Um estudo da relação entre o padrão transferencial e a aliança terapêutica de pacientes em psicoterapia psicanalítica

Introdução: A discussão sobre a relação entre transferência e aliança terapêutica iniciou na primeira metade do século passado. Um de seus marcos foi a polêmica entre Anna Freud (1927) e Melanie Klein (1926). A primeira ressaltava o papel do ego, salientando a importância da aliança terapêutica. A segunda não considerava o conceito de aliança terapêutica. Acreditava que a relação pacienteterapeuta teria origem nas relações primitivas de objeto, na relação da criança com o seio. A controvérsia sobre a questão prosseguiu, sendo a Escola Psicologia do Ego a que mais defendia o papel da aliança como autônoma, não influenciada pelos impulsos inconscientes. Após o Congresso de Genebra, em 1955, o posicionamento de muitos autores foi se modificando. Até mesmo integrantes da Psicologia do Ego passaram a não distinguir completamente estes dois conceitos e, de maneira geral, a literatura mostra uma tendência neste sentido. Porém, este assunto ainda apresenta contradições e existem poucos estudos empíricos exploratórios publicados. Objetivo: Esta dissertação tem como objetivo geral investigar a relação entre padrão transferencial e aliança terapêutica através do uso dos instrumentos Relationship Patterns Questionnaire – RPQ (KURTH et al., 2002; KURTH et al., 2004) – e The Revised Helping Alliance questionnaire – HAq-II (LUBORSKY et al., 1996), respectivamente. Método: Primeiramente, procedeu-se a adaptação transcultural do RPQ para o Português do Brasil, que envolveu a obtenção de licença dos autores, tradução, retrotradução, obtenção da equivalência semântica, consenso com profissionais da área da Psiquiatria e Psicologia e interlocução com a população alvo. Numa segunda fase de trabalhos, procedeu-se à investigação empírica a partir de estudo transversal com 63 pacientes do ambulatório de Psicoterapia Psicanalítica do Hospital de Clínicas de Porto Alegre e seus 27 terapeutas. Foram aplicados, então, os instrumentos para avaliação da transferência e aliança terapêutica. A coleta dos dados foi feita com duração média de uma hora, individualmente, para cada paciente. Os terapeutas preencheram a versão correspondente do HAq-II. Resultados: Observou-se relação significativa entre algumas variáveis do padrão transferencial e a qualidade da aliança terapêutica, como escores mais altos na variável submissão à mãe e ao pai e aliança terapêutica forte percebida pelo paciente; escores mais altos na escala de ataque à mãe e ao pai e aliança terapêutica fraca percebida pelo paciente. Muitas variáveis do RPQ não apresentaram relação significativa com a qualidade da aliança terapêutica. Discussão: Os achados sugeriram que, muitas vezes, a aliança terapêutica pode estar relacionada com estereótipos de conduta dirigidos, no passado, às figuras primárias, o que a colocaria como manifestação da transferência. Outras variáveis de transferência não se mostraram relacionadas com a aliança, o que pode ser um fato ou reflexo de limitação metodológica, como número de sujeitos insuficiente ou limitações nos instrumentos usados neste estudo. Conclusão: A aliança terapêutica nem sempre se apresenta como entidade autônoma, livre de conflitos. É importante que a mesma seja entendida e não somente julgada como a parte estável e positiva da relação. Isto pode ser verdade em muitos casos, mas, em outros, a aliança terapêutica pode estar vinculada a fantasias inconscientes que desencadeiam o processo da transferência.

Modelo unidimensional do atrito em escala atômica : um estudo por dinâmica molecular

o trabalho de Krim e Windom [Phys. Rev B 38, 12184(1988)], que revelou a natureza viscosa do atrito em escala atômica, gerou uma intensa atividade tanto teórica quanto experimental. Contudo, questões fundamentais ainda se matém em aberto com opor exemplo a relação entre o coeficiente de atrito viscoso e a topologia do substrato assim como a dependência com a temperatura do substrato. Neste trabalho apresentamos os resultados, obtidos usando dinâmica molecular, para um modelo unidimensional de um sistema adsorvato/substrato. Pesquisamos diferentes relações de comensuração entre o adsorvato e o substrato assim como também a dependência do coeficiente de atrito fonônico, Nph, com a temperatura. Para todas as configurações estudadas obtivemos que o coeficiente de atrito fonônico depende quadráticamente da amplitude de corrugação do substrato, mas tem uma dependência não trivial com a razão de comensuração adsorvato/substrato. O resultado mais impressionante é que para relações de comensuração entre 0.65 e 0.9 o atrito fonônico é muito fraco. Nosso resultados podem explicar as diferencias encontradas na literatura em relação à magnitude do atrito de origem eletrônico e o de origem fonônico.

