RESUMO
OBJECTIVE: to develop and validate educational material to strengthen adolescent health care on non-suicidal self-injury. METHOD: methodological research designed in three stages: (1) construction of the material based on a mixed study on needs related to the theme through social networks and an umbrella review on health care related to non-suicidal self-injury; (2) validation with 10 experts in mental health and/or self-inflicted violence selected through the Lattes Platform; (3) evaluation by the target public, with health professionals being invited, without restriction of training. Validation and evaluation data were collected by using a sociodemographic questionnaire and the Suitability Assessment of Materials for evaluation of health-related information for adults. We used descriptive statistics, content validity index, and Gwet's AC1 test. RESULTS: the material obtained good general acceptance and reliability in the validation by the experts (AC1= 0.633; p=0.0000) and in the evaluation by the target public (AC1=0.716; p=0.0000). All professionals pointed out the personal contribution and educational potential of the material. CONCLUSION: we highlight the construction of science-based educational material to strengthen the health care for adolescents with non-suicidal self-injury. KEYPOINTS: (1) Scientific data-based construction of educational material for prevention of non-suicidal self-injury (NSSI). (2) General acceptance and reliability in the validation of the material by experts. (3) Acceptance and reliability in the evaluation of the material by health professionals. (4) Dissemination of material for health education initiatives to prevent NSSI.
Assuntos
Comportamento Autodestrutivo , Adulto , Adolescente , Humanos , Reprodutibilidade dos Testes , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Inquéritos e QuestionáriosRESUMO
Abstract Objective: to develop and validate educational material to strengthen adolescent health care on non-suicidal self-injury. Method: methodological research designed in three stages: (1) construction of the material based on a mixed study on needs related to the theme through social networks and an umbrella review on health care related to non-suicidal self-injury; (2) validation with 10 experts in mental health and/or self-inflicted violence selected through the Lattes Platform; (3) evaluation by the target public, with health professionals being invited, without restriction of training. Validation and evaluation data were collected by using a sociodemographic questionnaire and the Suitability Assessment of Materials for evaluation of health-related information for adults. We used descriptive statistics, content validity index, and Gwet's AC1 test. Results: the material obtained good general acceptance and reliability in the validation by the experts (AC1= 0.633; p=0.0000) and in the evaluation by the target public (AC1=0.716; p=0.0000). All professionals pointed out the personal contribution and educational potential of the material. Conclusion: we highlight the construction of science-based educational material to strengthen the health care for adolescents with non-suicidal self-injury.
Resumo Objetivo: elaborar e validar um material educativo para fortalecer a assistência em saúde aos adolescentes sobre a autolesão não suicida. Método: pesquisa metodológica delineada em três etapas: (1) construção do material a partir de estudo misto sobre necessidades ligadas à temática por meio das redes sociais e uma revisão guarda-chuva sobre a assistência relacionada à autolesão não suicida; (2) validação com 10 especialistas em saúde mental e/ou violência autoprovocada selecionados pela Plataforma Lattes; (3) avaliação pelo público-alvo, sendo convidados profissionais de saúde, sem restrição de formação. A coleta dos dados de validação e avaliação foi realizada por um questionário sociodemográfico e o Suitability Assessment of Materials for evaluation of health-related information for adults. Foi empregada a estatística descritiva, índice de validade de conteúdo e o teste AC1 de Gwet. Resultados: o material obteve boa aceitação geral e confiabilidade na validação pelos especialistas (AC1=0,633; p=0,0000) e na avaliação pelo público-alvo (AC1=0,716; p=0,0000). Todos os profissionais apontaram a contribuição pessoal e potencial educativo do material. Conclusão: destaca-se a construção de material educativo embasado em ciência para o fortalecimento da assistência aos adolescentes com autolesão não suicida.
