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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
861

The Role of Calcineurin in Dendritic Remodeling and Epileptogenesis in a Rat Model of Traumatic Brain Injury

Campbell, John 14 February 2012 (has links)
Traumatic brain injury (TBI), a leading cause of death and disability in the United States, causes potentially preventable damage in part through the dysregulation of neural calcium levels. This dysregulation likely affects the activity of the calcium-sensitive phosphatase, calcineurin, with serious implications for neural function. To test this possibility, the present study characterized the role of calcineurin in a rat model of brain trauma, the lateral fluid percussion injury model. Golgi-Cox histochemistry revealed an acute post-TBI loss and delayed overgrowth of dendritic spines on principal cortical cells. The spine loss appeared to require calcineurin activity, since administering a calcineurin inhibitor, FK506, 1 hour after TBI prevented the spine loss. Additional experiments showed how calcineurin activity might be related to the spine loss. Specifically, Western blots and enzyme activity assays revealed an acute increase in the cortical activity of calcineurin and its downstream effector, the actin-depolymerizing protein, cofilin. The cofilin activation was blocked by the same FK506 treatment that prevented spine loss, suggesting a relationship between cofilin activation and spine loss. To investigate long-term consequences of calcineurin activation after TBI, rats were administered FK506 (Tacrolimus) 1 hour after TBI and then monitored for spontaneous seizure activity months later. Acute post-TBI treatment with FK506 reduced the frequency of late non-convulsive seizures but did not prevent late convulsive seizures, cortical atrophy, or thalamic damage. The results of the present study implicate calcineurin in the acute dendritic remodeling and late non-convulsive seizures that occur after TBI. Importantly, these findings reveal calcineurin as a potential therapeutic target in the treatment of TBI and its sequalae.
862

Člověk s postižením v sourozeneckých konstelacích dvojčat a trojčat / Person with disability in sibling constellations of twins and triplets

Kaletová, Magdalena January 2014 (has links)
THE ABSTRACT The thesis deals with sibling relationships of twins and triplets when one or more siblings suffer from some health disability or handicap. It outlines the way of life in sibling constellations of twins and triplets. It deals with the topic of a disabled person who has brothers or sisters. It defines family as a pillar of person's life and it focuses on the sibling relationships. The thesis explains the connection between multiple births and the occurrence of disability, and it considers certain aspects of family life, with the main focus on siblings, when one of the siblings suffers from some health limitation. It also describes twins and triplets and their specific features. For example, it shows the development of the identity of each of the siblings, the role of their birth order, the types of relationships that occur in a family with twins and triplets, and the way the siblings may experience the separation from one another. It draws on publications and other sources that deal with sibling constellations and the resulting relationships among the siblings, on the publications on twins and triplets, on children and adults with disability or handicap. Last not least, it draws on personal experience of the author and on the research interviews. Apart from that, the thesis clarifies how twins...
863

Specifika krizové intervence poskytované příslušníkům policie České republiky / The specifics of crisis intervention provided by members of the police Czech republic

Ottová, Kamila January 2011 (has links)
This diploma thesis deals with the system of a crisis intervention for the staff members of the Police of the Czech Republic. There are described means of psychological assistance for the staff members of the police and the research of trust in the psychological assistance and its awareness of the assistance and whether they use it.
864

Back on the Home Front: Demand/Withdraw Communication and Relationship Adjustment Among Student Veterans

Carver, Kellye Diane Schiffner 08 1900 (has links)
Today’s military encompasses a wide variety of families who are affected by deployments in multiple and complex ways. Following deployments, families must reconnect in their relationships and reestablish their way of life. Appropriate and effective communication during this time is critical, yet many military couples struggle with this process. Moreover, student service members/veterans and their families are in a unique position. In addition to coping with changes in their marital relationship, student veterans may feel isolated or unsupported on college campuses, often experiencing anxiety, depression, posttraumatic stress, or suicidality. The current study seeks to bridge the gap between the military family literature and the student service member/veteran literature by examining how deployment experiences, mental health issues, and communication patterns influence post-deployment relationship adjustment among student veterans. Analyses tested whether communication style and/or current mental health concerns mediate associations between combat experiences and couples’ relationship adjustment, as well as between experiences in the aftermath of battle and relationship adjustment. Results suggest that although posttraumatic stress is significantly related to deployment experiences among student veterans, participants report no significant negative effects of deployment on relationship adjustment. Communication style, however, was significantly associated with relationship adjustment, and a lack of positive communication was found to correlate with PTSD diagnosis. Research and clinical implications are discussed.
865