A relação entre os factores de desenvolvimento grupal, liderança e eficácia na díade treinador-equipa desportiva

O objectivo central do presente trabalho consistiu em compreender como é que a interacção entre o padrão comportamental adoptado pelos treinadores principais e as fases de desenvolvimento grupais em que as respectivas equipas se encontravam e se modificaram ao longo de dois momentos de observação numa época desportiva, influía ao nível da satisfação das mesmas, assim como no seu desempenho colectivo. Foram realizados dois estudos empíricos ancorados no Modelo Integrado de Desenvolvimento Grupal de Miguez e Lourenço (2001) (MIDG). O estudo I teve como propósito central a construção e validação de um instrumento de auto-resposta, a Escala de Desenvolvimento Grupal no Desporto (EDG_D), de forma a ser possível identificar o nível de existência grupal das equipas desportivas. A EDG_D demonstrou possuir boas qualidades psicométricas, revelando-se capaz de identificar com clareza a fase 1 e a fase 2 de desenvolvimento grupal do MIDG. Embora não tivesse conseguido discriminar entre as fases 3 e 4, foi capaz de medir outra fase que possuía características que indicavam um maior desenvolvimento grupal. O Estudo II, de natureza longitudinal, norteou-se pelo objectivo de compreender como é que a interacção entre o estilo de liderança adoptado pelo treinador principal e a fase de desenvolvimento grupal, se relacionava com a eficácia socioafectiva e de tarefa ao longo de uma época desportiva. Os principais resultados apontaram para a não existência de um efeito positivo do ajustamento do estilo de liderança apresentado pelo treinador principal ao nível de existência grupal, no desenvolvimento grupal das equipas, no nível de satisfação das mesmas e no nível de desempenho percepcionado pelos treinadores. Os resultados mostraram a existência de uma relação positiva entre o ajustamento do estilo de liderança adoptado pelo treinador principal à fase de desenvolvimento grupal e o nível de consecução dos objectivos. Outrossim, foi possível verificar um efeito diferenciado, no sentido positivo, do nível de desenvolvimento grupal das equipas que se situavam no 2º ciclo do MIDG, e nas que se encontravam na fase 1, nos níveis de satisfação, de desempenho percepcionado pelo treinador principal e de consecução dos objectivos.

Saudosa Maloca, Maloca querida: um estudo morfológico da relação forma/usos do espaço em moradias autoconstruídas e construídas pelo poder público após um ano de ocupação

This study intends to enhance the existing knowledge concerning the patterns of the uses of space for low cost housing in Parnamirim, Rio Grande do Norte, Brazil, by way of comparative morphological studies in spatial arrangements and articulations regarding three distinct, however inter-related, sets of social housing: (1) a development comprising 21 self-built houses erected on public routes and illegal plots within a tract of land originally designed to be an industrial development: (2) architect-designed houses built by the public authority in order to accommodate the previous 21 (plus a few additions) families occupying the self-built dwellings, and (3) modifications performed by dwellers on a total of those 24 houses built by the public authority after an occupation period of one year. The predominant uses of each room within the self-built and modified houses were represented in ground plan, based on empirical observation, surveys with dwellers and the use of analytical procedures of morphologic analysis of nature predominantly geometric (specific) and topology (space syntax analysis). A scale of priorities was identified in relation to the uses of each room, its geometrical arrangement (adjacency, front/back relations etc), and underlying structures (connectivity, depth and spatial integration) in order to establish congruencies and non-congruencies between a social-cultural order embedded in the self-built domestic space and the design logic contained in the houses offered by official agencies. The comparative analysis points towards the convivial existence of two tendencies: one that seems to reinforce a design logic inasmuch as the additions and modifications performed by the dwellers do not alter but even emphasize the original configuration of the designed houses, and another one in which those patterns are subverted in accordance with a logic which, to a lesser or greater degree, coincides with that of the self-built dwellings

Simulação de fluxo de fluidos em meios porosos desordenados uma análise de efeito de escala na estimativa da permeabilidade e do coeficiente de arrasto

