Avoidance Of Fear Research Articles

Latina Women’s Perinatal Experiences and Perspectives Around Discrimination, Anti-immigrant Policies, and Community Violence

ObjectiveTo describe experiences of Latina women who were currently pregnant or recently gave birth around discrimination, anti-immigrant policies, and community violence during the early COVID-19 pandemic. DesignQualitative secondary analysis. SettingOnline or phone interviews. ParticipantsLatina women who were currently pregnant or recently gave birth (N = 26). MethodsWe used reflexive thematic analysis to examine transcribed data from semistructured interviews conducted during the early COVID-19 pandemic with a subgroup of participants enrolled in a larger study related to prenatal care. Participants were English- or Spanish-speaking, Medicaid-eligible, Latina-identifying women who resided in Fresno County, California. We analyzed responses to questions about personal discrimination, the Black Lives Matter movement, and immigration policies using the theoretical frameworks of critical race theory and the political economy of health. ResultsWe identified four major themes: Avoidance of Community Engagement, Chronic Fear and Vigilance, The Role of Media, and Everyday Discrimination and Injustice. ConclusionParticipant experiences reflect the pervasiveness of fear and socioeconomic inequity and call attention to the racialized structures that affect health and health care access for Latina women. These exposures during the perinatal period may have intergenerational effects. These findings underscore the need for responsive and race-conscious perinatal nursing care for Latina women, assessment of the effect of the current sociopolitical environment on well-being, and policies that support equitable access to health and social care.

Relevance of Emotion of Anxiety and Fear of Dentistry as Motivational Conflict in Oral Health Behaviors.

This study was undertaken with an aim to explore the influence of factors associated with anxiety and fear of dentistry on oral health behavior. A total of 84 patients aged 20-40 years visiting the dental institute for the management of gum diseases (gingivitis and periodontitis) and tooth decay (dental caries) were enrolled. Fear of dentistry and oral health behaviors were recorded employing a dental fear survey (DFS) and oral health behaviors checklist. Each of the 20-item scale of DFS was rated on a 5-point Likert scale. The oral health behavior checklist was based on oral hygiene habits, patterns of utilization of dental services, food habits, and use of tobacco products. Each of the 13-item checklist comprised a closed-ended statement with a high score corresponding to more positive oral health behavior. Domains of dental fear (avoidance of dentistry, physiological arousal, and fear of specific stimuli) and total dental fear did not predict oral hygiene habits and nutritional preferences (p > 0.05). Physiological arousal was a positive predictor of utilization of dental services (p = 0.009) and oral health behavior (p = 0.042). Oral health behaviors were found to be positively correlated with three factors of DFS. Anxiety and fear of dentistry are not found to influence personal preventive oral care with reference to oral hygiene habits. Avoidance of dentistry factor of DFS is positively correlated with oral health behavior. Dental fear and anxiety do not impact oral health behaviors adversely. In this era of youth and beauty, the utilization of professional dental care services is not affected by fear of invasive nature of dental procedures. Establishing the groundwork for knowledge regarding the scope of fear appeals in anxiety for dentistry may help to augment positive oral health behaviors for effective primary prevention of oral diseases. Interactions among personality characteristics, attitudes, emotions, and health behavior need further exploration. How to cite this article: Supriya, Singh R, Ahsan A. Relevance of Emotion of Anxiety and Fear of Dentistry as Motivational Conflict in Oral Health Behaviors. J Contemp Dent Pract 2024;25(3):280-288.

APPLICATION OF PATIENT SAFETY INCIDENT REPORTING SYSTEM IN HOSPITALS: LITERATURE REVIEW

Patient Safety Incident Reporting for improvement of the service system and prevention of recurring patient safety incidents is a very important part and affects the quality of service, so it is necessary to evaluate the implementation of the ICP reporting system at the hospital. Objective: To ascertain the elements that impact hospital patient safety event reporting. Method: This article was written utilizing a literature review methodology. Data was gathered from database sources, and 20 articles between 2018 and 2023 were examined for PICOT analysis using the keywords patient safety incident, reporting, and health service. Results: There are three elements that affect the reporting of patient safety incidents that take place in hospitals: government, organizational, and human factors. It can be observed from features of nurse skills and patient safety culture in addition to environmental influences (individuals, organizations, and government). Cultural barriers (avoidance of conflict and fear of being blamed and penalized) and practical barriers (lack of expertise, so officers do not know how to report occurrences, lack of feedback, and lack of socialization connected to reporting incidents). Discussion: As a result of the existing literature review, no one has discussed the existence of organizational/hospital and government targets in efforts to achieve the target percentage (%) of PSI reporting. In order to improve employee motivation and involvement in reporting patient safety incidents and, ultimately, raise the standard of care provided to hospital patients, more research is required regarding the implementation of patient safety incident reporting in hospitals. Conclusion: The reporting of patient safety incidents in hospitals is influenced by three factors: personal, organizational, and governmental. Lack of feedback has been recognized as one of the weaknesses in incident reporting.