Analyses of experiences of vicarious traumatisation in short-term insurance claims workers

Ludick, Marne 05 September 2013 (has links)
Thesis (Ph.D.(Psychology))--University of the Witwatersrand, Faculty of Humanities, 2013. / The research entailed a comprehensive study of vicarious trauma in short-term insurance claims workers, compared to trauma counsellors and a control group of holiday booking consultants. A well-known, comprehensive model of compassion fatigue/secondary traumatic stress, developed for therapists formed the basis of the study. The research attempted to determine whether this model can be applied more widely to include administrative populations exposed to traumatised clients on a regular basis. To this end, the model was deconstructed into its eleven constituent parts and each element was investigated in addition to other variables of interest to the study. This was done to determine the importance and applicability of each model element and other selected variables to the administrative context. A mixed methods approach was utilised, which combined quantitative and qualitative data. The results yielded by the study were collectively utilised to construct an etic and an emic voice from the research. At the same time, effects from vicarious trauma were considered from an overarching bio-psychosocial stance, systematically gauging effects on various levels of functioning. Scores from quantitative measures on secondary traumatic stress, negative cognitive schemas, empathy, social support and compassion satisfaction were statistically analysed, which revealed significant differences between the worker groups. Widely accepted relationships between the study variables were tested and found to hold true within and across groups. Regression analysis determined the roles of empathy, social support and compassion satisfaction in vicarious trauma, as measured by secondary traumatic stress and negative cognitive schemas. In addition, constructivist selfdevelopment theory was employed to interpret the negative cognitive effects from vicarious traumatisation. Qualitative data were utilised to further elucidate the role and nature of vicarious trauma in each of the worker groups. The themes of exposure to client suffering, detachment, level of empathic engagement, personal trauma history and difficult life demands were unearthed from the qualitative data, which illuminated the importance and role of each of these elements to claims workers. Other areas of interest, being utilisation of sick-leave as a means to cope, work-related illness, attitudes towards professional counselling, feelings evoked by traumatised clients, and the language utilised by workers in response to client traumata were investigated. Further effects on participants as well iv as effects that reach beyond the person were identified and examined. Effects on the social and work contexts were also elucidated. Finally, interesting themes that emerged spontaneously from the data were considered. The consideration of the various model elements and other areas of interest systematically revealed that administrative workers dealing with traumatised clients are also affected by the process of vicarious trauma. Furthermore, the model was found to be largely suitable to the context of claims workers. However, the model was expanded to augment its usability within the more general administrative domain. Finally, the overarching aim was to enrich, contextualise and elaborate on the experiences of claims workers within their unique work context, to facilitate insight and a deeper understanding of vicarious trauma in more administrative populations that have largely been overlooked in research.
866

Adaptação e validação de escalas de resiliência para o contexto cultural brasileiro: escala de resiliência disposicional e escala de Connor-Davidson / Cross-cultural adaptation and validation of resilience scales for Brazil: dispositional resilience scale and Connor-Davidson resilience scale

