Transgenerational transmission of trauma and resilience: a qualitative study with Brazilian offspring of Holocaust survivors

Background: Over the past five decades, clinicians and researchers have debated the impact of the Holocaust on the children of its survivors. the transgenerational transmission of trauma has been explored in more than 500 articles, which have failed to reach reliable conclusions that could be generalized. the psychiatric literature shows mixed findings regarding this subject: many clinical studies reported psychopathological findings related to transgenerational transmission of trauma and some empirical research has found no evidence of this phenomenon in offspring of Holocaust survivors.Method: This qualitative study aims to detect how the second generation perceives transgenerational transmission of their parents' experiences in the Holocaust. In-depth individual interviews were conducted with fifteen offspring of Holocaust survivors and sought to analyze experiences, meanings and subjective processes of the participants. A Grounded Theory approach was employed, and constant comparative method was used for analysis of textual data.Results: the development of conceptual categories led to the emergence of distinct patterns of communication from parents to their descendants. the qualitative methodology also allowed systematization of the different ways in which offspring can deal with parental trauma, which determine the development of specific mechanisms of traumatic experience or resilience in the second generation.Conclusions: the conceptual categories constructed by the Grounded Theory approach were used to present a possible model of the transgenerational transmission of trauma, showing that not only traumatic experiences, but also resilience patterns can be transmitted to and developed by the second generation. As in all qualitative studies, these conclusions cannot be generalized, but the findings can be tested in other contexts.Universidade Federal de São Paulo, São Paulo Sch Med, Dept Psychiat, BR-04023061 São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo Sch Med, Dept Psychiat, BR-04023061 São Paulo, BrazilWeb of Scienc

TERMINAÇÃO DE CORDEIROS, COM E SEM SUPLEMENTAÇÃO NA FASE DE CRIA, CONFINADOS OU SEMICONFINADOS EM Brachiaria brizantha DIFERIDA: PARASITISMO GASTRINTESTINAL E EFICIÊNCIA BIOECONÔMICA

Objetivou-se avaliar os efeitos da suplementação na fase de aleitamento sobre o desempenho ponderal, o grau de infecção por nematódeos gastrintestinais e a viabilidade econômica na terminação de cordeiros em confinamento ou semiconfinamento. Na fase de aleitamento, os cordeiros de seis lotes de 30 ovelhas foram pesados ao nascimento e ao desmame. Três lotes foram suplementados em cochos individuais e o consumo de alimento foi mensurado. Na segunda fase, pós-desmame, os cordeiros foram distribuídos em dois grupos, considerando sexo, peso ao desmame e suplementação durante o aleitamento, para terminação em confinamento ou semiconfinamento. Todos os animais foram everminados no início da terminação. Os animais foram pesados a cada 14 dias e arraçoados com concentrado na proporção de 2% do peso vivo. Os animais confinados receberam silagem de sorgo, e os semiconfinados foram mantidos em pastagem de Braquiaria brizantha cv Piatã. A suplementação na fase de cria teve efeito no peso e no ganho em peso na desmama e na terminação, mas com retorno econômico favorável somente na terminação. O diferimento do pasto no sistema de semiconfinamento controlou a verminose, evitando mortes, e não houve diferenças no peso e no ganho em peso entre os cordeiros confinados ou semiconfinados. Os dois sistemas foram viáveis, mas o lucro no semiconfinamento foi 2,3 vezes superior ao do confinamento.  Palavras-chave: suplementação privativa, cordeiro pantaneiro, nematódeos, ganho de peso, sistema de terminação

A atuação e importância do nutricionista no âmbito da saúde pública/ Nutritionist's role and importance in public health

A atuação do nutricionista no âmbito da saúde pública é de considerável importância devido as suas ações de promoção a saúde através de diversos recursos, assim como ações de prevenção de doenças. Desta forma, a revisão sistemática objetivou identificar evidências disponíveis na literatura acerca da atuação e importância do nutricionista no âmbito da saúde pública. A busca bibliográfica se deu através da pesquisa nas bases de dados Scielo e Biblioteca Virtual em Saúde (BVS), sites institucionais e livros. A dimensão temporal considerada das publicações foi entre 1993 e 2018. Foram excluídos os achados científicos que não estavam de acordo com a abordagem proposta. O profissional da área de nutrição pode realizar funções relacionadas à nutrição e alimentação da população no setor público através de diversas áreas de atuação, como, Conselhos Federais e Regionais de Nutrição, fiscalização sanitária, gestão em programas de alimentação e nutrição e Estratégia Saúde da Família (ESF). Diante disso, as ações de alimentação e nutrição na saúde pública, por meio da atuação do nutricionista, são destacáveis e necessárias para a população devido aos diversos benefícios proporcionados pelas mesma

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS >5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p<0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe