RICEM ÁBACO 2025 EM

It is with great satisfaction that we present the new edition of the High School Scientific Initiation Journal, a significant milestone in the history of Colégio Ábaco. This project was born from the desire to create a space where our students can share their discoveries, reflections, and investigations—promoting dialogue and the advancement of scientific knowledge.

Ábaco has always believed in the importance of investing in different dimensions of learning. Science, in particular, plays a central role in this commitment—it teaches us to observe the world with curiosity, to question what seems given, and to transform reality through critical thinking. The Scientific Initiation Journal perfectly embodies this vision: that learning and producing science are exercises in autonomy, discovery, and growth.

It is also a great joy to host another edition of the Scientific Initiation Congress, a space for students and teachers to meet, exchange experiences, debate ideas, and celebrate knowledge in its most genuine form.

I deeply thank the pedagogical team and the students who dedicated themselves with commitment and enthusiasm to make this project possible. I wish everyone an inspiring and transformative reading experience.

Rodolfo Saad General Director of Grupo Ábaco

EDITORIAL

It is with great joy that we present the new edition of RICEM, the result of the scientific learning journey experienced by our students throughout High School. This publication represents the culmination of a learning process that combines curiosity, methodological rigor, and intellectual autonomy.

Throughout the school terms, students deepened their understanding of what distinguishes scientific knowledge from other ways of thinking—be it philosophical, religious, or traditional—and developed solid criteria for identifying reliable sources, analyzing data, and building evidence-based arguments.

Each theme presented here was freely chosen by the students themselves, without external guidance, and reflects each young researcher’s unique perspective on the world. This process—defining a problem, determining a focus, and structuring a coherent investigation—is what transforms learning into an experience of authorship and discovery.

RICEM thus brings together a rich sample of this diversity of interests and approaches, revealing not only the results of each research project but also the maturity of a generation learning to think scientifically and to communicate ideas with clarity and purpose.

We wish everyone an enjoyable, thought-provoking, and inspiring read—and may this journal continue to serve as an invitation to think, investigate, and transform.

CREDITS

Editor-in-Chief

Guilherme Bergaro Sagula de Almeida

Editors

Leandro Megna e Athos Poli

English Text Revision

Equipe Access International School

Design and Layout

Isabela Pascoaso

Rodrigo Fiorito

PORTUGUESE VERSION

For those who wish to explore the Portuguese version, click the link below. Then, you’ll be directed to the Portuguese edition of our handbook and will be able to navigate all texts and scientific discoveries made by our students.

Read the Portuguese edition

SUMÁRIO

Connected childhoods: consequences of prolonged screen use in the process of children’s learning. Flora Bonfanti, Gabriela Machado e Letícia Cardoso

How does the representation of psychopathy in the media and the public perception of cases like Jeffrey Dahmer’s influence the acceptance of the use of biosensors in the monitoring and treatment of psychopathy?

Evellyn Andrelina da Silva, Heloisa Santos Andres e Julia Agostinho Silva

To what extent are traumatic factors in childhood and early behavioral patterns associated with the development of psychopathy and the formation of different profiles of serial killers, and what clinical pathways are viable for the intervention and treatment of these individuals?

Beatriz Brandão Rosian, Laura Adami Rodriguez, Maria Luiza Diniz Ramos, Mariana Perandini Paes e Victor Naoki Sampei

History of Video Games in Brazil: Correlation between the Popularization of Video Games and Brazilian Economic Development.

Jean Michel Dornelas Salem Sugui

The development of socio-emotional skills and competencies through UN simulations for high school students

Letícia dos Santos Alencar, Amira Sopri Salem e Arthur Mota da Silva

The difference in the absorption time of macronutrients and strategies to better develop muscle hypertrophy in weight training sessions

Gabriela Guerra Micali, Gabriela Vieira Araújo, Isabela Lúcio de Oliveira e João Victor dos Santos Silva

Evaluation of the BLIAR Method: a possible non-invasive approach for early detection of Alzheimer’s through biomarkers

Beatriz Calabria e Mariana Parussolo

Between Biomedical Advances and Social Inequalities: The Complexity of Tackling HIV/AIDS in Brazil

Gabriela Megumi Fujii Ferreira, Sophia Matos Santos e Glaucya Odette Macedo Juncken

Ozempic® and the culture of the ideal body: eating disorders and body dysmorphia, medicalization of esthetics, and the influence of social media

Isadora de Oliveira Martins e Sofia Sayuri Ishizawa

Digital Childhood: The Impact of Social Media on the Development of Children and Adolescents

Amanda Lessa, Beatriz Gregolin, Julia Turini e Sophia Fernandes

Therapeutic approaches for Alzheimer’s Disease: green chemistry, stem cells, and music therapy

Gabriel Rio, Giovana Borali, Vinícius Massao e Yasmim Dreos

Family emotional environment and child development: neural, hormonal, and emotional impacts in early childhood

Ana Luiza Alvarez Frugoli, Fernanda Fagundes Camara, Luiza Midori Florio Tsukamoto e Maitê

Pádua Galindo

The psychosexual development of children and the consumption of pornography: implications for adult affective relationships

Anne Cardozo, César da Costa, Natália Freitas e Rafaela Mees

01.

Connected childhoods: consequences of prolonged screen use in the process of children’s learning.

Flora Bonfanti, Gabriela Machado e Letícia Cardoso

This article analyzes the cognitive, emotional, and behavioral consequences of early and excessive screen use during early childhood, a crucial phase for the development of brain and social functions. With technological advancement and increased access to the internet, especially after the COVID-19 pandemic, the time children are exposed to digital devices has significantly increased, resulting in significant impacts on child development. The intense stimuli from screens—such as lights, sounds, and immediate rewards—repeatedly activate pleasure circuits and reinforce patterns of digital dependency. This overstimulation compromises attention, logical reasoning, sleep, and emotional self-regulation, directly interfering with learning and social interactions. The study highlights the importance of the role of parents and educators in mediating the use of technology, as well as in creating balanced environments that favor healthy cognitive development. It is suggested to adopt practices that encourage reading, meaningful social interactions, and pedagogical methods that value creativity and active learning, such as the Waldorf method. It is concluded that the conscious use of technology is essential to ensure a more critical, autonomous, and emotionally stable childhood.

1. INTRODUCTION

Early Childhood is an important period for the development and changes in cognitive, affective, social, and motor aspects (Madigan et al., 2019), during which the development of brain structures and circuits occurs that will allow the enhancement of more complex future skills (BRETANI, et al., 2014). Children with healthy holistic development during the early years of life find it easier to adapt to different environments and acquire new knowledge, contributing to their later academic success, personal, vocational, and economic fulfillment, and becoming responsible citizens (Scientific Committee of the Science for Childhood Center, 2014, Study No. 1).

The use of screens is listed as a risk factor for interferences in children's neuropsychomotor development, and it may be related to deficits and delays in language, communication, motor skills, and socio-emotional health (Madigan et al., 2019). In this way, the topic becomes relevant since a large part of the routine of children and young people revolves around technology and the internet, which sometimes represents an abusive consumption that can directly interfere with health and child development (CARDOSO et al., 2007).

This work seeks, through scientific studies, to understand the consequences and cognitive damage caused in children during the early childhood phase by early exposure to screens. Based on these considerations, the aim is to raise

In the context of the expansion of internet access and the transformations of a globalized world, electronic devices have been incorporated into the routine of people from various social and age groups, including children (NOBRE et al., 2021). Simultaneously, with the onset of the COVID-19 pandemic in March 2020, schools closed and classes moved online. In addition to classes, daily communication between friends and family became heavily reliant on digital devices due to the impossibility of in-person meetings. As a result, the average screen time for children increased from 2.7 hours/day pre-pandemic to 4.1 hours/day during the pandemic (Sheri Madigan et al., 2022).

parents' awareness about the associated risks, with the goal of contributing to the formation of a more analytical and critical generation. The importance of the role of adults in guiding and creating a balanced environment that favors the integral development of the child is emphasized, highlighting that the choices made in the present can significantly influence the cognitive and emotional future of new generations.

RICEM - COLÉGIO

2. DEVELOPMENT

The use of screens in child development has become increasingly common, with a significant rise between 2015 and 2024, according to the Maria Cecilia Souto Vidigal Foundation. The research indicates that children aged 0 to 2 years old saw an increase from 9% in 2015 to 44% in 2024; those aged 3 to 5 years old increased from 26% to 71%, and children aged 6 to 8 years old from 41% to 82%. This access to screens began to intensify in recent decades, especially with the advancement of technology such as smartphones (CETIC.br, 2025).

Early Childhood encompasses the phase from zero to three years old and is a crucial period in which the development of brain structures and circuits occurs, as well as the acquisition of fundamental capacities that will enable the enhancement of more complex future skills (SOUSA; CARVALHO, 2023, p. 2).

Therefore, children and adolescents are more vulnerable to cell phone use due to their nervous systems still being in development and the potential for greater

cumulative exposure to radiofrequency (RF) throughout their lives (THOMAS et al., 2010, p. 108). It is also observed that the increase in exposures leads to different responses in the child's brain compared to the adult brain, and such susceptibility can impair the development of the nervous system during adolescence (VRIJHEID et al., 2010, p. 107).

Children excessively exposed to digital screens often face difficulties in developing sustained attention and logical reasoning (LIN et al., 2019, p. 9). This impairment is largely linked to the way the brain responds to the intense and constant stimuli provided by these devices (KRUPA et al., 2019, p. 9). Videos with quick cuts, highly interactive games, and frequent notifications create an environment of continuous stimulation that overloads the neurological systems involved in concentration and inhibitory control (SOUSA; CARVALHO, 2023, p. 2).

During screen use, there is a significant release of dopamine, a neurotransmitter related to the sensation of pleasure and reward. This constant release induces a

pattern of immediate reinforcement, causing the brain to repeatedly seek out this pleasurable stimulus (ARANTES; MORAIS, 2021, p. 114). Over time, the child may develop a kind of neurological dependence, a "digital addiction" that makes it difficult to engage in activities requiring continuous focus, such as reading, solving math problems, or even attentive listening in the classroom (VAIDYANATHAN et al., 2021, p. 6).

The content available through cell phones and other mobile devices is accessed with just a few taps on the screen, offering the child a universe of videos, games, and interactions without the need to wait for long loading times or lengthy ads. (ROCHA et al., 2022, p. 2). This characteristic of digital immediacy significantly reduces frustration tolerance, as the child's brain begins to associate the use of technology with instant gratification (ROCHA et al., 2022, p. 2). Studies in developmental psychology indicate that when frequently exposed to quick rewards, children tend to have more difficulty developing skills such as patience, self-regulation, and

persistence (SOUSA; CARVALHO, 2023, p. 2).

Together, the absence of pauses in content consumption, often accelerated by functions like "autoplay," which consists of automatic sequential playback of content without direct user action (STEINER; MAGUIRE, 2020, p. 213), and recommendation algorithms, whose main objective is to analyze user behaviors and patterns and personalize content that pleases them and exclusively directs the user's attention to this content (Gomez-Uribe; Hunt, 2016), can stimulate a behavior pattern characterized by high attention turnover and low ability to maintain focus (LIN et al., 2019, p. 9). 9). This continuous anticipation for new stimuli can, over time, reconfigure the brain circuits related to concentration, making it difficult for the child to engage in activities that require waiting, reflection, or gradual effort (SOUSA; CARVALHO, 2023, p. 2). Moreover, immediate access to digital rewards can inhibit the development of what is called inhibitory control, a fundamental executive function for academic and social progress (KRUPA et al., 2019,

p. 9). When there are no visible or immediate rewards, as happens in more abstract school tasks or more complex social interactions, these children may show restlessness, disinterest, or early frustration (VAIDYANATHAN et al., 2021, p. 6).

As a result, the cycle of immediate gratification provided by technology can compromise not only the quality of learning but also emotional maturity and the ability to deal with real challenges. VICTORIN, 2018, p. 7). In the long term, this can have significant impacts on academic performance, conflict resolution skills, and the building of resilience (VICTORIN, 2018, p. 7).

The sounds emitted by mobile devices such as notifications, game sound effects, animated soundtracks, and vocal interjections of characters function as powerful enhancers of the digital sensory experience, especially for children. (PREVITALE, 2006, p. 115). Even though most studies on screens focus on visual stimuli, the importance of auditory stimuli in user engagement and emotional activation should be considered (PREVITALE, 2006, p. 115). When

combined with vibrant and constantly moving images, sounds create a multimodal experience that intensifies the child's immersion, activating brain regions linked to reward (ARANTES; MORAIS, 2021, p. 114), such as the nucleus accumbens, considered a fundamental structure in the reward circuit, promoting the release of dopamine in response to pleasurable or rewarding stimuli. The activation of this pathway is directly related to sensations of pleasure, motivation, and excitement, influencing the pursuit of experiences that reinforce these emotional states (Volkow; Morales, 2015, p. 720).

All these elements, colors, sounds, rapid transitions, and immediate access converge at the same point: the recurrent release of dopamine and the creation of repetitive behavioral patterns. (SOUSA; CARVALHO, 2023, p. 2). Systematic reviews show that the relationship between increased screen time and deficits in attention and self-control, especially in children and adolescents, is directly proportional (SOUSA; CARVALHO, 2023, p. 2). The I-PACE model (Person-Affect-Cognition-Execution)

describes how emotional and cognitive factors interact, resulting in a constant pursuit of gratification and weakening of inhibitory control (SANTOS et al., 2020, p. 113).

The prefrontal cortex performs fundamental executive functions, such as the retention and manipulation of information (GARCÍA-MOLINA et al., 2009, p. 48). Early alterations, associated with the pursuit of immediate rewards, can lead children to experience difficulties in dealing with new situations and changes (GARCÍA-MOLINA et al., 2009, p. 48). Such changes compromise cognitive development, favoring impulsive decisions and hindering learning from consequences, in addition to impairing the adaptation of choices based on values (Kennerley; Walton, 2011, p. 688). In this sense, abusive use can compromise family relationships, which constitute the basis of primary socialization, being responsible, according to Homans (1950), for the formation of the first affective bonds and the internalization of social norms. In addition to modifying behavior patterns, which can be shaped according to social and

emotional contingencies (PubMed, 2006), and promoting social isolation, which consists of the absence of interactive bonds over a long period, leading to cognitive and emotional dysfunctions (PubMed, 2014).

These devices repeatedly reinforce this mechanism through various digital stimuli (KÜHN; GALLINAT, 2011, p. 87), generating a positive and continuous effort from the brain. For children, this creates a difference compared to the book, which does not offer instant rewards capable of activating the dopaminergic system (KÜHN; GALLINAT, 2011, p. 88).

While books contribute to cognitive development, requiring the brain to work without the support of immediate rewards (PEKUCONIS et al., 2025, p. 44), cell phones, in addition to negatively impacting cognition, activate the dopaminergic system by offering instant gratifications (PEKUCONIS et al., 2025, p. 45). 45). This difference creates a disadvantage for books, as the attractiveness and convenience provided by screens, aligned with the interests of this age group, tend to

surpass engagement with physical reading, resulting in a preference for digital exposure over traditional reading practices (PEKUCONIS et al., 2025, p. 50).

In addition to affecting brain development, screens can induce consumerism, as many videos, games, and digital influencers include practices of disguised advertising, such as unboxings, which consist of a detailed presentation of the product unboxing process, highlighting its features and generating an indirect consumption experience that stimulates the desire for acquisition (LEE; WATKINS, 2016, p. 5758). Brand challenges that are widely disseminated on digital platforms use the logic of gamification and viralization to encourage the active participation of children and adolescents, expanding the reach of advertising campaigns (Nouri, 2018, p. 333). Products embedded in the content represent a technique of indirect advertising, in which consumer items appear integrated into the storyline, subtly and continuously reinforcing their attractiveness. BELLONI, 2005, p. 115). Small children have difficulty distinguishing entertainment from

advertising, making them easy targets for consumer inducement. This raises serious ethical questions about children's exposure to marketing (BELLONI, 2005, p. 115).

Children exhibit limited absorption of the information transmitted by devices, which compromises the effectiveness of learning (J Pediatr, 2007). Despite this limited absorption of content, it is common for them to remember sequences of behaviors or emotions conveyed in the media and attempt to imitate them, demonstrating a certain superficial retention (J Pediatr, 2007). The difficulty these children have in understanding the persuasive nature of marketing compromises the effectiveness of their learning, leading them to superficially retain sequences of behaviors or emotions conveyed by the media, which end up being imitated without a full understanding of their meaning. However, these children may face difficulty in transferring such behaviors to the real world, resulting in a learning process that is not very functional and has low practical applicability (J Pediatr, 2007). Moreover, although infants have a limited capacity to

assimilate, process, and meaningfully retain digital content, the visual and auditory stimuli present in these materials are effective in capturing and maintaining their attention for prolonged periods, even without a full understanding of what is being presented (Brown et al., Pediatrics. 2011;128(5):1040 104). This reveals a discrepancy between the sensory engagement promoted by the media and the actual quality of the learning generated by them.

Being in their inaugural phase of interaction with the environment, these children exhibit a primary exposure to the world around them, possessing a certain sensitivity to instant reward systems (Marciano, 2021, p. 222), which activates pleasure and happiness in their brains with low cognitive capacity (J Pediatr, 2007) upon receiving immediate rewards, thus instigating addictive behavior. (CHENG; CAO, 2023, p. 45). The use of devices is becoming an addiction, which is a new and increasingly prominent social problem (Zou et al; 2017, p. 111). Studies show that one in five preschoolers has a significant addiction to cell phones (Park; Park

2021, p. 152), as they offer various stimuli (CHENG; CAO, 2023, p. 47), providing an emotional reward for children such as bright screens, colors, sudden changes, and continuous positive triggers, which leads to dependence and becomes harmful to this age group (CHENG; CAO, 2023, p. 47). 47).

The vibrant colors, constant sounds, and rapid changes present in digital devices act as stimuli that keep children's brains alert, prolonging the sensation of immediate reward (MORA, 2004, p. 35). This same intense stimulation can hinder the natural transition to rest, becoming a direct interference factor in sleep, which is an essential biological function for children's growth and cognitive development (RIBEIRO, 2007, p. 4).

In this way, screen exposure significantly interferes with sleep, which is not just a moment of rest, but an essential biological function for the balance of the organism. During the deeper phases of sleep, the body carries out important regenerative processes, such as protein synthesis, which are fundamental for the maintenance and expansion of

neural networks responsible for memory, learning, and cognitive development (MORA, 2004, p. 35).

This process is especially relevant in children, whose brains are still developing and require quality sleep to consolidate what has been learned throughout the day (RIBEIRO, 2007, p. 4).

