ABSTRACT Introduction Work can be a protective or risk factor for mental health, depending on individual and organizational strategies. In addition to studies pointing to health professionals as a group at greater risk in this area, in Occupational Medicine medical examinations we found a higher frequency of psychiatric pathology. Objectives The main objective of the article is to identify occupational psychosocial risk factors in Centro Hospitalar Universitário Lisboa Central and relate them to work dimensions, hospital hub, professional experience, professional category and hospital services. Methodology With an exclusive psychologist in the Occupational Health Service of Centro Hospitalar Universitário Lisboa Central, the “Evaluate, Reflect and Act Project” was developed in partnership with the Order of Psychologists over four phases, distributing the Copenhagen Psychosocial Questionnaire questionnaire to its professionals. The chosen methodology involved raising awareness among workers and their managers about the topic of FRPS, evaluating and recommending preventive and corrective strategies in this area. Results The results demonstrate that the dimensions of severity are more relevant in relation to work rhythms and cognitive and emotional demands, presenting self-efficacy, the meaning of work and role transparency as protective factors. Discussion/Conclusion This work aims to raise awareness of the need for multidisciplinary assessment and intervention from a biopsychosocial perspective, considering the increase in consequences for the mental health of health professionals and encourage to implement individual and organizational strategies to promote healthier work environments.

RESUMO Introdução O trabalho pode ser um fator protetor ou de risco para a saúde mental, dependendo de estratégias individuais e organizacionais. Para além dos estudos apontarem os profissionais de saúde como um grupo de maior risco neste âmbito, nos exames de Medicina do Trabalho destes profissionais verifica-se maior frequência de patologia psiquiátrica. Objetivos O principal objetivo do artigo é identificar os fatores de risco psicossociais ocupacionais presentes no Centro Hospitalar Universitário Lisboa Central e relacioná-los com dimensões laborais, polo hospitalar, experiência profissional, categoria profissional e serviços hospitalares. Metodologia Existindo uma psicóloga exclusiva no Serviço de Saúde Ocupacional do Centro Hospitalar Universitário Lisboa Central, desenvolveu-se em parceria com a Ordem dos Psicólogos o “Projeto Avaliar, Refletir e Agir” ao longo de quatro fases, distribuindo o questionário Copenhagen Psychosocial Questionnaire aos seus profissionais. A metodologia escolhida passou por sensibilizar os trabalhadores e respetivas chefias para a temática dos FRPS, avaliar e recomendar estratégias preventivas e corretivas neste âmbito. Resultados Os resultados demonstram como mais relevantes as dimensões da severidade face aos ritmos de trabalho e as exigências cognitivas e emocionais, apresentando-se como fatores protetores a autoeficácia, o significado do trabalho e a transparência do papel. Discussão/Conclusão Com este trabalho pretende-se alertar para a necessidade de avaliação e intervenção multidisciplinar numa vertente biopsicossocial, tendo em conta o aumento de consequências na saúde mental dos profissionais de saúde; bem como fomentar a implementação de estratégias individuais e organizacionais de modo a promover ambientes de trabalho mais saudáveis.

ABSTRACT Introduction Our society’s characteristics, with their constant evolution and globalization, have shown a significant impact on the way jobs have been structured over the years, with one of the most highlighted aspects being the possibility of practicing telecommuting. The prevalence of telecommuting and other forms of remote work enabled by technological innovations has increased in recent years. Objectives Exploring the most recently published literature on telecommuting; examining its relationship with psychosocial risk factors and making inferences about the need for the implementation and improvement of policies aimed at promoting mental health in occupational settings, with a focus on preventing psychosocial risks. Methodology Integrative literature review using the terms "teleworking," "remote work," "telework," "telecommuting," "psychosocial risks," "mental health," and "occupational health" in both Portuguese and English. The primary databases used for the research included Pubmed, UpToDate, Clinical Key, Medscape, World Health Organization, International Labour Organization, Centers for Disease Control and Prevention, “Revista Portuguesa de Saúde Ocupacional” and “Direção Geral de Saúde”. A total of 24 documents with the highest relevance to the study’s theme were selected, published between 2010 and 2023. Discussion Psychosocial risks in telecommuting are undergoing constant changes and align with demographic, nature, content and organization. These changes may increase exposure to already recognized psychosocial risks or give rise to new emergent ones. The widespread and unexpected adoption of telecommuting due to COVID-19 with the simultaneous advancement of digitization processes have made telecommuting a more common practice. However, this mass adoption has increased instances of technological stress among workers, potentially leading to adverse consequences for mental health. While the widespread implementation of telecommuting aimed to protect workers from biological risks, it has, in various situations, increased social isolation, work-family conflicts, and a lack of social support, with negative consequences for the mental health of the working population. Conclusion The increasing of telecommuting in our society is leading to assess the psychosocial risk factors that arise with it, so that they are recognized by occupational health experts and intervened upon, thus ensuring that telecommuting becomes healthier.

