Effects of SARS-COVID-19 lockdown on menstrual patterns: A transversal large sample survey.

OBJECTIVE: To elucidate the presence, importance, and characteristics of menstrual changes related to stressful circumstances during the COVID-19 lockdown in Spain. STUDY DESIGN: An online survey was administered in Spain to menstruating women aged 15-55 who had not contracted COVID-19. It collected information on activities during the lockdown, sexual activity, perceptions of emotional status, any changes in menstrual characteristics, and impact on quality of life. The analysis of menstrual changes was limited to responders who did not use hormonal contraception. RESULTS: A total of 6449 women answered the survey, and 4989 surveys were valid for the final analysis. 92.3% of women had at least one menstruation period during the lockdown, while 7.7% had amenorrhea. Quality of life (QoL) associated with menstruation worsened in 19% of women, did not change in 71.7%, and improved in 1.6%. For 50.1% of the women, global QoL worsened during the lockdown; 41.3% remained about the same and 8.7% reported improvement. Sexual activity during the lockdown decreased in 49.8% of the respondents, remained unchanged in 40.7%, and increased in 9.5%. As far the menstrual changes are concerned, there were no statistically significant differences in amenorrhea incidence, regularity of the menstrual cycle, or the amount or duration of menstrual bleeding in non-hormonal contraceptive users when evaluated by the length and characteristics of isolation, the perception of exposure to COVID-19 and the economic or employment situation. Conversely, we found statistically significant differences according to the intensity of changes in emotional status due to lockdown stressors and changes in regularity, duration, and heaviness of menstruation. CONCLUSION: Changes in emotional status, but not the length and intensity of the isolation or exposure to the disease, significantly influenced menstrual disturbances during the COVID-19 lockdown.

Evaluación del estado emocional de personas con diabetes mellitus en la práctica ambulatoria / Evaluation of the emotional state of people with diabetes mellitus in outpatient practice

La aparición de una enfermedad crónica, como la diabetes mellitus (DM), pone a prueba la respuesta del universo físico y psíquico de un individuo. Como objetivo general, se propone evaluar el estado emocional de las personas con DM en la consulta ambulatoria. Como objetivo particular, detectar y monitorear las necesidades psicológicas que deben formar parte integral del cuidado de la DM mediante el uso de métodos validados. El cuestionario WHO-5 se incluye como índice de bienestar general, el PAID-5 revela la existencia de una posible angustia emocional vinculada a la enfermedad, y el PHQ- 9 como índice de depresión. Ante esta situación, el Comité de Aspectos Psicosociales recomienda explorar estos aspectos para optimizar el control y el tratamiento de la enfermedad, proponiendo estas herramientas para que el equipo de salud las emplee en la detección y el reconocimiento del estado emocional de las personas con DM

Occurrence of a chronic disease, such as diabetes, prove the response of the physical and psychic universe of individuals. As a general objective, is proposed to evaluate emotional state of people with diabetes in the outpatient clinic. As principal objective, detection and monitoring the psychological needs should be a main part of diabetes care, using validated tools to evaluate this aspect. WHO-5 questionnaire is included as an index of general well-being, PAID-5, reveals the existence of a possible emotional distress linked to disease, and PHQ-9 is used as an index of depression. At this situation, the Committee on Psycho-Social Aspects recommends explore these psychological aspects, as a way to optimize the control and treatment of disease, and propose the cited tools, to be used by the health team, in detection and recognition of emotional state in people with diabetes.

Efecto del hilt en el estado de anímo en personas con sobrepeso en un entrenamiento virtual y presencial

Rojas-Ilama, V., Castro-Ramírez, M.L., Víquez-Arce, R., Jiménez-Díaz. y Montero-Herrera, B. (2022). Efecto del HIIT en el estado anímico en personas con sobrepeso en un entrenamiento virtual y presencial. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 20(1), 1-17. El principal objetivo fue comparar los efectos de una sesión HIIT de 35 minutos, en modalidad virtual y presencial, en los estados anímicos y en el esfuerzo percibido en personas con sobrepeso. Se reclutaron un total de 13 personas (5 hombres y 8 mujeres) con una edad promedio de 37.85 ± 13.20 años (rango entre 17 y 60 años) los cuales fueron asignados a cada una de las tres condiciones de manera aleatoria (control, entrenamiento presencial y entrenamiento virtual). Previo a, e inmediatamente después de cada una de las intervenciones, se aplicó el test POMS para medir los estados anímicos. En lo que respecta al esfuerzo percibido (EP), su medición se llevó a cabo finalizado cada uno de los ejercicios HIIT (no se evaluó durante el calentamiento y el retorno a la calma). Al aplicar un ANOVA de 2 vías de medidas repetidas (condición (3) x medición (2)), se encontró que tanto la tensión como el vigor después de haber aplicado el tratamiento presencial presentaron un aumento significativo; además, la tensión aumentó en la sesión virtual. Por su parte, los valores de EP reportados en las mediciones de las sesiones presencial y virtuales estuvieron por encima de lo sugerido en la literatura. En conclusión, una sesión de HIIT para personas con sobrepeso de manera presencial o virtual presenta resultados similares en los estados de ánimo, excepto el vigor, el cual incrementa solo en la condición presencial; las otras variables mostraron un comportamiento similar.

Rojas-Ilama, V., Castro-Ramírez, M.L., Víquez-Arce, R., Jiménez-Díaz. & Montero-Herrera, B. (2022). Effects of HIIT on the mood of overweight people in virtual and face-to-face training. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 20(1), 1-17. The main objective was to compare the effects of 35-minute HIIT session, in both virtual and face-to- face modes, on the mood and the perceived effort of overweight people. A total 13 people (5 men and 8 women) were recruited, in an average age of 37.85 ± 13.20 years (17-60 year range), who were randomly assigned to each of the three conditions (control, face-to-face training, virtual training). Prior to and immediately after each of the interventions, the POMS test was applied in order to measure mood. The measuring of perceived effort (PE) was carried out at the end of each of the HIIT exercises (it was not assessed during warm-up or return to calm). When a 2-way repeated-measure ANOVA was applied (condition (3) x measurement (2)), it was found that both stress and vigor after applying face-to-face treatment showed a significant increase. In addition, stress increased in the virtual session. For their part, the PE values reported in the measurements of the face-to-face and virtual sessions were above those suggested in the literature. In conclusion, a HIIT session for overweight people, whether face-to-face or virtual, shows similar results in their moods, except for vigor, which only increases in the face-to-face situation. The other variables showed a similar behavior.