Resumen Objetivo: elaborar y validar un material educativo para fortalecer la asistencia en salud a los adolescentes sobre la autolesión no suicida. Método: investigación metodológica delineada en tres etapas: (1) Construcción del material a partir de un estudio mixto sobre las necesidades vinculadas al tema por medio de las redes sociales y una revisión paraguas sobre la asistencia relacionada con la autolesión no suicida; (2) validación con 10 especialistas en salud mental y/o violencia autoprovocada seleccionados por la Plataforma Lattes; (3) Evaluación por parte del público objetivo, siendo invitados profesionales de salud, sin restricción de formación. La recolección de los datos de validación y evaluación fue realizada por un cuestionario sociodemográfico y el Suitability Assessment of Materials for evaluation of health-related information for adults. Se empleó la estadística descriptiva, el índice de validez de contenido y el test AC1 de Gwet. Resultados: el material obtuvo una buena aceptación general y confiabilidad en la validación por parte de los especialistas (AC1=0,633; p = 0,0000) y en la evaluación por el público objetivo (AC1 = 0,716; p=0,0000). Todos los profesionales señalaron la contribución personal y el potencial educativo del material. Conclusión: se destaca la construcción de material educativo basado en ciencia para fortalecer la asistencia a los adolescentes con autolesión no suicida.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Inquéritos e Questionários , Reprodutibilidade dos Testes , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Assistência à Saúde MentalRESUMO
Estudos indicam importante defasagem na formação profissional em saúde sobre a autolesão não suicida (ALNS) com consequente fragilização da assistência e notificação. Trata-se de pesquisa metodológica com objetivo de elaborar e validar material educativo para subsidiar a capacitação de profissionais da saúde sobre a ALNS. Realizado estudo misto para identificação de necessidades sobre ALNS no Twitter, sendo coletadas 6.302 postagens em português, publicadas entre 2016 e 2017. Os dados quantitativos foram analisados com estatística descritiva e testes de associação (p≤0,005). Para a abordagem qualitativa foram incluídas 663 postagens de incentivo à ALNS analisadas por Análise Temática. Para aprofundamento na temática foi realizada uma Umbrella Review com análise qualitativa de revisões sistemáticas publicadas entre 2010 a 2021. Todos os dados foram sintetizados na construção visual e textual do material educativo, sendo validados por especialistas que atenderam a critérios de expertise. Após correções, o material educativo foi avaliado por profissionais de saúde. Os dados de validação e avaliação foram coletatos através de questionário sociodemográfico e o instrumento Suitability Assessment of Materials for evaluation of health-related information for adults. Os dados foram analisados com estatística descritiva simples, índice de validade de conteúdo (IVC) e teste AC1 de Gwet. A pesquisa foi aprovada sob o número do parecer nº 3.627.052 pelo CEP/EERP-USP. Destaca-se o compartilhamento de material educativo embasado cientificamente e validado (boa aceitação geral=IVC≥0,8 e confiabilidade p=0,0000) para a qualificação profissional em saúde sobre a ALNS. O trabalho ressalta o compromisso social da ciência através da popularização científica, sendo reforçado pela premiação no 3º Edital Prêmio Vídeo Pós-Graduação USP e II Encontro de Pós-graduação (2021)
Studies indicate an important gap in professional training in health on non-suicidal selfinjury (ALNS) with a consequent weakening of care and notification. This is a methodological research aimed at developing and validating educational material to support the training of health professionals on ALNS. A mixed study was carried out to identify needs on ALNS on Twitter, collecting 6,302 posts in Portuguese, published between 2016 and 2017. Quantitative data were analyzed using descriptive statistics and association tests (p≤0.005). For the qualitative approach, 663 posts encouraging the ALNS were included, analyzed by Thematic Analysis. To deepen the theme, an Umbrella Review was carried out with qualitative analysis of systematic reviews published between 2010 and 2021. All data were synthesized in the visual and textual construction of the educational material, being validated by experts who met the criteria of expertise. After corrections, the educational material was evaluated by health professionals. Validation and evaluation data were collected through a sociodemographic questionnaire and the instrument Suitability Assessment of Materials for evaluation of health-related information for adults. Data were analyzed with simple descriptive statistics, content validity index (CVI) and AC1 Gwet test. The research was approved under opinion number 3.627,052 by CEP/EERP-USP. The sharing of scientifically based and validated educational material stands out (good general acceptance=CV≥0.8 and reliability p=0.0000) for professional qualification in health on the ALNS. The work emphasizes the social commitment of science through scientific popularization, being reinforced by the award in the 3rd USP Post-Graduate Video Award and II Post-Graduate Meeting (2021)
