Treatment In Health Research Articles

Heat treatment in health and disease: How water-filtered infrared-A (wIRA) irradiation affects key cellular mechanisms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients compared to healthy donors

Heat treatment or hyperthermia is a promising therapy for many diseases, especially cancer, and can be traced back thousands of years. Despite its long history, little is known about the cellular and molecular effects of heat on human cells. Therefore, we investigated the impact of water-filtered infrared-A (wIRA) irradiation (39 °C, 60 min) on key cellular mechanisms, namely autophagy, mitochondrial function and mRNA expression, in human fibroblasts and peripheral blood mononuclear cells (PBMCs) from healthy donors and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients. Our results show an induction of autophagy in healthy fibroblasts and PBMCs from healthy donors and ME/CFS patients. ME/CFS patients have higher mitochondrial function compared to healthy donors. The wIRA treatment leads to a slight reduction in mitochondrial function in PBMCs from ME/CFS patients, thereby approaching the level of mitochondrial function of healthy donors. Furthermore, an activation of the mRNA expression of the autophagy-related genes MAP1LC3B and SIRT1 as well as for HSPA1, which codes for a heat shock protein, can be observed. These results confirm an impact of heat treatment in human cells on key cellular mechanisms, namely autophagy and mitochondrial function, in health and disease, and provide hope for a potential treatment option for ME/CFS patients.

EFETIVAÇÃO DO DIREITO DE HABILITAÇÃO E REABILITAÇÃO DA PESSOA COM DEFICIÊNCIA INTELECTUAL PELO SUS

This study aims to discuss the habilitation and rehabilitation for People with Disabilities (PCD), specifically for people with intellectual disabilities, as it contributes to more means of information for users who need this treatment and follow-up, since the greater the sources of information, more people will have access to treatments, which will make a difference in their lives. The realization of the right to habilitation and rehabilitation of people with intellectual disabilities aims at knowledge about the Brazilian Law of Inclusion of Persons with Disabilities (Statute of Persons with Disabilities), aiming at the work of the Unified Health System (SUS), which is important for PCD in their qualification and rehabilitation process. Ensuring a dignified treatment in health is to bring the PWD to a better coexistence in civil society. Aiming at quality of life and guarantee of rights, public health is directed to Persons with Disabilities, being composed of a wide network of care. Specifically in this work, the main approach is related to intellectual disability (ID), always with the aim of verifying and intensifying its potential. Interventions are carried out by a multi-professional technical team, which will work with People with Intellectual Disabilities in an individualized way, seeking success within the context presented to each one. The mechanisms for the implementation of this public policy must be allied to the family, civil society and the networking articulation is essential. Thus, the work presents a brief context about the functioning of the unified health system in Brazil, which covers People with Disabilities.

Discrimination between migrants and non-migrants in depression’s management by General Practitioners

Abstract Background In Europe, migrants have a higher prevalence of depression compared to the native population and, more often, they face unmet medical needs, including less frequent referral to mental health services. According to social psychology, general practitioners (GPs) may undertreat migrants due to unconscious stereotypical bias that could lead to and sustain discrimination in primary health care. The central question in this research is whether patients' migration background influences GPs' attitudes and decisions regarding treatment and referral in mental health. Methods In 2021, an experimental design was delivered to GPs with two video vignettes staging a depressed native and a Belgo-Moroccan patient, respectively. The randomly assigned vignette was followed by an online questionnaire regarding treatment and referral decisions. We recruited a national sample of Belgian GPs' (n = 700). T-tests and chi-square were used for analyses. Results The preliminary results are based on the first 224 respondents. Overall, there was no significant difference in the management of depression between a Belgian patient and a Belgo-Moroccan patient. Nevertheless, severity of symptoms was rated lower in the Belgo-Moroccan as compared to the Belgo-Moroccan (t = 2.37, p = .019). Conclusions In summary, these results indicate that general practitioners seem to treat migrants fairly in comparison with non-migrants. However, underestimation of the severity of the symptoms could lead to a different medical decision. This hypothesis will be investigated in the coming months. Key messages These findings may help us to further understand the role of general practitioner behaviour in mental health care discrimination. This research shed light on current management of migrants’ mental health by the primary health care providers in Belgium.