It is during the deepest sleep (REM sleep) that the strengthening of certain memories and the weakening or extinction of others occur (Stickgold et al., 2008, p. 121).

In this sleep, the expression of genes that help to solidify recently used synaptic connections also occurs. (RIBEIRO, 2007, p. 34). He is necessary to filter the acquired information, eliminating or storing the data. This process can be compromised when REM sleep does not occur, resulting in symptoms of fatigue, poor reasoning quality, inability to make decisions correctly, and difficulty concentrating (RIBEIRO, 2007, p. 4).

By emitting blue light, a range of luminous radiation that, when absorbed, interferes with the production of melatonin - the hormone that regulates sleep -

screens hinder the onset and maintenance of sleep, especially affecting deep sleep (PREVITALE, 2006, p.115). Moreover, the fastpaced and highly stimulating content to which many children are exposed with vibrant colors, intense sounds, and a rapid pace can increase brain arousal levels before sleep (PREVITALE, 2006, p.115), favoring episodes of nightmares and even nite terrors (LIN et al., 2019, p. 9). With this, the circadian cycle, responsible for the biological rhythm of sleep and wakefulness, ends up being deregulated, which compromises neurological, behavioral, and emotional development over time (ROCHA et al., 2022, p. 2).

Given this scenario, it is interesting to promote the conscious use of technology from childhood, with clear limits and encouragement for activities that gradually and in a balanced way develop patience, concentration, and logical thinking (ROCHA et al., 2022, p. 2).

Parents increasingly expose their children to screens (GARRISON; CHRISTAKIS, 2005; LINEBARGER; WALKER, 2005;

ZIMMERMAN et al., 2007) for various reasons such as babysitting, belief in entertaining programs, and means of relaxation that can bring comfort in moments of distress (RADESKY et al., 2014, 2016; NEVSKI; SIIBANK, 2016; LEVINE et al., 2019; DARDANOU et al., 2020). According to Guellai et al. (2014), this continuous use of mobile devices has a significant negative impact during the preschool phase, potentially leading to attention deficits, which can result in a significant lack of interest in these children, causing them to have fewer interactions with their caregivers, which is predominant in their cognitive development, making them increasingly lazy and disinterested in their learning. One of the solutions to rekindle a child's interest in active and non-technological activities is the constant presence of a caregiver during screen time, acting as a mediator of the experience. This active participation fosters the restoration of interpersonal relationships, often weakened by the excess of digital stimuli. According to Barr et al. (2008), other solutions found to generate interest in activities that enhance mental skills would be meaningful social interactions, as the

presence of a caregiver helps the child strengthen emotional bonds and encourages the child to explore the world through sensory experiences, which can be a great example to spark curiosity. Such experiences can indeed awaken curiosity (Christakis et al., 2004; Linebarger & Vaala, 2010), and sensory engagement promotes the activation of brain areas linked to attention and active learning (Christakis et al., 2004; Linebarger & Vaala, 2010). And ensuring that children are in a safe environment that involves not only safety from physical risks but also the promotion of cognitive and emotional development, such as learning opportunities, ensuring stable bonds and positive experiences. (Souza, 2020) so that they are more inclined to explore and not be restricted by screens (Ainsworth et al., 1978).

Thus, encouragement of reading coming directly from caregivers is an alternative to cognitive damage in the development of skills (Bus, van IJzendoorn & Pellegrini, 1995).

Shared reading between family members and children strengthens emotional bonds, in addition to

promoting intrinsic motivation for learning, creating an environment rich in language and stimuli (Bus, van IJzendoorn & Pellegrini, 1995). For the learning process to be effective, it is essential that studying is enjoyable and fun (Guthrie & Wigfield, 2000), as playful engagement is associated with greater interest and retention of knowledge (Guthrie & Wigfield, 2000). In this sense, the Waldorf method stands out for its pedagogical approach centered on the holistic development of the student, (Tyson, 2024) which values creativity, imagination, and practical experience as essential elements for the construction of knowledge.

Originating from the anthroposophical philosophy of Rudolf Steiner, the method emphasizes teaching in the natural rhythms and phases of the child, incorporating artistic, manual, and narrative activities that make learning more meaningful and connected to real life (Tyson, 2024). In the context of reading, the method promotes early contact with stories and oral storytelling, gradually stimulating interest in language and literature in a way that is integrated with the

child's emotional and social development. Tyson, 2024) Furthermore, classroom interaction is essential to make teaching more stimulating (Alexander, 2020) through productive dialogs, openended questions, and collaborative activities that encourage active student participation and the development of critical thinking (Alexander, 2020). The combination of family support, playfulness in the learning process, the principles of the Waldorf method, and dynamic interaction in the classroom creates a rich and motivating educational environment (Alexander, 2020) that fosters the development of children's reading and cognitive skills in a holistic and sustainable manner (Tyson, 2024).

3. CONCLUSION

This work aims to analyze the consequences caused by the disproportionate use of cell phones, highlighting the need for a more conscious attitude from parents and guardians in order to ensure that the use of technology occurs in a balanced manner. Consequently, it is emphasized that the present plays a decisive role in the formation of new

generations, as the experiences lived during this period directly shape their future capacities for learning, social interaction, and adaptation.

The constant stimuli from screens, such as intense colors, repetitive sounds, rapid image changes, and immediate access to rewards, create an environment of continuous gratification. This pattern recurrently activates the pleasure circuits in the child's brain and promotes the formation of repetitive habits, which weaken self-control and attention. Various analyzes indicate that the more time spent in front of digital devices, the greater the damage to essential cognitive functions, resulting in difficulties in concentration, decision-making, and self-regulation.

In addition to understanding the damages, this work also aimed to stimulate reflections on healthy alternatives that can minimize the negative effects of technology. Encouraging reading practices, meaningful social interaction, and educational methodologies that value creativity and practical experience represents a fundamental strategy to balance

technological advancement on human development. Creating environments rich in emotional bonds and learning opportunities outside of screens is, therefore, a way to protect childhood and prepare children for a more critical, autonomous, and resilient life.

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How does the representation of psychopathy in the media and the public perception of cases like Jeffrey Dahmer’s influence the acceptance of the use of biosensors in the monitoring and treatment of psychopathy?

In recent years, psychopathy has received increasing attention in the scientific literature due to its neurobiological and behavioral complexity, as well as the influence of media representations on the public perception of the disorder. The present study investigates the intersection between the media representation of psychopathy, the public perception of emblematic cases, such as that of Jeffrey Dahmer, and the acceptance of the use of biosensors for the monitoring and treatment of this personality disorder. Psychopathy, characterized by antisocial behaviors and emotional deficits, is frequently stigmatized by the media, which associates it with criminal figures, hindering proper understanding and the pursuit of therapeutic interventions. Neuroscience, through its subdisciplines such as neuroanatomy and neuropsychology, elucidates the brain dysfunctions underlying psychopathy, while biosensors emerge as innovative tools for identifying neurochemical biomarkers. However, negative public perception, exacerbated by distorted media representations, constitutes a significant obstacle to the acceptance of these technologies. It is concluded that overcoming the stigma associated with psychopathy and promoting a wellfounded understanding of the disorder are imperative for the effective implementation of new therapeutic approaches.

Evellyn Andrelina da Silva, Heloisa Santos Andres e Julia Agostinho Silva

1. INTRODUCTION

The study of the human brain according to Neuroscience branches is divided into three distinct areas: neuropsychology, neurophysiology, and neuroanatomy (FIRMINO; BRAZ, 2020). From this perspective, extreme behaviors, such as cannibalism and psychopathy, should be understood in light of concepts from neuroanatomy and neuropsychology (RODRIGUES; DA SILVEIRA, 2023). Psychopathy is primarily related to the atrophied amygdala (RODRIGUES; DA SILVEIRA, 2023), a fact that highlights its connection with neuroanatomy and results in the difficulty of individuals affected by this condition in understanding emotions, such as empathy (RODRIGUES; DA SILVEIRA, 2023).

Although many still believe otherwise (MOREIRA; ANZOLIN; TOZATTO, 2022), antisocial personality disorder can be exacerbated by social and economic factors, so that the more precarious the situation in which the individual is inserted, the more individualistic they become, leading to the development of the disorder (MOREIRA; ANZOLIN; TOZATTO, 2022). The disorder is more easily identified in men, as they exhibit more violent behaviors than women in general (PORFIRIO; SILVA, 2021), just as Pardini et al. discussed, males with reduced amygdala mass tend to have more aggressive behaviors (RODRIGUES; DA SILVEIRA,

2023). The disorder can also originate in childhood, as children tend to follow behaviors influenced by external factors, such as those from the media and aggressive family members (PORFIRIO; SILVA, 2021), imitating them as a form of play and becoming more aggressive over time.

Psychopathy is a complex personality disorder characterized by persistent patterns of antisocial behavior, lack of empathy, manipulation, and difficulty in establishing emotional bonds, and should be understood based on clinical and neurobiological criteria to avoid distortions and undue media interpretations (FURNHAM; LISTER, 2017). Media representations of psychopaths in television series and news can, even if unintentionally, become a stereotyping, turning them into killers and romanticizing them, as seen in the series "Dexter," whose protagonist, a man trying to deal with his personal life and childhood traumas, presents justifications for his crimes (FREITAS DA SILVA, 2016). Moreover, the recent trend of believing in content disseminated through social media can be considered both beneficial and harmful, as the internet hosts a vast range of accurate information on various topics, but it is also permeated by a substantial amount of incorrect information. In this context, the media can distort the image of murderers, portraying them as psychopaths, with the aim of increasing viewership and profiting from the exploitation of the condition

of those who suffer from mental disorders (MOREIRA; ANZOLIN; TOZATTO, 2022).

This distorted view not only affects public perception and the acceptance of new approaches (FURNHAM; LISTER, 2017), but can also negatively influence the receptivity and application of advanced technological tools, such as biosensors, which have already demonstrated efficacy in identifying biomarkers in conditions like cancer (TOTHILL, 2009) and Alzheimer's (YOON et al., 2020) in the monitoring and personalized treatment of psychopathy (INSEL, 2017).

2. DEVELOPMENT

2.1. Psychopathic Disorder: Theoretical and Practical Aspects

Initially, for a better understanding of psychopathic disorder, it is necessary to know neuroscience. Neurophysiology is the area of science that studies the functioning of the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). The first commands and coordinates the functions of the body, that is, it receives information, interprets it, and sends commands for the body to react, in addition to acting with the senses (touch, vision, smell, hearing, and taste). Furthermore, it is responsible for encompassing the spinal cord and the brain. The second allows the connection between the CNS and the rest of the body, carrying motor and sensory

information, that is, respectively from the brain to the other organs and from the body to the brain.

Neuroanatomy, on the other hand, studies the structure of the CNS and PNS, seeking to understand their composition. It is in this branch of neuroscience that the function and importance of the cerebral amygdala (BLAIR, 2007) and the hippocampus (ALVES et al., 2022) in the study of psychopathy are understood. Finally, in neuropsychology, there is the pursuit of understanding brain function and human behaviors, that is, the union of psychology with neurology. This area is important for understanding general psychological disorders (AZEVEDO, 2016), including psychopathy and schizophrenia.

With these perspectives, studies indicate that pathological behaviors associated with psychopathy are directly related to neurobiological dysfunctions, especially imbalances in neurotransmitter systems (KIEHL, 2006), such as dopamine and serotonin, which play fundamental roles in the regulation of mood, impulsivity, and aggression (LORBER, 2004). Dopaminergic dysfunction may be associated with the pursuit of sensations and the difficulty in learning from punishments, while serotonergic alterations impact emotional regulation.

These neurochemical dysfunctions are compounded by structural alterations. Research

indicates that individuals with a propensity for homicidal behaviors and psychopathic traits exhibit dysfunctions in the ventromedial and dorsolateral prefrontal cortexes (RODRIGUES; DA SILVEIRA, 2023), regions involved in decisionmaking processes and the regulation of social behaviors. Moreover, there is a connection between psychopathy and the atrophy of areas in the limbic system (DE SOUZA; DE MATTOS, 2021), which are responsible for memory and emotion recognition (COSTA; LEITE; SOARES, 2023), particularly the amygdala, considered the starting point of this system (SALVADORSILVA et al., 2017).

However, it is not only biological characteristics that define this pathological disorder. Robert Hare and Adrian Raine, whose works advocate for the influence of external factors in the development of psychopathy, present complementary ideas about Antisocial Personality Disorder (ASPD) (FREITAS DA SILVA, 2016). According to them, growing up in a troubled environment, with aggressive or negligent parents, favors the repetition of violent behaviors and increases vulnerability to the disorder.

Imitating aggressive behaviors of others induces the child to become truly aggressive (GAO et al., 2010) toward people they dislike, thereby later developing psychopathic disorder and becoming antisocial (PORFIRIO; SILVA, 2021).

The factor of parental neglect directly affects the child's emotions and interpretations of the world, as parents guide them during childhood, proposing values and behaviors they deem appropriate (PORFIRIO; SILVA, 2021). However, without the support of relatives, there may be a cognitive failure regarding socialization, leading them to believe, for example, that their abnormal and aggressive behaviors are common to everyone (PORFIRIO; SILVA, 2021). Moreover, when the child realizes they are being neglected, they may develop the need to attract attention from others at all costs, becoming aggressive and antisocial, which enhances the development of the disorder (PORFIRIO; SILVA, 2021).

The identification of these neurochemical imbalances paves the way for the development of neurosensors capable of monitoring these markers in real-time²³, offering a window for a deeper understanding of psychopathy and, consequently, for the possibility of more targeted pharmacological or neuromodulatory interventions (YANG; RAINE, 2009).

2.2. Media relationship in the erroneous representations of the disorder

The previously mentioned Antisocial Personality Disorder can be misrepresented by the media, such as in television series, which stereotype it and associate it with murders and violent crimes. However, according to Arfeli, psychopathy is not necessarily

associated with violence (MILHOMEN; BORGES, 2023).

Robert Hare complements Arfeli's argument by stating that not all psychopaths are criminals and that, in reality, regardless of the psychopathic disorder, despite this (MOREIRA; ANZOLIN; TOZATTO, 2022).

According to Moreira, Anzolin, and Tozatto (2022), a large part of the knowledge the population has about psychopathy comes from social media. This data highlights the influence of the media in shaping perceptions about the disorder, which can generate both positive views, by emphasizing characteristics such as persuasion and sociability, and negative ones, when it is directly associated with criminality or extremism (MOREIRA; ANZOLIN; TOZATTO, 2022). The same study (MOREIRA; ANZOLIN; TOZATTO, 2022), conducted through the analysis of media publications and the survey of social perceptions, indicates that people tend to be more interested in deaths involving social interactions, such as murders, than in deaths resulting from natural accidents, such as shark attacks. In this context, the media often distorts the image of murderers by portraying them as psychopaths, contributing to a mystification of the disorder (FURHAM; LISTER, 2017). Thus, a stereotyped ideal of psychopathy is constructed, oscillating between the figure of the charismatic individual, capable of occupying prominent positions in companies (FIRMINO; BRAZ, 2020),

and that of the introspective subject, lacking a vision for the future and exhibiting antisocial traits. Such a stereotype limits the understanding of the diversity of manifestations of the disorder.

The case of Jeffrey Dahmer, also known as the "Milwaukee Cannibal" (COSTA; LEITE; SOARES, 2023), is taken as an example. Operating between the years 1978 and 1991, Dahmer was responsible for seventeen murders (COSTA; LEITE; SOARES, 2023) and the case contributed to the debate on severe mental disorders, psychopathy, and extreme behaviors (COSTA; LEITE; SOARES, 2023). In the media landscape, the characterization of the figure highlighted a relationship between sensationalism, public fascination, and the pathologization of criminal behavior. According to Richard Tithecott (1997), media coverage shaped the public image of Jeffrey as a "symbolic killer," as a figure of cultural villainy. This view gave the serial killer an almost mythological image (BRANCO; GIORDANO; LESTER, 2015), as Scott A. Bonn (2020), obscuring the critical understanding of his crimes. By focusing on the heinous and repulsive details of his crimes, the image that was created of the Milwaukee cannibal was, inevitably, sensationalist and far from reality (DONDE, 2002).

Public perception, shaped by high-impact cases, often reinforces the idea that psychopaths are

"irrecoverable," which can generate resistance to investments in research and the development of new therapeutic approaches. This deterministic view, fueled by the media, makes it difficult to accept that psychopathy, like any other disorder, can benefit from innovative interventions (FRICK et al., 2014).

2.3. Diagnosis, monitoring, and treatment: perspectives and challenges

The advancement of biomedical technology, with the emergence of biosensors, functional neuroimaging, and artificial intelligence systems, has expanded diagnostic possibilities in mental health. Biosensors are analytical devices that convert biological responses into measurable signals, based on the specific interaction between an analyte of interest and a biological element. In practice, they can be wearable devices (e.g., bracelets/patches) and/or clinical tests that monitor physiological and neurochemical markers, usually discreetly from third parties. In psychopathy, the application of biosensors represents an emerging frontier, with the potential to detect specific neurochemical biomarkers, such as dysfunctions in dopaminergic and serotonergic transmission, and reduced activity of the amygdala and prefrontal cortex (LINK et al., 2008). Wearable devices and artificial intelligence have a promising future (PESCOSOLIDO et al., 2010).

Individuals with marked psychopathic traits, especially those with high scores on the PCL-R (HARE, 2003) (scale of 0 to 40; higher scores indicate greater severity), demonstrate low emotional responsiveness, difficulty in forming therapeutic bonds, and a tendency to instrumentalize the relationship with the therapist. This compromises the effectiveness of interventions based on empathy, introspection, or cognitive restructuring (FRICK et al., 2014).

Scientific research advances in the search for effective therapeutic approaches (HARE; NEUMANN, 2008). The understanding of neurobiological bases, including neurotransmitter dysfunctions, suggests that psychopathy is not merely a matter of intrinsic human evil, but a complex set of characteristics that can be influenced (GLENN; RAINE, 2014). Although traditional psychotherapeutic treatments face challenges due to low emotional responsiveness and a tendency toward manipulation (HARRIS; RICE, 2006), the possibility of treatment through interventions aimed at modulating brain activity and neurotransmitter systems offers new alternatives (SALEKIN, 2002). This includes the development of pharmacological therapies that act on dopamine and serotonin, as well as neuromodulation approaches that aim to address dysfunctions in specific regions (DECETY; SKELLY; KIEHL, 2013).