Assuntos
Comportamento Autodestrutivo/prevenção & controle , Estudo de Validação , Materiais Educativos e de Divulgação , Capacitação de Recursos Humanos em SaúdeRESUMO
Objetivou-se analisar saberes e práticas de agentes comunitários de saúde (ACS) sobre prevenção do comportamento suicida. Estudo qualitativo apoiado pela pesquisa-ação, realizado com 13 ACS. A coleta de dados ocorreu em Unidade Básica de Saúde (UBS) por meio de seminários temáticos. Os dados foram submetidos à análise de conteúdo. Os saberes dos ACS apontam para a relação entre comportamento suicida com perdas (materiais e afetivas), adoecimento mental, isolamento e uso de substâncias psicoativas. Na prática, a prevenção do comportamento suicida envolve avaliação das pessoas em situação de risco por meio do reconhecimento de sinais de alerta; fortalecimento dos vínculos familiares, sociais e religiosos; e apoio do setor de Saúde. Portanto, faz-se necessário que os ACS sejam qualificados para rastreamento de pessoas em situação de risco para comportamento suicida. (AU)
This study analyzed the knowledge and practices of community health workers regarding the prevention of suicidal behavior. We conducted a qualitative research-action study with 13 community health workers. The data were collected in health centers using thematic seminars and analyzed using content analysis. The knowledge of the community health workers included the relation between suicidal behavior and losses (material and affective), mental illness, loneliness and the use of psychoactive substances. In practice, the prevention of suicidal behavior involved the assessment of people at risk through the recognition of warning signs, strengthening of family, social and religious ties, and health service support. Community health workers should be trained in screening of people at risk of suicidal behavior. (AU)
El objetivo fue analizar los saberes y prácticas de agentes comunitarios de salud sobre la prevención del comportamiento suicida. Estudio cualitativo apoyado por la investigación-acción, realizado con 13 agentes comunitarios de salud. La colecta de datos se realizó en una Unidad Básica de Salud por medio de seminarios temáticos. Los datos se sometieron al análisis de contenido. Los saberes de agentes comunitarios de salud señalan hacia la relación entre comportamiento suicida con pérdidas (materiales y afectivas), enfermedad mental, aislamiento y uso de substancias psicoactivas. En la práctica, la prevención del comportamiento suicida envuelve evaluación de las personas en situación de riesgo, a partir del reconocimiento de señales de alerta; fortalecimiento de los vínculos familiares, sociales y religiosos; y apoyo del sector de salud. Por lo tanto, se hace necesario que los ACS estén calificados para el rastreo de personas en situación de riesgo para comportamiento suicida. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Atenção Primária à Saúde , Comportamento Autodestrutivo/prevenção & controle , Agentes Comunitários de Saúde/educação , Prevenção do Suicídio/métodos , Saúde MentalRESUMO
OBJETIVO: apreender por meio da Terapia Comunitária Integrativa (TCI) os fatores relacionados à autolesão não suicida em adolescentes e à contribuição da mesma para as estratégias de enfrentamento. MÉTODO: estudo qualitativo, conduzido com adolescentes que participaram das rodas de Terapia Comunitária Integrativa, as quais foram gravadas e registradas em diário de campo. Utilizou-se análise temática e fundamentou-se no Modelo de Habilidades de Vida. RESULTADOS: a autolesão emergiu em seis rodas, como tema ou envolto a outro sofrimento vivenciado pelas adolescentes mulheres. Foram evidenciadas as categorias "Adolescência e autolesão não suicida: alívio da angustia", "Roda de Terapia Comunitária Integrativa: espaço terapêutico" e suas subcategorias. CONCLUSÕES: as adolescentes encontram na autolesão não suicida uma forma para materializar e aliviar o sofrimento decorrente de múltiplos fatores. A Terapia Comunitária revelou um espaço vivo de partilha e de ressignificação do sofrimento.
OBJECTIVE: to learn though the Integrative Community Therapy (ICT) the factors related to non-suicidal self-harm in adolescents and their contribution to coping strategies. METHOD: a qualitative study, conducted with adolescents who participated in the Integrative Community Therapy wheels, which were saved and recorded in a field diary. Thematic analysis was used and it was based on the Life Skills Model. RESULTS: self-harm has emerged on six wheels, as a theme or wrapped in other suffering. The following categories emerged from the analysis: "Adolescence and non-suicidal self-harm: Anguish relief" and "Integrative Community Therapy Wheel: Therapeutic space" and its subcategories. CONCLUSIONS: adolescents find in non-suicidal self-harm a way to materialize and alleviate the suffering resulting from multiple factors. Community Therapy revealed a living space of sharing and re-signification of suffering.
