Os trabalhos na área de neuroimumomodulação vêm contribuindo de forma marcante para o entendimento da regulação/modulação das respostas adaptativas dos organismos frente ao estresse ou às doenças. Sabe-se que o ato de um animal conviver com outro doente leva a alterações imunes e comportamentais, assim como acontece em humanos, nos caregivers. Nos animais foi comprovado que o odor liberado pelo outro doente é a fonte de estresse para todas essas alterações neuroimunes. Estudos em camundongos fêmeas mostraram uma diminuição de imunidade inata, alteração de comportamento; redução da atividade de neutrófilos e menor resistência ao crescimento de tumores em companheiros de animais doentes. O presente estudo teve como objetivo avaliar alterações neuroimunes em camundos machos que conviveram por 11 dias com um companheiro doente portador de um tumor ascítico de Ehrlich, e avaliar a participação do eixo Hipotálamo-Pituitária-Adrenal (HPA) e do Sistema Nervoso Autônomo Simpático (SNAS) no fenômeno observado. Os resultados obtidos mostraram que esta convivência: 1) não alterou os níveis séricos de corticosterona; 2) não modificou o peso relativo da glândula adrenal; 3) aumentou os níveis plasmáticos de adrenalina e noradrenalina; 4) diminuiu o burst oxidativo de neutrófilos induzido por PMA e por S. aureus, porém não modificou a porcentagem e a intensidade de fagocitose; 5) diminuiu a resistência ao crescimento de um tumor ascítico de Ehrlich; 6) aumentou os níveis de TNF-α, INF-γ e IL-6 após 24 horas e de TNF-α e IL-6 após 48 horas de incubação de esplenócitos com LPS; 7) não modificou o comportamento avaliado no campo aberto; 8) aumentou o turnover de noradrenalina no córtex frontal, diminuiu os níveis de noradrenalina no bulbo olfatório, diminuiu os níveis de HVA, um metabólito da dopamina, no hipotálamo e no bulbo e aumentou os níveis de serotonina e seu metabólito 5HIAA no córtex frontal; 9) não modificou a expressão IL-1, IL-6 e TNF-α no hipotálamo e no córtex frontal. Em seu conjunto, os presentes resultados mostram que a convivência de camundongos machos com portadores de um tumor ascítico de Ehrlich, o que representa aqui um estresse prolongado, embora não tenha alterado o comportamento dos machos e a atividade do eixo HPA, modificou nestes animais a atividade do SNAS, reduzindo a imunidade inata dos animais. Conclui-se então, estar o SNAS envolvido com as alterações de imunidade inata desencadeadas em camundongos machos pela convivência com um companheiro doente. / Studies in the neuroimmunomodulation area have markedly contributed to the understanding of the regulation / modulation of the organisms adaptive responses against stressors or diseases. Cohabitation with a sick cage mate leads to immune and behavioral changes, similar to those reported in humans, called caregivers. In animals, it was shown that the odor released by the tumor injected partner is pivotal for the stress response they presented and for all the neuroimmune changes reported that included: a decreased innate immunity, altered behavior such as increased levels of locomotion and decreased resistance to tumor growth. Following this line of research, the present study aimed to evaluate the possible neuroimmune changes presented by males mice that lived for 11 days with a sick cage mate, i.e., carrier of an Ehrlich ascitie tumor; a search for the pathways responsible for the observed effects was also an objective of the present work. Our results showed that cohabitation with a sick cage mate produced in male mice: 1) increased levels of plasmatic adrenaline and noradrenaline, 2) decreased neutrophil oxidative burst after PMA and S. aureus stimulatior, but no changes in the percentage and intensity of neutrophil phagocytosis, 3) decreased organic resistance to an Ehrlich tumor growth 4) increased levels of TNF-α, INF-γ and IL-6 24 hours after and TNF-α and IL-6 48 hours after splenocytes stimulation with LPS, 5) increased turnover of norepinephrine in the frontal cortex, decreased levels of norepinephrine in the olfactory bulb, reduced levels of HVA in the bulb and hypothalamus and increased levels of serotonin and its metabolite 5HIAA in the frontal cortex. Further analysis, showed no changes in: 6) serum corticosterone; 7) the relative weight of adrenal glands; 8) behavior assessed by open field, 9) IL-1, IL-6 and TNF-α expression in both hypothalamus and frontal cortex. Taken together our results, showed that cohabitation with a male sick cage mate taken here as a source of a prolonged stress induced in male mice a decrease in their innate immunity, most probably thought SANS stimulation and peripheral cytokine changes. As reported for female mice, the HPA axis was also not changed in male companion of tumor injected mice. Furthermore and importantly, our data showed some neuroimmune differences between male and female responses to the condition imposed, being the males less sensible than females. Differences in hormonal status and/or in the ethological predisposition and response of male and female mice the stress of living with a sick cage mate were discussed and taken as the possible causes for the observed discrepancies.