Antimyostatin Treatment in Health and Disease: The Story of Great Expectations and Limited Success.

In the past 20 years, myostatin, a negative regulator of muscle mass, has attracted attention as a potential therapeutic target in muscular dystrophies and other conditions. Preclinical studies have shown potential for increasing muscular mass and ameliorating the pathological features of dystrophic muscle by the inhibition of myostatin in various ways. However, hardly any clinical trials have proven to translate the promising results from the animal models into patient populations. We present the background for myostatin regulation, clinical and preclinical results and discuss why translation from animal models to patients is difficult. Based on this, we put the clinical relevance of future antimyostatin treatment into perspective.

Desafios da enfermagem em saúde mental nas estratégias saúde da família

O objetivo do presente estudo foi investigar os desafios da assistência de enfermagem no âmbito da Saúde Mental nas Estratégias Saúde da Família. Trata-se de um estudo transversal, de caráter misto, quantitativa e qualitativa, em que 24 participantes foram entrevistados, 4 enfermeiros e 16 técnicos de enfermagem, em 8 equipes de ESF no município de Maceió - AL, sorteadas aleatoriamente através do programa Excel®. Dentre os resultados encontrados, destacam-se a inexistência de práticas em Saúde Mental, falta de capacitação e infraestrutura inadequada, recursos humanos e monetários insuficientes, predomínio cultural pela assistência ineficaz, ideologia de que o tratamento em Saúde Mental é para loucos e não como uma doença a ser tratada, receio e insegurança da equipe de enfermagem. Conclui-se que os desafios, apesar de reincidentes, são particulares entre os indivíduos em decorrência dos seus conhecimentos, preceitos e experiências. Os participantes identificaram seus desafios, angústias, necessidades, e consequentemente, alcançaram reflexões quanto às ações e práticas que possam ser realizadas no âmbito da SM, o que possibilita estratégias de mudança na assistência.

A combined individual and group-based stabilization and skill training intervention versus treatment as usual for patients with long lasting posttraumatic reactions receiving outpatient treatment in specialized mental health care \u2013 a study protocol for a randomized controlled trial

BackgroundSuffering linked to previous interpersonal trauma is common among patients in mental health care. Diagnostic labels may vary, but the clinical picture is often characterized by long-lasting and complex psychological and somatic symptoms, subjective distress and reduced quality of health and life. A substantial proportion of patients do not recover after individual treatment in ordinary specialized mental healthcare settings, despite the proven usefulness of individual trauma-specific treatments. The therapeutic factors that arise in group settings, such as normalization, shame reduction and corrective relational experiences, may be particularly useful for trauma survivors. However, evidence in support of group treatment for trauma survivors is scarce. This study aims to test whether combining a novel group intervention to individual treatment is superior to conventional individual out-patient treatment in an ordinary community mental health hospital.MethodsIn a single-site, non-blinded, randomized controlled trial (RCT), the effect of a combined group-based stabilization and skill-training (SST) intervention added to individual treatment will be compared to conventional treatment (treatment as usual, TAU) alone. Participants (N = 160) with ongoing and long-lasting reactions related to known adverse life events from the past will be recruited among patients at general outpatient clinics in a community mental health centre at St. Olav’s University Hospital, Trondheim, Norway. Following baseline assessment and randomization, participants will complete follow-up measures at 4, 8, 13 and 19 months post-baseline. The primary outcome is personal recovery (The questionnaire about the process of recovery , QPR). Secondary outcomes include (1) self-reported symptoms of posttraumatic stress, general mental and somatic health symptoms, well-being, functional impairment and client satisfaction, (2) immunological and endocrine response measured in blood samples and (3) national registry data on occupational status, use of mental health services and pharmacological treatment. Additionally, mechanisms of change via posttraumatic cognitions will be examined.DiscussionThe addition of a group-based intervention to individual treatment for trauma survivors might prove to be an efficient way to meet the need of long-lasting high-intensity treatment in a large group of patients in mental health care, thereby reducing their suffering and increasing their psychosocial functioning.Trial registrationClinicalTrials.gov: NCT03887559. Registered on 25 March 2019.

Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach

BackgroundThe implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., Implementation Sci. 4:50, 2009) provided structural guidance for this national level coordinated implementation.MethodsA mixed methods approach was utilised to explore the national multisite implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders (n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists (n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis.ResultsFive themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management.ConclusionsThe barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework (Toms et al., Borderline Personal Disord Emot Dysregul. 6: 2, 2019). Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.Trial registrationClinicalTrials.gov ID: NCT03180541; Registered June 7th 2017 ‘retrospectively registered’.

Magnitude and factors associated with anti-malarial self-medication practice among residents of Kasulu Town Council, Kigoma-Tanzania.

Anti- malarial self-medication practice in Africa is very common. It is considered as an alternative way for people who cannot afford the cost of health care services. This study was conducted to assess the magnitude and factors associated with anti-malarial self-medication practice among residents of Kasulu Town Council. The study was a descriptive cross sectional study. Two hundred and eighty consenting respondents were selected by systematic random sampling and interviewed with the aid of a semi structured questionnaire to assess anti-malarial self- medication practice. A p value of less than 0.05 was considered statistically significant, at 95% confidence interval. Prevalence of anti-malarial self-medication was (69.6%). Majority of the respondents (83.1%) reported that, they did not get better after self- medication. About 36% of the respondents metioned time taken in health facilities as the main factor for self-medication. This study revealed that, self-medication practice is very common among community members in Kasulu district. The main reasons identified for self-medication was long time taken to get treatment in health facilities.

Qualidade do sono de cuidadores primários de crianças com microcefalia em uma unidade de saúde pública de Alagoas, Brasil

OBJECTIVE: To evaluate the sleep quality of primary caregivers of children with microcephaly that receive treatment in a public health facility.METHODS: This is a transversal, descriptive and quali-quantitative study. Ten informal primary caregivers of children with microcephaly from a public health facility in Alagoas were interviewed one-on-one for 20 minutes using the mini-sleep questionnaire (MSQ). MSQ scores were statistically analyzed to describe sleep disturbances (mean, median and standard deviation), and the relationship between the level of microcephaly and sleep quality was tested by Kruskal-Wallis non-parametric test.RESULTS: Results found herein shows the predominance of women as caregivers of children with microcephaly. Overall, the studied population showed a high prevalence of alteration in sleep quality, with 70% of sampled caregivers showing severe sleep disturbances (scores greater than 30). No relationship between the level of microcephaly and sleep disturbances were found (p>0.05).CONCLUSIONS: There is a high prevalence of sleep disturbances among primary caregivers of children with microcephaly in the studied facility. This pattern is of great concern as such disorders may negatively affect not only the caregivers’ life quality, but also the quality of provided care.

The Family Experience of the Crisis of Involuntary Treatment in Mental Health

ABSTRACTWhile policy and practice standards emphasise the importance of engaging and supporting families of people with mental health problems, many families have reported feeling unsupported and distanced from treatment and care planning in acute inpatient units. There has been little systematic interest in the changing role and experiences of families throughout the emergence of illness, crisis, seeking of treatment, and subsequent recovery. Nineteen in-depth interviews were conducted with the next of kin of 17 people who had been admitted under an Involuntary Treatment Order in a large metropolitan hospital in the Brisbane region. A general inductive approach was used to analyse the data. While hospital admission was described as a time where, ideally, families were able to let go of being responsible for their relative's behaviour and let the health care professionals take over, for many this did not occur. We suggest four critical elements for providing recovery-oriented support to families. These include: (a) ensuring that families feel that their relative is safe and receiving the care needed; (b) keeping the family informed about their relative's progress; (c) ensuring families have access to information about the mental health system, and (d) working in partnership with the families.IMPLICATIONSFamily wellbeing is improved when they feel part of a supportive team.Instituting an open policy where families can contact ward staff easily and access information about the person they care for may alleviate families’ anxieties and minimise stress.Family work is enhanced when health professionals acknowledge families’ relationships, expertise, and understanding of their family member.

Treatment and Spiritual Care in Mental Health: Recovery As a Journey, Not a Destination.

Treatment and Spiritual Care in Mental Health: Recovery As a Journey, Not a Destination.