The present study provides a methodology that gives a predictive character the computer simulations based on detailed models of the geometry of a porous medium. We using the software FLUENT to investigate the flow of a viscous Newtonian fluid through a random fractal medium which simplifies a two-dimensional disordered porous medium representing a petroleum reservoir. This fractal model is formed by obstacles of various sizes, whose size distribution function follows a power law where exponent is defined as the fractal dimension of fractionation Dff of the model characterizing the process of fragmentation these obstacles. They are randomly disposed in a rectangular channel. The modeling process incorporates modern concepts, scaling laws, to analyze the influence of heterogeneity found in the fields of the porosity and of the permeability in such a way as to characterize the medium in terms of their fractal properties. This procedure allows numerically analyze the measurements of permeability k and the drag coefficient Cd proposed relationships, like power law, for these properties on various modeling schemes. The purpose of this research is to study the variability provided by these heterogeneities where the velocity field and other details of viscous fluid dynamics are obtained by solving numerically the continuity and Navier-Stokes equations at pore level and observe how the fractal dimension of fractionation of the model can affect their hydrodynamic properties. This study were considered two classes of models, models with constant porosity, MPC, and models with varying porosity, MPV. The results have allowed us to find numerical relationship between the permeability, drag coefficient and the fractal dimension of fractionation of the medium. Based on these numerical results we have proposed scaling relations and algebraic expressions involving the relevant parameters of the phenomenon. In this study analytical equations were determined for Dff depending on the geometrical parameters of the models. We also found a relation between the permeability and the drag coefficient which is inversely proportional to one another. As for the difference in behavior it is most striking in the classes of models MPV. That is, the fact that the porosity vary in these models is an additional factor that plays a significant role in flow analysis. Finally, the results proved satisfactory and consistent, which demonstrates the effectiveness of the referred methodology for all applications analyzed in this study.

Relação entre ambiente familiar e capacidade funcional de idosos residentes no município de Jequié-BA

(Objective) Assess the functional capacity and determine the difference between the means of functional capacity (basic and instrumental activities of daily living) and the age groups of elderly residents in an outlying area in the hinterland of Bahia/Northeast of Brazil. (Methods) Analytical study with cross-sectional design and a sample of 150 elderly individuals enrolled in four Health Units in the municipality of Jequié, Bahia, Brazil. The instrument consisted of sociodemographic and health data, the Barthel Index and the Lawton scale. (Results) In all, 78.00% of the elderly were classified as dependent in the basic activities and 65.33% in the instrumental activities of daily living. Using the Kruskal- Wallis test, we found a statistically significant difference between the means of instrumental activities and the age groups (p= 0.011). (Conclusion) An elevated number of elderly were classified as dependent in terms of functional capacity and increased age is related to greater impairment in the execution of instrumental activities of daily living

HIV/AIDS e estilo de vida: parâmetros imunológicos, virológicos, síndrome lipodistrófica e sua relação com a prática de exercícios

This descriptive study aimed to investigate the relationship between expression of immunological (TCD4 +) and virological (viral load) parameters, lipodystrophy syndrome and lifestyle variables of people living with HIV who underwent a program of physicalexercise. Initially, the sample was composed by 17 persons, recorded at the Department of Giselda Trigueiro Hospital Care (GTH), Natal-RN . With the passing of the stages of intervention (physical training program- PTP) the number of participants has changed (17, 9, 8 and 7) as the training phases (I, II, III and IV). Data collected were on total cholesterol, High Density Lipoprotein (HDL) and triglycerides. The % fat (% F), body mass index (BMI), waist-hip ratio (WHR), lean mass (LM), central fat (BF), total (TF) and peripheral (PF), weight and height were used to measure the morphological parameters. For control of variables (TCD4 +, viral load, Triglycerides, Cholesterol, HDL), the information contained in the blood tests every four months were investigated. After Phase I and II, it was used a structured interview. Then sampling was carried out considering the pre-and post-tests 1, 2, 3 and 4 (after 16, 32, 48 and 64 weeks of training, respectively). Daily, the intensity of the work was checked by the scale of perceived exertion for exercises adapted to resistance34. Procedures used were descriptive statistics (dispersion, absolute and relative frequencies, means, standard deviations and minimum and maximum values) as well as Spearman linear correlation adopting a significance level of p ≤ 0.05. Positive changes were observed for TCD4 + and viral load in all phases of the PTP. For the morphological components, the loss of central subcutaneous fat (CSF) and total subcutaneous fat (TSF) for both sexes and the decrease in % BF among women were the most dramatic results after the training phase I. For men, results were more significant to % F and LM in Phases I and II and peripheral subcutaneous fat (PSF) declined in all phases of the exercise. As for women, results were more expressive for % F and TM in the phases I and II and the PSF decreased in all phases of the exercise. Whereas for women, the waist/hip ratio (WCQ) and 0% F decreased and showed a positive association with triglycerides (WHR r * 0.82, p 0.042, r 0.88 TSF *, p 0.019 and r 1.00 ** CSF, p <0.001) and among men with limb subcutaneous fat (LSF)* r 0.65, p 0.029). The PTP provided improvement in the health, self-esteem and quality of life, proving to be a possible strategy to positively influence the expression of immunological parameters (TCD4 +) and virological (viral load) and morphological components of people living with HIV causing no deleterious effects in these parameters

