Uso de antidepressivos e benzodiazepínicos em mulheres atendidas em unidades de saúde da família e sua dimensão psicossocial

Introdução: A preocupação em torno do uso irracional de psicofármacos tem sido observada em diversos países, constituindo-se uma questão importante para a saúde pública mundial. No Brasil, a promoção do uso racional de psicofármacos é um desafio para a atenção primária, sendo importante caracterizar sua dimensão psicossocial. Objetivos. O artigo 1, com características descritivas, tem como objetivo caracterizar o uso de psicofármacos em unidades de saúde da família segundo a presença de transtornos mentais comuns (TMC) e segundo as principais características socioeconômicas e demográficas. O artigo 2, com um caráter analítico, tem como objetivo avaliar o papel da rede social no uso de cada um destes psicofármacos segundo a presença de TMC. Métodos O estudo utiliza um delineamento seccional e abarca a primeira fase de coleta de dados de dois estudos em saúde mental na atenção primária. Esta se deu em 2006/2007 para o estudo 1 (Petrópolis, n= 2.104) e em 2009/2010 para o estudo2 (São Paulo, n =410, Rio de Janeiro, n= 703, Fortaleza , n=149 e Porto Alegre, n= 163 participantes). Ambos os estudos possuem o mesmo formato no que se refere à coleta de dados, seu processamento e revisão, resultando em uma amostra de 3.293 mulheres atendidas em unidades de saúde da família de cinco diferentes cidades do país. Um questionário objetivo com perguntas fechadas foi utilizado para a coleta de informações socioeconômicas e demográficas. O uso de psicofármacos foi avaliado através de uma pergunta aberta baseada no auto-relato do uso de medicamentos. A presença de TMC foi investigada através do General Health Questionnaire, em sua versão reduzida (GHQ-12). O nível de integração social foi aferido através do índice de rede social (IRS), calculado a partir de perguntas sobre rede social acrescentado ao questionário geral. No estudo descritivo (artigo 1), a frequência do uso de antidepressivos e o uso de benzodiazepínicos na população de estudo foram calculadas para cada cidade, tal como a frequência do uso destes psicofármacos entre as pacientes com transtornos mentais comuns. A distribuição do uso de cada um destes psicofármacos segundo as principais características socioeconômicas, demográficas e segundo transtornos mentais comuns foi avaliada através do teste de qui-quadrado de Pearson. No estudo analítico (artigo 2), a associação entre o nível de integração social e o uso exclusivo de cada um dos psicofármacos foi analisada através da regressão logística multivariada, com estratificação segundo a presença de TMC. Resultados: A frequência do uso de psicofármacos foi bastante heterogênea entre as cidades, destacando-se, porém, a importância do uso de benzodiazepínicos frente ao uso de antidepressivos em sua maioria. A proporção do uso de psicofármacos, sobretudo antidepressivos, foi predominantemente baixa entre as pacientes com TMC. Entre elas, o uso de antidepressivos mostrou-se positivamente associado ao isolamento social, enquanto o uso de benzodiazepínicos associou-se negativamente a este. Conclusão: Os resultados colaboram para a caracterização do uso de psicofármacos em unidades de saúde da família e para a discussão acerca de sua racionalidade. Destaca-se a importância de avaliar a dimensão psicossocial que envolve o uso destas substâncias com vistas ao desenvolvimento de estratégias de cuidado mais efetivas

Capital como Droga, Trabalho como Vício: subjetividade, euforia e depressão na pós-modernidade

