La esquizofrenia está considerada un síndrome clínico heterogéneo con una etiopatogenia de origen multifactorial, en el que se incluyen factores ambientales, caracteriales y genéticos. A pesar de que más del 50% de la variabilidad de la enfermedad se puede deber a uno o varios factores genéticos, sólo un número limitado de variantes de riesgo genético y con un efecto muy débil han podido ser identificados. Muchos de ellos no han podido reproducirse tanto por la diversidad de las muestras y poblaciones estudiadas como por su asociación a diversas enfermedades mentales. Parte de esta heterogeneidad ha intentado ser solventada mediante el uso de endofenotipos o fenotipos intermedios y marcadores biológicos, usados como marcadores de vulnerabilidad genética. El gen de la Catecol-O-Metil Transferasa (COMT), que codifica un enzima catabolizador de dopamina en el córtex prefrontal ha sido estudiado como uno de los genes candidatos más prometedores en el estudio de la etiopatogenia de la esquizofrenia, especialmente el polimorfismo rs4680 (COMT Val158Met). La posibilidad de asociar alteraciones en la regulación dopaminérgica prefrontal se encontraría refrendada por la hipótesis dopaminérgica revisada, según la cual, en la esquizofrenia existiría un desequilibrio dopaminérgico, con un incremento en la función dopaminérgica subcortical D2 y un déficit de estimulación D1 cortical. El polimorfismo COMT Val158Met no ha podido confirmar su asociación con esquizofrenia, existiendo en todo caso un riesgo muy débil asociado al alelo hiperfuncionante Val158. El estudio de endofenotipos y marcadores biológicos ha sugerido la asociación del polimorfismo con alteraciones cognitivas, neurofisiológicas, neuroanatómicas y a fenotipos clínicos como agresividad, suicidio, síntomas psicóticos, edad de inicio y respuesta clínica, encontrándose resultados heterogéneos, así como la existencia de una modulación del riesgo de asociación por el consumo de cannabis. Gran parte de la heterogeneidad puede explicarse por problemas metodológicos, relacionados con la validez y representatividad de las muestras, que podrían solventarse con la recogida sistemática de variables en muestras epidemiológicas en fases iniciales de la enfermedad. Partiendo de la hipótesis de la existencia de una alteración dopaminérgica prefrontal en la esquizofenia, el alelo Val158 del gen COMT estaría asociado a una expresión de síntomas psicóticos más graves, especialmente los negativos y a factores de mal pronóstico. Igualmente el consumo de cannabis podría modular este riesgo, incrementando el riesgo o contrarrestando los factores protectores. El objetivo principal fue estudiar la asociación de la presentación clínica y evolución a las seis semanas de tratamiento antipsicótico de pacientes con un primer episodio de psicosis y las variantes del polimorfismo COMT Val158Met así como su interacción con el consumo de cánnabis premórbido. Los objetivos secundarios fueron estudiar la incidencia de esquizofrenia y validar la representatividad de la muestra, analizar la relación entre el polimorfismo Val158Met y sintomatología clínica, edad de inicio, respuesta al tratamiento y estimar la presencia de interacciones gen-ambiente con el consumo de cánnabis premórbido. Para ello, se reclutaron 174 pacientes consecutivos con un primer episodio de psicosis de esquizofrenia, trastorno esquizofreniforme, trastorno esquizoafectivo, trastorno psicótico breve o trastorno psicótico no especificado, incluidos dentro del programa PAFIP, diseñado para la detección y tratamiento de los casos incidentes en la comunidad de Cantabria de Febrero 2001 a Febrero 2005. Los pacientes fueron evaluados con una entrevista semiestructurada, las escalas SANS, SAPS, HDRS, CDS, YMRS y la entrevista SCID-I. Fueron seguidos durante las primeras seis semanas de tratamiento antipsicótico de asignación aleatoria (olanzapina, risperidona o haloperidol). El genotipo del polimorfismo rs4680 se determinó en muestras de sangre venosa. Un primer estudio mostró una incidencia tratada de 1.38/10000 y la asociación de esta incidencia a factores de riesgo como edad menor de 25 años, sexo masculino, estado marital soltero, desempleo nivel educativo primario, ambiente urbano y consumo de cannabis. Un segundo estudio encontró una asociación del alelo Val158 con sintomatología negativa al inicio y edad de inicio temprana, diagnóstico de esquizofrenia y duración de psicosis sin tratar prolongada en mujeres. En un tercer estudio se mostró la asociación del consumo de cánnabis premórbido con edad de inicio más temprana y una interacción entre consumo de cannabis y el genotipo, de modo que el consumo de cannabis contrarresta el efecto protector del alelo 158 Met. Finalmente, en un cuarto estudio se confirmó la persistencia de la asociación del genotipo Val158Met con mayor sintomatología negativa tras seis semanas de tratamiento, no encontrando diferencias en cuanto a la respuesta clínica. Los resultados muestran que el polimorfismo COMT Val158Met pueden estar asociados a una edad de inicio más temprana y una mayor gravedad de síntomas negativos. Del mismo modo, el consumo de cánnabis premórbido se asocia a una menor edad de inicio y se