A series of investigations were undertaken to determine whether physical or emotional stress, catecholamines or naloxone (B-endorphon blocker) would increase serum total cholesterol and LDL and HDL levels. Physical stress given daily over a period of time caused a steady increase in serum total cholesterol and LDL without a significantly altering high density lipoproteins (HDL) or serum triglycerides. Daily injections of epinerphrine in oil caused an increase in both serum total cholesterol and LDL levels while daily injections of norepinephrine did not. Reversal of the treatments caused a reversed response in both groups of rats. Similar increases in both total cholesterol and LDL levels occurred in graduate students during preparation for their comprehensive written or oral thesis/dissertation defense. Injection of eigher dichloroisoproterenol (M.W. = 248) or naloxone (M.W. = 346) in rats prior to stress inhibited the increase in total cholesterol and LDL levels, although naloxone at the dosage given was more effective, possibly due to its larger molecular weight. When naloxone plus epinephrine was injected into non-stressed rats, there was a significant increase in total cholesterol and LDL levels, but the increase was not as great as that of groups injected with epinephrine only. Stressed, adrenalectomized rats exhibited higher cholesterol and LDL levels than the normal reported range for rats of their age and weight, but their levels did not differ from those of stressed, sham-operated rats indicating that the adrenals per se are not needed for stress-induced elevation of blood LDL levels.

Bakgrund: Intensivvårdsavdelningen är en högteknologisk miljö där kritiskt sjuka patienter vårdas. Intensivvårdssjuksköterskor möts ständigt av situationer där de utsetts för stress. Det kan vara situationer, anhöriga eller identifiering med patienten som ger emotionell stress. Stress som inte hanteras kan ge följdsjukdomar, kvarvarande emotionell påverkan och leda till utbrändhet. Syfte: Att beskriva intensivvårdssjuksköterskors upplevelser av emotionell stress och copingstrategier efter kritiska incidenter. Metod: Intervjustudie med åtta informanter genomfördes. En kvalitativ innehållsanalys genomfördes av de transkriberade intervjuerna. Resultat: Anhörigas reaktioner uppfattades som en stor del av den emotionella stressen, även brister i vård och rutiner lämnar minnen kvar efter kritiska incidenter. Kollegialt samtal var det som upplevdes ha bäst copingstrategi mot den emotionella stressen. Avkoppling, distraktion och sociala miljöer var också ett stöd mot emotionella upplevelsen. En önskan om mer utrymme för kollegiala samtal framkom under intervjuerna. Slutsats: Att kunna få och ta utrymmet för att genomföra samtal mellan kollegor skulle vara stöd mot emotionell stressen framkom i föreliggande intervjustudie. Ledningen bör skapa utrymme för att kollegiala samtal kan genomföras då det har uppvisat vara bästa copingstrategin hos intensivvårdssjuksköterskor. Det uppdagades att vissa brister fanns i att ledningen inte fick information under obekväm arbetstid och rutiner samt informationskällor behöver förtydligas. Fortsatt forskning: Coping av emotionell stress ger styrkor hos personal att kunna hantera svåra situationer, och gå vidare i arbetet utan kvarvarande påverkan av stressen. Intresse skulle finnas att ta reda på hur andra yrkesgrupper resonerar om coping av emotionell stress i samverkan med intensivvårdssjuksköterskor. / Background: The intensive care unit is a high technology environment were critical ill is treated. Intensive care nurses comes in contact of situation where they may encounter stress. It can be situation, relatives or own identifications that gives emotional stress. Stress that is not cooped with can lead to sickness, persistent emotional effects and lead to burnout. Aim: To describe intensive care nurses experiences of emotional stress and coping strategies after a critical incident. Method: Interview study with eight informants was done. A qualitative content analysis was performed of the transcribed interviews. Results: Relatives reaction is a large part of the emotional stress that was experienced, even flaws in care and routines left memories after critical incidents. Peer to peer talks was the support that had best coping strategies against emotional stress. Relaxation, distraction and social context were also support against the emotional distress. Space, time and place, for peer to peer conversation is a desire among informants. Conclusion: To have and to take the time to perform peer to peer talks is a relief against emotional stress. Management should make it a possibility to conclude these talks as it is the preferred coping strategy. Some indication of flaws in information to management during unsocial hours and a need for routines of information need to be looked over and clarified. Further research: Coping of emotional stress gives resilience with the staff to handle difficult situation and to move forward without any lasting effect of the stress. An interest could be in the future to find out how other professionals reasoning about coping of emotional stress in cooperation with intensive care nurses.