Rojas-Ilama, V., Castro-Ramírez, M.L., Víquez-Arce, R., Jiménez-Díaz. e Montero-Herrera, B. (2022). Efeito do HIIT no estado anímico de pessoas com sobrepeso em um treinamento virtual e presencial. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 20(1), 1-17. O principal objetivo foi comparar os efeitos de uma sessão de HIIT de 35 minutos, em modalidades virtual e presencial, nos estados anímicos e no esforço percebido de pessoas com sobrepeso. Foram recrutadas um total de 13 pessoas (5 homens e 8 mulheres) com idade média de 37,85 ± 13,20 anos (faixa etária entre 17 e 60 anos) que foram designados a cada uma das três condições de maneira aleatória (controle, treinamento presencial e treinamento virtual). Antes e imediatamente depois de cada uma das intervenções, foi aplicado o teste POMS para medir os estados anímicos. Com relação ao esforço percebido (EP), a medição foi feita ao finalizar cada um dos exercícios HIIT (não foi avaliado durante o aquecimento e a volta à calma). Ao aplicar um ANOVA de 2 vias de medidas repetidas (condição (3) x medição (2)), observou-se que tanto a tensão quanto o vigor depois da aplicação do tratamento presencial aumentaram de maneira significativa; além disso, a tensão aumentou na sessão virtual. Por outro lado, os valores de EP relatados nas medições das sessões presenciais e virtuais estiveram acima do sugerido na literatura. Como conclusão, uma sessão de HIIT para pessoas com sobrepeso, seja presencial ou virtual, apresenta resultados semelhantes nos estados de ânimo, exceto o vigor, que aumento somente na condição presencial; as outras variáveis mostraram um comportamento semelhante.

Diagnóstico de enfermería del estado emocional en pacientes con insuficiencia renal crónica durante su tratamiento / Nursing diagnosis of the emotional state in patients with chronic renal insufficiency during their treatment

La insuficiencia renal crónica (IRC) provoca cambios bruscos en la vida del individuo, como el desarrollo de trastornos emocionales que pueden conllevar a cuadros de ansiedad, depresión y estrés; afectando su estado emocional. Objetivo: Validar los instrumentos para analizar la influencia de la hemodiálisis en el estado emocional. Materiales y métodos: La investigación fue de diseño transversal con análisis descriptivo no experimental, modalidad cuali-cuantitativo. Los instrumentos utilizados fueron diseñados y validados por juicio de expertos y analizados estadísticamente con alfa de Cronbach, se empleó una prueba piloto compuesta por 15 personas con insuficiencia renal crónica para la validación de los instrumentos. Resultados: El instrumento cuantitativo presentó un coeficiente de fiabilidad de 0.75 en alfa de Cronbach y el instrumento cualitativo de acuerdo a la rúbrica de los expertos obtuvo un promedio de confiabilidad de 96; por lo que los instrumentos son aprobados y pueden aplicarse con resultados confiables. Conclusión: Los instrumentos tienen una validez, pertinencia y coherencia, adecuados para trabajar en la recolección de datos para determinar el estado emocional de los pacientes sometidos a hemodiálisis. El estudio estableció las asociaciones entre las variables de acuerdo a las etapas de la enfermedad será la predisposición a trastornos del estado de ánimo. Los resultados obtenidos validan la utilidad científica y la efectividad de los instrumentos diseñado(AU)

Chronic renal failure (CRF) causes sudden changes in the individual's life, such as the development of emotional disorders that can lead to anxiety, depression and stress; affecting your emotional state. Objective: To validate the instruments to analyze the influence of hemodialysis on the emotional state. Materials and methods: The research was of a cross-sectional design with non-experimental descriptive analysis, qualitative-quantitative modality. The instruments used were designed and validated by expert judgment and statistically analyzed with Cronbach's alpha. A pilot test consisting of 15 people with chronic renal failure was used to validate the instruments. Results: The quantitative instrument presented a reliability coefficient of 0.75 in Cronbach's alpha and the qualitative instrument, according to the experts' rubric, obtained a reliability average of 96; so the instruments are approved and can be applied with reliable results. Conclusion: The instruments have validity, relevance and coherence, adequate to work on data collection to determine the emotional state of patients undergoing hemodialysis. The study established the associations between the variables according to the stages of the disease will be the predisposition to mood disorders. The results obtained validate the scientific usefulness and effectiveness of the instruments designed(AU)

Evaluación del estado emocional de personas con diabetes mellitus en la práctica ambulatoria / Evaluation of the emotional state of people with diabetes mellitus in outpatient practice

Resumen La aparición de una enfermedad crónica, como la diabetes mellitus (DM), pone a prueba la respuesta del universo físico y psíquico de un individuo. Como objetivo general, se propone evaluar el estado emocional de las personas con DM en la consulta ambulatoria. Como objetivo particular, detectar y monitorear las necesidades psicológicas que deben formar parte integral del cuidado de la DM mediante el uso de métodos validados. El cuestionario WHO-5 se incluye como índice de bienestar general, el PAID-5 revela la existencia de una posible angustia emocional vinculada a la enfermedad, y el PHQ-9 como índice de depresión. Ante esta situación, el Comité de Aspectos Psicosociales recomienda explorar estos aspectos para optimizar el control y el tratamiento de la enfermedad, proponiendo estas herramientas para que el equipo de salud las emplee en la detección y el reconocimiento del estado emocional de las personas con DM.

Abstract Occurrence of a chronic disease, such as diabetes, prove the response of the physical and psychic universe of individuals. As a general objective, is proposed to evaluate emotional state of people with diabetes in the outpatient clinic. As principal objective, detection and monitoring the psychological needs should be a main part of diabetes care, using validated tools to evaluate this aspect. WHO-5 questionnaire is included as an index of general well-being, PAID-5, reveals the existence of a possible emotional distress linked to disease, and PHQ-9 is used as an index of depression.