encuentra un patrón de interacción con el polimorfismo, eliminando los efectos protectores del alelo Met158. Los hallazgos sugieren la importancia del polimorfismo COMT Val158Met y del consumo de cannabis en la etiopatogenia de la esquizofrenia, que podría explicarse por la disminución de trasmisión dopaminérgica prefrontal. / The schizophrenia is considered a heterogeneous syndrome which has multifactorial causes, including environmental, characterial and genetic factors. Despite the fact that 50% of the variability of the illness is explained by genetic factors, only a limited number of genetic variants have been identified as weak risk factors. Most of them have not been replicated because of the heterogeneity of the studied samples and the association with other mental illnesses. This variability has been tried to be solved by the use of endophenotypes and biological markers, as indicators of genetic vulnerability. Catechol-O-Methyltransferase gene, that codifies a dopamine degradation enzyme active in prefrontal cortex, has been studied as one of the most promising candidates in the etiopathogenesis of schizophrenia, particularly the rs4860 polymorphism (Val158Met). The possible association with an altered prefrontal dopaminergic transmission would be supported by the revised dopaminergic theory. Following this theory, there is a dopaminergic disequilibrium in schizophrenia, with an increase in subcortical D2 dopaminergic transmission and a deficit in D1 cortical stimulation. COMT Val158Met polymorphism has not consistently associated with schizophrenia. The study of endophenotypes and biological markers has suggested associations with cognitive deficits, neurophysiologic and neuroanatomic markers and with clinical phenotypes, such as aggressiveness, suicide, psychotic symptoms, age of onset and clinical response. It also has been reported an interaction with cannabis in the modulation of the risk of psychosis. This heterogeneity could be explained by methodological biases, related to the validity and representativeness of the studied samples and may be solved with the systematic study of epidemiological samples of patients in the initial phases of psychosis. Following the hypothesis of the existence of an altered prefrontal dopaminergic transmission, the Val158 allele in the COMT gene would be associated with more severe psychotic symptoms, particularly negative symptoms and with poor prognostic factors. Likewise, the premorbid use of cannabis could modulate this risk, increasing the risk or counteract the protective factors. The main objective was to study the association between the clinical onset and evolution in the first 6 weeks of treatment and the COMT Val158Met polymorphism as well as the interaction with premorbid cannabis use. The secondary objectives were to study the incidence of schizophrenia and validate the representativeness of the sample, to analyse the relation between the Val158Met polymorphism and clinical symptoms, age of onset, clinical response to treatment and to estimate the presence of gen-environment interactions with the premorbid cannabis use. 174 consecutive first episode psychosis patients with a diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder or psychosis non-otherwise specified were included in the PAFIP program. The program was designed for the detection and treatment of all cases in the region of Cantabria, form February 2001 to February 2005. The patients were assessed with a semi-structured interview, SANS, SAPS, HDRS, CDS, YMRS scales and the SCID-I interview. They were followed up to 6 weeks and treated with a randomly assigned antipsychotic (olanzapine, risperidone or haloperidol). Rs4680 polymorphism was assessed in peripheric blood samples. A first study showed a treated incidence of 1.38/10000 and the association with several risk factors such as age under 25 years, male gender, single marital status, unemployment, primary educational level, urban environment and cannabis use. A second study found an association between the Val158 allele and negative symptoms severity at onset, early age of onset, schizophrenia diagnosis and longer duration of untreated psychosis in females. A third study showed an association between premorbid cannabis use and early age of onset and an interaction between cannabis use and genotype, indicating that the cannabis use counter act the protective effect of the Met158Met allele in age of onset. Finally, in a fourth study the association between the Val158 allele and negative symptoms was confirmed after 6 weeks of treatment, although no relation was found with clinical response. The results showed that the COMT Val158Met polymorphism could be associated with an earlier age of onset and a higher severity of negative symptoms. Likewise, the premorbid use of cannabis was associated with an earlier age of onset and there was found a gene-environmental interaction, deleting the protective effect of the Met158 Allele. These findings suggest the importance of COMT Val158Met polymorphism and premorbid cannabis use in the etiopathogenesis of the schizophrenia that could be explained by a decrease in the prefrontal dopaminergic transmission.