RESUMO Introdução As sociedades atuais e a sua constante evolução e globalização, têm demonstrado um impacto significativo na forma como se estruturam os postos de trabalho ao longo dos anos, nos quais, mais recentemente e com maior tradução mediática, se destaca a possibilidade de praticar teletrabalho, potenciada pela inovação tecnológica. Objetivos Conhecer a literatura mais recentemente publicada acerca do teletrabalho; bem como a sua relação com fatores de risco de origem psicossocial e inferir sobre a necessidade de implementação e aperfeiçoamento de políticas voltadas para promoção da saúde mental em contexto ocupacional, com enfoque na prevenção dos riscos psicossociais. Metodologia Revisão da literatura integrativa com os termos “teleworking”, “remote work”, “telework”, “telecommuting”, “psychosocial risks”, “mental health” e “occupational health”, em português e em inglês. Foram utilizadas como principais bases de dados a Pubmed, UpToDate, Clinical Key, Medscape, World Health Organization, International Labour Organization, Centers for Disease Control and Prevention, bem como a Revista Portuguesa de Saúde Ocupacional e a Direção Geral de Saúde. Selecionaram-se os 24 documentos com maior relevância na temática em estudo, publicados entre 2010 e 2023. Discussão As fontes de riscos psicossociais do teletrabalho encontram-se em constante mudança e acompanham as alterações demográficas e da organização. A prática de teletrabalho parece ser uma oferta cada vez mais comum, a sua adoção em larga escala e inesperada devido à COVID-19 e coligada ao enorme avanço dos processos de digitalização, aumentaram as situações de stress tecnológico entre os trabalhadores, com possíveis consequências adversas para a saúde mental. Esta massificação do Teletrabalho, embora com o intuito de proteger os trabalhadores relativamente a um risco biológico aumentou, em diversas situações, o isolamento social, os conflitos trabalho-família e a falta de suporte social, com consequências negativas na saúde mental da população ativa. Conclusão Com o aumento deste tipo de trabalho emerge a necessidade de avaliar os fatores de risco psicossociais que surgem em conformidade, para que estes sejam reconhecidos pelos peritos em saúde ocupacional e intervencionados, assegurando assim que o teletrabalho se torna mais saudável.

ABSTRACT Introduction Healthcare workers are exposed to many psychosocial risk factors. These have consequences at an individual and organizational level. Occupational health psychology applies the principles of psychology to the protection and promotion of workers' health and well-being. Here, it can act at the organizational level, with interventions that improve the working environment, and at the individual level, providing individuals with resources to deal with different types of settings. It was in this context that the occupational health service of a Lisbon hospital center decided to incorporate a psychologist into its team. Objective To describe a sample of health professionals referred for a psychology consultation, looking to generate hypotheses about characteristics that may constitute risk factors for needing this support. Methodology This is a descriptive study in which the sample corresponds to the group of workers that was referred to psychology, over seven months. The following symptoms were assessed: depressed mood, thoughts of death, anxiety, and sleep disturbances. All the data came from the clinical records of the psychologist and the occupational medicine physician, obtained through a clinical interview, and were previously anonymized. Results A total of 47 workers were followed in psychology appointments, corresponding to 1% of the hospital's population. The most prevalent professional group in the sample was operational assistants. Most of the workers reported having a previous diagnosis of psychopathology and 55% were still medicated. Only 15% of the workers identified work as a determining factor in their symptoms. Discussion There was a higher proportion of women compared to the overall population of the hospital, a finding that could be related to a greater risk inherent in the expectations imposed by society regarding the role of women as caregivers and the accumulation of functions in the social/family sphere. The "doctors" professional group is absent from the sample, hypothetically due to their lower attendance at occupational medicine consultations or the possible protection afforded to higher levels of education. Conclusions Contrary to the existing evidence, in this sample of health professionals from a hospital center in Lisbon, work was not the preponderant factor for the appearance of adverse health effects and determining follow-up in psychology consultations. In the future, the relationship between gender, educational level and professional group and increased risk of psychopathology should be tested more robustly.