The media representation of psychopathy, which often associates figures like serial killers and heinous criminals such as Jeffrey Dahmer, generates a profound stigma that directly affects the pursuit of treatment (FURNHAM; LISTER, 2017). This simplified and sensationalist view, instead of informing, instigates fear and marginalization, leading individuals who might exhibit psychopathic traits to fear social and professional judgment (FURNHAM; LISTER, 2017). The idea of being labeled as "psychopaths," a term laden with negative connotations and often misunderstood by the public, can inhibit the seeking of specialized help, even when there is recognition of behavioral or emotional difficulties. This reception of being equated with distorted media figures, like Dahmer, creates a significant barrier to accessing early diagnoses and therapeutic interventions, perpetuating a cycle of misunderstanding and lack of support (SARTESCHI, 2016). However, the accessibility of using these tools in the monitoring and treatment of psychopathy can be hindered by public perception: the idea of monitoring a psychopath, especially when associated with heinous cases like Dahmer's, can generate fear and distrust, instead of being seen as a tool for understanding and intervention (LINK et al., 2008).

Psychopathy, a complex personality disorder with neurobiological bases, faces significant challenges both in public understanding and in traditional therapeutic approaches. Media stigmatization, amplified by notorious cases like that of Jeffrey Dahmer, and the consequent distorted public perception, create an environment resistant to the acceptance of new technologies. In this scenario, the application of biosensors, although promising for more precise and early diagnosis and for the personalization of therapies, encounters the barrier of distrust and fear generated by the image of the psychopath as "irrecoverable." The effective clinical implementation of these technologies requires not only robust trials to prove their scientific viability but also a responsible approach to address the ethical and social impacts, such as stigmatization, misuse in legal contexts, and inequality of access. The future of psychopathy treatment, and the acceptance of tools like biosensors, lies in the ability of the scientific community and society to build a model of biomedical precision, social sensitivity, and ethical rigor.

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To what extent are traumatic factors in childhood and early behavioral patterns associated with the development of psychopathy and the formation of different profiles of serial killers, and what clinical pathways are viable for the intervention and treatment of these individuals?

Beatriz Brandão Rosian, Laura Adami Rodriguez, Maria Luiza Diniz Ramos, Mariana Perandini Paes e Victor Naoki Sampei

The present research addresses in a multidisciplinary manner the influence of adverse childhood experiences, such as physical abuse, emotional neglect, abandonment, and domestic violence, on the neurobiological, psychological, and behavioral development of individuals who exhibit extreme violent behaviors, especially serial killers. Based on a literature review, the analysis highlights the neurophysiological mechanisms involved, with an emphasis on changes in the amygdala, prefrontal cortex, and other brain regions associated with emotional regulation, inhibitory control, and empathy, often compromised in individuals with a history of childhood trauma (Teicher & Samson, 2016; Raine, 2013). The Macdonald triad and its relation to disruptive behavior disorders are discussed, highlighting the role of early intervention to curb the escalation of violence (Frick & Viding, 2009). The study also analyzes the MAOA gene and other genetic variants in the modulation of aggressiveness, emphasizing the interaction between biological predisposition and adverse environmental context (Caspi et al., 2002). The exposure of cases like Jeffrey Dahmer, Aileen Wuornos, and Ted Bundy allows for the construction of profiles that articulate emotional, biological, and social factors, avoiding the view of psychopathy as a deterministic condition. Finally, the importance of public policies, child protection networks, and evidence-based therapeutic models to prevent violent behavior is highlighted.

1. INTRODUCTION

Childhood represents the fundamental foundation for the biopsychosocial development of the human being. It is during this period that the neurological, cognitive, emotional, and social foundations are consolidated, influencing the construction of identity, adaptive skills, and social coexistence capacity (Shonkoff et al., 2012). The environment in which the child is placed plays a role in this process, as affection, stability, and care are essential elements for healthy development. However, when replaced by abandonment, neglect, or violence, the consequences can be profound and lasting.

A considerable number of children in different social contexts are exposed to severe adverse experiences, such as physical and sexual abuse, emotional neglect, and domestic violence. These experiences, classified as Adverse Childhood Experiences (ACEs), constitute risk factors for the impairment of neuropsychological development and the emergence of mental and behavioral pathologies, such as depression, personality disorders, and antisocial behaviors (Felitti et al., 1998; Anda et al., 2006). The scientific literature has shown that these experiences not only affect the emotional functioning of the child but also cause structural and functional changes in the brain, leading to vulnerability to the development of extreme violent behaviors (McCrory, De Brito & Viding, 2011).

Given this scenario, the present study proposes an integrative analysis that relates early traumatic experiences to genetic

predispositions and environmental factors in the emergence of extreme violence profiles, with special emphasis on serial killers as paradigmatic representations of this phenomenon. To this end, early behavioral patterns indicating risk, the neurobiological correlates of psychopathy, and the involvement of institutions, or their absence, in containing or exacerbating these trajectories are examined. Based on interdisciplinary evidence, the aim is to overcome reductionist conceptions and contribute to the delineation of more effective preventive and therapeutic strategies, capable of mitigating the impact of homicidal violence from childhood.

2. DEVELOPMENT

Adverse childhood experiences, such as abuse, neglect, and domestic violence, are stres sful events that impact the individual's neurological, behavioral, and adaptive development and cause changes in the brain and emotional capacities throughout life (Silva, 2009; Carvalho, 2021). The seminal study by Felitti et al. (1998), known as the Adverse Childhood Experiences (ACE) Study, demonstrated that repeated exposure to childhood trauma is associated with a higher incidence of psychiatric disorders, risk behaviors, and chronic pathologies in adulthood, such as depression, substance abuse, and interpersonal violence. This data demonstrates that the impacts of childhood violence are not restricted to the immediate period but constitute a persistent risk factor capable of compromising mental and social health throughout life. Thus,

understanding this correlation is essential to justify the need for prevention and early intervention policies.

The work of Teicher and Samson (2016) demonstrates that such traumas cause structural changes in the brain, including a reduction in hippocampal volume, which is involved in memory and emotional processing, and modifications in neural connectivity between areas that regulate stress. Moreover, dysfunctions in the hypothalamic-pituitary-adrenal (HPA) axis can generate exacerbated stress responses and hormonal changes that compromise emotional balance, affective regulation capacity, and social behavior, with a direct impact on regions such as the amygdala and the prefrontal cortex.

The amygdala is one of the structures responsible for threat detection and emotional processing, primarily fear. Hyperactivity can translate into an exacerbated sensitivity to negative stimuli and, consequently, provoke intense and disproportionate emotional responses (McCrory et al., 2011). In combination with hypoactivity or insufficient development of the prefrontal cortex, the region responsible for emotion regulation, rational decision-making, planning, and impulse control, a neurofunctional mismatch is created that hinders the modulation of emotions and adaptive behavior (Blair, 2010).

These imbalances reveal a dysfunctional brain adaptation to adverse contexts, which can delineate and affect behavioral patterns prone to the perpetuation of

violence and psychosocial difficulties (Silva, 2009; Carvalho, 2021).

Repeated and prolonged exposure to childhood trauma can lead to a process of affective desensitization, characterized by a reduction in the emotional capacity to feel empathy, remorse, and guilt, which are essential components for healthy social interaction and morality (Hare, 1999). This phenomenon occurs as an adaptive strategy to cope with psychic pain by disconnecting from negative emotions to survive, being characteristic of secondary psychopaths who often have a history of trauma, abuse, or adverse environments. According to Hare (1993), this group differs from primary psychopaths by exhibiting greater impulsivity, emotional instability, and risk-taking behaviors, which can be understood as responses developed in the face of painful experiences. Consequently, they exhibit manipulative, predatory, and impulsive behaviors.

Individuals with psychopathic traits do not internalize social norms nor do they feel guilt for their actions, which facilitates transgression without remorse. However, the occurrence of such behaviors cannot be understood in a deterministic manner, being modulated by intermediate variables such as high levels of impulsivity, deficits in affective empathy, cognitive distortions that justify violence, as well as contextual factors associated with adverse social environments. Although the absence of remorse constitutes a central characteristic of psychopathy, the behavioral expression of this trait depends on the interaction between individual predispositions and specific

environmental conditions (Hare, 1993). This combination of affective desensitization and self-control deficits creates a potentially dysfunctional and dangerous behavioral profile (Carvalho, 2021; Hare, 1999).

The Macdonald Triad, initially proposed in the 1960s, is a clinical and criminological marker for identifying children at high risk for developing violent and antisocial behaviors in adulthood. This triad encompasses three specific behaviors: persistent enuresis (bedwetting beyond the expected age), pyromania (compulsive firesetting behavior), and cruelty to animals, which together suggest a pattern of emotional and social difficulties. These behaviors indicate that the child may be suffering from unresolved emotional issues, difficulties in affective regulation, and a possible early rupture with internalized social norms (Macdonald, 1963). The persistence of these behaviors, especially when observed in dysfunctional family contexts, serves as a warning for mental health and education professionals, as it is associated with an increased likelihood of involvement in violent crimes and psychiatric disorders, such as Conduct Disorder (CD). Although the triad is not a definitive diagnosis, its early recognition can facilitate preventive interventions that interrupt the trajectory toward violence, proving to be a valuable tool in the field of prevention (Silva, 2009).

The behaviors that make up Macdonald's Triad show a strong link, correspondence with the symptoms of Conduct Disorder (CD) and Oppositional Defiant Disorder

(ODD), both characterized by persistent patterns of defiant, aggressive, and antisocial behavior. CD involves repeated violations of others' rights and social norms, including physical assaults, theft, and property destruction, while ODD manifests through challenging, provocative, and hostile behaviors primarily directed against authority figures (American Psychiatric Association, 2013). Longitudinal studies show that children who exhibit the triad and diagnoses of CD or ODD in childhood are more likely to develop serious criminal behaviors and, in some cases, to develop psychopathy (Vieira, 2020).

However, not all children exposed to these factors exhibit the same progression, which has led research in neuroscience and genetics to investigate possible biological mechanisms that modulate this vulnerability. The MAOA gene, which encodes the enzyme monoamine oxidase A, responsible for the metabolism of neurotransmitters such as serotonin and dopamine, is widely studied for its relationship with impulsivity, aggressiveness, and violent behavior, especially when interacting with adverse environmental factors. The research by Caspi et al. (2002) was pioneering in demonstrating that individuals with the low-activity variant of MAOA are at greater risk for aggressive behaviors and delinquency only if exposed to maltreatment in childhood, highlighting the importance of geneenvironment interaction for the manifestation of violent behavior. Subsequent studies confirmed that low activity of the MAOA gene is associated with a reduced ability to regulate emotions and impulses, increasing the risk of intense

aggressive responses to environmental stressors (Silva, 2009). This epigenetic model shows that genetics alone does not determine behavior, but that gene expression can be modulated by the environment, bringing significant implications for the prevention and treatment of violence.

It is imperative to highlight that, despite the robust evidence linking certain genes to traits of aggression and psychopathy, genetics should never be seen as deterministic. Human behavior is the result of the dynamic interaction between genetic predispositions and the environment, where social, familial, and cultural factors modulate gene expression and neural circuits (Raine, 2013) For example, individuals with genetic vulnerability to impulsivity may exhibit adaptive behavior if placed in stable environments, while the same genetic risk can be exacerbated in adverse environments, resulting in psychopathic traits and violent behaviors.

James Fallon, an American neuroscientist, inadvertently discovered that he has a brain and genetic pattern compatible with psychopathy without ever exhibiting violent or antisocial behaviors (Fallon, 2013). The explanation for this apparent contradiction lies in the healthy and stimulating family environment in which he was raised, which acted as a protective factor capable of neutralizing the expression of his biological predisposition. Fallon emphasizes that genetics is not an immutable destiny, and that the environment, especially in the early stages of life, can reconfigure the risk for adaptive outcomes. This case illustrates the

importance of rejecting simplistic and deterministic interpretations and considering biography and social context for understanding psychopathy and violence. The profile of Aileen Wuornos, an American serial killer convicted of murdering seven men, is paradigmatic in illustrating how the confluence of childhood traumas, institutional failures, and biological predispositions can result in trajectories of extreme violence, but with distinct characteristics. Dahmer had a childhood marked by social isolation and family difficulties that possibly contributed to his instrumental psychopathy, where the homicidal act is planned and devoid of emotion (Schmid, 2005). On the other hand, Aileen Wuornos suffered sexual abuse, abandonment, and domestic violence, which may have contributed to the development of reactive and defensive psychopathy, with homicides motivated by selfprotection and retaliation against a world perceived as hostile (Michaud & Aynesworth, 1999). These cases reinforce that extreme violence can arise from multiple pathways and that preventive interventions need to be personalized according to individual profiles and contexts.

Contemporary criminology highlights the heterogeneity of serial killer profiles, evidencing that these extreme homicidal behaviors emerge from multiple combinations of traumatic, biological, and social factors (CUNHA et al, 2022).

The reactive profile, associated with severe trauma and chronic violence in childhood, is characterized by homicides motivated by intense emotions of self-protection or retaliation, without pleasure in the act, as exemplified by

Aileen Wuornos (REALE et al., 2022). The controlling profile, in turn, seeks to compensate for childhood helplessness through domination and control as well as by resorting to violence as an instrument of power, which can be illustrated in cases like Ed Kemper (CUNHA et al., 2022).

The cold psychopathic profile, on the other hand, demonstrates instrumental psychopathy, with calculated homicides, lack of empathy, and pleasure derived from emotional desensitization, as seen in Jeffrey Dahmer (REALE et al., 2022). Finally, the hedonistic profile represents "pure" psychopathy, without apparent traumas, driven by pleasure, sexual excitement, and a sense of power, illustrated by Ted Bundy (Michaud & Aynesworth, 1999). These profiles indicate that extreme violence is not possibly the product of a single cause, but of multiple interactions that require diverse approaches for understanding and prevention.

The analysis of these profiles reveals that homicidal behavior can have diverse origins, including untreated traumas, biological predispositions, neuropsychological dysfunctions, and negligent social contexts. Even tho the motivational and emotional mechanisms may vary, from explosive rage to cold and calculated pleasure, all profiles converge to a central point: early vulnerability, whether emotional, social, or neurobiological. When unrecognized and untreated, it creates fertile ground for the emergence of extreme violent trajectories (REALE et al., 2022). This finding demystifies the simplistic idea that serial killers "are born monsters" and reinforces the need for integrated interventions that act

from childhood to break these cycles (Carvalho, 2021).

The lack of effective clinical and social interventions in the childhood of children who already exhibit psychopathic traits or disruptive behavior patterns, especially in contexts of family neglect, domestic violence, and social exclusion, is a recurring factor in trajectories that culminate in violent behavior. Evidence suggests that early interventions, such as Parent-Child Interaction Therapy (PCIT), parental training programs focused on emotional sensitivity, and school initiatives that promote socioemotional skills, can prevent the consolidation of antisocial patterns and significantly reduce the risk of progression to delinquent behavi ors.

In this sense, the importance of public policies aimed at children and adolescents in psychosocial risk situations is emphasized, focusing on the early identification of signs of vulnerability and the promotion of healthy emotional bonds. The complexity of serial violence also requires multidisciplinary approaches that integrate knowledge from criminology, psychology, neuroscience, and social assistance, in order to formulate more effective preventive and interventive responses (Blair, 2010).

For this, integrated clinical interventions have proven effective. Cognitive Behavioral Therapy (CBT), for example, contributes to the restructuring of dysfunctional thought patterns and the development of emotional and social skills (Kazdin, 2010). Neurofeedback acts on neurophysiological self-regulation, promoting emotional control and impulsivity management (Hammond,

2011). Intensive parental programs, which involve the family in the therapeutic process, strengthen the home environment, making it more stable and conducive to behavioral change [Parent–Child Interaction Therapy (PCIT)].

International experiences such as the Fast Track Project, Incredible Years, and Multisystemic Therapy (MST) reinforce the importance of intersectoral and continuous approaches. These programs operate at multiple levelsfamily, school, and community - and combine clinical, educational, and social interventions to reduce violent behaviors and promote socioemotional competencies (Conduct Problems Prevention Research Group, 2010).

Psychopathy, when detected in adulthood, shows low responsiveness to treatment due to the consolidation of traits and resistance to change (Hare, 1999). In contrast, childhood offers a critical window of neuroplasticity and emotional malleability, making it possible to reconfigure neural circuits and modulate dysfunctional behaviors. The construction of secure therapeutic bonds, associated with a protective family and social environment, increases the chances of intervention success and reduces the likelihood of evolving into chronic violent behaviors.

Understanding the genesis of violent behaviors requires an integrated perspective, in which genetic, neurobiological, emotional, and social factors interact dynamically to shape human development (Beauchaine & Zalewski, 2016). This systemic view

allows for the formulation of more effective prevention strategies, with coordinated actions between different sectors of society, and the more efficient allocation of public resources.

It is important to emphasize that genetic predispositions or early traumas do not, in isolation, determine the emergence of violent or homicidal behaviors. The presence of protective factors, such as healthy emotional bonds, social support, access to mental health services, and educational opportunities, can significantly neutralize or mitigate these risks (Raine, 2013). Longitudinal studies demonstrate that many vulnerable individuals develop adapt ive trajectories when placed in favorable contexts.

3. CONCLUSION

Throughout this study, it was assessed that the development of extreme violent behaviors, such as those exhibited by serial killers, cannot be attributed to a single cause, but rather to a network of interdependent biopsychosocial factors. Neuroscientific evidence demonstrates that childhood traumas significantly affect brain plasticity and crucial regions for emotional regulation, empathy, and impulse control, fundamental elements for moral and behavioral development (Teicher & Samson, 2016; Raine, 2013). These functional deficits partly explain characteristics observed in individuals with psychopathic traits, such as affective desensitization, impulsivity, and lack of guilt (Hare, 1999; Blair, 2010).

Moreover, the early screening of indicative behaviors, such as Macdonald's triad, along with the diagnosis of disruptive disorders in childhood, constitutes an essential preventive strategy for effective clinical intervention (Frick & Viding, 2009). The influence of genetic factors, especially the MAOA gene variant associated with aggression, reaffirms the need to consider the dynamic interaction between biological inheritance and adverse environmental context, rejecting absolute genetic determinism (Caspi et al., 2002; Raine, 2002).

The analysis of real profiles, such as the cases of Jeffrey Dahmer, Aileen Wuornos, Ed Kemper, and Ted Bundy, exemplifies the heterogeneity of violent trajectories, which can result both from the overlap of childhood traumas and biological predispositions, as well as from the pure manifestation of innate psychopathy, devoid of a recognized traumatic history (Fallon, 2013; Schmid, 2005). In all cases, the absence of social protection networks and institutional failures exacerbated vulnerabilities and led to the perpetuation of cycles of violence and social marginalization (Oliveira & Silva, 2017).