Increased levels of stress in the workplace have led the American Psychological Association to predict a looming public health crisis. Critical care nurses (CCNs) are highly exposed to stressors in the workplace, more than other nurses. Tens of billion dollars were reported lost in productive work time yearly due to ill health from depression alone. An important gap remains in understanding the relationships of stressors with the amount of stress. Supported by the biopsychosocial stress theory, the purpose of this study was to determine the relationship between frequencies of perceived stressors (IVs) as a source of perceived levels of stress (DV) or allostasis. The mixed-methods study included an online questionnaire and an e-mail interview of 400 hospital-based CCNs from professional nurses' associations in the United States. The Nursing Stress Scale was used to determine the kinds and frequencies of IVs, while the Psychological Stress Measure was used to assess the DV. Multiple regression analysis assessed the strength and direction of the relationships between IVs and DV. Interviews fell short of the minimum sample size for saturation and were not analyzed. Quantitative findings indicated workload as the most frequently perceived stressor, correlating positively with allostasis (p = .0005). Death and dying, conflict with other nurses, and lack of support for CCNs were also statistically significant (p < .05). Implications to practice and social change include promoting changes in policy with management support to reduce workload, death and dying, conflict with other nurses, and lack of social support for CCNs. Personal behavior changes like relaxation and physical exercises as coping methods may also reduce levels stress.

The purpose of this study is to explore the effects of scale of change and behaviors of change leadership on employee job psychological stress and employee affective commitment to change, and to explore the job psychological stress in the organizational change strategy and affective commitment to change, whether in relations with intermediary results. Besides, this research also explores the moderating effects of employee positive psychological capital on organizational change strategy. Five hundred and eleven effective surveys were received by employees of Taiwanese banks. The data was analyzed by factor analysis, reliability analysis, using the LISREL model to measure the relationship amongst the constructs. Results showed that organizational change strategy and employee positive psychological capital had significant positively influence on employee affective commitment to change. Furthermore, job psychological stress had a significant negative influence on employee affective commitment to change. The mediating effects of employee job psychological stress towards organizational change strategy can negatively influence employee affective commitment to change. We also found that employee positive psychological capital could moderate the relationship between behaviors of change leadership and affective commitment to change. As a result, it is suggested that by improving psychological factors at work, it is possible to promote employee affective commitment to change as well as positive organization change.

Einleitung: Brustkrebspatientinnen sind im Rahmen ihrer Erkrankung in klinisch relevantem Ausmaß psychisch belastet. Die Stärke der Belastung wird durch verschiedene Faktoren determiniert. Ziel dieser Arbeit war die Untersuchung des Zusammenhangs der psychischen Belastung mit Erwerbstätigkeit und dem Vorhandensein eigener Kinder unter Einbeziehung der Zeit seit Diagnosestellung. Material und Methodik: Im Rahmen einer randomisierten klinischen Studie wurden 724 Brustkrebspatientinnen im Alter von 18–65 Jahren im kurativen Stadium mit einer Zeit seit Diagnosestellung von 0–12 Monaten hinsichtlich ihrer psychischen Belastung (Ängstlichkeit und Depressivität) mit der Hospital Anxiety and Depression Scale (HADS) beurteilt. In uni- und multivariaten Analysen wurde der Zusammenhang von Ängstlichkeit und Depressivität mit den Variablen Erwerbstätigkeit, Elternschaft und Zeit seit Diagnosestellung geprüft. Ergebnisse: Patientinnen mit längerer Zeit seit Diagnosestellung (4–12 Monate) zeigen geringere Werte für Ängstlichkeit (6,28) als die Patientinnen, bei denen die Diagnosestellung erst 0–3 Monate zurück liegt (7,24; p < 0,01). Zwischen Elternschaft und Ängstlichkeit gibt es keinen eindeutigen Zusammenhang. Das Alter der Kinder ist entscheidend. Auch unter Kontrolle des Lebensalters der Patientinnen zeigt sich Ängstlichkeit bei Frauen mit Kindern unter 16 Jahren signifikant höher (7,84) als bei kinderlosen Patientinnen (6,42) oder solchen mit Kindern ab 16 Jahren (6,87; p = 0,04). Erwerbslose Frauen zeigen signifikant höhere Depressivitätswerte als alle anderen Studienteilnehmer (p = 0,02). Wechselwirkungen zwischen den untersuchten Variablen treten nicht auf. Schlussfolgerung: Zwischen der Zeit