<p>  </p> <p>Harshly affected by recent economic recessions, young Millennials had been having a hard time finding a job that meets their expectations or an affordable house. Although it seems like Millennials are suffering financial hardship, media often depict them as impulsive shoppers. Taking inspiration from this contradictory aspect of Millennials, this research explores the relationship between Millennials’ subjective evaluation of their financial status and their spending behaviors. In order to achieve this goal, this study first applies a new psychometric scale, called perceived financial insecurity, to measure Millennials’ feelings and thoughts toward their financial status. Second, it examines the psychological antecedents to perceived financial insecurity. Last, the relationship between financial insecurity and spending behaviors in several consumption areas is examined using the framework of compensatory behavior from social psychology.</p> <p>For the first stage of this research, a perceived financial insecurity scale was developed by conducting literature reviews, in-depth interviews with Millennial consumers, and two online surveys. Consequently, five statements were selected from the initial pool of questionnaire items and used in later stages of this research. Next, another online survey was conducted to empirically test for the impact of six antecedents, namely, perfectionism, self-efficacy, perceived economic mobility, resource scarcity, materialism, and social comparison orientation on perceived financial insecurity. Findings revealed that among the six variables, four (i.e., perfectionism, self-efficacy, perceived economic mobility, and resource scarcity) were found to be the antecedents to financial insecurity. In the final stage, the proposed financial insecurity–compensatory spending model was tested using PLS-SEM. Data used in this stage were self-reported online survey data collected via Prolific. The results showed that financial insecurity directly lessens the amount of dining-out expenditures. However, in four areas of consumption (i.e., fine dining visit frequency, performance visit frequency, short-travel frequency, and long-travel frequency), the indirect path through the increase in dichotomous thinking and impulsivity partially accounted for the relationship between financial insecurity and spending behaviors. Moreover, the relationship between financial insecurity and expenditure amount in the fine dining, short-trip and long-trip areas were fully mediated by dichotomous thinking and impulsivity.</p> <p>In summary, current research shows that a rational thought process prevails in Millennial decision-making for hospitality and tourism consumption, but an irrational thought process through dichotomous thinking and impulsivity accounts for their decision-making for some consumption behaviors. The findings of this research enhance the understanding on Millennials’ subjective evaluation of their financial status by developing a perceived financial insecurity scale and investigating the antecedents to this variable. Moreover, this dissertation offers practical insights to industry professionals by showing the decision-making mechanism behind Millennials’ spending behaviors in several consumption areas. Industry professionals could formulate more detailed marketing strategies using the findings of this dissertation. </p>

Thesis (MEd (Educational Psychology))--University of Stellenbosch, 2009. / Schools, parents and learners have certain expectations of teachers, including their expectations regarding the emotional behaviour of teachers in the classroom. This implies that teachers are occasionally required to project emotions that they are not really experiencing, thereby affecting and influencing their own identity and integrity as teachers. It is with this phenomenon in mind that the influence of feeling rules that form part of emotional labour was researched: the experiences of teachers, and the support that schools provide in this regard, as well as the impact of emotional labour on different teachers. The problem studied is the role that emotional labour plays in the high school educator’s classroom. This problem was researched specifically in the context of the teachers’ personal experiences and opinions. The study focused on how teachers experience emotional labour in their classrooms and working environment, and the influence that it has on them. The primary objective of this research was to analyse and describe the teachers’ perceptions and experiences of emotional labour in the teaching environment. On the one hand, teachers must be aware of the role that emotional labour plays in the classroom. On the other hand, it is particularly important that the management of schools should provide teachers with the required recognition, support and development relevant to this important concept. The purpose of this study is therefore, to sensitise awareness of this concept and to contribute to improved insight into it, so that the feelings and perceptions of teachers regarding the effort that emotional labour demands from them can be better understood. This study has a generic qualitative perspective in the use of the research approach and methods that embrace a phenomenological point of view, where reality is based upon the perceptions of teachers –in the field – that participated in the study. The result is of a descriptive nature. A non-probability sampling technique was adopted, specifically the convenience sample, on the basis of which ten participants were selected according to their availability and willingness to participate in this study. Data was generated by means of semi-structured interviews with two focus groups and four individual interviews recorded on tape and transcribed verbatim. Data processing was done by means of the constant comparative method of analysis. The coding of data according to certain selection criteria led to the identification of themes, categories and sub-categories. The relationships between the themes were integrated into a conceptual model. These themes describe the possible elements that influence the role of emotional labour in the classroom of the educator. The results illustrate that teachers identify the elements that play a role in how the teachers in this group experience emotional labour in the classroom: their identity as teachers, their work context, the feeling rules, the support they receive or the lack thereof, the extent of their practical experience in education, the strategies they use in handling emotional labour, and lastly, the consequences of emotional labour. This implies that the ability of teachers to experience emotional labour positively in the education environment is largely dependent on the support, guidance and leadership that they receive from their schools.