Given this, this study highlights that addressing extreme violence must begin in childhood, a phase in which neuropsychological plasticity offers a crucial window for prevention and rehabilitation, as psychopathy shows low responsiveness in adulthood (Frick & Viding, 2009). In this context, intersectoral public policies aimed at the comprehensive protection of children are essential, such as Cognitive-Behavioral Therapy and intensive parental interventions

(Kazdin, 2010; Hammond, 2011). Addressing this problem should be conducted as a collective, multidisciplinary, and systemic effort, promoting safe environments conducive to healthy development, as well as ensuring continuous support for vulnerable populations.

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History of Video Games in Brazil: Correlation between the

Popularization of Video Games and Brazilian Economic Development.

Jean Michel Dornelas Salem Sugui

This article focuses on analyzing the history of video games in Brazil, in dialog with Brazilian socioeconomic history and its indicators. In understanding the history of video games in Brazil, it is notable that the characteristics of the national market have affected both positively, with the influence of TecToy in the national market along with exclusive Brazilian games, and negatively, with the constant presence of piracy since NES clones and the pirated games of Sony consoles in the 90s and 2000s. Today, this market directly influences the Brazilian economy and it is of notable importance to Brazilian retail.

1. INTRODUCTION

In the early 1980s, the world witnessed an era of video game popularization, mainly with the Atari 2600, which sold 25 million units in five years (SOUZA and ROCHA, 2005). The console, however, due to a repetition of concepts and graphically unpolished games, such as the port of Pac-Man for the console in 1982 and E.T., based on the movie of the same name released in 1982 at Christmas, caused the home console market in 1983 to go through a crisis known as the "Atari Shock," creating a rejection of electronic games by the public around the world (DE SOUZA, 2024).

Brazil, however, distant from the reality of other nations, with a protectionist and little variable market encouraged by the military regime, had little impact from the new video game market, not going through a crisis similar to that of the United States (FERREIRA, 2020).

Brazil, distant from this reality, was a nation with a high IPCA, exceeding 1,764.83% in 1989, a poverty rate of 43.57%, a growing external debt of 121.188 billion dollars, a dollar reaching a value close to 16,000 cruzeiros by the end of the 80s, and other social problems (IBGE, n.d.). Economically, the government followed protectionist and interventionist trends, facing difficulties in importing video games and arcade machines into the national territory (PEREIRA, 2017). However, after the return of a democratic regime and the

implementation of neoliberal measures carried out during the governments of Collor, Itamar Franco, and Fernando Henrique Cardoso (NEGRÃO, 1996), video games became a significant part of the national market (MENDONÇA, 2019).

Therefore, in recent decades, video games in Brazil have undergone a significant evolution, gaining greater relevance in the electronic games market. As a result, various companies began to adapt and translate their games for Brazil and distribute them to the national market (SOUZA, 2015). This market, thus, becomes an important topic for the movement of the Brazilian economy and its efficiency (NEWZOO, 2023).

Hence, considering Brazil's increasing interaction in the video game market, this article aims to relate the popularization of video games in Brazil, along with the economic policies handled by the federal government and their cultural consequences and impact on the consumption of consoles in Brazil.

2. DEVELOPMENT

2.1. First and second generation of video games

In 1958, the first game in history emerged, created by physicist Willy Higinbotham, named Tennis Programing, in which it was possible to play on an oscilloscope (AMORIN, 2006). A few years later, in 1961, at the Massachusetts Institute of Technology (MIT), the institute's

researchers created Spacewar! a game set in a space war, where players had to face enemy ships (SOUZA and ROCHA, 2005).

In 1972, the first console in history, the Odyssey 100, was released by Raph Baer, offering the choice of 12 games, all based on sports, in addition to containing a commercial rifle to be used in shooting games of the time (SOUZA and ROCHA, 2005). The console sold 100,000 copies and 20,000 rifles; however, within a few years, the console stopped being sold and being frequently used due to its low variety and simplicity (CLUA and BITTENCOURT, 2005).

The Odyssey, to be able to play more than one game, required mechanical operations, such as removing the printed circuit boards (BRESCIANI, 2001). Thus, to avoid problems, in 1976, the first console in history to be considered programmable emerged, the FairChild Channel F, eliminating the need for a complex process to change games, but only requiring a cartridge swap (NEWORAL, 2022).

Nolan Bushnell, in 1977, in the United States, launched the Atari VCS console, which would later be renamed the Atari 2600. This was the console that popularized video games, with games that stood out on the console, such as Pitfall!, Asteroids, and Adventure. However, despite the initial success, the oversaturation of consoles in stores, along with poorly detailed games, caused the video game market to

enter a recession in 1983 (KENT, 2001).

In Brazil, however, unlike the countries of the Global North such as the United States, the situation was different, both in the domestic console market and in the country's socioeconomic reality (FERREIRA, 2020).

2.2. Brazilian economic scenario at the end of the 70s and the beginning of the 80s, and the early years of video games in Brazil

The Brazilian economy at the end of the 70s and the beginning of the 80s was mainly marked by a rise in inflation after several years of stability, going from 15.5% in 1973 to 211% in 1983 (BAER, 1987). The number of informal workers increased from 41.9% in 1981 to 47.2% in 1983, and Brazil's external debt grew as a consequence of the second oil shock in 1979 and the rise in international interest rates. On the other hand, per capita GDP indices grew by 81% in the 1970s, but in the first four years of the 1980s, they fell by 13%, stabilizing until the early 1990s (OMETTO; FURTUOSO; SILVA, 1995).

Figure 1: Distribution of families according to household income in Brazil, from 1979 to 1990: average

household income (M), Gini index (G), percentage of income corresponding to the poorest 50% (50⁰), the richest 10% (10⁺), and the richest 5% (5⁺), percentage of the poor (H)

As shown in Figure 1, income inequality among families was also critical, as demonstrated by the GINI index (OMETTO; FURTUOSO; SILVA, 1995). In 1986, as a result of the Cruzado Plan, which included a freeze on prices and partially on wages, and the introduction of a new monetary unit, it managed to improve economic and social indicators in the short term, but the actions of the plan were inefficient in the long term and caused these figures to revert to their previous levels (BAER, 1987).

In this scenario of social problems and economic crises, video games began to enter the Brazilian retail market in a limited manner, facing barriers to their commercialization. The Brazilian economy made it difficult for products to be imported into Brazil through restrictive customs policies, which had been in effect since the Vargas government, with some barriers being abolished by the Castelo Branco government, only to be quickly restored under the Costa e Silva government (PEREIRA, 2017).

At the end of the 1970s, the market reserve policy was put into effect, which restricted the importation of electronic components by national companies for the manufacturing of their products, especially those related to computing or

microelectronics, also prohibiting foreign companies in these sectors from selling their products in Brazil. It was also prohibited for Brazilian companies to send royalties to foreign companies (MARQUES, 2000).

With this market scenario, video games took a long time to be commercialized in Brazil compared to other countries, such as the United States, with the first Brazilian home console emerging only in 1977, which was the Telejogo, manufactured by Philco-Ford, following the Pong style seen in firstgeneration consoles, which included three games: Paredão, Tennis, and Soccer, with two paddles built into the console itself. In 1979, its successor Telejogo 2 was launched, which came with 10 games: Hockey, Tennis, Paredão I, Paredão II, Basketball I, Basketball II, Soccer, Barrier, Target Shooting I, and Target Shooting II. Now, with two joysticks that were permanently connected to the console. For the second generation, due to the impossibility of importing the Atari 2600, solutions were created through reverse engineering. Units of the Atari 2600 were brought from the United States by managers and engineers, and they began manufacturing consoles similar to the Atari 2600, mixing national and imported components (FERREIRA Emmanoel, 2017). Thus, in 1980, the company Atari Eletrônica Ltda. launched the first clone of the Atari 2600 in Brazil, naming it the CX-2600 (CHIADO, 2013).

However, beyond the console, games were needed, and with this demand, small companies began to clone Atari 2600 cartridges, not only for the clones but also for the demand from Atari 2600 owners, coming from upper-middle-class families who had the possibility to travel abroad and buy the console outside Brazil, making it easier for these consumers to purchase games (FERREIRA Emmanoel, 2017). Among these cartridges, there were those of dubious quality, as well as differentiated cartridges, such as those from Tron, which provided consumers with a kind of handle that made it easier to remove the cartridge from the console. Others translated the titles and manuals of the games, as was the case with Atari Eletrônica Ltda. (CHIADO, 2013).

In April 1983, Gradiente, together with Warner, which at the time was the holder of the American Atari, officially produced the Atari 2600 in Brazil, overcoming the limitations imposed by the federal government. However, the late launch of the official Atari in Brazil made it necessary for Gradiente to run a major marketing campaign, highlighting the differences between the official console and the clones, with slogans like "The Atari from Atari," in addition to reinforcing to consumers that the delivered product would be better because it was original. The extensive distribution and technical support network of Gradiente present in the country would also be available in case

repairs or support for the console were needed (FERREIRA, 2020).

In 1985, similar to the United States in 1983, sales of home consoles began to decline. Thus, microcomputers, small and low-cost computers that ran various software, including games, began to gain prominence as an alternative to home consoles in Brazil, with the Japanese MSX standard being one of the most popular. Cloned by companies like Gradiente and Epcom, these microcomputers offered technical specifications that allowed for greater graphical, sound, and gameplay variety compared to those available on Atari video games. The parallel market in cassette tapes and floppy disks further popularized this alternative. Even outside the realm of home consoles, the MSX played an important role in the national gamer culture (FERREIRA Emmanoel, 2017).

Still in 1985, in the United States, the Nintendo Entertainment System was officially launched, once again popularizing the video game market in the North American country (BATISTA et al., 2007). In Brazil, on the other hand, the Market Reserve prevented the direct importation of these products, which indirectly encouraged the practice of cloning Nintendo consoles, leading to the emergence of several national NES clones at the end of the 80s, the most famous of which was the Phantom System by Gradiente, the former official distributor of Atari in Brazil. After encountering partnership

issues in marketing the Atari 7800 in the national market, they used the console's casing and employed a design similar to Sega's Mega Drive when creating the controller. Another important clone was the Dynavision II, from Dynacom, compatible with 60-pin cartridges from the Japanese Famicom and, through adapters, with 72-pin American cartridges. National companies also produced their own cartridges, just like in the Atari era, modifying labels, titles, and even the content of the games to avoid legal issues. An example is Super Mario Bros., renamed as Super Irmãos or Super Mário by different manufacturers, with visual alterations on the title screen and removal of the original credits (FERREIRA Emmanoel, 2017).

Figure 2: Left: Original Super Mario Bros. (Nintendo); Center: Super Irmãos (Gradiente/Phantom System); Right: Super Mário (Dismac).

Figure 3: Left: opening screen of the original Super Mario Bros. (Nintendo)

Center: opening screen of Super Irmãos (Gradiente/Phantom System) with the game title logo removed; Right: opening screen of Super Mário (Dismac), with the game title altered.

2.3. The influence of Sega and TecToy on the Brazilian prospect and Nintendo's late entry into Brazil.

The NES clones, however, were not the only ones in the Brazilian market during the third generation of video games, as Sega, unlike Nintendo, officially brought its video games to Brazil. Sega was excluded from the American and Japanese markets in foreign markets because Nintendo had exclusive contracts with studios, producing games exclusively for their console (CHAUVEAU, 2022). Nintendo, in this situation, dominated the market by 90% in the United States (KENT, 2001). Accordingly, Sega was looking for a market that would provide the opportunity for success, and Brazil was an option, despite obstacles such as high taxes. Thus, the Master System was officially launched in Brazil before Nintendo, in 1989, costing around 630 dollars. To avoid taxes, Sega partnered with a recent company called TecToy, which had already produced another Sega product, the SEGA Zillion (CHAUVEAU, 2022).

In order to bring Brazilians closer to their products, Sega in Brazil granted Tec Toy autonomy for game translations, as well as for modifications, altering not only the texts in the games but also their sprites and scenarios, as seen in

Sapo Xulé vs Os Invasores do Brejo (1995), a modification of the game Psycho Fox (1989), or in a more drastic example, such as Mônica no Castelo do Dragão (1991), an appropriation of Wonder Boy in Monster Land (1987), with the character Wonder Boy replaced by the Brazilian comic book character Mônica, and his sword being swapped for her plush bunny. Unlike the previous example, the game's narrative was also altered: instead of saving the world from chaos and destruction, the player's objective became to prevent the villain Capitão Feio from polluting the world. (AMARO & FRAGOSO, 2020).

In addition to translations and proprietary games, Tectoy adopted other marketing strategies for the Master System. According to Stefano Arnhold, CEO of Tectoy, the idea was to make the console and SEGA an exclusive club in Brazil. The owners of the Master System had access to arcade competitions, special events, a phone line available 24 hours a day for game tips, and technical assistance. Tectoy also sponsored a TV program on Rede Globo with game tips for the Master System called "Master Dicas," during children's programming hours (CHAUVEAU, 2022).

Between November and December 1990, TecToy brought the company's latest video game to the country, the Mega Drive, promoted with an emphasis on its 16-bit processing capability, superior graphics, and stereo sound. The

console managed to stand out in the market, using similar marketing techniques as those employed with the Master System, with the program "Master Dicas," which was replaced by "Sega Dicas," including Mega Drive games in the program (DAS VIRGENS, 2019).

Nintendo entered the market in 1993, in partnership with Playtronic (a joint venture between Estrela and Gradiente) (AMARO & FRAGOSO, 2020). This entry happened mainly due to the revocation of the Market Reserve made during the Collor government, which proved to be inefficient and left Brazil technologically outdated, expensive, and dependent on reverse engineering of foreign models. Thus, Nintendo entered a market dominated by clones and Sega consoles (LUZIO & GREENSTEIN, 1995). In addition to the competition, Brazil had high inflation, making it even more difficult for Nintendo's consoles to sell, as they coexisted in establishments with older and cheaper video games, such as clones and Sega consoles (DAS VIRGENS, 2019).

2.4. Real Plan and its impact on the national video game market in the fifth and sixth generations of home consoles.

Despite the growing popularity of video games in Brazil, especially among Sega consoles and clones, inflation hindered the development of this market, with the annual IPCA in 1993 being 2,477.15%, and it continued to rise (IBGE, n.d.). The

federal government, in this scenario, tried to combat inflation through various plans, namely: Cruzado Plan (1986), Bresser Plan (1987), Summer Plan (1989), Collor Plan I (1990), and Collor Plan II (1991) (BRITO; AGUIAR, 2018).

Faced with the hyperinflation scenario and the succession of various plans that were ineffective, Itamar Franco's government began to adopt a new approach. In 1994, under the leadership of then Minister of Finance Fernando Henrique Cardoso, the Real Plan was launched, with its planning divided into three phases: fiscal adjustment, the creation of the Real Unit of Value (URV), and finally, the introduction of a new currency, the Real. Distant from other plans that focused on price freezes or confiscation of financial assets, the Real Plan contained inflation, based on the credibility of the currency and the balance of public accounts (IANONI, 2009).

Figure 5: Values of the poverty lines relative to the specified dates for the six metropolitan regions investigated by the PME.

Figure 6: Evolution of Sales of Perishables and Grocery in Supermarkets in São Paulo from January 1993 to February 1997.

Quickly, the plan proved to be successful, reducing the IPCA to 22.41% annually in 1995, far from the 2,477.15% annually in 1993 (IBGE, n.d.). In this context, poverty decreased, as shown in figure 5, where the data demonstrate the appreciation of the minimum wage and the reduction of people below the poverty line, and consequently, consumption increased, as shown in the graphs of figure six, indicating an increase in the sale of products, such as food items.

With a more flexible market opening, along with a more stable economy post-Real Plan, video game consumption also increased, becoming more accessible to consumers (PASE, 2013). However, it was not only liberal public policies that boosted video game consumption in Brazil; simultaneously, CDs helped in this process, as they had more storage space and gradually became more accessible to consumers, being used as the main medium in fifth-

generation consoles, such as the Sega Saturn and Sony's first home video game console, the PlayStation. Nintendo, unlike its competitors, launched the Nintendo 64, which still used cartridges as media; however, it was technically more advanced, composed of a 64-bit processor, compared to the 32-bit processors of its competitors (DAS VIRGENS, 2019).

According to Pase (2013), in Brazil, with smuggling present at the border with Paraguay, game media were often pirated. However, unlike the cartridges used previously, CDs could be replicated with a computer, not necessarily requiring a largescale industry for their reproduction. In other words, even though the raw material was Paraguayan, smugglers could now reproduce the games on CDs within Brazil itself, in offices located in the outskirts or commercial buildings in the city center. With the large production of pirated games on CD, the games were transported in small plastic bags and sold on streets and squares dominated by smuggling (PASE, 2013).

One of the most notable places for such practice is Santa Ifigênia, where various counterfeit items are sold, in addition to video games, such as bags, watches, perfumes, fashion accessories, toys, and others (UNITED STATES TRADE REPRESENTATIVE, 2024). Such smuggling made consoles that did not use CDs, like the old Sega consoles and the

Nintendo 64, become elitist products, as they were more restricted to parallel trade, in addition to being sold in specific stores and consequently being more expensive. The Sega Saturn, despite using CDs like Sony's PlayStation, also suffered from this problem, as its games were sold exclusively in stores selected by Tectoy, which were more elitist, hindering the console's popularity (PASE, 2013). Furthermore, its official launch price was $899.99, with games ranging from 60 to 70 reais (DAS VIRGENS, 2019), making it inaccessible for many Brazilians, especially those earning the minimum wage, which in the year of the Sega Saturn's launch was 100 reais (IBGE, n.d.). Thus, due to its high price and limited variety in its game collection as a result of its programming complexity, the Sega Saturn not only sold poorly in Brazil but also had weak sales in all countries, leading Sega to retire the console prematurely and launch the Dreamcast in 1998 (BATISTA et al., 2007).

The Dreamcast, however, despite its innovations (such as the introduction of GD-ROMs, media that had more space for content than the CDs used in the PlayStation, and the ability to play online and access the internet through the SegaNet service), did not succeed in the market for reasons similar to those of the Sega Saturn. As a result of these events, SEGA decided to exit the home console market (DEEMING; MURPHY, 2017).

With the launch of the Nintendo GameCube, Nintendo had difficulties integrating into the console market, failing to attract the audience with its marketing and its games considered infantilized by the public (BARNETTE, 2022). In Brazil, the reality was no different, and the console did not succeed in retail. Consequently, due to these sales results, Gradiente ended its partnership with Nintendo in 2003, discontinuing the production and distribution of the current console in the Brazilian market. (DAS VIRGENS, 2019).

