Introdução: Alterações de parâmetros clinico-funcionais e parâmetros biomecânicos da marcha, são características marcantes na Doença de Parkinson (DP). Tais alterações são incapacitantes para a realização das atividades de vida diária (AVDS), pois representam um alto risco de quedas e comprometem a qualidade de vida (QV) desta população. Embora o exercício físico seja preconizado com um modelo de intervenção terapêutica eficaz para minimizar os sintomas da doença, pouco se sabe sobre os efeitos da caminhada nórdica sobre sintomas motores e não motores em pacientes com DP. Objetivo: o objetivo do presente estudo foi avaliar e comparar os efeitos de um programa de treinamento de caminhada nórdica e de caminhada livre sobre parâmetros clínico-funcionais e biomecânicos da marcha de pessoas com DP. Desenho Experimental: ensaio clínico controlado randomizado (ECR). Local da Pesquisa: Escola de Educação Física da Universidade Federal do Rio Grande do Sul e Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brasil. Métodos: Participaram deste estudo 33 voluntários, com idade acima de 50 anos, de ambos os sexos, com diagnóstico clínico de DP idiopática, com o estadiamento entre 1 a 4 na escala Hoehn e Yahr (H&Y). Voluntários com DP receberam dois tipos de intervenções: treinamento de caminhada nórdica (CN, N = 16) e caminhada livre (CL, N = 17), durante seis semanas. Com o intuito de avaliar os efeitos do treinamento, avaliações foram realizadas: Baseline: avaliação inicial pré-treinamento + préfamiliarização (T1); avaliação pós-familiarização + pré-treinamento (T2); avaliação pós-treinamento (T3). Desfechos do estudo A: Sintomas motores: estadiamento e gravidade da DP, equilíbrio (EEB), mobilidade funcional da caminhada, velocidade autosselecionada da caminhada (VAS), e índice de reabilitação (IR). Sintomas não motores: função cognitiva, sintomas depressivos e qualidade de vida. Desfechos do estudo B: Parâmetros cinemáticos (espaço-temporais e estabilidade dinâmica da caminhada) e parâmetros neuromusculares (amplitude do sinal eletromiográfico, limiar inicial e final de ativação, duração de ativação e índice de co-contração dos músculos: vasto lateral (VL), bíceps femural (BF), tibial anterior (TA) e gastrocnêmio medial (GM)). Análise Estatística: Os dados de descrição da amostra, no baseline, foram comparados aplicando-se ANOVA one-way. Os desfechos foram analisados utilizando as Equações de Estimativas Generalizadas (GEE), para a comparação entre os grupos (CN e CL) e os momentos (T1, T2 e T3). Utilizou-se um post-hoc de Bonferroni, para identificar as diferenças entre os efeitos e interações. Os dados foram apresentados em “model-based adjusted means”, e foram analisados com o software Statistical Package for the Social Sciense (SPSS) v.20.0. Adotou-se um nível de significância de α=0,05. Resultados: A intervenção proposta no presente estudo proporcionou um efeito benéfico significativo após o período de treinamento, para todos os domínios da CIF (função e estrutura corporal, atividade e relações sociais e ambientais). No estudo A, para os desfechos dos sintomas motores, houve uma redução da UPDRS III (p < 0,001), aumento nos escores da EEB (p < 0,035), incremento da mobilidade funcional da caminhada por meio da redução do TUGVAS (p < 0,001), TUGVR (p < 0,001), VAS (p < 0,001) e IR (p < 0,001), bem como para os desfechos dos sintomas não motores: aumento na função cognitiva (p < 0,046), redução dos sintomas depressivos (p < 0,001), e aumento para os domínios de QV geral (p < 0,001), físico (p < 0,037), psicológico (p < 0,019), participação social (p < 0,007) e intimidade (p < 0,033), independente do grupo de treinamento. O grupo da CN apresentou melhora, estatisticamente significativa, no domínio autonomia (p < 0,001), quando comparado ao grupo da CL. No estudo B, para os desfechos cinemáticos, houve uma redução do tempo de contato tempo de contato (TC), tempo de balanço (TB), comprimento (CP) e frequência de passada (FP) para a CN quando comparada a CL (p < 0,05). Em relação aos parâmetros neuromusculares, houve um aumento na amplitude do sinal EMG do VL e BF, redução do limiar final de ativação (offset) do VL e GM (p < 0,05), redução da ativação do VL e BF (p< 0,05) e índice de co-contração do TA e GM (p < 0,05), enquanto que o grupo da CL apresentou melhoras significativas somente na amplitude do GM quando comparado ao grupo da CN. Conclusão: Conclui-se que os programas de treinamento de CN e CL, promoveram melhora sem diferença entre os grupos, em todos os domínios da funcionalidade propostos pela CIF (estrutura e função corporal, atividade e relação social, e meio ambiente), após a intervenção proposta. Entretanto, o uso de bastões através da técnica da CN em comparação ao treinamento de caminhada sem bastões (CL), mostrou vantagens na mobilidade funcional e parâmetros neuromusculares pontuais (índice de co-contração de membros inferiores, offset dos músculos TA e GM) ao mesmo tempo em que