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-17T10:23:56Z No. of bitstreams: 2 Dissertação - Gabriel Camargo da Silva - 2016.pdf: 2237673 bytes, checksum: f750ddf2e821b6d6b8bc80eae327232d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-17T10:24:17Z (GMT) No. of bitstreams: 2 Dissertação - Gabriel Camargo da Silva - 2016.pdf: 2237673 bytes, checksum: f750ddf2e821b6d6b8bc80eae327232d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-01-17T10:24:17Z (GMT). No. of bitstreams: 2 Dissertação - Gabriel Camargo da Silva - 2016.pdf: 2237673 bytes, checksum: f750ddf2e821b6d6b8bc80eae327232d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-10-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Ghrelin is a 28 amino acid peptide described at 90’s. Within its multiple functions, production of growth hormone (GH), food intake, cell proliferation, regulation of cardiovascular system and behavior may be highlighted. Ghrelin actions are mediated by the growth hormone secretagogue receptor subtype 1a (GHS-R1a), which is distributed along several peripheral tissues and central areas involved in the control of cardiovascular responses to aversion. Since GHS-Rs1a is expressed in central areas that govern cardiovascular responses to aversion, our aim was to assess the role of Ghrelin in the cardiovascular reactivity to acute emotional stress. Adult male Wistar rats (250-350g) underwent acute emotional stress following i.v. injection of ghrelin (1 or 10 µg/kg), the antagonist of GHS-R1a (PF04628935) or vehicle (VHE). We further investigated the cardiac beta-adrenergic sensitivity in vivo by injecting isoproterenol (1 µg/kg) and ghrelin (10 µg/kg). Autonomic blockade was reached by subsequent injections of atenolol (4 mg/kg), methylatropine (3 mg/kg), ghrelin (10 µg/kg) e VHE. Finally, we evaluated in isolated hearts the effects of perfusion with ghrelin (0.2nMol/L) followed by crescent bolus concentrations of isoproterenol and acetylcholine. Current findings show that ghrelin potentiates the tachycardia evoked by restraint and by air jet stress. We demonstrated that administration of ghrelin improves beta-adrenergic sensitivity in vivo and ex vivo. Autonomic blockade experiments revealed that autonomic nervous system, through sympathetic branch, modulates the stress-evoked positive chronotropy. Furthermore, perfusion of isolated hearts with ghrelin resulted in positive inotropy and potentiated contractile responses caused beta-adrenergic agonism, without altering the amplitude of the responses evoked by acetylcholine. In conclusion, administration of ghrelin and the consequent activation of GHS-R1a increased the magnitude of the tachycardia evoked by acute emotional stress by modulating autonomic nervous system and through peripheral mechanisms, strongly dependent on activation of cardiac beta-adrenergic receptors. / A grelina é um peptídeo de 28 aminoácidos identificado no fim da década 90. Dentre suas várias funções, destacam-se a produção do hormônio de crescimento (GH), os efeitos sobre o apetite, proliferação celular, participação no sistema cardiovascular e regulação do comportamento. Sua ação se dá pela ligação ao receptor secretagogo do hormônio do crescimento subtipo 1a (GHS-R1a) distribuído em vários tecidos periféricos e em algumas regiões do sistema nervoso central (SNC) envolvidas na modulação cardiovascular durante eventos aversivos. Sabendo que os GHS-R1a são distribuídos em áreas centrais que modulam as respostas cardiovasculares durante eventos aversivos, o objetivo do nosso trabalho foi avaliar o papel da grelina nas respostas cardiovasculares evocadas por estresse emocional agudo. Ratos Wistar (250-350g) foram submetidos ao estresse emocional agudo após administração i.v. de grelina (1 ou 10 µg/kg), antagonista de GHS-R1a (PF04628935) ou veículo (VHE).Também avaliamos a sensibilidade beta adrenérgica cardíaca in vivo com administrações de isoproterenol na dose 1 µg/kg e grelina (10 µg/kg). O bloqueio autonômico cardíaco foi realizado com administrações de atenolol (4 mg/kg), metilatropina (3 mg/kg), grelina (10 µg/kg) e VHE. Por fim, avaliamos em corações isolados os efeitos da perfusão com grelina na concentração de 0,2 nMol, seguida de administrações in bolus de concentrações crescentes de isoproterenol e acetilcolina. Os achados demonstram que a grelina potencia a taquicardia evocada pelo estresse por contenção e por jato de ar. Demonstramos que a administração de grelina promove um aumento da sensibilidade beta adrenérgicai n vivo e ex vivo. Os experimentos de bloqueio autonômico revelaram que o sistema nervoso central, através do eixo simpático, modula a resposta taquicárdica pela administração de grelina. Além disso, a perfusão de corações isolados com grelina promoveu um aumento da contratilidade cardíaca e potenciação da resposta ao agonismo beta adrenérgico, sem alterar a resposta à acetilcolina. Em conclusão, a administração de grelina e subsequente ativação de GHS-R1a potencia a taquicardia evocada por estresse emocional agudo através da modulação do sistema nervoso central e de mecanismos periféricos, dependentes da ativação de receptores beta adrenérgicos cardíacos.

