In the last decade, many first-episode psychosis programs have been developed in the United States and elsewhere. First-episode psychosis typically affects adolescents and young adults. These programs, therefore, emphasize early intervention to alter long-term consequences and address specific needs of the affected population. Open Dialogue, which has shown promise in Finnish studies, is one such program that is gaining popularity outside of Finland. The program emphasizes active involvement of family and collaborative decision making. The three studies in this dissertation elucidate how Open Dialogue can contribute to current treatment options and describe considerations in adaptation and implementation of Open Dialogue in the United States. The Promoting Action on Research Implementation in Health Services (PARiHS) framework describing the role of evidence, context, and facilitation in successful implementation provides the theoretical basis for these studies. Study One is a systematic scoping review of the literature describing first-episode psychosis programs. Study Two is a qualitative study of stakeholder experiences in a pilot study of the Open Dialogue model in the United States. It examines perceived usefulness, contextual support, and factors facilitating participation. Study Three examines organizational characteristics that supported implementation at the agency where the program was piloted in the United States. The scoping review of first-episode psychosis programs indicates a need for further research regarding their long-term benefits, optimal duration and intensity, and critical components. Family intervention appears to be beneficial, suggesting that the Open Dialogue approach to family support might be a valuable addition warranting further investigation. Stakeholders involved in the Open Dialogue pilot identified several unique and beneficial features of the approach, focusing particularly on the value of family involvement, transparency, respectfulness, and collaborative nature of the approach. The compatibility of the Open Dialogue model with agency values, strong leadership support and vision, alongside organizational capacity to deliver the services emerge as critical factors in successful implementation of the model in the pilot study. As per the PARiHS framework, contextual factors, particularly funding of this model of services in the United States healthcare environment are key determinants to address for the future implementation of Open Dialogue in the United States. / 2019-12-31T00:00:00Z

Bakgrund: Årligen insjuknar 2000 personer i psykossjukdom i Sverige. Återhämtning följande förstagångsinsjukande i psykos är ett komplext fenomen där personens subjektiva upplevelser är avgörande för återhämtningen. Att ha kunskap om dessa subjektiva upplevelser skapar förutsättningar hos sjuksköterskan att tillgodose en god personcentrerad omvårdnad av denna individgrupp. Syfte: Syftet med denna studie var att beskriva personers upplevelse av återhämtning efter förstagångsinsjuknande i psykos. Metod: Pubmed och Cinahl har använts för att söka artiklar. Totalt tio kvalitativa artiklars resultat har analyserats och granskats enskilt. De enskilda analysernas resultat har sammansatts i ett analysschema där kategorier och subkategorier identifierats.  Resultat: Efter analysen framkom fyra kategorier, Att uppleva ett förlorat jag, Att uppleva stöd, Att uppleva försoning samt Att åter uppleva en ljus framtid, med sammanlagt tio subkategorier som beskrev upplevelser av återhämtning efter förstagångsinsjuknande i psykos. Konklusion: De subjektiva upplevelserna följande återhämtning vid förstagångsinsjuknande i psykos är komplexa och medföljes av diverse känslor och tankar. Denna studies fynd tyder på vikten av sjuksköterskans roll i personens upplevelse där sjuksköterskan måste arbeta utifrån ett personcentrerat förhållningssätt för att kunna tillgodose personens behov av vård och stöd. Vidare forskning bör undersöka hur sjuksköterskan med hjälp av ett personcentrerat förhållningssätt kan främja dessa gynnsamma upplevelser av återhämtning / Background: Annually, 2000 individuals fall ill in a psychotic disorder in Sweden. Recovery following first episode psychosis is a complex phenomenon where the individuals’ subjective experiences are crucial for recovery. To have knowledge about these subjective experiences creates opportunities for the nurse to provide a good person-centered care for this group of individuals. Aim: The aim of this study was to describe individuals’ experiences of recovery following a first episode psychosis Methods: Pubmed and Cinahl has been used to search articles. In total, ten qualitative articles results have been analyzed and reviewed individually. The individually analyses’ results were compiled in an analysis table where categories and subcategories were identified. Results: Following the analysis emerged four categories, To experience a lost self, To experience support, To experience reconciliation and To once again experience a bright future, with a total of ten subcategories which described experiences of recovery following first episode psychosis.  