Solano, João Paulo Consentino 02 June 2016 (has links)
INTRODUÇÃO: a resiliência é um construto associado às características pessoais que permitem a um indivíduo adaptar-se e superar situações adversas. Uma pessoa mais resiliente é aquela com maiores habilidades de se adaptar sob estresse, a despeito da carga de dificuldades enfrentada e de um contexto desfavorável no entorno. A Dispositional Resilience Scale (DRS-15) e a Connor-Davidson Resilience Scale (CD-RISC) tentam aferir a resiliência individual e já tiveram suas propriedades testadas em vários países da América do Norte, África, Europa e Ásia. OBJETIVO: traduzir, realizar a adaptação para o contexto cultural brasileiro e verificar a confiabilidade e a validade das escalas DRS-15 e CD-RISC. MÉTODO: uma metodologia com as etapas seqüenciais de tradução/retro-tradução/adaptação cultural/estudo de confiabilidade/estudo de validade foi utilizada. A adaptação cultural foi executada por um grupo de especialistas em epidemiologia, linguística, psiquiatria e tratamento da dor. A compreensão das versões culturalmente adaptadas foi testada com 65 pacientes adultos do grupo de avaliação pré-anestésica e do ambulatório geral de ansiedade do Hospital das Clínicas da FMUSP. Retro-traduções das versões finais foram aprovadas pelos autores principais das escalas originais. O estudo de validade foi conduzido pela aplicação conjunta de ambas as versões brasileiras das escalas, do Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), do Self-report questionnaire (SRQ), da escala de incapacitação de Sheehan (SDS) e da Escala Graduada de Dor Crônica (CPG-Br) a 575 pacientes e acompanhantes adultos da mesma população. A confiabilidade teste-reteste foi avaliada por uma segunda aplicação das escalas de resiliência a 123 participantes, entre 7 e 14 dias após a entrevista inicial. RESULTADOS: entre os participantes da fase de validação, a idade média foi de 44 anos (amplitude de 18-93), com predomínio de mulheres (74%), e média de dez anos de estudo. A maioria dos entrevistados (93%) pertencia aos estratos socioeconômicos B e C. Três fatores e quatro fatores foram identificados por análise fatorial exploratória para as versões da DRS-15 e CD-RISC, respectivamente. O coeficiente alfa de Cronbach foi de 0,71 para a DRS, e de 0,93 para a CD-RISC, indicando melhor consistência interna para a segunda. A confiabilidade teste-reteste retornou coeficientes de correlação intra-classe de 0,81 e 0,86 para a DRS e CD-RISC, respectivamente. A correlação entre as duas escalas foi de 0,52. Observaram-se correlações negativas significativas entre os escores das escalas de resiliência e os escores para cinco das seis dimensões do ISSL, assim como para com os escores do SRQ e SDS (p < 0,001). Não houve correlação entre as escalas de resiliência e a CPG-Br. A CD-RISC encontrou correlações mais fortes que a DRS para com as variáveis de comparação externa. As duas escalas discriminaram resiliência menor para os pacientes dos ambulatórios psiquiátricos, em comparação aos dos ambulatórios não-psiquiátricos. Entre os pacientes psiquiátricos, os escores de resiliência foram significativamente menores para os pacientes com transtorno Borderline de personalidade, em comparação aos pacientes com transtorno de estresse pós-traumático. CONCLUSÃO: propriedades de consistência interna, estabilidade temporal e validade foram satisfatoriamente demonstradas para as versões brasileiras da DRS e da CD-RISC