ABSTRACT This work pretends to study the possible contribution of the television advertising to increase the stereotypes about the elderly people collective. This article makes a review about the main investigations done in which is considered how the television shows through the advertising the image of the elderly people as well as present the opinion of a sample selected composed by forty elderly persons keeping in mind the institutionalization as a factor. Results shows no differences between hours of consumption of television and self-perception, but positive differences between positive auto-evalutation in non-institutionalization persons (p=0,46) and with cognitive process deterioration (p=0,000). Institutionalization persons affirm that old age block to realize activities that one likes (p=0,027). In conclusion, the institutionalization of elderly persons is a key factor in the perception of the old age, probably influence by greater autonomy and by contact with their families.
RESUMEN El presente trabajo analiza la posible contribución de la publicidad televisiva al fomento de los estereotipos en el colectivo de personas mayores. Se recoge en este artículo, la revisión de las principales investigaciones realizadas en las que se plantea cómo la televisión articula a través de la publicidad la imagen de las personas mayores además de contar con la opinión de una muestra seleccionada de 40 personas mayores donde se ha tenido en cuenta el factor de la institucionalización. Los resultados confirman que no hay diferencias entre el consumo de horas de televisión y la autopercepción, pero sí en autovaloración positiva en personas no institucionalizadas (p = 0,46) y en deterioro de proceso cognitivo (p = 0,000). Al mismo tiempo, las personas institucionalizadas afirman que la vejez impide realizar actividades que a uno le gustan (p = 0,027). En conclusión, la institucionalización supone una variable clave en la percepción sobre las personas mayores, posiblemente influenciada por el contacto con sus familias y una mayor autonomía.
ABSTRACT Objective To explore the meaning of beliefs and practices related to family functioning and health care in a Venezuelan indigenous group. Materials and Methods A qualitative research study was conducted using a focused-ethnography (FE) method. The techniques implemented during data collection were focus group and observer-as-participant. Twenty-seven people distributed into four groups were included in the study. The qualitative content analysis method was selected for the interpretation stage. Results The most significant findings revealed that Jivi people's customs were mixed with modern practices. Cultural practices such as maternity and childbirth are processes in which the formal healthcare system has a secondary role. Moreover, participants showed flexibility in terms of responsibilities without association to sex. Conclusion Training of human resources with an intercultural approach is a measure that could strengthen the practices of ethnic groups in terms of healthcare.
RESUMEN Objetivo Explorar el significado de las creencias y prácticas relacionadas con la función familiar y el cuidado de salud en un grupo indígena venezolano. Métodos Se realizó una investigación cualitativa razonada con el método de Etnografía Enfocada (EE), las técnicas implementadas fue el grupo focal y la observación participante. Participaron N=27 personas distribuidas en cuatro grupos. El método seleccionado para la fase de interpretación fue el Análisis Cualitativo de Contenido. Resultados Los hallazgos mostraron que las creencias del pueblo Jivi se mezclaron con las prácticas modernas; las prácticas culturales como la maternidad y el parto se asumieron como un proceso en el cual el Sistema de Salud formal tiene una relación secundaria. Además, los participantes mostraron flexibilidad de responsabilidades sin referencia al género. Conclusión Una medida para fortalecer las prácticas de los grupos étnicos en términos de atención de salud es la capacitación de recursos humanos en el enfoque intercultural.
ABSTRACT Objective: To identify interventions for the health promotion of frail elderly individuals and those at risk of frailty. Method: Integrative review of the literature performed in the following databases: LILACS, CINAHL, MEDLINE, Web of Science, COCHRANE and Scopus, using the Descriptors: “frail elderly”, “aging”, “health services for the aged” and “health promotion” combined with Boolean operators “AND” and “OR”. Results: Randomized controlled clinical trials (RCTs) classified as level of evidence II represented 82.6% of studies. Interventions were analyzed according to the following categories: Interventions for the elderly at risk of frailty and Interventions for the frail elderly. Conclusion: The following interventions were identified: educational multiprofessional group meetings, physical training, home visit/home care program, nutrition assessment and supplementation, health maintenance programs and cognitive training; models/programs of management and monitoring, use of assistive technology devices and hospitalization program for geriatric rehabilitation.
RESUMEN Objetivo: Identificar intervenciones para promover la salud de ancianos frágiles y con riesgo de fragilidad. Método: Revisión integrativa de la literatura realizada en las siguientes bases de datos: LILACS, CINAHL, MEDLINE, Web of Science, COCHRANE y Scopus, utilizando los Descriptores: “frail elderly”, “aging”, “health services for the aged” y “health promotion”, combinados por medio de operadores Booleanos “AND” y “OR”. Resultados: Los ensayos clínicos aleatorizados controlados (ECAC) clasificados como nivel de evidencia II correspondieron al 82,6% de los estudios. Las intervenciones fueron analizadas según las categorías: Intervenciones para ancianos con riesgo de fragilidad e Intervenciones para el anciano frágil. Conclusión: Las intervenciones identificadas fueron: reuniones educativas de grupos multiprofesionales, entrenamiento físico, visita domiciliaria/programa de atención domiciliaria, evaluación y suplementación nutricional, programas para el mantenimiento de la salud y entrenamiento cognitivo; modelos/programas de gestión y monitoreo, uso de dispositivos de tecnología asistiva y programa de internación para rehabilitación geriátrica.