RESUMO Introdução Os profissionais de saúde estão expostos a um elevado número de fatores de risco psicossociais. Estes têm consequências a nível individual e organizacional. A psicologia da saúde ocupacional aplica princípios da psicologia na proteção e promoção da saúde e bem-estar dos trabalhadores. Neste âmbito, pode atuar a nível da organização, com intervenções que melhorem o ambiente de trabalho, e a nível individual, dotando os indivíduos de recursos para lidar com diferentes tipos de ambientes. Foi neste contexto que um serviço de saúde ocupacional de um centro hospitalar de Lisboa decidiu integrar na sua equipa um psicólogo. Objetivo Descrever uma amostra de profissionais de saúde referenciados à consulta de psicologia, com vista a gerar hipóteses quanto a características que possam constituir fatores de risco para carecer desse apoio. Metodologia Trata-se de um estudo descritivo em que a amostra corresponde ao grupo de trabalhadores referenciado à consulta de psicologia ao longo de sete meses. Foram avaliados os sintomas humor deprimido, pensamentos de morte, ansiedade e alterações do sono. Todos os dados provêm dos registos clínicos do psicólogo e do médico do trabalho, obtidos através de entrevista clínica, tendo sido previamente anonimizados. Resultados Foram acompanhados em consulta de psicologia 47 trabalhadores, correspondendo a 1% da população do centro hospitalar. O grupo profissional mais prevalente na amostra foram os assistentes operacionais. A maioria dos trabalhadores referia já ter um diagnóstico prévio de psicopatologia e 55% mantinham-se medicados. Apenas 15% dos trabalhadores identificavam o trabalho como fator determinante na sintomatologia. Discussão Verificou-se uma maior proporção do sexo feminino, em relação com a população global do centro hospitalar, um achado que poderá relacionar-se com um maior risco inerente às expectativas impostas pela sociedade relativamente ao papel da mulher como cuidadora e o acúmulo de funções na esfera social/familiar. Está ausente da amostra o grupo profissional “médicos”, hipoteticamente por uma menor afluência destes às consultas de medicina do trabalho ou eventual proteção conferida a níveis educacionais mais altos. Conclusões Ao contrário da evidência existente, nesta amostra de profissionais de saúde de um centro hospitalar de lisboa, o trabalho não foi o fator preponderante para o aparecimento de efeitos adversos na saúde e a determinar o seguimento em consulta de psicologia. No futuro, deve ser testada de forma mais robusta a relação entre género, nível educacional e grupo profissional e aumento do risco de psicopatologia.

ABSTRACT Gender inequality (imbricated with class and race inequalities) is a social and historical problem with serious objective and subjective consequences. It produces suffering collectively shared by oppressed groups. This text is a reflection on suffering and resistance, based on the memories and life stories of women who participate in feminist social movements. We seek to apprehend the meanings and psychological transformations that accompany this political participation, especially in the context of a feminist, anti-racist and anti-capitalist social movement: World March of Women. Starting from the biographical trajectory of a deponent, we reflect on psychosocial aspects of silence and speech as linked to historical processes of domination and exploitation, of resistance and confrontations. imbricated inequalities consequences groups movements participation antiracist anti racist anticapitalist capitalist movement Women deponent exploitation confrontations

RESUMO A desigualdade de gênero (imbricada às desigualdades de classe e raça) configura-se como um problema social e histórico de graves consequências objetivas e subjetivas. Produz sofrimentos coletivamente compartilhados pelos grupos oprimidos. Este texto é uma reflexão sobre sofrimento e resistência, a partir das memórias e histórias de vida de mulheres que participam de movimentos sociais feministas. Buscamos apreender os sentidos e as transformações psicológicas que acompanham essa participação política, especialmente no contexto de um movimento social feminista, antirracista e anticapitalista: a Marcha Mundial das Mulheres. Partindo da trajetória biográfica de uma depoente, refletimos sobre aspectos psicossociais do silêncio e da fala como ligados a processos históricos de dominação e exploração, de resistência e enfrentamentos. imbricada raça configurase configura se subjetivas oprimidos feministas política feminista anticapitalista Mulheres depoente exploração enfrentamentos

ABSTRACT Introduction: Burnout syndrome gains attention from researchers and professionals, particularly in the health area, due to the consequences and implications that it can lead to in professionals affected by the disease, which can compromise patient safety and the quality of offered care. Objective: To characterize the scientific production about strategies and interventions for reducing the risk of Burnout syndrome among nursing professionals. Methods: A bibliometric analysis was performed of publications until 2021 in the PubMed, Scopus and Web of Science databases. The analyzes were developed with the support of the bibliometrix R-package. The study recovered 70 publications. Conclusions: The analysis of the most cited works revealed psychoeducational, psychosocial and yoga strategies for self-care. Among the research trend topics, the most prominent was the term mindfulness, a fact showing an increase in research that applied this intervention to reduce burnout. The number of studies produced is incipient. However, with the inclusion of burnout within the International Classification of Diseases, an increase is expected in the number of publications, as well as in the interest of organizations in implementing strategies to promote health and well-being among professionals.

RESUMEN Introducción: El síndrome de Burnout gana atención de investigadores y profesionales, en particular en el área de la salud, por las consecuencias e implicaciones que puede generar en los profesionales afectados por la enfermedad, lo que puede comprometer la seguridad del paciente y la calidad del servicio ofrecido. Objetivo: Caracterizar la producción científica sobre estrategias e intervenciones para reducir el riesgo del síndrome de Burnout entre los profesionales de enfermería. Métodos: Análisis bibliométrico de las publicaciones hasta el 2021 en las bases de datos PubMed, Scopus y Web of Science. Los análisis se desarrollaron con el apoyo del bibliometrix R-package. El estudio recuperó 70 publicaciones. Conclusiones: El análisis de los trabajos más citados reveló estrategias psicoeducativas, psicosociales y de yoga para el autocuidado. Entre los temas de tendencia de investigación, el más destacado fue el término Mindfulness, lo que muestra un aumento en las investigaciones que aplicaron esta intervención para reducir el Burnout. El número de estudios producidos es incipiente. Sin embargo, con la inclusión del Burnout en la Clasificación Internacional de Enfermedades, se espera un aumento de las publicaciones y del interés de las organizaciones en implementar estrategias para promover la salud y el bienestar entre los profesionales.