O objetivo central deste estudo é examinar as novas formas de subjetivação e de mal-estar engendradas pelas exigências da sociedade do trabalho no contexto do capitalismo contemporâneo. A emergência de uma nova e perversa forma de sociabilidade e de uma subjetividade ligada a ela está intrinsecamente associada às transformações estruturais da sociedade capitalista e suas atuais condições da acumulação de capital. Considerando o caráter social e histórico da sociedade capitalista, do sujeito e da subjetividade, o foco deste trabalho deve ser o sujeito interpelado pela ideologia, clivado pelo inconsciente e individualizado pelo mercado. Busco, portanto, articular pontos teóricos entre os conceitos de ideologia, fetiche e inconsciente referenciados no materialismo histórico e na psicanálise. Ao apresentar o Capital como droga e o Trabalho como vicio, pretende-se de forma alegórica desvelar os impasses e sintomas de um sistema em crise que, apesar das sucessivas tentativas de recuperação, colapsa historicamente, levando sua dinâmica perversa aos limites do insuportável. Ao subordinar a reprodução da vida ao trabalho assalariado, ao mesmo tempo em que para se reproduzir tem sistematicamente de aboli-lo, o capitalismo engendra, na sua crise estrutural, uma das mais sofisticadas formas de dominação, sujeição e exploração: a utilização dos componentes do psiquismo e da subjetivação em nome dos interesses da ordem mercantil. No mundo globalizado pelo mercado, vem aumentando o uso de drogas lícitas, fruto ou não de prescrição médica, como um recurso para inibir todo tipo de mal-estar e impasse psíquico ou reações indesejáveis que possam comprometer a adequação dos indivíduos aos padrões da produtividade, a permanência no ambiente de trabalho, bem como o enfrentamento de conflitos e frustrações inerentes à condição humana. Essa manipulação química da subjetividade potencializa-se na atualidade, expandindo globalmente a drogadicção, no sentido amplo do termo, privando o sujeito da capacidade de pensar. Ela aponta também para as impossibilidades de o sujeito desenvolver suas faculdades ativas e criativas, assim como o diálogo com o outro, o que nos conduz cada vez mais a atitudes de intolerância e violência ou estados compulsivos e depressivos. Ao contrário do que o capitalismo podia propiciar em seu período de ascensão, os modos de inclusão imaginária engendrados pelo capitalismo pós-moderno estão baseados no consumo conspícuo e no gozo imediato, implicando novos contornos para o sofrimento psíquico, agora marcado por transtornos narcísico-identitários e saídas não-representacionais. A partir dessa reflexão, busco a crítica do conceito de sujeito configurado pelo trabalho e pelo psicologismo, que tem contribuído para práticas legitimadoras de exclusão no interior da própria psicologia. Esta crítica representa um compromisso ético-político pela desalienação do sujeito e pela superação do capitalismo, aqui entendido como um sistema que produz mercadorias e viciados em drogas.

Age, size, and sexual maturity of channeled whelk (Busycotypus canaliculatus) in Buzzards Bay, Massachusetts

With the southern New England lobster fishery in distress, lobster fishermen have focused more effort toward harvesting channeled whelk (Busycotypus canaliculatus). However, minimal research has been conducted on the life history and growth rates of channeled whelk. Melongenid whelks generally grow slowly and mature late in life, a characteristic that can make them vulnerable to overfishing as fishing pressure increases. We sampled channeled whelk from Buzzards Bay, Massachusetts, in August 2010 and in July 2011, studied their gonad development by histology, and aged them by examining opercula. Males had a slower growth rate and a lower maximum size than females. Male whelk reached 50% maturity (SM50) at 115.5 mm shell length (SL) and at the age of 6.9 years. Female whelk reached SM50 at 155.3 mm SL and at the age of 8.6 years. With a minimum size limit of 69.9 mm (2.75 in) in shell width, males entered the fishery at 7.5 years, a few months after SM50, but females entered the fishery at 6.3 years, approximately 2 years before SM50. Increased fishing pressure combined with slow growth rates and the inability to reproduce before being harvested can easily constrain the long-term viability of the channeled whelk fishery in Massachusetts.

Effect of chloral hydrate on metabolic rate of Labeo rohita (Ham) and Poecilia reticulata (Peters)

Comparative impact of chloral hydrate anaesthesia on the metabolic rate of Indian major carp Labeo rohita and larvivorous fish Poecilia reticulata was assessed. Observation on the Oxygen Consumption Rate (OCR) revealed that in common guppies OCR was substantially low (1.105 and 1.097 mg/g/hr) at 0.1 and 0.25 g/l concentrations of chloral hydrate as against OCR of 1.487 mg/g/hr in the control. Fry of L. rohita in group showed lower metabolic rates in the control as well as treated conditions as compared to the individuals of this fish. This may be due to sympathetic psychophysiological reflex of grouped fish. Higher dose of chloral hydrate (0.25 g/l) also caused higher OCR probably due to distress. Application of chloral hydrate also favoured lesser release of metabolic wastes (ammonia and carbon dioxide). There was significant positive correlation between time and oxygen consumption, whereas, for time and OCR this relationship was negative. Regression of chloral hydrate doses for OCR and time has also been calculated.