OBJETIVO: aprender a través de la Terapia Comunitaria Integradora (TCI) los fatores relacionados con la autolesión no suicida en adolescentes y su contribución a las estrategias de afrontamiento. METODO: estudio cualitativo, conducido con adolescentes que participaron en las ruedas de TCI, las cuales fueron grabadas y registradas en diario de campo. Se utilizó análisis temáticos y se fundó en el Modelo de Habilidades de Vida. RESULTADOS: La autolesión surgió en seis ruedas, como tema vinculado a otro sufrimiento. Del análisis surgieron las categorías "Adolescencia y autolesiones no suicidas: alivio de la angustia" y "Rueda de Terapia Comunitaria Integrativa: espacio terapéutico" y sus subcategorías. CONCLUSIONES: Las adolescentes utilizan la autolesión no suicida como forma de materializar y aliviar el sufrimiento resultante de múltiples factores. La Terapia Comunitaria reveló un espacio vivo de compartir y redefinir el sufrimiento.
Assuntos
Masculino , Feminino , Adolescente , Assunção de Riscos , Estresse Psicológico , Estudantes , Comportamento Autodestrutivo/prevenção & controle , Pesquisa Qualitativa , Bullying , Pessoal de Educação , Serviços de Saúde Mental EscolarRESUMO
OBJECTIVES: To evaluate effectiveness of Milieu Therapy in reduction of conflict and containment rates among schizophrenia patients. METHODS: This study utilized quasi experimental non-equivalent control group pre-post design. One hundred schizophrenia patients admitted in acute psychiatric wards were non-randomly assigned to either of the experimental (n=50) or control group (n=50). The experimental group received both milieu therapy and routine hospital treatment. The Milieu Therapy intervention Included environmental modification and structuring ward activities, establishing effective interaction with patient, and teaching caregivers on managing conflict behavior of patient. The control group received only routine treatment in the hospital. Outcome measures on conflict and containment rates were evaluated for both the groups at baseline and at 2nd, 3rd and 15th day. The Patient-Staff Conflict Checklist Shift Report (PCC-SR) was used to collect information about rates of conflict and containment. RESULTS: Compared with control group, the experimental group participants showed decrease in aggressive behavior, self-harm behavior and general rule breaking behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p < 0.004, η2=0.04; F=11.92, p < 0.001, η2=0.11; F=6.94, p < 0.001, η2=0.06) over seven days interval. CONCLUSIONS: The present study findings provided evidence for the effectiveness of integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors among schizophrenia patients. Milieu therapy should be considered as an integral part of psychiatric care settings in these patients.
Assuntos
Conflito Psicológico , Terapia Ambiental/métodos , Esquizofrenia/terapia , Adulto , Agressão , Estudos de Casos e Controles , Lista de Checagem , Saúde da Família , Feminino , Unidades Hospitalares , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Comportamento Autodestrutivo/prevenção & controle , Resultado do Tratamento , Violência no Trabalho/prevenção & controle , Adulto JovemRESUMO
Objetivo: estudo transversal quantitativo com objetivo de verificar a prevalência de comportamentos de risco à saúde em universitários. Método: amostra de cinquenta e dois (52) estagiários do último ano do curso de graduação em enfermagem de uma Universidade pública no nordeste do Brasil. Utilizou-se o Youth Risk Behavior Survey. Resultados: prevaleceu sexo feminino 39 (75%), média de idade 24,8 anos, cor branca 29 (55,7%), peso corporal normal 35 (67,3%) e sedentarismo 34 (65,4%), consumo de refrigerantes 25 (48%), frutas e verduras 23(44,2%), bebida alcóolica 42 (80,8%) e cigarros 21(40,4%). A maconha foi relatada por 13 (25%), além de outras substâncias 14 (26,9%); 44 (84,6%) declaram experiência sexual, início aos 17 anos 18 (34,6%), uso do preservativo masculino 20 (38,5%) e 16 (30,8%) relataram tristeza, 14 (26,9%) intenção de suicídio e 47 (90,4%) negaram ameaças ou agressão. Conclusão: os universitários apresentam comportamentos considerados de risco a saúde adotando atitudes e condutas prejudiciais