em uma amostra de pacientes e acompanhantes adultos dos ambulatórios do Hospital das Clínicas de São Paulo / INTRODUCTION: Resilience is a construct related to the personal characteristics that allow an individual to adapt and overcome adversity. A more resilient person is the one that exhibits greater abilities to adapt under stress, despite the burden of difficulties and of an unfavorable context. The Dispositional Resilience Scale (DRS-15) and the Connor-Davidson Resilience Scale (CD-RISC) are two scales to measure individual resilience, both of which have had psychometrics evaluated by researchers from the US, Africa, Europe and Asia. OBJECTIVE: To verify the reliability and validity of culturally adapted Brazilian Portuguese versions of the DRS-15 and CD-RISC. METHODS: The following stepwise methodology was used: translation / back translation / cultural adaptation / reliability study / validation study. Cultural adaptation was performed by an expert committee of epidemiologist, linguists, psychiatrist and pain specialists. Comprehension of the culturally adapted versions was tested through 65 interviews with adult patients from the pre-anesthetic consultation ambulatory and general ambulatory for anxiety disorders of Hospital das Clínicas of FMUSP. Back-translations of the culturally adapted versions were fully approved by the authors of the original scales. Validation studies were carried out by concurrent application of both the adapted versions of resilience scales, the Brazilian Stress Symptoms Inventory for Adults (ISSL), the Self-report Questionnaire (SRQ), the Sheehan Disability Scale (SDS) and the Chronic Pain Grade (CPG-Br) to 575 participants (outpatients and companions) from the same population. Test-retest reliability was studied by means of a second interview with 123 subjects, which took place between 7 and 14 days after the first one. RESULTS: Subjects of the validation phase were mostly women (74%), with an average of 44 years of age (18-93) and 10 years of formal schooling. There was a predominance of socioeconomic levels B or C (93%) on an A to E scale. Exploratory factor analyses resulted in a three-factor for the DRS and a four-factor solution for the CD-RISC. Alpha coefficients of 0.71 for the DRS and 0.93 for the CD-RISC indicated better internal consistency for the latter. Temporal stability was regarded as excellent, with intra-class correlation coefficients of 0.81 and 0.86 for the DRS and CD-RISC, respectively. Correlation coefficient between the two scales was 0.52. Significant negative correlations were observed between the scores of both resilience scales and five out of six dimensions of the ISSL, and so as between the resilience scales scores and those of the SRQ and SDS (p < 0.001). No correlation was observed between the resilience scales and the CPG-Br. The CD-RISC was more competent than DRS to depict such correlations. Both scales were able to discriminate differences in resilience scores of non-psychiatric and psychiatric patients, the latter presenting with lower scores. The group of borderline patients significantly presented with lower resilience scores in comparison with those of the post-traumatic stress disorder patients. CONCLUSION: Good reliability and validity were demonstrated with the Brazilian Portuguese versions of the DRS and CD-RISC as tested on a sample of adult ambulatory patients and their adult companions at Hospital das Clínicas, São Paulo
867