Introducció: Són molts els estudis que, en els darrers quinze anys, han demostrat l'efectivitat delsprogrames d'intervenció precoç en la esquizofrènia i el seu impacte sobre el pronòstic de lamalaltia. De fet, la intervenció preventiva a la fase prodròmica i posterior al primer episodi haesdevingut una de les línies principals de recerca i d'aplicació clínica per l'abordatge de laesquizofrènia.Objectiu: Avaluar l'impacte d'una intervenció psicoterapèutica durant la fase inicial de laesquizofrènia sobre la millora clínica i les recaigudes d'un grup que va rebre una intervencióprecoç (PIPE) en comparació amb un grup control (GC) que va rebre controls psiquiàtrics rutinaris.Mètode: Es va realitzar un assaig clínic controlat a simple cec per tal de comparar un grup que vaser tractat amb un programa de controls rutinaris (CG) amb un grup que va participar en elprograma PIPE. Es van aleatoritzar 34 pacients que estaven a la fase inicial de l'esquizofrènia aambdós grups: GC (n=13) i GC+PIPE (n=21). El programa PIPE va estar conformat per teràpiaindividual i familiar cognitivo-motivacional, tenint una duració de 18 mesos (entre 34-36sessions). Les avaluacions clíniques es van portar a terme a la valoració basal, als 3,6,9,12 i 18mesos per avaluadors externs, a més del seguiment als 6 mesos d'haver finalitzat la intervenció. Esva avaluar als pacients mitjançant l'escala PANSS (versió espanyola de l'Escala dels síndromespositiu i negatiu; Cuesta i Peralta, 1994) , l'escala BPRS (Brief Psychiatry Rating Scale; Overall iGorham, 1962), l'escala CGI (Clinical Global Impressions; National Institute of Mental Health,1976) i l'EEAG (Escala d' Avaluació de l'Activitat Global; American PsychiatricAssociation,1995). A més, es van recollir els índexs de recaigudes globals i específiques en númerode hospitalitzacions, estades a l'hospital de dia, visites a urgències, visites no programades,agudització simptomàtica i els increments de medicació.Resultats principals: S'observen diferencies estadísticament significatives entre els dos grupsesmentats ja als tres mesos d'intervenció respecte a l'avaluació basal (p=0,000) que es mantenenestables fins al seguiment als 6 mesos (p=0,000) a l'avaluació amb l'escala BPRS. Respecte al'avaluació del síndrome positiu, negatiu i de psicopatologia general puntuat amb la PANSSs'observen també diferències notables als sis mesos que es mantenen fins al final de la intervencióals 18 mesos (PANSS-P, p=0,02;PANSS-N, p=0,004;PANSS-PG, p=0,000). D'acord amb aquestsresultats es presenten diferències estadísticament significatives a les puntuacions de les escales CGIi EEAG amb resultats notables ja als sis mesos (CGI, p=0,000; EEAG, p=0,001) i que es mantenenfins al seguiment (CGI, p=0,000; EEAG, p=0,000). Respecte a les recaigudes s'observendiferències estadísticament significatives entre els grups als 18 i als 6 mesos de seguiment ennúmero d'hospitalitzacions (p=0,000), en estades a l'hospital de dia (p=0,000), visites al serveid'urgències (p=0,048) i en augments de medicació (p=0,002). Resultats semblants s'observen a lesmesures de recaigudes globals en la comparació entre grups tant al final de la intervenció comdurant el seguiment als 6 mesos (p=0,018; p=0,048 respectivament).Conclusió principal: El programa d'intervenció precoç PIPE té un impacte alt sobre la milloraclínica i les recaigudes als 18 mesos d'intervenció que es manté durant el període de seguiment als6 mesos.