Objective: quantitative cross-sectional study in order to check the prevalence of health risk behaviors in college students. Method: sample of 52 (52) internes the last year of the degree course in nursing of a public University in the northeast of Brazil. The Youth Risk Behavior Survey. Results: prevailed 39 (75%) female, average age 24.8 years, white 29 (55.7%), normal body weight 35 (67.3%) and sedentary 34 (65.4%), soft drink consumption 25 (48%), fruits and vegetables 23 (44.2%), liquor 42 (80.8%) and cigarettes 21 (40.4%). Cannabis was reported by 13 (25%), in addition to other substances 14 (26.9%), 44 (84.6%) declare sexual experience, home to 17 years 18 (34.6%), use of the male condom 20 (38.5%) and 16 (30.8%) reported sadness, 14 (26.9%) intention of suicide and 47 (90.4%) denied threats or aggression. Conclusion: the present College of health risk behaviors considered adopting attitudes and harmful conduct
Objetivo: estudio cuantitativo transversal para comprobar la prevalencia de comportamientos de riesgo de salud en estudiantes universitarios. Método: una muestra de 52 (52) interna del último año de la Licenciatura en enfermería de una universidad públicaen el noroeste de Brasil. Encuesta de comportamiento el riesgo de la juventud. Resultados: prevaleció 39 (75%) femenino, media edad 24,8 años, blanco 29 (55,7%), peso corporal normal 35 (67,3%) y 34 sedentarios (65.4%), consumo de bebida 25 (48%), frutas y verduras 23 (44,2%), licor 42 (80,8%) cigarrillos y 21 (40.4%). Cannabis fue reportado por 13 (25%), además de otras sustancias 14 (26.9%), 44 (84.6%) declarar la experiencia sexual, inicio a 17 años 18 (34.6%), uso del condón masculino 20 (38.5%) y 16 (30.8%) tristeza reportado, 14 (26.9%) intención de suicidio y 47 (90.4%) negó las amenazas o la agresión. Conclusion: el actual Colegio de comportamientos de riesgo de salud considera la adopción de actitudes y conductas nocivas
Assuntos
Humanos , Adolescente , Adulto Jovem , Estudantes de Enfermagem , Fatores de Risco , Promoção da Saúde , Comportamento Autodestrutivo/prevenção & controle , Prevenção de DoençasRESUMO
Las conductas lesivas no suicidas suponen un problema sanitario de creciente importancia, con una prevalencia en muestras comunitarias de adolescentes del 15-20 %. Las autolesiones pueden tener un significado diverso; se clasifican en intrapersonales o interpersonales; son un factor de riesgo y evolutivo, con inicio en la adolescencia temprana. Se presenta el caso de una adolescente de 12 años con factores de riesgo psicosociales, que acudió a la consulta por cortes autoinfligidos en los brazos y las piernas, realizados con una cuchilla de afeitar, detectados en el colegio. Se intervino potenciando la autoestima y en regulación de emociones con intervención multidisciplinar (sistema educativo, servicios sociales, psiquiatría infantojuvenil y pediatría), con una evolución positiva. Es vital su detección y abordaje con el paciente y su familia para evitar riesgos futuros, especialmente, de patología psíquica. La intervención se realiza desde la Atención Primaria, pero precisa la colaboración de otros profesionales.
Non-suicidal harmful behaviors pose a health problem of increasing importance, with a prevalence in community samples of adolescents of 15-20 %. Self-harm can have adverse meaning, qualifying in intrapersonal or interpersonal; they are a risk and evolutionary factor, with an age of onset in early adolescence. We present the case of a 12-year-old adolescent with psychosocial risk factors, who went to the consultation for self-cuts in arms and legs, made with a razor, detected in the school. It was enhanced her self-steem an guided in regulation of emotions with multidisciplinary intervention (educational system, social services, infantile-juvenile Psychiatry and Pediatrics), with a positive evolution. It is vital to detect and approach this issue with the patient and the family to avoid future risks, especially psychic pathology. The intervention is done from Primary Care, but it is necessary the collaboration of other professionals.
