Malignas (FNM) e analisar fatores sociodemográficos e educacionais associados. Método: estudo observacional e transversal, realizado entre setembro e outubro de 2015, após aprovação por Comitê de Ética em Pesquisa. Foi aplicado questionário contendo componentes sociodemográficos, educacionais e relacionados à realização de curativos, escolha de coberturas e orientação. Os dados foram analisados por meio do Teste Qui-Quadrado, Exato de Fisher, Teste t de Student e correlação de Pearson. Resultados: participaram do estudo 37 profissonais, sendo a maioria técnicos (56,8%), mulheres (91,9%) e com idade média de 32 anos. Os profissionais apresentaram 56,5% de acertos. Não houve associações estatisticamente significativas entre variáveis sociodemográficas/educacionais e número de acertos. Conclusão: observou-se déficit de conhecimentos importantes sobre o cuidado de pacientes com FNM, o que deve nortear estratégias para capacitação das equipes atuantes em Oncologia.

Associação entre traumas na infância e a representação de apego parental na vida adulta / Association between Trauma in childhood and an parental attachment representation in adult life

A história pessoal do indivíduo, suas experiências na infância, influenciam e marcam o seu desenvolvimento psicológico. A vivência de traumas na infância é uma das possíveis adversidades que marcam o indivíduo e podem trazer implicações negativas em diversas áreas do seu funcionamento na vida adulta. Os pais apresentam um papel importante na modulação das respostas e funcionamento da criança frente ao trauma. O objetivo deste estudo foi avaliar a relação entre traumas na infância e estilos de apego parental em pacientes que buscam psicoterapia psicodinâmica. Foi realizado um estudo transversal e correlacional com 180 pacientes adultos que iniciaram psicoterapia psicodinâmica entre maio de 2015 e maio de 2016 em um ambulatório de saúde mental. Os resultados apontam que os traumas na infância apresentam correlação significativa com o estilo de apego com os pais. Quanto maior o controle materno e paterno maior o abuso emocional, negligência emocional e trauma total. O cuidado materno e paterno apresentou correlação inversamente proporcional com todas as dimensões do apego. Quanto maior o cuidado materno e paterno menor o abuso emocional, físico, sexual, negligência emocional, física e trauma total. Destacam-se características de controle na relação de apego como pai, no sentido de superproteção, que estão relacionadas a vivência de todos os tipos de trauma na infância.(AU)

The individuals personal history as his or her childhood experiences influences psychological development. The experience of a trauma in childhood is one of the possible adversities that's mark the subject and can have negative implications in various areas of the functioning of the individual in adulthood. Parents play an important role in modulating the childs responses and functioning to trauma. The objective was to evaluate the relationship between childhood trauma and parenting attachment styles in patients seeking psychodynamic psychotherapy. A cross-sectional, correlational study was conducted with 180 adult patients who started psychodynamic psychotherapy between May 2015 and May 2016 at a mental health outpatient clinic. The results indicate that the majority of patients who underwent trauma in childhood are significantly correlated with the type of attachment to parents. The greater the maternal and paternal control, the greater the emotional abuse, emotional neglect and total trauma. Maternal and paternal care showed an inversely proportional correlation with all attachment dimensions. The greater maternal and paternal care, the lower the impact of the emotional, physical, sexual abuse, emotional neglect, physical and total trauma. There are control characteristics in the attachment relationship with the father, in the sense of overprotection, which are related to the experience of all types of trauma in childhood.(AU)

La historia personal del individuo, sus experiencias infantiles, influyen en su desarrollo psicológico. La experiencia del trauma en la infancia es una de las posibles adversidades que marcan al individuo y puede tener implicaciones negativas en varias áreas de su funcionamiento en la vida adulta. Los padres juegan un papel importante en la modulación de las respuestas y el funcionamiento del niño ante el trauma. El objetivo de este estudio fue evaluar la relación entre el trauma infantil y los estilos de apego parental en pacientes que buscan psicoterapia psicodinámica. Se realizó un estudio transversal y correlacional con 180 pacientes adultos que comenzaron la psicoterapia psicodinámica entre mayo de 2015 y mayo de 2016 en una clínica de salud mental. Los resultados muestran que el trauma infantil tiene una correlación significativa con el estilo de apego con los padres. Cuanto mayor es el control materno y paterno, mayor es el abuso emocional, el abandono emocional y el trauma total. La atención materna y paterna mostró una correlación inversamente proporcional con todas las dimensiones del apego. Cuanto mayor es el cuidado materno y paterno, menor es el abuso emocional, físico, sexual, el abandono emocional, físico y el trauma total. Se destacan las características de control en la relación de apego con el padre, en el sentido de sobreprotección, que están relacionadas con la experiencia de todo tipo de trauma en la infancia.(AU)

Aplicação tópica de creme contendo nanopartículas com vitamina E para prevenção de radiodermatite em mulheres com câncer de mama: estudo piloto randomizado / Topical application of cream containing nanoparticles with vitamin E for radiodermatitis prevention in women with breast cancer: a randomized pilot study