RESUMEN El progreso científico-tecnológico en las ciencias biomédicas que tuvo lugar en el siglo XX, provocó la necesidad de responder a problemas éticos y buscó la protección de las personas. Por consiguiente, se asume la bioética como una disciplina cuyo objetivo principal es orientar las acciones por principios y valores en la toma de decisiones clínicas. En el estudio se reflexiona sobre la ética y la bioética en el tratamiento y las secuelas de la liposucción abdominal; todo ello con el fin de contribuir al comportamiento bioético de los profesionales de la salud. Según la literatura consultada, los profesionales de la salud involucrados en los procederes tecnológicos no siempre evalúan al paciente de forma integral, ni actúan de acuerdo a protocolos bioéticos. Al tener una adecuada valoración de los aspectos bioéticos del paciente tratado con liposucción abdominal, se disminuyen los riesgos de daños a su integridad personal y se minimizan los dilemas bioéticos. Se debe realizar una valoración clínica y sicosocial antes de determinar la modificación de apariencia física, para disminuir los riesgos de daños y complicaciones a la integridad física y sicológica.

ABSTRACT The scientific-technological progress in biomedical sciences that took place in the 20th century caused the need to respond to ethical problems and sought the protection of people. Consequently, bioethics is assumed as a discipline whose main objective is to guide actions by principles and values in clinical decision making. The study reflects on ethics and bioethics in the treatment and consequences of abdominal liposuction; all of this to contribute to the bioethical behavior of health professionals. According to the literature consulted, health professionals involved in technological procedures do not always evaluate the patient comprehensively nor do they act according to bioethical protocols. By having an adequate assessment of the bioethical aspects of the patient treated with abdominal liposuction, the risks of damage to their personal integrity are reduced and bioethical dilemmas are minimized. A clinical and psychosocial assessment must be carried out before determining the modification of physical appearance, to reduce the risks of damage and complications to physical and psychological integrity.

Resumen El presente artículo sobre la violencia laboral, muestra los resultados obtenidos de las evaluaciones para identificar y analizar los riesgos psicosociales de la guía de referencia II de la NOM-035-STPS-2018, implementadas en nueve centros de trabajo de diferentes giros, ubicados en diferentes ciudades de la República Mexicana. La obtención de resultados se realizó por medio de un software en línea programado con inteligencia de negocios en el que se parametrizó la guía anteriormente citada. Los resultados obtenidos nos demuestran que la violencia laboral es un problema recurrente en los centros de trabajo de nuestro país. El no prevenirla trae consecuencias graves de salud mental para los trabajadores, tales como: depresión, estrés laboral, ansiedad, baja autoestima, entre otros; ocasionando también, que exista un índice alto de rotación laboral en las organizaciones.

Abstract This article on Workplace Violence shows the results obtained from the evaluations to identify and analyze the psychosocial risks of the reference guide II of the NOM-035-STPS-2018, implemented in nine workplaces of different lines, located in different cities of the Mexican Republic. Results were obtained using online software programmed with business intelligence in which the mentioned guide was parameterized. The results obtained show us that workplace violence is a recurring problem in the workplaces of our country, not preventing it brings serious mental health consequences for workers, such as depression, job stress, anxiety, low self-esteem, among others; also causing a high rate of labor turnover in organizations.

Abstract Introduction: Informal consultations are medical acts characterized by the individual’s self-referral to a doctor, without clinical record or adequate follow-up. Despite controversy, this practice is an integral part of medical culture. This case report highlights the importance of understanding the consequences of informal consultations and the desirability of a preventive attitude towards one’s own health. Case description: A 28-year-old female health professional requests an informal consultation due to low-back pain after two months of evolution where a tentative diagnosis and treatment plan were brainstormed. Symptom aggravation led her to a formal ortho-traumatology consultation, whereupon she was definitively diagnosed with a herniated lumbar disc, and a treatment plan was discussed and implemented, with good outcomes. Commentary: This case reveals the complexity of clinical communication and psychosocial context involving informal consultations. Healthcare professionals are particularly susceptible to belittling signs and symptoms, using informal consultations to tackle the clinical situation quickly and be able to work, but without really addressing the underlying problem.