seit Diagnosestellung, dem Erwerbsstatus sowie dem Vorhandensein eigener Kinder und psychischen Belastung bei Brustkrebspatientinnen ergeben sich differenzielle Zusammenhänge. Bei der Erfassung der psychischen Belastung im 1. Jahr nach der Diagnosestellung sollte besondere Aufmerksamkeit auf erwerbslose Patientinnen und Patientinnen mit jüngeren Kindern gerichtet werden. / Introduction: Breast cancer patients suffer clinically relevant levels of psychological stress because of their disease. Various factors can affect the level of stress experienced. This study aimed to investigate the relationship between the level of psychological stress and employment and children, including time since diagnosis. Material and Methods: A randomised clinical study was done of 724 breast cancer patients aged between 18 and 65 years; all were in the curative stage of disease and had been diagnosed 0–12 months previously. Patients were investigated for their levels of psychological stress (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS). The relationship between anxiety and depression and the variables "employment", "parenthood" and "time since diagnosis" were investigated, using univariate and multivariate analysis. Results: Patients with a longer time since diagnosis (4–12 months) were found to have lower levels of anxiety (6.28) compared to patients who had been diagnosed only 0–3 months previously (7.24; p < 0.01). There was no unambiguous relation between parenthood and anxiety. The age of the children was crucial. Even when results were controlled for patient age, the anxiety levels of women with children below the age of 16 years were significantly higher (7.84) compared to patients without children (6.42) or patients whose children were older than 16 years (6.87; p = 0.04). Women who were not employed had significantly higher levels of depression compared to all other participants in the study (p = 0.02). No reciprocal effects were found between investigated variables. Conclusion: We found a differentiated relationship between the variables "time since diagnosis", "employment" and "children" and the level of psychological stress experienced by breast cancer patients. When determining the level of psychological stress in the 1st year after diagnosis, particular attention should be paid to patients who are not employed and patients with children below the age of 16 years.

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.

Made available in DSpace on 2014-12-17T14:46:43Z (GMT). No. of bitstreams: 1 GysellaRPCO_DISSERT.pdf: 1882123 bytes, checksum: 567dfcacd19a39b99bb1408ecf7decc2 (MD5) Previous issue date: 2008-12-22 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / We believe that the dissatisfaction arising from the lack of belief in the possibilities of change in the workplace, which cause difficulties to achieve professional results in the professional psychological distress that currently fits into the context of mental health. This is a qualitative, descriptive and representational research aiming to discover how the professional nurses represent the very psychological distress from work in the hospital environment. Aided and supported by specific objectives of identifying factors that generates this suffering and strategies for defense and confronting these professionals in the hospital. 22 nurses participated in this research, officials of the University Hospital Onofre Lopes, located in the city of Natal / RN, with length of service in the institution more than one year and less than five, and they accepted, by signing the Term of Free and Informed Consent, participate in the study. We use plurimethodological approach: a questionnaire, a semi-structured interview and the design-story with a theme adapted from Trinca with the support of the Theory of Social Representations and that nurses do in their psychological distress of the Central Core. We reviewed the data from the results generated by the ALCESTE software, based on hierarchical categorization downward, leading seven classes used as categories: Work process: completeness vs. incompleteness; labor contradiction of the nurse; qualitative aspects of interpersonal relationships; hospital surveillance: Challenges, muteness and neglect; Expectations, conflicts and feelings in the work process; Leisure: the other side of the work process, and Suffering generating aspects of in the work process. We consider the analysis of quarters generated by the program, which SLQ houses in the central core of the representations; the SRQ and the DLQ the intermediaries elements and the DRQ the peripheral elements that nurses do in their psychological distress. We analytically adequate results in the three belonging dimensions of social representations: the Subjectivity, the Intersubjectivity and Trans-subjectivity. We infer that the interpersonal relationship, the extra work, the deviation in the role of nurse show themself as the factors responsible for psychological