melhorou aspectos clínico-funcionais, fundamentais para a saúde e QV dos indivíduos com DP. / Introduction: Changes in clinical, functional and biomechanical parameters of gait are remarkable features in Parkinson's disease (PD). Such changes are disabling for the performance of daily living activities (DLAs) as they represent a high risk of falls and impair quality of life (QL) in this population. Although exercise is recommended as an effective model of therapeutic intervention, to minimize the symptoms of this disease, little is known about the effects of Nordic walking on motor and non-motor symptoms in patients with PD. Purpose: The aim of this study was to evaluate and compare the effects of a Nordic and free walking training program on clinical, functional and biomechanical parameters of gait, in people with PD. Experimental Design: Randomized controlled clinical trial (RCT). Study Site: Physical Education School of the Federal University of Rio Grande do Sul and the Clinical Hospital of Porto Alegre, in Porto Alegre, Rio Grande do Sul, Brazil. Methods: The sample comprised 33 participants, aged above 50 years, of both sexes, with a clinical diagnosis of idiopathic PD, with the staging of 1-4 in the Hoehn and Yahr scale (H&Y). The participants received two types of intervention: Nordic walking training program (NW, n = 16) and free walking training program (FW, n = 17), during six weeks. Aiming to evaluate the effects of the training program, the participants underwent the tests in the following period: pre-training + prefamiliarization (T1); post-familiarization + pre-training (T2); post-training (T3). Outcomes of Study A: Motor symptoms: Staging and severity of PD, balance, walking functional mobility, self selected walking velocity, and rehabilitation index. Non-Motor symptoms: Cognitive function, depressive symptoms and QL. Outcomes of Study B: Kinematic parameters (spatiotemporal and dynamic stability of walking) and neuromuscular parameters (amplitude of the EMG signal, initial and final activation threshold, activation time and co-contraction index, of the following muscles: Vastus Lateralis (VL), Biceps Femoris (BF), Tibialis Anterior (TA), Gastrocnemius Medialis (GM). Statistical Analysis: Sample characteristics, at baseline, were compared by applying the One Way ANOVA. Outcomes were analyzed using the Generalized Estimates Equations (GEE), to compare groups (NW and FW) and moments (T1, T2 and T3). The Bonferroni post-hoc was used to identify differences between effects and interactions. Data were presented in a “model-based adjusted means”, and analyzed using the Statistical Package for Social Sciences (SPSS, v.20.0) software. A significance level of α=0.05, was adopted. Results: The intervention proposed in this study provided a significant beneficial effect after the training period, for all ICF domains (body function and structure, activity, and social and environmental relations). Regarding study A, for motor symptoms outcomes, there was a reduction in UPDRS III (p < 0,001), increase in EEB scores (p < 0,035), increase in walking functional mobility through TUGVAS reduction (p < 0,001), as well as TUGVR (p < 0,001), VAS (p < 0,001) e IR (p < 0,001) reduction. For non-motor symptoms outcomes, there was an increase in cognitive function (p < 0,046), reduction of the depressive symptoms (p < 0,001), and increase in the overall QL domain (p < 0,001), as well as in the physical (p < 0,037), psychological (p < 0,019), social participation (p < 0,007) and intimacy (p < 0,033) domains, independent of the training group. The NW group showed significant improvement in the autonomy domain (p < 0,001), when compared to the FW group. Regarding study B, for kinematic outcomes, there was a reduction in contact time (CT), swing time (ST), stride length (SL) and stride frequency (FP), for NW when compared to FN (p <0.05 ). Regarding the neuromuscular parameters, an increase in the amplitude of the VL and BF EMG signal, reduction of the final activation threshold (offset) of the VL and GM (p <0.05), reduction in the activation of the VL and BF (p <0.05) and reduction in the co-contraction index of the TA and GM (p <0.05), were found for the NW group, whereas the FW group showed statistically significant improvements only on the amplitude of GM when compared to the CN group. Conclusion: The NW and FW training programs provided improvement, without difference between groups, in all functionality domains proposed by ICF (body function and structure, activity and social relationships, and environment), after the intervention. However, the use of sticks in the technique of NW compared to the free walking without the sticks (FW training), showed advantages in functional mobility and neuromuscular specific parameters (index of co-contraction of lower limbs, offset of muscles TA and GM), improving, as well, clinical and functional aspects, that are imperative to health and QL of individuals with PD.