Conclusion: The subjective experiences following recovery from first episode psychosis is complex and is followed by various emotions and thoughts. This study’s findings suggest the importance of the nurse’s role in the individual’s experience where the nurse must work from a person-centered approach to be able to provide the care required for the individual’s recovery. Further research should explore how the nurse, from a person-centered approach, can promote these favorable experiences of recovery

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Bakgrund Mer än 2000 personer insjuknar varje år i Sverige i förstagångsinsjuknande i psykos. Insjuknandet kan upplevas som en kris för personen och för dennes närstående samt medföra ett psykiskt, socialt och ekonomiskt lidande. Psykosvården är i behov av stora resurstillgångar från samhället och den drabbade behöver ofta flera stödinsatser från hälso-och sjukvården. Tidigare forskning finns om återhämtning från psykisk ohälsa och från psykossjukdomar. Det finns dock mindre forskning som fokuserar på patienter med förstagångsinsjuknande i psykos och deras upplevelse av återhämtning. Syfte Syftet var att beskriva patienters upplevelse av vad som påverkar återhämtningen efter förstagångsinsjuknande i psykos. Metod Litteraturöversikt med systematisk ansats inkluderat 15 studier med kvalitativ ansats. Litteratursökningar genomfördes i databaserna Cinahl Complete, PsycInfo och PubMed. Dataanalys utfördes genom Thomas och Hardens metod för tematisk analys. Resultat Tre huvudteman framkom i resultatet: Personliga processer bidrar till återhämtning, olika relationer bidrar till återhämtning samt stigma- ett hinder för återhämtning. En individuell förändringsresa genom acceptans, återtagen kontroll och hopp inför framtiden var bidragande faktorer i återhämtningen. Medicinering, stöd från hälso-och sjukvården och närstående samt social tillhörighet bidrog till återhämtningsprocessen. Stigma var hämmande för återhämtningen. Slutsats Återhämtning vid förstagångsinsjuknande i psykos är en komplex och individuell process, som påverkas av både personliga processer samt yttre faktorer. Att uppleva stigma är ett hinder för återhämtning. Specialistsjuksköterskan inom psykiatrisk vård har en central roll i patientens återhämtningsprocess, vilket förutsätter god kompetens och ett personcentrerat förhållningsätt. / Background More than 2000 people fall ill every year in Sweden with a first onset of psychosis. The illness is often experienced as a crisis for the person themselves and their family and can cause psychological, social and financial suffering. Psychiatric care is in need of large resources from the society, and the sufferer often needs several support measures from the health and medical care. Previous research exists on recovery from mental illness and from psychotic illnesses. However, there is less research focusing on first-time psychosis patients and their experience of recovery.  Aim The aim was to describe patients' experiences in what affects recovery after a first episode psychosis Methods Literature review with a systematic approach including 15 studies with a qualitative approach. The literature searches were conducted in the databases Cinahl Complete, PsycInfo and PubMed. Data analysis has been done through Thomas and Harden's methods for the thematic synthesis. Results Three main themes emerged in the results: Personal processes contribute to recovery, different relationships contribute to recovery and stigma - an obstacle to recovery. A individual journey of change through acceptance, regained control and hope for the future were contributing factors in the recovery. Medication, support from health care and relatives and social belonging contributed to recovery. Stigma were inhibiting the recovery. Conclusions Recovery from the first onset of psychosis is a complex and individual process, which is influenced by both personal processes and external factors. Experiencing stigma is a barrier to recovery. The specialist nurse in psychiatric care has a central role in the patient's recovery process, which requires good competence and a person-centred approach.