<(p> / Introducción: Son muchos los estudios que en los últimos quince años han demostrado laefectividad de los programas des intervención precoz en la esquizofrenia y su impacto sobre elpronóstico de la enfermedad. De hecho, la intervención preventiva en la fase prodrómica yposterior al primer episodio se ha convertido en una de las líneas principales de investigación y deaplicación clínica para el abordaje de la esquizofrenia.Objetivo: Evaluar el impacto de una intervención psicoterapéutica durante la fase inicial de laesquizofrenia sobre la mejoría clínica y las recaídas de un grupo que recibió una intervenciónprecoz (PIPE) en comparación con un grupo control (GC) que recibió controles psiquiátricosrutinarios.Método: Se realizó un ensayo clínico controlado a simple ciego para comparar un programa decontroles rutinarios (CG) con el programa PIPE. Se aleatorizaron 34 pacientes que estaban en lafase inicial de la esquizofrenia a ambos grupos: GC (n=13) y GC+PIPE (n=21). El programa PIPEestuvo conformado por terapia individual y familiar cognitivo-motivacional, teniendo una duraciónde 18 meses (entre 34-36 sesiones). Las evaluaciones clínicas se llevaron a cabo en la valoraciónbasal, a los 3,6,9,12 y 18 meses por evaluadores externos, además del seguimiento a los 6 meses.Se evaluó a los pacientes mediante la escala PANSS (versión española de la Escala de lossíndromes positivo y negativo; Cuesta y Peralta, 1994), la escala BPRS (Brief Psychiatry RatingScale; Overall y Gorham, 1962), la escala CGI (Clinical Global Impressions ; National Institute ofMental Health, 1976) y la EEAG (Escala de Evaluación de la Actividad Global; AmericanPsychiatric Association,1995). Además, se recogieron los índices de recaídas globales y específicasen número de hospitalizaciones, estancias en hospital de día, visitas a urgencias, visitas noprogramadas, agudización sintomática e incrementos de medicación.Resultados principales: Se observan diferencias estadísticamente significativas entre los gruposmencionados ya a los tres meses de intervención respecto a la evaluación basal (p=0,000) que semantienen estables hasta el seguimiento a los 6 meses (p=0,000) en la evaluación con la escalaBPRS. Respecto a la evaluación del síndrome positivo, negativo y de psicopatología generalpuntuado con la PANSS se observan también diferencias notables a los seis meses que semantienen hasta el final de la intervención a los 18 meses (PANSS-P, p=0,02;PANSS-N,p=0,004;PANSS-PG, p=0,000). En acorde con estos resultados se presentan diferenciasestadísticamente significativas en las puntuaciones de las escalas CGI y EEAG con resultadosnotables ya a los seis meses (CGI, p=0,000; EEAG, p=0,001) y que se mantienen hasta elseguimiento a los 6 meses (CGI, p=0,000; EEAG, p=0,000). Respecto a las recaídas se observandiferencias estadísticamente significativas entre los grupos a los 18 meses y los 6 meses deseguimiento en número de hospitalizaciones (p=0,000), en estancias en hospital de día (p=0,000),en visitas al servicio de urgencias (p=0,048) y en aumentos de medicación (p=0,002). Resultadossimilares se observan en las recaídas globales en la comparación entre grupos tanto al final de laintervención como en el seguimiento a los 6 meses (p=0,018; p=0,048 respectivamente).Conclusión principal: El programa de intervención precoz PIPE tiene un impacto alto sobre lamejoría clínica y las recaídas a los 18 meses de intervención que se mantiene durante el periodo deseguimiento a los 6 meses. / Introduction: Many studies have shown the effectiveness of early intervention programs forschizophrenia and its impact on illness outcome. In fact, the preventive intervention in theprodromical period and after the first episode of psychosis has become the main way for theresearch and clinical procedures for schizophrenia treatments.Objective: The aim of the current study is to assess the improvement and relapse rates of patientswith a diagnosis of schizophrenia (initial phase), which were taking part in a specific Cognitive-Motivational Therapy program (PIPE) in comparison with patients who received the usualpsychiatric treatment (Routine Care, RC).Method: A randomized, controlled, single-blind clinical trial was carried out. A total of 34 patientsand families who were in the initial phase of schizophrenia were allocated either to theexperimental intervention program plus routine care (PIPE, n=21) or to routine care alone (RC,n=13). PIPE consisted of an individual and a family Cognitive-Motivational Therapy, with 18months of length (between 34-36 therapy sessions). Clinical assessments