abstract: The primary aim of this study was to investigate resilient profiles in low-income Mexican American (MA) mothers. MA mothers are part of an under researched population, the fastest growing ethnic minority group, and have the highest birth rate in the United States, presenting a significant public health concern. The transition to motherhood can be an emotionally and physically complex time for women, particularly in the context of a stressful low-income environment. Although most low-income women navigate this transition well, a significant number of mothers develop moderate to severe depressive symptoms. The proposed research investigated profiles of resilience during the prenatal period using a person-centered approach via latent profile analysis. In alignment with current resilience theories, several domains of resilience were investigated including psychological, social, and cultural adherence (e.g., maintaining specific cultural traditions). Concurrent prenatal depressive symptoms and stress were correlated with the profiles in order to establish validity. Six week postpartum depressive symptoms and physiological processes (e.g., overall cortisol output, heart rate variability, and sleep) were also predicted by the prenatal resilient profiles. The resulting data revealed three separate profiles: low-resource, high-resource Anglo, and high-resource Mexican. These resilience profiles had differential associations with concurrent depressive symptoms and stress, such that women in the high-resource profiles reported less depressive symptoms and stress prenatally. Further, profile differences regarding cortisol output, resting heart rate variability, were also found, but there were no differences in insomnia symptoms. Profile classification also moderated the effects of prenatal economic stress on postpartum depressive symptoms, such that women in the high-resource Mexican profile were at risk for higher postpartum depressive symptoms under high economic stress compared to the high-resource Anglo group, which demonstrated a more resilient response. Overall, the results suggest the presence of multiple clusters of prenatal resilience within a sample of MA mothers facing health disparities, with various effects on perinatal mental health and postpartum physiological processes. The results also highlight the need for multi-dimensional models of resilience and the possible implications for interventions. / Dissertation/Thesis / Doctoral Dissertation Psychology 2014

Este trabalho investigou a manifestação de sintomas depressivos e eventos de vida estressantes em crianças e adolescentes, através de três estudos. No primeiro estudo, verificaram-se os sintomas depressivos, a freqüência e o impacto de eventos adversos de forma transversal, em 257 jovens, de ambos os sexos, de 7 a 16 anos, sendo que 130 residiam em abrigos de proteção governamentais e não governamentais e 127 moravam com suas famílias na região metropolitana de Porto Alegre. Foram utilizados o Inventário de Depressão Infantil (CDI) e o Inventário de Eventos Estressores na Infância e Adolescência (IEEIA) para avaliar depressão e eventos estressores, respectivamente. Os resultados apontaram médias mais altas de sintomas depressivos e de ocorrência de eventos estressores no grupo institucionalizado. No segundo estudo, foi explorada a estrutura fatorial de uma adaptação do CDI, a partir de um banco de dados composto por 951 crianças e adolescentes, de 7 a 17 anos. Os dados apontaram que o instrumento apresenta características psicométricas adequadas e foi possível estabelecer normas percentílicas por sexo e faixa etária. No último estudo, longitudinal, buscou-se identificar um modelo de preditores de sintomas depressivos em participantes institucionalizados (N=127), através de uma análise de regressão linear múltipla. O modelo preditivo englobou o escore inicial de sintomas, seguido pelos eventos “Ter problemas com professores”, “Sentir-se rejeitado pelos colegas e amigos” e “Um dos pais ter que morar longe”. Destaca-se a importância de prevenir a ocorrência de eventos estressores na escola e família, bem como promover intervenções junto às crianças e adolescentes institucionalizados. / The present study verified the depressive symptoms manifestation as well as the stressful events in children and adolescents through three studies. In the first study, the depressive symptoms and the frequency and impact of adverse events were verified. A total of 257 youths of both genders, age 7-16 took part in this study. Among those, 130 lived at government and non-government protection youth shelters and 127 lived with their families in the metropolitan region of Porto Alegre. The Children's Depression Inventory (CDI) and the Stressful Events in Childhood and Adolescence Inventory (IEEIA) were used to assess depression and stressful events respectively. The results showed a significant higher mean score among institutionalized children and adolescents for both depressive symptoms and frequency of stressful events mentioned. In the second study, the factorial structure of the Children’s Depression Inventory (CDI) for 951 children and adolescents, between 7 and 17 years was explored. Data pointed out good psychometric properties and it was possible to present norms in percentiles by gender and age group. Finally, the last study aimed at identifying, with a longitudinal design, a model of predictors of depressive symptoms in the institutionalized sample (N=127) through the regression linear multiple analysis. The predictive model included the initial depressive score, followed by the stressful events “to have problem with teacher”, “feelings of peer rejection” and “one of parents ought to live so far”. It is highlighted the importance of preventing events related mainly to the school and familiar conflicts, as well as promoting interventions with vulnerable families.

