RESUMO A educação de adultos pressupõe a utilização de metodologias ativas de ensino-aprendizagem, que proponham concretamente desafios a serem superados pelos estudantes, tendo o professor como facilitador e orientador do processo. O objetivo deste estudo foi relatar o uso da Aprendizagem Baseada em Equipes (ABE) como estratégia de avaliação dos alunos na disciplina Interação Ensino-Serviço na Comunidade (Iesc) no curso de Medicina. A aplicação da ABE ocorreu em duas turmas da Iesc, respeitando as três etapas previstas na metodologia. A experiência obtida com a aplicação da ABE em substituição à prova tradicional demonstrou aspectos relevantes, como: na preparação, é fundamental que o acadêmico se comprometa a estudar os temas propostos; a utilização de aplicativo foi uma estratégia inovadora; o desempenho da equipe superou o individual. A aplicação dos conceitos ocorreu nas aulas de campo da Iesc, pois esta propõe a observação de casos clínicos reais nas unidades de saúde e comunidade, utilizando os conhecimentos teóricos adquiridos para direcionar intervenções. A aplicação da ABE se mostrou um método eficiente para avaliação na Iesc, que se pauta na perspectiva da interação e processos colaborativos. O uso do recurso tecnológico como ferramenta despertou interesse entre os estudantes, minimizando a tensão que geralmente ocorre durante o processo da avaliação tradicional. É importante que os cursos de formação em saúde façam uma análise constante para que práticas do ensino tradicional não sejam supervalorizadas em detrimento das práticas ativas de aprendizagem.

ABSTRACT Adult education presupposes the use of active teaching and learning methodologies that propose challenges to be overcome by students, with the teacher acting as facilitator and guiding the process. The objective of this study was to report the use of Team-Based Learning (TBL) as one of the methods used to evaluate students in the subject Teaching-Service interaction in the Community (IESC), of the Medicine Course. TBL was applied with two classes IESC classes. The experience gained through the application of TBL, instead of the traditional test, demonstrated some relevant aspects, for example: in the preparation, it is fundamental that the student is committed to studying the proposed topics; the use of application was an innovative strategy that motivated the academics to participate actively in the process; the performance of the team took precedence over individual performance. The concepts learned were put into practice in the IESC field classes, since they involve observation of real clinical cases in the Health Units and in the community, using the theoretical knowledge acquired, in the interventions. The application of TBL proved to be an efficient evaluation method in the IESC, which is based on the perspective of interaction and collaborative processes. The use of the technological resource as a tool sparked the students’ interest, minimizing the stress that usually occurs during the traditional assessment. It is important that health training courses provide a review, to ensure that traditional teaching practices are not given too much weight, at the expense of active learning practices.

Objective: To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care. Method: A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster. Results: The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one’s own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships. Conclusions: Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.

ABSTRACT: The aim of the study was to validate the Reasons for Living (RFL) Inventory in Chile, using a purposive and consecutive sample of 705 mental health patients in the Metropolitan Region. The RFL scale assesses the importance ascribed to reasons for living when contemplating suicide. The factorial structure of the scale was analyzed through exploratory and confirmatory analysis of the original instrument. Internal consistency, construct validity, and concurrent validity were studied and score parameters were defined. The suggested cut-off point for Chile is 4.1, which means that lower scores indicate a higher probability of suicide risk. Sensitivity was estimated at 62.1% and specificity at 66%, which is considered to be acceptable, given the high incidence of false negatives and positives. The result of the evaluation warns health professionals to clinically investigate the suicide risk detected when administering the instrument. Additionally, results highlight the adaptive and therapeutic potential of the reasons to stay alive for the treatment of depressive patients who are contemplating suicide.

RESUMEN: El estudio tuvo como objetivo la validación para Chile de la escala Razones para Vivir (RFL) en una muestra intencionada y consecutiva de 705 consultantes a salud mental en la Región Metropolitana. La RFL evalúa la importancia atribuida a las razones para vivir cuando se piensa en el suicidio. Se analizó la estructura factorial a través de análisis exploratorio y confirmatorio del instrumento original. Se estudió la consistencia interna, la validez de constructo y la validez concurrente y se definieron los parámetros de puntajes. El punto de corte sugerido para Chile es 4,1, lo que significa que bajo este puntaje hay una mayor probabilidad de riesgo suicida. La sensibilidad es del 62,1% y la especificidad, 66%, considerado aceptable, dada la alta incidencia de falsos negativos y positivos. El resultado de la evaluación advierte a los tratantes para indagar clínicamente el riesgo suicida detectado en el momento de aplicar el instrumento. Además, para el tratamiento de pacientes con depresión y riesgo suicida, destaca el potencial adaptativo y terapéutico de las razones para mantenerse con vida cuando se está contemplando el suicidio.