Sony, with the PlayStation and PlayStation 2, unlike Nintendo, even though it did not officially sell its consoles in Brazil until the 2000s, dominated a considerable part of the video game market because smuggling made the consoles and games from the Japanese company more accessible (PASE, 2013). The pirated games, in addition to being cheaper, were also marked mainly by having modifications, such as in the cases of Grand Theft Auto and the well-known Bomba Patch, a modification of Pro Evolution Soccer/Winning Eleven (MOTA, 2017).

2.5. Latest generations of video games in Brazil and the fight against piracy.

The commercialization of video games in Brazil and their popularization, both through economic development and smuggling, made the use of consoles

more prevalent in Brazilian culture (MOTA, 2017).

The piracy scenario, despite having popularized an elitist market before, still needed to be combated. In 2013, the National Forum Against Piracy and Illegality released an estimate that 82% of video games sold in Brazil were pirated (FERREIRA Vinícius, 2017). In this scenario, some actions were taken, both by companies and the government (PASE, 2013).

Video game consoles became more difficult to unlock for running pirated games, as in the case of the PlayStation 3, Sony's seventhgeneration console, where its unlocking, although possible, was more time-consuming and complex to perform than in the previous console (BENADJILA; RENARD, 2016).

The other two seventhgeneration consoles, Wii and Xbox 360, despite being hacked and their games pirated, the recorded amount was already lower compared to previous generations (TSOTSORIN, 2012). Much of this was due not only to the companies' protection against unlocking but also to government actions, such as the work of the National Council for Combating Piracy (CNCP), which promotes coordinated operations between the Federal Revenue Service, Federal Police, Highway Police, and ANVISA, especially focused on physical goods like parallel CDs and DVDs (BRAZIL, 2017). In addition to promoting tax reductions, as done in

recent years, such as the reduction of the IPI by Decree 9.971/2019 (BRAZIL, 2019) and by Decree 10.532/2020 (BRAZIL, 2020), which consequently lowers the price of games and makes their acquisition possible.

In addition to making it difficult and promoting campaigns against piracy, companies, in an attempt to discourage unlocking, promote more frequent sales of games in their digital stores, which is an effective strategy to discourage consumption from the parallel market (REIS; CHAGAS; FILHO, 2025).

These actions did not discourage console sales; on the contrary, the video game market in Brazil continues to grow and become increasingly important to Brazilian retail, selling approximately R$ 3.2 billion in 2023 (NEWZOO, 2023). The consumption is such that about 73.9% of the Brazilian population plays video games, and of these, 85.4% of the respondents consider electronic games one of the main forms of entertainment, and 70.8% take pride in their gamer identity (SIOUX GROUP et al., 2024).

In addition to consumption, Brazilian game studios have grown in recent years, with Brazil going from 133 studios in 2014 to 1,042 in 2024, representing a 683.4% increase in a decade (ABRAGAMES, 2024). This index may increase in the coming years, especially with the ratification of the Legal Framework for Electronic Games, which aims to

encourage market innovation in Brazil (Law No. 14,852, of 2024).

3. CONCLUSION

When analyzing the history of video games in Brazil, along with the economic development of that period, it is observed that the economic guidelines adopted by the federal government influenced the electronic games market in Brazil, from the first clones resulting from the Market Reserve to the expansion of electronic game consumption following the resolution of hyperinflation with the Real Plan.

Additionally, challenges arise, such as combating piracy, which, since the early days of home consoles in Brazil, has remained present in the market, albeit on a smaller scale in recent years.

Video games have also exerted cultural influence in Brazil, as observed in national games, seen in TecToy's releases on Sega consoles, in game modifications on the Playstation 2, and in the recurring new games created by Brazilian companies. This cultural impact is mainly reflected when analyzing that more than half of the population consumes this product regularly.

Consequently, the video game market in Brazil is important, generating billions of reais every year, being relevant within the national market, especially with current laws aimed at encouraging this sector in the country.

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The development of socio-emotional skills and competencies through UN simulations for high school students

Letícia dos Santos Alencar, Amira Sopri Salem e Arthur Mota da Silva

This article addresses the use of United Nations (UN) simulations as a pedagogical practice applied in high school, focusing on the development of students’ socio-emotional skills. The characteristics of these activities are explored, which involve the engagement of participants in dynamics of dialog, negotiation, empathy, and decision-making in simulated environments that aim to represent real and complex situations. The text presents the different competencies that can be exercised through these simulations, such as communication, self-control, social awareness, and teamwork. Furthermore, the potential contributions of these experiences to the holistic development of students are discussed, as well as the possibilities and challenges related to the integration of these pedagogical practices in educational institutions. The article also considers the current educational context and the search for innovative methodologies that can promote more meaningful, participatory learning aligned with contemporary social demands, with the aim of supporting educational institutions in reflecting on and considering the application of these simulations in their curricula.

1. INTRODUCTION

Simulations of the United Nations (UN), also known as Model United Nations (MUN), are immersive educational activities that involve debates and international negotiations in UN committees on relevant global issues such as the environment, human rights, world security, public health, among others, allowing students to take on the role of diplomats (Dimitriu & Connolly, 2021). This type of experience promotes not only learning about international relations and global politics but also the enhancement of skills such as empathy, conflict resolution, teamwork, and critical thinking (ROBINSON; WHEELER, 2019).

In the educational context, there may be a growing concern in developing students' emotional intelligence and interpersonal skills, essential aspects for academic, professional, and social life (CHAMIZO-NIETO et al., 2021). Given that UN debates provide a dynamic and challenging environment, it is important to understand how these experiences contribute to the personal and emotional growth of the participants.

Furthermore, socio-emotional competencies refer to a set of skills that involve recognizing and regulating one's own emotions, establishing healthy relationships, and making responsible decisions. For the purposes of this research, the perspective of CASEL (Collaborative for Academic, Social, and Emotional Learning) is adopted, an organization that is a reference in the systematization of social-emotional learning and is responsible for the development and systematization of the concept of Social Emotional Learning (Lawson, 2019). According to this perspective, the competencies are structured into five core domains: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making (CASEL, 2020). These domains will be adopted as the theoretical framework for the analysis conducted in this study.

Considering the presented elements, a consistent analysis allows for the conclusion that UN simulations, by proposing negotiation, public speaking, and conflict resolution situations in an academic environment, create favorable conditions for the development of socio-emotional

skills (FILHO, 2024). The dynamics of these events require participants to possess skills such as selfmanagement in high-pressure contexts, social awareness in the face of multiple perspectives, and responsible decision-making in situations that simulate real dilemmas of international politics (ADAMSON, 2014). Under these circumstances, it becomes pertinent to investigate how these experiences contribute to the socio-emotional development of students, in light of the five domains established by CASEL.

This article proposes a discussion on the impact of innovative educational methodologies on the holistic development of students, with an emphasis on socio-emotional competencies. To this end, a literature review is conducted and reports and questionnaires from participants in UN simulations are analyzed, with the aim of understanding how these pedagogical practices can contribute to the formation of more critical, empathetic individuals who are prepared for life in society.

2. DEVELOPMENT

2.1. Theoretical foundation on socio-emotional competencies

Social and Emotional Learning (SEL) was conceived and systematized by the Collaborative for Academic, Social, and Emotional Learning (CASEL), an organization founded in 1994 in the United States, with the purpose of establishing the development of social and emotional competencies as an integral and essential part of the educational process (CASEL, 2003). In this context, social and emotional competencies constitute an element for academic success, as they directly influence the way students learn, relate to others, and face everyday challenges in the school environment (CASEL, 2015). Social and Emotional Learning (SEL) refers to the process through which children, adolescents, and adults acquire and apply knowledge, attitudes, and skills to develop healthy identities, manage emotions, achieve goals, demonstrate empathy, and maintain healthy relationships (CASEL, 2020).

The Collaborative for Academic, Social, and Emotional Learning proposed the CASEL 5 theoretical framework, which organizes socialemotional competencies into five

broad areas: self-awareness, selfmanagement, social awareness, relationship skills, and responsible decision-making (CASEL, 2020). This classification not only systematizes different dimensions of socio-emotional development but also provides a framework for the design of educational practices that promote these competencies. By considering these categories, it becomes possible to analyze in more detail how specific pedagogical interventions can promote the strengthening of fundamental skills for the personal and social lives of students, highlighting the practical applicability of the proposed model (OSHER et al., 2016).

Moreover, factors such as selfawareness, self-management, social awareness, interpersonal skills, and responsible decision-making constitute a set of competencies important for academic and social success, highlighting the relevance of educational practices, such as CASEL, that promote individual development in a coordinated manner (CASEL, 2020).

The visual representation of the CASEL framework, named the CASEL Wheel, constitutes a graphic synthesis of socio-emotional

competencies and the interdependent contexts in which these skills should be promoted. The following image expresses, in a structured and symbolic manner, the fundamental principles of socialemotional learning as outlined by the organization.

Figure 1: Representation of the five core competencies of socialemotional learning

The image is composed of three main circles. In the center, there are the five fundamental competencies of SEL: self-awareness, selfmanagement, social awareness, relationship skills, and responsible decision-making. As stated by CASEL (2020), these competencies are interrelated and should be developed in an integrated manner throughout the school life, as they

directly influence students' behavior, learning, and well-being.

The intermediate ring of the image highlights the environments where SEL can be applied: classroom, school, family, and community. This graphic representation conveys the notion that socio-emotional development occurs through multiple social interactions, as described in the ecological approach to human development proposed by Bronfenbrenner (1979), frequently referenced in the SEL literature (CASEL, 2020).

Finally, the outer ring emphasizes the structural and systemic elements that must support the work with SEL: intentional pedagogical practices, professional development, institutional commitment, equitable school policies, and continuous evaluation and improvement processes. This perspective is consistent with the systemic implementation model advocated by CASEL, in which social-emotional learning is incorporated transversally into the culture, policies, and practices of schools (CASEL, 2020).

2.2 What are UN simulations?

The simulations of the United Nations (UN) are configured as pedagogical practices that aim to reproduce the functioning of UN committees. In this activity, students take on the role of diplomats, representing countries, organizations, or specific characters, with the purpose of debating and negotiating solutions to relevant international issues (KABDESOV, 2022). Starting from this premise, Ho, Cowan, Bache et al. (2025) develop the idea that, traditionally, UN simulations are understood as spaces primarily aimed at training future diplomats and students who aspire to pursue careers related to social and political sciences, such as International Relations, Law, or Political Science. However, the authors, based on a literature review and a consistent theoretical foundation, argue that such activities should be accessible to all students, regardless of their field of study or academic interests. This defense is corroborated by studies that highlight the potential of simulations for the development of socio-emotional skills such as empathy, critical thinking, active listening, and emotional self-regulation skills that are fundamental for various

educational and professional trajectories (Durlak et al., 2011; Leib & Ruppel, 2019). In this sense, diplomatic events can provide much more than the mastery of strictly technical or diplomatic skills, encompassing transversal skills relevant to teamwork, interpersonal communication, and the development of ethical thinking. It is concluded, therefore, that UN simulations constitute a pertinent pedagogical practice for contemporary education, as they allow students to critically experience the dynamics of international relations, integrating theory and practice in a meaningful way. Such practices align with the principles of an emancipatory and transformative education, as proposed by Paulo Freire (1996), by promoting active participation, dialog, and student protagonism.

2.3 The pedagogical proposal of simulations

The pedagogical proposals of the United Nations (UN) simulations are based on principles of active and experiential learning, aimed at the holistic development of the student, encompassing cognitive, socio-

emotional, and ethical aspects (POPP; CARROLL, 2020). The Experiential Learning Theory, proposed by David Kolb (1984), is based on the premise that knowledge is generated through the transformation of experience, through a continuous cycle involving concrete experience, reflective observation, abstract conceptualization, and active experimentation. This theoretical model supports the relevance of Model United Nations (MUN) simulations as pedagogical practices that promote active learning, as students are placed in situations that require direct engagement, critical reflection, and practical application of complex international policy concepts. Thus, by aligning the stages of Kolb's experiential cycle with the dynamics of MUNs, it is observed that these simulations not only enhance the theoretical understanding of the content but also promote personal growth and the ability to make responsible decisions in collaborative and challenging contexts.

During the preparatory phase, students dedicate themselves to studying the foreign policy, history, and positions of the country they will

represent. This stage fosters intellectual autonomy, active research, and analytical thinking, as they understand complex issues, select reliable sources, and construct coherent positions (GODINHO, 2015). During the UN simulation, skills such as public speaking, synthesis ability, and respect for diplomatic norms are practiced. During the process, students participate in debates, draft and negotiate resolutions, interact with peers representing different countries, and need to adapt their argumentation strategies as discussions progress, promoting the development of communicative, analytical, and socio-emotional skills (MEDINA; PAVARINA, 2015).

The findings of KHADZIR (2022) corroborate the effectiveness of UN simulations as a pedagogical strategy in high school, especially in the development of essential competencies for the holistic formation of students. The study, conducted with 59 students, indicated that more than 80% of the participants showed significant improvements in communication skills, active listening, and critical thinking after participating in simulations. These results were

particularly evident in activities that required the construction of persuasive speeches, negotiation of proposals, and adaptation of argumentative strategies in the face of different perspectives.

These findings align with the results of (David K. Jesuit & Strachan (2021), who also highlight the ability of MUN simulations to promote significant changes in students' knowledge, attitudes, and socioemotional and ethical competencies. While Khadzir provides specific quantitative data on communication and critical thinking, Jesuit & Strachan offer a broader perspective, including skills in collaboration, empathy, and ethical decisionmaking.

The intersection of this evidence reinforces that UN simulations constitute an effective pedagogical practice, capable of promoting meaningful experiential learning, as advocated by (Kolb, 1984). By integrating theory and practice, these activities stimulate not only the conceptual understanding of complex international politics content but also the development of cognitive, socio-emotional, and ethical competencies, preparing students for critical and responsible

participation in collaborative and challenging contexts.

The reflective stage following the event contributes to the development of metacognition by encouraging students to analyze their own learning process. The systematic review by MDPI (2025) indicates that simulation-based learning promotes the consolidation of cognitive and socio-emotional skills, highlighting that structured reflection allows for the identification of effective strategies and gaps in understanding. Engel, Pallas, and Lambert (2017) demonstrate that simulations promote deep learning, enabling the appropriation of theoretical concepts through experiential practice. Post-simulation reflection, therefore, integrates practical experience and theoretical understanding, supporting the critical evaluation of one's own learning.

2.4. The role of UN simulations in skill development

UN simulations can be considered particularly effective tools in promoting socio-emotional skills, especially those outlined by CASEL, which groups them into five core domains. According to Raymond and

Usherwood, the challenging environment of debates requires students to manage frustrations, react with composure, and maintain an ethical stance in the face of disagreements (RAYMOND, C; USHERWOOD, S, 2020). The authors point out that participants in diplomatic simulations reported improvements in self-confidence, critical thinking, and decision-making under pressure.

In accordance with the experiences and situations present during the debates, (NAPOLITANO, 2021) propose a comprehensive model of social, emotional, and behavioral skills, with an emphasis on success during adolescence. Thus, an intrinsic and corresponding connection is established between the emotional aspects analyzed by Raymond and Usherwood developed during the debates and Napolitano's study, as both address the importance of fostering interpersonal skills for success, both academic and social, during the adolescent phase.

In the Brazilian educational context, Rocha's (2025) study highlighted that the participation of high school students in simulated activities of international

organizations fosters the development of skills such as leadership, empathy, responsibility, and autonomy. Through these experiences, students can deepen their understanding of international relations and practice negotiation, argumentation, and conflict resolution skills. The results indicate that, under certain circumstances, participation in these activities can contribute to the formation of critical, ethical, and socially committed individuals, although other individual and contextual factors may also influence this development. The analyzed experiences indicate that structured pedagogical activities favor the development of socioemotional skills, such as leadership, empathy, decision-making, and conflict management. These learnings have the potential to positively impact academic performance, well-being, and students' preparation for personal and social challenges.

2.5. Interface between UN simulations and the development of socio-emotional skills

practices and the development of socio-emotional skills (CASEL, 2020). The experience of roles in negotiations and conflict situations stimulates communication, argumentation, and civic engagement, strengthening students' ethical awareness (PEREIRA

JÚNIOR; CALDAS; MAGALHÃES, 2022),

potentially providing concrete and contextualized experiences of socioemotional learning.

The event exposes students to ethical and political dilemmas that require reflection on their emotional responses and the identification of personal biases, processes that, according to (CASEL, 2020), are associated with the development of emotional intelligence. By assuming different roles and perspectives, participants can enhance their perception of their own reactions and values, which fosters the ability for self-regulation and responsible decision-making (Zins et al., 2004). Complementarily, the continuous practice of reflection allows students to recognize their emotions and positions more clearly and critically (KUMAR et al., 2024).

UN simulations constitute an interface between educational

In this context, the participants face a dynamic environment that

requires self-management skills, such as intellectual discipline, emotional balance, and resilience in the face of frustrations (Lourenço et al., 2025). Participants need to manage their time, deal with contradictions, maintain a diplomatic stance under pressure, and quickly adapt to unforeseen circumstances (GROSS; NIEMANN, 2020). Due to this pressure, emotional regulation is essential for dealing with academic and social challenges (Cambron, 2017). The high-demand environment fosters the development of proactive selfcontrol, where students not only react with maturity but also learn to anticipate their emotions and positions, taking a more active role in shaping their own career paths (KILBRIDE; BROWN; LEWIS, 2021).

This scenario tends to provide students with an immersion in complex global landscapes, such as armed conflicts and economic crises, which require a deep understanding of the realities experienced by affected populations (JESUIT; ENDLESS, 2018). Thus, challenging environments stimulate empathy and critical reflection, allowing participants to recognize the human and social implications of these

issues (AMPUERO et al., 2013).

According to Tsang (2025), the practice of empathy in intercultural educational contexts significantly contributes to individuals better understanding the emotions and perspectives of people from different cultural backgrounds.

Complementarily, Zhang (2025) observes that continuous reflective practice allows students to identify behavior patterns and perceive how their actions affect others, promoting critical learning about justice, equity, and social responsibility. These studies suggest that, when confronting complex global problems, students not only develop cognitive and technical skills but also an understanding of the realities faced by other populations.

Naseem, Naseer, and Rahim (2024) demonstrate that educational practices promoting socio-emotional competencies, such as those developed in UN simulations, positively impact students' academic performance. They tend to promote practices that go beyond contentbased teaching, allowing students to internalize socio-emotional skills through real interactions and complex challenges (HAMMOND; ALBERT, 2020). The dynamics of

debates and negotiations simultaneously stimulate cognitive and emotional development, favoring the construction of integrated and lasting competencies, as demonstrated by recent studies analyzing socio-emotional interventions in school contexts (CIPRIANO et al., 2023).

