O Transtorno Afetivo Bipolar (TAB) é uma condição crônica, caracterizada pela existência de episódios agudos e recorrentes de alteração patológica do humor, que ocasiona grande impacto na vida do paciente, reduzindo seu funcionamento e sua qualidade de vida. O uso de medicamentos consiste em uma realidade necessária ao cotidiano da pessoa com TAB. Este estudo teve como objetivo compreender o significado da terapêutica medicamentosa para a pessoa com TAB, em sua perspectiva e na de seu familiar. Dada a natureza do problema, esta investigação utilizou uma abordagem qualitativa, tendo como referencial metodológico a Teoria Fundamentada nos Dados, à luz do Interacionismo Simbólico. Participaram do estudo 14 pessoas com TAB que estavam em acompanhamento em uma Unidade Ambulatorial de Transtornos do Humor de um hospital universitário e 14 familiares indicados pelas mesmas. A entrevista e observação foram utilizadas como principais estratégias de obtenção de dados. As entrevistas gravadas, após serem transcritas, foram codificadas em três etapas: codificação aberta, codificação axial e codificação seletiva. A análise comparativa dos dados resultou no fenômeno central: ?ESTANDO ENTRE A CRUZ E A ESPADA? em relação à terapêutica medicamentosa. Tal processo foi constituído pela integração entre categorias no modelo de paradigma de Strauss e Corbin, envolvendo a causa desencadeadora do fenômeno, o contexto em que o mesmo está inserido, as condições intervenientes, a estratégia de ação sobre o fenômeno e suas conseqüências. O fenômeno ESTANDO ENTRE A CRUZ E A ESPADA permitiu compreender que, para pessoas com TAB, existe uma situação de ambivalência em relação à terapêutica medicamentosa: no início, não reconhecendo o transtorno e, paralelamente, tomando muitos medicamentos. Como não se percebem doentes, geralmente não identificam motivos para utilizar medicamentos que lhes impõem como realidade conviver com o preconceito e com as perdas e limitações impostas tanto pelos seus efeitos colaterais quanto pelos sintomas do transtorno, sendo freqüente o abandono da terapia medicamentosa. Ao identificar a real necessidade do medicamento, evidenciada pela vivência de crises na ausência do mesmo, as pessoas com TAB percebem-se frente a um dilema entre as duas alternativas de vida em que se constituem a saúde e a doença. Nesse sentido, ao mesmo tempo em que depositam no medicamento o símbolo de sanidade, esse passa a ser a prova concreta e cotidiana de que possuem um transtorno mental e crônico. Este estudo permitiu, assim, compreender os fatores associados e determinantes da realidade vivenciada pelas pessoas com TAB em relação à terapêutica medicamentosa, possibilitando um salto na implementação de estratégias de intervenção nos serviços de saúde direcionadas à qualidade da assistência a esses pacientes / Bipolar Affective Disorder (BAD) is a chronic condition, characterized by the existence of acute and recurring episodes of pathological mood change, which causes a great impact on patients? lives, reduces their functioning and quality of life. Taking medication is a necessary reality in the daily lives of BAD patients. This study aimed to understand the meaning of medication therapy for these patients, according to their perspectives and those of family members. Given the nature of the problem, this research used a qualitative approach, based on Grounded Theory, in the light of Symbolic Interactionism. Study participants were 14 BAD patients who were followed at a Clinical Unit for Mood Disorders of a university hospital and 14 relatives they indicated. Interviews and observation were the main strategies for data collection. The recorded interviews were first transcribed and then coded in three phases: open coding, axial coding and selective coding. Comparative data analysis resulted in the central phenomenon: BEING BETWEEN THE DEVIL AND THE DEEP BLUE SEA with respect to medication therapy. This process was constituted by integrating categories in Strauss and Corbin?s paradigm model, involving the cause that triggered the phenomenon, the context in which it is inserted, intervening conditions, the strategy to act on the phenomenon and its consequences. The phenomenon of BEING BETWEEN THE DEVIL AND THE DEEP BLUE SEA allowed us to understand that, for patients with BAD, there is an ambivalent situation related to medication therapy. This is perceived, at first, by not acknowledging the disorder and, in parallel, by taking many drugs. As patients do not perceive themselves as ill, they generally do not identify, at this moment in the history of the disorder, motives to take drugs that impose the reality of living with prejudice and with the losses and limitations imposed by their collateral effects as well as by the symptoms of the disorders, with frequent abandonment of medication therapy. By identifying the real need for the drug, evidenced by the experience of crises when it is absent, patients with BAD find themselves faced with a dilemma between the two alternatives of life, which are health and disease. In this sense, patients place the symbol of sanity in the medication but, at the same time, it becomes the concrete and daily proof that they have a mental and chronic disorder. This study allowed us to understand associated and determinant factors of the reality BAD patients experience in relation to medication therapy, permitting a leap in the implementation of intervention strategies in health service directed at the quality of care for these patients