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. / The Valanginian stage witnesses a positive carbon isotope excursion (amplitude 1.5-2‰) in the sedimentary records, the so-called « Weissert Episode ». This event coincides with major palaeoenvironmental and palaeoclimatic changes. The formation of the Paraná-Etendeka large igneous province has widely been proposed as the major driving force behind these changes. However recent investigations demonstrate that the Weissert Episode precedes the volcanic activity. Thus the driving force(s) behind these changes are still under debate. In the herein study, cyclostratigraphic, biostratigraphic, mineralogical and geochemical analyses have been performed on mid- and high latitudes sites (the Orpierre and Arnayon/La Charce sections in the Vocontian Basin, and the ODP hole 765C in the Argo abyssal plain) in order (i) to explore the dynamic of the local versus global processes in the palaeoenvironmental changes and (ii) to discuss the possible forcing factors behind the Weissert Episode. Local diagenetic and sedimentological processes that might bias the palaeoclimatic signals are highlighted and discussed before any palaeoenvironmental interpretation. The astronomical calibration of the Weissert Episode performed at Orpierre, allowed for the first time, the calculation of detrital and nutrient influxes into the Vocontian basin. They highlight rapid climate changes at mid latitudes, characterized by pronounced humid conditions during the Weissert Event (Early–Late Valanginian transition) and drier conditions in the Late Valanginian. In parallel, new geochemical and mineralogical analyses performed on the ODP hole 765C have been integrated to a global compilation of published geochemical and mineralogical data from 23 sections, located in five depositional environments. Three latitudinal belts have been recognized during the Valanginian : (i) an arid palaeolatitudinal belt in the Proto North Atlantic Ocean (~15–17°N), (ii) a subtropical climatic belt in the Northwestern Tethyan margin (~25–30°N) ; and (iii) a warm temperate palaeoclimatic belt in the high latitudes site (~53°S and ~40 to 70°N). It appears that during this period, both tectonic and orbital factors might have controlled the distribution of the palaeoclimatic belts and the major palaeoenvironmental changes during the Weissert Episode.

Introduction : Issus des données animales, les modèles neurotrophiniques du mécanisme d’action des médicaments antidépresseurs pourraient permettre d’identifier chez l’Homme des biomarqueurs prédictifs de la réponse et de la rémission sous antidépresseurs. Nous évaluons l’intérêt clinique, chez les patients souffrant de trouble dépressif caractérisé unipolaire, de 11 biomarqueurs : polymorphismes nucléotidiques simples (SNP) du Brain Derived Neurotrophic Factor (BDNF) et de son récepteur, le Récepteur Tyrosine-Kinase B (TRKB), taux plasmatiques de BDNF et volume hippocampique sur la réponse/rémission sous antidépresseurs. Méthode : Les données originales de ce travail sont issues de la cohorte METADAP. Il s’agit d’une cohorte, prospective, multicentrique incluant 624 patients présentant un épisode dépressif caractérisé dans le cadre d’un trouble dépressif caractérisé unipolaire et nécessitant l’introduction d’un traitement antidépresseur. Le traitement antidépresseur est prescrit de façon naturaliste (tous antidépresseurs commercialisés en France). Les patients sont évalués 1, 3 et 6 mois après l’introduction du traitement antidépresseur. Les biomarqueurs étudiés sont les polymorphismes Val66Met du BDNF et 8 SNP du TRKB et les dosages de BDNF plasmatiques. Une étude ancillaire est menée à partir de 63 patients ayant bénéficié d’Imagerie par Résonnance Magnétique cérébrale réalisée en pratique courante à l’inclusion de cette cohorte afin d’évaluer les volumes hippocampiques. Résultats : 1) Une revue de la littérature met en évidence une association entre la réponse aux antidépresseurs et 12 SNP du BDNF/TRKB sur 242 étudiés, ainsi qu’une association entre allèle Met du polymorphisme Val66Met du BDNF et meilleure réponse sous antidépresseurs chez les patients asiatiques. 