Smartphone Use Side-by-Side with Burnout: Mediation of Work-Family Interaction and Loneliness

The main objective of this investigation is to study the relationship between compulsive smartphone use and burnout, and the potential mediating effect of negative work−family interaction and loneliness in this relationship. An online questionnaire was applied to a sample of 228 Portuguese workers, from various sectors, aged between 19 and 60 years (mean = 32.32); (standard deviation = 9.25), mostly female (64.5%; n = 154). The data were analyzed through descriptive and inferential statistics. The main results show that the compulsive use of the smartphone is positively and expressively related (β = 0.258; p < 0.001) to burnout, with compulsive users reporting more symptoms of burnout. In addition, this study shows the mediating power of negative work−family interaction and loneliness, in the relationship between compulsive smartphone use and burnout, with this effect being positive and significant (B = 0.072; 95% CI [0.026; 0.145]; B = 0.068; 95% CI [0.008; 0.141]). These results highlight the need for individuals and organizations to use smartphones with caution, as well as reinforce that companies must develop a way to prevent and treat possible risk factors associated with this phenomenon.

[The specificities of the online focal group: an integrative review]

The scope of this study is to analyze the specificities of conception and execution of the different modalities of online focus groups (OFGs), a qualitative technique that is an alternative to a traditional focus group, due to the social distancing required by the COVID-19 pandemic. An integrative literature review was conducted in PubMed Central and BVS. National and international studies published in the last 10 years that describe and discuss OFGs were included. A total of 291 articles were identified and 24 were included after evaluation in stages. Four OFG modalities were found: synchronous or asynchronous by writing; synchronous by video/audio or audio. The OFG was used to research different health topics. The same platform can be used for realizing different OFG modalities, guaranteeing the participants' security and anonymity. The lack of a real-life atmosphere can impact participant engagement, but it can be resolved. An OFG can produce quality data, save time and expense, expand the participation of people who are geographically dispersed, but limit those with restricted internet access. This study can help researchers who intend to choose anOFG modality. Studies that assess the limits of OFGs in Brazil are suggested, as well those which address the asynchronous OFG by audio.

Praying for a Miracle: Negative or Positive Impacts on Health Care?

The belief in miracle, as a modality of spiritual/religious coping (SRC) strategy in the face of stress and psychic suffering, has been discussed in psychological literature with regard to its positive or negative role on the health and well-being of patients and family members. In contemporary times, where pseudo-conflicts between religion and science should have been long overcome, there is still some tendency of interpreting belief in miracle – as the possibility of a cure granted by divine intervention, modifying the normal course of events in a bleak medical diagnosis – as having unhealthy impacts in the care and treatment of health. This position seeks to find a base in the three characteristics of hoping in a miracle, frequently pointed out by psychological literature: (a) it would imply a negation of reality instead of its confrontation; (b) it would be a coping strategy focused on emotion instead of the problem; (c) it would imply seeking to modify the supposed desire of God by extra-natural facts. In this study, we shall critically discuss this position and the dangers of its crystallization by the use of SRC scales in which the act of praying for a miracle is previously classified as a negative strategy. We revisit some tendencies in psychological literature about the subject, taking into consideration the various facets of miracle, sociocultural facts, elements of idiographic nature, and their profound outcomes in the lives of people especially in health contexts. We illustrate the dangers of a hasty generalization of the results of nomothetic studies about the role of belief in miracle with two examples of research in the Brazilian context: one carried out with pregnant women with fetal malformation and the other with family members caring for children and adolescents with cancer under chemotherapeutic treatment. In both studies, the results do not confirm the predominance of the negative aspects associated with the act of praying for a miracle, which we discuss and analyze in light of the phenomenological perspective. In this perspective, “pray for a miracle”, as experienced by patients and caregivers, can be recognized as an act of openness to life (instead of isolation in a bleak perspective), bolstering hope, and the resignification of reality in the psyche.

The discourse change in drugs users or addicts care: critical discourse analysis of a federal Act

Brazilian drug policies have undergone changes over time, bearing marks for each historical period and experienced sanitary-political interests. Nowadays, an anti-reformist character was perceived in changes concentrated on Law no. 13,840, of June 5, 2019. The aim of this study is to analyze the key elements of a normative document on drugs based on the Critical Discourse Analysis. We analyzed the Law no. 13,840 using Fairclough's method for three-dimensional analysis and then discussed it with Foucault's notions of Biopower and Biopolitics. We consider that the emphasis on involuntary hospitalization, therapeutic communities and abstinence opposes the Brazilian psychiatric reform movement. The development of oppressive care practices are hidden by the so-called ideological neutrality and scientific evidence.

[Chagas disease: tackling the invisibility through the analysis of life histories of chronic patients]

The scope of this article is to analyze the life histories of Chagas disease (CD) patients, searching for elements in their narratives that might present possibilities for coping with this problem. Caused by the protozoan Trypanosoma cruzi, Chagas disease combines conditions of infection and/or progression to disease, in accordance with biological and social determinants and affects around 6 to 7 million people infected with T. cruzi. More than 6,000 people die each year due to complications in the chronic CD phase. This is a qualitative study using the life history technique that was used in open interviews. We collected a wealth of material with which we can work on the context of the disease in multiple dimensions. We associate sensitive listening with the needs of people living with the CD to give strength to their voice, valuing their own life story, transforming them into masters of their history and knowledge. Visibility emerged and prevailed, exposing the disease itself as a central theme and two general sub-themes: their perceptions about the disease and their own life, in the context of the disease. We identified the need to (re)think the problem of Chagas disease as something visible and present.

The discourse change in drugs users or addicts care: critical discourse analysis of a federal Act

Abstract Brazilian drug policies have undergone changes over time, bearing marks for each historical period and experienced sanitary-political interests. Nowadays, an anti-reformist character was perceived in changes concentrated on Law no. 13,840, of June 5, 2019. The aim of this study is to analyze the key elements of a normative document on drugs based on the Critical Discourse Analysis. We analyzed the Law no. 13,840 using Fairclough’s method for three-dimensional analysis and then discussed it with Foucault’s notions of Biopower and Biopolitics. We consider that the emphasis on involuntary hospitalization, therapeutic communities and abstinence opposes the Brazilian psychiatric reform movement. The development of oppressive care practices are hidden by the so-called ideological neutrality and scientific evidence.