The relationship between depressive experience style, family satisfaction, discomfort in interpersonal relationships, and suicidal behavior was studied in a purposive sample of 405 mental health patients in the Metropolitan Region of Chile. They were classified into high severity suicide attempt, low severity suicide attempt, suicidal ideation, and no suicidal behavior. The instruments used were: DEQ, OQ-45.2, APGAR, RFL, Risk-Rescue Rating Scale, and Suicidal Intent Scale. ANOVA, ?2, and models of mediation and moderation of conditional processes were conducted. The high severity suicide attempt group showed a significant predominance of the dependent style compared with the group without suicidal behavior. There was a high presence of the self-critical style throughout the sample, especially in the suicidal ideation group. The groups with suicide risk had higher dysfunctional rates of interpersonal discomfort and a greater perception of severe family dysfunction than the group without suicidal behavior. Satisfaction with family functioning was observed to influence the intention to die at the time of the suicide attempt. These results underscore the importance of family functioning and interpersonal relationships in suicide risk.

Se estudió la relación entre estilo de vivencia depresiva, satisfacción familiar, malestar en las relaciones interpersonales y conducta suicida en 405 consultantes a salud mental en la Región Metropolitana, Chile, a través de una muestra intencionada. Se clasificaron en: intento de suicidio de alta gravedad, intento de suicidio de baja gravedad, ideación suicida y sin conducta suicida. Se utilizaron los instrumentos DEQ, OQ-45.2, APGAR, RFL, Escala de Riesgo-Rescate y Escala de Intención Suicida. Se realizaron ANOVA, ?2 y modelos de mediación y moderación de procesos condicionales. El grupo con intento suicida de alta gravedad mostró una predominancia del estilo dependiente. Hubo una alta presencia del estilo autocrítico en la muestra total, especialmente en el grupo con ideación suicida. Los grupos con riesgo suicida presentaron mayores índices disfuncionales de malestar interpersonal y una mayor percepción de disfuncionalidad familiar grave que el grupo sin conducta suicida. La satisfacción con el funcionamiento familiar mostró un efecto en la intencionalidad de morir al momento del intento de suicidio. Estos resultados subrayan la importancia del funcionamiento familiar y las relaciones interpersonales en el riesgo suicida.

Objective: To analyze suicidal behavior and build a predictive model for suicide risk using data mining (DM) analysis. Methods: A study of 707 Chilean mental health patients (with and without suicide risk) was carried out across three healthcare centers in the Metropolitan Region of Santiago, Chile. Three hundred forty-three variables were studied using five questionnaires. DM and machine-learning tools were used via the support vector machine technique. Results: The model selected 22 variables that, depending on the circumstances in which they all occur, define whether a person belongs in a suicide risk zone (accuracy = 0.78, sensitivity = 0.77, and specificity = 0.79). Being in a suicide risk zone means patients are more vulnerable to suicide attempts or are thinking about suicide. The interrelationship between these variables is highly nonlinear, and it is interesting to note the particular ways in which they are configured for each case. The model shows that the variables of a suicide risk zone are related to individual unrest, personal satisfaction, and reasons for living, particularly those related to beliefs in one’s own capacities and coping abilities. Conclusion: These variables can be used to create an assessment tool and enables us to identify individual risk and protective factors. This may also contribute to therapeutic intervention by strengthening feelings of personal well-being and reasons for staying alive. Our results prompted the design of a new clinical tool, which is fast and easy to use and aids in evaluating the trajectory of suicide risk at a given moment.

Resumo Objetivo: O método contabilístico pelo chamado “justo valor” não é consensual. Seus defensores dizem que permite encontrar o “valor correto” dos itens contabilísticos. Os críticos declaram que reduz a confiabilidade das demonstrações financeiras através de uma metodologia complexa, difícil de implementar e apoiada em informação subjetiva. Contudo, o debate tende a ignorar os impactos desse método nos impostos e nas receitas públicas. Metodologia: O caso português permite estudar os impostos e receitas públicas. Normas da União Europeia instruíram as empresas cotadas nas bolsas europeias a adotar as normas internacionais de contabilidade que preveem o “justo valor” após 2005 (inclusive). Contudo, o código do imposto empresarial português foi reformulado em 2010 de forma a restringir fortemente o “justo valor” para efeitos fiscais. Estudamos a utilização do “justo valor” nas Demonstrações de Resultados das maiores empresas cotadas na bolsa portuguesa entre 2005-2012. Resultados: Se Portugal não tivesse adotado as normas do “justo valor”, seus recolhimentos de impostos teriam sido superiores. Em todos os anos, e em quase todas as empresas estudadas, os ajustes médios são negativos. Apesar de ter sido encontrada alguma associação estatística entre os ajustes negativos e o ciclo econômico, ela não é muito forte. Como tal, o ciclo econômico não pode ser apresentado como a única explicação para o uso do “justo valor”. Contribuições: Este estudo demonstra que os debates sobre o método contabilístico do “justo valor” não podem ignorar seus possíveis impactos em termos fiscais e de receitas públicas.