Resumo Introdução: As consultas informais são atos médicos caracterizados pela autorreferenciação a um médico, sem registo clínico ou seguimento adequado. Apesar de controversa, esta prática assume-se como parte integrante da cultura médica. Este caso clínico mostra a importância de compreender as consequências das consultas informais e as vantagens de uma atitude preventiva em relação à saúde do próprio. Descrição do caso: Profissional de saúde do sexo feminino, de 28 anos, com lombalgia com dois meses de evolução recorre a uma consulta informal, na qual foram discutidos um diagnóstico presuntivo e um plano de tratamento a ser implementado. Devido ao agravamento sintomatológico recorreu a uma consulta formal de ortotraumatologia, na qual se estabeleceu um diagnóstico definitivo de hérnia lombar e foi discutido e implementado um plano de tratamento de forma partilhada, que teve bons resultados. Comentário: Este caso revela a complexidade da relação clínica e contexto psicossocial das consultas informais. Os profissionais de saúde estão particularmente suscetíveis à trivialização dos sinais e sintomas, recorrendo a consultas informais para uma rápida resolução da condição clínica, de forma a conseguirem manter-se a trabalhar, mas sem aprofundar a etiologia e causa do problema.

ABSTRACT Introduction: Teleworking is a reality for many workers around the world, and although it has advantages, there are recent studies indicating that it can have a negative impact on workers' mental health, increasing the risk of anxiety, depression and stress. Methodology: A literature search was conducted in March 2023 in the Scopus, SciELO, PePSIC, PsycInfo, PubMed, Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science databases. Contents: Telework allows the execution of work tasks without the need to physically move to the workplace. It is a practice that has advantages such as greater flexibility, autonomy, cost reduction and increased productivity, but can also have disadvantages and psychosocial risks for workers. The COVID-19 pandemic was a milestone of revolution in several aspects worldwide and, in this particular context, it marked a massive adoption of the Telework model by several companies. However, it is imperative to define strategies to prevent psychosocial risks and implement a sustainable model in order to ensure the physical and psychological well-being of individuals. The selected articles highlight as the main psychosocial risk factors the "work-family" conflict and its and demands. Discussion and Conclusions: It is important that all health professionals, and in particular occupational health physicians, recognize the main psychosocial risks associated with Telework. Only through the development and implementation of preventive measures will be possible to minimize the consequences of telework and ensure a healthy working environment for all employees.

RESUMO Introdução: O Teletrabalho é uma realidade para muitos indivíduos em todo o mundo e, embora possua vantagens, existem estudos recentes que indicam que pode ter um impacto negativo na saúde mental dos trabalhadores, aumentando o risco de ansiedade, depressão e stresse. Metodologia: Foi efetuada uma pesquisa da literatura, realizada em março de 2023, nas bases de dados Scopus, SciELO, PePSIC, PsycInfo, PubMed, Applied Social Sciences Index and Abstracts (ASSIA) e Web of Science. Conteúdo: O Teletrabalho permite a execução de tarefas laborais sem a necessidade de deslocação física para o local de emprego. É uma prática que tem vantagens como maior flexibilidade, autonomia, redução de custos e aumento da produtividade, mas também pode apresentar desvantagens e riscos psicossociais para os funcionários. A pandemia da COVID-19 foi um marco revolucionário em diversas vertentes a nível mundial e, neste contexto em particular, traduziu-se numa adoção massiva do modelo de Teletrabalho por várias empresas. Contudo, é imperativo definir estratégias de prevenção dos riscos psicossociais e implementar um modelo sustentável de forma a assegurar o bem-estar físico e psicológico dos indivíduos. Os artigos selecionados destacam como principais fatores de risco psicossociais o conflito “trabalho-família” e a intensidade e exigência do mesmo. Discussão/ Conclusão: É importante que todos os profissionais de saúde, e em particular os médicos do trabalho, reconheçam os principais riscos psicossociais associados ao Teletrabalho. Só através do desenvolvimento e implementação medidas preventivas será possível minimizar as consequências do mesmo e garantir um ambiente saudável para todos os funcionários.

Abstract Gestational diabetes mellitus (GDM) is a disease with fatal, disabling, and costly consequences for individuals, families, communities and countries. To systematically establish the psychosocial risk factors associated with GDM that should be monitored during and after pregnancy. Systematic review in PubMed/Medline and Cochrane databases. 1188 articles were found and 41 were selected. Some main themes were conflicts with cultural practices, social stigma, ethnicity/race influence, low educational level, sleep quality, breastfeeding problems, concern for one’s own health/baby, low perception of the risk of GDM/DM2 in the future, stress, anxiety and depression, limited knowledge, lack of support from the partner/family/social and health professionals, low levels of self-care/self-efficacy and difficulties with changes in the lifestyle. These factors should be monitored in pregnant women during and after delivery. Treatments should consider the psychological impact and the risk of developing DM2 after childbirth and should be included in clinical practice guidelines. Multi-ethnic populations and the most demographically and socioeconomically vulnerable groups are more susceptible to developing GDM.