Resiliência familiar no contexto do programa Caminhar em Família

A reunificação familiar é um processo complexo que se inicia com o acolhimento residencial da criança e/ou jovem na instituição e continua após o regresso a casa, podendo contribuir para consolidação e sucesso das medidas de proteção. O presente estudo teve como objetivo analisar as dinâmicas geradoras dos processos de resiliência em famílias após implementação do Programa “Caminhar em Família”  que visa a reunificação familiar por meio de promoção de competências parentais durante o acolhimento. Foi desenvolvido um estudo de caso qualitativo de caráter descritivo e retrospectivo. A amostra não probabilística foi composta por 4 famílias, sendo 5 progenitores e 6 crianças/jovens que saíram do acolhimento no ano de 2019  e estavam aptas à reunificação. A participação das famílias no programa permitiu confirmar o fortalecimento da resiliência no sistema relacional de pais e filhos graças à compreensão, capacitação e empoderamento suscitados nas diferentes etapas da medida de proteção. A associação conceitual de dois modelos teóricos da resiliência familiar das autoras  Froma Walsh e Lietz e Strenght  possibilitou identificar diferentes forças e recursos individuais e familiares na gestão da crise e respostas específicas às necessidades das famílias nos diferentes estádios do acolhimento e reunificação. Os resultados reforçam a importância de programas socioeducativos que privilegiam o fortalecimento das dimensões promotoras de aspectos saudáveis que compõe a resiliência em famílias.  Estes elementos devem ser os norteadores das intervenções para uma reunificação familiar segura e estável.

Pre- and Post-Activity Anxiety for Sustainable Rafting

This study aimed to (i) analyze the levels of state-anxiety of rafting customers, before and after the activity; and (ii) characterize the levels of trait-anxiety and the amount of physical activity performed weekly by clients of a rafting activity. The sample had 100 subjects of a nature sports company, in the rafting activity, with a mean age of 33.27 ± 10.10 years, with 44% female and 56% male participants. They were evaluated in two moments M1 (pre-activity) and M2 (post-activity). In M1, the STAI—State-Anxiety questionnaire and the IPAQ—International Physical Activity Questionnaire (short version) were applied. In M2, the STAI Form 1 State-Anxiety questionnaire was applied again, followed by the STAI trait-anxiety. The results showed no correlation between the amount of weekly physical activity and levels of trait-anxiety (rho(100) = −0.144; p-value = 0.152), thus not corroborating with the existing literature. Regarding state-anxiety, we found that in 55% of cases, it decreased with the practice of rafting, which suggests that the practice may have an anxiolytic effect and promote the well-being and relaxation of participants promoting, in this way, the sustainability of the rafting activity.

The relationship between emotional regulation and hemispheric lateralization in depression: a systematic review and a meta-analysis

From a neurobiological perspective, diverse studies have associated emotional regulation with cognitive deficits. Structural and/or metabolic changes in the frontal cortex are often inferred from dysfunction in cognitive-emotional processing. In addition, electroencephalographic findings support the idea that alpha band oscillations are responses to these same processes. Thus, the objective of this meta-analytical literature review is to verify whether the possible hemispheric lateralization attributed to frontal alpha asymmetry (FAA) correlates with emotional regulation and the cognitive deficits underlying depression. The data included in our meta-analysis are from articles published from 2009 to July 2020, which utilized DSM or ICD criteria to diagnose depression or anxiety disorders and included a control group. For statistical analysis, the measurements obtained through the 10-20 electroencephalography system were used. The frontal alpha asymmetry index was calculated from the difference between the logarithm of the absolute spectral values in the alpha rhythm observed from the F4 and F3 electrodes that were fixed to the scalp of the frontal region of the right and left hemispheres (ln µV² RH-ln µV² LH) = (F4-F3). Eighteen articles were included in the systematic review. Of these, 9 were homogeneous enough for statistical analyses (total N: 1061; N_Dep: 326; N_cont: 735). Nine others could not be statistically analyzed due to the absence of FAA measurements from the F4 and F3 electrodes. A random effects meta-analysis revealed low heterogeneity (Qt = 11,00, df = 8, p = 0.20, I² = 27%) and an average effect size of the studies equal to -0.03 (CI = [-0.07 to 0.01]). The results, although not significant, suggested a slight tendency toward left lateralization in the depression group. Although the effects shown in these data did not confirm hemispherical lateralization in depressed patients, it was found that emotional regulation and cognitive processes share similar neural circuits. Therefore, future research on this complex relationship is encouraged, especially studies that are focused on the search for quantitative biological markers in depression.

Behavioral aspects and learning motivation: a study of middle school adolescents

PURPOSE

To analyze the association between behavioral aspects and learning motivation according to age, sex, and grade in school in middle school students.

METHODS

Observational, analytical, and cross-sectional study with 11- to 14-year-old adolescents, who answered the participant characterization questionnaire, the Strengths and Difficulties Questionnaire - SDQ-Por, and the Learning Motivation Evaluation Scale - EMAPRE. Descriptive and bivariate statistical analyses were conducted.

RESULTS

In the sample researched, there was a statistically significant association between the Strengths and Difficulties Questionnaire domains and the learning motivation goals. It demonstrated that the students with higher means and medians for higher quality motivations had normal results in the SDQ conduct problems, whereas those with a greater tendency to a more extrinsic motivation had an abnormal result in peer relationship problems. In the total classification, the sample students with higher mean and median for the learning goal (which refers to a greater academic commitment) had a normal result, whereas those more prone to the performance-avoidance goal had more abnormal results. The learning motivation did not vary according to age and grade in school, and the adolescents had a greater tendency to the learning goal than to the other two.

CONCLUSION

The association between the behavioral aspects and the learning motivation in the sample assessed was present in the abnormal SDQ-Por scores in relation to the performance-avoidance goal, and in the normal SDQ-Por scores in relation to the learning goal.

Emotional face expressions recognition in childhood: developmental markers, age and sex effect

Recognizing emotional face expressions in others is a valuable non-verbal communication and particularly relevant throughout childhood given that children's language skills are not yet fully developed, but the first interactions with peers have just started. This study aims to investigate developmental markers of emotional facial expression in children and the effect of age and sex on it. A total of 90 children split into three age groups: 6-7 years old (n = 30); 8-9 years old (n = 30); 10-11 years old (n = 30) took part in the study. Participants were exposed to 38 photos in two exposure times (500 ms and 1000 ms) of children expressing happiness, sadness, anger, disgust, fear and surprise on three intensities, plus images of neutral faces. Happiness was the easiest expression to be recognized, followed by disgust and surprise. As expected, 10-11-year-old group showed the highest accuracy means, whereas 6-7-year-old group had the lowest means of accuracy. Data support the non-existence of female advantage.