were carried out byexternal raters at baseline, at 3,6,9,12 and 18 months, and the follow-up after 6 months. Patientswere assessed by the PANSS (spanish version of Positive and Negative Syndrome ofSchizophrenia, Cuesta & Peralta, 1994), the BPRS scale (Brief Psychiatry Rating Scale; Overall &Gorham, 1962), the CGI scale (Clinical Global Impressions; National Institute of Mental Health,1976) and the EEAG (Escala de Evaluación de la Actividad Global; American PsychiatricAssociation,1995). On the other hand, global and specific relapses rates were collected attending tothe number of admissions in acute care, admissions in day hospital, emergencies, non programmedvisits and deterioration of symptoms that require intervention by professionals (increase in / changeof medication or non-scheduled visits).Main results: Significantly clinical effects were observed in patients treated within PIPE program(pre-treatment vs. post-treatment at p=0,000) on the BPRS, already after three months. That resultsremain stable to the follow-up after 6 months (p=0,000). In reference to the evaluation for thepositive, negative syndrome and general psychopathology scored with the PANSS were alsoobserved remarkable differences from the 6th month of the intervention to the 18th month(PANSS-P, p=0,02;PANSS-N, p=0,004;PANSS-PG, p=0,000). According to those results,significant statistical differences were observed in CGI and EEAG scores. Those differences wereobserved already after six months (CGI, p=0,000; EEAG, p=0,001) with respect to the baselineassessment and remained stable to the follow-up after 6 months (CGI, p=0,000; EEAG, p=0,000).Statistical significant differences were found between groups with respect to relapses after 18 and 6months follow-up in admissions in the acute care unit (p=0,000), admissions at day hospital(p=0,000), emergencies (p=0,048) and pharmacological treatment increase (p=0,002). Analogueresults were observed in global relapses between groups at the end of the intervention and thefollow-up after 6 months (p=0,018; p=0,048 respectively).Main conclusion: The results show a positive impact of the PIPE intervention program on theimprovement of symptoms and the relapses in patients who are in the initial phase ofschizophrenia.

Bakgrund: En psykos innebär att tappa fotfästet i verkligheten. Risken för att drabbas av försämrad livskvalitet med stort lidande är hög. Tidigt insatta interventioner hos personer med nydebuterad psykos kan hindra ett ogynnsamt sjukdomsförlopp men forskning av nyinsjuknade genererar sällan kunskap gällande omvårdnad. Patienters symptombild med starka vanföreställningar och oro komplicerar ofta försök att interagera och en gynnsam vårdrelation kan vara svår att utveckla i och med patienternas speciella tillstånd. Syfte: Att beskriva hur personalen kan skapa en vårdprocessfrämjande relation med personen som drabbats av nydebuterad psykos på en slutenvårdsavdelning. Metod: Systematisk litteraturöversikt inkluderat femton artiklar med kvalitativt perspektiv för att besvara syftet. Data har analyserats med hjälp av kvalitativ metasummering. Resultat: Resultatet antyder på fördelar med att skapa tillit på ett tidigt stadium med hjälp av vårdrelationen. I och med ökande tillit till omgivningen ökar också behovet av att ha personalen som stöd med kunskap och förståelse för att kunna lösa problem i ett ömsesidigt samarbete. Personalen bör vara tillgänglig, vänlig, kunnig, tydlig, empatisk, flexibel med positiv hållning för gynnsamt skapande av hälsoprocessfrämjande omvårdnad.  