distress of it. In that sense, the central core of SR of this profession is based on the level of trans-subjectivity and understood as a Social Representation controversy / Entendemos que a insatisfa??o advinda da falta de cren?a nas possibilidades de mudan?a do contexto laboral que originam dificuldades para a realiza??o profissional resulta no sofrimento ps?quico do profissional que, atualmente se insere no contexto da sa?de mental. Trata-se de uma pesquisa qualitativa, descritiva e representacional objetivando apreender como os profissionais enfermeiros representam o pr?prio sofrimento ps?quico decorrente do trabalho no ambiente hospitalar. Auxiliado e amparado pelos objetivos espec?ficos de identificar fatores geradores deste sofrimento e de identificar estrat?gias de defesa e enfrentamento desses mesmos profissionais em ambiente hospitalar. Participaram desta pesquisa 22 enfermeiros, funcion?rios do Hospital Universit?rio Onofre Lopes, situado no munic?pio de Natal/RN, com tempo de servi?o na institui??o maior que um ano e menor que cinco e que aceitaram, mediante a assinatura do Termo de Consentimento Livre e Esclarecido, participar do estudo. Utilizamos abordagem plurimetodol?gica: um question?rio, uma entrevista semi-estruturada e o Desenho-est?ria com tema adaptado de Trinca com o suporte da Teoria das Representa??es Sociais e a que os enfermeiros fazem do seu sofrimento ps?quico do N?cleo Central. Analisamos os dados a partir dos resultados gerados pelo software ALCESTE com base na categoriza??o hier?rquica descendente, derivando sete classes usadas como categorias: processo de trabalho: completude vs. incompletude; antinomia laboral do enfermeiro; aspectos qualitativos do relacionamento interpessoal; vigil?ncia hospitalar: desafios, silenciamento e neglig?ncia; expectativas, conflitos e sentimentos no processo de trabalho; lazer: o outro lado do processo de trabalho e, aspectos geradores de sofrimento no processo de trabalho. Consideramos pela an?lise dos quadrantes gerados pelo programa, que o Quadrante Superior Esquerdo abriga o n?cleo central das representa??es; o Quadrante Superior Direito e o Quadrante Inferior Esquerdo os elementos intermedi?rios e o Quadrante Inferior Direito os elementos perif?ricos que os enfermeiros fazem do seu sofrimento ps?quico. Adequamos analiticamente os resultados nas tr?s dimens?es de pertencimento das representa??es sociais: a Subjetividade, a Inter-subjetividade e a Trans-subjetividade. Inferimos que a rela??o interpessoal, a sobrecarga de trabalho, o desvio da fun??o do enfermeiro apresentou-se como os fatores respons?veis pelo sofrimento ps?quico do mesmo. Nesse sentido, o n?cleo central da representa??o social desta categoria profissional, insere-se no n?vel da trans-subjetividade e est? compreendida como uma Representa??o Social Pol?mica

A utilização de instrumentos, escalas ou questionários pode ser uma estratégia útil para pesquisadores e profissionais da saúde com vistas a identificar problemas de saúde mental na infância e adolescência. A Arousal Predisposition Scale (APS) é uma escala com 12 itens elaborada para mensurar o nível de arousal de um indivíduo. Entende-se como arousal a predisposição ou característica individual de resposta aos estímulos ambientais. Estudos demonstram que existe associação entre problemas de comportamento e níveis de resposta a estímulos. Todavia, não há no Brasil instrumentos ou escalas adaptados transculturalmente para esse fim. O presente estudo tem por objetivo realizar a adaptação transcultural e a avaliação das propriedades psicométricas da versão em português do Brasil da APS para crianças e adolescentes. Utilizou-se o referencial de Beaton e colaboradores para validação de instrumentos para medidas de saúde. O estudo foi realizado com escolares da rede pública de ensino da área de abrangência de uma Unidade Básica de Saúde. Foram incluídas três faixas etárias: crianças de 8 a 10 anos, pré-adolescentes de 11 a 14 anos e adolescentes de 15 a 17 anos completos. O estudo foi dividido em duas etapas, sendo que a primeira tratou das etapas de tradução, retradução, avaliação por comitê de especialistas e avaliação da clareza da versão pré-final traduzida. A segunda etapa consistiu na avaliação das propriedades psicométricas da versão final (consistência interna, concordância intra-avaliadores e validade de critério). Utilizou-se a escala Questionário de Capacidades e Dificuldades (SDQ) para verificar a validade de critério. Após as considerações do comitê de especialistas e o resultado da avaliação da clareza por 76 estudantes, a escala foi retraduzida e enviada para o autor da APS, que aprovou a versão final, concluindo-se então a fase de adaptação transcultural. Um total de 189 estudantes participou da avaliação das propriedades psicométricas. A consistência interna dos itens foi aceitável para os grupos de pré-adolescentes e adolescentes, com alfa de Cronbach 0,766 e 0,772, respectivamente. Entretanto, não apresentou