The aims of the present thesis were: * To investigate how women patients with borderline personality disorder (BPD) perceive their suffering, quality of life and encounter with psychiatric care (paper 11 and III). * To describe BPD patients' and psychiatric professionals' perceptions of receiving and giving dialectical behavioural therapy, DBT (paper I). * To investigate how starting treatment of BPD patients with DBT affected the psychiatric professionals' experience of occupational stress and professional burnout (paper IV) Due to the different types of research questions the thesis deal with, it uses a mix of qualitative and quantitative research methods. In two of the studies (11 and 111) the main methods were qualitative. Data from free format questionnaires, individual- as well as group interviews and biographical texts, were analysed with content analysis or a hermeneutic approach. In study Ill the methods were quantitative. A summated rating scale measuring healthrelated quality-of-life (HRQOL) was analysed with descriptive and inferential statistics. In study IV quantitative and qualitative methods were combined. Two burnout inventories were analysed with descriptive and inferential statistics, and data from free format questionnaires and group interviews were analysed with qualitative content analysis. The main findings were that BPD patients suffer to an extent that is often unendurable, leading to deliberate self-harm (DSH) and suicide attempts to relieve suffering or just try to get away from it all (paper 11). In study Ill the BPD patients showed significantly poorer quality-of-life (even physical) than normal population controls of comparable age. The suffering, suicide attempts, DSH and poor quality-of-life (paper 11 and 111) put the patients in a position of voluntarily or involuntarily getting involved with psychiatric care. Study II revealed a double role of the psychiatric care in relation to BPD patients. On one hand, psychiatric professionals can add to the suffering by not being understanding and being disrespectful, on the other hand they can be helpful and relieve suffering by being respectful, understanding and validating. There was a clear relationship between the patients' experience of validation and the experience of being helped. DBT seems (both from the patients' and psychiatric professionals' perspective) to be a treatment with a philosophy, content and structure being able to relieve BPD patients suffering and helping them to independence and a bearable life-situation (paper I). Study IV confirms previous findings that psychiatric professionals experience treatment of self-harming patients as profoundly stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients due to its high degree of structure and specific techniques. The DBT team-work and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some professionals felt also improved their handling of other work stressors not related to DBT. This finding also corresponds to BPD patients' perceptions of the mindfulness component in DBT, which they reported as particularly helpful (paper 1). It should be noted that the patient samples in the thesis may be considered as a "worse off" subgroup among BPD patients, as they usually entered special treatment programs after a period of escalating symptoms, which standard psychiatric services had had difficulties handling. The rather small number of participants and the lack of equivalent andlor concurrent control groups in the quantitative studies limit the generalization of the results.

Submitted by Livia Mello (liviacmello@yahoo.com.br) on 2016-10-03T13:24:24Z No. of bitstreams: 1 DissLGS.pdf: 2043932 bytes, checksum: 2dbd0889b9f3fb31e59390124abd82bd (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-04-24T19:29:15Z (GMT) No. of bitstreams: 1 DissLGS.pdf: 2043932 bytes, checksum: 2dbd0889b9f3fb31e59390124abd82bd (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-04-24T19:29:21Z (GMT) No. of bitstreams: 1 DissLGS.pdf: 2043932 bytes, checksum: 2dbd0889b9f3fb31e59390124abd82bd (MD5) / Made available in DSpace on 2017-04-24T19:39:20Z (GMT). No. of bitstreams: 1 DissLGS.pdf: 2043932 bytes, checksum: 2dbd0889b9f3fb31e59390124abd82bd (MD5) Previous issue date: 2016-03-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The endocannabinoid neurotransmission has been reported as an important neurochemical mechanism involved in behavioral and physiological responses to stress. Previous studies provided evidence of endocannabinoid release in the bed nucleus of the stria terminalis (BNST) during aversive stimuli. Nevertheless, a possible involvement of this neurochemical mechanism in stress responses has never been evaluated. Therefore, in the present study we investigated the involvement of endocannabinoid neurotransmission within the BNST, acting via local CB1 receptor, in cardiovascular responses evoked by acute restraint stress in rats. We found that microinjection of the selective CB1 receptor antagonist AM251 (1, 30, and 100 pmol/100 nL) into the BNST enhanced the heart rate increase caused by restraint stress, without affecting the arterial pressure increase and the sympathetic-mediated cutaneous vasoconstriction response. Conversely, increase in endogenous levels of anandamide in the BNST evoked by local treatment with the fatty acid amide hydrolase (FAAH) enzyme inhibitor URB597 (30 pmol/100 nL) decreased restraint-evoked tachycardia. Inhibition of the hydrolysis of 2-arachidonoylglycerol (2-AG) in the BNST by local microinjection of the monoacylglycerol lipase (MAGL) enzyme inhibitor JZL184 (30 pmol/100 