In summary, it is observed that UN simulations create a complex and multifaceted context in which different dimensions of learning intertwine. The analysis of these experiences suggests an approach to challenging situations, in which multiple perspectives and interaction strategies are considered.

2.6 Empirical evidence: students' perception

To exemplify the possible effects of UN simulations on the development of socio-emotional skills, a survey was conducted with 70 high school students who participated in at least one edition of the activity. The majority of respondents (92.9%) stated that they had participated in between one and three simulations.

The responses were organized based on the five competency

domains proposed by CASEL. Selfawareness, for example, received an average score of 3.40 on a scale of 1 to 5, demonstrating that experiencing different roles and realities promoted internal reflections and recognition of one's own emotions. Selfmanagement, with an average of 3.47, stood out as a skill particularly developed in the face of negotiation challenges, emotional control, and time management characteristic of the simulations.

Social awareness was one of the most valued competencies by the participants, with an average of 3.84. This suggests that the students recognized the impact of the simulations on enhancing their empathy and understanding of different sociocultural realities. Relationship skills, essential for collaborative work and conflict resolution during debates, reached an average of 3.67. Finally, responsible decision-making, which requires ethical judgment and consideration of consequences, was also recognized, with an average of 3.84. These quantitative results reinforce the findings of the scientific literature (Raymond & Usherwood, 2020; CASEL, 2023; Machado et al., 2021), which point to simulations as

effective tools for strengthening emotional and social competencies in the school context. The applied research, therefore, does not intend to validate the theoretical relevance of the topic, but rather to exemplify the practical and perceptible effects of this methodology in the daily lives of students.

3. CONCLUSION

As discussed throughout the article, UN simulations can create rich and challenging environments, conducive to the development of various socio-emotional skills. These activities have the capacity to offer students the opportunity to experience situations that demand cognitive skills, fostering the development of essential competencies for their personal and social formation. The exercise of these competencies in simulated contexts has the potential to stimulate fundamental aspects for the holistic development of students. By involving participants in dialog and conflict resolution processes, simulations are capable of broadening the perception of different perspectives and encouraging critical reflection on

complex topics, which contributes to more meaningful learning.

Moreover, the incorporation of these pedagogical practices into the daily school routine constitutes a potential strategy to promote an education that transcends the mere transmission of traditional content, favoring a more integrated formation that aligns with the demands of the contemporary world. The dynamic interaction and engagement provided by such events not only have the potential to broaden the repertoire of knowledge but also to encourage the application of these concepts in real contexts, with the aim of contributing to the strengthening of students' socioemotional development. From this perspective, educational institutions tend to assume a central role as spaces for experimentation and innovation, capable of articulating cognitive and socio-emotional knowledge in a complementary manner.

Given the benefits presented, the adoption of UN simulations by educational institutions emerges as an opportunity to expand pedagogical methodologies and contribute to the formation of individuals more prepared for current

challenges. Incorporating these experiences into the school environment can promote a more participatory, critical, and socially connected education, fostering the academic and personal growth of students.

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The difference in the absorption time of macronutrients and strategies to better develop muscle hypertrophy in weight training sessions

Gabriela Guerra Micali,

The difference in the absorption time of macronutrients and strategies to better develop muscle hypertrophy in weight training. The increase in interest in weightlifting is not always accompanied by the necessary nutritional knowledge to optimize performance and hypertrophy, with the frequent use of restrictive diets and the consumption of ultra-processed foods, which harm health and esthetic results. This article analyzes how the digestion, metabolism, and timing of macronutrient intake influence lean mass gain, relating physiological aspects to sports practice. It was found that carbohydrates are the main energy source during exercise, and that complex options in pre-workout stabilize blood sugar and improve performance. Proteins, by providing amino acids that activate the mTOR pathway, are essential for protein synthesis and should be consumed in adequate amounts. Lipids act as an energy reserve according to the intensity of the effort, according to the crossover model. Timing strategies, such as consuming complex carbohydrates and proteins before training, followed by fast-absorbing proteins and highglycemic index carbohydrates post-workout, favor recovery and hypertrophy. It is concluded that balanced and individualized diets, combined with proper timing, promote better performance, lean mass gain, and overall health.

Gabriela Vieira Araújo, Isabela Lúcio de Oliveira e João Victor dos Santos Silva

1. INTRODUCTION

The pursuit of a healthy lifestyle has risen among 21stcentury society. As proof of this, an increase in interest among adults in the United States in maintaining a balanced diet and a regular exercise routine has been observed (Shan, 2023). Moreover, on social media platforms like Instagram and WhatsApp, it was found that a large portion of users follow profiles that share information about nutrition, which may demonstrate people's concern in adopting good habits (Cazal, 2017).

However, in Brazil, the dissemination of false nutrition information on the internet, driven by individuals without higher education, exacerbates and hinders knowledge, especially among young people, about the foods they consume (Rodrigues et al., 2006). In this context, the increase in the hiring of nutritionists by Brazilian municipalities stems from the search for reliable information regarding food security and dietary care (Vasconcelos, Sousa & Santos, 2015).

Paradoxically, the consumption of ultra-processed foods has increased (Monteiro et al., 2019), raising concerns not only regarding physical health but also mental health (Monteiro et al., 2019; Jacka et al., 2017), as these products, characterized by being rich in sugars, saturated fats, and preservatives, are widely associated with the development of chronic

diseases such as obesity, type 2 diabetes, and hypertension (Monteiro et al., 2019).

Regarding the enhancement of nutrition, supplements with proteins and amino acids are sought after, especially by athletes and sportspeople, as a way to increase the biological value of meal proteins and also for their anticatabolic and anabolic effects, which prevent muscle degradation (Rev Bras Med Esporte, 2012).

Moreover, research shows that people experience less hunger and greater satiety after protein intake compared to carbohydrate and fat intake (Crovetti et al., 1998). Considering this data, understanding how each macronutrient acts in the body is necessary to develop strategies that promote muscle benefits for the individual.

However, the adoption of a regulated diet supervised by nutrition professionals is often an inaccessible reality for the public that is not part of, for example, the high-performance sports context, with high training loads, extreme physical demands, an intense competitive schedule, and rigorous nutritional monitoring (Gomes & Silva, 2020). Restrictions such as the exclusion of sweets, alcoholic beverages, and ultra processed foods are common in this universe characterized by the pursuit of a specific beauty standard (Silva, Oliveira & Mendes, 2022). However, these choices, although fundamental for significant results, involve sacrifices that impact not only the

body but also the mind of these individuals (Coutinho, Andrade & Lopes, 2021).

This work aims to analyze the effects of these dietary behaviors on physical and mental health, focusing on metabolic and nutritional consequences. Specifically, the aim is to understand how the absorption and metabolism of different macronutrients occur and how nutritional timing can influence muscle hypertrophy.

2. DEVELOPMENT

Given the rise in global interest in weight training, (Bennie, J. A., Shakespear-Druery, J., & De Cocker, K., 2020) the lack of nutritional knowledge, evidenced by beliefs in rigid diets (Silva, Oliveira & Mendes, 2022) and the frequent consumption of ultra processed foods among the young population (Monteiro et al., 2019), becomes an obstacle, especially in the pursuit of esthetic results. Thus, an analysis of these difficulties and how they impact an individual's progress is necessary.

In light of this, the present article will address the processes of digestion and metabolism of macronutrients (carbohydrates, proteins, and fats), as well as dietary strategies combined with nutritional timing to optimize muscle results.

The digestion of carbohydrates begins in the mouth with the action of salivary amylase, which partially breaks down starch (a type of complex carbohydrate) into maltose, maltotriose, and dextrins

(disaccharides). In the small intestine, pancreatic amylase continues digestion, and the brush border enzymes, known as disaccharidases (maltase, lactase, and sucrase), convert the disaccharides into absorbable forms, monosaccharides. Glucose, galactose, and fructose (monosaccharides) are absorbed by enterocytes and transported into the bloodstream. Finally, these sugars migrate to the liver through the portal system, where glucose can be used as energy or stored as glycogen (SANIOTO, S. M. L, 2016).

The digestion of proteins begins in the stomach with the action of pepsin, which breaks down proteins into polypeptides. In the small intestine, the enzymes from pancreatic juice (proteolytic), such as trypsin and chymotrypsin, continue to break down the polypeptides into smaller peptides and amino acids. The brush border enzymes (in the intestinal wall) complete this digestion, forming free amino acids, dipeptides, and tripeptides. The free amino acids are then absorbed by the enterocytes and enter the blood capillaries of the intestine. Finally, they travel through the hepatic portal vein to the liver, where they will be used or distributed to the tissues, including the muscles (Freeman, Hugh J., Young S. Kim and Marvin H. Sleisenger, 1979).

The first stage of lipid absorption is emulsification, initiated in the small intestine. At this stage, bile salts, produced in the liver,

transform large fat droplets into smaller micelles, increasing the enzymatic action area. Next, pancreatic lipase, an enzyme produced in the acinar cells of the exocrine pancreas, further breaks down triacylglycerols with the help of the enzyme colipase. This action gives rise to free fatty acids and monoglycerides, which in turn are incorporated into water-soluble micelles, which transport lipids to the brush border of enterocytes. Inside the enterocytes, fatty acids and monoglycerides are reesterified to reform triacylglycerols. Subsequently, the reesterified lipids associate with apolipoproteins to form chylomicrons large lipoprotein particles that enter the lymphatic circulation. Lastly, the chylomicrons are transported by the lymphatic system to the thoracic duct, which releases them into the bloodstream, and subsequently, to the muscle tissues (Sant, Léa Silvia, 2004).

2.1. Metabolic effects of macronutrients

In light of the above description regarding carbohydrate absorption, understanding the concept of glycemic index is fundamental for analyzing dietary strategies. The glycemic index is the qualitative reference for the ability of a carbohydrate to raise blood glucose levels (Siu PM, Wong SH, 2004). Simple carbohydrates with a high glycemic index are quickly absorbed and raise blood glucose levels within 5 to 10 minutes after ingestion (Sapata, K. B., Fayh, A. P.

T., & Oliveira, A. R. D. 2006). Consequently, the immediate release of insulin to stabilize blood glucose levels causes a sharp drop in glucose within 20 minutes after ingestion (Marmy-Conus et al, 1996), an episode referred to as a "glycemic peak." This event leads to rebound hypoglycemia, which causes early fatigue, dizziness, or reduced performance. Thus, hypoglycemia close to exercise, such as weight training, can cause a lower immediate energy availability, in addition to the use of muscle glycogen and consequent protein catabolism (Sapata, K. B., Fayh, A. P. T., & Oliveira, A. R. D. 2006).

In turn, high glycemic index carbohydrates, but complex (long chains, glucose polymers), such as maltodextrin, have the ability to transport glucose into the bloodstream more slowly and gradually. A meal with complex carbohydrates and a high glycemic index consumed 45 minutes before exercise, according to a study by Kirwan et al. (31), caused an increase in blood sugar levels after 30 minutes. Subsequently, there was a decrease in blood glucose levels until the end of the test, resulting in the stabilization of glycemic levels (Sapata, K. B., Fayh, A. P. T., & Oliveira, A. R. D. 2006). However, in both cases, the high glycemic index of carbohydrates allows for increased utilization of CHO (carbohydrate) during exercise (Febbraio MA, Keenan J, Angus DJ, Campbell SE, Garnham AP,

2000)(Foster C, Costill DL, Fink WJ, 1979).

The metabolism of proteins begins with the digestion and absorption of amino acids, as previously discussed in this article. After that, for the ingested protein to be used by the muscles, muscle protein synthesis occurs, which involves the role of leucine, an essential branched-chain amino acid. In this process, leucine contributes to activation via mTOR, one of the main signaling pathways for muscle growth. However, for muscle repair and growth to occur, an adequate presence of this amino acid in the diet of the weight training individual is necessary to maximize MPS after exercise (Paes, Santiago Tavares, 2016). In weight training, for example, with the stimulation of MPS and adequate intake of 1.5g of protein/kg/day, it is possible to enhance this effect, as demonstrated by evidence from studies with isotopic markers. Based on this data, it is stated that the efficiency of protein in muscle synthesis is reinforced by the appropriate range of consumption, and not necessarily by high doses (Maestá, Nailza, et al, 2008).

In the metabolism of lipids and their role in muscle development, it is necessary to understand how the "crossover" model works in the body. It can be inferred from this model how the body prioritizes the use of carbohydrates or lipids according to the intensity of physical activity (Noland, Robert C, 2025). In low to

moderate intensity exercises, lipids are the energy source, while in high intensity exercises, carbohydrates serve this function (Noland, Robert C, 2025). For lipids to be used as energy, the process of oxidation occurs within the mitochondria: fatty acids are broken down into acetylCoA units, releasing NADH and FADH₂, which generate ATP in the respiratory chain (de Freitas, Ellen Crisitini, et al, 2012). In individuals who regularly engage in weight training, lipid oxidation is more efficient due to higher mitochondrial density and greater expression of enzymes related to beta-oxidation (de Freitas, Ellen Crisitini, et al, 2012). In this context, during prolonged efforts or low to moderate intensity, the mobilization of fatty acids from adipose tissuesconnective tissue that stores energy in the form of triglycerides - increases to skeletal muscle (de Freitas, Ellen Crisitini, et al, 2012). Moreover, physical training reduces the exclusive dependence on carbohydrates as an energy source, improving the body's ability to use fat for this purpose. With the aim of optimizing fat as an energy reserve, the daily intake of this macronutrient should approach 1g per kg/body weight (SANTOS, Marcela Oliveira; VIEIRA, Thayná Kelly da Silva, 2023).

2.2 . Nutritional timing: when to consume each macronutrient

Aiming at the development of muscle fiber, some dietary strategies are necessary within a window of 1 to

2 hours before weight training. In this context, it is recommended to consume 20 to 40g of protein from lean sources - low in fat(KERKSICK, Chad M. et al, 2017) to stimulate muscle protein synthesis (MPS) (Brooke R Stephens, Barry Braun, 2008), in addition to using whey to improve the delivery of amino acids to the muscle and prevent muscle catabolism during training - the use of muscle proteins for energy - (STECKER, Ryan A. et al, 2019). Pre-workout carbohydrate intake enhances the ability to provide energy substrate and preserve muscle glycogen (Brooke R Stephens, Barry Braun, 2008), with complex carbohydrates being the most recommended due to their ability to maintain stable blood sugar levels and, consequently, prevent fatigue resulting from a glycemic spike caused by simple, rapidly absorbed carbohydrates (KERKSICK, Chad M. et al, 2017). Regarding lipids, due to their slow absorption by the body, it is recommended to consume healthy lipid sources about 2 to 3 hours before training to minimize the risk of gastrointestinal discomfort (ORMSBEE, Michael J.). ; BACH, Christopher W. ; BAUR, Daniel A, 2014). Despite this caveat, its consumption remains beneficial before a strength training session, as it directs itself toward protein synthesis, in addition to preventing fatigue and ensuring better performance during the activity (SANTOS, Marcela Oliveira; VIEIRA, Thayná Kelly da Silva, 2023).

Just as before exercising, it is important to choose the right macronutrients to be consumed within 2 hours after the workout due to the physiological need to recover the muscles and thus promote muscle hypertrophy. In view of this, the consumption of 20 to 40g of leucine-rich protein (KERKSICK, Chad M. et al, 2017) is recommended, in addition to whey protein supplementation immediately after the workout (STECKER, Ryan A. et al, 2019), measures that maximize muscle protein synthesis (Brooke R Stephens, Barry Braun, 2008). The immediate intake of carbohydrates after training significantly contributes to the increase in the rate of resynthesis of muscle glycogen lost during exercise. Aiming for this replenishment, high glycemic index carbohydrates are recommended as the most strategic in the postworkout phase (MORAIS; SILVA; MACEDO, 2014) due to the release of insulin, which will enhance hormonal responses of GH and testosterone that contribute to the process of lean mass gain (SOUZA JÚNIOR; LOPES, 2008). Ripe bananas are a recommended source of high-glycemic carbohydrates and potassium, in order to help prevent muscle cramps by increasing antioxidant capacity and serum dopamine, thereby promoting recovery and immune function (Nieman DC, et al, 2010). Regarding lipid consumption, it is suggested that they should not be consumed in large quantities after training, as they

can delay the absorption of proteins and carbohydrates, affecting muscle recovery (KERKSICK, Chad M. et al, 2017). However, sources of fat rich in omega-3 fatty acids, such as fatty fish like salmon, tuna, sardines, and herring, are noted as beneficial for reducing inflammation and improving the cardiovascular health of physical activity practitioners (SANTOS, Marcela Oliveira; VIEIRA, Thayná Kelly da Silva, 2023).

Having as one of the objectives of this article the dissemination of dietary strategies, it is essential to highlight the multifaceted role of nutrition so that, in addition to providing energy for workouts, it directly participates in muscle recovery, hormonal regulation, immunity, and even the quality of individuals' sleep (Coutinho et al., 2021). Therefore, nutritional monitoring should be personalized, considering the physiological, psychological, and social characteristics of each individual (Coutinho et al., 2021).

Therefore, severe and unflexible restrictions on sweets, alcoholic beverages, and ultraprocessed foods can serve various purposes, such as in the context of high-performance sports, nutritionally monitored by a professional, which has objectives related to competitiveness and performance (Silva, J. M., Oliveira, R. C., & Mendes, T. F., 2022). In any case, these restrictions lead to an increase in ghrelin (hunger hormone) and a reduction in satiety hormones,

such as leptin, which increases the sensation of intense hunger and can result in physiological or emotional loss of control regarding food (SOIHET, Julie; SILVA, Aline David, 2019).

The excessive control of food intake, stemming from dietary restrictions, leads to a psychological environment of tension, anxiety, and guilt in the face of any dietary slip, as well as mental fatigue, difficulty concentrating, and even demotivation (Gomes, R. P., & Silva, L. C., 2020). Moreover, excessively rigid diets can trigger binge eating, especially with hyper-palatable foods (high in fat, sugar, and salt) (SOIHET, Julie; SILVA, Aline David, 2019), in moments of "escape," where the individual seeks a quick reward in stressful situations or after periods of severe restrictions, resulting in a dysfunctional relationship with food (Gomes, R. P., & Silva, L. C., 2020). Orthorexia, for example, is an eating disorder characterized by a pathological obsession with eating only foods considered "pure" or "healthy" (Gomes, R. P., & Silva, L. C., 2020). Moreover, excessively strict eating habits are hardly sustained in the long term, and the failure or slip of these plans generates frustration, a sense of failure, and a drop in self-esteem (Gomes, R. P., & Silva, L. C., 2020).