consistência interna aceitável para o grupo de crianças, com alfa de Cronbach de 0,633. Em relação à consistência intra-avaliadores, não houve diferença significativa entre a média do total da escala no teste-reteste dos três grupos (p>0,05). Observou-se correlação significativa de moderada a forte da APS com a SDQ, principalmente nos domínios equilíbrio emocional, conduta e hiperatividade. Portanto, a APS está adaptada e validada no Brasil para a faixa etária acima de 11 anos, sendo agora denominada Escala de Predisposição de Resposta a Estímulos (EPRE). A escala pode ser útil aos profissionais da saúde, sobretudo enfermeiros que atuam na atenção primária em saúde escolar, para identificar precocemente casos detectados de problemas comportamentais e neles posteriormente intervir. / The use of instruments, scales or questionnaires can be a useful strategy for researchers and health professionals to identify mental health problems in childhood and adolescence. The Arousal Predisposition Scale (APS) is a scale with 12 items designed to measure the level of arousal from an individual. Arousal is understood as a predisposition or individual response characteristic to environmental stimuli. Studies show that there is an association between behavior problems and levels of response to stimuli. However, there are no instruments or scales transculturally adapted for this purpose in Brazil. This study aims to perform the transcultural adaptation and evaluation of the psychometric properties of the Brazilian Portuguese version of APS for children and adolescents. We used the guidelines of Beaton et al. for validation of instruments for health measures. The study was conducted with students from public schools within an area covered by a primary care unit. We included three age groups: children aged 8 to 10 years, pre-adolescents 11 to 14 years and adolescents aged 15 to 17 years. The study was allocated into two phases, the first of which dealt with the stages of translation, backtranslation, expert committee review and assessment of the clarity of the pre-final version (translated). The second step was to assess the psychometric properties of the final version (internal consistency, intra-rater reliability and criterion validity). We used the scale Strengths and Difficulties Questionnaire (SDQ) to check the validity of the criteria. After the considerations of the committee of experts and the evaluation result of the clarity by 76 students, the scale was retranslated and sent to the author of the APS, who approved the final version, thus completing the stage of transcultural adaptation. The internal consistency of the items was acceptable for groups of pre-adolescents and adolescents, with Cronbach's alpha 0.766 and 0.772, respectively. However, it did not demonstrate acceptable internal consistency for the group of children, with Cronbach's alpha of 0.633. In relation to intra-rater reliability, there was no significant difference between the averages of the total scale on test-retest of the three groups (p > 0.05). We observed a significant correlation of moderate to strong of APS with SDQ, mainly in the areas of emotional balance, behavior, and hyperactivity. Therefore, APS is adapted and validated in Brazil for the age group above 11 years, and is now called Escala de Predisposição de Resposta a Estímulos, EPRE, (Predisposition Scale of Response to Stimuli). The scale can be useful to health professionals, particularly nurses who work in primary care in school health, to detect and identify early cases of behavioral problems and subsequently intervene. / La utilización de instrumentos, escalas o cuestionarios puede ser una estrategia útil para investigadores y profesionales de la salud con vistas a identificar problemas de salud mental en la infancia y en la adolescencia. Arousal Predisposition Scale (APS) es una escala que presenta 12 puntos y que ha sido elaborada para medir el nivel de arousal de un individuo. Se entiende como arousal la predisposición o la característica individual de respuesta a los estímulos ambientales. Estudios demuestran que existe una asociación entre los problemas de comportamiento y los niveles de respuesta a los estímulos. Sin embargo, en Brasil no existen instrumentos o escalas adaptados transculturalmente para esa finalidad. Este estudio pretende realizar la adaptación transcultural y evaluar las propiedades psicométricas de la versión en portugués de Brasil de APS para niños y adolescentes. Para la validación de instrumentos para medidas de salud se utilizó el referencial de Beaton y colaboradores. El estudio fue aplicado a escolares de la red pública de enseñanza del área de cobertura de una Unidad Básica de Salud. Se incluyeron tres franjas etarias: niños de 08 a 10 años, preadolescentes de 11 a 14 años y adolescentes de 15 a 17 años completos. Se ha dividido el estudio en dos etapas, siendo que la primera trató de las etapas de traducción, retraducción, evaluación por parte de un comité