Estimativa de prevalência de estresse emocional em uma amostra de policiais rodoviários federais do Estado de São Paulo / Estimation of the emotional stress prevalence in a sample of federal highway police officers of São Paulo State

Oliveira, Léa Pintor de Arruda 07 June 2017 (has links)
No Brasil, o amplo escopo de responsabilidades e também a diversidade de situações que demandam ações da Polícia Rodoviária Federal contribuem para que agentes/eventos estressores façam parte da rotina diária de centenas de policiais. Contudo, ainda existem poucos estudos dedicados a identificar o estresse nesta população. Assim, o objetivo principal do presente estudo é identificar a prevalência do estresse neste grupo, além de identificar as prevalências de transtorno de estresse pós-traumático (TEPT), de estresse ocupacional e, finalmente, a prevalência dos sintomas de Síndrome de Burnout. Para tanto foi utilizado um desenho de estudo transversal com amostra probabilística (n = 202) de policiais rodoviários federais do Estado de São Paulo. Os instrumentos para obtenção dos dados da amostra foram: i) Questionário Geral (QG), para a caracterização da amostra e obtenção de dados sociodemográficos e profissionais; ii) Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), para sintomas de estresse; iii) Escala de Impacto do Evento - Revisada (IES-R), para sintomas de TEPT; iv) Escala de Vulnerabilidade do Estresse no Trabalho (EVENT), para estresse ocupacional; v) Inventário de Burnout de Maslach, versão HSS (MBI-HSS), para identificação dos sintomas pertinentes à Síndrome de Burnout. Os dados foram armazenados em planilhas excel e analisados com a utilização dos softwares Stata 8.0 for Windows e R3.3.2. A medida de associação escolhida foi o Odds Ratio (OR) e o seu intervalo de confiança (IC). Para testar a significância estatística foram utilizados o teste de qui quadrado o teste Exato de Fisher, para as variáveis nominais e, o teste Mann-Whitney-Wilcoxon foi utilizado para as variáveis com distribuição não paramétrica: idade (faixa etária) e tempo de carreira. O nível de significância adotado foi de 5%. A prevalência de sintomas de estresse na amostra representou 43,1% (IC95% = 36,2-50,0) com a seguinte distribuição por fase: 2,3% (IC95% = 0,2-8,0) em \"Alerta\"; 82,7% (IC95% = 73,2-90,0) em \"Resistência\"; 11,5% (IC95% = 5,7-20,1) em \"Quase Exaustão\"; e 3,5% (IC95% = 0,7-9,7) em \"Exaustão\". Ainda, 60,9% da amostra apresentaram sintomas psicológicos de estresse, 33,3% sintomas físicos e 5,8% ambos. A prevalência de TEPT ocorreu em 25,4% (IC95% = 19,3-31,4) da amostra, sem a predominância entre as subescalas. A prevalência de sintomas de estresse ocupacional afetou 35,2% (IC95% = 28,5-41,8) dos policiais participantes do presente estudo. Não houve registro na amostra referente à Síndrome de Burnout. As prevalências de estresse encontradas neste estudo apresentaram valores compatíveis com os valores de pesquisas semelhantes - elaboradas em outras categorias de policiais -, tanto no contexto nacional como no internacional. Há indícios que o tempo para práticas de lazer pode exercer influência como fator de proteção contra os sintomas de estresse; por outro lado, há indícios que processos penais e o longo tempo de carreira podem exercer influência como fatores de risco. Em última análise, a combinação dos resultados aqui apresentados sugerem indícios do adoecimento - em curso - desta população em função dos elevados índices de prevalência dos sintomas de estresse, sintomas de TEPT e estresse ocupacional / In Brazil, the wide scope of responsibilities and also the diversity of situations that demand actions from the Federal Highway Police sharply contribute to stressor agents/events make part of the daily routine of hundreds police officers. However, there are still few studies dedicated to identify the stress symptoms in this population. Thus, this study aims to identify the prevalence of stress in this group as well as to identify also the prevalences of post-traumatic stress disorder (PTSD), occupational stress, and finally the prevalence of Burnout Syndrome symptoms. On this way, a cross-sectional design study was applied with probabilistic sample of (n=202) Federal Highway Police Officers on State of São Paulo. The tools to pick up the sample data were: i) General Questionnaire, picking up the sample features and getting socio-demographic and professional data; ii) Adult Stress Symptom Inventory by Lipp (pt.: ISSL), for stress symptoms; iii) Scale of Reviewed Event Impact (pt.: IES-R), for PTSD symptoms; iv) Stress Vulnerability Scale at Work (pt.: EVENT), for occupational stress; v) Maslach Burnout Inventory, HSS version (MBI-HSS), identifying the Burnout Syndrome symptoms. The database were stored in the excel spreadsheets and they were analyzed through by Stata 8.0 for Windows and R3.3.2 software. The association measure was Odds Ratio (OR) and its confidence interval (CI). In order to test the statistical significance the chi-square test and the Fisher Exact test were applied to the nominal variables. The Mann-Whitney-Wilcoxon test was applied to the variables with non-parametric distribution: age (age group) and professional career time. The significance level defined was 5%. The prevalence of stress symptoms appeared to 43,1% (CI95% = 36,2-50,0) of the sample and they were split in each phase as follow: 2,3% (CI95% = 0,2-8,0) in \"Alert\"; 82,7% (CI95% = 73,2-90,0) in \"Resistance\"; 11,5% (CI95% = 5,7-20,1) in \"Close Exhaustion\"; and 3,5% (CI95% = 0,7-9,7) in \"Exhaustion\". In addition, 60,9% of the sample presented stress psychological symptoms, 33,3% stress physical symptoms and 5,8% both ones. The prevalence of PTSD occurred in 25,4% (CI95% = 19,3-31,4) of the sample and there was no predominance among the subscales. The prevalence of occupational stress symptoms affects 35,2% (CI95% = 28,5-41,8) of the police officers who made part of this study. There was no record in the sample regarding Burnout Syndrome. The prevalence of stress found out in this study had compatible values as the same values found out in other similar researches - issued with other police categories - on the national as well as international context. It seems that booking time for leisure practices might be related as a protection factor against stress symptoms. In other hand, it seems criminal procedures and a long professional career time might be related as a risk factor. At last, the set of presented results suggests sickness signs - ongoing - in this population due to the high prevalence rates of stress symptoms, PTSD symptoms and occupational stress
868