The contact of rough surfaces carrying pressure sensitive boundary layers

When two rough surfaces are loaded together it is well known that the area of true contact is very much smaller then the geometric area and that, consequently, local contact pressures are very much greater than the nominal value. If the asperities on each surface can be thought of as possessing smooth summits and each of the solids is elastically isotropic then the pressure distribution will consist of a series of small, but severe, Hertzian patches. However, if one of both of the surfaces in question is protected by a boundary layer then both the number and dimensions of these patches, and the form of the pressure distribution within them, will be modified. Recent experimental evidence from studies using both Atomic Force Microscopy and micro-tribometry suggests that boundary films produced by the action of commercial anti-wear additives, such as ZDTP, exhibit mechanical properties, which are affected by local values of pressure. These changes bring about further modifications to local conditions. These effects have been explored in a numerical model of rough surface contact and the implications for the mechanisms of surface distress and wear are discussed. © 2000 Elsevier Science B.V. All rights reserved.

Pothole detection in asphalt pavement images

Pavement condition assessment is essential when developing road network maintenance programs. In practice, the data collection process is to a large extent automated. However, pavement distress detection (cracks, potholes, etc.) is mostly performed manually, which is labor-intensive and time-consuming. Existing methods either rely on complete 3D surface reconstruction, which comes along with high equipment and computation costs, or make use of acceleration data, which can only provide preliminary and rough condition surveys. In this paper we present a method for automated pothole detection in asphalt pavement images. In the proposed method an image is first segmented into defect and non-defect regions using histogram shape-based thresholding. Based on the geometric properties of a defect region the potential pothole shape is approximated utilizing morphological thinning and elliptic regression. Subsequently, the texture inside a potential defect shape is extracted and compared with the texture of the surrounding non-defect pavement in order to determine if the region of interest represents an actual pothole. This methodology has been implemented in a MATLAB prototype, trained and tested on 120 pavement images. The results show that this method can detect potholes in asphalt pavement images with reasonable accuracy.

Confidence in beliefs about pain predicts expectancy effects on pain perception and anticipatory processing in right anterior insula.

Psychological factors play a major role in exacerbating chronic pain. Effective self-management of pain is often hindered by inaccurate beliefs about the nature of pain which lead to a high degree of emotional reactivity. Probabilistic models of perception state that greater confidence (certainty) in beliefs increases their influence on perception and behavior. In this study, we treat confidence as a metacognitive process dissociable from the content of belief. We hypothesized that confidence is associated with anticipatory activation of areas of the pain matrix involved with top-down modulation of pain. Healthy volunteers rated their beliefs about the emotional distress that experimental pain would cause, and separately rated their level of confidence in this belief. Confidence predicted the influence of anticipation cues on experienced pain. We measured brain activity during anticipation of pain using high-density EEG and used electromagnetic tomography to determine neural substrates of this effect. Confidence correlated with activity in right anterior insula, posterior midcingulate and inferior parietal cortices during the anticipation of pain. Activity in the right anterior insula predicted a greater influence of anticipation cues on pain perception, whereas activity in right inferior parietal cortex predicted a decreased influence of anticipatory cues. The results support probabilistic models of pain perception and suggest that confidence in beliefs is an important determinant of expectancy effects on pain perception.

Anxiety reduction through detachment: subjective, physiological, and neural effects.

The ability to volitionally regulate emotions helps to adapt behavior to changing environmental demands and can alleviate subjective distress. We show that a cognitive strategy of detachment attenuates subjective and physiological measures of anticipatory anxiety for pain and reduces reactivity to receipt of pain itself. Using functional magnetic resonance imaging, we locate the potential site and source of this modulation of anticipatory anxiety in the medial prefrontal/anterior cingulate and anterolateral prefrontal cortex, respectively.