de especialistas y evaluación de la claridad de la versión pre final traducida. La segunda etapa consistió en la evaluación de las propiedades psicométricas de la versión final (consistencia interna, concordancia de los evaluadores internos y validez del criterio). Se ha utilizado la escala Cuestionario de Capacidades y Dificultades (SDQ) para comprobar la validez del criterio. Tras las consideraciones del comité de expertos y el resultado de la evaluación de la caridad por parte de 76 alumnos, la escala fue retraducida y enviada al autor de la APS, quien aprobó la versión final, por lo que se concluyó la etapa de adaptación transcultural. Un grupo de 189 alumnos participaron en la evaluación de las propiedades psicométricas. La consistencia interna de los ítems fue aceptable para los grupos de preadolescentes y adolescentes, con alfa de Cronbach, 0,766 y 0,772, respectivamente. Sin embargo, no hubo consistencia interna aceptable para el grupo de niños, con alfa de Cronbach de 0,633. Con relación a la consistencia entre los evaluadores internos, no hubo diferencia significativa entre el promedio del total de la escala en el test-retest de los tres grupos (p>0,05). Se observó una correlación significativa de moderada a fuerte de la APS con la SDQ, principalmente en los dominios de equilibrio emocional, conducta e hiperactividad. Por lo tanto, la APS está adaptada y habilitada en Brasil para la franja etaria superior a los 11 años, siendo que ahora se la denomina Escala de Predisposición de Respuesta a Estímulos (EPRE). La escala puede ser útil para los profesionales de la salud, principalmente para los enfermeros que actúan en la atención primaria en salud escolar, para identificar de forma precoz los casos detectados como trastornos del comportamiento y poder intervenir en ellos más tarde.

O modelo demanda e controle de Karasek, elaborado na década de 1970, postula que os trabalhadores expostos a situações de alta exigência no trabalho, decorrente da combinação entre altas demandas psicológicas e baixo controle sobre o processo de trabalho, tem maior risco de apresentar eventos em saúde relacionados ao estresse, em particular doenças cardiovasculares. Os objetivos desta tese incluíram: avaliar propriedades psicométricas do instrumento Demand-Control-Support Questionnaire (DCSQ) e conduzir uma meta-análise dos estudos publicados sobre a associação entre alta exigência no trabalho e hipertensão arterial. Três artigos foram elaborados. O primeiro artigo avaliou a validade dimensional e consistência interna da versão brasileira do instrumento DCSQ, quando aplicado a trabalhadores de um hospital e nove restaurantes no Rio de Janeiro. O segundo artigo comparou as propriedades psicométricas do DCSQ no contexto dos trabalhadores de hospital no Brasil e na Suécia. O terceiro artigo apresentou uma meta-análise dos estudos de associação entre alta exigência no trabalho e hipertensão arterial. Os resultados evidenciaram que o instrumento DCSQ tem estrutura tridimensional e equivalente nas versões brasileira e sueca (original), representada por demandas psicológicas, uso de habilidades e autonomia para a decisão. O modelo de melhor ajuste excluiu a dimensão apoio social no trabalho e o item trabalho repetitivo (uso de habilidades). A meta-análise revelou que os estudos foram heterogêneos, a população-alvo foi restrita a países da Europa, EUA e Japão, sem evidência de associação entre alta exigência no trabalho, demanda e controle, e hipertensão arterial. / Proposed in the 1970s, the demand control model stated that workers in high strain jobs, a combination of high levels of psychological demands and low levels of control, have an increased risk of stress-related outcomes, particularly cardiovascular diseases. The aim of this thesis is to evaluate the psychometric properties of the Demand-Control-Support Questionnaire (DCSQ) and to conduct a meta-analysis of published studies about the association of job strain and hypertension. Three articles were presented. The first article evaluated the dimensional validity and internal consistency of the Brazilian version of DCSQ, when applied to hospital and restaurant workers in Rio de Janeiro. The second article compared the psychometric properties of the Swedish and Brazilian versions of DCSQ, when applied to hospital workers. The third article presented a meta-analysis of the association studies of job strain and hypertension. The results evidenced a three-factor structure of the DCSQ, which was equivalent in the Brazilian and Swedish versions and closely related to psychological demands, skill discretion and decision authority dimensions. The best fit model was achieved by excluding the social support at work dimension and the item repetitive work (skill discretion). The meta-analysis revealed no association between high strain, and related dimensions, and hypertension in samples restricted to European countries, USA and Japan, in which heterogeneity between studies was evidenced.