Mindfulness-based interventions in undergraduate students: a systematic review

ObjectiveTo describe how mindfulness-based intervention (MBIs) are held with undergraduate students, systematize the outcomes of these interventions and indicate possible limitations. Method: Systematic searches were performed in seven databases in January 2019 with the following descriptors: ("mindfulness intervention" AND ("undergraduate" OR "college" OR "students"). Results: A total of 510 articles were found, and 19 articles fully met the inclusion criteria. The searches showed a visible growth in this field of research as articles publications increased in the past years. Regardless of intervention's length, most studies reported beneficial effects. The examination of Anxiety, Stress, and Depression constructs have shown to be predominant. Even though study designs were mostly randomized controlled trials (RCT), it was noticed a shortage use of physiological measures and follow-up assessments. Conclusions: Nonetheless, MBIs have shown to be promising interventions to promote mental health in academic settings.

A rapid systematic review of attention-deficit/hyperactivity disorder (ADHD) and high order writing: Current findings and implications for intervention

BACKGROUND

Theoretical writing models and empirical studies have suggested a possible strong association between attention-deficit/hyperactivity disorder (ADHD) and high order writing (e.g., planning, text production, and revising).

AIM

A rapid systematic review was conducted to examine this relationship with the aim of informing writing interventions specific to the ADHD population.

METHOD

A systematic search for empirical studies on ADHD and high order writing performance from the last two decades identified 18 eligible studies.

RESULTS

Most studies showed that, compared to their peers, students with ADHD have more significant difficulties in high order writing performance. Writing quality and writing process (e.g., planning and editing) were identified as a challenge for ADHD students and may be more challenging than writing productivity and meta-cognitive knowledge of writing. Individuals' inattention, short-term memory, working memory, executive functions, reading, oral language skills, and externalising behavioural problems were identified as significant predictors of high order writing performance.

CONCLUSIONS AND IMPLICATIONS

The findings support theoretical writing models that propose writing as a complex process influenced by multiple cognitive factors, which are commonly impaired in individuals with ADHD. Interventions specific to the identified problems are discussed.

The Sexual and Emotional Life Experiences Reported by Brazilian Men with Head and Neck Cancer at a Public University Hospital: A Qualitative Study

This study explored the sexual and emotional experiences of male patients with head and neck cancer. This study utilized a clinical-qualitative method. Twelve patients with head and neck cancer were recruited to participate in the research through in-depth semi-directed interviews with open-ended questions recorded. Data was collected at the radiotherapy of a Brazilian hospital. All patients demonstrated negative impacts on the dynamics of affective and sexual relationships caused by a serious disease. Data revealed that impacts mainly affect “The felt/lived body”, and “The affective-sexual body”. Requiring, then, an “Elaboration of the grief of the bodily and sexual changes”. Considering, evaluating and proposing care for a sexual and emotional aspects of patients with head and neck cancer is essential for the creation and implementation of comprehensive health measures, especially in terms of quality of life for patients.

Parent-Child Relationships and Academic Performance of College Students: Chain-Mediating Roles of Gratitude and Psychological Capital

This study used the Social Cognitive Theory and Broaden-and-Build Theory to propose and validate a chain mediation model. In total, 417 Chinese college students were studied to explore the effects of parent-child relationships on their academic performance. In addition, we investigated the chain-mediating roles of gratitude and psychological capital. The results showed that (1) the parent-child relationship significantly and positively affected the academic performance of college students; (2) gratitude partially mediated the parent-child relationship and the academic performance of college students; (3) psychological capital partially mediated the parent-child relationship and the academic performance of college students; and (4) gratitude and psychological capital exerted a chain-mediating effect between parent-child relationships and the academic performance of college students. Based on the results of the study, we conclude that the parent-child relationship not only directly affects the academic performance of college students but also indirectly affects it through the chain mediation of gratitude and psychological capital. Moreover, we proposed reasonable suggestions on how colleges and universities can guide students to deal with parent-child relationships, strengthen gratitude education, and improve psychological capital.

Brazilian Adaptation and Validation of the Religious and Spiritual Struggles (RSS) Scale—Extended and Short Version

Studies highlight that although the spiritual/religious dimension is commonly used as a resource for coping with stress and suffering, sometimes this dimension can also be a locus of struggles. The Religious and Spiritual Struggles (RSS) Scale, composed of 26 items (extended version), is an instrument that assesses the presence of six types of spiritual struggles, categorized into three major categories: Intrapersonal, Interpersonal, and Supernatural. More recently, studies have presented a leaner version, with 14 items (short version), also suitable for evaluating religious/spiritual struggles. This study aimed to validate the RSS Scale, in its two versions, in the Brazilian cultural context and was able to attest to its quality and reliability, albeit with small variations. The Brazilian extended version presented six components (similar to the original version) explaining 68.48% of variance and 0.907 of KMO. Two items were withdrawn due to low loadings, but the psychometric qualities of both versions in two different samples (one wide sample and one with LGBTQIA+ individuals) were maintained. The reliability (Cronbach’s alpha) for each one of the six components ranged from 0.78 to 0.88 (24 items) and from 0.73 to 0.83 (14 items). The TLI and CFI were, respectively, 0.934 and 0.945 (24 items) and 0.982 and 0.988 for the short version (14 items). Furthermore, convergent validity tests indicated correlations with the Satisfaction with Life Scale. The RSS Scale (the Brazilian versions with 24 and 14 items), demonstrated reliability in the studied sample and can be applied in clinical and research contexts.