共情、共情唤醒机制及共情结果的关系

Empathy was defined as affective experience isomorphic to another person’s affective experience elicited by the person’s affective state in this research. By constructing questionnaires and situational measurement approaches, the relationship among empathy, perspective-taking, imagination, empathic concern, distress, and interconnectedness and helping was analyzed. Perspective-taking and imagination were regarded as arousal mechanisms of empathy. Empathic concern and distress were reactive outcomes of empathy. Interpersonal outcomes of empathy were discussed in this research were empathic interconnectedness and helping. The results showed that perspective-taking had significant positive influence on empathic concern. Empathy partly mediated the effects of perspective-taking on empathic concern. Influence of imagination on empathic distress was partly mediated by empathy also. Perspective-taking had significant negative influence on empathic distress. Empathy had direct effects on its reactive outcomes, and indirect effects on its interpersonal outcomes mediated totally by empathic concern. Classification analysis according to the relationship among empathy, its arousal mechanisms, and reactive outcomes of empathy showed that disposition of empathic reactivity could be divided into 4 styles: general high empathy (22.5%), general low empathy (25.7%), empathic concern (24.4%) and empathic distress (27.3%). 4 styles were different in interpersonal acuity and mental health. It was suggested that adaptive function of 4 styles was different. And the styles of disposition of empathic reactivity significantly predicted situational empathy and its intrapersonal and interpersonal outcomes.

In pursuit of an identity: A qualitative exploration of retirement from women's artistic gymnastics

David Lavallee, Hannah K. Robinson, In pursuit of an identity: A qualitative exploration of retirement from women's artistic gymnastics, Psychology of Sport and ExerciseVolume 8, Issue 1, , January 2007, Pages 119-141. RAE2008

Rambo's Interdisciplinary Approach to Religious Conversion: The Case of St. Augustine

This dissertation illustrates the merits of an interdisciplinary approach to religious conversion by employing Lewis Rambo’s systemic stage model to illumine the process of St. Augustine’s conversion. Previous studies of Augustine’s conversion have commonly explored his narrative of transformation from the perspective of one specific discipline, such as theology, history, or psychology. In doing so, they have necessarily restricted attention to a limited set of questions and problems. By bringing these disciplines into a structured, critical conversation, this study demonstrates how formulating and responding to the interplay among personal, social, cultural, and religious dimensions of Augustine’s conversion process may eventuate in the consideration of issues previously unarticulated and thus unaddressed. Rambo (1993) formulates a model of religious change that consists of what he calls context, crisis, quest, encounter, interaction, commitment, and consequences. Change is explained by drawing upon the research and scholarship of psychologists, sociologists, anthropologists, and religionists, in conjunction with the contributions of theologians. This study unfolds in the following chapters: I. Introduction; II. Literature review of scholarship about conversion, with emphasis on explication of Rambo’s model; III. A description of the case of Augustine, drawn from a close reading of the Confessions; IV. Literature review of scholarship about Augustine’s conversion; V. Interdisciplinary interpretation of Augustine’s conversion; and VI. Implications for scholars of conversion, and for pastoral caregivers, as well as recommendations for future research. This dissertation demonstrates how Augustine’s conversion experience was deeply influenced by 1) psychological distress and crisis; 2) the quest to know himself and the divine; 3) interactions with significant others; 4) participation in Christian communities; 5) philosophical and cultural changes; and 6) the encounter with the divine. As such, this study reveals the value of interpreting Augustine’s conversion as an evolving process constituted in multiple factors that can be differentiated from one another, yet clearly interact with one another. It examines the implications of constructing an interdisciplinary approach to Augustine’s conversion narrative for both the academy and the Christian community, and recommends the use of Rambo’s model in studies of other cases of religious change.

Example-Based Image Restoration via Boosted Classifiers

We propose a novel image registration framework which uses classifiers trained from examples of aligned images to achieve registration. Our approach is designed to register images of medical data where the physical condition of the patient has changed significantly and image intensities are drastically different. We use two boosted classifiers for each degree of freedom of image transformation. These two classifiers can both identify when two images are correctly aligned and provide an efficient means of moving towards correct registration for misaligned images. The classifiers capture local alignment information using multi-pixel comparisons and can therefore achieve correct alignments where approaches like correlation and mutual-information which rely on only pixel-to-pixel comparisons fail. We test our approach using images from CT scans acquired in a study of acute respiratory distress syndrome. We show significant increase in registration accuracy in comparison to an approach using mutual information.