O Transtorno Afetivo Bipolar (TAB) é uma condição crônica, caracterizada pela existência de episódios agudos e recorrentes de alteração patológica do humor, que ocasiona grande impacto na vida do paciente, reduzindo seu funcionamento e sua qualidade de vida. O uso de medicamentos consiste em uma realidade necessária ao cotidiano da pessoa com TAB. Este estudo teve como objetivo compreender o significado da terapêutica medicamentosa para a pessoa com TAB, em sua perspectiva e na de seu familiar. Dada a natureza do problema, esta investigação utilizou uma abordagem qualitativa, tendo como referencial metodológico a Teoria Fundamentada nos Dados, à luz do Interacionismo Simbólico. Participaram do estudo 14 pessoas com TAB que estavam em acompanhamento em uma Unidade Ambulatorial de Transtornos do Humor de um hospital universitário e 14 familiares indicados pelas mesmas. A entrevista e observação foram utilizadas como principais estratégias de obtenção de dados. As entrevistas gravadas, após serem transcritas, foram codificadas em três etapas: codificação aberta, codificação axial e codificação seletiva. A análise comparativa dos dados resultou no fenômeno central: ?ESTANDO ENTRE A CRUZ E A ESPADA? em relação à terapêutica medicamentosa. Tal processo foi constituído pela integração entre categorias no modelo de paradigma de Strauss e Corbin, envolvendo a causa desencadeadora do fenômeno, o contexto em que o mesmo está inserido, as condições intervenientes, a estratégia de ação sobre o fenômeno e suas conseqüências. O fenômeno ESTANDO ENTRE A CRUZ E A ESPADA permitiu compreender que, para pessoas com TAB, existe uma situação de ambivalência em relação à terapêutica medicamentosa: no início, não reconhecendo o transtorno e, paralelamente, tomando muitos medicamentos. Como não se percebem doentes, geralmente não identificam motivos para utilizar medicamentos que lhes impõem como realidade conviver com o preconceito e com as perdas e limitações impostas tanto pelos seus efeitos colaterais quanto pelos sintomas do transtorno, sendo freqüente o abandono da terapia medicamentosa. Ao identificar a real necessidade do medicamento, evidenciada pela vivência de crises na ausência do mesmo, as pessoas com TAB percebem-se frente a um dilema entre as duas alternativas de vida em que se constituem a saúde e a doença. Nesse sentido, ao mesmo tempo em que depositam no medicamento o símbolo de sanidade, esse passa a ser a prova concreta e cotidiana de que possuem um transtorno mental e crônico. Este estudo permitiu, assim, compreender os fatores associados e determinantes da realidade vivenciada pelas pessoas com TAB em relação à terapêutica medicamentosa, possibilitando um salto na implementação de estratégias de intervenção nos serviços de saúde direcionadas à qualidade da assistência a esses pacientes / Bipolar Affective Disorder (BAD) is a chronic condition, characterized by the existence of acute and recurring episodes of pathological mood change, which causes a great impact on patients? lives, reduces their functioning and quality of life. Taking medication is a necessary reality in the daily lives of BAD patients. This study aimed to understand the meaning of medication therapy for these patients, according to their perspectives and those of family members. Given the nature of the problem, this research used a qualitative approach, based on Grounded Theory, in the light of Symbolic Interactionism. Study participants were 14 BAD patients who were followed at a Clinical Unit for Mood Disorders of a university hospital and 14 relatives they indicated. Interviews and observation were the main strategies for data collection. The recorded interviews were first transcribed and then coded in three phases: open coding, axial coding and selective coding. Comparative data analysis resulted in the central phenomenon: BEING BETWEEN THE DEVIL AND THE DEEP BLUE SEA with respect to medication therapy. This process was constituted by integrating categories in Strauss and Corbin?s paradigm model, involving the cause that triggered the phenomenon, the context in which it is inserted, intervening conditions, the strategy to act on the phenomenon and its consequences. The phenomenon of BEING BETWEEN THE DEVIL AND THE DEEP BLUE SEA allowed us to understand that, for patients with BAD, there is an ambivalent situation related to medication therapy. This is perceived, at first, by not acknowledging the disorder and, in parallel, by taking many drugs. As patients do not perceive themselves as ill, they generally do not identify, at this moment in the history of the disorder, motives to take drugs that impose the reality of living with prejudice and with the losses and limitations imposed by their collateral effects as well as by the symptoms of the disorders, with frequent abandonment of medication therapy. By identifying the real need for the drug, evidenced by the experience of crises when it is absent, patients with BAD find themselves faced with a dilemma between the two alternatives of life, which are health and disease. In this sense, patients place the symbol of sanity in the medication but, at the same time, it becomes the concrete and daily proof that they have a mental and chronic disorder. This study allowed us to understand associated and determinant factors of the reality BAD patients experience in relation to medication therapy, permitting a leap in the implementation of intervention strategies in health service directed at the quality of care for these patients