2) Nos données ne mettent pas en évidence d’impact de 8 SNP du TRKB sur la réponse/rémission après traitement antidépresseur, mais un effet différentiel du Val66Met du BDNF selon la classe de traitement antidépresseur. 3) L’étude des dosages de BDNF plasmatiques n’est pas concluante. 4) Concernant les volumes hippocampiques, notre méta-analyse montre que des volumes hippocampiques moindres prédisent une moindre réponse/rémission après traitement antidépresseur. 5) Concernant les liens entre les biomarqueurs étudiés, nous ne mettons pas en évidence d’association. Conclusion : Sur les 11 biomarqueurs étudiés, seuls 2 pourraient présenter une utilité en pratique clinique. Si nos travaux étaient répliqués, le polymorphisme Val66Met du BDNF et le volume hippocampique pourraient conduire à orienter le choix des antidépresseurs dans le traitement des épisodes dépressifs caractérisés. Malgré une littérature cohérente chez l’Animal, nous n’avons pas mis en évidence, dans l’échantillon étudié, de lien entre les biomarqueurs génétiques étudiés et les volumes hippocampiques. Nous poursuivons ce travail d’évaluation des biomarqueurs neurotrophiniques et neurogéniques avec des méthodes d’évaluations nouvelles : séquençage nouvelle génération pour la génétique et imagerie multimodale (acquisition répétée d’IRM structurelle, fonctionnelle et de diffusion) de l’hippocampe. Nous évaluerons également de nouveaux biomarqueurs. / Introduction: developed with Animal preclinical approachs, neurtrophinic and neurogenic models of antidepressant mechanism of action lead to identify biomarkers in Human which could be predict antidepressant response and remission in depressed patients. We assess the clinical benefit of 11 biomarkers in depressed patients: Brain Derived Neurotrophic Factor (BDNF) and its receptor Tyrosine Receptor -Kinase B (TRKB), Plasma BDNF and Hippocampal volumes to predict antidepressant response/remission. Methods: The original research data of this work are from METADAP cohort. It is a prospective, multicentric cohort including 624 patients with a diagnosis of major depressive disorder and a current major depressive episode at the start of the index antidepressant treatment. Antidepressant treatment is prescribed in naturalistic conditions (all commercialized antidepressant in France). Patient are assessed 1, 3 and 6 months after the start of antidepressant treatment. Studied biomarkers are BDNF Val66Met polymorphism, 8 TRKB SNP and plasma BDNF. Ancillary study are done with 63 patients which benefit in clinical practice of Magnetic Resonnance (MRI) at the inclusion of the cohort. Results: 1) A review of literature reports associations between antidepressant efficacy and 12 BDNF/TRKB SNP on 242 studied SNP and an association with Met allele of Val66Met BDNF polymorphism and a best antidepressant efficacy in Asian patients. 2) Our original data show no impact of 8 TRKB SNP on antidepressant response remission but a differential effect of Val66Met BDNF polymorphism depending on antidepressant treatment class. 3) Plasma BDNF study is not conclusive. 4) Concerning hippocampal volumes, our meta-analysis show that smaller hippocampal volumes predict lower response/remission rate after antidepressant treatment. 5) No association is found between studied biomarkers. Conclusion: 2 of the 11 studied biomarkers could be useful in clinical practice. After replication of our results, Val66Met polymorphism could lead to personalized antidepressant prescription in major depressive disorder. Although the animal prelinical littérature appar strong, we dont report association between genetic biomarker and hippocampal volume in ours ample. We will assess neurotrophinic and neurogenic biomarkers with new methods: next generation sequencing for genetic, multimodal imaging (repeated structural, functional and diffusion MRI) of hippocampus. We also will assess new biomarkers.