Relación entre empleo y bienestar emocional en personas con trastorno mental grave / Relationship between employment and emotional state in people with severe mental disorder

Las personas con un diagnóstico de trastorno mental grave (TMG) tienen tasas de desempleo notablemente superiores a las de la población general. Esto se asocia con mayor riesgo de exclusión social y de marginalidad, y favorece la cronicidad de las dificultades personales y sociales. Este estudio observacional pretende evaluar la relación entre el empleo y el estado emocional subjetivo en personas con TMG. El estudio incluyó 744 participantes (304 con TMG usuarias de recursos de rehabilitación psicosocial, 168 personas con TMG con empleo protegido y 272 personas sin TMG con empleo ordinario), con una edad media de 41.9 años y 50.1% mujeres. De los 744 participantes, 577 (77.6%) tuvieron empleo remunerado (409 (60.9%) empleo ordinario y 168 (29.1%) empleo protegido); 244 (32.8%) comunicaron que tenían un diagnóstico de psicosis y 400 (53.8%) que tenían reconocida la discapacidad. Las personas con empleo tuvieron mejores valores de bienestar psicológico subjetivo (p=0.013) que las personas sin empleo, independientemente del diagnóstico o de la discapacidad. Sin embargo, no hubo diferencias significativas en bienestar psicológico subjetivo entre las personas con empleo ordinario y con empleo protegido (p=0.687). Como conclusión, las personas con empleo remunerado tuvieron mayor bienestar psicológico subjetivo que las personas sin empleo, independientemente del diagnóstico, de la discapacidad o de que el empleo fuera ordinario o protegido. (AU)

People with a diagnosis of severe mental disorder (SMD) have significantly higher unemployment rates than the general population. This is associated with a greater risk of social exclusion and marginalization, and favors the chronicity of personal and social difficulties. This observational study aims to assess the relationship between employment and subjective emotional state in people with a SMD diagnosis. The study included 744 participants (304 with a SMD diagnosis who were users of psychosocial rehabilitation resources, 168 with a SMD diagnosis with supported employment, and 272 people without diagnosis of SMD with ordinary (non-supported) employment), with a mean age of 41.9 years and 50.1% women. Out of the 744 participants, 577 (77.6%) had an employment (409 (60.9%) ordinary employment and 168 (29.1%) supported employment), 244 (32.8%) reported that they have a diagnosis of psychosis and 400 (53.8%) that they have a recognized disability. People with an employment had better subjective psychological well-being values than people without an employment (p=0.013), regardless of diagnosis or disability. There were no significant differences in subjective psychological well-being between people with ordinary employment and people with supported employment (p=0.687). In conclusion, people with a paid employment had higher subjective psychological well-being than people without an employment, regardless of diagnosis, disability or whether the employment was ordinary or supported. (AU)

Investigation of pre-school childrens' self-concept in terms of emotion regulation skill, behavior and emotional status / Investigación del autoconcepto de los niños en edad preescolar en términos de habilidad para regular las emociones, comportamiento y estado emocional

The purpose of the present research is presenting the predictor relations between self-concept, emotion regulation, behaviour and emotional state among 5-6 years old children and test the model set in accordance with these relationships. The present research adopted the relational survey model, which is a sub-type of general survey model. The work group of the research consists of 263 children (136 boys, and 127 girls), who were selected among students of various pre-schools schools. Data collection tools utilized for the present research are Purdue Self Concept Scale For Preschool (PSCS), Emotion Regulation Checklist (ERC) and Preschool Behavioural and Emotional Rating Scale (PreBERS). Structural equation modelling analysis was conducted to present the predictor relationships between self, emotion regulation, behaviour and emotional state among pre-school students and to investigate their effects. Structural equation modelling analysis was conducted in AMOS 19 software program. In the final model obtained in the present research (X 2 = 201.711, df = 71, p < .001), there were four exogenous (physical, academic, social and mother acceptance) and six endogenous behaviour and emotional state, emotion regulation (dz, oh, sg, aao, emotion regulation and variability negativity) data. The Bentler-Bonett normed fit index (NFI), The Tucker-Lewisco efficient fit index (TLI) and other fit indices showed that the model presented a good fit. According to the findings obtained with predictor relationships, there was a positive linear relationship between self and behaviour and emotional state and there was a positive linear relationship between self-concept and emotion regulation among pre-school students.(AU)

El propósito de la presente investigación es presentar las relaciones predictoras entre el autoconcepto, la regulación de las emociones, el comportamiento y el estado emocional en niños de 5 a 6 años y probar el conjunto de modelos de acuerdo con estas relaciones. La presente investigación adoptó el modelo de encuesta relacional, que es un subtipo de modelo de encuesta general. El grupo de trabajo de la investigación está conformado por 263 participantes (136 niños y 127 niñas), quienes fueron seleccionados entre el alumnado de varios centros de preescolar. Las herramientas de recopilación de datos utilizadas para la presente investigación son Purdue Self Concept Scale for Preschool (PSCS), Emotion Regulation Checklist (ERC) y Preschool Behavioral and Emotional Rating Scale (PreBERS). Se realizó un análisis de modelos de ecuaciones estructurales para presentar las relaciones predictoras entre el yo, la regulación de las emociones, el comportamiento y el estado emocional entre los estudiantes de preescolar y para investigar sus efectos. El análisis de modelado de ecuaciones estructurales se realizó con el programa de software AMOS 19. En el modelo final obtenido en la presente investigación (χ 2 = 201.711, df = 71, p <.001), se encontraron cuatro exógenos (aceptación física, académica, social y materna) y seis endógenos de comportamiento y estado emocional, regulación emocional (dz, oh, sg, aao, regulación de las emociones y negatividad de la variabilidad). El índice de ajuste normalizado (NFI) de Bentler-Bonett, el índice de ajuste eficiente (TLI) de Tucker-Lewisco y otros índices de ajuste mostraron que el modelo presentaba un buen ajuste. De acuerdo con los hallazgos obtenidos con las relaciones predictoras, hubo una relación lineal positiva entre el yo y la conducta y el estado emocional y hubo una relación lineal positiva entre el autoconcepto y la regulación de las emociones entre los estudiantes de preescolar.(AU)

Intervención de enfermería en el estado emocional de pacientes hemodializados en el Hospital General Ambato / Nursing intervention strategy to improve the emotional state of hemodialyzed patients atAmbato General Hospital