Positive Development Based on the Teaching of Personal and Social Responsibility: An Intervention Program With Institutionalized Youngsters

From the standpoint of the school settings, sport participation constitutes a key strategy concerning the manifestation of positive behaviors that result from the development of personal and social responsibility. Based on the TPSR model, the goal of this study was to evaluate the effects of an intervention geared toward teaching life skills through sport to youngsters who had been committed. The participants were evaluated before and after the intervention. After the initial evaluation, they were randomly assigned to the experimental and control groups. The experimental group took part in the community football program, while the control group attended physical education classes not based on the TPSR model. The experimental model consisted of 3 weekly sessions over the course of 6 weeks, which totaled 18 sessions. This investigation supplied empirical evidence concerning the potential of community sport programs in the teaching and development of life skills deemed necessary for an adequate reintegration of such at-risk youngsters. The model was shown to be valid both in stimulating changes of attitudes and in promoting the adherence to socially positive behaviors. The effectiveness of the model, as well as its unique approach, make its application attractive to both the youngsters and the professionals. This program facilitates the training of youngsters to act, in the sense of promoting both their autonomy and the acquisition of a system of ethics and moral values within a culture of responsibility for how decisions affect the individual and the community. Finally, this intervention generated empirical support in favor of the argument that sport constitutes a unique opportunity within the educational process to establish values, beliefs, attitudes, and practical habits pertaining relationships and cooperation that generate social responsibility in individuals.

Spirituality in Brazilian family caregivers of patients with cancer from the end-of-life care to bereavement

Although spirituality can be a source of support during end-of-life and engage a transformative experience after loss, few studies report family members' spiritual and existential needs considering their experiences over time. We conducted a longitudinal interpretative phenomenological analysis from audio-recorded interviews of 10 family caregivers while providing end-of-life care for cancer patients and during bereavement. Participants' spirituality experiences were presented in three superordinate themes: connectedness with religious beliefs and the deceased; re-signifying relationships, life, and loss; suffering and the family caregiver's needs. Finding connection through relationships, greater existential and spiritual suffering post-loss were important issues involved in expressing their spirituality.

A CONSTRUÇÃO DO PROJETO ADOTIVO EM UMA VIA DE MÃO DUPLA

A constituição de uma família por meio da adoção legal não se dá de modo repentino, mas é fruto de uma delicada construção de projetos, sonhos e expectativas, que ocorrem tanto por parte dos postulantes à adoção, quanto da criança e/ou adolescente que aguarda por uma nova família. Buscou-se conhecer como ocorreu a construção do projeto adotivo, sob a perspectiva dos pais e dos filhos, para uma família composta por um casal e quatro irmãos que foram adotados juntos. A coleta de dados foi realizada por meio de entrevistas e observação com registro em diário de campo. Verificou-se que a principal motivação dos pais para adotar foi o desejo de constituir uma família e exercer a parentalidade. Constatou-se que houve abertura em relação ao perfil desejado e abertura para o encontro com a criança real. No que se refere às crianças, houve dificuldades para que expressassem como vivenciaram o projeto adotivo, o que sugere a necessidade de que haja mais ações voltadas para a preparação das crianças e adolescentes, em vias de serem adotados. Concluiu-se sobre a relevância da construção do projeto adotivo por todos os envolvidos e que é dado pouco espaço para que a criança apresente suas narrativas e faça suas elaborações sobre essa construção.  

REDES SOCIAIS SIGNIFICATIVAS DE GESTANTES DE ALTO RISCO: UM ESTUDO QUALITATIVO

As redes sociais significativas constituem importantes recursos de enfrentamento diante de períodos de transição, em que são exigidas adaptações frente a situações difíceis, como no caso de uma gestação de alto risco. Este estudo objetivou compreender a dinâmica relacional das redes sociais significativas de gestantes de alto risco. Trata-se de uma pesquisa qualitativa, da qual participaram 13 mulheres que estavam sendo acompanhadas em um ambulatório de pré-natal de alto risco, localizado na região Sul do Brasil. A coleta dos dados ocorreu por meio de um roteiro de entrevista semiestruturada e da construção de mapas de rede. Os dados foram submetidos à análise de conteúdo proposta por Bardin e organizados com auxílio do software Atlas.ti 7.0. Os resultados mostraram que houve predomínio de redes grandes, com maior concentração de membros da família, em especial do companheiro e da mãe. Destaca-se o apoio emocional como principal função desempenhada pelos integrantes da rede, a centralidade do médico nos cuidados de alto risco e a importância do apoio prestado às gestantes, na prática de hábitos saudáveis e no autocuidado.

Obesity and social representations among patients subjected to argon plasma coagulation (APC)

This study sought to identify the Social Representations of Obesity among 15 individuals who underwent bariatric surgery through the Roux-en-Y Gastric Bypass (RYGB) method and were subjected to Argon Plasma Coagulation (APC) due to weight relapse. Data were collected through interviews and analyzed via Descending Hierarchical Classification. Obesity was associated with physical limitations and difficulties in social relationships. Prejudice and difficulty in changing habits are associated with the choice to undergo surgical treatment and to weight relapse. The suffering that goes along with obesity and the difficulty in changing habits seem to be associated with the search for surgical help.

Preschoolers’ Attitudes, School Motivation, and Executive Functions in the Context of Various Types of Kindergarten

European policy has seen a number of changes and innovations in the field of early childhood preschool education over the last decade, which have been reflected in various forms in the policies of individual EU countries. Within the Czech preschool policy, certain innovations and approaches have been implemented in the field of early children education, such as the introduction of compulsory preschool education before entering primary school from 2017, emphasis on inclusive education, equal conditions in education and enabling state-supported diversity in the education concepts of kindergartens. The aim of our study was to assess the influence of various preschool education systems in the Czech Republic in the context of psychological variables reflecting selected children’s outcomes which may contribute to future school achievement. The monitored variables were the attitudes, motivations and executive functions of children in the last year of preschool education. A comparison was made between the traditional preschool education program and the so-called alternative types of preschool education, such as Montessori, Waldorf and religious schools. The total sample was divided into four subgroups, namely a group of children attending traditional kindergartens (731, 84.9%), religious (65, 7.5%), Montessori (35, 4.1%), and Waldorf (30, 3.5%) kindergartens. To determine empirical data, the following research methods were used: Attitude Questionnaire, School Performance Motivation Scale, and Behavior Rating Inventory of Executive Function (BRIEF). The results of our survey show the fact that the type of kindergarten attended has a significant effect on the child’s level of school performance motivation, attitudes toward school as well as executive functions. Significant differences were found between the different types of kindergartens attended in the monitored variables.