Moral shielding: A grounded theory of integrity maintenance in multidisciplinary teams

Using a classic grounded theory methodology (CGT), this study explores the phenomenon of moral shielding within mental health multidisciplinary teams (MDTS). The study was located within three catchment areas engaged in acute mental health service practice. The main concern identified was the maintenance of a sense of personal integrity during situational binds. Through theoretical sampling thirty two practitioners, including; doctors, nurses, social workers, occupational therapists, counsellors and psychologists, where interviewed face to face. In addition, emergent concepts were identified through observation of MDTs in clinical and research practice. Following a classic grounded theory methodology, data collection and analysis occurred simultaneously. A constant comparative approach was adopted and resulted in the immergence of three sub- core categories; moral abdication, moral hinting and pseudo-compliance. Moral abdication seeks to re-position within an event in order to avoid or deflect the initial obligation to act, it is a strategy used to remove or reduce moral ownership. Moral gauging represents the monitoring of an event with the goal of judging the congruence of personal principles and commitments with that of other practitioners. This strategy is enacted in a bid to seek allies for the support of a given moral position. Pseudo-compliance represents behaviour that hides desired principles and commitments in order to shield them from challenge. This strategy portrays agreement with the dominant position within the MDT, whilst holding a contrary position. It seeks to preserve a reservoir of emotional energy required to maintain a sense of personal integrity. Practitioners who were successful in enacting moral shielding were found to not experience significant emotional distress associated with the phenomenon of moral distress; suggesting that these practitioners had found mechanisms to manage situational binds that threatened their sense of personal integrity.

The effect of positive psychological interventions on psychological and physical well-being during pregnancy

Prenatal well-being can have significant effects on the mother and developing foetus. Positive psychological interventions, including gratitude and mindfulness, consistently demonstrate benefits for well-being in diverse populations. No research has been conducted on gratitude during pregnancy; the few studies of prenatal mindfulness interventions have demonstrated well-being benefits. The current study examined the effects of gratitude and mindfulness interventions on prenatal maternal well-being, cortisol and birth outcomes. Five studies were conducted. Study 1 was a systematic review of mindfulness intervention effects on cortisol; this highlighted potential benefits of mindfulness but the need for rigorous protocols in future research. In Study 2 a gratitude and a mindfulness intervention were developed and evaluated; findings indicate usefulness of two 3 week interventions. Study 3 examined the effects of these interventions in a randomised controlled trial (RCT) of non-pregnant women, before examining a pregnant group. No significant intervention effects were found in this study, potentially due to insufficient power and poor protocol adherence. Changes in expected directions were observed for most outcomes and the potential utility of a combined gratitude and mindfulness intervention was noted. In Study 4 a gratitude during pregnancy (GDP) scale was developed and the reliability of an existing mindfulness measure (MAAS) was examined in a pregnant group. Both scales were found to be suitable and reliable measures in pregnancy. Study 5 incorporated the findings of the previous four studies to examine of the effect of a combined mindfulness and gratitude intervention with a group of pregnant women. Forty-six participants took part in a 5-week RCT that examined intervention effects on prenatal gratitude, mindfulness, happiness, satisfaction with life, social support, prenatal stress, depression and sleep. Findings indicated that the intervention improved sleep quality and that effects for prenatal distress were approaching significance. Issues of attrition and non-compliance to study protocols were problematic and are discussed. In summary, the current thesis highlights the need for robust measurement, and intervention and cortisol sampling protocols in future research, particularly with pregnant groups. Findings also demonstrate tentative benefits of a gratitude and mindfulness intervention during pregnancy.

A qualitative analysis of parental coping with an early diagnosis of hearing loss in Ireland

The recent implementation of Universal Neonatal Hearing Screening (UNHS) in all 19 maternity hospitals across Ireland has precipitated early identification of paediatric hearing loss in an Irish context. This qualitative, grounded theory study centres on the issue of parental coping as families receive and respond to (what is typically) an unexpected diagnosis of hearing loss in their newborn baby. Parental wellbeing is of particular concern as the diagnosis occurs in the context of recovery from birth and at a time when the parent-child relationship is being established. As the vast majority of children with a hearing loss are born into hearing families with no prior history of deafness, parents generally have had little exposure to childhood hearing loss and often experience acute emotional vulnerability as they respond to the diagnosis. The researcher conducted in-depth interviews primarily with parents (and to a lesser extent with professionals), as well as a follow-up postal questionnaire for parents. Through a grounded theory analysis of data, the researcher subsequently fashioned a four-stage model depicting the parental journey of receiving and coping with a diagnosis. The four stages (entitled Anticipating, Confirming, Adjusting and Normalising) are differentiated by the chronology of service intervention and defined by the overarching parental experience. Far from representing a homogenous trajectory, this four-stage model is multifaceted and captures a wide diversity of parental experiences ranging from acute distress to resilient hopefulness