Sintomas depressivos, sedentarismo e obesidade são problemas de saúde pública prevalentes em idosos e, quando presentes, podem diminuir a qualidade de vida e aumentar a incapacidade no envelhecimento. O presente estudo teve como objetivo geral estudar a associação entre sintomas depressivos, atividade física e obesidade de idosos residentes no município de São Paulo Estudo SABE: Saúde, Bem-estar e Envelhecimento. Realizou-se estudo longitudinal, com amostra de 826 idosos. Os sintomas depressivos (SD) foram avaliados pela Escala de Depressão Geriátrica (GDS), forma abreviada de 15 itens. Foram excluídos idosos com comprometimento cognitivo e que haviam tido ajuda de informante para responder à GDS. O nível de atividade física foi avaliado pelo IPAQ (International Physical Activity Questionnaire, questionário internacional, validado e adaptado para idosos) e a obesidade pelo cálculo do Índice de Massa Corporal (IMC). Para a classificação do estado nutricional, utilizou-se a classificação da OPAS(2002). Informações sociodemográficas e econômicas (sexo, idade, escolaridade, arranjo familiar, situação conjugal, percepção de renda, situação ocupacional e arranjo familiar), informações sobre condições de saúde e importância da religião também foram avaliadas. As associações foram estudadas por meio do teste de Rao-Scott. Foi realizada a análise múltipla por meio da regressão logística (RL) tipo stepwise/forward. Foram incluídas no modelo da RL todas as variáveis que apresentaram p<0,20 na análise univariada e outras variáveis de relevância teórica. O programa estatístico utilizado para análise de dados foi o programa estatístico Stata (versão 12.0), sendo para todas as análises utilizado o nível de significância de 5 por cento . Obteve-se prevalência de 12,92 por cento de sintomas depressivos. Associaram-se significativamente a SD: sexo (OR: 3,44;IC95 por cento : 1,93-6,16), percepção de saúde classificada como regular (OR: 3,60;IC95 por cento : 1,80-7,17) e ruim (OR: 9,23;IC95 por cento : 3,32-25,66), dificuldades em realizar de uma a duas atividades básicas da vida diária (OR:1,80;IC95 por cento : 1,03-3,16) ou três ou mais atividades básicas da vida diária (OR:4,15;IC95 por cento : 1,72-10,0), ter sido classificado como insuficientemente ativo quanto às práticas de caminhadas (OR:2,38;IC95 por cento : 1,17-3,32) e não ter relatado a religião como importante em sua vida (OR:9,75;IC95 por cento : 2,10-45,14. A incidência de sintomas depressivos foi de 28,6 casos por 1.000 pessoas ano (IC: 22,7-36,7), associando-se significativamente à: tomar entre um a quatro medicamentos (OR: 3,43; IC95 por cento :1,67 7,07) e cinco ou mais medicamentos (OR:81,39; IC95 por cento :8,42-786,70), ter dificuldades para realizar de uma a duas atividades básicas da vida diária (OR:2,0; IC95 por cento : 1,04-3,85), perceber a saúde como ruim (OR: 3,85; IC95 por cento : 1,21-12,26). Praticar de forma irregular atividades físicas como a caminhada também foi um fator de risco associado aos sintomas depressivos, apesar da associação ter sido limítrofe (OR: 1,78; IC95 por cento : 0,98 3,22). Portanto, não se obteve associação significativa entre sintomas depressivos e obesidade, mas constatou-se associação de sintomas depressivos com a prática de caminhada e outros fatores que corroboram com a literatura nacional e internacional / Depressive symptoms, sedentary lifestyle and obesity are prevalent public health problems in the elderly and, when present, may decrease quality of life and increase disability in aging. The present study aimed to study the association between depressive symptoms, physical activity and obesity among elderly people living in the city of São Paulo - SABE Study: Health, Welfare and Aging. A longitudinal study was carried out, with a sample of 826 elderly. Depressive symptoms (SD) were evaluated by the Geriatric Depression Scale (GDS), abbreviated form of 15 items. Elderly individuals with cognitive impairment and who had the help of informant to respond to GDS were excluded. The level of physical activity was assessed by the IPAQ (international questionnaire, validated and adapted for the elderly) and obesity by the calculation of Body Mass Index (BMI). For the classification of nutritional status, the PAHO classification (2002) was used. Sociodemographic and economic information (sex, age, schooling, family arrangement, marital status, income perception, occupational situation and family arrangement), information about health