Resumen La diabetes mellitus gestacional DMG es una enfermedad con consecuencias mortales, incapacitantes y costosas para las personas, las familias, las comunidades y los países. Con el fin de establecer de manera sistemática los factores de riesgo psicosocial asociados con la DMG que deberían ser monitoreados durante y después del embarazo se realizó una revisión sistemática en las bases de datos PubMed/Medline y Cochrane. Se encontraron 1188 artículos y se seleccionaron 41. Algunos temas principales fueron conflictos con prácticas culturales, estigma social, influencia de la etnia/raza, bajo nivel educativo, calidad del sueño, problemas con la lactancia materna, preocupación por la propia salud o la del bebé, baja percepción de riesgo de DMG o de diabetes mellitus tipo 2 en el futuro, estrés, ansiedad y depresión, conocimiento limitado, falta de apoyo de la pareja, de la familia o social y de los profesionales de la salud, bajos niveles de autocuidado/autoeficacia y dificultades con cambios en el estilo de vida. Estos factores deberían monitorearse en las embarazadas durante y después del parto. Los tratamientos deberían considerar el impacto psicológico y el riesgo de desarrollar diabetes mellitus tipo 2 después del parto, y deberían ser incluidos en las guías de práctica clínica. Las poblaciones multiétnicas y los grupos más vulnerables demográficamente y socioeconómicamente son más susceptibles de desarrollar DMG.

Abstract Objective: Female genital mutilation/cutting (FGM/C) can affect women’s lives through various physical, psychological, social and even sexual mechanisms. According to the World Health Organization guidelines for managing the health effects of FGM/C, further research into its psychological effects and preventative measures is required. In this study, a comprehensive review of the mental health consequences of circumcised women of reproductive age has been conducted with a special focus on providing preventive solutions. Methods: A comprehensive search of the Web of Science, PubMed(MEDLINE), Proquest ,Scopus and Google scholar was carried outfrom 2000 to 2022. The second stage of search was conducted in grey literature. To facilitate a systematic approach to search the literature, the PECO framework, was adopted. Results: The result of this narrative review study showed that, the most common mental health disorder in reproductive age circumcised women were depression, anxiety and post-traumatic stress disorder. Some studies found a significant relationship between parents’ education level and circumcised girls, so that parents of the circumcised women had a low level of education. Two studies considered religious beliefs, tradition, cleanness, sexual desire control and virginity as the reasons for FGM/C. Conclusion: All forms of FGM/C may be harmful to one’s health. Women, who have undergone widespread forms of circumcision, are more likely to develop mental disorders. As the psychosocial effects of circumcision can affect the sexual experience of circumcised women, addressing this issue, emphasizing its legal aspects, and providing preventative solutions can improve physical, mental, social, and even sexual health in circumcised women. Objective mutilationcutting mutilation cutting FGMC FGM C (FGM/C womens s physical mechanisms required Methods Science PubMedMEDLINE, PubMedMEDLINE PubMed MEDLINE , PubMed(MEDLINE) Scopus 200 2022 literature framework adopted Results depression posttraumatic post traumatic girls beliefs tradition cleanness Conclusion ones one Women disorders issue aspects PubMed(MEDLINE 20 202 2

BACKGROUND: Despite policies promoting transport inclusivity, persons with disabilities in South Africa experience difficulties when accessing public transport. Poor community mobility hampers community integration and participation in occupations outside the home. This article describes the psychosocial community mobility experiences, of stroke survivors using wheelchairs in a town in the Western Cape province of South Africa METHOD: The study used a descriptive qualitative design. The study population were community dwelling stroke survivors, from Worcester, using wheelchairs. Data was collected from eight participants through semi-structured telephonic interviews. Inductive thematic analysis was used FINDINGS: The four themes derived from the data were: Freedom of movement (My power chair, my Ferrari'), Social anxiety (People stare at you like they do not have a heart), Dependency (I must dance along to his fiddle), and Social isolation (You feel done in, dejected). Participants identified wheelchairs, private vehicles, and mini-bus taxis as modes of community mobility CONCLUSION: When transport barriers prevent dignified, spontaneous community integration negative psychosocial consequences (social anxiety, dependency, and social isolation) followed. Community mobility barriers hampered participants' ability to participate in meaningful occupations and left them isolated. Occupational therapists should take cognisance of the community mobility challenges wheelchair users might experience and implement intervention strategies to mediate these Implications for practice • Community mobility is essential to perform occupations outside the residential setting and must be included in occupational therapy assessment and intervention strategies. • Occupational therapists can empower individuals with mobility impairments with the life skills to manage psychological challenges caused by accessing public transport and decreased community mobility. • Occupational therapy intervention for wheelchair users accessing public transport should include effective, appropriate transfer strategies to embark and disembark from minibus taxis. • In certain circumstances the occupational therapist should consider the possibility of a motorised wheeled mobility device to facilitate community integration.