Avaliação da magnitude do transtorno de estresse em vítimas de sequestro / Evaluation of the magnitude of the stress disorder caused by the trauma of kiddnapping

Santos, Eduardo Ferreira 10 November 2006 (has links)
Considerando que estamos vivendo em São Paulo e em todos os Estados do Brasil, um brutal estado de insegurança pública, vemos o crime de seqüestro (tanto na sua modalidade clássica de manter a vítima em cativeiro por período de tempo variável até o pagamento de resgate, quanto à modalidade conhecida como \"seqüestro-relâmpago\", no qual a vítima fica em poder dos criminosos por poucas horas, enquanto eles agem sobre caixas eletrônicos de bancos e as ameaçam de várias maneiras) atingir um grande número de pessoas com conseqüências graves para o desempenho de suas funções existenciais pós-seqüestro. Este trabalho mostra, através de Entrevistas Estruturadas e Escalas de Avaliação, que o grau de magnitude do Transtorno de Estresse Pós-Traumático que acomete vítimas de ambos os tipos de seqüestro atinge picos suficientemente elevados e que devem receber maior atenção tanto em nível de Saúde Pública quanto Segurança Pública. / Considering that we are living in Sao Paulo and all others States of Brazil, a brutal state of public unsafeness, we see the kidnapping crime (not only in its classical modality of keeping the victim in captivity for a variable period of time until the rescue payment, but also in the modality known as \"lightning-kidnapping\", in which the victim remains under the criminal´ s arrest for few hours, while they act on cash machines and threaten the victims) reaching a great number of people with serious consequences for the performance of their post-sequestration existential functions. This work shows that the magnitude level of the Post-Traumatic Stress Disorder that attacks kidnapping victims reaches sufficiently high peaks, that must receive more attention, not only in terms of Public Health but also Public Security.
869

Violência na gestação e saúde mental de mulheres que são vítimas de seus parceiros / Violence during pregnancy and the mental health of women victims of their partners