RESUMO Objetivo: Identificar intervenções para promoção da saúde de idosos frágeis e em risco de fragilização. Método: Revisão integrativa da literatura realizada nas bases de dados: LILACS, CINAHL, MEDLINE, Web of Science, COCHRANE e Scopus, utilizando os Descritores: “frail elderly”, “aging”, “health services for the aged” e “health promotion”, combinados por meio de operadores boleanos “AND” e “OR”. Resultados: Ensaios clínicos randomizados controlados (ECRC) classificados como nível de evidência II corresponderam a 82,6% dos estudos. As intervenções foram analisadas segundo as categorias: Intervenções para idoso em risco de fragilização e Intervenções para o idoso frágil. Conclusão: As intervenções identificadas foram: reuniões educativas de grupos multiprofissionais, treinamento físico, visita domiciliar/programa de cuidados domiciliar, avaliação e suplementação nutricional, programas para manutenção da saúde e treinamento cognitivo; modelos/programas de gestão e monitoramento, uso de dispositivos de tecnologia assistiva e programa de internação para reabilitação geriátrica.
Introduction: Insulin resistance is the most common metabolic disorder associated with obesity and highest cardiometabolic risk in children. If the inadequate physical condition is added, they have a high risk of developing cardiometabolic complications at an early age. Objective: To evaluate physical fitness and insulin sensitivity in obese school children of 8-13 years of age from three public schools in the Metropolitan Region of Santiago. Methods: the study was carried out in 61 obese school children (25 Tanner I-II y 36 Tanner III-V). Anthropometric measures, Tanner stages, body composition (using 4-compartment model), physical fitness with the six-minute test and laboratory indicators, glucose, insulin and HOMA-IR, were measured. Metabolic syndrome was diagnosed according to the criteria of Cook. Results: Obese prepubertal and pubertal children and adolescents showed inadequate physical fitness, reflected in the distance and heart rate during and after the six-minute test. In turn, the sample has a high prevalence of insulin resistance in conjunction with metabolic syndrome. Conclusions: Regardless of the pubertal status, obese schoolchildren have a poor physical fitness and decreased insulin sensitivity reflected in a compensatory hyperinsulinemia.
Introducción: la resistencia a la insulina es la alteración metabólica más común relacionada con la obesidad y se asocia a un mayor riesgo cardiovascular en la edad pediátrica. Si a esto se suma una inadecuada condición física, existe un alto riesgo de desarrollar complicaciones cardiometabólicas tempranamente. Objetivo: evaluar la condición física y la resistencia insulínica en escolares obesos de 8 a 13 años de edad, seleccionados en tres establecimientos públicos de la Región Metropolitana de Santiago. Métodos: el estudio se llevó a cabo en 61 escolares obesos (25 Tanner I-II y 36 Tanner III-V). Se realizaron mediciones antropométricas, etapas de Tanner, composición corporal con el modelo de cuatro compartimentos, condición física con el test de seis minutos (TM6min) e indicadores de laboratorio, glicemia, insulinemia y HOMA-IR. Se diagnosticó síndrome metabólico según criterio de Cook. Resultados: los escolares y adolescentes obesos prepúberes y púberes presentan una inadecuada condición física, reflejada en la distancia recorrida y en la frecuencia cardiaca durante y posterior al TM6min. A su vez, la muestra presenta una alta prevalencia de resistencia a insulina en conjunto con síndrome metabólico. Conclusiones: independientemente del estado puberal, los escolares obesos presentan una baja condición física y una disminución de la sensibilidad a la insulina, que se refleja en un hiperinsulinismo compensatorio.
Fundamento: A raíz de las transformaciones necesarias en el sector de la salud se requiere de una mejor organización del proceso de enseñanza aprendizaje para garantizar la calidad de la formación de los futuros egresados. Objetivo: Evaluar la utilidad de la multimedia metodológica para perfeccionar la planificación, ejecución y control del proceso de enseñanza aprendizaje de las ciencias médicas. Metodología: Investigación de desarrollo tecnológico que tiene tres fases: la fase de diagnóstico (la identificación de necesidades de aprendizaje mediante el grupo focal); la fase de diseño, la cual contiene una sección superior con las imágenes de la Universidad Médica, una sección central que registra los contenidos fundamentales de la multimedia y una sección lateral con las temáticas fundamentales; y la fase de evaluación con la entrevista al azar a 762 profesores de los 24 departamentos docentes de la provincia Sancti Spíritus. Resultados: El 100 % de los entrevistados refirió que la multimedia facilita acceder a las principales normativas para el trabajo docente metodológico, más del 95 % que ayuda a una correcta planificación y control, además, que contribuye a la auto preparación y actualización pedagógica. Conclusiones: La multimedia metodológica resultó de gran utilidad para perfeccionar la planificación, ejecución y control del proceso de enseñanza aprendizaje por su nivel de generalización y actualización.