conditions and importance of religion were also evaluated. The associations were studied using the Rao-Scott test. Multiple analysis was performed using stepwise / forward logistic regression (RL). All the variables that presented p <0.20 in the univariate analysis and other variables of theoretical relevance were included in the RL model. The statistical program used for data analysis was the statistical program Stata (version 12.0), and for all analyzes the significance level of 5 per cent was used. A prevalence of 12.92 per cent of depressive symptoms was obtained. There was a significant association between SD: sex (OR: 3.44; CI95 per cent : 1.93-6.16), health perception classified as regular (OR: 3.60; CI95 per cent :1.80-7.17) and poor (OR: 9.23, CI95 per cent :3.32-25.66), difficulties in performing one to two basic activities of daily living (OR: 1.80, CI95 per cent : 1.03 - 3,16) or three or more basic activities of daily living (OR: 4.15, CI 95 per cent : 1.72-10.0), were classified as insufficiently active in walking practices (OR 2.38, CI95 per cent : 1.17-3.32) and did not report religion as important in their life (OR: 9.75; CI95 per cent : 2.10-45.14). The incidence of depressive symptoms was 28.6/1,000 patients a year (CI95 per cent : 22.7 - 36.7), significantly associated with: taking between one to four medications (OR: 3.43; CI95 per cent : 1.67 - 7.07) and five or more medications (OR: 81.39, CI95 per cent : 8.42-786.70), have difficulty performing one to two basic activities of daily living (OR:2.0, CI95 per cent : 1.04-3.85) , perception health as poor (OR: 3.85; 95 per cent CI: 1.21-12.26). Irregularly performing physical activities such as walking was also a risk factor associated with depressive symptoms, although the association was borderline (OR: 1.78; CI95 per cent : 0.98 - 3.22). Therefore, there was no significant association between depressive symptoms and obesity, but there was an association of depressive symptoms with walking and other factors that corroborate with the national and international literature

Background: Skilled birth attendance, usually available by promoting childbirth at health care institutions in low-resource settings, is known to prevent maternal and neonatal morbidity and mortality. While institutional childbirths in India have increased at an exponential rate, the infrastructure, material and manpower resources to support this practice are lagging, raising concerns about the quality of childbirth services. Methodology: A mixed-method approach was used in this project: in-depth interviews with women (n= 13); and focus-group-discussions with the care providers (n=27) were conducted and analysed using Grounded Theory. A cross-sectional survey (n= 1004) assessed prevalence of Fear of Birth (FoB) and postnatal depressive symptoms (PND), along with satisfaction with childbirth services among women in the immediate postpartum period. Results: The system of cashless childbirth provided at the public health facilities, in the women’s experiences, came at the hidden cost of them having to make themselves subordinate to the offered services. The prevalence of FoB and PND was 13.1% and 17.1%, respectively, and these were significantly associated (p &lt; 0.001). Among women with vaginal births (VB), 41.2% had experienced a perineal wound and 59% of them underwent repair without local anaesthesia. While the majority of the women were satisfied (VB 68.7%; Caesarean births 79.2%) with the services; women having VBs at Community Health Centres (nearly 81%) were more commonly satisfied compared to those at the District Hospitals (nearly 60%) (p &lt; 0.001). From the care providers’ perspective, maintaining quality of childbirth services was like a balancing act between the realities of low-resource settings with stakeholders’ expectations. While the providers remained proud and committed; the challenges often left them fatigued, disillusioned, irritable and sceptical. Conclusion: There is a need to improve the sensitivity with which childbirth services are being delivered to women coming to public health facilities; as well as towards improving the care providers’ work conditions. Suboptimal birth experiences are associated with the women’s perinatal mental health and satisfaction, while perpetual work challenges may make the care providers frustrated and/or apathetic. Improving manpower resources could reduce work-stress in care providers and thereby improve childbirth processes.