Introducción:La hemodiálisis es el método más común para tratar la insuficiencia renal avanzada y permanente. La afectación está determinada por los cambios asociados a la enfermedad, pero se ve influida por múltiples factores, entre los que destaca la respuesta emocional, por su evidencia e implicación en el estilo de vida, las relaciones personales y el afrontamiento.Objetivo:Elaborar una estrategia de intervención de Enfermería para el mejoramiento del estado emocional de los pacientes sometidos a hemodiálisis.Métodos:Se realizó un estudio descriptivo, explicativo, en un universo de 60 pacientes atendidos en el servicio de Hemodiálisis del Hospital General Ambato, las técnicas empleadas para la recolección de los datos fueron la encuestas y análisis documental siendo procesados en el programa SPSS.Resultados:Predominóen la investigación que el 66.7% no recibe información por parte del personal de enfermería sobre el proceso que está atravesando. También el 86.7% determinaron que la actuación de la familia en todos los procesos crónicos del paciente es fundamental, ya que éste presenta cambios, convirtiéndose así en un eje para la adaptación de su proceso y tratamiento. Se propusieron acciones estratégicas a cumplir por el personal de enfermería.Conclusiones:Los resultados de la investigación demostraron que las acciones del personal de enfermería fueron un factor determinante en el estado emocional del paciente hemodializado, de igual manera las relaciones familiares y de pareja. Se elaboró una estrategia de intervención de enfermería para mejorar el estado emocional de los pacientes hemodializados en el Hospital General Ambato

Introduction:Hemodialysis is the most common method to treat advanced and permanent renal failure. Affectation is determined by the changes associated with the disease, but it is influenced by multiple factors, among which the emotional response stands out, due to its evidence and involvement in lifestyle, personal relationships and coping.Objective:To develop a nursing intervention strategy to improve the emotional state of patients undergoing hemodialysis. Methods:A descriptive, explanatory study was carried out in a universe of 60 patients treated in the Hemodialysis service of the Ambato General Hospital. The techniques used to collect the data were the surveys and documentary analysis being processed in the SPSS program.Results:I predominate in the research that 66.7% does not receive information from the nursing staff about the process that is going on. Also, 86.7% determined that the action of the family in all the chronic processes of the patient is fundamental, since it presents changes, thus becoming an axis for the adaptation of its process and treatment. Strategic actions were proposed to be fulfilled by the nursing staff.Conclusions:The results of the investigation showed that the actions of the nursing staff were a determining factor in the emotional state of the hemodialysis patient, as well as the family and couple relationships. A nursing intervention strategy was developed to improve the emotional state of hemodialysis patients in the Ambato General HospitaL

Resposta emocional de pacientes à terapia com música na hemodiálise: uma ferramenta de humanização / Emotional responses of patients to music therapy on hemodialysis: a humanization tool

A música, como recurso complementar junto à terapêutica clínica, vem sendo implementada de acordo com a Política Nacional de Humanização do SUS (HumanizaSUS), instituída pelo Governo Federal desde 2003. Artigos publicados em jornais estrangeiros indicam mudanças benéficas no aspecto neuro-hormonal após escuta musical em pessoas saudáveis analisadas, podendo trazer novas perspectivas no manejo de doentes crônicos que tenham participação em atividades artísticas. Este estudo teve como objetivo, avaliar mudanças nos aspectos emocionais de pacientes submetidos à hemodiálise após cinco sessões musicais. A metodologia escolhida consistiu em estudo qualitativo, no qual utilizamos como ferramenta a análise de conteúdo, após entrevistas com dez pacientes, que foram direcionadas pela aplicação do pós-teste PCQ-12 modificado. A intervenção musical teve efeito positivo nos aspectos de relaxamento, nas lembranças da história de vida, como força espiritual para enfrentar as dificuldades, como forma de recreação, mudanças na percepção do tempo, na resiliência e na esperança. Concluímos que a música trouxe mudanças na esfera emocional dos pacientes, indicando ser bené- fica se associada como terapia complementar.(AU)

Music, as a complementary resource along with clinical therapy, has been implemented in accordance with the National Humanization Policy of Public Health System ('HumanizaSUS'), instituted by the Brazilian Federal Government since 2003. Articles published in international journals indicate beneficial changes in the neuro-hormonal aspect after listening to music in healthy people analyzed, and it can bring new perspectives in the management of chronic patients who participate in artistic activities. This study aimed to evaluate changes in emotional aspects of patients submitted to hemodialysis after five musical sessions. The study methodology was qualitative. The tool was the content analysis, after interviews with ten patients, who were directed for the application of the modified PCQ-12 post-test. The musical intervention had a positive effect on the aspects of relaxation, on the life history memories, as a spiritual force to face difficulties, as a form of recreation, as changes in the perception of time, as resilience and hope. We conclude that music brought changes in the emotional sphere of patients, indicating that it is beneficial as a complementary therapy.(AU)

COVID 19, Bolivia: Estado Emocional, Percepción, Acatamiento, Expectativas y Propuestas

Se describe la crisis de salud pública más impactante en la actualidad, donde se han generado medidas paliativas originadas en organismos internacionales, y se ha establecido la necesidad de que las ciencias sociales analicen el efecto de la pandemia en la salud mental. Para este fin, proponemos priorizar el análisis de las formas más efectivas de abordar el estado emocional y de proyectar una propuesta general para enfrentar situaciones similares en el futuro en el contexto del país.

The most shocking public health crisis today is described, where palliative measures originated in international organizations have been generated, and the need for the social sciences to analyze the specific impact of the pandemic on mental health has been established. To this end, we propose to prioritize the analysis of the most effective ways to address the affective state, and to project a general proposal to face similar situations in the future in the context of the country.

Sumario É descrevida a crise de saúde pública mais chocante da atualidade, onde medidas paliativas originadas em organizações internacionais foram geradas, assim como foi estabelecida a necessidade que as ciências sociais analisem o impacto específico da pandemía na saúde mental. Para esse efeito, é proposto priorizar a análise das formas mais eficazes de enfrentar o estado afetivo e projetar uma proposta geral para enfrentar no futuro situações semelhantes no contexto do país.

Especificidades sobre processo de luto frente ao suicídio / Specificities about the grieving process forward to suicide / Especificidades sobre el proceso de duelo hacia adelante al suicidio

O suicídio de um ente querido pode desencadear nas pessoas diversas reações. No presente artigo apresentam-se as especificidades para diferenciar o processo de luto após o suicídio dos demais lutos, causados por outros tipos de morte. O artigo tem o objetivo de refletir sobre o processo de luto pelo suicídio por meio da compreensão do luto de nove filhos de pessoas que consumaram o suicídio. Foram extraídas 14 unidades de significados a partir do método fenomenológico e compreendidas pela perspectiva da abordagem da Gestalt-terapia. Os depoimentos dos colaboradores, apontam que, ao enfrentar a morte, o filho pode experienciar o sofrimento com sentimentos de culpa, raiva, sensações de desamparo, abandono, rejeição, solidão, além da fragmentação de tudo o que era conhecido.