Introdução: Apesar da ação promissora dos agentes antioxidantes contra as radiodermatites, os estudos sobre esse tema ainda são pouco consistentes. Diante dessas considerações, questionou-se sobre a ação da vitamina E, veiculada por meio de nanotecnologia, na prevenção das radiodermatites. Objetivo: Avaliar o potencial efeito da aplicação tópica de creme com nanopartículas lipídicas contendo vitamina E, na concentração final de 2%, para a prevenção de radiodermatite aguda em mulheres com câncer de mama submetidas à teleterapia. Método: Estudo piloto randomizado e duplo cego, realizado em um hospital oncológico de Minas Gerais. A amostra foi constituída de 40 mulheres, divididas em três grupos: Intervenção - realizaram a aplicação tópica de creme com nanopartículas lipídicas contendo vitamina E; Controle 1 - realizaram a aplicação tópica de creme sem nanopartículas lipídicas e sem vitamina E; Controle 2 - realizaram a aplicação tópica de creme com nanopartículas lipídicas sem vitamina E. A incidência de radiodermatite, o grau (pelas escalas RTOG e CTCAE) e o tempo para o aparecimento da reação foram considerados desfechos primários; a qualidade de vida, a temperatura da mama e os sintomas relatados como desfechos secundários. Todas as participantes seguiram as orientações padrão para prevenção de radiodermatites, realizaram a aplicação de creme três vezes por dia e foram avaliadas três vezes por semana. Para a coleta dos dados, utilizaram-se quatro instrumentos: dados sócio-demográficos e clínicos, registro das avaliações periódicas, e avaliação da qualidade de vida relacionada à saúde (QVRS) EORTC-QLQ-30 e EORTC-QLQ-BR23. Os dados foram analisados por meio de: modelo ANOVA, teste de Kruskal-Wallis, qui-quadrado, exato de Fisher, modelo de riscos proporcionais de Cox e modelo de efeitos mistos. O projeto foi aprovado por Comitê de Ética em Pesquisa. Resultados: Todas as pacientes da amostra apresentaram radiodermatites em algum grau. As incidências de reações graus 1, 2 e 3 foram, respectivamente: 58%, 25% e 17% para o grupo Intervenção; 36%, 29% e 36% para o grupo Controle 1; e 50%, 43% e 7% para o grupo Controle 2. Não houve diferenças significativas entre os grupos do estudo no que concerne ao grau de radiodermatite, QVRS e temperaturas das mamas. Observou-se uma tendência para potencial efeito protetor do creme com nanopartículas contendo vitamina E no que concerne ao tempo para aparecimento da radiodermatite nas pacientes que não receberam a dose de boost (p=0,03) e ocorrência de eritema leve inframamário (p=0,04). Prurido foi reportado por 90% das mulheres, apresentando por mais tempo naquelas do grupo Intervenção (p=0,05). Os dados encontrados permitiram subsidiar o cálculo amostral para o ensaio clinico definitivo, que deverá ser composto de 108 pacientes. Conclusões: Observou-se um potencial efeito protetor do creme com nanopartículas contendo vitamina E com relação ao tempo para aparecimento da radiodermatite e ocorrência de eritema leve inframamário. Não foram observadas diferenças significativas entre os grupos do estudo com relação a incidência e intensidade de radiodermatites, QVRS e temperatura das mamas. Amostra constituída de 108 pacientes deverá compor o ensaio clínico definitivo para evidenciar as hipóteses levantadas neste estudo piloto.

Introduction: Despite the promising action of antioxidant agents against radiodermatitis, studies on this topic are still poorly consistent. In view of these considerations, vitamin E transmitted through nanotechnology action on radiodermatitis prevention was questioned. Aims: To evaluate acute radiodermatitis prevention effect of topical application of a cream with lipid nanoparticles containing vitamin E (final concentration of 2%) in women with breast cancer submitted to radiotherapy. Method: Randomized, double blind pilot study performed at a cancer hospital in Minas Gerais. The sample consisted of 40 women, divided into three groups: Intervention - they performed topical application of the cream with lipid nanoparticles containing vitamin E; Control 1 - they performed topical application of the cream without lipid nanoparticles and without vitamin E; Control 2 - performed the topical application of cream with lipid nanoparticles without vitamin E. The incidence of radiodermatitis, the classification (by the RTOG and CTCAE scoring systems) and the time for appearance of the reaction were considered primary outcomes; quality of life, breast temperature and symptoms reported as secondary outcomes. All participants followed the standard guidelines for the prevention of radiodermatitis, performed the application of cream three times a day and were evaluated three times a week. Four instruments were used to collect data: socio-demographic and clinical data, record of periodic evaluations, and health-related quality of life assessment (HRQoL) - EORTC-QLQ-30 and EORTC-QLQ-BR23. The data were analyzed by means of: ANOVA model, Kruskal-Wallis test, chi-square test, Fisher's exact test, Cox proportional hazards model and mixed effects model. The project was approved by the Research Ethics Committee. Results: All patients in the sample presented radiodermatitis to some degree. The incidence of grade 1, 2 and 3 reactions were, respectively: 58%, 25% and 17% for the intervention group; 36%, 29% and 36% for the Control 1 group; and 50%, 43% and 7% for Control group 2. There were no significant differences between the study groups regarding the degree of radiodermatitis, HRQoL and breast temperatures. There was a trend towards a potential protective effect of the cream with vitamin E-containing nanoparticles regarding the time to onset of radiodermatitis in patients who did not receive the boost dose (p = 0.03) and the occurrence of mild inframammary erythema (p = 0.04). Pruritus was reported by 90% of the women, presenting more time in the Intervention group (p = 0.05). The colected data allowed to calculate the sample size for the definitive clinical trial, which should be composed of 108 patients. Conclusions: It was observed a potential protective effect of the cream with nanoparticles containing vitamin E concerning to the time of radiodermatitis appearance and the occurrence of inframammary light erythema. There were no significant differences between the study groups regarding the incidence and intensity of radiodermatitis, HRQoL and breast temperature. A sample consisting of 108 patients should compose the definitive clinical trial to highlight the hypotheses raised in this pilot study.