Assuntos
Humanos , Feminino , Adolescente , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Psiquiatria do Adolescente , Bullying , Sistemas de Apoio PsicossocialRESUMO
En Argentina hay 17,4 casos de suicidios de niños y jóvenes por semana, y sobre 3.202 casos registrados en el año 2015, 905 fueron en niños, adolescentes y jóvenes. Un alto % de ellos tuvieron contacto con el sistema de salud en el año previo de su muerte, por ello la detección es un primer paso hacia su prevención. El objetivo general: analizar la opinión que tienen los adolescentes y jóvenes de cinco provincias argentinas acerca de ser interrogados en el marco de los sistemas de salud con el objeto de identificar los que presentan riesgo de suicidio. El estudio es observacional, descriptivo y de corte transversal. La población fue de 1.153 adolescentes y jóvenes (10-24 años) asistentes a establecimientos educativos públicos y privados, y usuarios servicios de salud pública o privada de las provincias argentinas de Buenos Aires (325), Santiago del Estero (322), La Rioja (301), Córdoba (128) y Salta (77). Se utilizó un muestreo intencional, y se aplicó un cuestionario semi-estructurado. Se utilizó un abordaje cuantitativo y tratamiento cualitativo de algunas variables. El promedio de edad fue 17.2 años, con respecto al sexo predominaron las mujeres, y al estrato social el medio. Un 68,7% nunca fueron consultados por su estado de ánimo, y a 8 de cada 10 tampoco se les preguntó por autolesiones. Les cuesta muchísimo expresarse sobre estos temas. Pero un 87% considera importante que los profesionales les preguntemos sobre estos temas, y lo perciben como un problema dentro de la sociedad, sobre todo en las provincias donde el suicidio es más alto. Nuestros adolescentes y jóvenes están de acuerdo en ser interrogados sobre la problemática de suicidio, por ello no debemos perder la oportunidad, más allá del motivo de consulta, considerando es parte de nuestro trabajo y responsabilidad
In Argentina there are 17.4 cases of suicides of children and young people per week, and of 3,202 cases registered in 2015, 905 were in children, adolescents and young people. A high percentage of them had contact with the health system in the year before their death, so detection is a first step towards prevention. The general objective is to analyze the opinion of adolescents and young people in five Argentine provinces about being questioned within the framework of health systems in order to identify those at risk of suicide. The study is observational, descriptive and cross-sectional. The population was 1,153 adolescents and young people (10- 24 years old) attending public and private educational institutions, and users of public or private health services in the Argentine provinces of Buenos Aires (325), Santiago del Estero (322), La Rioja (301), Córdoba (128) and Salta (77). Intentional sampling was used, and a semi-structured questionnaire was applied. We used a quantitative approach and qualitative treatment of some variables. The average age was 17.2 years, with respect to the sex predominated the women, and to the social layer the means. 68.7% were never consulted for their state of mind, and 8 out of 10 were also not asked about self-harm. They have a hard time expressing themselves on these issues. But 87% consider it important for professionals to ask about these issues, and perceive it as a problem within society, especially in the provinces where suicide is highest. Our adolescents and young people agree to be questioned about the problem of suicide, so we should not miss the opportunity, beyond the reason for consultation, considering it is part of our work and responsibility
Assuntos
Humanos , Adolescente , Adulto , Suicídio/prevenção & controle , Tentativa de Suicídio/prevenção & controle , Epidemiologia Descritiva , Estudos Transversais/estatística & dados numéricos , Coleta de Dados , Comportamento Autodestrutivo/prevenção & controle , Comportamento Aditivo/prevenção & controle , Depressão/prevenção & controle , Estudos de Avaliação como Assunto , Declaração de HelsinkiRESUMO
Adolescents in Puerto Rico are at an increased risk for suicide attempts, though evidence-based treatments specifically for this group have not been tested. The current study was designed to develop and pilot test a culturally sensitive, manualized outpatient treatment for Puerto Rican adolescents who have experienced a suicidal crisis. The study was divided into phases. Phase 1 consisted of developing a socio-cognitive behavioral treatment for suicidal behavior. Phase 2 tested the treatment protocol in an open trial with 11 (6 male and 5 female) Puerto Rican adolescents. Active treatment had an approximate duration of 3-6 months. An initial assessment, process measures, and posttreatment assessment were completed with each participant to measure treatment feasibility as well as suicidality, symptoms, and risk factors. Participants were very satisfied with treatment and reported relevant clinical benefits. The retention rate was 73% (8 out of 11). For those who completed the treatment protocol, the goal of reducing further suicide risk was achieved; 2 showed reliable clinical changes in suicidal ideation, while 6 maintained low levels during treatment. All treatment completers had either a partial or total remission of their pretreatment diagnosis and half had reliable improvements in at least 1 risk factor. A theory-driven treatment protocol was developed according to patient's needs, but further research is needed to continue its development and to explore its efficacy.