The suicide of a loved one can trigger different reactions in people. In the current article which intends to be a research report, the specificities are presented to differentiate the grieving process after a suicide of others grief, caused by other types of death. The article has a purpose of reflecting the process of grieving through the understanding of the nine children - sons and daughters of parents of people who consummated suicide. The results of the research from 14 units of meaning were extracted according to the phenomenological method and understood by the perspective of Gestalt therapy approach, this article has the purpose of reflection about the grieving process of suicide, show that when facing death, the child may live experience whose suffering causes guilt, anger, feelings of helplessness, abandonment, rejection, loneliness and fragmentation of all that was known.

El suicidio de un ser querido puede provocar en las personas diferentes reacciones. En este artículo, que pretende ser un informe de investigación, se presentan las especificidades para diferenciar el proceso de duelo tras el suicidio de los seres queridos, causado por otros tipos de muerte. En este artículo, pretende ser un informe de investigación, se presentan el proceso de duelo tras el suicidio por medio de la comprensión del luto de nueve hijos de personas que consumaron el suicidio. Los resultados de la investigación, muestran 14 unidades de significado fueron extraídos según el método fenomenológico y entendidos desde la perspectiva del enfoque de la terapia Gestalt, cuando se enfrenta a la muerte, el niño puede tener - vivir experiencias cuyo sufrimiento provoca culpa, ira, sentimiento de desamparo, abandono, rechazo, soledad y la fragmentación de todo lo conocido.

O processo de luto do filho da pessoa que cometeu suicídio / The grieving process of the offspring of the person who committed suicide

O suicídio é uma morte repentina e violenta, que choca. Pode provocar indignação, pois causa em quem ficou um hiato, em relação à experiência de dizer adeus àquele que é amado. A morte autoinfligida causa sofrimento e, por isso, o enlutado por suicídio é reconhecido como sobrevivente. Este estudo teve como objetivo a compreensão do processo de luto do(a) filho(a) da pessoa que cometeu o suicídio. Jamison (2010), Alvarez (1999) e Shneidman (1985; 1993) foram os principais autores que fundamentaram a discussão sobre o suicídio. As obras de Parkes (1998; 2009), Franco (2002; 2010), Kovács (1992; 2003) e Clark (2001; 2007), as fontes básicas consultadas para a compreensão do processo de luto. Trata-se de pesquisa de natureza qualitativa, tendo como participantes 9 (nove) filhos de indivíduos que cometeram o suicídio. Os princípios éticos de sigilo, privacidade, confidencialidade, não identificação dos dados do colaborador e liberdade de participação foram respeitados. Os depoimentos foram gravados com a anuência dos entrevistados e realizados: entrevista para a coleta de depoimento, de aproximadamente 3 (três) horas de duração e 2 (dois) contatos por e-mail para enviar a transcrição das entrevistas, e outro, depois da análise dos dados, para compartilhar com o colaborador a compreensão da pesquisadora. As unidades de significados foram extraídas conforme o método fenomenológico (Moustakas, 1994) e compreendidas pela perspectiva da abordagem da Gestalt-terapia. Observou-se que para alguns entrevistados, a superação da falta do progenitor trouxe ambivalências: vivos, foram ausentes; mortos, tornaram-se presentes. O ato suicida pode denunciar uma dinâmica familiar cujo rompimento de vínculos já acontecia, ou seja, o estresse foi experienciado antes, durante e depois do suicídio. Portanto, o suicídio não foi fator precipitante, mas, sim, o processo como um todo.(AU)

Suicide is a sudden and violent death, which shocks. It may cause outrage, as it causes a gap in those who remained, in relation to the experience of saying goodbye to the one who is loved. The self-inflicted death causes suffering and, thus, the bereaved by suicide is recognized as a survivor. This study had as goal the comprehension of the grieving process of the offspring of the person who committed suicide. Jamison (2010), Alvarez (1999) and Shneidman (1985; 1993) were the main authors who grounded the discussion about suicide. The works of Parkes (1998; 2009), Franco (2002; 2010), Kovács (1992; 2003) and Clark (2001; 2007), the basic sources consulted to the comprehension of the grieving process. It is a research of qualitative nature, having as participants nine (9) offspring of individuals who committed suicide. The ethical principles of secrecy, privacy, confidentiality, no identification of the data of the collaborators and freedom of participation were respected. The testimonies were recorded with the consent of the interviewees and carried out: interview - to collect the testimony, approximately three (3) hours long - and two (2) contacts by e-mail one to send the transcripts of the interviews, and other after analyzing the data, to share with the collaborator the comprehension of the researcher. The units of meaning were extracted according to the phenomenological method (Moustakas, 1994) and understood through the perspective of the Gestalt-Therapy approach. It was observed that for some interviewees, overcoming the lack of a parent brought ambivalences: as alive, they were absent; as dead, they became present. The suicidal act may denounce a family dynamic in which breaking of bonds has already happened, in other words, the stress was experienced before, during and after the suicide. Therefore, suicide was not a triggering factor, but, instead, the process as a whole.(AU)

Influencia de la Casa de Abuelos sobre el adulto mayor / Influence of the Grandparents' house on the elderly

Se realizó una investigación prospectiva de 27 ancianos que acudían diariamente a la Casa de Abuelos del municipio de San Luis en la provincia de Santiago de Cuba, los cuales intervinieron entusiastamente en ejercicios físicos, charlas educativas y técnicas grupales participativas; actividades desarrolladas para calibrar la influencia de estas sobre la salud de los senescentes, así como también para determinar su estado emocional. Entre las variables predominantes en los integrantes de la casuística figuraron: edades entre 75 _ 79 años, sexo masculino, padecimiento de artrosis, ánimo de tristes a alegres y compensación de los procesos morbosos al final del estudio(AU)

A prospective research of 27 elderly that attended the Municipal San Luis grandparents' house daily in Santiago de Cuba was carried out, who underwent with enthusiasm physical exercising, educative chats and participative group techniques, activities developed to measure their influences on health status of the aged, as well as to determine their emotional status. Among the predominant variables in the case material figured: ages between 75-79 years old, male sex, history of arthritis, changes of mood from sadness to happiness and compensation of the morbid processes at the end of study(AU)