Resumen Existe un creciente consumo de sustancias psicoactivas a pesar de que genere múltiples efectos perjudiciales para la salud y problemáticas psicosociales. Se propone que múltiples creencias sociales de la filosofía contemporánea promueven el consumo de estas sustancias, especialmente en la juventud y adolescencia. Se reflexiona sobre la sinergia entre múltiples ideas postmodernas y los efectos desinhibitorios, sedativos, anestésicos, psicoestimulantes y disociativos de las sustancias psicoactivas para el desarrollo de conductas socialmente esperadas. La diversión como valor fundamental, la búsqueda de excesos, el consumismo, la relativización del conocimiento, la moral estadística, la filosofía de la inmediatez, la digitalización de las interacciones sociales y las relaciones líquidas serían algunos de los factores implicados. La baja percepción de riesgo sobre las sustancias, la publicidad dirigida a jóvenes, el aumento de la prevalencia de la depresión, el estigma sobre la patología psiquiátrica y los servicios de atención de salud mental deficitarios serían otros aspectos que en conjunto con la ideología predominante podría acrecentar estas problemáticas sociales y de salud. La morbi-mortalidad temprana, los incidentes viales, los embarazos adolescentes y conductas violentas son algunas de las consecuencias que se ven potenciadas por el consumo de sustancias. La promoción de estas sustancias está especialmente dirigida a adolescentes que por razones biológicas y sociales se encuentran en la etapa de la vida más vulnerable para iniciar estas conductas de riesgo. Como conclusión se destaca la necesidad de conversar con los más jóvenes a edad temprana sobre estas creencias para prevenir el consumo problemático de sustancias psicoactivas y sus consecuencias sociales.

Summary A steady growth in the use of psychoactive substances is being observed, despite the multiple harmful health and psy-chosocial effects associated with their consumption. The present paper argues that a host of social beliefs emerging from the current zeitgeist or life philosophy encourage substance abuse, especially during youth and adolescence. It analyses the synergy between post-modern life views and the disinhibiting, sedative, anesthetic, psychostimulant and dissociative effects of psychoactive substances in the development of current social standards of behavior. Fun and enjoyment held as core values, the pursuit of excess, consumerism, the relativization of knowledge, a statistical view of morality, the quest for in-stant gratification, the digitalization of social interactions and liquid relationships are some of the contributing factors. Low risk percep-tion about substance use, mass-media campaigns directed at the young, the rise of depression, the stigma associated with mental illness and deficiencies in mental health services further compound this issue. Premature morbidity and mortality, traffic incidents, teenage pregnancy and violent behaviors are some of the consequences exacerbated by substance abuse. The situation is compounded by media promotion of such substances, targeted at teenagers who owing to social and biological reasons find themselves at a higher probability of incurring risky behaviors. As a conclusion, the present study underscores the need to hold early discussions with the young regarding current belief systems in order to mitigate the detrimental social and health effects of substance abuse.

ABSTRACT BACKGROUND: Hypertension is the most common disease in primary care settings. Only 30% of cases were adequately controlled. OBJECTIVES: To analyze the knowledge and understanding of patients with hypertension regarding the factors that facilitate and limit adherence to treatment and, based on the results, build specific guidelines on hypertension self-care and control. DESIGN AND SETTING: This qualitative study was conducted in a primary healthcare setting. METHODS: Patients with hypertension who were followed at a primary healthcare unit were interviewed through focus groups, and a qualitative interpretation of their statements according to Bardin’s content analysis was performed. RESULTS: Three focus groups were formed (21 participants), from whose analysis emerged 74 core ideas related to the concept of hypertension, causes of increase in blood pressure, clinical consequences of hypertension, and possible patients’ contributions to help control blood pressure, arising from eating habits, psychosocial conditions, and lifestyle. Patients tend to accept the concept of “high blood pressure” as an inherent condition of the disease in their lives. Eating habits are strongly related to life history and self-perception of health. The association between high blood pressure and nervousness or stress appears to be strong. CONCLUSION: The experience of having “pressure problem” is unique for each person. It is necessary to optimize listening, recognizing that, for the patient to understand what hypertension is and its management, there must be understanding and convergence of proposals, adjustments, and changes in a positive and personalized way. As a result of this study, we implemented educational actions in primary healthcare units. BACKGROUND settings 30 controlled OBJECTIVES results selfcare self SETTING setting METHODS Bardins Bardin s performed RESULTS 21 (2 participants, participants , participants) 7 conditions lifestyle lives selfperception perception health strong CONCLUSION problem person listening management proposals adjustments way units 3 2 (