Avaliação da atuação da rede comunitária de saúde mental em um município paulista de médio porte

RESUMO Tendo como norteadores as recentes mudanças na condução das políticas de saúde mental no País e as disparidades em saúde vivenciadas por pessoas que convivem com transtornos mentais, este estudo buscou avaliar a atuação de uma rede de saúde mental comunitária a partir de três componentes principais: 1) a caracterização do perfil dos usuários; 2) a identificação das ofertas terapêuticas; e 3) a identificação dos cuidados clínicos recebidos pelos usuários em cada um dos serviços estudados, a saber: Centro de Atenção Psicossocial-II; Centro de Atenção Psicossocial-AD; ambulatório; e 13 serviços de Atenção Básica. Trata-se de um estudo transversal baseado em documentos, realizado através da análise de 4582 prontuários. Foram evidenciadas diferenças importantes entre os serviços quanto ao seu funcionamento e diálogo com outros pontos da rede de atenção. As ofertas terapêuticas foram caracterizadas, principalmente, pela oferta de consultas médicas e consultas individuais com profissionais da equipe multidisciplinar. Houve baixa utilização dos recursos comunitários e das oficinas terapêuticas. Foi observada, ainda, baixa oferta de cuidados clínicos aos usuários dos serviços especializados, em contraponto com a Atenção Básica, que, por sua vez, mostrou-se como um serviço potente e necessário para o cuidado das pessoas com transtornos mentais.

Psychological Distress, Coping Strategies, and Quality of Life in Breast Cancer Patients Under Neoadjuvant Therapy: Protocol of a Systematic Review

Introduction

Women with breast cancer eligible for neoadjuvant therapy (NAT) present a disorder of biopsychosocial variables and alteration of their quality of life. They cope with this changing by adopting psychological adjustment strategies, either passive or active. This systematic review aims to investigate the psychological distress, coping strategies, and quality of life in breast cancer patients under neoadjuvant therapy.

Methods

Cochrane Library, PubMed, ScienceDirect, Scopus, Web of Science, and Wiley Online library represent the databases that were searched to identify relevant published articles until September 27, 2021. Full-text published articles, written in English and assessing the main outcomes (namely: psychological distress, coping strategies, and quality of life) in women with breast cancer under NAT will be included. Also, we will integrate papers dealing with the related bio psychosocial variables to the main variables. The paper selection, data extraction, and quality assessment of selected studies will be performed independently by two researchers, and disagreements will be resolved through discussions. We will bring together the results of all of the included studies to draw conclusions based on the body of evidence. The narrative approach will be adopted to analyze the results and conclusions extracted and we would perform quantitative groupings if we have similar data.

Ethics and dissemination

Ethical approval is not required as the proposed systematic review will not use primary data. The results of this review will be disseminated through publication in a peer-reviewed journal and conference presentation(s). PROSPERO registration number: CRD42021230300.

AVALIAÇÃO E PROCESSOS DE SUBJETIVAÇÃO NA ATENÇÃO BÁSICA À SAÚDE: AVALIAÇÃO E SUBJETIVAÇÃO

Desde a redemocratização no Brasil, o tema da subjetividade tem sido um componente importante na discussão e na formulação das políticas públicas no país. Existe um grande embate na literatura em torno dos méritos e dos prejuízos decorrentes dos processos de avaliação. O objetivo desta pesquisa é investigar os efeitos das práticas avaliativas nos processos de subjetivação vividos por profissionais das equipes de Saúde da Família na Atenção Básica, em um distrito sanitário do município de Belo Horizonte. Buscamos também compreender os efeitos da avaliação na subjetividade dos profissionais envolvidos. Realizamos 16 entrevistas semiestruturadas com os profissionais e gestores de duas Unidades Básicas de Saúde. Fizemos uma análise temática das entrevistas em três eixos: os ganhos desencadeados pelas práticas de avaliação, os seus aspectos problemáticos e os processos de subjetivação decorrentes das avaliações. Os ganhos que as avaliações permitiram foram: detectar as falhas no trabalho e redirecionar as atividades; melhorar o atendimento à população e modificar o comportamento com os colegas e em relação ao trabalho. As críticas se direcionaram aos indicadores dos instrumentos, aos processos de avaliação, à dificuldade de colocar em prática os resultados obtidos e ao não cumprimento dos acordos por parte dos gestores municipais. Os processos de subjetivação promovidos pelas avaliações foram por um lado a reflexão em relação ao trabalho e aos colegas, produzindo mudanças de atitudes, e por outro os sentimentos de medo, culpa e frustração em relação ao processo de avaliação, seus resultados e consequências.

SENTIDOS DA VIVÊNCIA UNIVERSITÁRIA PARA ESTUDANTES COM MAIS DE 40 ANOS

As universidades brasileiras contam com um público de estudantes cada vez mais diversificado. Dentre eles, constam estudantes adultos(as) que ingressaram no ensino superior anos após a conclusão do ensino médio, destacando-se por serem mais velhos do que seus colegas de curso. Suas condições de vida e as possibilidades de permanência nessas instituições diferem daquelas de estudantes mais jovens, situação que exige o investimento em estudos sobre esse grupo específico. Nessa direção, este artigo analisa os sentidos sobre o processo de ingresso; sobre os desafios enfrentados no relacionamento com colegas; e sobre como estudantes que ingressaram na graduação após os 40 anos de idade vivenciam as práticas de ensinar e aprender na universidade. Os depoimentos de três estudantes desse grupo, que participaram de uma pesquisa-intervenção metodologicamente organizada no formato de oficinas de leitura e escrita, foram submetidos a uma análise de discurso de orientação bakhtiniana. Eles(as) relataram como realizam o enfrentamento das tensões que envolvem a inserção no campo discursivo universitário, dando destaque a embates no relacionamento com colegas mais jovens, à apropriação das novas tecnologias de informação e aos aprendizados propiciados pela participação no cotidiano acadêmico-universitário.

Differences in Resilience, Psychological Well-Being and Coping Strategies between HIV Patients and Diabetics

The aim of the study was to determine the differences in resilience, psychological well-being and coping strategies between patients with HIV and diabetics. The sample included a total of 400 subjects (199 patients with HIV and 201 subjects with diabetes). The instruments applied for data collection were a sociodemographic data questionnaire, the Resilience Scale (Wagnild and Young), the Ryff Psychological Well-being Scale and the Coping Strategies Questionnaire (Sandín and Chorot). The data collection period was approximately 2 years (between February 2018 and January 2020). Based on the results of our work it was found that the subjects with HIV had lower scores than the diabetic subjects in all the resilience factors, except for the factor "feeling good alone". In addition, the subjects with HIV scored significantly lower than the diabetic subjects on all the variables of psychological well-being. Subjects with HIV used problem-solving coping, social support seeking, positive reappraisal, religious coping and avoidance coping with less frequency than diabetic subjects. However, they used more negative auto-focused coping compared to diabetic subjects. Therefore, subjects with HIV show a different psychological pattern in relation to resilience, psychological well-being and use of coping strategies compared to diabetic subjects.