Influencia de la Casa de Abuelos sobre el adulto mayor / Influence of the Grandparents' house on the elderly

Se realizó una investigación prospectiva de 27 ancianos que acudían diariamente a la Casa de Abuelos del municipio de San Luis en la provincia de Santiago de Cuba, los cuales intervinieron entusiastamente en ejercicios físicos, charlas educativas y técnicas grupales participativas; actividades desarrolladas para calibrar la influencia de estas sobre la salud de los senescentes, así como también para determinar su estado emocional. Entre las variables predominantes en los integrantes de la casuística figuraron: edades entre 75 _ 79 años, sexo masculino, padecimiento de artrosis, ánimo de tristes a alegres y compensación de los procesos morbosos al final del estudio

A prospective research of 27 elderly that attended the Municipal San Luis grandparents' house daily in Santiago de Cuba was carried out, who underwent with enthusiasm physical exercising, educative chats and participative group techniques, activities developed to measure their influences on health status of the aged, as well as to determine their emotional status. Among the predominant variables in the case material figured: ages between 75-79 years old, male sex, history of arthritis, changes of mood from sadness to happiness and compensation of the morbid processes at the end of study

Vivência de luto em adultos que perderam a mãe na infância / Mourning in adults who have lost their mothers in the childhood

O presente trabalho teve como objetivo compreender a vivência de luto em adultos pela perda de suas mães na infância e como pode ser ressignificada em outras fases da vida. A morte de um ente querido leva a processos de luto dolorosos e, no caso de crianças que perdem uma figura parental, este sofrimento pode se agravar pelo fato de serem ainda dependentes física e emocionalmente de seus pais. Assim, buscou-se compreender, a partir do relato de adultos, a experiência vivida na infância e a possibilidade de ressignificações na história de vida de cada indivíduo. Trata-se de pesquisa qualitativa, com inspiração em aspectos da Abordagem Centrada na Pessoa, teoria desenvolvida por Carl Rogers. Foram realizadas entrevistas abertas, que partiram da pergunta: como foi ter vivido a perda de sua mãe? e foram acompanhadas de acordo com o que os colaboradores consideravam relevante. Participaram deste estudo seis adultos, 3 homens e 3 mulheres, com idades entre 32 e 61 anos, que perderam a mãe por morte quando tinham entre 5 e 12 anos de idade. Os colaboradores foram localizados pela divulgação do trabalho entre pessoas conhecidas e escolheram participar voluntariamente. Na análise compreensiva das narrativas foram destacados os trechos mais representativos e apresentados por categorias temáticas, as quais foram surgindo e se estruturando a partir dos relatos, não tendo sido estabelecidas a priori. A análise mostrou que: 1) É preciso compreender a vivência de perda da mãe no início da vida como processo dinâmico, havendo inúmeras variáveis envolvidas em cada história individual, não se podendo determinar ou prever como a criança que perdeu a mãe será quando adulta; 2) Mostrou-se importante lidar com a experiência da perda e com a dor para poder ressignificá-las, enxergando-as de maneiras diferentes, e assim integrá-las à vida, diminuindo o medo de sentimentos negativos do passado retornarem; (...)

... 3) Foi possível perceber que o comportamento de permanecer vinculado à mãe ajudou os participantes a lidar com a ausência desta e a redefinir este relacionamento, integrandoo em suas vidas, não da mesma forma como era quando estava viva, mas ainda como figura importante e significativa em suas histórias. Tendo como base estes três aspectos observados, foram apresentadas orientações a profissionais de saúde, familiares e pessoas que estão próximos a crianças e adultos que perderam suas mães em idade precoce. Este trabalho pode contribuir com reflexões no sentido de minimizar o estigma social em relação a crianças e adultos que perderam suas mães de maneira prematura. E, ainda, incentivar esforços para auxiliar pessoas enlutadas em direção a maior comunicação e expressão de sentimentos relacionados à perda por morte, acreditando que um acolhimento adequado pode ajudar a lidar com essa dor e crescer por meio dela

The present work aims at comprehending the mourning in adults who have lost their mothers during childhood and how this experience can be resignified in other life stages. The loved persons death leads to a painful mourning and, in the case of children who have lost a parent, this suffering might get worse because they are still physically and emotionally dependent on their parents. Thus, it was intended to comprehend, from adult narrative, the loss experience in the childhood and the possibility of resignification in each individual life. We used the qualitative approach with inspiration in some aspects of the Approach Centered in the Person, theory developed by Carl Rogers. The interviews had a non-directive approach and were started with the question: how did you experience your mother loss? and were conducted taking in account what the participants considered as relevant issues. Six adults participated, three men and three women, ranging from 32 to 61 years of age, whose mothers died when they were between 5 and 12 years old. The collaborators were people who had knowledge about the study through divulgation and voluntarily wished to cooperate with the research. In the narrative comprehensive analysis, outstanding issues were categorized considering thematic points, which have stood out from the speeches since they were not previously established. The analysis showed that: 1) Mother loss in the beginning of life must be understood as a dynamic process, considering that there are many factors involved in each individual life. Therefore it is not possible to determine or foresee how the child who has lost his mother will be as an adult; 2) It was shown that it is important to face the loss and grief, in order to resignify and to perceive them by different forms, and consequently be able to integrate them to the life, reducing the fear of past negative feelings; (...)