Diskussion: I den optimala vårdrelationen sker ett samarbete runt mål och hälsoprocessfrämjande interventioner där personalen stöttar patienternas val med kunskap, uppmuntran och positiv feedback. Att få patienten att acceptera sin situation, att det kanske aldrig blir som förr och att leda in patienten på nya realistiska banor som inger livsmod och hopp kan vara en av personalens största utmaningar. / Background: A psychosis brings a lost sense of reality and generates a high risk of impaired quality of life with great suffering. Research shows that early intervention can prevent a disadvantageous health course whilst seldom generates knowledge regarding nursing as such. The nurse patient relationship is essential but often complicated by lack of trust due to symptoms such as strong delusions and anxiety. Aim: To describe how staff can create a care process promoting relationship with persons affected by recent-onset psychosis at an inpatient ward. Methods: Systematic literature review based on fifteen articles with a qualitative perspective. A qualitative meta-summary was chosen as method for synthesizing and analyzing the findings. Results: The result shows that the caring relationships focus may be on gaining trust at an early stage. As the patient gains trust in the surrounding environment the need for support from staff increases. Problem solving, together with staff, becomes more appreciated as symptoms fade away. Staff who are accessible, friendly, knowledgeable, clear, empathetic, flexible with a positive attitude are beneficial in creating a healthy process of promoting nursing. Discussions: Optimal nurse patient relationship interacts around goals and health process promotion interventions where staff supports the patients’ choices with the use of knowledge, encouragement and positive feedback. Getting the patient to accept their situation, making them realize that life may never be the same, leading them onto new realistic paths inspiring courage and hope, can be one of the staff's greatest challenges.

No description available.

L'étage Valanginien est caractérisé dans le registre sédimentaire par une excursion positive des isotopes du carbone (amplitude 1,5-2‰), appelée " Episode Weissert ". Cet événement coïncide avec des changements paléoenvironnementaux et paléoclimatiques majeurs. La formation de la province volcanique ignée du Paraná-Etendeka a été proposée comme principal facteur forçant contrôlant ces changements. Cependant, de récentes études démontrent que l'Episode Weissert précède systématiquement l'activité volcanique. Ainsi, les facteurs déclenchant qui contrôlent ces changements sont encore source de débat. Dans cette étude des analyses cyclostratigraphique, biostratigraphique, minéralogique et géochimique ont été réalisés sur des sites de moyennes et hautes latitudes (coupes d'Orpierre et de La Charce/Arnayon dans le Bassin Vocontien, site 765C dans la plaine abyssale Argo) dans le but (i) d'explorer la dynamique des changements paléoenvironnementaux à l'échelle locale versus globale et (ii) de discuter des possibles facteurs forçant contrôlant l'épisode Weissert. Les processus diagénétiques et sédimentologiques locaux, qui pouvaient modifier le signal paléoclimatique, ont été discuté avant des interprétations paléoenvironnementales. La calibration astronomique de l'épisode Weissert, réalisée sur la coupe d'Orpierre, a permis pour la première fois le calcul de flux détritiques et de nutriments dans le Bassin Vocontien. Ces résultats indiquent de rapides changements climatiques aux moyennes latitudes, marqués par des conditions plus humides pendant l'Episode Weissert et des conditions plus sèches au Valanginien supérieur. En parallèle de nouvelles données géochimiques et minéralogiques, réalisés sur le site ODP 765C, ont été intégrées à une compilation globale de données géochimique et minéralogique sur 23 coupes répartie dans cinq grands environnements. Trois ceintures climatiques latitudinales majeures ont été identifié durant le Valanginien : (i) une ceinture aride dans l'océan proto Nord Atlantique (~15-17°N), (ii) une ceinture climatique subtropical dans la marge NW téthysienne (~25-30°N), et (iii) une ceinture climatique chaude et tempéré aux sites de hautes latitudes (~53°S et ~40 à ~70°N). Il apparaît que durant cette période, des facteurs orbitaux et tectoniques peuvent avoir contrôlé la distribution de ces ceintures et les principaux changements durant l'Episode Weissert.