Abstract Purpose: “Fair value” accounting standards are not consensual. Supporters claim that they offer a methodology to find the “correct” value of accounting items, whereas critics contend that “fair value” accounting reduces the reliability of financial statements through a complex and unpractical method based on subjective information. Still, the impacts of “fair value” accounting upon taxes and public revenues are rarely discussed. Design/methodology/approach: The Portuguese case allows us to study taxation and public revenues. Through European Union norms, “fair value” standards have become mandatory after 2005 for companies listed in European stock-exchanges. Nevertheless, Portuguese corporate tax law was reformulated in 2010 to strongly restrict the use of “fair value” for taxation purposes. We study the use of “fair value” in the Income Statements of the largest companies listed in the Portuguese exchange between 2005 and 2012. Findings: If Portugal had not adopted “fair value” standards, its tax revenue would have been higher. Over all analyzed years and in almost all studied companies, average “fair value” adjustments are negative. Although a statistical association between negative adjustments and the economic cycle was found, this statistical association is not very strong. Therefore, the economic cycle cannot be used as the only explanation for the use of “fair value”. Originality/value: This paper demonstrates that discussions concerning the “fair value” accounting method must not ignore its possible impacts on government taxes and public revenue.

The article presents an exploratory cross-sectional study of factors associated with suicide risk in 193 patients hospitalized in Chile. The intentional sample included groups of patients displaying: (a) suicide attempt, (b) suicidal ideation, and (c) other psychiatric causes without suicidal manifestations. Using c², a test of proportion differences, and ANOVA, they were compared according to their psychiatric and personality diagnosis and their reasons for living. The results confirm the high association of mood disorder and borderline personality disorder with suicidal manifestations. Although the instrument used, Reasons for Living, has not been validated in Chile, it showed that the group without suicidal manifestations presents more reasons for living than the other groups, that the group with suicide attempt gives more importance to reasons related to the care of close friends, and that the group with suicidal ideation assigns greater importance to the fear of failing in the attempt and going to hell. This appears to indicate the existence of deterrents to suicidal behavior that could differentiate a clinical population with lower and higher suicide risk.

Se presenta un estudio exploratorio transversal de factores asociados al riesgo suicida en 193 pacientes hospitalizados en Chile. La muestra intencionada incluyó grupos de pacientes con: (a) intento de suicidio, (b) ideación suicida y (c) otras causas psiquiátricas sin manifestación suicida. Por medio de c², prueba de diferencia de proporciones y ANOVA, fueron comparados según el diagnóstico psiquiátrico y de la personalidad y las razones para vivir. Los resultados confirman la alta asociación entre trastorno del ánimo y de la personalidad límite con manifestaciones suicidas. Se utilizó la Escala Reasons for Living que, aunque no está validada en Chile, mostró que el grupo sin manifestación suicida presenta mayor cantidad de razones para vivir; el grupo con intento de suicidio le otorga mayor importancia a motivos relacionados con el cuidado de amigos cercanos y el grupo con ideación suicida le otorga mayor importancia al miedo a fallar en el intento e ir al infierno. Esto indicaría que existen motivos disuasivos de la conducta suicida que podrían diferenciar una población clínica con menor y mayor riesgo suicida.

Presentamos un estudio cuantitativo de sujetos con conducta suicida, realizado en 176 pacientes consultantes en servicios de salud mental, los que tenían diagnóstico de trastorno depresivo, bipolar y adaptativo. Se estudió la percepción que ellos tenían acerca del modo en que habían sido cuidados por sus padres hasta los 16 años. Los resultados indican que el riesgo de un intento de suicidio de alta severidad se asocia a una percepción de cuidado parental, definido como negligencia en el cuidado y en la protección. Esta asociación sería particularmente clara con la figura paterna. Un vínculo paterno que privilegia la sobre protección, aun si presenta bajos niveles de cuidado, se asocia a menor riesgo de suicidio y/o a intentos suicidas de menor severidad. Un rol materno de cuidado pareciera ser un factor protector. Estos hallazgos abren preguntas importantes acerca de la necesidad de estudiar factores protectores o de riesgo, en los antecedentes biográficos de los pacientes con riesgo de suicidio.