Avaliação de características morfométricas na relação solo-superfície da Bacia Hidrográfica do Córrego Rico, Jaboticabal (SP)

Com a análise das características morfométricas procura-se entender a relação solo-superfície, em decorrência dos processos erosivos sobre estruturas e litologias variadas. Neste trabalho, objetivou-se avaliar as características morfométricas do padrão de drenagem e do relevo em microbacias hidrográficas de 2ª ordem de magnitude, em Latossolo Vermelho-Escuro e Argissolo Vermelho-Amarelo, com vistas ao planejamento agroambiental da Bacia Hidrográfica do Córrego Rico, município de Jaboticabal, SP. O estudo foi baseado em fotografias aéreas, pancromáticas, verticais na escala 1:35.000 da região administrativa de Ribeirão Preto. Com técnicas de fotointerpretação, foram traçadas a rede de drenagem e respectivas microbacias hidrográficas, onde as variáveis selecionadas foram determinadas. As classes de risco de degradação, resultando no uso potencial do solo, foram determinadas de acordo com o coeficiente de rugosidade. As características do padrão de drenagem e do relevo repercutiram no comportamento hidrológico e litológico das microbacias hidrográficas, possibilitando a diferenciação entre as unidades de solos. A densidade de drenagem e a amplitude altimétrica foram as características que mais contribuíram para o poder discriminatório na relação solo-superfície. Na análise conjunta do potencial de uso do solo, verificou-se, principalmente, adequação para agricultura nos Latossolos e pecuária e, ou, reflorestamento nos Argissolos.

Funcionalidade em pacientes após acidente vascular encefálico: relação com o sono e ritmo de atividade-repouso

It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters

Análise da relação entre alterações do padrão do sono e dor lombo-pélvica em mulheres no segundo trimestre gestacional

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Validação da escala de fatigabilidade percebida para avaliação da fadiga em idosas

The term fatigability concerns the degree of fatigue associated with performing an activity of any type (physical, mental, emotional and / or social). Recently scales for assessing fatigue in the English language were created, however, gaps exist regarding the validity of these scales in relation to oxygen consumption and levels of perceived fatigue. Objective: To investigate the validity of perceived fatigability scale in older women frail and non-frail by the expired gases kinetics. Methods: This is a study of type validation, where were evaluated 48 elderly. The evaluation was conducted at two different sessions. In the first, data were collected demographic partners, as well as assessment of cognitive function, physical health, and the phenotype of frailty. The second was composed by the test 6-minute walk (6MWT) associated the expired gases kinects and assessment of perceived fatigability. Statistical analysis was performed a descriptive analysis and then we used the Pearson correlation test to evaluate the relationship between the measure of perceived fatigue and variables oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER)before and after 6MWT. We used a linear regression model initially considering the following explanatory variable: age, Body Mass Index (BMI), presence of frailty, comorbidities, level of physical activity, distance covered in the 6MWT , the energy cost of walking and severity of fatigability on performance. Results: The final sample consisted of 44 elderly women, 4 elderly were excluded because they didn t complete all phases of this study. The mean age obtained was 75 years (± 7.2 years). There was no significant correlation between fatigability measures and the values of VO2 ( r = .09 , p = .56 ) , VCO2 ( r = .173 , p = .26 ) , RER ( r = - .121 , p = .43 ). The final linear regression model showed that the energy cost of walking, the usual level of physical activity and the performance severity of fatigability explained 83.5 % (R2 = 0.835, p < 0.01) of the variation in the perceived fatigability. Conclusion: Our findings indicate a relationship between greater severity of fatigability and lower levels of physical activity and increased energy cost in walking, suggesting that the fatigability analyses using a simple numeric scale is valid and viable for assessment of fatigue in older women

Habilidades sociais educativas de mães separadas e sua relação com o comportamento de pré-escolares