She deserved it: Analysis of variables that influence the accountability of victims of sexual violence

This article aims to analyze the effect of the combination of the variables - victim characteristics (skin color and normativity), observer sex, Belief in a Just World, and ambivalent sexism - on sexual violence victim blaming. Three studies were conducted with university students (Study 1, N=288; Study 2, N=226; Study 3, N=307), who were asked to answer some items on victim blaming, Belief in a Just World, and Ambivalent Sexism. The ANOVA and ANCOVA analyses have shown that the combination of these variables resulted in higher black and counter-normative victim blaming. The results confirmed that victim skin color, victim normativity, and the observer sex influence victim blaming for sexual violence (study 1); that bjw predicts the attribution of the victim’s accountability for sexual violence (study 2), and that only benevolent sexism, together with bjw, was responsible for predicting victim blaming for sexual violence (study 3).

Complicated Grief After the Loss of a Baby: A Systematic Review About Risk and Protective Factors for Bereaved Women

This study sought to identify the factors associated with the development and prevention of complicated grief in women who have lost a baby. This is a systematic review of scientific articles in the main mental health databases: MEDLINE (PubMed), EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), and APA Databases (PsycINFO). The selection and data extraction processes occurred independently and blindly by two authors, considering the eligibility criteria. The analysis included publications from 2013 to 2021 of observational studies with adult women who had experienced losing a baby (during pregnancy up to 2 years of life) and that employed standardized instruments to evaluate grief. From the 8,200 records found, 23 articles were selected for analysis. As risk factors, we identified the presence of mother’s psychopathology, history of gestational loss, and social pressure for a new pregnancy, while as protective factors, we identified the presence of another child other than the deceased one, the quality of specialized healthcare, and the social support provided by either a partner, community, or spiritual activities. Furthermore, the studies pointed to the event of losing a baby as an opportunity for posttraumatic growth. Although complicated grief is often associated with other mental health conditions, such as anxiety, depression, or posttraumatic stress, it is necessary to differentiate it for a clearer understanding of the complicated grief as a singular condition, to enable access to appropriate care for bereaved mothers and families, as well as to promote public policies which provide support to them.

Percepção de familiares de pessoas com transtornos alimentares acerca do tratamento: uma metassíntese da literatura

Resumo Relações familiares parecem ter uma contribuição relevante na etiopatogenia dos transtornos alimentares (TAs), o que faz com que as diretrizes internacionais de tratamento recomendem a participação da família. Esta metassíntese teve como objetivo sintetizar e reinterpretar os resultados de estudos qualitativos primários sobre a percepção de familiares de pessoas com TAs acerca do tratamento. A estratégia de busca foi organizada utilizando-se a ferramenta SPIDER e as análises foram realizadas por dois revisores independentes. A partir de 1.115 estudos originariamente recuperados de 6 bases de dados (CINAHL, LILACS, PsycINFO, PubMed, Scopus e Web of Science), foram selecionados 19 artigos. Os resultados convergem para o reconhecimento de que a família é parte do processo saúde-doença e precisa ser considerada como destinatária de cuidados, não apenas como coadjuvante/acompanhante no cuidado à pessoa acometida. Como a dinâmica familiar tem contribuição relevante no desenvolvimento e na manutenção dos TAs, é necessário investir na transformação das relações familiares para que se possam obter ganhos mais efetivos e duradouros no tratamento.

Jovens com transtorno autista, suas mães e irmãos: vivências familiares e modelo bioecológico

Resumo No modelo bioecológico, compreende-se o desenvolvimento a partir da interação entre o sujeito e os múltiplos contextos nos quais está inserido, considerando a dimensão temporal. Nessa direção, por meio de um estudo descritivo, objetivou-se analisar as concepções de jovens com transtorno autista, suas mães e seus irmãos acerca de suas vivências familiares. Para tanto, foram realizadas entrevistas com 12 mães, 17 irmãos e 2 jovens com autismo, sendo transcritas e analisadas a partir da técnica de análise de conteúdo. Os resultados evidenciaram que as atividades, a rede de apoio e as concepções descritas pelos participantes funcionam como fatores protetivos, mesmo diante de fatores de risco em seu desenvolvimento. O presente estudo suscita novas questões de pesquisa e elucida aspectos das vivências familiares importantes para delinear intervenções.

Construction and validation of a mobile application for health education about COVID-19

ABSTRACT Objective: To construct and validate a mobile application for health education about COVID-19. Method: Methodological study, developed in six stages, in the state of Rio de Janeiro, between June 2020 and August 2021, with 20 health professionals, using an electronic form. Validation took place through the Content Validity Index, whose indexes should be greater than or equal to 80%. Results: The application called ROBOVID was constructed and validated by expert judges on the subject, with a Content Validity Index of 100% for the domains of content and cultural adequacy, and with a variation of 90 to 100% for the domains of language, illustration, and presentation, achieving 97% on the Overall Validity Index and 98% on the “ten golden rules” for use in health education. Conclusion: The ROBOVID application proved to be a valid technological tool for health education about COVID-19 among the Brazilian population.

COVID-19 en Brasil: ¿Hay diferencias entre la alfabetización en salud mental de los hombres jóvenes y la de los mayores?

Resumen Objetivo: analizar la Alfabetización en Salud Mental de hombres jóvenes y mayores residentes en Brasil en el contexto de la pandemia de COVID-19. Método: estudio cualitativo, realizado con 87 hombres, mediante survey online asincrónica. Los datos fueron procesados usando el software NVIVO12®, estructurados usando el método del Discurso del Sujeto Colectivo y analizados usando el concepto teórico de Alfabetización en Salud Mental de Anthony Jorm. Resultados: del análisis de un discurso síntesis sobre los componentes de la Alfabetización en Salud Mental, surgieron seis ideas centrales: capacidad para reconocer trastornos específicos o diferentes tipos de sufrimiento psíquico; conocimiento y creencias sobre factores y causas de riesgo; conocimiento y creencias sobre las intervenciones de autoayuda; conocimiento y creencias sobre la ayuda profesional disponible; actitudes que facilitan el reconocimiento y la búsqueda de ayuda adecuada; y conocimiento sobre cómo buscar información sobre salud mental. Conclusión: hay diferencias entre la Alfabetización en Salud Mental de los hombres jóvenes y la de los mayores que vivían en Brasil durante la pandemia de COVID-19. Los hombres mayores fueron más competentes para gestionar el cuidado y proteger su salud mental que los hombres jóvenes, según los niveles de Alfabetización en Salud Mental.