Untreated substance use disorders are a major public health concern that has costly consequences at both the societal and individual level. Identifying the characteristics and resources of those who seek help for substance abuse problems in order to inform more effective intervention and treatment techniques is therefore an important research objective. Using the Network Episode Model (NEM) as a theoretical framework, this dissertation examines both substance abuse help-seeking (i.e. inpatient/outpatient treatment and 12-Step meeting attendance) and patterns of drug use over time among low-income African American women, with a special focus on the role of the social network system in shaping these outcomes. Drawing on social network theory, critical race theory, and health service utilization research, this test of the Network Episode Model addresses the relative absence of work examining the connections between network characteristics and help-seeking in multiply marginalized groups. The core relationships proposed by the NEM are systematically tested using longitudinal data gathered for the Black Women in the Study of Epidemics Project (N=643). Findings of multilevel models indicate strong support for the Network Episode Model. Specifically, measures of social influence, social control, and social integration significantly predict both patterns of drug use and help-seeking. Importantly, having contact with and receiving health advice from a physician emerged as a significant predictor of a number of positive outcomes, including quitting or abstaining from illicit drug use during the study and attending 12-Step meetings. Results also reveal that experiences specifically related to low-income African American women’s multiply marginalized status – such as experiencing gendered racism – significantly predict patterns of drug use over the study timeframe and may be an important risk factor for substance abuse. In all, this research reveals the important contributions of both traditional predictors and social network predictors on substance abuse help-seeking and patterns of drug use over time. Conclusions suggest that given the limited financial and material resources of multiply marginalized groups, learning how to mobilize or effectively build upon available social network resources to encourage substance abuse treatment may be a particularly fruitful strategy to explore.

A sociedade contemporânea, atravessada por tecnologias digitais de comunicação e informação (TDCI), experimenta um período de constantes mudanças nas suas formas de estruturação, organização e também nas suas materialidades, práticas e saberes. Parece haver uma complexificação da dinâmica das disputas simbólicas políticas, implicando em alterações de várias ordens, principalmente nas relações existentes entre campo político, esfera midiática e sociedade, introduzindo novos processos, sociabilidades, atores, grupos etc. Em função disso, este trabalho tem por objetivo compreender como se estabelecem – nas esferas conversacionais dos blogs – as interações simbólicas, e como circulam, nas redes sociais digitais, as opiniões formadas nos embates opinativos e orientadas para a disputa na e pela opinião pública. Para tanto, por meio dos procedimentos metodológicos de análise de conteúdo e de análise de redes sociais, estudamos o episódio de racismo na internet contra os nordestinos, deflagrados pelos comentários da estudante Mayara Petruso logo após as Eleições Presidenciais do Brasil, publicados no dia 1º de novembro de 2010, tanto na plataforma Twitter, quanto no seu perfil do Facebook. Os resultados obtidos pelas análises demonstram uma série de potencialidades de ação proporcionadas pelas TDCI aos indivíduos, que possibilitam redimensionamentos dos capitais simbólicos, da esfera de visibilidade pública, do common, dos habitus individuais/coletivos e também da instância da opinião pública. / Given a context extremely surrounded by digital technologies of communication and information (DTCI), contemporary society is undergoing constant changes in its forms of structuring, organizing, and also in its materiality, practices and knowledge. From this, there seems to be a complexification of the dynamics of symbolic political disputes, resulting in changes of several orders, especially in the relations between the political field, media sphere and society, introducing into it new processes, sociability, actors, groups etc. As a result, this study aims to understand how the symbolic interactions are settled within the blog´s conversational sphere and how opinions formed within blogs circulate in digital social networks, leading to the symbolic dispute of public opinion. To achieve that, methods of content analysis and social networks were applied to study the episode of racism on the Internet against the Northeast Brazilian people, triggered by comments made on the 1st of November of 2010 - both on Twitter and Facebook - by the student Mayara Petruso, right after the presidential elections in Brazil. The results obtained by the analysis show a series of potential actions offered by DTCI to individuals, which enable the resizing of their symbolic capital and also on the realm of public visibility, in the common, in the individual/collective habitus and in the instance of public opinion.