2.3 Ultra processed foods and their impact on the body

Based on the digestive processes and dietary parameters discussed earlier, it is understood

that a healthy diet that strategically utilizes the absorption time and metabolism of each macronutrient favors progress in relation to the increase of lean mass.

It is evident that the consumption of ultra-processed foods - such as soft drinks, snacks, filled cookies, instant noodles, and frozen meals - has increased significantly (Mesas AE, et al, 2022). However, foods of low nutritional quality like these are intrinsically associated with the development of chronic diseases such as obesity, type 2 diabetes, and hypertension (Monteiro et al., 2019). These products are characterized as industrial formulations primarily made from substances extracted from foods, such as oils, fats, sugars, starches, and isolated proteins. Furthermore, they contain chemical additives intended to enhance flavor, appearance, and increase shelf life; examples include colorants, flavorings, and preservatives (Monteiro et al., 2019).

Cohort studies such as NutriNet Santé (Adjibade, M., Julia, C., Allès, B. et al, 2019) have shown that a 10% increase in the proportion of ultra processed foods in the diet raised the risk of developing depressive symptoms by 21% over 5.4 years. Similarly, the SUN study (Gómez-Donoso, C., SánchezVillegas, A., Martínez-González, MA et al, 2020) identified a link between high consumption of ultra-processed foods and a higher incidence of depression.

Due to the fact that ultra processed foods are poor in essential nutrients, such as B vitamins, magnesium, zinc, and amino acids like tryptophan (a precursor to serotonin), there is a low supply of raw materials that the brain needs to produce serotonin and other mood-related neurotransmitters (Jacka et al., 2017). Thus, changes in the availability of these neurotransmitters can contribute to the onset of symptoms such as irritability, sadness, anxiety, and, in more severe cases, depression (Jacka et al., 2017).

In this context, a diet poor in nutrients and rich in artificial additives can promote systemic inflammatory processes, caused by the diversion of tryptophan for the production of inflammatory metabolites (Khalid et al., 2016; O’Neil et al., 2014). Moreover, ultra processed foods can cause imbalances in the gut-brain axis - a bidirectional communication system between the gastrointestinal tract and the central nervous system, responsible for regulating mood, cognition, and emotional responses (Khalid et al., 2016; O’Neil et al., 2014). In this case, the imbalances occur because the gastrointestinal system is responsible for about 90% of serotonin production, and intestinal dysbiosis, caused by the frequent consumption of ultra processed foods, reduces the production of beneficial metabolites, such as short-chain fatty acids, which have anti-inflammatory and

neuroprotective effects (Khalid et al., 2016; O’Neil et al., 2014).

3 CONCLUSÃO

This article aimed to analyze how the digestion, the metabolism, and the timing of the intake of each macronutrient influence muscle gain, that is, hypertrophy. To this end, the digestive and metabolic processes of each macronutrient were discussed, as well as the impacts of a restricted diet or one rich in ultra processed foods on the individual's physical and mental health.

It was evidenced that the timing of nutrient intake can become an ally or enemy of performance in weight training. Regarding carbohydrates, the glucose produced by the digestive process can be used as energy about 1 to 2 hours after consumption or stored in the form of glycogen. Simple carbohydrates with a high glycemic index, due to the risk of causing insulin spikes in the body and subsequent fatigue, are not recommended to be consumed less than 1 hour before weight training. However, the consumption of complex carbohydrates is considered strategic for better physical performance due to the slower release of glucose into the bloodstream, keeping blood sugar levels stable.

The digestion of proteinsinitiated in the stomach and continued in the small intestine and liver- results in the formation of amino acids that are distributed to

the muscles and participate in muscle protein synthesis. Due to its importance in the SPM process, it is recommended to consume about 1.5 g of protein/kg/day, especially through sources that are rich in leucine -an amino acid that activates the mTOR pathway, which regulates muscle growth-. However, the nutritional window is an important factor in the proper absorption of this macronutrient, with intake advised 1 to 2 hours before training, along with supplementation with whey protein immediately after. In this case, the amount of 20 to 40 grams of protein before being lean and after the activity proves to be effective for stimulating MPS and preparing the muscles for weight training, as well as for muscle recovery and consequent muscle hypertrophy.

The fatty acids formed by the digestive process of lipids, through the action of enzymes, give rise to triacylglycerols, which will subsequently be converted into chylomicrons and transported to the muscles. According to the "crossover" model, the body uses lipids or carbohydrates as a source of energy depending on the intensity of the exercise, with lipids being predominant in low to moderate intensity efforts. Physical training increases the efficiency of fat oxidation and reduces carbohydrate dependence, indicating a daily intake of about 1 g of lipids per kg of body weight to optimize their function as an energy reserve. Regarding the ideal timing for the consumption of this macronutrient, it is not

recommended immediately after the workout due to the delayed absorption of carbohydrates and proteins. However, the regular intake of foods rich in omega-3 fatty acids is recommended for weightlifters due to their anti-inflammatory effects and benefits to heart health, which contributes to better individual performance.

A balanced diet, planned according to the absorption and metabolism time of macronutrients, directly promotes the increase of lean mass and the overall health of the body. However, it is observed that the consumption of ultra processed foods, such as sodas, snacks, and ready-made meals, has been growing at a concerning rate, given their association with chronic diseases such as obesity, type 2 diabetes, and hypertension. These products, poor in essential nutrients and rich in chemical additives, compromise the production of neurotransmitters linked to mood, promote systemic inflammatory processes, and cause imbalances in the gut-brain axis, increasing the risk of depressive symptoms. Thus, it is noted that dietary patterns based on ultra-processed foods harm not only physical health but also mental wellbeing, which reinforces the importance of more natural and nutritionally rich food choices for the physiological and mental benefits of individuals.

In high-performance sports, severe dietary restrictions are applied with the aim of achieving the

athlete's maximum performance. However, very restrictive diets increase ghrelin (hunger hormone) and reduce leptin (satiety hormone), intensifying the feeling of hunger, which can trigger binge eating and even episodes of compulsive eating, especially of hyper-palatable foods during stressful moments. In addition to this eating disorder, cases of orthorexia, tension, anxiety, guilt over slip-ups, mental fatigue, difficulty concentrating, and demotivation are common in these competitive environments.

Therefore, the individualization of the diet, as well as its preparation in a healthy manner, rich in natural foods and, nonetheless, without restrictions, are requirements so that, before starting their muscle gain process, the individual who aims for this has a dietary plan to follow. Thus, the next step is the management and understanding of the timing of nutrient intake, considering their digestive and metabolic processes. Therefore, with the goal of muscle hypertrophy, individual physiological factors linked to strategies for the timing of each macronutrient intake and knowledge regarding the importance of conscious and nutritious food choices, as well as the consequences of dietary restriction, are necessary for this purpose.

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Evaluation of the BLIAR Method: a possible non-invasive approach for early detection of Alzheimer’s through biomarkers

Beatriz Calabria e Mariana Parussolo

The study evaluates the diagnostic potential of the BLIAR technique (Bioluminescence Imaging of Amyloid Reservoirs) as a tool for early detection of Alzheimer’s Disease (AD), considering the accelerated aging of the Brazilian population. The preclinical phase of AD is characterized by the progressive and asymptomatic accumulation of beta-amyloid (Aβ) deposits, preceding clinical manifestation by up to two decades, which demands high-sensitivity methods for early diagnosis. Conventional techniques, such as PET/CT and cerebrospinal fluid (CSF) analysis, present operational limitations, high costs, and low accessibility. BLIAR proposes a non-invasive optical approach based on the use of AkaLumine-HCL, a luciferin analog that, when binding to Aβ plaques and reacting with luciferase, emits near-infrared (NIR) radiation, enabling the detection of low concentrations of Aβ (0.5 ng). Preclinical studies have demonstrated its ability to identify diffuse plaques associated with the early stage of AD, favoring the application of early immunotherapies and longitudinal monitoring. Due to its portability, reduced cost, and population applicability, BLIAR presents itself as an option for the public health system, with the potential to optimize diagnoses, reduce costs, and minimize the socioeconomic impacts of AD in Brazil.

INTRODUCTION

Alzheimer's Disease (AD), according to the biochemical definition, is a neurodegenerative disorder, possibly characterized by the progressive accumulation of beta-amyloid (Aβ) plaques, which are deposits of amyloid protein fragments in brain tissues (SILVA: 2020), impairing neuronal communication and causing the disease to worsen over time. Given the early detection of these aggregates, therapeutic interventions tend to be more effective when initiated in the preclinical phase, that is, before the onset of severe symptoms (SCHILLING: 2021). Considering the aging Brazilian population, in which the elderly population has grown exponentially over a period of 10 years (IBGE: 2022)(KANSO: 2022), it is estimated that the number of Alzheimer's disease cases will progressively increase in the coming decades, reinforcing the need for agile and precise diagnostic methods (MATANÓ: 2023).

In light of this, the BLIAR method (Bioluminescence Imaging of Amyloid Reservoirs) emerges as an approach that uses AkaLumine-HCL, an analog of firefly luciferin, which, when reacting with the enzyme luciferase, emits light energy in the near-infrared (NIR) (ONO: 2021), allowing for the monitoring of Aβ levels and, possibly, the diagnosis of Alzheimer's in its early stages. There are indications that Aβ plaques begin to accumulate years before the first

symptoms of AD (SCHILLING: 2021), highlighting the need for sensitive methods, such as BLIAR, for their early identification (MATANÓ: 2023). Moreover, with the aging population scenario, Alzheimer's will become an even greater challenge for healthcare systems, which will require new strategies for early detection and continuous monitoring to reduce costs and improve the effectiveness of early treatments (MATANÓ: 2023).

In this context, BLIAR could possibly overcome the limitations of current techniques, such as PET/CT, which has a high cost and low availability (SILVA: 2020), in the in vivo quantification of Aβ plaques in a more accessible, precise, and less invasive manner. The studied hypothesis suggests that AkaLumine-HCL temporarily binds to Aβ deposits, acting as a reservoir that gradually releases the compound and modulates light emission (YANG: 2022). This dynamic was confirmed in an experiment conducted with mice (YANG: 2022), in which the bioluminescence, initially reduced in the presence of Aβ, surpassed the control group at more advanced stages, thus demonstrating the ability of BLIAR to cross the blood-brain barrier (BBB) and monitor the progression of amyloidosis.

And this study, based on a literature review, aims to evaluate the effectiveness of the BLIAR method in the pre-diagnosis of the neurodegenerative disease

Alzheimer's, also considering the challenges of the clinical application of this methodology.

2. DEVELOPMENT

Population aging is a global phenomenon caused by the decrease in fertility and mortality rates, as well as the improvement in living conditions, factors that result in increased life expectancy (ALCÂNTARA: 1987). In Brazil, the proportion of people over sixty years old grew from 11.3% to 14.7% of the total population over a period of 10 years (IBGE: 2022)(KANSO: 2022). According to the data presented by GBD 2022, this scenario allows for projecting a trend of a 200% increase in Alzheimer's Disease (AD) cases by 2050. This estimate is due to the fact that the disease is rarer before the age of 65, and that, after this age range, the chances of developing Alzheimer's disease tend to double every five years (SPERLING: 2011). Given this, the aging of the national population can be considered a socioeconomic challenge, as it may put pressure on the healthcare system and require not only new forms of treatment for AD but also new, faster, and more precise diagnostic methods. (CAMPOS: 2020/ KIPPER:2022)

The methods available for the diagnosis of AD present adversities that, on a large scale, affect their efficacy. In a scenario of an aging population, as demand tends to increase, methods capable of

overcoming current technical difficulties are necessary. Currently, one of the main diagnostic methods on the market is Positron Emission Tomography, which uses the radiotracer florbetapir, marked with fluorine-18 (¹⁸F). After its intravenous application, the radiotracer crosses the blood-brain barrier (BBB) and attaches to deposits of amyloid protein fragments. The images in the PET/CT technique are obtained through the process of radioactive decay, which refers to the release of radioactive particles by an unstable atomic nucleus, which seeks stabilization. The decay of ¹⁸F, in turn, involves the emission of positrons that are used for the photographs that quantify amyloid beta (Aβ) plaques (KLUNK:2004). Due to the rapid half-life of fluorine-18 (approximately only 110 minutes), this method requires quick production and transportation, as well as nuclear infrastructure and knowledge, resulting in high costs and limited accessibility, especially in more remote and underserved regions (RIBEIRO: 2020/ MATANÓ: 2023). In addition to PET/CT, another commonly used technique is the analysis of cerebrospinal fluid (CSF), which is the fluid that surrounds the brain and spinal cord. Its study can help in the diagnosis of various neurological conditions, including Alzheimer's, as it is possible to measure Aβ levels. However, this procedure requires the so-called lumbar puncture, also known as spinal tap, which is invasive and painful. (TAPIA: 2019)

These limitations lead to late diagnoses, reducing the preclinical intervention window. Given this issue, the BLIAR technique (Bioluminescence Imaging of Amyloid Reservoirs) emerges as a possibility. The method uses the luciferin analog from fireflies, AkaLumine-HCL, which, when interacting with beta-amyloid plaques, emits light in the nearinfrared (NIR) spectrum. With this technique, protein loads as low as 0.5 ng can be identified, a protein uptake capacity superior to that achieved by the PET/CT method (YANG: 2022). Due to this high sensitivity, BLIAR allows the identification of AD up to 20 years before the appearance of symptoms, in the so-called preclinical phase, which enables early clinical interventions, such as immunotherapies, making treatments more efficient (VAN DYCK: 2023). In addition, because it is a non-invasive process, unlike CSF analysis, because it does not require the radiopharmaceuticals needed in PET/CT, and because it has a considerably lower cost than both techniques, it allows for more constant and facilitated monitoring of AD, even in geographically more remote regions (KUCHIMARU: 2018).

2.1. Characterization of Alzheimer's disease

Alzheimer's disease (AD) is a neurological disease, that is, it affects the nervous system. The disease, which progressively affects

specific brain regions, begins in the entorhinal cortex and the hippocampus, where it causes memory lapses. With its progression, it advances to the association cortex, impairing language and reasoning, and in the most advanced state, it reaches diffuse areas, thus deteriorating the patient's motor control (JACK: 2010/ THAL: 2006). Given this, those who have it present, as initial symptoms, episodes of recent memory loss, disorientation, and linguistic difficulties. These clinical signs, in turn, evolve along with AD and begin to compromise both the executive and behavioral functioning of the patient.

And in its so-called preclinical phase, which occurs up to two decades before the clinical diagnosis, it is an asymptomatic process, which makes early diagnosis difficult in most cases. During this period, there is a silent accumulation of beta-amyloid plaques (Aβ), whose progressive aggregation, combined with Tau neurofibrillary tangles, leads to the worsening of AD (SPERLING: 2011).

In addition to the lack of symptoms in the latent phase, its early detection is still hindered by the blood-brain barrier (BBB), an endothelial structure that, due to its high impermeability, prevents the passage of markers (BANKS: 2016), and by the heterogeneous distribution of senile plaques. (THAL: 2006).

Aβ plaques are extracellular aggregates composed mainly of the Aβ42 peptide, which is generated especially by the sequential cleavage of the amyloid precursor protein (APP), that is, it is a protein fragment. The process of beta-amyloid plaque formation begins with the excessive production of Aβ peptides, resulting from the abnormal proteolysis of APP by the β and γ-secretase enzymes (HAASS & SELKOE: 2007).

In the initial stage of the disease, Aβ42 monomers aggregate into soluble oligomers, which are small yet highly toxic structures that damage synapses, thereby interfering with neuronal communication. These oligomers tend to be more neurotoxic than mature Aβ plaques, as they alter the permeability of cell membranes and trigger inflammatory reactions in the brain through the activation of microglia and astrocyte cell types (SERENIKI & VITAL: 2008). Over time, the oligomers undergo changes and reorganize into protofibrils, which subsequently become insoluble fibrils that accumulate in the extracellular space and form dense nuclei that attract components such as metals and acute-phase proteins (APP), thus consolidating beta-amyloid plaques, also known as senile plaques (HAASS & SELKOE: 2007).

The complex formation process results in chemical heterogeneity at different stages of the disease and is, therefore, one of the main obstacles to the pre-

diagnosis of AD. In its preclinical phase, the predominant plaques are diffuse and composed of non-fibrillar Aβ42, basically a soluble and less aggregated form of the peptide. This composition, in turn, prevents the detection of the disease by traditional methods, such as PET/CT, since they rely on the interaction between compact fibrillar structures (more clustered) (THAL: 2006). Moreover, the lack of symptoms at this stage is a result of the low toxicity of diffuse plaques, to the extent that the identification of measurable neurological damage tends to come years after their silent accumulation, along with the appearance of clinical signs of AD.

2.2. Bioluminescence imaging method of amyloid reservoirs

The Bioluminescence Imaging of Amyloid Reservoirs (BLIAR) technique, unlike current techniques, stands out in this context for being able to detect senile plaques in the asymptomatic stage of the disease, when they have not yet compromised cognitive functions (YANG: 2022). The method uses the molecule AkaLumine - HCL, an analog of luciferin (a molecule that emits light upon oxidation) from the firefly, which, when binding to Aβ fibrils in the brain and reacting with the enzyme luciferase (the enzyme that catalyzes the phenomenon), results in a chemical reaction called bioluminescence, which emits light energy in the near-infrared (NIR) (YANG: 2022).

The examination begins with the intravenous injection of AkaLumine-HCL, which, due to its small molecular size, crosses the blood-brain barrier and selectively binds to Aβ fibrils, thanks to its chemical structure that is capable of recognizing the characteristic folds of these protein aggregates. After this binding, AkaLumine-HCL temporarily attaches to senile plaques, forming a kind of "reservoir" that gradually releases the compound's molecules.

(YANG: 2022)

These molecules, in the presence of the enzyme luciferase, result in an oxidation reaction analogous to that performed by fireflies. Since the method, unlike the process carried out by these beetles, operates without the requirement of ATP, that is, it combines AkaLumineHCL only with oxygen, and therefore an unstable molecule is formed. In this context, to stabilize, this set of atoms releases light energy in the NIR spectrum, which reaches a wavelength greater than 650 nm, while the yellowish light emitted by bioluminescent beetles is approximately 560 nm, thus enabling BLIAR to achieve greater tissue penetration with minimal scattering.