Fonseca-Machado, Mariana de Oliveira 15 May 2014 (has links)
Este estudo teve como objetivo verificar as repercussões da violência por parceiro íntimo, ocorrida durante a atual gestação, na saúde mental de mulheres usuárias de um serviço de atendimento pré- natal. Trata-se de estudo observacional, com delineamento transversal, desenvolvido no Centro de Referência da Saúde da Mulher de Ribeirão Preto, São Paulo, Brasil, com 358 gestantes, em acompanhamento pré-natal no serviço, entre maio de 2012 e maio de 2013. A coleta dos dados aconteceu no dia da primeira consulta de pré-natal das gestantes no serviço, por meio de sete instrumentos: i. instrumento de caracterização sociodemográfica, econômica e comportamental; ii. instrumento de caracterização obstétrica; iii. Edinburgh Postnatal Depression Scale; iv. Post-Traumatic Stress Disorder Checklist - Civilian Version; v. Escala de Ideação Suicida de Beck; vi. Inventário de Ansiedade Traço-Estado; vii. Instrumento de identificação e caracterização da violência. Os dados foram analisados no software Statistical Package for Social Sciences, versão 21.0. Utilizamos as análises univariada, bivariada e multivariada dos dados, por meio da distribuição de frequências absolutas e relativas, medidas de tendência central e de variabilidade, os testes estatísticos Qui- quadrado e Teste t, razões de prevalência, razões de chances de prevalência, regressão logística múltipla e regressão linear múltipla. No momento da coleta dos dados, as participantes tinham, em média, 25 anos de idade e 9,5 anos de escolaridade formal. A maioria considerou-se não branca, era solteira, coabitava com o parceiro íntimo, possuía alguma religião, não exercia atividade remunerada e possuía renda familiar mensal média de 2,6 salários-mínimos, sendo o parceiro o principal provedor da família. A maioria não fumou, não consumiu bebidas alcoólicas e não fez uso de drogas ilícitas, durante a atual gestação. A amostra caracterizou-se por mulheres multigestas e nulíparas que, em sua maioria, possuíam filhos vivos e não haviam abortado. A prevalência da violência por parceiro íntimo, durante a atual gestação, foi de 17,6%. As prevalências dos indicativos das presenças de transtorno depressivo, do diagnóstico de transtorno de estresse pós-traumático e de ideação suicida foram de 28,2%, 17,0% e 7,8%, respectivamente. Os escores médios das gestantes nas escalas ansiedade-traço e ansiedade- estado foram de 39,1 e 42,5 pontos, respectivamente. Após se ajustar aos modelos de regressão logística múltipla, a violência por parceiro íntimo, durante a gestação, associou-se com o indicativo da presença de transtorno depressivo, com o indicativo do diagnóstico de transtorno de estresse pós- traumático e com o indicativo da presença de ideação suicida. Os modelos de regressão linear múltipla ajustados evidenciaram que as mulheres em situação de violência por parceiro íntimo, na atual gestação, apresentaram maiores escores dos sintomas de ansiedade-traço e estado do que aquelas que não sofreram esse tipo de violência. Portanto, reconhecer a violência como um fator de risco clinicamente relevante e identificável para a ocorrência de transtornos mentais, durante a gestação, pode ser um primeiro passo na prevenção destes problemas. Idealmente, as respostas devem incluir os setores da saúde, assistência social e justiça, no sentido de cumprir a obrigação do Estado para eliminar a violência contra a mulher / The objective of this study was to verify the repercussions of violence by the intimate partner during the present pregnancy on the mental health of women users of a prenatal care service. This is an observational study, performed with a cross-sectional design, at the Reference Center for Women\'s Health of Ribeirão Preto, São Paulo, Brazil, with 358 pregnant women following prenatal care at the referred service between May 2012 and May 2013. Data collection was performed on the day of the women\'s first prenatal appointment at the service, using seven instruments: i. instrument for sociodemographic, economic and behavioral characteristics; ii. instrument for obstetrical characteristics; iii. Edinburgh Postnatal Depression Scale; iv. Post-Traumatic Stress Disorder Checklist - Civilian Version; v. Beck Scale for Suicidal Ideation; vi. State-Trait Anxiety Inventory; vii. instrument for violence identification and characterization. The data were analyzed using Statistical Package for Social Sciences, version 21.0. Furthermore, univariate, bivariate and multivariate analyses of the data were performed, by absolute and relative frequency distribution, central and variability tendency measures, the Chi-square and T-Test statistical tests, prevalence ratio, prevalence odds ratio, multiple logistic regression and multiple linear regression. At the moment of data collection, the participants\' mean age was 25 years, and they had a mean of 9.5 years of formal education. Most women reported having the following characteristics: skin color different from white; single; living with the intimate partner; having some kind of religion; unemployed; mean monthly family income of 2.6 Brazilian minimum wages; partner was the breadwinner. Most reported not having smoked, consumed alcohol or any illicit drugs during the present pregnancy. Moreover, the sample was characterized by multiparous and nulliparous women, most of whom had living children and without a history of miscarriages. The prevalence rate for intimate partner violence during the present pregnancy was 17.6%. The prevalence rates of probable antenatal depression, probable antenatal post-traumatic stress disorder and probable antenatal suicidal ideation were 28.2%, 17.0% and 7.8%, respectively. The women\'s mean scores on the trait-anxiety and state-anxiety scales were 39.1 and 42.5, respectively. After adjustment using multiple logistic regression models, associations were found between intimate partner violence during the pregnancy and probable antenatal depression, probable antenatal post-traumatic stress disorder and probable antenatal suicidal ideation. The adjusted multiple linear regression models showed that women victims of intimate partner violence in the present pregnancy had higher scores for trait-anxiety and state-anxiety symptoms compared to those who did not endure this type of violence. Therefore, recognizing violence as a clinically relevant and identifiable risk factor for the occurrence of mental disorders during pregnancy may be a first step to prevent these problems. Ideally, the answers should include the health, social work and justice domains so as to meet the duty of the Brazilian State of eliminating the violence against women
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Eficácia da Terapia Focada na Compaixão em grupo no transtorno de estresse pós-traumático / The Efficacy of group Compassion-Focused Therapy in Posttraumatic Stress Disorder