... 3) It was realized that the behavior of been kept attached to their mothers aids the participants to deal with such absence and to redefine this relationship, integrating it in their life. Although it is not just same way when their mothers were alive, it keeps meaningful and important figure in their own histories. Based on these three considerations, orientations were presented to health professionals, relatives and people who are near of bereaved children and adults who suffered from mothers loss at an early ages. This study can contribute with the reflection on a way to soften the social stigma of children and adults who have lost their mother prematurely. Moreover, it can encourage the assistance to bereaved people toward a larger communication and expression of the loss feelings, considering that an adequate care can help to deal with grief and can help to grow through this situation

Assessment of daytime symptoms in snoring subjects and obstructive sleep apnea patients / Evaluación de síntomas diversos en sujetos con ronquido y pacientes con apnea obstructiva del sueño

Summary: The obstructive sleep apnea syndrome (OSAS) is a type of sleep disorder that has called the attention of many researchers because of its widespread distribution among middle-aged subjects. The OSAS is a respiratory problem characterized by the existence of apneas, defined as 10 second minimum intervals during which no aerial flux exchange takes place through the upper airways and the hypopneas not characterized by an arrest, but by a reduction of aerial flux through the upper airways. The most widespread index used in the diagnosis of the OSAS severity has been the apnea/hypopnea index (AHI). There is little consensus based on the apnea/hypopnea index regarding the clinical definition of the sleep apnea syndrome, as there is not a single criterion for the categorization of sleep apnea patients into severity levels. Nowadays, it is estimated that about 70% of the patients referred to sleep laboratories suffer from snoring, and it is suspected that they might also suffer from sleep apnea. Obstructive sleep apnea patients may suffer from memory and cognitive problems, excessive daytime sleepiness, as well as mood disturbance, among other symptoms. Additionally, this disorder has severe medical and social consequences. One of the most characteristic symptoms in sleep apnea is snoring. Although snoring is one of the symptoms of sleep apnea, it should be remembered it is a typical phenomenon among population in general. There is a primary kind of snoring, the most frequent type in less severe cases, which even occurs among the normal population. In this case, the noise accompanying inspiration is made with almost every breath. Secondly, there is another kind of snoring that is either intermittent or cyclic, and snoring does not come with every breath but silent periods are also frequent. The latter indicates apnea. A considerable number of epidemiological studies regarding snoring have been produced of late. Several of them have concluded that snoring may have severe clinical consequences. Most patients suffering from obstructive sleep apnea start having simple snores. In the last decade there has been a marked increase of patients who manifest respiratory disorders related to sleep who do not fall into the category of apnea patients. Nevertheless, the morbidity of these clinical disorders is not yet known, a circumstance that makes treatment more difficult. Only a reduced number of studies have tried to find out whether snorers show any kind of symptoms that could be used as a preventive measure against the development of sleep apnea. For all the previous reasons, the aim of this study is to assess whether there are any differences in daytime sleepiness, reaction time, short-term memory, depression, trait anxiety, state anxiety and neuroticism between a group of patients with obstructive sleep apnea and a group of snoring individuals who had not been diagnosed as suffering from OSAS. Material and method: The sample was made up of 11 snorers (two women and nine men), in an age range between 29 and 58 (X= 43.82 and SD= 8.67), and 14 patients with OSAS (two women and 12 men), in the age range between 30 and 65 (X= 49.64 and SD= 10.67), who were selected from a clinical population. The AHI used for establishing an OSAS diagnostic was of 10 apneas/hypopneas per sleeping hour. The patients were diagnosed to be snorers if they showed an apnea/hypopnea index <10. The following instruments were used in the evaluation of snoring subjects and obstructive sleep apnea patients: 1. Cardio-respiratory polygraph of every hour of sleep for each one of the patients. The procedure consists in night-time monitoring of the following parameters: a) electrocardiogram; b) respiratory movements (expansion and relaxation of the thorax and abdomen), which evaluate the respiratory force; c) oronasal flow and d) oxygen saturation. The snoring was measured through a tracheal microphone. 2. To measure the subjective daytime sleepiness, the Epworth Sleepiness Scale was used. 3. A BASIC software program was used to measure the simple perceptual reaction times in milliseconds. 4. The digits test of WAIS was used in straight and inverse order to evaluate the capacity of short term memory. 5. To evaluate the depressive symptoms, the Beck's Depression Inventory was employed. 6. The State/Trait Anxiety Inventory was used as a measurement of the state and trait anxiety levels. 7. As an index of neuroticism levels, the Eysenck Personality Inventory was used. Subjects under clinical risk of an OSAS diagnosis were referred to a sleep unit by primary care physicians. Respiratory pathologies other than OSAS were ruled out before the subjects' inclusion. Among these were, in particular, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease. All the patients underwent a medical examination and a medical interview in which a detailed clinical history of each patient was compiled. Once the medical examination was over, each patient was given an appointment to sleep one night in hospital. Subsequently, cardio-respiratory poligraphy, registering height hours of sleep, was administered to each patient with the objective to establish a diagnosis. The morning after, a manual analysis was made of the following parameters which indicate the presence or absence of the disturbance and its severity: total number of nocturnal obstructive apneas, total number of hypopneas, value of saturation during the night, mean and minimum levels of SaO2% and apnea/hypopnea index. Afterwards, the sleep apnea diagnosis was established for those patients who showed an apnea/hypopnea index higher than 10. Snoring subjects with a lesser apnea/hypopnea index than 10 did not fit into the pathology of sleep apnea. Obstructive apneas were defined as the arrest of air flux during sleep along with the occurrence of respiratory movements lasting more than 10 seconds. Hypopnea was defined as an episode during which the partial obstruction of the upper airways produced a significant reduction of the air flux. The following morning, the psychological variables were evaluated (daytime sleepiness, short-term memory, reaction time, depression, neuroticism, state and trait anxiety). This process was carried out in the same place and under the same conditions for every subject. The tests were completed between 8:30 and 11:30 in the morning. Additionally, an exclusion criterion was established as the suffering from any psychiatric illness past or present in any way that could influence the psychological functioning of the patient. As a method of analysis of the results, a non-parametric analysis technique was used: the U Mann-Whitney test. All statistical analyses were made with the statistics package SPSS, 8.0, Spanish version. Results: Results from this study show that there are statistically significant differences between daytime sleepiness (p<0.05) and depressive symptoms (p<0.01) between both groups of subjects, whereas no statistically significant differences were found in terms of short term memory, reaction time, state anxiety levels, trait anxiety and neuroticism. Conclusions: The analysis of the results obtained reveals that the levels of daytime sleepiness are much higher in patients with OSAS than those in the snoring group. Some studies note that the fragmentation of sleep is responsible for excessive sleepiness during the day. Nevertheless, in this study we observed greater levels of obesity in patients with OSAS than in snoring patients, which could also explain the greater levels of sleepiness. In relation to the depression variable, the average scores show that depression levels are higher in apnea patients than in the snoring group. One of the possible explanations of this result is that the majority of apnea patients, due to the severity of the pathology, consequently present higher deficits in their daily social functioning, etc. Probably, the conditions previously described tend to influence an increase of depression levels.