Background: Soon after the necessary transformation in the health sector is required a better organization of the process of teaching- learning to guarantee the quality of the formation of the future graduated. Objective: To evaluate the utility of the methodological multimedia to perfect the planning, execution and control of the process of teaching- learning of the medical sciences. Methodology: Investigation of technological development that has three phases: the phase of diagnostic (the identification of learning necessities by means of the focal group); the design phase, which contains a superior section with the images of the Medical University, a central section that registers the fundamental contents of the multimedia and a lateral section with the most important thematic; and the evaluation phase with the interview at random to 762 professors of the 24 educational departments of the municipality of Sancti Spíritu. Results: 100% of the interviewees referred that the multimedia facilitates to have access to the main normative for the methodological educational work, more than 95% that helps to a correct planning and control, also that contributes to the self- preparation and pedagogic upgrade Conclusions: The methodological multimedia was of great utility to perfect the planning, execution and control of the process of teaching- learning by its generalization level and upgrade.
Abstract This study evaluated the effects of a dating violence prevention intervention on intentions of coping with this type of violence, difficulties in regulating emotions and endorsement of traditional male gender norms. There were 45 adolescent participants, not randomly placed in an experimental group (N = 21) and a control group (N = 24). The intervention encompassed nine sessions focused on information about dating violence, social skills, decision making, sexual and reproductive rights, and empowerment. Analyses intra and between groups had shown significant reduction in beliefs that supported emotional restriction as a masculinity characteristic in the experimental group, whereas the intentions of coping with dating violence and emotional regulation had not suffered significant changes in any of the Groups. However, qualitative evaluations had evidenced the external practice of self-control and emotional expression skills, assertiveness and empathy. New studies, mainly longitudinal, are recommended to elucidate these results.
Resumen Este estudio evaluó los efectos de una intervención para la prevención a la violencia en el noviazgo sobre cómo hacer frente a tales intenciones de violencia, dificultades en la regulación de las emociones y aprobación de normas tradicionales de roles de género masculino. Participaron 45 adolescentes, no asignados no aleatoriamente en un grupo experimental (N = 21) y un grupo de control (N = 24). La intervención consistió en nueve sesiones que se centraron en información sobre violencia en el noviazgo, habilidades sociales, toma de decisiones, roles de género, derechos sexuales y reproductivos y en la potenciación. Análisis intra y entre grupos revelaron una reducción significativa en las creencias que apoyan la restricción emocional como característica masculina en el grupo experimental, mientras que las intenciones de enfrentamiento a la violencia en el noviazgo y la regulación emocional no sufrieron cambios significativos en ninguno de los grupos. Pese a eso, las evaluaciones cualitativas mostraron la práctica externa al período de las sesiones de habilidades de autocontrol y expresión emocional, asertividad y empatía. Son recomendados nuevos estudios, principalmente longitudinales, para esclarecer estos resultados.
Resumo Este estudo avaliou os efeitos de uma intervenção para prevenção à violência no namoro sobre intenções de enfrentamento a esse tipo de violência, dificuldades em regulação das emoções e endosso a normas tradicionais de papéis de gênero masculino. Participaram 45 adolescentes, alocados não randomicamente em um grupo experimental (N = 21) e um grupo controle (N = 24). A intervenção compreendeu nove sessões focadas em informações sobre violência no namoro, habilidades sociais, tomada de decisão, papéis de gênero, direitos sexuais e reprodutivos e empoderamento. Análises intra e entre grupos revelaram redução significativa em crenças que apoiam a restrição emocional como característica masculina no grupo experimental, ao passo que intenções de enfrentamento à violência no namoro e regulação emocional não sofreram mudanças significativas em nenhum dos grupos. Contudo, avaliações qualitativas evidenciaram a prática extrassessão de habilidades de autocontrole e expressão emocional, assertividade e empatia. Novos estudos, principalmente longitudinais, são recomendados para elucidar esses resultados.
Aim: This qualitative research with gender perspective aims to illustrate the usefulness of Focus Group Discussion in the study of factors influencing gender relations, based on the conceptions of urban community members. The methodology included focus groups with n=5 women and n=5 men members of the community selected. For the systematization of the data handled Atlas ti 6.2 (Demo) and the stage of reasoning of the testimony was used discourse analysis. The results showed: Gender relations based on the traditional gender represent a risk to physical and mental health of the group being studied. Demonstration of manhood, individuality and promiscuity in the male gender, put them in such risk. In female gender submissiveness may trigger low self-esteem, blaming and mental suffering. Conclusions: This study describes how Focal Group Discussion represented an effective tool during the exercise of community nursing because this kind of technique promoted dialogue and exchange with community members.
Objetivo: Esta investigación cualitativa con perspectiva de género tiene como meta mostrar la utilidad del Grupo Focal de discusión en el estudio de los factores que influyen en las relaciones de género partiendo de las concepciones de los miembros de una comunidad urbana. La metodología incluyó la realización de un grupo focal con un total de n=5 mujeres y n=5 hombres, todos pertenecientes a la comunidad seleccionada para el estudio. Para la sistematización de los datos se manejó Atlas ti 6.2 (versión Demo) y en la etapa de razonamiento de los testimonios fue usado análisis del discurso. Los resultados mostraron: Las relaciones de género basadas en el modelo de género tradicional representan un riesgo para la salud física y mental del grupo estudiado. Las demostraciones de hombría, individualidad y promiscuidad en el género masculino ponen su salud en riesgo. En el género femenino la sumisión puede desencadenar baja autoestima, sentimientos de culpa y sufrimiento mental. Conclusiones: Este estudio describe cómo grupo focal de discusión representó una herramienta efectiva durante el ejercicio de la enfermería comunitaria, ya que este tipo de técnica promueve el dialogo y el intercambio con miembros de la comunidad.
In Mexico, alcohol and drug consumption has been a social problem for many years. Epidemiological studies show that moderate-to-high alcohol consumption has persisted in recent years, whereas in the case of illegal drugs consumption has become more widespread in both men and women. In fact, there is a tendency for consumption rates to level out between men and women, especially regarding legal drugs. Although most users are moderate consumers, between 5-10% are chronic consumers. It is necessary for these people to have access to a range of treatments that incorporate a system of examination and systematization. Consequently, in Mexico it is necessary to create new programs with a methodological structure that makes it possible to assess whether they assist in curtailing this social problem. One program that has proven to be effective is the Daily Satisfaction Program (DSP), which is based on the Community Reinforcement Approach (CRA). CRA is notable as one of the most successful programs in helping chronic users of legal or illegal drugs in the United States to give up substance abuse. In Mexico, it was necessary to modify some of the elements of DSP in order to adapt it to our culture, but it has encouraged a significant reduction in consumption patterns among participating users. This is an intensive program that includes several components, due to the serious nature of the problem to be tackled. However, it is necessary to carry out a systematized assessment of each of these components that foster in the user not only a reduction in consumption but also an increase in the satisfaction found in day-to-day activities. In Mexican culture, there are strong social pressures that affect consumption. Consequently the refuse-to-consume component is one of the most important, as it provides the user with the necessary strategies to be able to decline in a situation with peer pressure and in those moments when impulsive thoughts occur that might trigger the consumption response in the subject. The refuse-to-consume skills that were assessed in users were: body language, assertive refusal, suggesting alternatives, changing the subject of conversation, offering an explanation, suspending interaction, confronting the offerer, and changing impulsive thoughts by using cognitivist restructuring. Some investigators have detected a correlation between high consumption levels and a low degree of self-efficacy in refusing consumption. According to this theory, low self-efficacy in refusing consumption is the most accurate indicator of consumption behavior and makes it possible to discriminate between different types of user. High self-efficacy in refusing consumption is associated with less frequent episodes of consumption. With regard to motivation, these authors suggest that better self-efficacy in refusing consumption when offered the substance or in response to impulsive thoughts has an influence on the decision to consume or not to consume. In order to achieve a higher degree of self-efficacy in refuse-to-consume skills, it is necessary to control certain body responses that denote the desire or wish to consume. Some of these responses are: avoidance of eye contact, trembling, stuttering, blushing, sweating, palpitations, etc. The physiological responses associated with consumption are still displayed after the user has been through a period of non-consumption. They may be triggered by words associated with consumption or by watching videos of people who are consuming. Responses of this kind may be explained from a classical conditioning viewpoint, whereby a given stimulus provokes a given type of response. To explain what elicits, maintains, and increases the consumption of alcoholic drinks, three models of conditioning have been posited: the conditioned withdrawal model, the compensatory response model, and the conditioned motivational model. These models are based on an analysis of alcohol consumption situations with the aim of identifying the related variables. The model that most clearly explains alcohol consumption as a conditioned response is conditioned withdrawal. According to this model, in the case of people who have a history of alcohol dependence the stimuli associated with alcohol consumption (visual, olfactory, and auditory) provoke physiological responses such as salivation, trembling hands, or sweating. Alcohol consumption reduces these responses, which the subject is averse to. Users learn that, when they are offered a drink or drugs (the stimulus), they should accept it (the response). The aim of refuse-to-consume skills is to teach them to change their response to the stimulus, in other words, to teach users the necessary skills so that they learn to say no. When people are in the process of changing their consumption patterns by learning refusal skills and they experience high-risk situations, it is very probable that on the first few occasions they will exhibit a behavior that shows they are feeling insecure or anxious, such as avoiding eye contact with the person offering them the substance, stuttering, mumbling, not speaking with a decisive tone of voice, sweating, or having shaky hands. These responses make the offerer doubt whether the individual wishes to give up consuming, so he or she is more likely to insist and encourage a relapse in the user. Consequently, it is necessary to teach users how to react to these offers by relaxing and behaving assertively. This can be achieved by applying refuse-to-consume skills. Relaxation produces emotional effects that are the exact opposite of anxiety and which may be used therapeutically in everyday situations. Thus, it is less likely that the person offering the substance will follow up a refusal by repeating the offer, and the user may then take control of the situation and feel more secure. Peer pressure constitutes a high-risk factor that causes many users to relapse. It consists of direct or indirect pressure from other individuals or social groups who exert an influence on the user. In the case of direct pressure, the contact is personal, the offer involves verbal interaction, and the offerer is insistent that the user should consume the substance. In the case of indirect peer pressure, the user responds by watching other people use the substance in question. Often peers do not understand that the user has made a decision to quit and are insistent that he or she should continue to consume; the user also frequently feels that justification should be provided when refusing an offer. In reality, such an explanation is not necessary in most cases. It is frequently the case that when the user is with family members or close friends, they may question the refusal. For this reason, it is important for the user to preempt this reaction by asking friends and family members for support as a first step in the recovery process. The user must also interpret events, impulses, and emotions rationally, bearing in mind the negative consequences of consuming and the benefits of being sober or drug-free. Consequently, the user needs to learn to say no to him- or herself whenever temptation arises in the form of thoughts or desires. The user must confront them and change them into positive thoughts that favor his or her wellbeing and are unrelated to consumption. The objective of this study was to assess the degree of aptitude attained in refuse-to-consume skills by four chronic drug users in the Daily Satisfaction Program (DSP). Each user performed an evaluation of the high-risk situations in which consumption might occur as a result of peer pressure, and carried out a behavioral test in which the skills learnt were put to use. Subsequently, the users identified their impulsive thoughts and carried out an exercise in which the therapist repeated out loud the impulsive thoughts and the user replaced them with positive thoughts oriented toward reversing the decision to consume. These exercises were recorded and evaluated by two DSP therapists. Results indicate a high level of skill in refusing consumption in the face of external and internal pressure. Users also put these skills into practice in real-life situations, thereby reducing their episodes of consumption or maintaining abstinence.
En México, el consumo de alcohol y drogas ha sido un problema social. Los estudios epidemiológicos indican que el consumo moderado alto de alcohol ha prevalecido en los últimos años, se ha igualado la cantidad de ingesta en ambos sexos y alcanzado el consumo crónico hasta entre un cinco a 10% de la población. En lo referente al consumo de drogas ilegales, éste se ha incrementado tanto en hombres como en mujeres. Es indispensable que esta población tenga acceso a diversos tratamientos y se evalúe su impacto en la reducción de éste problema. El Community Reinforcement Approach (CRA) ha demostrado ser uno de los mejores programas de intervención para lograr la abstinencia en usuarios con consumo crónico de drogas legales o ilegales en los Estados Unidos. En México, la adaptación del CRA requirió modificar algunos de sus componentes y añadirle el de autocontrol emocional. A partir de estos cambios se estructuró el Programa de Satisfactorios Cotidianos (PSC) que favoreció la reducción significativa en el patrón de consumo en los usuarios participantes y el incremento en la satisfacción con su funcionamiento cotidiano. Este es un Programa intensivo, que integra diversos componentes en función de la gravedad de la problemática por modificar. Sin embargo, requiere la evaluación sistematizada de cada uno ellos. En un estudio con una población mexicana de consumidores crónicos, la habilidad para rechazar la presión social al consumo y los pensamientos de apetencia o necesidad por consumir funcionaron como precipitadores predictores de la abstinencia. El componente de Rehusarse al Consumo es uno de los más importantes ya que provee al usuario de las estrategias necesarias para negarse ante situaciones de ofrecimiento e insistencia en las invitaciones y en momentos en los que sus pensamientos precipitadores le activan la conducta de consumo. Las habilidades para rehusarse al consumo evaluadas en estos usuarios fueron: negarse asertivamente, sugerir alternativas, cambiar el tema de la plática, ofrecer justificación, interrumpir la interacción, confrontar al otro y su lenguaje corporal, así como el cambio de pensamientos precipitadores mediante el uso de la reestructuración cognoscitiva. El objetivo de este estudio fue evaluar el nivel de dominio alcanzado en las habilidades de rehusarse al consumo por cuatro usuarios crónicos de drogas del Programa de Satisfactores Cotidianos (PSC). Cada usuario realizó un análisis de sus situaciones de riesgo para el consumo ante la presión social y efectuó un ensayo conductual en el que ponía en práctica las habilidades. Posteriormente identificó sus pensamientos precipitadores y llevó a cabo un ejercicio en el que el terapeuta repetía en voz alta los pensamientos precipitadores del usuario y éste los cambiaba por pensamientos positivos orientados a modificar la decisión de consumir. Estos ejercicios fueron grabados y evaluados por dos terapeutas del PSC. Los resultados indican un nivel de dominio alto de las habilidades de rehusar el consumo ante presión externa e interna; adicionalmente, los usuarios aplicaron las habilidades de rehusarse a consumir en escenarios naturales. Redujeron sus episodios de ingesta, lograron mantener la abstinencia, disminuyeron las situaciones de ofrecimiento en las que tuvieron consumo e incrementaron su seguridad para no consumir al exponerse a ofrecimientos.
Summary The objective of this study was to evaluate a conceptual model to explain alcohol and drugs abstinence in persons that meet the DSM-IV dependence criteria. This study incorporated and evaluated the conceptual proposal of the Integrated Model of Everyday Satisfaction. The structure of this model is based on the Niaura’s Dynamic Regulatory Model and the Social Learning Theory that included the classical conditioning, the operant and the vicar to explain the dependent-consumption and incorporated some of the criticisms to the different cognitive-behavioral models, as the need to measure, by means of a direct observation, the specific type of skills used by the consumption-dependent users when facing everyday situations; as well as identifying changes of the functioning of the variables making up the model at the moment of turning towards abstinence; it also considered the indicators that the variable everyday satisfaction has been poorly studied and not been included in the study of conceptual models. Thus, the proposed conceptual model: Integrated Model of Everyday Satisfaction, included the following variables: consumption, precipitators, self-efficacy, everyday satisfaction, as well as variables measuring the facing of specific situations: communication, problem-solving, refusal of consumption, depression and anxiety. These variables were evaluated in an intentional, non-probabilistic sample with 20 dependent users of addictive substances, before and after the cognitive-behavioral intervention adapted to the Mexican population. This intervention model included the following components: Functional Analysis, Demonstration of Non-Consumption, Daily Life Goals, Communication, Problem Solving, Consumption Refusal, Marriage Guidance, Employment Searches, Recreational and Social Skills, Emotional Self-Control and Prevention of Relapses. The pre-post-test evaluation methods were: Retrospective Baseline, Situational Confidence Scale and/or Drug Consumption Self Confidence Scale, Daily Life Satisfaction Scale, Inventories of Drug Consumption Situations and/or Inventories of Alcohol Consumption Situations, Beck´s Inventories for Depression and Anxiety. Occurrence records were used to assess the video-filmed behavioral assays of consumption refusal, problem-solving and communication. The didactic techniques used in the training were: verbal instruction, modeling, behavioral trials and feedback. In the scaled analysis, the Model showed, at the moment of consumption, solidity accounting for 95% of the variance. At this moment, significantly related to the variables: risk situations, selfefficacy to avoid consumption, everyday satisfaction and anxiety. Dependent consumers, showed bigger diversity and intensity of risk situations previously associated to consumption, reduction of facing skills that caused their insecurity to refuse consumption, increased of their physical symptoms of anxiety and decreased of everyday satisfaction related with their poor functioning in different areas of daily living. The increase of anxiety was an indicator of manifested abstinence syndrome, and confirmed that the used filter criterion, showed sensitivity to attract target population; in turn, anxiety as precipitator confirmed, was sustained by the conditioned withdrawal model. Refusal of consumption, communication and problem-solving at the moment of consumption in the user prior to the training were not significantly associated, indicating the need to acquire and develop these skills in the behavioral repertoire. Eighteen from the twenty dependent users showed in the analysis of interrupted time series, that the amount and frequency of the consumption was significantly changed toward abstinence after their participation in the cognitive-behavioral intervention. The scaled analysis indicates that it was a solid model in terms of abstinence accounting for 96% of the variance. In the final configuration of the Model variables with regard to its proximity to abstinence, identified the proximity between the: decreased of consumption, the more skills for facing risk situations, and refusal of consumption were detected with major proximity; subsequently, more everyday satisfaction and more self-efficacy to avoid consumption; then less anxiety and depression; and eventually, more communication and problem-solving skills. The following variables were significantly associated, during abstinence: the More Everyday Satisfaction from the functioning in daily living, more skills and variety of behavioral alternatives to cope risk situations, more self-efficacy to avoid consumption at coping different risk situations, less anxiety and depression, also more skills to consumption refusal, and decrease of substance consumption. Self-efficacy worked as mediator between behavior and emotion; everyday satisfaction was associated to cognitive variables: self-efficacy and emotional self-control; anxiety and depression. This study detected that it may work as an early advice of relapse, and as antecedent of abstinence. The variables that acted as predictor of abstinence, accounted for 73.2% of the variance and were: coping risk situations with alternative behaviors, getting everyday satisfaction from their performance in activities of different areas of daily living, self-efficacy to resist consumption at risk situations and refusal of consumption in front of persons modeling consumption and invitations and pressure to consume; depression was not significant with the Enter method regression model. The measuring of problem-solving did not include the efficacy of application in everyday life, so that it was not directly associated to consumption. One limitation was not having evaluated the generalization behavior of variables: communication and problem-solving in natural settings; and the lack of physiological measures in order to evaluate the emotional self-control. In another study, it is suggested to assess the variables during follow-up to detect changes in its functioning in this other moment. It may be concluded that the relationship between the diversity of variables inserted in this Model during the organism-environment interaction, is favorable to the abstinence, everyday satisfaction, facing non-consumption, behavior entails, flexibility and integration of a number of cognitive-behavioral skills. The functioning of Everyday Satisfaction as early warning of relapse is an important finding to be considered by the therapist who, when applying the intervention on these users, will have to perform subsequent evaluations of this variable in the process of change in order to anticipate and avoid relapses.
INTRODUCTION: The large use of plants in the prevention and treatment of different diseases is a milenar practice. In Brazil due to it's rich flora there is a huge material for research and use in popular medicine. The babassu (Orbignya phalerata) is a native tree from North of the Brazil and has a high concentration at the State of Maranhão. The powder of it's mesocarp is known as amid, and has been used as meal and medication due to the known activity against antiflammatory reaction, pain, pyrexia and immunomodulation. PURPOSE: To analyze the effect of mesocarp of Orbignya phalerata (babassu) in gastric wound healing in rats under morphologic and tensiometric aspects. METHOD: Forty Wistar rats, male, adults were submitted to a longitudinal incision of 1 cm in the gastric body and sutured with separated stitches of polypropilene 6.0. After this common procedure the animals were allocated in the aleatory way in two groups Orbignya (GO) and Control (GC) with 20 animals each one. In the GO was used intraperitoneal doses of 50mg/kh of Orbignya phalerata extract and in the GC water 1ml/Kg. Each group was divided in two subgroups of ten rats according to the period of death, at 3rd and 7th post-operative days. After the death, the abdominal cavity was evaluated and the stomach withdrawn. For the comparative analysis between the groups the macroscopic and histological parameters of wound healing were utilized. RESULTS: There were no abscess, fistulae and haematom in the animals of the study. Abdominal adhesions were observed in both groups of the animals at 3rd and 7th post-operative days. Dehiscence of the gastrorraphy was identified in one 3rd day rat of subgroups GO. The resistance to air insufflation was higher in GO 3rd day (p=0,087). The analysis of histological parameters showed statistical difference related to wound coaptation in favor to subgroup GO 7th post-operative day. CONCLUSIONS: The extract of mesocarp of Orbignya phalerata in dose and path utilized positively interfered on the gastrorraphy when compared with control group in animals at 7th post-operative day.
INTRODUÇÃO: A utilização de plantas na prevenção e no tratamento de doenças é prática milenar. O babaçu (Orbignya phalerata) é uma palmeira nativa do meio norte do Brasil, tendo sua maior concentração no Estdo do Maranhão. O pó do mesocarpo do coco babaçu é popularmente conhecido como amido e tem sido usado como alimento e como medicamento por apresentar atividade antiinflamatória, imunomoduladora, analgésica e antipirética. OBJETIVO: Avaliar o efeito do extrato aquoso do mesocarpo de Orbignya phalerata na cicatrização do estômago em ratos, sob aspectos morfológico e tensiométrico. MÉTODOS: Quarenta ratos da linhagem Wistar, adultos, machos foram submetidos à incisão longitudinal de 1cm no corpo gástrico e síntese em plano único com pontos separados de polipropilene 6-0. Após este procedimento comum, os animais foram distribuídos aleatoriamente em dois grupos, Orbignya (GO) e Controle (GC), contendo 20 animais cada. No GO utilizou-se dose única intra-peritoneal de extrato aquoso da planta na dose de 50mg/kg e no GC, água destilada, 1ml/kg de peso. Cada grupo foi dividido em dois subgrupos de 10, conforme o dia da morte dos animais, nos 3° e 7° dias do período pós-operatório. Após a morte, foi realizado o inventário da cavidade abdominal e procedeu-se a retirada do estômago, com posterior avaliação tensiométrica e análise miccccroscópica. Na análise comparativa entre os dois grupos utilizou parâmetros macroscópicos e microscópicos da cicatrização. RESULTADOS: Não foram detectados abscessos, fístulas ou hematomas em nenhum animal. Houve aderências abdominais nos animais dos 3° e 7° dias do período pós-operatório nos dois grupos. Houve deiscência da gastrorrafia em um rato do sub-grupo GO morto no 3º dia. A resistência à insuflação de ar atmosférico foi maior no GC de três dias (p=0,087). A análise dos parâmetros histológicos demonstrou diferença estatisticamente significativa apenas quanto à coaptação das bordas, favorecendo o sub-grupo GO de sete dias (p-0,000). CONCLUSÃO: O extrato aquoso do mesocarpo de Orbignya phalerata, na dose e via de acesso utilizadas, favoreceu a coaptação das bordas da gastrorrafia nos animais mortos no 7º dia do período pós-operatório.