Videira, Lina Sue Matsumoto 02 October 2018 (has links)
Objetivo: Avaliar a eficácia da Terapia Focada na Compaixão em grupo no transtorno de estresse pós-traumático. Desenho: Estudo randomizado controlado, cego, dois braços paralelos, no grupo controle a Terapia de Apoio em grupo (TA-G) e no grupo experimental a Terapia Focada na Compaixão em grupo (TFC-G). Duração e frequência: Os dois grupos receberam oito sessões semanais de 90 minutos e, caso necessário, tratamento psiquiátrico. Todos preencheram escalas de avaliação, antes (T-1), depois da terapia (T-2) e no seguimento de três meses (T-3). Oitenta e sete pacientes foram randomizados (TA-G=44 e TFC-G=43) e sessenta e um pacientes completadores foram analisados (TA-G=30 e TFC-G=31). Resultados: Os pacientes melhoraram significativamente e não houve efeito de interação entre os grupos e os tempos, exceto na escala de trauma CAPS-5, F (1, 171) = 4,35, p = 0,041. Houve uma diminuição expressiva, comparando a média do T-3 em relação ao T-1, nos dois grupos (TA-G e TFC-G, respectivamente) nas escalas: CAPS-5 de trauma (24,40 e 29,77), DTS de trauma (31,83 e 33,94), BDI de depressão (9,77 e 12,06), BAI de ansiedade (7,33 e 8,23), BHS de desesperança (3,53 e 3,55), ATQ-N de pensamentos automáticos negativos (15,67 e 14,90), OAS de vergonha (8,20 e 7,68), FSCS de autocrítica (9,07 e 6,71) e aumento na escala ATQ-P de pensamentos automáticos positivos (10,96 e 16,36) e SCS de autocompaixão (0,50 e 0,52). Conclusões: A significativa melhora dos pacientes comprova a importância da terapia em grupo no tratamento do TEPT. A redução de 30 pontos na escala de trauma CAPS-5, em apenas oito semanas, somente no grupo da Terapia Focada na Compaixão, é uma evidência robusta de que este modelo de tratamento focado na compaixão, vergonha, culpa e autocrítica, é seguro, eficaz e uma esperançosa opção no tratamento de pessoas que vivenciaram eventos traumáticos / Objective: To evaluate the efficacy of Group Compassion-Focused Therapy in posttraumatic stress disorder. Design: A randomized controlled trial, blind study, with two parallel arms, control group with Supportive Therapy Group (SUP-G) and experimental group with Compassion-Focused Therapy Group (CFT-G). Duration: The two groups received eight weekly sessions of 90 minutes and, if necessary, psychiatric treatment. All patients completed evaluation scales, before (T-1), after therapy (T-2) and in three months follow-up (T-3). Eighty-seven patients were randomized (SUP-G=44 and CFT-G=43) and sixty-one completers were analyzed (SUP-G=30 and CFT-G=31). Results: Patients improved significantly and there was no interaction effect between groups and times, except for the trauma scale CAPS-5, F (1, 171) = 4.35, p = 0.041. There was an expressive decrease, comparing the mean of T-3 in the relation to T-1, in both groups (SUP-G and CFT-G, respectively) in the scales: trauma CAPS-5 (24,40 and 29,77), trauma DTS (31,83 and 33,94), depression BDI (9,77 and 12,06), anxiety BAI (7,33 and 8,23), hopelessness BHS (3,53 and 3,55), automatic negative thoughts ATQ-N (15,67 and 14,90), shame OAS (8,20 and 7,68), self-critical FSCS (9,07 and 6,71) and an increase in the scales of automatic positive thoughts ATQ-P (10,96 and 16,36) and self-compassion SCS (0,50 and 0,52). Conclusions: Significant improvements in the patients confirm the importance of group therapy in PTSD treatment. The 30-point CAPS-5 trauma scale reduction, in eight weeks only, in the Compassion-Focused Therapy group alone, is robust evidence that this treatment model focused on compassion, shame, guilt and self-criticism, is safe, effective and a hopeful option in treating people who have experienced traumatic events

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