Shirley Silva Lacerda

Adaptação transcultural da versão brasileira da Escala do Impacto do Evento - Revisada (IES-R)

The Impact of Events Scale-Revised (IES-R) is used to screen for post-traumatic stress disorder (PTSD). The aim of this study was to assess the cross-cultural adaptation of the IES-R. The scale was translated into Brazilian Portuguese and culturally adapted. Reliability and validity were evaluated in 45 individuals divided into three groups of 15 (without PTSD, with PTSD, and treated for PTSD). Reliability was evaluated using intraclass correlation coefficient - ICC and Cronbachs alfa. Discriminant validity was evaluated by comparing mean IES-R scores in the three groups. The area under the ROC curve (AUC) was evaluated to determine cut-offs with higher sensitivity (s) and specificity (e) using the clinical interview (DSM-IV) as reference. The IES-R showed good reliability (ICC = 1; alfa from 0.75 to 0.93). The mean IES-R scores (p < 0.05) and ROC curve had good discriminant validity for a cut-off of 5.6 (s = 0.80, e = 0.70 and AUC = 0.81). The Brazilian version of IES-R showed good properties and can be a useful screening tool for PTSD.

Positive Effects of a Stress Reduction Program Based on Mindfulness Meditation in Brazilian Nursing Professionals: Qualitative and Quantitative Evaluation

CONTEXT Mindfulness meditation has been shown to effectively mitigate the negative effects of stress among nursing professionals, but in countries like Brazil, these practices are relatively unexplored. OBJECTIVE To evaluate the effects of a Stress Reduction Program (SRP) including mindfulness and loving kindness meditation among nursing professionals working in a Brazilian hospital setting. DESIGN Pilot study with a mixed model using quantitative and qualitative methods was used to evaluate a group of participants. The quantitative data were analyzed at three different time points: pre-intervention, post-intervention, and follow-up. The qualitative data were analyzed at post-intervention. SETTING Hospital São Paulo (Brazil). PARTICIPANTS Sample 13 nursing professionals, including nurses, technicians, and nursing assistants working in a hospital. INTERVENTION Participants underwent mindfulness and loving kindness meditation during a period of six weeks. INSTRUMENTS Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Satisfaction With Life Scale (SWLS), Self-Compassion Scale (SCS), WHOQOL-BREF quality of life assessment, and Work Stress Scale (WSS). Qualitative data were collected via a group interview following six weeks participation in the SRP. RESULTS The quantitative analyses revealed a significant reduction (P < .05) between pre-intervention and post-intervention scores for perceived stress, burnout, depression, and anxiety (trait). These variables showed no significant differences between post-intervention and follow-up scores. The WHOQOL-BREF revealed significant increase (P < .05) just in the physical and psychological domains at post-intervention scores, which remained at the follow-up. Qualitative results showed improvement in the reactivity to inner experience; a more attentive perception of internal and external experiences; greater attention and awareness of actions and attitudes at every moment; and a positive influence of the SRP in nursing activities.

Sintomas de estresse pós-traumático em profissionais durante ajuda humanitária no Haiti, após o terremoto de 2010