Justiça Organizacional - Um Panorama da Produção Científica Brasileira

Resumo A relevância da justiça organizacional para melhoria da relação entre trabalhadores e organizações conferiu ao tema destaque em cenário internacional nas últimas décadas. No Brasil, discrepâncias entre as contribuições nacionais e estrangeiras foram apontadas pela última revisão do tema, em 2005. Assim, buscando responder como as dimensões de justiça foram pesquisadas, baseadas em que teorias e quais as principais relações investigadas, este estudo analisou o desenvolvimento da produção científica brasileira sobre justiça organizacional. Realizou-se uma revisão semi-sistemática da literatura, em 19 periódicos (1996-2018). Os resultados evidenciaram diferenças significativas entre a produção nacional e internacional. Apresenta-se uma agenda de pesquisa nacional, explicitando as necessidades de investigação dos antecedentes e dos efeitos mediacionais e interacionais do construto e de melhor fundamentação teórica.

Prevalência de cinesiofobia e catastrofização em pacientes com disfunção temporomandibular

RESUMO Objetivo: identificar a frequência e os níveis de cinesiofobia e catastrofização em pacientes com Disfunção Temporomandibular que realizaram terapia fonoaudiológica. Métodos: a amostra compreendeu pacientes com Disfunção Temporomandibular muscular e mista com predominância muscular, grupo de estudo e adultos saudáveis, o grupo controle. Os instrumentos utilizados foram: Diagnostic Criteria for Temporomandibular Disorders, Escala Tampa para Cinesiofobia e Escala de Catastrofização da Dor. A análise estatística foi composta do Teste de Mann-Whitney para comparar as médias entre os grupos de cada escala e o teste de Coeficiente de Correlação de Spearman para analisar a correlação entre as escalas em cada grupo e sua significância. Resultados: foi identificado um alto índice de catastrofização da dor no grupo de estudo em comparação ao grupo controle. Quanto à cinesiofobia, houve maior índice positivo para essa variável no grupo de estudo e menor para o grupo controle. Além disso, identificou-se correlação moderada e positiva entre a cinesiofobia e catastrofização no grupo de estudo. Conclusão: Pacientes com Disfunção Temporomandibular possuem níveis de cinesiofobia e catastrofização mais altos que pacientes que não foram diagnosticados com o distúrbio.

The association between language and recognition of facial emotional expressions in elderly individuals

ABSTRACT Purpose To check the association between a good performance of language and the recognition of facial emotional expressions in elderly individuals. Methods Transversal study performed with 118 elderly individuals from the primary care services of health of a city in the state of São Paulo. Sociodemographic data were collected, regarding the performance of language through the domain of Addenbrooke Cognitive Examination – Revised and Recognition of Facial Emotional Expressions. The sample was divided in thirds according to the performance of language: T1 = the best, T2 = average, and T3 = the worst. The groups T1xT3 were compared regarding the performance of recognition of facial expressions of anger, disgust, fear, happiness, sadness, and surprise, and for the intensities of 40%, 60%, 80%, and 100%. The association of independent variables over the performance of language was analyzed through logistic regression. The multivariate model was built from the results of the univariate analyses and has included the continuous variables by emotion and by intensity. Age and schooling associated to the performance of language in the univariate model were included in the multivariate model in order to adjust association analyses. Results The sample was mainly female (84.7%), with an average age of 70.5 years old, and 3.5 schooling years. The variables associated to the best performance of language in comparative analysis of T1 and T3 were: surprise (OR = 1.485, IC 95% 1.194 – 1.846), and disgust (OR = 1.143, IC 95% 1.005 – 1.300). Conclusion The recognition of facial emotional expressions of surprise and disgust were shown as important factors associated to the good performance of language.

Perfil de Psicoterapeutas Pais-Bebê de Porto Alegre: Formação e Atuação Profissional

Resumo A psicoterapia pais-bebê é uma modalidade terapêutica que enfoca a relação da díade/tríade pai-mãe/bebê, geralmente embasada no referencial teórico psicanalítico. No Brasil, são escassas as pesquisas sobre o tema. Este estudo teve como objetivo investigar o perfil de profissionais que atuam como psicoterapeutas pais-bebê em Porto Alegre e as características e especificidades deste campo de atuação. Trata-se de estudo qualitativo, de caráter exploratório-descritivo. Os dados foram coletados por meio de entrevista semiestruturada realizada presencialmente. Participaram do estudo 10 psicoterapeutas do sexo feminino, selecionadas por conveniência. Utilizou-se a Análise de Conteúdo proposta por Laurence Bardin para a análise dos dados. A possibilidade de intervir precocemente foi descrita como a principal motivação para a inserção na área, que ocorreu sem uma formação acadêmica estruturada. Possuir conhecimentos sobre desenvolvimento infantil, constituição de vínculos e dinâmica familiar foi citado como imprescindível para a atuação profissional. Quanto às características pessoais e técnicas, foram mencionadas a necessidade de identificação com a técnica e com o trabalho com bebês e de possuir formação sólida, pautada em estudo teórico, supervisão e análise pessoal. A importância da experiência prática e da observação de bebês enquanto ferramentas de aprendizagem também foi destacada, e constatou-se a necessidade de ampliar a visibilidade desse campo de atuação entre profissionais e público em geral.

Interações sexuais entre indivíduos do mesmo sexo: um olhar evolucionista

Resumo Sob uma perspectiva evolutiva, as interações sexuais entre indivíduos do mesmo sexo foram por muito tempo consideradas um grande paradoxo. Isso por terem persistido no decorrer das gerações apesar de supostamente não oferecerem benefícios reprodutivos diretos, reduzindo, aparentemente, a aptidão individual. Apesar disso, são comuns em muitas espécies animais. Neste artigo, revisaremos algumas das hipóteses funcionais que tentam resolver esse quebra-cabeça evolutivo. Algumas dessas hipóteses consideram essas interações adaptativas, o que significa que trariam benefícios para os indivíduos. Outras as consideram neutras, derivadas de características realmente vantajosas. Por fim, existem as que consideram essas interações como não-adaptativas e potencialmente prejudiciais aos indivíduos. Ao final, abordaremos uma hipótese revolucionária que, de forma inédita, questiona se as interações sexuais envolvendo exclusivamente indivíduos de sexos diferentes seriam realmente o estado basal do comportamento sexual.