Este estudo teve por objetivo: (a) caracterizar uma amostra de mães e filhos, em famílias separadas, quanto às suas habilidades sociais; (b) investigar relações entre as habilidades sociais educativas das mães e o comportamento das crianças; e (c) comparar grupo clínico e não-clínico quanto ao repertório comportamental. Participaram da pesquisa 43 mães de crianças de ambos os sexos, com idade entre quatro e seis anos. As participantes responderam a um Questionário Sociodemográfico, Roteiro de Entrevista de Habilidades Sociais Educativas Parentais, Child Behavior Checklist - CBCL, Questionário de Respostas Socialmente Habilidosas e Escala Infantil A2 de Rutter. Para análise de dados, empregaram-se os testes Spearman e Mann-Whitney. Os resultados mostraram que habilidades sociais educativas das mães estiveram relacionadas a habilidades sociais das crianças, enquanto práticas negativas foram relacionadas a problemas de comportamento. Discutem-se como as habilidades sociais maternas podem influenciar o comportamento dos filhos em famílias separadas.

A memória de curto prazo e a síndrome de down: a relação entre contextos de desenvolvimento

Down syndrome (DS) is one of the most frequent causes of intellectual disability, affecting one in every 600 to 1000 live births. Studies have demonstrated that people with DS have a lower capacity for short-term memory (STM) and working memory (WM), which affects their capability to learn new words and to follow spoken instructions, specially when they involve multiple information or consecutive orders/orientations. It seems that the basis of the learning process, as it happens with language and mathematics comprehension and reasoning, relies in the STM and WM systems. Individuals with DS are increasingly included in mainstream education, and yet, very few researches have been conducted to investigate the influence of memory development and the type of enrollment (regular school and special school). This study investigated the relationship between the type of school enrollment with the performance on STM tests and also, the relationship of this performance with early stimulation (ES). The tests used in the first research were the digit span, free recall, word recognition and subtests of the Wechsler Intelligence Scale for Children Third Edition (WISC-III). Individuals enrolled in the regular schools group had higher scores on the digit span test and the subtests of the WISC-III. In the free recall and recognition tests, no differences were found. This study indicates that the type of enrollment might influence the memory development of individuals with DS and clearly points the need for future investigations. In the second research, the tests used were the digit span, free word recall and subtests of the WISC-III. The test results showed better performance by adults that received ES before six months of age. The studies showed improvement in STM both in people who attended or were attending regular school, as well as those who benefited from ES before six months of age. However, some issues still need to be better understood. What is the relation between this stimulation with the individual s education? Since ES may reflect a greater family involvement with the individual, what is the role of emotional components derived from this involvement in the cognitive improvement? These and other questions are part of the continuity of this study

Relação entre o ciclo sono e vigília e a função cardiorrespiratória em estudantes de medicina

Students, normally, present an irregular sleep pattern characterized by delays in sleep onset and offset from weekdays to weekends, short sleep duration on weekdays and long sleep duration on weekends. The reduction of the necessary sleep and the irregularity in the sleep patterns provoke relevant short- and long-term impairments on performances, for example, in cardiorespiratory function. The cardiorespiratory performance represents, in addition to fitness, traces associated to health conditions and in several studies to pattern and/or individual s sleep quality. The aim of this study was to evaluate the pattern of the sleep-wake cycle and the cardiorespiratory function of medical students under different class schedules. The study was accomplished with two classes of medical students of UFRN, one had classes at 7 am (n = 47) and the second had classes at 8 am (n = 41) during the week. On the first stage of the study all volunteers filled out an anamnesis, the International Physical Activity questionnaire, the Pittsburgh index of sleep quality, the Portuguese version of the Horne and Östberg cronotype questionnaire, the Health and Sleep questionnaire and the Epworth Scale of Somnolence (ESS). On the second stage, 24 students (12 of each class) had their activity rhythm monitored by actimeters set to record activity at a 2-min interval for 14 days concomitant to the completion of the sleep diary. In this same stage, each volunteer performed the effort test (treadmill) only once in the morning period (between 9:00 and 11:00). The students showed an irregular pattern of the sleep-wake cycle and this irregularity is strongly influenced by the class schedules, in addition to the contribution of the academic demand, social activities and endogenous factors. The students who woke up earlier showed greater irregularity in the sleep-wake pattern. The earlier was the class schedule the worse was the sleep quality and the greater was the frequency of students with excessive diurnal somnolence. The classes schedules and the irregular pattern of the sleep-wake cycle did not show effect on the cardiorespiratory performance of the medical students. The performance on the test seems to be affected by other factors, which can be related to the pattern of the sleep-wake cycle or not. Therefore, it is suggested that the late start of classes provokes less irregularity on the pattern of the sleep-wake cycle. However, it was observed that this irregularity and the class schedule seem not to affect the cardiorespiratory performance directly