Assuntos
Comportamento do Adolescente/psicologia , Protocolos Clínicos , Terapia Cognitivo-Comportamental/métodos , Prevenção do Suicídio , Suicídio/psicologia , Adolescente , Assistência Ambulatorial/métodos , Feminino , Humanos , Masculino , Projetos Piloto , Porto Rico , Fatores de Risco , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Resultado do TratamentoRESUMO
INTRODUCTION: Violent acts in young people constitute one of the most serious forms of violence in any society. Violence by young people in schools, on the streets, and in their families has been documented in many studies worldwide. Homicide and non-fatal assaults involving young people have been reported as a great global burden of premature death, injury and disability. Adolescents and young people are both the main victims and perpetrators of such violence. In Vietnam, an emerging pattern of health problems in adolescents related to intentional injury and violence is drawing increasingly more attention from government and the public. OBJECTIVE: Describe the situation of intentional injury among Vietnamese youth, including risk and protective factors, in order to suggest policy implications. METHODS: The 2003 Survey Assessment of Vietnamese Youth was used as a data source, providing a nationally representative sample of 7584 youth aged 14-25 years, resident in 42 of the country's 61 provinces. This sample was drawn from the 45,000 households in the 2002 Vietnam Living Standards Survey, with a multi-staged and stratified design, using the probability-proportional-to-size method to maintain representativity. Data were analyzed using bivariate and multivariate statistical techniques. RESULTS: Of the sample of young people, 2.2% reported injury resulting from violent behavior by a family member and 8.0% by non-family members, the latter demonstrating a significantly higher rate among males than females (13.6% vs. 2.4%). Characteristics of youth most likely to hurt others included: male sex, inebriation at some point, victims of intentional injury, group riot participants and carriers of weapons. Youth who had been members of mass social organizations or clubs in the community were half as likely to hurt other people as those who were unaffiliated with such groups. Females were almost four times more likely than males to attempt suicide. Other risk factors for suicide attempts were past inebriation (OR 2.7, 95% CI 1.3-5.4), ever having been a victim of intentional injury by a family member (OR 3.3, 95% CI 1.1-11.5) or ever having had feelings of hopelessness (OR 6.5, 95% CI 3.3-13.6). CONCLUSIONS: Prevalence of violence and self-harm among Vietnamese youth is comparatively less than in Western and other Asian countries. Risk and protective factors appear similar to those found in most populations. In particular, this study indicated a possible protective effect of membership in social groups. National policy for injury prevention should include strategies to reduce violence and self-harm within this population group.
Assuntos
Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/prevenção & controle , Violência/prevenção & controle , Violência/estatística & dados numéricos , Adolescente , Estudos Transversais , Violência Doméstica/prevenção & controle , Violência Doméstica/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Prevalência , Fatores de Risco , Assunção de Riscos , Fatores Socioeconômicos , Suicídio/estatística & dados numéricos , Vietnã/epidemiologia , Adulto Jovem , Prevenção do SuicídioRESUMO
OBJECTIVE: To assess different approaches to the dental management of lip injuries caused by self-inflicted oral trauma in 7 patients. METHOD AND MATERIALS: The patients were grouped based on 3 treatment approaches: group 1, placement of an oral appliance; group 2, botulinum toxin type A neuromuscular block; and group 3, oral surgery. RESULTS AND CONCLUSION: Neuromuscular block can be the first choice of treatment for patients with self-injurious behavior since botulinum toxin A injection is a well-tolerated, safe, and effective procedure, permitting improvement in muscle spasticity, bruxism, range of mouth opening, oral hygiene, and lip trauma. The second option would be the use of the oral appliance, and the last choice is oral surgery. Laser therapy was also found to be effective when applied to traumatic injuries in patients who present self-inflicted oral trauma.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Lábio/lesões , Protetores Bucais , Fármacos Neuromusculares/uso terapêutico , Procedimentos Cirúrgicos Bucais/métodos , Comportamento Autodestrutivo/prevenção & controle , Bruxismo/prevenção & controle , Paralisia Cerebral/complicações , Criança , Coma/complicações , Feminino , Humanos , Terapia a Laser , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Amplitude de Movimento Articular/fisiologia , Espasmo/prevenção & controle , Língua/lesõesRESUMO
This study examines suicide intent among parasuicide patients in a low-income country, Nicaragua, with special reference to gender patterns and future suicidal behavior. Using the Suicide Intent Scale (SIS), suicide intent was assessed in 204 persons presenting to hospital after parasuicide. Repetition was checked after a mean follow-up period of three years. The total SIS scores did not differ between women and men. However, a higher SIS score among women was significantly associated with older age, having children and use of pesticide as the parasuicide method. The overall method of suicide intent was low in Nicaragua compared to other countries, as was the nonfatal repetition rate (4.8% after three years). Subsequent suicides were found only in three men. Factor structures within the SIS disclosed supported the cross-cultural validity of the instrument. The level of suicide intent at the index attempt did not show any association with future suicidal behavior.