Sex divergent behavioral responses in platform-mediated avoidance and glucocorticoid receptor blockade

Women are more likely than men to develop anxiety or stress-related disorders. A core behavioral symptom of all anxiety disorders is avoidance of fear or anxiety eliciting cues. Recent rodent models of avoidance show reliable reproduction of this behavioral phenomenon in response to learned aversive associations. Here, a modified version of platform-mediated avoidance that lacked an appetitive task was utilized to investigate the learning and extinction of avoidance in male and female C57BL6/J mice. Here, we found a robust sex difference in the acquisition and extinction of platform-mediated avoidance. Across three experiments, 63.7% of female mice acquired avoidance according to our criterion, whereas 83.8% of males acquired it successfully. Of those females that acquired avoidance, they displayed persistent avoidance after extinction compared to males. Given their role in regulating stress responses and habitual behaviors, we investigated if glucocorticoid receptors (GR) mediated avoidance learning in males and females. We found that a subcutaneous injection (25 mg/kg) of the GR antagonist, RU486 (Mifepristone), significantly reduced persistent avoidance in females but did not further reduce avoidance in males after extinction. These data suggest that GR activation during avoidance learning may contribute to persistent avoidance in females that is resistant to extinction.

Anxiety? Stay Away From Me!

Have you ever felt anxious? How do you usually react when you are afraid of something? Anxiety is a normal feeling that everyone gets from time to time. Since it is an unpleasant feeling, people often try to avoid situations that make them feel that way. For example, skipping school because you have to give a presentation in front of the whole class. Some people can feel too much anxiety. Anxiety makes them nauseous, and they might start to stutter. In our work, we would like to discuss “avoidance of learned fear”. In this article, we will explore anxious feelings and whether people tend to avoid things they are anxious about.

‘It just doesn't feel right’ and other reasons why some people fear and avoid positive emotions

The need to further our understanding of positive affect dysregulation in depression has been widely acknowledged. Two related relevant concepts in this realm, are Avoidance Of Positivity (AOP; referring to avoidance behaviour towards positivity) and Fear Of Positivity (FOP; referring to anxious or unpleasant feelings related to positivity). However, traditionally manifestations of AOP and FOP are considered in isolation, and self-report scales used to measure both concepts show considerable content overlap. Therefore, the first study aim was to examine how AOP and FOP relate to one another, depressive symptomatology and anhedonia, through new clearly delineated scales. For exploratory purposes, general and state-specific versions were developed. The second aim was to uncover beliefs that underlie the tendency towards AOP/FOP. An adult community sample (n = 197) completed online measures of AOP, FOP, depressive symptoms and anhedonia, and answered open-ended questions about reasons for AOP and FOP. Cross-sectionally, preliminary evidence was found for AOP and FOP being positively associated with one another, depressive symptomatology and anhedonia. Even after controlling for depressive symptomatology, anhedonia remained positively associated with AOP and FOP. So, AOP and FOP may be viable candidate mechanisms maintaining anhedonia that are worth further investigation and may be appropriate to target during treatment. Answers to the open-ended questions (n = 77) reflected various beliefs underlying AOP/FOP, which were broader than simply anticipating negative consequences of feeling positive and also touched on themes of unworthiness and social inappropriateness of feeling positive. Some theoretical and clinical implications of different beliefs underlying AOP/FOP are discussed.

Reducing avoidance of learnt fear: Extinction of an imminent threat signal partly decreases costly avoidance to a distal threat signal

In the interplay of fear and avoidance, not only imminent threat signals that directly predict potential threat evoke avoidance, but also distal threat signals that predict these imminent threat signals. Avoidance of learnt fear refers to avoidance to a distal threat signal that prevents the occurrence of an imminent threat signal. In clinical anxiety, it is often pathological given its persistence in the absence of threat and the impairments it inflicts. The current study examined whether fear extinction to an imminent threat signal would effectively reduce avoidance of learnt fear in a sensory preconditioning procedure. Three neutral preconditioning stimuli (PSs), serving as distal threat or safety signals, were paired with three neutral to-be conditioned stimuli (CSs), serving as imminent threat or safety signals. After assessing baseline levels of costly avoidance to the PSs, two CSs were paired with threat. One of these CSs then ceased to predict threat during extinction training. In test, participants showed limited avoidance to the PS that signaled the extinguished CS, however, the level of avoidance was still stronger compared to a PS that signaled a safety CS. Results suggest that exposure to an imminent threat signal partly reduces avoidance to a distal threat.