The Strong Black Woman Schema (SBWS) refers to the collective believes, behaviors, resources and responses Black women are socialized to embody. The SBWS was developed as a positive counterimage to the negative stereotypes of Black women, such as the mammy or the jezebel, and is an important image among Black women. Observations suggest that the SBWS may affect how Black women experience and interpret stress and mental illness. I assert the SBWS may serve as one comprehensive explanation for the mental health outcomes observed for Black women. Qualitative and quantitative studies have identified a set of characteristics (i.e. strength, emotion regulation, caretaking) related to the schema. However, scales developed to measure the schema lack the ability to isolate adequately a unique typology for Black women. I argue that the SBWS is representative of a specific compilation of psychosocial resources (i.e. mastery, self-efficacy, resilience, self-esteem) representative of the cultural response to historical experiences of racism and sexism. I explore how the SBWS influences the reporting of depressive symptoms, depression and anxiety through a secondary data analysis of African American, Caribbean Black and White American women using data from the National Survey of American Life. Through a three part analysis, I answer the following questions: 1) Is a compilation of psychosocial measures an appropriate measure of the Strong Black Woman Schema? 2) What sociodemographic factors influence distinct typologies reflective of at least one uniquely Black form of the Strong Black Woman Schema? And 3) Does the Strong Black Woman Schema influence depressive symptons, depression, and anxiety? Results of this study clarify how socio-cultural aspects of oppression influence the mental health of Black women.

Early life experiences such as childhood maltreatment are important contributors to depression, one of the most significant mental health problems in Canada; approximately 11.2% of Canadian adults will experience major depression at some point in their life (Knoll & MacLennan, 2017). Although psychological maltreatment and neglect are the most common forms of child maltreatment, and it has been suggested that they are linked to later depression, the underlying mechanisms explaining this relation have yet to be determined. The current investigation examined the role of adult attachment and relationship satisfaction in the prediction of depressive symptomology in 676 university students (74% female). Both anxious and avoidant attachment were mediators of the relationship between childhood psychological maltreatment (CPM) and adult depressive symptoms. Only avoidant attachment was a mediator of the relationship between childhood psychological neglect (CPN) and depressive symptoms. Relationship status did not moderate the relationship between maltreatment and attachment. However, for those currently in romantic relationships, the effect of CPM on avoidant attachment was moderated by relationship satisfaction. Specifically, those with a history of CPM who were currently in a satisfying relationship experienced heightened attachment avoidance along with subsequent depressive symptoms. Implications and strategies for clinical intervention are discussed. / Graduate

Introducción y objetivos Los trastornos del sueño son una de las comorbilidades más comunes en pacientes en hemodiálisis. Los objetivos del estudio fueron determinar la prevalencia de mala calidad de sueño y establecer potenciales factores asociados a la mala calidad de sueño. Materiales y métodos Estudio transversal analítico enrolando pacientes con enfermedad renal crónica en hemodiálisis. La variable resultado fue calidad de sueño evaluado mediante la Escala de Pittsburgh, mientras que las variables de exposición fueron el tiempo en hemodiálisis, la historia de diabetes mellitus tipo 2 y de hipertensión arterial, la presencia de sintomatología depresiva, la presencia de anemia y el compromiso urémico. Se usó el modelo de regresión de Poisson para verificar las asociaciones de interés reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC95%). Resultados Fueron enrolados un total de 450 pacientes, de los cuales, 259 (57.5%) fueron varones, y con una edad entre 18 y 97 años. La prevalencia de mala calidad de sueño fue de 79.3% (IC95%: 75.6%–83.1%). Se encontró asociación significativa entre mala calidad de sueño y sintomatología depresiva (RP=1.28; IC95%: 1.17-1.39), anemia (RP=1.18; IC95%: 1.04-1.34) y compromiso urémico (RP=1.26; IC95%: 1.17-1.36) después de controlar por potenciales confusores. Conclusiones La presencia de sintomatología depresiva, anemia