RESUMEN Objetivos analizar la percepción de mujeres egresadas del sistema penitenciario sobre los principales estresores que marcaron sus trayectorias de vida y discutir la viabilidad de la técnica de Entrevista Narrativa Etnográfica Clínica para facilitar la narrativa de este grupo. Método investigación narrativa desarrollada en un dispositivo de protección social del interior de São Paulo. Los datos fueron recolectados en 2021 (enero y febrero) utilizando la técnica de Entrevista Narrativa Etnográfica Clínica, que intercala narrativas y ayudas visuales. Se adoptó como marco teórico la sinergia entre los conceptos de vulnerabilidad y estrés y se realizó un análisis de contenido. La discusión de viabilidad se basó en los criterios de aceptabilidad y expansión Resultados Las narrativas abordaron las dificultades psicosociales previas al encarcelamiento y el ambiente hostil de la prisión superpoblada como locus de conflicto y abuso de poder. Se mencionaron como consecuencias de la reclusión el desamparo familiar, el alejamiento de los hijos, las emociones negativas, los síntomas somáticos y los traumas. Los participantes también relataron procesos de afrontamiento con palabras que hacían referencia a las ideas de superación, esperanza, nuevo comienzo y gratitud. Se entiende que este punto alto de las narraciones puede reflejar el potencial de la técnica de la entrevista y corrobora su adecuación. Conclusión El indudable carácter doloroso de las narrativas sobre las diferentes adversidades vividas, especialmente a raíz del encierro, también estuvo permeado por aspectos que denotaban procesos resilientes. La adopción de esta técnica de entrevista hizo que la recolección de datos fuera más sensible, acogedora y oportuna para ampliar el repertorio de palabras en la expresión de sentimientos y revivir experiencias dolorosas, vislumbrando posibilidades positivas para el futuro. grupo Paulo 202 enero febrero visuales contenido poder familiar hijos negativas traumas superación esperanza gratitud adecuación vividas encierro resilientes sensible dolorosas futuro 20 2

ABSTRACT Objectives to analyze the perception of women discharged from the prison system about the main stressors that marked their life trajectories and to discuss the feasibility of the Clinical Ethnographic Narrative Interview technique to facilitate the narrative of this group. Method narrative research developed in a social protection center in the interior of São Paulo. Data were collected in 2021 (January and February) using the Clinical Ethnographic Narrative Interview technique, which intersperses narratives and visual aids. The synergy between the concepts of vulnerability and stress was adopted as a theoretical framework, and content analysis was performed. The discussion of viability was based on the criteria of acceptability and expansion. Results The narratives addressed psychosocial difficulties prior to incarceration and the hostile environment of the overcrowded prison as a place of conflict and abuse of power. Family helplessness, estrangement from children, negative emotions, somatic symptoms and traumas were mentioned as consequences of seclusion. The participants also reported coping processes with words that referred to the ideas of overcoming, hope, new beginning and gratitude. It is understood that this high point of the narratives may reflect the potential of the interview technique and corroborates its adequacy. Conclusion The undoubted painful character of the narratives about the different adversities experienced, especially as a result of seclusion, was also permeated by aspects that denoted resilient processes. The adoption of this interview technique made data collection more sensitive, welcoming and timely to expand the repertoire of words in the expression of feelings and revisit painful experiences, envisioning positive possibilities for the future. group Paulo 202 January February aids framework performed expansion power helplessness children emotions seclusion overcoming hope gratitude adequacy experienced sensitive experiences future 20 2

RESUMO Objetivos analisar a percepção de mulheres egressas do sistema prisional sobre os principais estressores que marcaram suas trajetórias de vida e discutir a viabilidade da técnica Entrevista Narrativa Etnográfica Clínica para facilitar a narrativa desse grupo. Método pesquisa narrativa desenvolvida em um dispositivo de proteção social do interior de São Paulo. Os dados foram coletados em 2021 (janeiro e fevereiro) utilizando a técnica Entrevista Narrativa Etnográfica Clínica, que intercala narrativas e recursos visuais. A sinergia entre os conceitos de vulnerabilidade e estresse foi adotada como referencial teórico, tendo sido realizada a análise de conteúdo. A discussão da viabilidade foi pautada nos critérios aceitabilidade e expansão. Resultados As narrativas abordaram dificuldades psicossociais pregressas ao encarceramento e o ambiente hostil do cárcere superlotado como lócus de conflitos e abuso de poder. Desamparo familiar, distanciamento dos filhos, emoções negativas, sintomas somáticos e traumas foram mencionados como consequências da reclusão. As participantes também relataram processos de enfrentamento com palavras que remetiam às ideias de superação, esperança, recomeço e gratidão. Entende-se que esse ponto alto das narrativas pode ter reflexos do potencial da técnica de entrevista e corrobora a sua adequação. Conclusão O indubitável caráter doloroso das narrativas sobre as diferentes adversidades vivenciadas, sobretudo em decorrência da reclusão, também foi perpassado por aspectos que denotaram processos resilientes. A adoção da referida técnica de entrevista tornou a coleta de dados mais sensível, acolhedora e oportuna para ampliar o repertório de palavras na expressão dos sentimentos e revisitação de experiências dolorosas, vislumbrando possibilidades positivas para o futuro. grupo Paulo 202 janeiro fevereiro visuais teórico conteúdo expansão poder familiar filhos negativas reclusão superação esperança gratidão Entendese Entende se adequação vivenciadas resilientes sensível dolorosas futuro 20 2