Assuntos
Intenção , Vigilância da População/métodos , Testes Psicológicos , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Criança , Análise Fatorial , Feminino , Seguimentos , Humanos , Masculino , Nicarágua/epidemiologia , Modelos de Riscos Proporcionais , Curva ROC , Recidiva , Fatores de Risco , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/prevenção & controle , Fatores Sexuais , Fatores Socioeconômicos , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/estatística & dados numéricosRESUMO
Psychotherapies recommended for borderline personality disorder (BPD) can be difficult to implement in public hospitals. For example, in Chile, patients with BPD generally receive only pharmacotherapy, which is far from sufficient. This report describes a group psychotherapy approach called Intermittent-Continuous Eclectic Therapy (ICE) developed to treat patients with BPD. Results are presented from a small pilot study in which 15 outpatients with BPD between 15 and 40 years of age treated with ICE were followed for 1 year. In this small group of patients, improvements were seen in self-aggression and general symptoms. These preliminary findings suggests that ICE may be a useful option for treating BPD in real-world clinical settings and that more research in this area is warranted. A case report illustrating the implementation of ICE is also presented.
Assuntos
Transtorno da Personalidade Borderline/terapia , Psicoterapia de Grupo/métodos , Psicoterapia/métodos , Adolescente , Adulto , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Chile , Feminino , Seguimentos , Humanos , Pacientes Desistentes do Tratamento/psicologia , Projetos Piloto , Retratamento , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologiaRESUMO
Self-inflicted oral trauma occurs in a number of conditions with different etiologic and clinical characteristics. The management of such trauma also varies depending on the medical history of the patient; the etiology of the behavior; and the severity, frequency, and method of inflicting injury. This case report describes a modified oral screen placed in a 10-month-old female infant with cerebral palsy who had been having feeding problems caused by self-inflicted oral trauma. The modified oral screen effectively protected the wounds against further oral trauma to the lower lip and tongue without being fixed to the dentition.
Assuntos
Paralisia Cerebral/complicações , Protetores Bucais , Boca/lesões , Comportamento Autodestrutivo/prevenção & controle , Materiais Biocompatíveis/química , Desenho de Equipamento , Feminino , Humanos , Lactente , Lábio/lesões , Polivinil/química , Propriedades de Superfície , Língua/lesõesRESUMO
OBJECTIVES: To explore whether self-injurious behavior (SIB) alters pain expression in children with severe cognitive impairments and the relation between SIB and chronic pain. STUDY DESIGN: Caregivers of 101 nonverbal children 3 to 18 years of age (55% boys) completed the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R) retrospectively and for an observed pain episode. Caregivers of children with SIB (n = 44) completed the Behavior Problems Inventory, the Self-Injury Grid, and the Self-Injury and Self-Restraint Checklist. RESULTS: Multivariate analysis of variance indicated that NCCPC-R scores did not differ between children with and those without SIB. However, t tests indicated that children with chronic pain (n = 13) self-injured less body surface (P =.01) and fewer body sites (P =.04) than did children without (n = 31). Multiple Correspondence Analysis generated 2 dimensions (49% variance), suggesting a distinction between two SIB forms: (1) high frequency of SIB to the head/hand and absence of chronic pain and (2) less frequent SIB near the site of pain. CONCLUSIONS: Children with severe cognitive impairments who display SIB do not have reduced pain expression, and chronic pain may influence the frequency and location of SIB. Further research should examine the usefulness of these findings for management of SIB and pain.