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RESUMO O artigo busca discutir singularidades do trabalho da atenção primária à saúde (APS) em contextos onde a violência, apoiada fortemente pelo uso de armas de fogo, tem expressão rotineira, crônica e sistêmica, e dimensionar a potência da APS enquanto canal de empoderamento da comunidade onde a violência armada é uma vulnerabilidade expressiva. Com base na Declaração de Alma-Ata e nos princípios da APS enumerados por Barbara Starfield, e com enfoque na participação comunitária e na perspectiva de determinantes sociais de saúde, a discussão tem como ponto de partida realidades observadas em países da América Latina e os compromissos voltados ao acesso e cobertura universal à saúde previstos no terceiro dos Objetivos de Desenvolvimento Sustentável. É necessário qualificar a caracterização qualitativa e quantitativa da violência armada e de suas consequências, a partir de uma abordagem intersetorial com ampla participação comunitária na busca por respostas coerentes e significativas. Também é preciso garantir a proteção e a segurança dos profissionais para que a presença dos serviços de saúde nos espaços seja contínua.

Objective: To assess the discriminative capacity of the Kenny Music Performance Anxiety Inventory (K-MPAI), in its version adapted for Brazil, in a sample of 230 Brazilian adult musicians. Method: The Social Phobia Inventory (SPIN) was used to assess the presence of social anxiety indicators, adopting it as the gold standard. The Mann-Whitney U test and the receiver operating characteristic (ROC) curve were used for statistical analysis, with p f 0.05 set as the significance level. Results: Subjects with social anxiety indicators exhibited higher mean total K-MPAI scores, as well as higher individual scores on 62% of its items. The area under the ROC curve was 0.734 (p = 0.001), and considered appropriate. Within the possible cutoff scores presented, the score -15 had the best balance of sensitivity and specificity values. However, the score -7 had greater specificity and accuracy. Conclusion: The K-MPAI showed appropriate discriminant validity, with a marked association between music performance anxiety and social anxiety. The cutoff scores presented in the study have both clinical and research value, allowing screening for music performance anxiety and identification of possible cases.

Introduction Music performance anxiety (MPA) is characterized by long-lasting, high intensity apprehension associated with performing music in public. At extreme levels, MPA can impair the career and quality of life. Our goal is to describe the clinical profile, perceived causes and coping strategies associated with MPA. Methods In this cross-sectional study, several self-assessment instruments were administered to a sample of 214 Brazilian musicians (68% male, 53.3% classical/46.7% popular musicians). Data were analyzed using descriptive and parametric statistics, based on the variables of musical training and level of MPA. Results Percentages of indicators of pathology were high (40% high MPA levels, 37% social anxiety, 12.5% depression, 13.5% alcohol abuse), and musicians with high MPA levels were the most affected. A wide variety of situations were associated with MPA, especially those related to the individual (pressure from self/concern about audience). Emotion-focused coping and internal resources were prominent among the resources used for coping with MPA (breathing, increased practice, familiarization with performance venue), although they were not always effective. It was relatively uncommon for musicians to seek specialized resources and treatments. Conclusions The results demonstrate the vulnerability of the targeted professional groups and the need for preventive strategies and behavioral, environmental, educational, and pharmacological interventions to change this scenario.

Background: The Kenny Music Performance Anxiety Inventory (K-MPAI) is very significant among the available instruments which measures Musical Performance Anxiety (MPA). Objective: The aim of this study is to find evidence of validity of the Kenny Music Performance Anxiety Inventory (K-MPAI), in its translated and adapted Brazilian version, through the study of its factor structure. Methods: A convenience sample of 230 amateur musicians completed the K-MPAI. Results: The initial factor analysis yielded eight factors, explaining 62.4% of variance. However, due to the factors' composition and internal consistency values lower than 0.50, the number of factors was later set at three, considering the internal consistency of those, the theoretical propositions and symptomatology aspects that supported the construction of scale. They were named "Worries and insecurity" (α = 0.82), "Depression and hopelessness" (α = 0.77) and "Early parental relationships" (α = 0.57). Discussion/Conclusions: These results point to the scale's construct validity, since they support the theoretical basis used for the development of the K-MPAI and the clinical manifestations of the MPA.

IntroductionThe understanding of the causes of music performance anxiety (MPA) and of strategies to cope with it is important for the comprehension/management of this common condition in musicians.ObjectiveTo investigate the causes of MPA reported by Brazilian musicians and the efficacy of the most commonly used strategies to cope with it.MethodsTwo hundred and fourteen Brazilian musicians (53% professional/musicians from orchestras, 67% male, mean age: 34.02 years, 65% with over 11 years of education, 42% of which played string instruments) completed different self-rating scales to assess the presence/absence of MPA.ResultsThirty-nine per cent of the musicians had indicators of MPA. The most commonly reported causes were repertoire difficulty (57%), concerns about audience response (52%), and self-pressure (51%). The most common coping techniques included breathing/relaxing techniques (66%) and increased practice (53%), regarded as efficient by at least 49% of the musicians. Strategies like seeing a doctor/psychiatrist/psychologist and taking antidepressant/anxiolytic medication were among the least frequently used in the sample. Also, 18% of musicians with MPA used beta-blockers and 6% used non-prescribed medications. Comparatively, musicians with MPA believed that it was associated with a higher number of conditions and regarded coping techniques as less efficient.ConclusionMusicians consider internal situations to be the most frequent causes of MPA and use different coping strategies with average effectiveness. Results highlight the poor use of well-established therapeutic resources and the occurrence of self-medication in the sample, which together point to the need for attention on the part of mental health professionals to this specific group.Disclosure of interestThe authors have not supplied their declaration of competing interest.

This essay examines the pressures and narratives that constrain humanitarian health actors from meeting their commitments to ethical conduct. I focus on critical contemporary issues that exacerbate or generate new ethical concerns for humanitarians, such as the imperatives to be accountable to affected populations, to “decolonize” humanitarianism, and to respect intersectional diversity; and how maleficence should be interpreted in this changing context. I argue that by adopting certain practices-particularly those that create space for new voices and confront entrenched power systems-today's humanitarian health actors can remain true to their core ethical principles.

Music Performance Anxiety (MPA) is defined as an anxious condition, when directly related to solo or group musical performance, and for any instrument, singing included. The assessment of MPA is a challenge to researchers and clinical professionals involved with this disorder. Many instruments are available to assess MPA, but mostly of these instruments are available only in English. Objective: to report the process of cross-cultural validation of the Kenny Music Performance Anxiety Inventory (KMPAI) for Brazil and to describe the study of internal consistency in a Brazilian musicians sample (230 amateur and professional musicians; 58.3% females; 39.17 years mean age). Methods/ Results: the translation was carried out through a rigorous process of translation, backtranslation and face validity. The internal consistency was evaluated with the Cronbach's alpha, and was considered appropriate with a 0.82 value. No item from the scale would alter the value of alpha, which supports the internal consistency of the scale. The highest item correlation was among items 11 and 23 (r=0.50, p<0.001). Conclusion: considering that the MPA is a very prevalent disorder among musicians, with significant impairment in social and work life, we hope that the KMPAI will contribute to a better knowledge in screening of MPA in Brazil, making it easier for musicians to be properly treated with specific and effective interventions.