Abstract P4-10-16: Impact of delay in breast cancer diagnosis and treatment in public health according to nationality: Brazil vs US

Abstract Background: Delays in diagnosis and treatment is associated with recurrence. Access to medical care in public health systems (PHS) may vary across Southwest Brazil and Houston, Texas. Objective: To evaluate disparities in breast cancer (BC) diagnosis and treatment between public services in southwest Brazil and at a public safety net hospital in Houston, Texas. Methods: Women diagnosed with BC stages I-III between 2009 to 2011, and treated at thefour hospitals in Brazil and two health centers in US were included. All statistical analyses was performed in R studio, and p<0.05 was considered significant. Results: 967 women from PHS were included: 778 from Brazil and 189 from US. Recurrence rates were not significantly different (15.9% vs. 9.5%, p=0.233) Table 1. Clinical and demographic characteristics of the patientsCharacteristicsBrazil (%), n=778US (%), n=189pDiscovery of BC By patient443 (56.9)87 (46) Routine exam82 (10.5)5 (2.7) Screening mammography207 (26.6)63 (33.4) Other46 (6)34 (17.9)<0.001Initial treatment Surgery587 (75.4)100 (52.9) Neo-adjuvant chemotherapy176 (22.6)48 (25.4) Neo-adjuvant hormone therapy9 (1.1)14 (7.4) Unknown6 (0.9)27 (14.3)<0.001Clinical Stage I234 (30.1)59 (31.2) II289 (36.8)56 (29.7) III239 (30.7)32 (16.9) Unknown19 (2.4)42 (22.2)0.027IHQ Subtype HR+/HER2 -467 (60)94 (49.7) HR+/HER2+91 (11.7)17 (9) HR-/HER2+66 (8.5)10 (5.3) Triple negative123 (15.8)26 (13.8) Unknown31 (4)42 (22.2)0.853Symptoms Yes492 (63.2)99 (52.4) No248 (31.9)58 (30.7) Unknown38 (4.9)32 (16.9)0.410Recurence No599 (77)120 (63.5) Yes124 (15.9)18 (9.5) Unknown55 (7.1)51 (27.0)0.233 . Considering the interval in weeks: symptoms to diagnosis, diagnosis to first systemic therapy and diagnosis to radiotherapy were longer in Brazil PHS patients (24.4 vs. 22.8; 18.9 vs. 16.1 and 51.8 vs. 47.8 p<0.001). Table 2. Delay disparities in public health system between Brazil and US BrazilUSpSymptoms to diagnosis Number of patients473102 Time (weeks)24.4 (0.5-102.6)22.8 (0.1-124.8)<0.001Diagnosis to first treatment Number of patients546117 Time (weeks)10.8 (1.9-31.7)12.2 (3.1-26.4)<0.001Diagnosis to first systemic treatment Number of patients45967 Time (weeks)18.9 (2.4-45.6)16.1 (3.3-38.6)<0.001Diagnosis to surgical treatment Number of patients541116 Time (weeks)16.4 (3.1-43.1)19.2 (4.5-51.2)<0.001Diagnosis to radiotherapy Number of patients41352 Time (weeks)51.8 (19.4-89.7)47.8 (14.9-84.8)<0.001 However, considering the interval in weeks: diagnosis to first treatment (either surgery or neoadjuvant chemotherapy) and diagnosis to surgical treatment were shorter in Brazil PHS patients (10.8 vs. 12.2 and 16.4 vs. 19.2, p<0.001). When considering surgery as initial treatment, treatment in Brazil PHS and stage III disease at diagnosis were associated with worse prognosis (HR: 1.91, 95%CI: 1.38 – 1.99, padj=0.015; HR 1.44, 95%CI:1.11-1.87, padj=0.006). Conclusions: There were significant disparities between Brazil and US PHS. Women in Brazil PHS presented higher rates of advanced clinical stages at diagnosis and diagnosis by routine exam, while US PHS present higher rates of diagnosis by screening mammography. When considering surgery as initial treatment, Houston PHS women had a better prognosis. Citation Format: Ramalho S, Dória MT, Natal RA, Conz L, Cabello V, Pavanello M, Cabello C, Mano MS, Linck RD, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, NematiShafaee M, Bondy ML. Impact of delay in breast cancer diagnosis and treatment in public health according to nationality: Brazil vs US [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-16.