resumen está disponible en el texto completo

Crianças com dificuldade de aprendizagem e a escola: emoções e saúde em foco / Learning disability children and the school: the emotions and the health in focus

Relações entre emoções e saúde de alunos com e sem dificuldade de aprendizagem foram analisadas por indicadores de ansiedade, depressão, stress, doenças físicas, queixas somáticas, faltas escolares, peso e altura. Responderam ao Inventário de Ansiedade Traço-Estado para Criança e à Escala de Stress Infantil 60 alunos (8-14 anos) da 3ª e 4ª série, divididos em G1 (desempenho inferior no Teste de Desempenho Escolar) e G2 (desempenho superior no Teste de Desempenho Escolar). A Escala de Sintomatologia Depressiva para Mestres e o questionário sobre doenças e queixas somáticas dos alunos foram respondidos por 6 professoras. Não houve diferenças significativas entre dados das escalas, mas naqueles obtidos com as professoras, identificando-se 23,3 da amostra com indicações de risco para problemas emocionais e de saúde. Formaram-se dois subgrupos - G1a e G2a - com 14 alunos, entrevistados individualmente sobre o estado de saúde e a escola, dados esses submetidos à análise funcional, identificando-se eventos do contexto escolar e familiar que dificultam o desempenho acadêmico.

O modelo cognitivo-comportamental em grupos e seus efeitos sobre as estratégias de enfrentamento, os estados emocionais e a pressão arterial de mulheres hipertensas / The cognitive-behavior model in group and its effects on the coping, the emotional states and blood pressure of hypertension women

O estudo objetivou conhecer os efeitos do Treinamento de Problema aplicado em grupo, sobre as estratégias de enfrentamento, o estado de ansiedade, o nível de depressão, o bem-estar psicológico e a pressão arterial de mulheres hipertensas, em relação àquelas em atendimento individual para verificação da pressão arterial. A amostra constituiu-se de 37 pacientes no grupo experimental (GE) e 41 no grupo controle (GC). A coleta de dados compreendeu nove semanas. No que diz respeito ao procedimento usado, na primeira semana do estudo (pré-intervenção), os dois grupos (GE e GC) tiveram uma entrevista inicial e, na segunda semana, as pacientes responderam aos seguintes inventários: Ansiedade Traço-Estado de Spilberger, Depressão de Beck, Bem-estar Psicológico de Goldberg e Estratégias de Enfrentamento de Folkman e Lazarus. Da terceira à oitava semana, as pacientes do GC foram acompanhadas individualmente, para verificação da pressão arterial, enquanto o GE recebeu o Treinamento em Solução de Problema, em seis sessões grupais. Formaram-se inicialmente, quatro grupos fechados com dez, onze, doze e nove pacientes em cada grupo. Na nona semana (pós-intervenção), os inventários foram repetidos. A pressão arterial foi verificada semanalmente nas nove semanas da coleta de dados pelo método oscilométrico, com monitor automático, em todas as pacientes. O tratamento estatístico privilegiou a técnica de Análise de Perfis de Médias, com nível de significância de 5%. Os resultados evidenciaram: a) os dois grupos (GE e CC) não apresentaram diferença significante nas médias nas duas condições de avaliação (pré e Pós-intervenção), nas variáveis estudadas, evidenciando que eles se comportaram de maneira semelhante; b) houve diferença entre as respostas médias antes e depois da intervenção proposta, independente do grupo, com melhora significante dos escores no momento pós-intervenção, nas variáveis: depressão; bem-estar psicológico ) (nos fatores geral, estresse psíquico, desejo de morte, desconfiança no desempenho e distúrbio do sono); e pressão arterial sistólica e diastólica; e c) a média de estratégia de enfrentamento direcionada à solução de problema no momento pós-intervenção, aumentou significativamente nos dois grupos. Concluiu-se que a melhora das variáveis estudadas no momento pós-intervenção, nos dois grupos (GE que recebeu o treinamento e o GC que recebeu atenção), tenha ocorrido pelos efeitos não específicos da intervenção, como o ambiente terapêutico e a relação interpessoal estabelecida, proporcionando acolhimento, empatia e suporte. Quanto ao descenso significante da pressão arterial sistólica e diastólica, ao final do estudo, além dos efeitos inespecíficos da intervenção, pode ter sofrido influência do uso menos irregular da medicação anti-hipertensiva ou das verificações repetidas da pressão (fenômeno de habituação).

The study had the purpose of knowing the effects of Problem-Solving Training used for groups, about the coping, the anxiety state, the depression level, the psychological welfare and the blood pressure of hypertension women, concerning those on individual care for blood pressure checking. The sample had 37 patients in the experimental group (EG) and 41 in the control group (CG). The collecting data was done in nine weeks. Concerning the procedure used on the first week study (pre treatment), both groups (EG and CG) had one initial interview and on the second week the patients answered the following inventories: Spilberger State-Trait Anxiety; Beck Depression; Goldberg Psychological Welfare and Folkman and Lazarus Coping. From the third to the eight week, the CG patients were followed individually to check the blood pressure while the EG group received the Problem-Solving Training in six group sessions. Initially four closed groups of ten, eleven, twelve and nine patients were formed. On the nineth week (post-treatment), the inventories were repeated. The blood pressure was weekly checked during the nine weeks of data collecting by the oscillometric method using an automatic monitor on all the patients. The statistical tratment favoured the Mean Profile Analysis technique with a significance level of 5%. The results demonstrated: a) both groups (EG and CG) haven't showed significant difference on the means in two assessment conditions (pre and post-treatment), in all the variables of the study, showing clearly that the groups behaved similarly; b) there was a difference between the mean of answers before and after the suggested treatment, independent of group, with a significant improvement of the scores at the post-treatment moment, on the variables: depression; psychological welfare (for general factor and psychic stress, desire of death, lack of self-confidence and sleep disturbance) and systolic and diastolic blood pressure; and c) the mean of coping aiming the problem-solving, at the post-treatment moment, improved significantly in both groups. In conclusion, the improvement of the variables of the study at the post-treatment moment, in both goups (EG which received the training and the CG which received attention), had occurred due to non-specific intervention effects as the therapeutic environment and the interpersonal relation established, providing a favourable reception, empathy and support. As for the significant decrease of systolic blood pressure, at the end of the study, besides the unspecific treatment effects, it could have been affected by the less irregular antihypertensive medication use or by the blood pressure reapeated measures (habituation phenomenon).