Este trabalho teve por objetivo estudar o stress e a qualidade de vida em esposas de alcoolistas. O stress pode ser definido como uma reação do organismo, com implicações físicas e/ou psicológicas que ocorrem quando a pessoa se confronta com uma situação que a amedronta, irrita, excita ou que ocasiona intensa felicidade (LIPP, 1996). O relacionar-se com um dependente alcoólico, segundo Edwards (1999), tende a provocar stress, principalmente graças à imprevisibilidade do seu comportamento. Dessa forma, a esposa, em particular, não sabe o que a espera ao se deparar com o cônjuge em estado de embriaguez. Diante desse quadro, optamos por realizar um estudo sobre stress e qualidade de vida em esposas de alcoolistas. Nesta pesquisa foram avaliadas 31 esposas, cujos cônjuges estavam em início de tratamento ambulatorial de reabilitação em uma clínica psiquiátrica na cidade de Garanhuns PE. Utilizamos os seguintes instrumentos: Inventário de Sintomas de Stress para Adultos de Lipp (ISSL); Inventário de Qualidade de Vida (IQV) e roteiro de entrevista. No que se refere aos resultados, 93,54% das esposas apresentaram stress; 67,7% na fase de resistência e 12,9% na fase de exaustão. Para analisarmos o nível de significância em relação à ocorrência de stress na amostra pesquisada, usamos o X (qui-quadrado). Os resultados encontrados foram considerados significativos para 1 &#945; ao nível de 1%. Esses dados podem indicar o mal que o convívio com o alcoolista acarreta a essas mulheres, interferindo na sua qualidade de vida. A análise das entrevistas identificou que as esposas enfrentam, em seu dia-dia, fontes externas e internas de stress. Dentre os estressores externos, um dos fatores que sobrecarrega a mulher é o fato de que ela geralmente é a responsável por todos os aspectos relacionados à família; ela também não recebe ajuda no manejo com o esposo, além de sofrer agressões verbais. Quanto às internas, encontramos: a esposa não consegue perceber alternativas que possam ajudar na recuperação de seu marido; nutre o sentimento de raiva ao percebê-lo alcoolizado; sente-se tensa e preocupada quando o marido sai de casa. Em relação às estratégias de enfrentamento mais utilizadas pela esposa, destacamos: busca de apoio para si; orientação para lidar com o alcoolismo do marido; conversa com outras pessoas a respeito do problema e incentivo ao marido na procura de algum tipo de tratamento. Vale ressaltar que esses resultados referem-se aos estudos obtidos através dos dados coletados com esse grupo. Reconhecemos a necessidade de mais pesquisas com a finalidade de melhor conhecermos a mulher companheira do alcoolista, oferecendo-lhe um melhor atendimento voltado para as estratégias de controle do stress / This works object was to study the stress and the quality of life in alcohol addicts wives. Stress can be defined as an organisms reaction, with physical and/or psychological, that occurs during a confronting situation that may frighten, irritate, excite or cause intense happiness (LIPP, 1996). To be related to an alcohol addict, according to Edwards (1999), tends to cause stress, mainly because of an unexpected behavior. In that matter alcohol addicts wives, in particular, dont know what to expect when they find themselves with their husbands drunk. Before this scene we opted to research about the stress and the quality of life in alcohol addicts wives. In this research 31 alcohol addict wives were evaluated. Alcohol addicts were in the beginning of their ambulatorial rehabilitation treatment in a psychiatrical clinic in the city of Garanhuns PE. The following instruments were used: Lipps Stress Symptom Inventory for Adults (ISSL); The Quality of Life Inventory (IQV) and interviews. The results showed that, 93.54% of the alcohol addicts wives presented stress, 67.7% in the resistance level and 12.9% in the level of exhaustion. To analyze the level of significance related to the occurrence of stress in the data of the present research, the X (qui-quadrate) was used. The results found were considered significant for 1 &#945; in a 1%. These can be indicating the harm caused by a close relationship between the alcoholics and their wives, interfering in their quality of life. The interviews analyzed identified that the wives deal with, in their daily routine, internal and external sources of stress. As to speak of the external stressful causes, one of the facts that overstresses Is the fact that shes responsible for all families matters; also she doesnt receive any help on how to cope with her husband, and added to that suffers verbal aggression. We found our that the internal sources are: the impossibility to identify any alternative so to help in their husbands recovery; they nurture anger when they find them drunk; feel tense and worried when their husbands leave the house at any time. Related to the strategies used by the alcoholics wives: search for self-orientation on how to cope with their husbands alcoholism; conversations with other people about the problem and the help needed to make their husbands start an alcoholism treatment. Its also important to note that the results were related to the studies based on the data collected for this specific group. Therefore we recognize the need of other researches as to get to know alcoholics wives better, becoming possible to offer them proper conditions based on the stress control strategies.