We present a quantitative study on people with suicidal behavior, it evaluated 176 patients of mental health consultants, diagnosed with mood disorder, bipolar disorder and adjustment disorder. We investigated the perception that the evaluated patients had about early parental care until age 16. The results show that the the perception of negligence in matters of caretaking and protection is related to a higher probability to commit a severe suicide attempt. This association is particularly clear with the father figure. Also, the kind of paternal bond that favors overprotection, even if it presents low levels of care, is associated to a lower risk of committing suicide or less severe suicide attempts. A maternal role in caretaking seems to have a protective role of suicide risk. These findings open important questions about the necessity of studying the protective and risk factors in the biography of the patients with suicidal risk. Also, this investigation invites us to keep on studying these factors, to corroborate these findings and to achieve a better understanding of them.

Apresentamos um estudo quantitativo de sujeitos com comportamento suicida, realizado em 176 pacientes consulentes em serviços de saúde mental, com diagnóstico de Transtorno Depressivo, Bipolar e de Adaptação. Estudou-se a percepção que eles tinham acerca do modo como tinham sido cuidados por seus pais até os 16 anos. Os resultados indicam o risco de uma tentativa de suicídio de alta severidade, associado a uma percepção de cuidado parental, definido como negligência no cuidado e na proteção. Esta associação seria particularmente clara com a figura paterna. Um vínculo que privilegia o controle excessivo, ainda se apresenta baixos níveis de cuidado, se associa a menor risco de suicídio e/ou a tentativas mais leves. Um papel materno de cuidado parecesse ser um fator protetor. Estes resultados geram perguntas importantes acerca da necessidade de estudar fatores protetores ou de risco, nos antecedentes biográficos dos pacientes com risco de suicídio.

Resumen La leptospirosis es una enfermedad bacteriana caracterizada por producir clínicamente en equinos signos clínicos inespecíficos como fiebre, anemia, depresión, y otros específicos, como aborto, muerte neonatal y uveítis recurrente. La finalidad del trabajo fue determinar la seroprevalencia en 55 equinos pertenecientes al Centro Ecuestre de la Escuela Artillería de Linares, Región del Maule. Las muestras (suero), fueron obtenidas de animales sin distinción de sexo o edad y analizadas mediante el método de Aglutinación Microscópica (MAT) para nueve serovares a títulos de dilución de 1/100 o superiores. Determinando una seropositividad general del 65,4%, distribuido en los serovares: Autumnalis (54,5%), Bratislava (52,7%), Canicola (20%), Copenhageni (12,7%) y Hardjo (7,3%), mientras que para Pomona, Grippothyphosa, Bataviae y Ballum no se obtuvieron sueros reaccionantes. Finalmente, no se observó diferencia estadística significativa (P≥0,05) en los individuos reaccionantes según sexo y edad, demostrándose que a mayor edad menor es la seropositividad.

Abstract Leptospirosis is a bacterial disease characterized in horses by nonspecific clinical signs such as fever, anemia, depression; and specific signs such as abortion, neonatal death, and recurrent uveitis. The objective was to determine seroprevalence in 55 horses from the equestrian center of Linares Artillery School, located in the Maule region. Serum samples were obtained from animals of both sexes and several ages. Samples were analyzed by Microscopic agglutination (MAT) for nine serovars with dilution titles of 1:100 or higher. The overall seropositivity was 65.4%, distributed in the following serovars: autumnalis (54.5%), bratislava (52.7%), canicola (20%), copenhageni (12.7%), and hardjo (7.3%); whereas reacting sera were not obtained for pomona, grippothyphosa, ballum, or bataviae. Finally, no statistically significant difference was observed between sex or age (P≥ 0.05). Seropositivity was lower in older than in younger horses.

Resumo A leptospirose é uma doença bacteriana caracterizada por produzir em equinos alguns signos clínicos inespecíficos, como febre, anemia, depressão; e outros específicos, como aborto, morte neonatal e uveíte recorrente. A finalidade deste trabalho foi determinar a soroprevalência em 55 equinos pertencentes ao Centro Equestre da Escola de Artilharia de Linares, região de Maule no Chile. As amostras (soro) foram obtidas de animais sem distinção de sexo ou idade e analisadas pelo método de aglutinação microscópica (MAT) para nove serovares a títulos de diluição de 1/100 ou superiores. Determinando uma seropositividade geral de 65,4%, distribuído nos serovares: Autumnalis (54,5%), Bratislava (52,7%), Canicola (20%), Copenhageni (12,7%) e Hardjo (7,3%), enquanto que para Pomona, Grippothyphosa, Bataviae e Ballum não se obtiveram soros reacionantes. Finalmente, não houve diferença significativa (P≥0,05) nos indivíduos reacionantes segundo sexo e idade, conferindo que a maior idade menor é a seropositividade.