Abstract PR003: Colorectal cancer screening among Native Americans of Nebraska: A qualitative analysis of the barriers and facilitators

Abstract As a component of statewide cancer needs assessment, this study explored factors impacting colorectal cancer (CRC) screening and approaches to increase screening among Native Americans of Nebraska. Three 75-minute focus groups were conducted October-December 2021: Omaha Urban Indian clinic (n=11), Lincoln Urban Indian clinic (n=6), and Ponca Tribe (n=9). Participants were Native American cancer survivors and caregivers aged 30+ residing in Nebraska. Verbatim transcripts were inductively coded and analyzed using a directed content analysis approach. Most participants were female (88%) and caregivers (85%). Most had heard of colonoscopies (83%), but awareness of fecal tests was low with two participants unaware of any screening. Only 38% had heard of the Fecal Occult Blood Test despite tribal outreach during March incentivizing stool tests. Reasons for low uptake of screening tests included lack of awareness (“What is colorectal cancer?” and “I don't think a lot of Natives get that type of cancer, do they?”), elderly avoidance of medical care (“even when I’m real sick I have to be…near…death” before seeking care), fear (“fearing what they’re gonna find out”), and embarrassment (“perception of manhood”). The invasive and uncomfortable procedural aspect of colonoscopy and use of excreta for stool-based tests "Because I don't wanna be digging in my poop" were other deterrents. Some providers did not strongly recommend the screening. Other barriers include insurance and transportation/travel distance for colonoscopy. Suggested approaches to improve CRC screening were increasing awareness of CRC and screening options using billboards, flyers, posters, brochures, health fairs, public meetings, and social media (e.g., Facebook). Posters and educational materials in clinics were already in use. Suggested message content should portray that CRC is treatable “if they catch it in time,” emphasizing being there for family (“you’ve got kids, you want to see them graduate”), funny (“goofy…they can kinda laugh at the ad and hopefully not be so nervous”) and having community members share CRC survival stories. Engaging the community was also discussed either through 1) having nursing students provide health education outreach, 2) forming elder committees to encourage the elderly to complete screenings, and/or 3) ensuring physicians recommend and explain the importance of screenings during appointments. Community support in terms of transportation, social workers to attend appointments with the elderly, and financial counselors were discussed as important to complete screenings. Certain types of health facilities should enhance their partnership with Native Americans to share information with the community. Low awareness and wrong perception of CRC and screening tests are reasons for low utilization of screening. Participants expressed a desire for the researchers to continue building relationships with the tribal groups to address CRC. The state can use study results to prioritize interventions to reduce cancer care disparities. Citation Format: Krishtee Napit, Kendra L. Ratnapradipa, Lady Beverly Luma, Danae Dinkel, Shinobu Watanabe-Galloway. Colorectal cancer screening among Native Americans of Nebraska: A qualitative analysis of the barriers and facilitators [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR003.

Fear of Cancer Recurrence: Lived Experiences of Cancer Survivors’ Spouses

Fear of cancer recurrence is the most prevalent and burdensome emotional concern among cancer survivors’ spouses after treatment. This qualitative study aimed to disclose, what are cancer survivors’ spouses lived experiences of fear of cancer recurrence. Seven adult spouses were explored. Data were obtained using a semi-structured interview and analyzed by inductive thematic analysis. Analysis revealed that fear of cancer recurrence is interpersonal experience and fear transmits in a couple. The spouses associate cancer recurrence with death and risk of losing their spouse. The threat of cancer recurrence triggers not only the feelings of insecurity, uncertainty about the future and loss of control, but also appreciation of life. Planning and control, religiosity, avoidance and awareness of fear helped spouses to reduce concerns about relapse. Interventions for spouses should focus on promotion of emotional expression of cancer recurrence concerns, also learning to accept and tolerate uncertainty.