O SENTIDO DO TRABALHO PARA HOMENS COM ANEMIA FALCIFORME E ÚLCERAS FALCÊMICAS

RESUMO Objetivo: analisar o sentido do trabalho para homens com anemia falciforme e úlceras falcêmicas e discutir os desafios que eles enfrentam para manterem-se no mundo do trabalho. Método: estudo qualitativo e descritivo, desenvolvido em dois cenários, um ambulatório de curativos de um hospital de grande porte e uma clínica de enfermagem em estomaterapia, ambos vinculados a uma universidade pública do Rio de Janeiro, Brasil. A coleta de dados ocorreu de agosto a novembro de 2019, por meio de entrevista semiestruturada, com 20 homens com úlceras falcêmicas. A análise lexical dos dados foi realizada a partir do software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: verificou-se a penosidade física, social e psicológica que a ferida origina nos homens que atuam no mundo do trabalho. Além disso, constatou-se que o trabalho representa um valor importante para o homem, além de ser visto como refúgio para lidar com a dor imposta pela ferida. Conclusão: o trabalho representa utilidade e satisfação, pois possibilita prover materialmente o homem e suas famílias, reafirma sua virilidade e seu domínio nos contextos familiar e social, o faz sentir-se útil e produtivo. Mas, contraditoriamente, também produz sofrimento quando esses homens precisam se manter no trabalho com dor, cansaço, vergonha e frustração decorrentes de uma doença e de uma lesão que altera sua imagem corporal e sua produtividade, além de gerar sentimento de repulsa no seu coletivo profissional.

A Dimensão Ética das Representações Sociais: O Crack entre Usuários da Rede Socioassistencial

Resumo O consumo de crack na cena pública tem sido simbolicamente apropriado por meio de significados e práticas inseridos em contextos de vulnerabilidade e degradação social. O objetivo desta pesquisa foi investigar as implicações da dimensão ética dos processos de construção de representações sociais sobre o crack em usuários da rede socioassistencial. Foram realizados três grupos focais com 15 homens, todos usuários do Centro de Acolhimento e Apoio do Programa de Atenção Integral aos Usuários de Drogas e seus Familiares (Programa Atitude), em Pernambuco. As comunicações foram transcritas e os dados submetidos a uma análise de conteúdo. Os resultados evidenciam o papel dos afetos na regulação dos modos de ser e agir dos participantes diante das normas do campo representacional do crack e seus fenômenos. Destacaram-se afetos de raiva, ódio, vergonha e humilhação articulados com processos de exclusão e estigmatização social, racial e territorial, que os constroem hegemonicamente como alteridades criminalizadas e desumanizadas. Desse modo, a dimensão ética analisada indica que o sentido de vida que circunscreve as experiências desses sujeitos se conforma pela busca de um status social valorizado, processo no qual a relação com o crack está presente, mas não é exatamente o aspecto mais importante das suas experiências no mundo.

O tempo do luto materno pelo filho que morreu na infância

Resumo Objetivo desvelar o movimento existencial da mãe após a morte do filho por acidente doméstico na infância. Método pesquisa embasada no referencial teórico-filosófico-metodológico da fenomenologia de Martin Heidegger, com dados coletados entre maio e junho de 2017, mediante entrevista fenomenológica com 10 mães cujos filhos morreram em decorrência de acidentes domésticos na infância. Resultados da compreensão dos relatos, emergiram três temáticas: Lembrando o sofrimento profundo diante da morte do filho e os primeiros dias/meses sem ele; Revivendo a dor no presente, por meio da falta diária e das datas importantes e objetos/símbolos da criança; e Antecipando que a dor e a falta que sentem dos filhos nunca irão passar. Conclusão e implicações para a prática o tempo não é preditor da elaboração do luto materno. Neste contexto, o vivido da mãe é composto por um conjunto de significados, que envolvem multiplicidade de fatores e geram importantes repercussões ao longo da vida. Na perspectiva para promoção do cuidado, emergem, assim, a necessidade de ampliar a compreensão e as ações de acolhimento à mãe enlutada, refletindo sobre a temporalidade como constituinte do enlutamento materno.

Análisis de la motivación extrínseca y la retroalimentación afectiva en la interacción profesor-alumno

El objetivo del presente estudio fue identificar y analizar cuáles son las categorías de retroalimentación afectiva que se presentan con mayor incidencia y la interpretación de contenido de las mismas, y si esto se refleja en la motivación extrínseca del alumno de medicina, es decir, en su participación activa dentro la clase. Se videograbó a un grupo de medicina, se transcribió y codificó la clase con base en el instrumento de categorías motivacionales, obteniendo frecuencias y porcentajes de cada una de ellas. También, se realizó un análisis del discurso, seleccionando los discursos más relevantes de algunas de las categorías para su análisis. Se encontró que la retroalimentación afectiva que el profesor ofrece fomenta la participación del alumno; la apreciación, el reconocimiento y el ánimo que el profesor da sobre la respuesta del alumno, hace que éste participe, impulsándolo a contestar correctamente las preguntas abiertas o directas que el profesor ha formulado.

Beliefs and knowledge of formal caregivers about old age and its relationships with sociodemographic variables

Abstract Attitudes based on outdated stereotypes about aging can limit development possibilities in old age. The objective of this paper was to describe the beliefs and the level of knowledge about old age among formal caregivers of the elderly, verifying the relationship with the socio-demographic variables age, education and length of service in the job. The sample included 32 caregivers from two Long-Term Institutions. This is a correlational study, based on a cross-sectional survey. Results: in general, caregivers’ beliefs regarding old age were neutral, that is, neither positive nor negative; the knowledge on the topic were scarce, and the longer the time in the function, the more positive beliefs were manifested about the autonomy of the elderly (agency domain). It is believed that investment in the training of caregivers will increase the benefits both for the professional class (caregivers), yielding care skills improvement, and for the elderly themselves, by providing greater quality in the elderly-elderly and elderly-caregiver interaction.