Understanding the academic training as a pre-professional activity can be considered that college students live with stressors related to the profession and the academic environment. Thus, if students do not opt for effective strategies to cope with the wear, the permanence of stressors can lead to chronicity of stress and in the long term, the Burnout Syndrome. This study aims to determine the association between level of stress and Burnout Syndrome in nursing students from three universities. It is part of a project entitled Stress, Coping, Burnout, and Depressive Symptoms in Hardiness Learners and Teachers of Nursing, registered and approved with the Research Ethics Committee under nº 0380.0.243.000-10. It is an analytical, cross-sectional and quantitative research carried out from a database constructed with data from 571 nursing students from three institutions of higher education in Brazil, two in the Southeast region (one public and one private) and one in the region South (public). Data were collected and partially analyzed in 2011 and 2012, through the form for socio-demographic and academic characteristics of students, the Instrument for Assessing Stress in Nursing Students and the Maslach Burnout Inventory - Student Survey. To test the hypothesis of this study, the chi-square analysis will be performed. P values <0.05 were considered statistically significant, with a confidence interval of 95%. Observed the predominance of female students (84.21%), aged between 20 and 24 years (47.37%), single (74.43%), no children (81.09%) and reside with family (75.61%). Regarding the level of stress there was 55.40% of students in middle stress level and 24.74% indicative for Burnout Syndrome. In the association between level of stress and the occurrence of Burnout Syndrome showed statistically significant difference (p = 0.0380). On the association between stress levels in the areas and Burnout there is a significant statistical difference in the areas Professional Communication (p = 0.0297), and Activity Theory (p = 0.0434). The interaction with the stressors of training can lead to occurrence of burnout. Also we identified students in average level of stress without burnout, which may suggest that these students use strategies to minimize the stressors and thus avoid the syndrome. / Ao compreender a formação acadêmica como atividade pré-profissional pode-se considerar que os estudantes universitários convivem com estressores relacionados à profissão e ao ambiente acadêmico. Assim, se os acadêmicos não optarem por estratégias efetivas para enfrentar o desgaste, a permanência dos estressores pode levar a cronificação do estresse e, em longo prazo, à Síndrome de Burnout. Esse estudo tem como objetivo verificar a associação entre nível de estresse e a Síndrome de Burnout nos acadêmicos de enfermagem de três universidades brasileiras. É parte de um projeto intitulado Estresse, Coping, Burnout, Sintomas Depressivos e Hardiness em Discentes e Docentes de Enfermagem, registrado e aprovado junto Comitê de Ética em Pesquisa sob nº 0380.0.243.000-10. Trata-se de uma pesquisa analítica, transversal e quantitativa, realizada a partir de um banco construído com dados de 571 acadêmicos de enfermagem de três Instituições de Ensino Superior do Brasil, duas da região Sudeste (uma pública e uma privada) e uma da região Sul (pública). Os dados foram coletados e parcialmente analisados em 2011 e 2012, por meio do formulário para caracterização sociodemográfica e acadêmica dos discentes, do Instrumento para Avaliação de Estresse em Estudantes de Enfermagem e do Maslach Burnout Inventory Student Survey. Para testar a hipótese deste estudo, foi realizada a análise de qui-quadrado. Valores de p<0,05 foram considerados estatisticamente significantes, com intervalo de confiança de 95%. Observou-se o predomínio de discentes do sexo feminino (84,21%), na faixa etária entre 20 e 24 anos (47,37%), solteiros (74,43%), sem filhos (81,09%) e que residem com a família (75,61%). Quanto ao nível de estresse verificou-se 55,40% dos estudantes em médio nível de estresse e 24,74% com indicativo para a Síndrome de Burnout. Na associação entre nível de Estresse e a ocorrência da Síndrome de Burnout observa-se diferença estatisticamente significativa (p=0,0380). Na associação entre níveis de estresse nos domínios do AEEE e Burnout verifica-se diferença significativamente estatística nos domínios Comunicação Profissional (p=0,0297) e Atividade Teórica (p=0,0434). O convívio com os estressores da formação pode levar a ocorrência de Burnout. Também identificou-se estudantes em médio nível de estresse sem Burnout, o que pode sugerir que estes estudantes utilizam estratégias de modo a minimizar os estressores e assim, evitar a síndrome.