y el compromiso urémico estuvieron positivamente asociados a mala calidad de sueño en pacientes con enfermedad renal crónica en hemodiálisis. Un gran porcentaje de esta población sufre de mala calidad de sueño. Se sugiere desarrollar estrategias para mejorar la calidad de sueño en estos pacientes. / Introduction and objectives Sleep disorders are one of the most common comorbidities among patients on hemodialysis. The aims of this study were to determine the prevalence of poor sleep quality as well as to establish potential factors associated with poor sleep quality. Materials and Methods A cross-sectional study was performed enrolling patients with chronic kidney disease on hemodialysis. The outcome was sleep quality evaluated using the Pittsburgh Scale, whereas the exposure variables were time on hemodialysis, history of type-2 diabetes and hypertension, depressive symptoms, anemia, and uremia. We used Poisson regression model to determine the association of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). Results A total of 450 patients were enrolled, 259 (57.5%) were male, aged from 18 to 97 years. The prevalence of poor sleep quality was 79.3% (95%CI: 75.6%– 83.1%). Poor sleep quality was associated with depressive symptoms (PR=1.28; 95%CI: 1.17-1.39), anemia (PR=1.18; 95%CI: 1.04-1.34) and uremia (PR=1.26; 95%CI: 1.17-1.36) after controlling for potential confounders. Conclusions The presence of depressive symptoms, anemia and uremia were positively associated with poor sleep quality among patients with chronic kidney disease on hemodialysis. A great proportion of this population had poor sleep quality. Strategies are needed to improve sleep quality in these patients.

This exploratory enquiry into the effectiveness of an in-patient psychotherapy program measured the changes in mood and anxiety symptoms, difficulty with emotion regulation, and dispositional mindfulness in a clinical population with diverse psychiatric morbidity. Participants were 53 adults (74.5% female, mean age = 35 years) who participated in a 4-week in-patient psychotherapy program offering a variety of interventions, including mindfulness skills training, and Dialectical Behaviour Therapy-psychosocial skills training. Program input data, demographic variables, psychiatric morbidity, and medication on discharge were tracked. There was an average improvement of 29.86 ± 20.56 on the Mood and Anxiety Symptoms Questionnaire-D30 and 12.43 ± 17.75 on the Difficulty with Emotion Regulation Scale-Short Form, indicating an improvement in mood and anxiety symptoms and emotion regulation post-intervention. There was an average improvement of 17.6 ± 23.66 on the Five Facets of Mindfulness Questionnaire, indicating an increase in dispositional mindfulness post-intervention.

<div>Exposure to racial discrimination has been consistently linked with risk for substance use. However, outside of affect-based factors, few other mechanisms have been examined in the literature. One potential candidate is locus of control (LOC). LOC is a learning processes that involves the degree to which an individual attributes rewards as resulting from their own control (internal LOC) versus outside control (external LOC). There is evidence that exposure to stressors is associated with LOC, with a separate body of literature linking LOC with substance use. Thus, it is plausible that LOC may be a mechanism underlying the relationship between racial discrimination and substance use. Additionally, there is evidence that depression is related to LOC. Thus, the relationship between racial discrimination, locus of control, and substance use may also be serially mediated through depressive symptoms. The current study investigated these two pathways among 503 racial/ethnic minority adults aged 18-35 who completed an online questionnaire that included measures on racial discrimination related stress, locus of control, depressive symptoms, and substance use. Results indicated a significant indirect effect of racial discrimination related stress through external locus of control, specifically the chance orientation, on substance use. Moreover, for both domains of external locus of control (i.e., chance and powerful others) a significant serial indirect effect was found through depressive symptoms within the racial discrimination-substance use pathway among racial/ethnic minority adults. These findings expand our understanding on potential mechanisms that underlie the racial discrimination-substance use risk pathway among racial/ethnic minority adults, which may in turn provide important targets for substance use intervention programming for this population.</div>