P135 Intermittent theta burst increases action potential threshold and spike firing in cortical layer 5 pyramidal neurons

Introduction Repetitive transcranial magnetic stimulation has become a popular method of inducing neural plasticity in humans. In particular, complex patterned stimulation such as intermittent theta burst stimulation (iTBS) is routinely used to increase corticospinal excitably. Despite its wide use, the mechanisms underlying iTBS-induced increases in corticospinal excitability remain unclear. Objectives Experimental (acute brain slices) models of repetitive magnetic stimulation (rMS) allow for direct investigation of iTBS-induced plasticity, such as changes at the single neuron level. Here we investigated whether iTBS rMS alters the active and passive electrophysiological properties of layer 5 pyramidal neurons in the juvenile mouse cortex. Materials & methods Acute brain slices were prepared from the motor and somatosensory cortex of P12-P15 C57Bl6J mice. rMS was delivered with a custom circular coil (8 mm diameter) placed underneath the perfusion bath and slice. Whole cell current clamp recordings were made from layer 5 pyramidal neurons to characterise (i) passive membrane properties (resting membrane potential, input resistance) (ii) active membrane properties (action potential threshold, rheobase) and (iii) spike firing. Baseline recordings were followed by 192s of control (n = 10/9 animals) or iTBS rMS (n = 9/7 animals). Recordings were made immediately post stimulation and again after 10 and 20 min. Results ITBS did not alter the resting membrane potential (p = 0.464) or input resistance (p = 0.418) of layer 5 pyramidal neurons. Interestingly, iTBS increased action potential threshold relative to baseline (control 1.855 mV ± 1.098 vs iTBS −1.537 mV ± 1.158, p = 0.048) but did not alter the rheobase current (p = 0.328). iTBS also increased the number of action potentials (spike firing) generated in response to suprathreshold currents (control 0.783 Hz ± 0.426 vs iTBS 3.167 Hz ± 0.449 p = 0.001). Conclusion Our data suggest that rTMS-induced plasticity may be in part due to electrophysiological changes at the single neuron level, such as altered action potential thresholds and spike firing. These results help elucidate the mechanisms of rTMS-induced plasticity which is essential for the optimisation of rTMS treatment in health and disease.

Differential Regulation of Cardiac Function and Intracardiac Cytokines by Rapamycin in Healthy and Diabetic Rats.

Diabetes is comorbid with cardiovascular disease and impaired immunity. Rapamycin improves cardiac functions and extends lifespan by inhibiting the mechanistic target of rapamycin complex 1 (mTORC1). However, in diabetic murine models, Rapamycin elevates hyperglycemia and reduces longevity. Since Rapamycin is an immunosuppressant, we examined whether Rapamycin (750 μg/kg/day) modulates intracardiac cytokines, which affect the cardiac immune response, and cardiac function in male lean (ZL) and diabetic obese Zucker (ZO) rats. Rapamycin suppressed levels of fasting triglycerides, insulin, and uric acid in ZO but increased glucose. Although Rapamycin improved multiple diastolic parameters (E/E′, E′/A′, E/Vp) initially, these improvements were reversed or absent in ZO at the end of treatment, despite suppression of cardiac fibrosis and phosphoSer473Akt. Intracardiac cytokine protein profiling and Ingenuity® Pathway Analysis indicated suppression of intracardiac immune defense in ZO, in response to Rapamycin treatment in both ZO and ZL. Rapamycin increased fibrosis in ZL without increasing phosphoSer473Akt and differentially modulated anti-fibrotic IL-10, IFNγ, and GM-CSF in ZL and ZO. Therefore, fundamental difference in intracardiac host defense between diabetic ZO and healthy ZL, combined with differential regulation of intracardiac cytokines by Rapamycin in ZO and ZL hearts, underlies differential cardiac outcomes of Rapamycin treatment in health and diabetes.

Políticas de assistência estudantil em saúde nos institutos e universidades federais

Resumo O trabalho aborda as políticas públicas de saúde estudantil das instituições federais de ensino técnico e superior, tendo como objetivo avaliá-las. A partir de revisão bibliográfica, documental e da atuação das autoras, alguns impasses são levantados: ausência de ações conjuntas entre Ministério da Educação - MEC e Ministério da Saúde - MS; falta de capacitação de técnicos do MEC em Saúde Pública; segregação entre as ações de saúde estudantil e do trabalhador; falta de políticas para estudantes de pós-graduação; ações voltadas ao tratamento em Saúde, em detrimento das atividades de promoção, prevenção e articulação com a rede de Saúde; ausência de pesquisas que embasem as ações. Conclui-se que é necessária a criação de um modelo de serviço calcado na pesquisa, de acesso universal; e ações de prevenção e promoção em Saúde concernentes à realidade enfrentada nas instituições e por cada segmento do alunado.