Avoidance of learnt fear: Models, potential mechanisms, and future directions

Avoiding stimuli that were previously associated with threat is essential for adaptive functioning, but excessive avoidance that persists in the absence of threat can turn dysfunctional and results in severe impairments. Fear and avoidance conditioning models have substantially contributed to the understanding of safety behaviors towards learnt fear stimuli. Safety behaviors are executed in the presence of a feared stimulus to prevent the upcoming threat and are well-established in laboratory models. Avoidance of learnt fear, i.e., avoidance of the feared stimulus itself, is typically initiated before the onset of a feared stimulus: individuals oftentimes avoid fear stimuli to prevent negative emotions evoked by them or ultimately the associated threat. Avoidance of learnt fear is surprisingly understudied despite its prevalence in pathological anxiety. The current overview proposes potential behavioral mechanisms and neural circuits of avoidance of learnt fear in humans, and discusses findings and paradigms suitable for examining it. Specifically, higher-order conditioning, decision making paradigms, and context-cue conditioning investigate distinct forms of avoidance of learnt fear. We also discuss the clinical prospects and future directions of research in avoidance of learnt fear.

Avoiding a feared stimulus: Modelling costly avoidance of learnt fear in a sensory preconditioning paradigm

Avoidance of learnt fear prevents the onset of a feared stimulus and the threat that follows. In anxiety-related disorders, it turns pathological given its cost and persistence in the absence of realistic threat. The current study examined the acquisition of costly avoidance of learnt fear in healthy individuals (n = 45), via a sensory preconditioning paradigm. Two neutral preconditioning stimuli (PSs) were paired with two neutral conditioned stimuli (CSs). One CS then came to predict an aversive outcome whereas the other CS came to predict safety. In test, participants engaged in stronger avoidance to the PS associated with the fear-related CS than the PS associated with the safety-related CS. Of note, executing behavioral avoidance led to missing out a competing reward, thus rendering avoidance costly. The results also provide preliminary evidence that threat anticipation and a negative change in valence play a role in driving costly avoidance of learnt fear. Future studies should examine how avoidance of learnt fear maintains pathological anxiety.

Vil Du?! incorporation of a serious game in therapy for sexually abused children and adolescents

BackgroundTalking about experiences of sexual abuse in therapy is difficult for children and adolescents, amongst others due to a lack of vocabulary to describe the situation, avoidance, or feelings of shame, fear, and self-blame. The serious game Vil Du?! was developed to help children open up about sexual experiences. Vil Du?! is a non-verbal communication game, which resembles a dress-up game, in which children can show the therapist what happened to them. The current study examined how and for which therapy components Vil Du?! was used by therapists.MethodsWe used a mixed-methods triangulation design. Therapists filled out online surveys about the use of Vil Du?! with 23 clients (Mage = 11.38 years, SD = 3.96; 61 % female). We also conducted semi-structured interviews with 10 therapists. The data were analyzed in SPSS (quantitative) and Nvivo (qualitative) following the stepwise guidelines of Zhang and Wildemuth.ResultsMerged qualitative and quantitative data revealed that therapists acknowledged the usefulness of Vil Du?! mostly for the therapy components trauma narration and processing, and psycho-education about sexuality. In addition, Vil Du?! might be most useful for clients who have difficulty with disclosing sexual abuse experiences, due to limited verbal abilities or feelings of guilt, shame, avoidance, and tension.ConclusionsRecommendations from this study were incorporated in a user manual as a first step toward more systematic and broad implementation of Vil Du?! in the treatment of young sexual abuse victims. A next step is to test whether implementing Vil Du?! in therapy is effective in reducing the negative mental health consequences of sexual abuse for children and adolescents.

Time course of attentional bias in social anxiety: The effects of spatial frequencies and individual threats.

Hypervigilance and attentional bias to threat faces with low-spatial-frequency (LSF) information have been found in individuals with social anxiety. The vigilance-avoidance hypothesis posits that socially anxious individuals exhibit initial vigilance and later avoidance to threatening cues. However, the temporal dynamics of these two processes in response to various LSF threats in social anxiety remain unclear. In the current study, we presented faces containing anger, disgust, and fear in high and low spatial frequencies and compared the neural correlates with sensory perception and attention in individuals with high versus low social anxiety (HSA/LSA, n=24). A visual search task was used to investigate the attentional effects of threats and spatial frequencies, and event-related potentials, particularly, the visual components of P1 and P250, were measured to index visual perceptual and attentional processes, respectively. We found that HSA individuals showed pronounced P1 and reduced P250 to LSF (vs. HSF) faces, regardless of emotion type, suggesting a general pattern of initial vigilance and later avoidance to LSF faces in social anxiety. Furthermore, while LSA individuals showed enhanced P250 to both fear and disgust (vs. neutral) faces, HSA individuals showed pronounced P250 to disgust faces alone. Our results, thus, elucidate the temporal profile of early vigilance and later avoidance in social anxiety, highlighting its broad implication for all faces and predominance in the low spatial frequency. Considering individual threats, our results demonstrate specific attentional avoidance of fear faces in social anxiety.

Is Abortion Included in Maternal and Child Health Curricula in the United States?

Purpose The purpose of this study is to assess whether Maternal and Child Health (MCH) graduate programs address abortion content in their programs' foundational courses, elective courses, and general curricula. Description Between January and March 2017, we conducted a descriptive study with faculty from the 13 Centers of Excellence in Maternal and Child Health Education, Science and Practice (COEs). We reviewed syllabi and discussed foundational and elective course content via email and key informant interviews with COE faculty. We categorized abortion coverage in foundational courses as "transparent" or "tangential" depending on inclusion of the word "abortion" in course syllabi. We identified electives addressing abortion as "electives including abortion" and courses that focus on abortion as "abortion-specific electives." Assessment Evidence demonstrated that most programs do not transparently address abortion in required course curricula. Only one of 13 COEs transparently addresses abortion in the foundational course(s); seven COEs tangentially include abortion in foundational courses; and all programs address abortion in some capacity though no standard exists to ensure its inclusion. Despite barriers, including avoidance of controversy and fear of losing funding, COEs could address abortion by establishing shared curricular standards, facilitating values clarification and attitude transformation activities, utilizing information-sharing networks, strengthening relationships between MCH programs and abortion-related organizations, and using professional societies. The scope of our study does not allow us to conclude why abortion content is lacking nor the quality of current content. Conclusion MCH programs should transparently incorporate abortion content in foundational and electives courses to educate students on how to engage with complex and sometimes stigmatized public health issues.

Testing a novelty-based extinction procedure for the reduction of conditioned avoidance

Background and objectivesExcessive avoidance towards non-dangerous cues is a key diagnostic criterion across anxiety-related disorders. Despite current therapies being successful in reducing such avoidance, relapse rates remain high. Based on recent findings, according to which learned fear responses were reduced after the presentation of the fear stimulus with a novel-neutral event (novel-based extinction), we tested whether novel-based extinction could diminish conditioned avoidance. MethodsForty-six participants completed a Pavlovian acquisition procedure during which two pictures of a spider were presented, one of which (CS+) was always followed by a shock (US), while the other (CS−) was never followed by a US. Next, participants learned that they could avoid the shock by pressing a computer button. An extinction and response procedure followed. During this phase, the control group was presented with both CSs that were not followed by the US. The experimental group encountered both CSs, but the CS+ was followed by a neutral event (i.e., presentation of a tone). Return of avoidance (i.e., button presses) and fear (i.e., US-expectancies and fear-ratings) towards both CSs was tested after three unexpected presentations of the US. ResultsSimilar levels of return of avoidance and explicit fear were found for both groups. LimitationsWe collected no physiological measures of fear and we assessed only the short-term effects of our manipulation. ConclusionsOur results do not support the hypothesis that novelty-based extinction reduces avoidance responses. This study can serve as a first exploration of novelty-based extinction for reducing avoidance and explicit measures of fear.

Psychometric Evaluation of the Social Phobia Inventory and the Mini-Social Phobia Inventory in a Swedish University Student Sample.

Social anxiety is common in the general population, as well as among students in higher education. For screening of social anxiety, there is a need for brief scales. In the present study, the psychometric properties were examined in a Swedish version of the Social Phobia Inventory (SPIN) and the Mini-Social Phobia Inventory (Mini-SPIN) in a university student sample ( n = 161). In addition to the SPIN and Mini-SPIN, participants completed measures of fear of public speaking, general anxiety, depression, and quality of life. Exploratory factor analyses were used to investigate the underlying dimensions of the SPIN, and reliability, convergent, and divergent validity of SPIN and Mini-SPIN were examined by Cronbach's alpha and correlation analyses. It was found that a shorter eight-item version of the SPIN was associated with two solid factors ( fear and avoidance of social interaction and fear and avoidance of criticism), and acceptable internal consistency, convergent, and divergent validity. In addition, the Mini-SPIN was associated with satisfactory convergent validity, but the reliability was not acceptable. It is concluded that the SPIN-8 is a viable screening tool for social anxiety in a university student population.

The Role of Relocation Patterns and Psychosocial Stressors in Posttraumatic Stress Disorder and Depression Among Earthquake Survivors.

The psychological impact of relocation within and outside of a disaster region was examined in 541 survivors of the 2011 Van earthquake in Turkey at 16.5 months postdisaster. Relocation out of the region was determined by disaster-related property/financial losses and fear during the earthquake. Anticipatory fear of future earthquakes and less sense of control over life were the strongest predictors of posttraumatic stress disorder (PTSD) and depression symptoms. Relocation within the disaster region predicted PTSD but not depression. Dissatisfaction with emotional support received from close ones was significantly associated with depression, but it was associated with PTSD at a marginally significant level. Survivors who experienced more intense fear during the earthquake displayed higher levels of anticipatory fear in the long term, whereas avoidance of trauma reminders and fear-evoking situations sustained anticipatory fear of future earthquakes. These findings suggest that interventions that reduce fear and avoidance behaviors would help survivors overcome traumatic stress and depressive symptoms.

Scheduling the Stork: Media Portrayals of Women's and Physicians' Reasons for Elective Cesarean Delivery.

Media interest in cesarean delivery has grown in recent years driven both by rising cesarean delivery rates and the decision by the American College of Obstetrics and Gynecology (ACOG) to permit elective cesarean (EC) delivery. A content analysis of United States newspaper and magazine articles from 2000 to 2013 (n=131 articles) was completed to understand how the news media portrays ECs. The majority of articles (71.8%) emphasized reasons to support women having an EC, while 38.2 percent of the articles exhibited themes of physician support for ECs. Relatively few articles mentioned reasons against ECs either from the women's perspective (11.5%) or the practitioners' (3.8%). The most common themes given for women choosing ECs were convenience/scheduling (48.9%), avoidance of pain or fear of labor (29.8%), and physical harm to women from vaginal birth (17.6%). Doctors' perspectives were less prevalent in the media than women's perspectives, but when mentioned they were almost exclusively in support of ECs for reasons including avoiding malpractice (28.2%), avoiding physical harm to the woman or baby (16.8%), and timing/scheduling (14.5%). Media coverage suggests ECs are widely accepted by both women and doctors, with women choosing an EC mainly for convenience/scheduling and fear. However, 43 percent of doctors surveyed by ACOG said they were not willing to perform the procedure, and surveys report that mothers rarely request an EC.

Perioperative Schmerztherapie bei opioidgewöhnten Patienten

In this review article the special anesthesiological problems of opioid tolerance and surgical interventions will be presented. These affect patients with a long-term opioid therapy of chronic pain, addicts with long-term substitution therapy and addicts with current or previous heroin addiction ("clean"). For all patient groups a guarantee of continuous and adequate analgesia (avoidance of fear and increasing patient compliance), exploiting suitable regional anesthesia or regional analgesia procedures when possible, and prevention of a physical opioid withdrawal syndrome have utmost priority. The necessary optimization of perioperative pain therapy only succeeds when based on a thorough preoperative examination of the clinical history which subtly inquires into the drug taking habits with respect to opioids and associated medications. Systemic and/or regional analgesia procedures are possible. Regional procedures are more effective for analgesia. Systemic analgesia procedures do not basically differ from those routinely used for patients without opioid tolerance. However, higher doses of opioids are necessary as well as individual titration according to needs. Special conditions apply to patients previously addicted to opioids (clean) when they are to be operated on. Non-opioids are sufficiently effective for low level pain and opiates can be avoided. Opioid therapy with inclusion of a non-opioid is necessary following major operations or for severe postoperative pain, even as i.v. patient-controlled analgesia (i.v. PCA) if needed. For these patients a relapse to addiction can be provoked by insufficient administration of analgesics, not by pain management including opioids.

Aportes sobre no violencia: la propuesta del socialismo autogestionario noviolento

Ahora más que nunca existe militarismo y militarización de la sociedad. Pero además, este sistema injusto desarrolla para imponerse y controlar a la población otros muchos mecanismos basados sobre todo en el control de la información, la manipulación de las conciencias, el fomento de la cultura de la evasión y la gestión del miedo y la inseguridad. Creemos que aún no se ha profundizado suficientemente en la noviolencia como propuesta global de sociedad, más allá de su dimensión de estrategia de lucha, y esa es nuestra propuesta: construir la sociedad Noviolenta, o Socialismo Autogestionario Noviolento. Se exponen las características de la sociedad noviolenta como autogestión, interculturalidad, superación del patriarcado...