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INTRODUÇÃO: Transtornos psiquiátricos com sintomas psicóticos trazem prejuízos ocupacionais e sociais significativos aos seus portadores, com aumento da mortalidade e morbidade. Estes transtornos têm sido estudados como alterações do padrão de conectividade funcional nas redes cerebrais do estado de repouso. Entretanto, tais relatos são mais frequentes em pacientes crônicos, com literatura escassa sobre pacientes em primeiro episódio psicótico, principalmente não realizando comparações entre as redes. OBJETIVO: Este foi um estudo exploratório com objetivo de caracterizar a conectividade funcional cerebral das redes do estado de repouso em pacientes de primeiro episódio psicótico através da ressonância nuclear magnética funcional comparando-os a irmãos e a controles de base populacional. MÉTODOS: A amostra foi composta por por 38 pacientes em primeiro episódio psicótico, 13 irmãos e 41 controles de base populacional. Foram coletadas imagens por ressonância magnética funcional e a conectividade funcional foi obtida através do coeficiente de correlação de Pearson da série temporal do sinal BOLD de 264 regiões de interesse. A comparação da conectividade funcional entre os grupos de participantes foi feita pelo método Partial Least Square. Também foi utilizado o método Behavior Partial Least Square para buscar um padrão de conexões alteradas que estivesse associado a gravidade dos sintomas psicóticos, ao tempo de tratamento e a duração da psicose não tratada. A análise estatística contou com 10.000 permutações e um método de reamostragem e foram considerados significativos valores de p<0.05. RESULTADOS: As alterações nas redes, em sua maioria, foram devido à mudança de correlação positiva para correlação negativa nos pacientes em relação aos controles. As redes com maior número de conexões alteradas entre pacientes e controles foram a rede sensóriomotor mão, Default Mode Network (DMN) e rede visual. As conexões estiveram mais alteradas no lobo frontal direito. Não foi encontrada associação entre o padrão de conectividade funcional dos pacientes e a duração de psicose não tratada, o tempo de tratamento farmacológico e a gravidade da psicose. Na comparação entre pacientes e irmãos, foi encontrada uma tendência à significância de um padrão de conexões alteradas. Não foi encontrada diferença significativa entre o grupo de irmãos e o grupo controle. DISCUSSÃO: Pacientes em primeiro episódio psicótico apresentaram maior segregação das redes do estado de repouso comparados a controles de base populacional, corroborando a hipótese etiológica da Esquizofrenia de uma desconectividade funcional do cérebro. A rede sensório-motor mão surpreendentemente foi a rede com maior número de alterações, apontando a necessidade de mais estudos sobre a mesma. Os irmãos não apresentaram um padrão de conexões do repouso diferente dos controles, não corroborando as hipóteses de que tal grupo apresentaria um padrão intermediário entre pacientes e controles. CONCLUSÃO: Os achados apontam para um uma topologia cerebral amplamente prejudicada já no início da psicose, com uma maior segregação entre as redes do estado de repouso em pacientes de primeiro episódio psicótico. / INTRODUCTION: Psychiatric disorders with psychotic symptoms bring significant occupational and social harm to their patients, with increased mortality and morbidity. These disorders have been studies as changes in the functional connectivity patterns in resting state brain networks. However, reports are more frequently made in chronic patients, with a scarce literature from first episode psychosis patients, mostly not making intra-networks comparison. OBJECTIVE: This was an exploratory study that had the objective of characterize the brain functional connectivity of resting networks in first episode psychosis patients through functional magnetic resonance imaging compared to siblings and to population based controls. METHODS: Final sample consisted of 38 first episode psychosis, 13 siblings and 41 population-based controls. Functional magnetic resonance images were collected in first episode psychosis, siblings and population based controls. Functional connectivity was obtained through the Pearson Correlation Coefficient of 264 regions of interest BOLD signal time series´. Comparison of functional connectivity among groups of participants was made using Partial Least Square method. Behavior Partial Least Square was performed to seek for a pattern associated with illness severity, pharmacological treatment time and duration of untreated psychosis. The statistical analysis was conducted with 10,000 permutations and bootstrap considering significant values of p<0.05. RESULTS: Aberrant network connections were mostrly due to changes of positive correlation to negative correlation in patients compared to controle. The majority of altered connections were found in sensory-motor network, DMN and visual network. The areas most affected were right frontal lobe. It was not found a functional connectivity pattern associated with illness severity, treatment time and duration of untreated psychosis. A tendency difference was found in the connectivity pattern between siblings and patients. No different connectivity pattern was found between siblings and controls. DISCUSSION: First episode psychosis presented more segregated resting state networks than controls, reinforcing the disconnectivity etiology hypothesis for schizophrenia. An unexpected result was sensory-motor hand network being the network with more altered connections, pointing to the need of more studies to comprehend it. The sibling group did not differ from the control group, not corroborating the hypotheses that such a group would present an intermediate pattern between patients and controls. CONCLUSION: The findings point to a largely impaired brain topology already at the beginning of the psychosis, with greater segregation between resting state networks in patients with first episode psychosis.

Made available in DSpace on 2016-04-28T19:58:43Z (GMT). No. of bitstreams: 1 Silvia da Silva Oliveira.pdf: 942339 bytes, checksum: ee0e8114babb49a421a1e3b6531390fe (MD5) Previous issue date: 2011-10-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research has as focus the possibilities of communication as result of the relationship between the chronicles and poetry of Cecília Meireles. In the first moment we turn to the comparison of her verses and prose, our corpus of study: the book Episódio Humano, published posthumously in 2007. We present, a minuscious analysis of the elements that compose the poetic genre, besides the definition of chronicle, the caracteristics and transformation along the history. The thoughts of Roman Jakobson, Jean Cohen, Tzevtan Todorov, Henry Suhamy, Maurice-Jean Lefebve, Octavio Paz, Antonio Candido and Massaud Moisés were essential to the development of this work. Through the inherent poetic sign aspects we can see the possible dialogues found between the different texts of Cecília Meireles, and answer the essential question: Is there poeticity in the chronicles Episódio Humano? In other words, is there confluence between the prose and the poetry in the studied work? Does the carioca writer reveal herself on prose the poetess she is on verses? Critics of the first phase of modernism or of a more mature moment of our literature helped us to answer this question. By preparing the chapter Critical Fortune of Cecília Meireles , we obteined some important reviews regarding the production of the poetess. Here is a brief definition about the art of the writer under the light of the critic Nunes Sampaio: The poetry of Cecília Meireles is one of the most pure, beautiful and valuable manifestation of the contemporary literature . This thought is intended just tostir our expectation in relation to Cecília s poetry / Esta pesquisa tem como abordagem as possibilidades comunicativas que resultam das relações entre a crônica e a poesia de Cecília Meireles. Para tanto, recorremos, num primeiro momento, à comparação entre os versos da escritora e a sua obra em prosa, nosso corpus de estudo: o livro Episódio Humano, publicado postumamente em 2007. Apresentamos, ainda, uma minuciosa análise dos elementos que compõem o gênero poético, além da definição sobre crônica, suas características e transformações ao longo da história. O pensamento de teóricos como Roman Jakobson, Jean Cohen, Tzevtan Todorov, Henry Suhamy, Maurice-Jean Lefebve, Octavio Paz, Antonio Candido e Massaud Moisés foram essenciais para o desenvolvimento deste trabalho. Por meio da abordagem dos aspectos inerentes ao signo poético, vislumbramos os possíveis diálogos existentes entre os textos distintos de Cecília Meireles, e respondemos à pergunta essencial: há poeticidade nas crônicas de Episódio Humano? Ou seja, há confluência entre a prosa e a poesia na obra estudada? A escritora carioca revela-se, na prosa, a poeta que é nos versos? Críticos da fase primeira do modernismo ou de um momento mais maduro de nossa literatura nos ajudaram a responder a esse questionamento. Ao elaborarmos o capítulo Fortuna crítica de Cecília Meireles , obtivemos algumas preciosas opiniões acerca da produção da poeta. Eis uma breve definição sobre a arte da escritora à luz do crítico Nunes Sampaio: A poesia de Cecília Meireles é uma das mais puras, belas e válidas manifestações da literatura contemporânea. Esse pensamento serve apenas para aguçar as nossas expectativas em relação à poética ceciliana