Quality of life and its influencing factors in post-stroke patients with depression

Post-stroke depression had a serious influence on treatment in later stage, physical and mental health and so on in patients, so how to improve and exactly evaluate the quality of life of post-stroke patients became focus topics in medical worker. This review summarized the frequently-used instruments for evaluating quality of life and influencing factors of quality of life in post-stroke patients with depression by searching literature. Generally, instruments for evaluating quality of life in post-stroke patients could be divided into two categories including universal instruments and and specific instruments. Influencing factors of quality of life involved personal factors, disease factors, social factors and so on. Key words: Post-stroke depression; Quality of life; Influencing factors

Economic stress and condescending treatment in childhood and adult self-rated health in Sweden

Economic stress and condescending treatment in childhood and adult self-rated health in Sweden

ESTÁGIO INTEGRADO: EXPERIÊNCIA DE ATUAÇÃO ENTRE ACADÊMICOS DE TERAPIA OCUPACIONAL E RESIDENTES DE SAÚDE DA FAMÍLIA

Este trabalho tem como objetivo relatar a experiência de acadêmicos do quinto ano do curso de Terapia Ocupacional no estágio de saúde coletiva no ano de 2012 que tiveram a oportunidade de passar alguns meses integrados a uma equipe de Residência Multiprofissional em Saúde da família. As ações multidisciplinares eram realizadas em uma comunidade do município de Maceió-AL, em uma unidade básica de saúde (UBS) através de sala de espera, de atendimento domiciliar individualizado e de ações em uma escola de educação básica na qual a metodologia utilizada era educação em saúde. O trabalho integrado promoveu uma percepção dos estagiários quanto a importância do trabalho multidisciplinar na saúde coletiva. A prática acadêmica do estágio integrado com os residentes de saúde da família teve uma fundamental importância no estágio curricular do curso de Terapia Ocupacional onde os acadêmicos obtiveram uma visão rica das ações de prevenção de agravos e doenças e promoção da saúde, transformando o modo de ensino e prática em saúde coletiva.

A Dynamic Cycle of Familial Mental Illness

In this paper, we present A Dynamic Cycle of Familial Mental Illness; an innovative framework, which considers family members’ experiences and responses to mental illness. There is an acknowledged discourse noting parental experiences of mental illness alongside a growing body of knowledge acknowledging children's needs while living with parental mental illness. However, there is a paucity of literature that makes reference to the concept of familial mental illness and the cyclic interface of parental and child distress and symptoms. The model is supported by published research studies from several differing disciplines to demonstrate the relationship between parent and child experiences and to synthesise the published short- and longer-term possible impact of familial mental illness. An extensive search of the literature using recognised search engines, keywords and phrases has been undertaken, to generate an appropriate literature base for this work. This literature demonstrates how a child's possible emotional distancing as a response to parental mental illness could increase parental distress. A Dynamic Cycle of Familial Mental Illness adopts the underpinning philosophy of a Stress Vulnerability Model of Mental Illness, which assumes that predisposing factors and increased stress for a parent may have possible links to exacerbation of parental mental distress and symptomology. We advocate for further research of familial mental illness, and argue for a family approach to mental health assessment and treatment in mainstream health and social care sectors.

Exploring Vulnerability to Suicide in the Developmental History of Young Men: A Psychological Autopsy Study

This study explores the developmental history of ten young men who completed suicide in the transition to adulthood. The young men, aged 18–30, had no previous history of suicide attempts or treatment in mental health. In-depth interviews with four to eight informants for each suicide were analyzed using Interpretative Phenomenological Analysis. Three developmental issues from early age onwards emerged: (a) unsuccessful in becoming independent; (b) weakened competence to deal with shame; and (c) trapped in anger. The capacity to regulate emotions like shame and anger could make certain men vulnerable to suicide when facing adult challenges and defeats.