Abstract: The chronical abuse of addictive substances is a major public health problem, due to the seriousness of the consequences: fatal automobile accidents or others involving traumatic injury and emergency medical care, chronic physical diseases such as cirrhosis of the liver, cardiovascular complaints, cerebrovascular problems and pancreatitis, as well as disability and disruption in different functional areas of daily life, whether social, psychological, legal, personal, family, economic or professional. These factors include: depression, anxiety, loss of sleep, loss of support networks, suicide, violence, injury in fights, homicide, financial debt, divorce, loss of employment, hospitalization, crime and imprisonment, among others. It is therefore required to establish multidisciplinary intervention models that respond to the seriousness of the problem. In Mexico, reports show that there is a need for the development of more intervention models for chronic users of addictive substances, which include systematic implementation and evaluation as well as medium- and long-term measurements to assess effectiveness. Intervention services often do not go beyond support for the initial detoxification. Additionally, the high cost of most treatment schemes makes them inaccessible to the majority of the people affected by these problems. Intervention models must be designed and developed to include elements from other models that have proven to be reliable and effective on the basis of empirical evidence. The Community Reinforcement Approach or "CRA" intervention model has gained recognition in scientific literature and from international institutions (the National Institute of Drug Addiction, NIDA, and the National Institute of Alcoholism and Alcohol Abuse, NIAAA) as one of the most effective means in reducing consumption by chronic users of addictive substances. Consequently, the objective of this research was to use a pilot project to adapt, systemize, implement and assess the impact of the Community Reinforcement Approach intervention model in reducing consumption patterns among chronic dependent users of alcohol and other drugs within the Mexican population. A cognitive-behavioral intervention model was applied to 9 chronic users who had requested psychological help at the Psychological Service Centers of the Faculty of Psychology. The average age of the users was 35. Seven of them were male and two female. The most commonly consumed addictive substance was alcohol by six users, with other drugs accounting for three (benzodiazepine, marihuana, cocaine, solvents and amphetamines). On average, the subjects had spent 14 years in schooling. Five of them were single, one was married, one cohabiting and two divorced. With regard to the occupations of the sample, one was a student, two had abandoned a course of study, four were employed before treatment and two were unemployed. The criteria that the users had to meet for inclusion in the study were: to be aged 18 or over; to be able to read and write; to have a medium-to-severe level of alcohol dependence corresponding to a range between 22 and 47 points on the Alcohol Dependence Scale (ADS) and/or a substantial-to-severe level of dependence on other drugs of between 11 and 20 points according to the Drug Abuse Questionnaire (DAQ); to consume a quantity of 14 or more measures of alcohol per occasion and/ or 20 or more measures per week for men, and 10 or more per occasion or 15 or more per week for women; to have been treated or interned on at least one previous occasion; to suffer consumption-related difficulties in different areas of daily life. The duration of the treatment period was from 15 to 24 sessions, depending on the specific training needs of each user. Sessions lasted 1% hours, and were given twice a week. The methodology used was single case with repetitions and follow-up. The cognitive-behavioral model included the following intervention components: Functional Analysis, Demonstration of Non-Consumption, Daily Life Goals, Communication, Problem Solving, Consumption Refusal, Marriage Guidance, Employment Searches, Recreational and Social Skills and Prevention of Relapses. The didactic techniques used in the training for each of the aforementioned components were: verbal instruction, modeling, behavioral trials and feedback. The original model (CRA) was adapted to include the following changes: 1) More communication skills were integrated, including listening, starting conversations, giving and receiving criticism, giving and receiving recognition, and sharing positive and negative feelings; 2) Relapse prediction variables were assessed: self-effectiveness and triggers; 3) New skills for refusing consumption were added: interrupting interaction, justification for non-consumption. Occurrence records were kept for the application in natural settings of the skills taught. In addition, teaching materials were prepared, along with information brochures on different addictive substances and the different training components, lists of community resources and therapist checklists to guarantee the systematic implementation of the model. The pre-post-test evaluation methods were: Retrospective Baseline (RETBAS), Self-Recording, Situational Confidence Scale and/or Drug Consumption Self-Confidence Scale, Daily Life General Satisfaction Scale, Inventories of Drug Consumption Situations and/or Inventories of Alcohol Consumption Situations. The significant changes identified in this preliminary research were: decreases in consumption patterns during and after treatment, since in the pre-post-test statistical analysis for paired samples the results t= 4.75 p = .001 were obtained in the comparison of baseline and treatment, and t= 4.28 p=.002 in the comparison of the baseline and follow-up; increases in the levels of general satisfaction in daily life following treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t=-3.94 and p=.004 were obtained, and t=-4.03 and p=.004 in the pre-follow-up comparison; increases in levels of self-effectiveness after treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t= -5.08 and p=.001 were obtained, and t= 4.37 and p=.002 in the pre-follow-up comparison; decrease in the number of consumption triggers after treatment and during follow-up, since in the pre-post-test statistical analysis for paired samples the results t= 5.80 and p=.000 were obtained, and t= 5.3 and p=.001 in the pre-follow-up comparison. As a result of the foregoing, the researchers were able to verify the effectiveness of this intervention model in significantly reducing consumption patterns in nine chronic dependent users of addictive substances. Similarly, the model had a significant impact on consumption prediction variables, as well as increasing self-effectiveness levels and eliminating triggers to avoid relapses. Users learnt how to create a more satisfying day-to-day lifestyle, by including activities incompatible with consumption. Finally, in repetitions of the implementation of this intervention model, it is recommended that a training component be introduced for emotion management (depression, anxiety and anger), as well as an assessment of cognitive functioning as a relapse prediction variable, and the participation of users that have been part of a social-recreational activity group to reinforce sustained abstinence in the long term.