Contexte : Malgré les directives sur le temps d’écran, les enfants passent plus de temps sur des appareils électroniques qu’auparavant, ce qui en fait un facteur de risque important pour le développement social ultérieur. Les facteurs de protection à l’utilisation prolongée des écrans dans le contexte de l’enfance sont peu explorés. Partager des repas dans un contexte familial pourrait offrir un moyen de favoriser le développement psychosocial et de contrer les risques associés au temps d’écran élevé. Cette étude examine l’interaction entre l’environnement des repas en famille et la tendance de temps d’écran à la petite enfance sur les principales relations sociales des adolescents. Il est attendu qu’une meilleure qualité des repas en famille joue un rôle protecteur sur l’association entre les tendances d’habitudes d’écran et les relations sociales adolescentes. Méthode : Les participants sont 1 455 enfants (50,9 % de filles) de la cohorte de naissances de l’Étude longitudinale du développement des enfants du Québec. Les parents ont rapporté l’utilisation d’écrans des enfants à 2 et 6 ans et la qualité de l’environnement des repas en famille à 6 ans. Les parents et les enfants ont respectivement fourni des mesures sur la relation parent-enfant et la victimisation à 13 ans. Les analyses ont testé l’association directe entre les tendances du temps d’écran et la qualité de l’environnement familial durant les repas sur les relations sociales ultérieures, en utilisant des régressions linéaires. Les analyses de modération ont ensuite examiné l’interaction entre les tendances de temps d’écran et la qualité de l’environnement des repas en famille sur les relations sociales. Résultats : Nous avons observé qu’une hausse dans le temps d’écran était associée à une relation père-fille moins conflictuelle et moins de victimisation chez les filles ainsi qu’à des relations moins positives avec les deux parents et moins de victimisation chez les garçons. Pour tous, un meilleur environnement lors des repas était associé à des relations sociales plus saines avec les parents et les pairs. L’environnement familial lors des repas avait un effet modérateur distinct sur l’association entre les habitudes télévisuelles et les relations des filles avec leur mère ainsi que leurs pairs. Entre autres, lorsque les repas représentaient une occasion d’expression et de communication, une hausse du temps d’écran était associée à une relation mère-fille plus positive et moins conflictuelle. Étonnamment, les filles participant à des repas en famille moins positifs et ayant une tendance de temps d’écran plus élevée éprouvaient moins de victimisation à l’adolescence. L’interaction entre les tendances de temps d’écran et la qualité de l’environnement des repas en famille n’était pas trouvée significative pour les garçons. Conclusion : Encourager les repas familiaux représente une activité simple/rentable qui peut compenser certains risques à long terme associés à une utilisation accrue des écrans au-delà des caractéristiques individuelles et familiales préexistantes et concurrentes. Les initiatives de santé publique devraient considérer les repas en famille comme une stratégie d’intervention complémentaire aux directives d’utilisation des écrans. Les directives sur l’utilisation des écrans devraient considérer les repas en famille comme une stratégie compensatoire. / Background: Despite screen time recommendations, children are increasingly spending time on electronic devices, rendering it an important risk factor for subsequent developmental outcomes. Not much is known about protective factors in childhood context. Sharing meals could offer a way to promote psychosocial development and counter risks associated with screen use. This study examines the interaction between family meal environment and early childhood screen time on key adolescent social relationships. We expect that better mealtime environment plays a protective role in the association between screen time trends and adolescent social relationships. Method: Participants are 1455 millennial children (50.9% girls) from the Quebec Longitudinal Study of Child Development birth cohort. Parents reported on child screen use at ages 2 and 6 years and family meal environment quality at age 6 years. Parents and children reported on parent-child relationships and victimization experiences, respectively, at age 13 years. Multiple regression estimated the direct association between screen time trends and family meal environment quality and the interaction between screen time trends and family meal environment quality on later social relationship outcomes. Results: We observed that a greater increase in screen time was associated with a less conflictual father-daughter relationship and less peer victimization for girls as well as less positive relationships with both parents and less victimization for boys. For both girls and boys, a better mealtime environment was associated with better social relationships with parents and peers. For girls, early childhood screen time trends had distinct impacts on relationships with mothers and peers, conditional on mealtime environment. When family meals are an opportunity to express feelings and communicate, increasing trends in screen time are associated with more positive and less conflictual mother-daughter relationships. These same increases in screen time were associated with less peer victimization when family meal environment quality was more dysfunctional. No meaningful non-linear associations between screen time trends and family meal environment quality were observed for boys. Conclusion: Capitalizing on family meal environment represents a simple/cost-efficient activity that can compensate for some long-term risks associated with increased screen use, above and beyond pre-existing and concurrent individual and family characteristics. Public health initiatives may benefit from considering family meals as a complementary intervention strategy to screen use guidelines.