nL) also decreased the HR response to restraint. Effects of BNST treatment with either URB597 or JZL184 were inhibited by local pretreatment with the CB 1 receptor antagonist AM251. These findings indicate an involvement of BNST endocannabinoid neurotransmission, acting via CB1 receptor, in cardiovascular adjustments during emotional stress. Furthermore, present findings provide evidence that this control may be mediated by local release of either anandamide or 2-AG. / A neurotransmissão endocanabinóide tem sido reportada como um importante mecanismo neuroquímico envolvido em respostas comportamentais e fisiológicas ao estresse. Estudos anteriores forneceram evidências da liberação de endocanabinóides no núcleo leito da estria terminal (NLET) durante os estímulos aversivos. No entanto, um possível envolvimento deste mecanismo neuroquímico do NLET nas respostas ao estresse nunca foi investigada. Portanto, no presente estudo nós investigamos o envolvimento da neurotransmissão endocanabinóide no NLET, agindo via receptor CB1 local, nas respostas cardiovasculares desencadeadas pelo estresse de restrição agudo em ratos. A microinjeção de AM251 (antagonista seletivo do receptor CB1) (1, 30 e 100 pmol/100 nL) no NLET aumentou a resposta de taquicardia causada pelo o estresse de restrição agudo, sem afetar as respostas de aumento da pressão arterial e a de vasoconstrição cutânea. Por outro lado, o aumento dos níveis endógenos do endocanabinóide anandamida (AEA) no NLET causado pelo tratamento local com URB597 (inibidor da enzima ácido graxo amino hidrolase -FAAH) (30 pmol/100 nL) atenuou o aumento da frequência cardíaca desencadeada pelo o estresse de restrição agudo. O aumento nos níveis locais de 2-araquidonoilglicerol (2-AG) no NLET causado pelo tratamento local com JZL184 (inibidor da enzima monoacilglicerol lipase - MAGL) (30 pmol/100 nL) também reduziu a resposta taquicárdica desencadeada pelo o estresse de restrição agudo. Os efeitos tanto do URB597 quanto do JZL184 foram abolidos após o pré-tratamento local do NLET com o antagonista seletivo do receptor CB1 (AM251). Estes resultados indicam um envolvimento da neurotransmissão endocanabinóide no NLET, agindo via receptor CB1 , nos ajustes cardiovasculares durante o estresse emocional. Além disso, nossos achados fornecem evidências de que este controle pode ser mediado pela liberação local tanto de anandamida quanto de 2-AG.

Ce travail avait pour but de déterminer, chez le rat vigil, le rôle de l’innervation sympathique dans le contrôle de l’hémodynamique cérébrale 1/ au cours d’une période d’activité normale d’environ 4 heures, et 2/ lors d’une augmentation aiguë de la pression artérielle (PA) induite par un stress émotionnel (jet d’air). Les débits sanguins dans les artères carotides internes (DSCa) ont été mesurés grâce à des sondes Doppler chroniquement implantées, chez des rats intacts ou ayant subi l’exérèse unilatérale du ganglion cervical supérieur. Le stress induit une élévation brusque et importante de la PA qui s’accompagne d’une hyperémie et d’une vasodilatation beaucoup plus marquées du côté dénervé que du côté innervé. Dans les conditions de base, l’analyse spectrale révèle une augmentation de la variabilité du DSCa du côté dénervé. La cohérence entre les deux DSCa, qui fournit un index de corrélation linéaire dans le domaine fréquentiel, a été calculée avant (cohérence ordinaire) et après élimination mathématique de l’influence de la PA (cohérence partielle). Les cohérences ordinaire et partielle sont diminuées par la sympathectomie unilatérale dans une bande de fréquences comprises entre 0,01 et 0,1 Hz. Ceci suggère un rôle modulateur important de l’innervation sympathique vis-à-vis de ces fluctuations lentes des DSCa. Ces résultats montrent que chez le rat vigil, l’innervation sympathique exerce un rôle protecteur de la circulation cérébrale face aux augmentations de PA au cours du stress émotionnel. Par ailleurs, cette innervation module des fluctuations spontanées lentes du débit sanguin cérébral qui ne sont pas directement reliées aux fluctuations de la PA. / The goal of the present work was to determine, in conscious rats, the role of the sympathetic innervation in the control of cerebral hemodynamics 1/ during a baseline period lasting ~4 h, and 2/ during an acute increase in blood pressure (BP) evoked by an emotional stressor (jet of air). Blood flows in internal carotid arteries (CaBF) were recorded with Doppler flow probes chronically implanted in intact rats and in rats that underwent unilateral excision of the superior cervical ganglion. Stress induced a large and brisk increase in BP which was accompanied by hyperemia and vasodilatation that were much stronger on the denervated than on the intact side. Spectral analysis demonstrated an overall enhancement of CaBF variability on the denervated side. Coherence between the two CaBFs, which provides an index of linear correlation in the frequency domain, was computed before (ordinary coherence) and after (partial coherence) mathematically eliminating the influence of BP. Both ordinary and partial coherences were lowered by unilateral sympathectomy in the 0.01-0.1 Hz frequency range, which suggests an important modulatory role for sympathetic innervation with respect to these slow CaBF fluctuations. These results indicate that in the conscious rat, sympathetic innervation plays a protective role of the cerebral circulation in the face of stress-induced increases in BP. On the other hand, this innervation modulates slow, spontaneous fluctuations of cerebral blood flow which are not directly related to BP fluctuations.

