The hypothalamic-pituitary-adrenal and sympathetic-adrenomedullary axes are the main systems activated in response to stress. Alterations in salivary components and flow rate have been associated with oral health problems and psychological stress. Objectives: The aim of the present study was to investigate the influence of psychological stress on salivary flow, total protein concentration and IgG, IgM and IgA concentrations. Methods: Thirty-eight medical students, average age of 21.4 ± 2.1 years and enrolled in the 2nd to 5th years of their course, took part voluntarily in the study which involved two different periods: the first after vacations and the second during the final exams (a gap of 4 months). An Oral Health Questionnaire and the Lipp Inventory of Stress Symptoms for Adults (ISSL) were applied during both these periods. The flow rate, total protein concentration and immunoglobulin titers of saliva samples, collected after stimulation and stored in a container with protease inhibitor, were measured. Results: Analysis of the ISSL showed that 42.1% (n = 16) of the students had stress during the post-vacation period, and 44.7% (n = 17) during the final exams. The students’ salivary flow rate was significantly lower during the latter period than during the post-vacation period (p < 0.0001), regardless of the presence or absence of psychological stress as measured by the ISSL. There was a reduction in salivary flow rate and a consequent reduction in total protein concentration during the exam period (p = 0.0058). However, during both periods of the study there was no significant difference in total salivary protein concentration between the groups of students with or without psychological stress according to the ISSL (p > 0.05). IgG predominated over IgA and IgM (p < 0.001) during both study periods, regardless of the presence or absence of psychological stress. The study period and the presence of stress influenced the secretion of salivary immunoglobulins. IgM titers during the post-vacation period (p = 0.0044), and IgA (p = 0.028), IgG (p = 0.022) and IgM (p = 0.0075) titers during the final exams were higher in students with symptoms of psychological stress. Conclusions: Although the immunoglobulin titers were high, there was a reduction in the students’ salivary flow rates and a consequent reduction in total protein concentrations.

ResumoO presente trabalho propõe uma análise teórica do constructo "sofrimento psíquico" do trabalhador na Estratégia Saúde da Família (ESF). Para isso, optou-se pelo uso da teoria da psicodinâmica do trabalho do autor Christophe Dejours, visando a uma articulação entre a teoria e os aspectos da práxis do modelo de reorientação da atenção primária no Brasil. Nesse aspecto, a análise da saúde mental dos trabalhadores inseridos na linha de frente da atenção à saúde mostra-se de suma importân-cia, uma vez que pode auxiliar na construção de propostas avaliativas que superem perspectivas tradicionais e excludentes, indicando caminhos para a superação de entraves nas políticas públicas, a fim de que seja oferecido aos usuários serviço satisfatório na Atenção Básica. Ainda, foi possível por meio dessa articulação teórica permitir uma ampliação acerca das possibilidades de falar sobre o trabalho, ser escutado, exercitar a mobilização subjetiva e buscar a transformação das condições patogênicas, esperando causar um reflexo direto na organização do trabalho.Palavras-chave: saúde da família; saúde mental; saúde do trabalhador. AbstractThis paper proposes a theoretical construct of "mental suffering" of the worker at the Family Health Strategy (FHS). To this end, we opted for using the theory of the psychodynamics of work from the author Christophe Dejours, seeking a link between theory and practice aspects of the reorientation of primary care model in Brazil. In this sense, the analysis of the workers' mental health employed at the health care forefront appears to be of paramount importance, since it can assist in building evaluation proposals that go beyond traditional and exclusionary perspectives, indicating ways to overcome barriers in public policies, so that it is offered satisfactory service to users in Primary Care. Still, it was possible through this theoretical articulation allow an expansion about the possibilities of talking about work, be heard, to exercise subjective mobilization and seek the transformation of pathogenic conditions, hoping to cause a direct reflection on the organization of work.

ObjectiveTo examine cerebral cortex thickness in asymptomatic first-degree relatives of patients with mesial temporal lobe epilepsy (MTLE).MethodsWe investigated 127 asymptomatic first-degree relatives of patients with MTLE due to hippocampal sclerosis (HS) (mean age ± SD = 39.4 ± 13 years) and 203 healthy control individuals (mean age ± SD = 36.0 ± 11 years). Participants underwent a comprehensive clinical evaluation and structural brain MRI at 3 study sites. Images were processed simultaneously at each site using a surface-based morphometry method to quantify global brain measures, hippocampal volumes, and cerebral cortical thickness. Differences in brain measures between relatives of patients and controls were examined using generalized models, while controlling for relevant covariates, including age and sex.ResultsNone of the asymptomatic first-degree relatives of MTLE + HS patients showed evidence of HS on qualitative image assessments. Compared to the healthy controls, the asymptomatic relatives of patients displayed no significant differences in intracranial volume, average hemispheric surface area, or hippocampal volume. Similarly, no significant cerebral cortical thinning was identified in the relatives of patients. This was consistent across the 3 cohorts.ConclusionLack of cortical thickness changes in the asymptomatic relatives of patients indicates that the previously characterized MTLE + HS-related cortical thinning is not heritable, and is likely driven by disease-related factors. This finding therefore argues for early and aggressive intervention in patients with medically intractable epilepsy.