The scope of this article is to screen the symptoms of Post-Traumatic Stress Disorder (PTSD) among the professionals who provided humanitarian aid for the Haitian population after the 2010 earthquake. It involvess a cross-sectional study. The Impact of Event Scale - Revised (IES-R) was used for screening symptoms of PTSD. The participants included 32 Brazilians (mean age = 37.58 +/-7.01), 22 Americans (mean age =33.67 +/-8.03) and 12 Ecuadorians (mean age = 44.80 +/- 15.88). The professionals did not have PTSD symptoms. The relationship between prior experience variables in disaster situations and the total score of the IES-R (F (2) = 4.34, p = 0.017), as well as prior experience in disaster situations and the intrusion subscale (F (2) = 3.94, p = 0.024) were significant in linear regression models. The number of prior experiences was revealed as a significant predictor for the total score of IES (p < 0.05). The results showed that current experiences can be exacerbated by memories of prior experiences, increasing the likelihood of developing PTSD. Therefore the mental health care of the professionals should foster the early identification of prior experience risk factors, thereby not permitting voluntary initiative to transcend selective criteria and specific care.Acidentes que ocorrem entre duas motocicletas tem sido esquecidos na imensidao dos acidentes de trânsito no Brasil, carecendo de serem melhor analisados. Este estudo buscou analisar epidemiologicamente os acidentes que ocorrem entre duas motocicletas, comparando com os outros tipos, a partir de dados do estado do Parana. Foram capturadas informacoes do sitio eletronico da Corporacao de Bombeiros relativas ao periodo de um ano (julho/2010 a junho/2011), sobre o numero e tipo de acidente, dia da semana, periodo do dia, numero de vitimas, genero, idade e gravidade das lesoes. Ocorrencias moto x moto representaram 3,4% do total de acidentes de trânsito registrados e 6,2% dos acidentes envolvendo motocicleta; as vitimas deste tipo de acidente corresponderam, respectivamente, a 4,4% do total de vitimados e a 8,5% daquelas em acidentes com motocicleta. Acidentes ocorridos aos sabado, sexo masculino e idade entre 20 a 29 anos foram mais frequentes neste tipo de eventos. Dentre as dez cidades mais populosas do estado, algumas se destacaram pelo alto indice destes acidentes, que parece guardar relacao com o indice de motorizacao de motos das localidades. Assim, torna-se fundamental a constante avaliacao destes indices e a implantacao de medidas que visem proporcionar um trânsito mais seguro.

Psychological distress in survivors of the 2010 Haiti earthquake

ABSTRACT Objective: To investigate the presence of depression and anxiety symptoms in survivors of the Haiti earthquake who were assisted by a healthcare team from the Hospital Israelita Albert Einstein, and to evaluate the impact that losing a family member during this catastrophe could have on the development of these symptoms. Methods: Forty survivors of the Haiti earthquake who were assisted by the healthcare team between February and March of 2010 were included in this study. All subjects underwent a semi-structured interview. The group was divided into Group A (individuals who had some death in the family due to the disaster) and Group B (those who did not lose any family member). Results: A total of 55% of the subjects had depression symptoms whereas 40% had anxiety symptoms. The individuals who lost a family member were five times more likely to develop anxiety and depression symptoms than those who did not. Conclusion: Catastrophe victims who lost at least one family member due to the disaster were more likely to develop anxiety and depression symptoms. To these individuals, as well as others showing psychological distress, should be offered early mental health care to help them cope with the great emotional distress inherent in these situations.

Effects of a 7-Day Meditation Retreat on the Brain Function of Meditators and Non-Meditators During an Attention Task

Meditation as a cognitive enhancement technique is of growing interest in the field of health and research on brain function. The Stroop Word-Color Task (SWCT) has been adapted for neuroimaging studies as an interesting paradigm for the understanding of cognitive control mechanisms. Performance in the SWCT requires both attention and impulse control, which is trained in meditation practices. We presented SWCT inside the MRI equipment to measure the performance of meditators compared with non-meditators before and after a meditation retreat. The aim of this study was to evaluate the effects of a 7-day Zen intensive meditation training (a retreat) on meditators and non-meditators in this task on performance level and neural mechanisms. Nineteen meditators and 14 non-meditators were scanned before and after a 7-day Zen meditation retreat. No significant differences were found between meditators and non-meditators in the number of the correct responses and response time (RT) during SWCT before and after the retreat. Probably, due to meditators training in attention, their brain activity in the contrast incongruent > neutral during the SWCT in the anterior cingulate, ventromedial prefrontal cortex/anterior cingulate, caudate/putamen/pallidum/temporal lobe (center), insula/putamen/temporal lobe (right) and posterior cingulate before the retreat, were reduced compared with non-meditators. After the meditation retreat, non-meditators had reduced activation in these regions, becoming similar to meditators before the retreat. This result could be interpreted as an increase in the brain efficiency of non-meditators (less brain activation in attention-related regions and same behavioral response) promoted by their intensive training in meditation in only 7 days. On the other hand, meditators showed an increase in brain activation in these regions after the same training. Intensive meditation training (retreat) presented distinct effects on the attention-related regions in meditators and non-meditators probably due to differences in expertise, attention processing as well as neuroplasticity.

A Stress Reduction Program Adapted for the Work Environment: A Randomized Controlled Trial With a Follow-Up

Objective: The aim of this study was to evaluate an in situ stress reduction program, named PROGRESS, developed to meet the specific needs of workers in a business context and to research its impact upon non-severe psychiatric symptoms, stress, anxiety, depression, processing speed/attention and mindfulness. Methods: Participants with stress complaints were randomized into two groups: the main intervention group: group 1-G1, (n = 22); and the control group: group 2-G2, (n = 22). The protocol was divided into three distinct phases for the purpose of the study. Both groups were evaluated at time 1 (T1), before the first 8-week intervention, which only G1 received. The second evaluation was made on both groups at time 2 (T2), immediately after this first program; in order to test the program’s replicability and investigate possible follow-up effects, an identical second 8-week program was offered to G2 during time 3 (T3), while G1 was simply instructed to maintain the practice they had learned without further instruction between T2 and T3. A Confirmatory factor analysis (CFA) was conducted to investigate the construct validity of PROGRESS. Results: Repeated measures MANOVA test, comparing G1 and G2, showed the effect of the intervention from T1 to T2 (p = 0.021) and from T2 to T3 (p = 0.031). Univariate analysis showed that participants from G1 improved levels of non-severe psychiatric symptoms, anxiety, depression, stress, processing speed/attention and mindfulness when compared with G2, from T1 to T2 (p < 0.05). After the participants in G2 received the intervention (T2 to T3), this group also showed improvement in the same variables (p < 0.05). At the end of their follow-up period (T2-T3) – during which they received no further support or instruction – G1 maintained the improvements gained during T1-T2. The two main components were stress (stress in the last 24-h, in the last week and last month) and mental health (non-severe psychiatric symptoms, depression, anxiety and mindfulness). Conclusion: PROGRESS, an in situ mindfulness program adapted to fit within the reality of business time constraints, was effective at replicating in more than one group the reduction of stress, depression, anxiety, non-severe psychiatric symptoms, processing speed and also the improvement of attention skills, showing sustained improvement even after 8-weeks follow-up. Clinicaltrails.gov identifier: NCT02660307. https://clinicaltrials.gov/ct2/show/NCT02660307?term=Progress&rank=6

Cognition and brain function in elderly Tai Chi practitioners: A case-control study

Objective: To compare cognition and brain function in elderly Tai Chi and Water Aerobics practitioners. Methods: Eight Tai Chi (TC) and 8 Water Aerobics (WA) practitioners matched by gender, education and age underwent neuropsychological and fMRI scan during attention (Stroop Word Color Task) and working memory (N Back) tasks. Results: Groups were similar for demographic and cognitive variables. Besides anxiety (smaller in TC group), there were no differences between groups in neuropsychological variables. During the Stroop Word Color Task, TC group had smaller brain activation in the right intracalcarine cortex, lateral occipital cortex, and occipital pole, than WA. During N back, TC group presented smaller brain activation in the right frontal pole and superior frontal gyrus. Conclusion: Despite the small number of participants in this preliminary study, both groups had similar cognitive performance, however the Tai Chi group required less brain activation to perform the attention and memory tasks, therefore they may have a more efficient cognitive performance than Water Aerobics group.

The effects of perceived chronic stress on the fMRI correlates of attentional control in women managers

The aims of the current study were to examine differences in brain responses to cognitive control in stressed and non-stressed women managers. Stress complaints are highly prevalent among active workers and play an important role in women managers mental health and cognitive functioning. Psychosocial stress has been associated with differential executive functions in this population, but little is known about the neural correlates underlying such differences. We examined brain responses of a particular group of workers that has been proposed to have a different response to stress as a function of their status (i.e., managers). Stressed (n = 19) and non-stressed women managers (n = 21) were scanned using functional magnetic resonance imaging (fMRI) during the performance of a cognitively demanding task. We used the Stroop color-word task to compare neural activation associated with the suppression of a predominant response tendency (i.e., word reading) and the initiation of an appropriate behavior alternative (i.e., naming word color). Despite similar behavioral performances, stressed managers exhibited increased activation in the occipital cortex during response inhibition. No regions were more activated in the non-stressed relative to the stressed group. This finding of greater activation has been interpreted as compensatory brain response to maintain performance in front of cognitive challenge.