Neste trabalho realizou-se a avaliação de pacientes com doenças inflamatórias intestinais (DII) - doença de Crohn (DC) e retocolite ulcerativa idiopática (RCUI) quanto às variáveis psicológicas estresse e modos de enfrentamento utilizado frente à situação de doença. Investigaram-se, ainda, as relações entre estas variáveis e diferentes aspectos clínicos das DII. Os grupos de pacientes com DC e RCUI foram compostos por 25 integrantes cada, que foram comparados com igual número de controles doentes (CD) e saudáveis (CS), sendo estes últimos selecionados dentre os acompanhantes dos pacientes. Empregaram-se instrumentos padronizados e validados de avaliação psicológica: escala de eventos vitais e inventário de enfrentamento. Os resultados mostraram que proporções elevadas e semelhantes (64 80%) dos integrantes dos quatro grupos apresentaram-se sob estresse intenso, ocorrendo, porém, diferenças entre os grupos quanto aos tipos de eventos vitais estressantes experimentados. O estresse intenso se mostrou maior e associado significativamente à idade mais avançada na DC e à doença em atividade na RCUI. Quanto aos modos de enfrentamento, na DC e na RCUI, verificaram-se proporções semelhantes e significativamente superiores à do grupo CD de casos utilizando a estratégia de confronto (40% vs. 12%; p=0,01). Na DC, a proporção de pacientes utilizando a estratégia de resolução de problemas foi significativamente maior que na RCUI (96% vs. 80%; p=0,05). Na RCUI, a proporção de pacientes utilizando a estratégia de fuga/esquiva (96%) foi significativamente maior (p=0,05) que nos grupos CD (80%) e CS (76%). A utilização das várias estratégias de enfrentamento parece ser afetada, na DC, por sexo, escolaridade e estado de atividade da doença. Na RCUI, houve efeito das variáveis: escolaridade, estado de atividade e duração da doença e estresse intenso. Estes dados indicam a ocorrência de estresse intenso nos pacientes, independente do tipo de doença e, também nos acompanhantes. A DC e a RCUI se diferenciam quanto às estratégias de enfrentamento mais utilizadas e pelos fatores que as afetam, o que deve ser levado em consideração no estabelecimento de medidas de intervenção psicológica necessárias ao cuidado integral ao paciente. / This work aimed at assessing emotional stress and coping strategies in patients with inflammatory bowel diseases (IBD): Cohns disease (CD) and ulcerative colitis (UC), as well as studying the relationships between this psychological variables and demographical and clinical characteristics. Groups of patients with CD and UC (N=25) were compared with equal number of subjects from two control groups: healthy caregivers (HC) and patients with other digestive diseases (DC). Validated and standardized psychological tools, such as a stressful live events scale and a ways of coping questionnaire were utilized. Results showed that substantial proportions (64 80%) of subjects pertaining to each of the four groups were under severe stress, with a number of inter-group differences regarding the most quoted stressful event. Severe stress was associated with older age in CD patients, and with disease activity in UC patients. Regarding coping strategies, IBD patients showed an increased proportion of utilization of confrontation (40% vs. 12%; p=0.01), when compared to the DC group. In the CD group, there was a higher proportion of patients utilizing the problem solving strategy, than in the UC group (96% vs. 80%; p=0.05). In the UC group, the proportion of patients utilizing the avoidance strategy (96%) was significantly greater (p=0.05) than in both DC (80%) and HC (76%) groups. In IBD patients, coping styles seemed to be affected by sex (only in the CD group), educational level and disease activity, as well as by disease duration and severe stress (only in the UC group). Our data therefore show that severe emotional stress occurs not only in IBD and other digestive disease patients but also in their caregivers. CD and UC patients show different coping styles, which seems also to be affected by distinct demographical and clinical variables. These findings should be taken into account when designing psychological interventions, which are needed for a more comprehensive health care.