A sociedade contemporânea, atravessada por tecnologias digitais de comunicação e informação (TDCI), experimenta um período de constantes mudanças nas suas formas de estruturação, organização e também nas suas materialidades, práticas e saberes. Parece haver uma complexificação da dinâmica das disputas simbólicas políticas, implicando em alterações de várias ordens, principalmente nas relações existentes entre campo político, esfera midiática e sociedade, introduzindo novos processos, sociabilidades, atores, grupos etc. Em função disso, este trabalho tem por objetivo compreender como se estabelecem – nas esferas conversacionais dos blogs – as interações simbólicas, e como circulam, nas redes sociais digitais, as opiniões formadas nos embates opinativos e orientadas para a disputa na e pela opinião pública. Para tanto, por meio dos procedimentos metodológicos de análise de conteúdo e de análise de redes sociais, estudamos o episódio de racismo na internet contra os nordestinos, deflagrados pelos comentários da estudante Mayara Petruso logo após as Eleições Presidenciais do Brasil, publicados no dia 1º de novembro de 2010, tanto na plataforma Twitter, quanto no seu perfil do Facebook. Os resultados obtidos pelas análises demonstram uma série de potencialidades de ação proporcionadas pelas TDCI aos indivíduos, que possibilitam redimensionamentos dos capitais simbólicos, da esfera de visibilidade pública, do common, dos habitus individuais/coletivos e também da instância da opinião pública. / Given a context extremely surrounded by digital technologies of communication and information (DTCI), contemporary society is undergoing constant changes in its forms of structuring, organizing, and also in its materiality, practices and knowledge. From this, there seems to be a complexification of the dynamics of symbolic political disputes, resulting in changes of several orders, especially in the relations between the political field, media sphere and society, introducing into it new processes, sociability, actors, groups etc. As a result, this study aims to understand how the symbolic interactions are settled within the blog´s conversational sphere and how opinions formed within blogs circulate in digital social networks, leading to the symbolic dispute of public opinion. To achieve that, methods of content analysis and social networks were applied to study the episode of racism on the Internet against the Northeast Brazilian people, triggered by comments made on the 1st of November of 2010 - both on Twitter and Facebook - by the student Mayara Petruso, right after the presidential elections in Brazil. The results obtained by the analysis show a series of potential actions offered by DTCI to individuals, which enable the resizing of their symbolic capital and also on the realm of public visibility, in the common, in the individual/collective habitus and in the instance of public opinion.

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A sociedade contemporânea, atravessada por tecnologias digitais de comunicação e informação (TDCI), experimenta um período de constantes mudanças nas suas formas de estruturação, organização e também nas suas materialidades, práticas e saberes. Parece haver uma complexificação da dinâmica das disputas simbólicas políticas, implicando em alterações de várias ordens, principalmente nas relações existentes entre campo político, esfera midiática e sociedade, introduzindo novos processos, sociabilidades, atores, grupos etc. Em função disso, este trabalho tem por objetivo compreender como se estabelecem – nas esferas conversacionais dos blogs – as interações simbólicas, e como circulam, nas redes sociais digitais, as opiniões formadas nos embates opinativos e orientadas para a disputa na e pela opinião pública. Para tanto, por meio dos procedimentos metodológicos de análise de conteúdo e de análise de redes sociais, estudamos o episódio de racismo na internet contra os nordestinos, deflagrados pelos comentários da estudante Mayara Petruso logo após as Eleições Presidenciais do Brasil, publicados no dia 1º de novembro de 2010, tanto na plataforma Twitter, quanto no seu perfil do Facebook. Os resultados obtidos pelas análises demonstram uma série de potencialidades de ação proporcionadas pelas TDCI aos indivíduos, que possibilitam redimensionamentos dos capitais simbólicos, da esfera de visibilidade pública, do common, dos habitus individuais/coletivos e também da instância da opinião pública. / Given a context extremely surrounded by digital technologies of communication and information (DTCI), contemporary society is undergoing constant changes in its forms of structuring, organizing, and also in its materiality, practices and knowledge. From this, there seems to be a complexification of the dynamics of symbolic political disputes, resulting in changes of several orders, especially in the relations between the political field, media sphere and society, introducing into it new processes, sociability, actors, groups etc. As a result, this study aims to understand how the symbolic interactions are settled within the blog´s conversational sphere and how opinions formed within blogs circulate in digital social networks, leading to the symbolic dispute of public opinion. To achieve that, methods of content analysis and social networks were applied to study the episode of racism on the Internet against the Northeast Brazilian people, triggered by comments made on the 1st of November of 2010 - both on Twitter and Facebook - by the student Mayara Petruso, right after the presidential elections in Brazil. The results obtained by the analysis show a series of potential actions offered by DTCI to individuals, which enable the resizing of their symbolic capital and also on the realm of public visibility, in the common, in the individual/collective habitus and in the instance of public opinion.