INTRODUÇÃO: Pacientes candidatos à cirurgia frequentemente experimentam estresse, condição que os torna suscetíveis a desfechos desfavoráveis como exacerbação de dor, maior consumo de analgésicos e anestésicos, aumento no tempo de hospitalização, maior risco de infecção pós- operatória e aumento no risco de cronificação da dor pós-operatória. Embora seja conhecido que a carga de estresse emocional negativa aumente a morbimortalidade perioperatória, faltam instrumentos práticos desenvolvidos para captar as emoções vinculadas a este contexto. OBJETIVOS: Desenvolver um instrumento breve para medir o estresse psicológico pré-operatório (B-MEPS), tornando possível identificar pacientes mais vulneráveis e assim otimizar medidas de controle. PACIENTES E MÉTODOS: Neste estudo transversal foram incluídos 863 pacientes (643 mulheres) agendados para cirurgia eletiva. Idade entre 18 a 60 anos, classificados de acordo com o estado físico da Sociedade Americana da Anestesiologia (ASA) nas classes I-III. Os seguintes instrumentos foram aplicados: o Inventário de Ansiedade Traço-Estado (IDATE), a Escala de Depressão de Montgomery-Asberg, o Self-Reporting questionnaire (SRQ-20) e o Questionário de Expectativa de Futuro (FSPQ). A fim de selecionar os itens mais discriminativos em relação ao estresse, realizou-se uma análise exploratória usando cada um dos instrumentos. Os critérios utilizados no processo de seleção dos itens, por meio da análise discriminante, foram os candidatos à cirurgia por patologia oncológica ou terem reportado dor pós-operatória moderada a intensa [escore na Escala Análogo-Visual (EAV) > 30 mm]. Neste processo foram selecionados 24 itens, os quais foram ajustados utilizando o modelo de crédito parcial generalizado (GPCM), que é um modelo da Teoria de Resposta ao Item (TRI). A partir do GPCM foram selecionados 16 itens. A validade de face foi realizada por um Comitê de especialistas em medicina perioperatória. Os escores do B-MEPS foram correlacionados com o nível de dor reportado na EAV, na maior parte do tempo das primeiras 24 h do período pós-operatório e com o consumo de morfina pós-operatória quantificado em mg/dia. Esta versão refinada do B-MEPS foi aplicada a 40 pacientes (20 mulheres), ASA II-III, candidatos à cirurgia eletiva. Os escores da B-MEPS foram correlacionados com questões cuja valência semântica apresenta situações que expressam a interferência do estresse na vida diária. RESULTADOS: Inicialmente 24 itens com diferentes números de categorias ordinais foram selecionados a partir dos quatros instrumentos. No processo da GPCM, que objetivou dentre outras finalidades maximizar a confiabilidade, foi realizada a eliminação sequencial de itens internamente inconsistentes. Este processo foi finalizado quando não se observou melhora no nível de consistência nos 16 itens remanescentes, cujo coeficiente alfa de Cronbach foi de 0,83. A TRI propôs modificações nos itens de resposta pelas características das categorias nas Curvas de Resposta ao Item. A curva que avalia a relação entre a localização do conteúdo de traços latentes dos itens sugere que estes apresentam melhor desempenho para identificar níveis de estresse mais levados. O desempenho do conjunto final de itens foi correlacionado com variáveis clínicas relacionadas ao estresse emocional perioperatório como dor (r = 0,23, P < 0,01) e consumo de morfina (r = 0,17, P < 0,01). Um Comitê de experts em medicina perioperatória (N = 30) avaliou a clareza dos itens do B-MEPS usando uma escala análogo-visual de zero a 10. A média global do conjunto de itens foi 8.53 (1,54) e por sugestão deste Comitê o item 16 foi eliminado por falta de clareza. Dois itens do SRQ-20, que apresentavam possibilidade respostas dicotômicas, passaram a ter três possibilidades de respostas. Os escores da versão final preliminar do B-MEPS foram correlacionados com questões cuja valência semântica apresenta situações que expressam a interferência do estresse na vida diária, respondidas por pacientes candidatos à cirurgia eletiva, visando uma validação concorrente preliminar. CONCLUSÃO: Nosso estudo permitiu construir o B-MEPS, que é o resultado do refinamento do conjunto de itens selecionados a partir de instrumentos clássicos para avaliar a carga emocional negativa, a partir da TRI. O conjunto de itens remanescentes apresentou satisfatório nível de consistência interna e o seu escore está correlacionado ao nível de dor. A validação de face e uma pré-validação concorrente preliminar foram realizadas. Este estudo, portanto, concretiza a validação preliminar do B-MEPS como um instrumento útil para ser validado em futuro estudo prospectivo, com o intuito de avaliar a capacidade do B-MEPS predizer desfechos clínicos e orientar o planejamento de intervenções que possam para maximizar o cuidado perioperatório. Embora, este instrumento ainda possa sofrer pequenos ajustes ou adições de algum item após nova analise de TRI prevista após estudo prospectivo com grande numero de pacientes. / INTRODUCTION: Patients who are candidates for surgery often undergo stress, a condition that makes them susceptible to unfavorable outcomes, such as exacerbated pain, greater consumption of analgesic and anesthetics, longer stay in hospital, greater risk of postoperative infection and increased risk of chronification of postoperative pain. Although it is known that the amount of negative emotional stress increases perioperative morbidity and mortality, not many practical instruments have been developed to pick up the emotions connected to this context.. OBJECTIVES: To develop a brief instrument to measure preoperative emotional stress (B-MEPS), enabling the identification of more vulnerable patients and thus optimizing control measures. PATIENTS AND METHODS: In this cross-sectional study, 843 patients were included (643 women) scheduled for elective surgery, age between 18 and 60 years, classified according to the physical status of the American Society of Anesthesiology (ASA) in classes I-III. The following instruments were applied: the State and Trait Anxiety Inventory (STAI), the Montgomery-Asberg Depression Scale, the Self-Reporting Questionnaire (SRQ-20 and the Questionnaire on Expectations for the Future (FSPQ) Future self-perception questionnaire. In order to select the most discriminative items regarding stress, an exploratory analysis was performed using each of the instruments, The criteria used in the process of selecting the items, by means of discriminant analysis, are that they were candidates for surgery due to an oncological pathology, or that they had reported moderate to intense postoperative pain [score on the Analogue-Visual Scale AVS > 30 mm]. In this process 24 items were selected which were adjusted using the generalized partial credit model (GPCM), which is a model of the Theory of Response to Item (TRI). Sixteen items were selected based on the GPCM. The face validity was performed by a Committee of specialists in perioperative medicine. The B-MEPS scores were correlated with the level of pain reported in the AVS, mostly in the first 24 hours of the postoperative period, and with the consumption of morphine postoperatively, quantified as mg/day. This refined version of B-MEPS was applied to 40 ASA II-III patients (20 women) who were candidates for elective surgery. The B-MEPS scores were correlated with questions whose semantic valence present situations that express the interference of stress in everyday life. RESULTS: Initially, 24 items with different numbers of ordinal categories were selected based on the four instruments. In the GPCM process which, among other goals included maximizing reliability, the sequential elimination of internally inconsistent items was performed. This process was finalized, when no improvement was found in the level of consistency in the 16 remaining items, whose Cronbach’s Alpha coefficient was 0.83. The TRI proposed modifications in the response items due to the characteristics of the categories in the Curves of Response to the Item. The curve that evaluates the relationship between the location of the content of latent traits of the items suggests that these present a better performance to identify higher levels of stress. The performance of the final set of items was correlated with clinical variables related to perioperative emotional stress, such as pain (r = 0.23, P < 0.01) and consumption of morphine (r = 0.17, P < 0.01). A Committee of experts in perioperative medicine (N=30) evaluated the clarity of the items of B-MEPS using an analogue-visual scale from zero to 10.. The global mean of the set of items was 8.53 (1,54) and per suggestion of this Committee, item 16 was eliminated due to lack of clarity. Two items of the SRQ-20, which presented the possibility of dichotomous answers acquired three possible answers. The scores of the preliminary final version of B-MEPS were correlated with questions whose semantic valence presents situations that express the interference of stress in everyday life, answered by patients who were candidates to elective surgery, aiming at a preliminary concurrent validation. CONCLUSION: Our study allowed constructing B-MEPS, which is the result of the refinement of the set of items selected from classical instruments to evaluate the negative emotional load based on TRI. The set of remaining items presented a satisfactory level of internal consistency and its score is correlated with the level of pain. Face validation and a preliminary concurrent pre-validation were performed. This study, thus, materializes the preliminary validation of B-MEPS as a useful instrument to be validated in a future prospective study, aiming at evaluating the capacity of B-MEPS to predict clinical outcomes and guide the planning of interventions that can maximize perioperative care. However, this instrument may still undergo small adjustments or additions of some item after a new TRI analysis foreseen after a prospective study with a large number of patients.