(ONO: 2021/ KUCHIMARU: 2018)

This reaction enables the mapping of the distribution and density of beta-amyloid plaques with high sensitivity, identifying concentrations of up to 0.5 ng of Aβ (YANG: 2022), that is, it is capable of detecting the presence of this peptide even in extremely low

concentrations, thus allowing for an early diagnosis of AD in its preclinical phase, that is, before the disease begins to manifest its symptoms. Given this characteristic, BLIAR provides a window for increasing early interventions, such as the use of monoclonal antibodies or Aβ modulators, treatments that, in turn, are capable of slowing the progression of Alzheimer's disease.

(VAN DYCK: 2023)

To prove its validation and high sensitivity, tests conducted on animal models in the study "Reporting amyloid beta levels via bioluminescence imaging with amyloid reservoirs in Alzheimer’s disease models" from 2022 provided results that demonstrate a statistically positive correlation between the luminescent signal and the amyloid load measured postmortem, showing a progressive increase in the signal by approximately 300% in transgenic mice compared to the control group. This increase is directly related to the accumulation of amyloid plaques, confirming that the technique is capable of monitoring the progression of the pathology. These tests also demonstrated the ability of the compound AkaLumine-HCL to cross the blood-brain barrier and specifically bind to Aβ deposits.

The technique also presents advantages such as its considerably lower cost, especially when compared to other current methods, not being an invasive clinical process due to its intravenous administration,

and its portability, which allows access to more remote areas since it can be adapted to compact imaging devices. BLIAR, moreover, demonstrates advantages in the social sector, as it enables population screening, that is, the early detection of asymptomatic individuals at increased risk of developing AD, such as carriers of the apolipoprotein E ε4 allele (APOE ε4) (a genetic variant that increases the patient's risk of developing AD by up to fifteen times) (CORDER: 1993) or individuals with a family history of Alzheimer's. Therefore, when integrated into clinical measures, such as preventive health protocols, it can result in long-term Alzheimer's disease, making it a controllable condition, a factor that would reduce the costs associated with hospitalizations and palliative care, which are the highest public expenditures caused by the disease in its moderate and advanced stages.

However, the main limitation of the technique is its low quantum yield, which occurs due to energy dissipation through non-radiative processes, which, in turn, impacts the intensity of the emitted light signal (YANG: 2023). In light of this, advances in the molecular field, which aim at the structural modification of probes - such as the synthesis of luciferin analogs with greater stability - and enzyme engineering - such as the modification of active sites of the luciferase enzyme - become important to maximize

bioluminescent emission, as it reduces non-radiative energy loss, that is, it increases the efficiency of the technique (CONTAG: 2002/ PRESCHER: 2010) in clinical scenarios with low pathological load (LOZOVOY: 2023/ BRUSCHINI: 2019).

3. CONCLUSION

The BLIAR method (Bioluminescence Imaging of Amyloid Reservoirs) presents itself as a possible approach for the early diagnosis of Alzheimer's Disease (AD), in the context of the aging Brazilian population, which tends to significantly increase the prevalence of the disease in the coming decades, revealing itself as a promising technique for mitigating the socioeconomic impacts of AD in Brazil.

The technique uses the compound AkaLumine-HCL, which, when reacting with the enzyme luciferase, emits light in the nearinfrared spectrum, allowing for the non-invasive detection of betaamyloid plaques (Aβ) years before the appearance of disease symptoms in the so-called preclinical phase. This demonstrates potential to overcome the limitations of current methods, such as PET/CT and CSF analysis, due to its high sensitivity, non-invasiveness, considerably lower cost, portability, and ability for population screening, that is, the identification of the presence of AD in at-risk groups before its clinical manifestation.

Early detection of AD, in turn, can facilitate therapeutic interventions, when these tend to be more effective, allowing, for example, early immunotherapies and potentially reducing costs associated with the late diagnosis of the disease. However, the clinical application of BLIAR faces technical challenges, such as low quantum yield, which occurs due to energy dissipation through non-radiative processes, and directly impacts the intensity of the light signal in low pathological load scenarios. Therefore, advances in molecular engineering, including the synthesis of luciferin analogs with greater quantum stability and modifications of the active sites of the luciferase enzyme, are necessary for an efficient clinical application of the method.

Thus, this study, through the conducted literature review, concludes that the BLIAR method proves favorable for the purpose of enabling the pre-diagnosis of Alzheimer's disease, thereby speeding up diagnoses and the early identification of the disease, especially in its preclinical phase, which can begin up to 15 years before the appearance of symptoms. Thus, the technique demonstrates its potential ability to reduce costs caused by late diagnoses and mitigate the socioeconomic impacts of AD in the Brazilian context.

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Between Biomedical Advances and Social Inequalities: The Complexity of Tackling HIV/ AIDS in Brazil

Gabriela Megumi Fujii Ferreira, Sophia Matos Santos e Glaucya Odette Macedo Juncken

The article studies the HIV/AIDS epidemic in Brazil, highlighting scientific advances, such as antiretroviral therapy (ART), and pioneering public policies, such as universal access to medications through the SUS. It also highlights the progress in preventing vertical transmission and in reproductive health care. The structural and social challenges, such as regional inequalities, stigma, and discrimination, which hinder equitable access to treatment, especially among vulnerable populations, are also being investigated. The article presents intersectoral public policies that consider the social determinants of health and that unite science, education, and social justice. It is assumed that controlling AIDS requires an ethical and collective effort that goes beyond the biomedical response, recognizing the infection as a deeply social and human issue.

1. INTRODUCTION

In 1980, the first case of AIDS was recorded in Brazil, along with the first death declaration caused by the disease. Three years later, newspapers were already reporting the first cases of the HIV virus in the country, and the infection was labeled as "homosexual cancer," as until then, the records were concentrated in men, with the first diagnoses in women occurring only in 1983 (FIOCRUZ, 2000). In São Paulo, the first state program to combat AIDS, linked to the State Health Department, was launched in 1983, especially on December 1st, with the aim of promoting epidemiological surveillance, combating stigma, providing care for cases, and guiding health professionals. Still in the same decade, the Ministry of Health established the guidelines for the "program for controlling Acquired Immunodeficiency Syndrome (AIDS)," and, a year later, the disease became mandatory to report. Next, the National AIDS Program was created, and the provision of medications to treat opportunistic infections began through the public health system. By the end of the 1980s, Brazil had a total of 6,371 HIV cases, with 905 in women, and 4,893 recorded deaths (of these, 666 were female) (EPIDEMIOLOGICAL BULLETIN, in ABIA, n.d.). Although the HIV/AIDS epidemic was initially associated with homosexual and bisexual men, which generated strong social stigma, subsequent studies showed that the infection also affected other groups, such as sex workers, injectable drug users, and hemophiliacs. These last two groups highlighted the transmission through contaminated blood, mainly through shared needles and untested blood

products (MINISTRY OF HEALTH, 2021; FIOCRUZ, 2000).

Social reactions to the HIV/AIDS epidemic were marked by prejudice and exclusion, with seropositive individuals often rejected by their communities, especially in smaller towns (FREIRE, 1998; SILVA; SANTOS, 2005). Studies indicate that the fear of contagion, combined with moralistic conceptions of sexual behavior, reinforced stigmas and hindered social integration and access to health services. Influenced by religious beliefs, people interpreted AIDS as a moral punishment, which intensified the stigma (STIGMA INDEX, 2025). Although scientific advances have transformed AIDS into a treatable condition, the disease is still strongly linked to behaviors considered "deviant." Over the years, there has been an increase in cases among women, mainly through heterosexual transmission, which highlights inequalities in access to treatment benefits: women, people in peripheral regions, or with lower income often face more difficulties in receiving early diagnosis, antiretroviral treatment, and adequate follow-up, reflecting that scientific advances do not benefit everyone equally (SANTOS et al., 2002; FIOCRUZ, 2000). The marginalization of vulnerable groups shows that, even with effective medications, the impact of the epidemic continues to be intertwined with class and structural inequalities, which increase social vulnerability, limit access to information about prevention, and amplify exposure to infection among low-income populations or residents of peripheral regions.

Given this, the following question is proposed: in what ways do

historical, social, and biomedical factors influence the access of women living with HIV to public policies for prevention and reproductive health care in Brazil?

The proposal is to analyze the main milestones of the Brazilian response to HIV/AIDS, understanding how scientific advances are affected by stigma and inequality in controlling the epidemic. It also seeks to reflect on the limits and challenges still present, emphasizing the importance of an integrated and multidimensional approach.

2. DEVELOPMENT

2.1. Scientific and Therapeutic Advances: ART as a Biomedical Pillar

HIV is a virus that weakens the human immune system by attacking CD4+ T cells, which are essential in defending against infections. To infect these cells, the virus employs specific receptors such as CD4 and co-receptors, like CCR5 and CXCR-4. These infection mechanisms have enabled therapeutic advances, such as the development of drugs that prevent the virus from entering cells, making treatment more effective.

The main strategy in combating the epidemic is Antiretroviral Therapy (ART), which works by inhibiting viral replication and facilitating the recovery of the immune system, limiting the viral load to undetectable levels and reducing the risk of transmission. Since the 1990s, therapeutic regimens for HIV have advanced significantly, becoming more potent and less toxic, which contributes to the infection currently being considered a controllable chronic condition (SANTOS et al., 2015;

SOUZA LIMA, 2018). Studies indicate that the introduction of highly active antiretroviral therapy (HAART) was crucial for reducing mortality and improving the quality of life for people living with HIV (Ministry of Health, 2020).

In Brazil, an important milestone was the implementation of the policy of universal and free access to ART by the Unified Health System (SUS), guaranteed by Law No. 9,313 of 1996. This measure resulted in an improvement in patient survival and a reduction in AIDSrelated mortality (BRAZIL, 2019; MINISTRY OF HEALTH, 2002).

Tancredi and Waldman (2014) assessed that, after this policy, the median survival of patients increased from 18 to 58 months.

Despite the advances, adherence to treatment remains a central challenge. The effectiveness of ART depends on the regularity with which the patient takes the medications at least 95% of the doses must be followed correctly. Factors such as side effects, social stigma, difficulties in accessing healthcare services, and low education levels influence this adherence, especially in low-income countries where infrastructure is poor (CONCEIÇÃO; LIMA; SOLER, 2024).

Recent data from UNAIDS and WHO show that, although there has been global progress, significant gaps remain: in 2023, 86% of people living with HIV knew their serostatus, 77% were on antiretroviral treatment, and only 72% achieved viral suppression. In many regions of SubSaharan Africa and parts of Latin America and Asia, therapeutic coverage remains insufficient, with millions of people either not receiving treatment or without viral

suppression. In resource-limited contexts, the main gaps refer to low adherence, interruptions in the supply of medications, and the absence of strategies adapted to local realities (UNAIDS, 2024; HIV.GOV, 2023; FRONTIERS IN PUBLIC HEALTH, 2025).

Studies indicate that an effective response to HIV depends on the integration of science, public policies, education, stigma reduction, and psychosocial support, fundamental elements to increase treatment adherence and reduce social vulnerabilities (UNAIDS, 2024; PARKER; AGGLETON, 2003). The Brazilian experience, with the policy of universal and free access to antiretroviral therapy implemented by the Unified Health System (SUS), has been internationally recognized as a model of success, demonstrating that political engagement combined with social inclusion strategies can yield significant public health results (MALTA et al., 2009). However, the global challenge persists, as tackling the epidemic requires approaches that consider social inequalities and the complexity of the determinants of health, citizenship, and dignity (PARKER; CAMARGO, 2000).

2.2. Stigma, Prejudice, and Public Policies: The Persistence of Social Barriers

Initially, HIV was associated with specific groups, especially men who have sex with men (MSM), being derogatorily labeled as "gay cancer" or "gay plague," terms present in the early reports of the epidemic and in the journalistic coverage of the time (HEREK; CAPITANIO, 1990). As presented by Parker and Aggleton (2003), this process may have strengthened social exclusion, in addition to

contributing to the moralization and criminalization of the disease, linking the infection to behaviors considered deviant or immoral.

Emblematic historical cases clarify this social exclusion: HIVpositive individuals were expelled from their cities, especially in rural areas, supported by religious beliefs that viewed the disease as a "divine justice" against non-heteronormative sexualities. These interpretations frequently associated HIV with divine punishments, reinforcing stigmas and discriminatory practices in communities (MUÑOZ-LABOY et al., 2011). In the 1980s, police operations, such as "Tarantula" in Brazil, which targeted transgender individuals and the LGBT population, constituted discriminatory public policies, closer to extermination actions than to health protection (CAVALCANTI; BARBOSA & BICALHO, 2018).

Despite scientific advances and the creation of public policies for prevention and treatment, prejudice persisted, negatively impacting people's access to diagnosis, adequate information, testing, and antiretroviral therapy (STIGMA INDEX 2025, 2025). The stigma related to HIV harms the psychological well-being of people living with the virus and contributes to their social exclusion, making it difficult for specific groups to effectively adopt preventive measures. Studies show that, in certain social contexts such as urban health services or communities with higher social vulnerability the fear of judgment or discrimination leads to avoidance of testing, non-adherence to antiretroviral therapy, and less pursuit of information about

prevention (PARKER; AGGLETON, 2003).

More recently, the rise of ultraconservative discourses in Brazil and other countries has been associated with setbacks in public policies on sexual and reproductive health, including measures for the prevention of HIV/AIDS (PARKER; AGGLETON, 2003). Since 2013, there has been a resurgence of conservative rhetoric that has negatively impacted the implementation of public policies aimed at promoting sexual health and human rights in Brazil, especially in areas related to gender, sexual diversity, racism, and harm reduction (DINIZ, 2016). Ideological attacks such as opposition to sexual education programs in schools, cuts in harm reduction policies, and restrictions on discussions about sexual diversity contributed to the weakening of educational and preventive programs. This scenario has increased the vulnerability of groups such as adolescents, LGBTQIA+ individuals, and peripheral populations, potentially partially hindering the achievement of international epidemic control goals, such as those proposed by UNAIDS, depending on political, social, and economic factors (CAMPOS; SCHALL; NOGUEIRA, 2013; SOUZA et al., 2022).

Moreover, the social perception of HIV/AIDS as a "controlled" disease and the reduction of the topic's approach in educational and family spaces can contribute to gaps in young people's knowledge about prevention, diagnosis, and infection risk. Studies indicate that this misinformation interacts with other factors, such as limited access to health services, social stigma, and low coverage of

educational programs, complexly influencing the motivation for testing and the adoption of preventive behaviors (PARKER; AGGLETON, 2003; CAMPOS; SCHALL; NOGUEIRA, 2013). From this perspective, research shows that the persistence of stigma and discrimination, even in less explicit forms, undermines the effectiveness of preventive strategies and reinforces processes of social invisibility for people living with HIV (HEREK, 1999; MAHAJAN et al., 2008).

In summary, the stigma and prejudice surrounding HIV constitute structural barriers that limit the effectiveness of public policies (PARKER; AGGLETON, 2003; MAHAJAN et al., 2008). The current debate points to the need to strengthen approaches anchored in human rights and social inclusion, but situated in specific contexts and vulnerable groups. Among them, pregnant women living with the virus face overlapping vulnerabilities biological and social that impact treatment adherence and maternal and child health outcomes (UNAIDS, 2021).

2.3. Reproductive Health and Vertical Transmission: Vulnerability of Pregnant Women

Reproductive health is a fundamental right and one of the pillars of maternal care in the public health system. In Brazil, policies such as the National STD/AIDS Program, created in 1986 by the Ministry of Health, sought to expand access to antiretrovirals and specialized prenatal care for pregnant women living with HIV (BRAZIL 2022). The program works on the prevention and control of STIs, ensuring the free availability of medications, the provision of

diagnostic tests, comprehensive care for pregnant women and newborns, and psychosocial support. In addition, it promotes coordination between health services and civil society organizations, with educational actions and epidemiological surveillance. These actions aim to ensure comprehensive and respectful care, enabling women to access the necessary treatment for maintaining their health and preventing the transmission of the virus to their children.

Vertical transmission of HIV also known as mother-to-child transmission — refers to the passage of the virus from the mother to the baby during pregnancy, childbirth, or breastfeeding. According to the Ministry of Health, the rate of this form of transmission fell from 16% to less than 3% between 2000 and 2020, demonstrating significant advances in prevention strategies. However, significant regional disparities persist. For example, in the state of Amazonas, the HIV detection rate in pregnant women recorded 4.2 cases per thousand live births in 2021, well above the national average of 2.5, reflecting failures in early diagnosis and service coverage (BRAZIL, 2022). These data show that, despite the overall reduction, the risk and vulnerability remain high in certain regions, especially in the North of the country, compared to the South, where the coverage and effectiveness of services tend to be greater. The maintenance of these indices suggests structural failures in the screening of infection during prenatal care, particularly in areas with lower infrastructure and restricted access to health services.

Moreover, pregnant women living with HIV face challenges that compromise adherence to specialized prenatal care. The distance from care centers, combined with the shortage of qualified professionals, has been identified as a factor that compromises regular and qualified access to the follow-up of people living with HIV. Studies indicate that geographical barriers and the limitation of specialized human resources are associated with lower treatment adherence rates and inadequate clinical follow-up (MINISTRY OF HEALTH, 2023; UNICEF, 2023; SILVA et al., 2018). Moreover, factors such as low education levels and lack of proper guidance can increase the vulnerability of these women. Social stigma and discrimination, even present in healthcare services, hinder the establishment of reliable bonds between patients and medical teams, negatively impacting the continuity of treatment (SOUZA; LIMA, 2020; SILVA et al., 2020). The concentration of specialized services in large urban centers excludes women who reside in rural, peripheral, or remote areas, where the care structure is often fragmented or nonexistent (ALVES, 2018; MINISTRY OF HEALTH, 2019; PAN AMERICAN HEALTH ORGANIZATION, 2022). These structural and social barriers can contribute to inequalities in access to healthcare services, influencing the effectiveness of public policies and the quality of care during the gestational and post-gestational periods.

Continuous and comprehensive monitoring during prenatal care, childbirth, and the postpartum period is important to ensure the health of the mother and

baby, especially among pregnant women living with HIV. Regular monitoring enables the early detection of complications and effective interventions, reducing obstetric and infectious risks (BRAZIL, 2022). In this sense, the work of multidisciplinary teams which brings together professionals from the medical, psychological, social, and nursing fields is fundamental for comprehensive care. Humanization strategies, centered on respecting the dignity, autonomy, and individual needs of the pregnant woman, promote a welcoming, safe, and judgment-free environment, factors that favor adherence to antiretroviral treatment and the quality of life of these women (SOUZA et al., 2021; CUNHA; ALMEIDA, 2020). Practices such as respectful childbirth and continuous psychosocial support represent advances in promoting maternal and child health in vulnerable contexts, reinforcing the need to invest in integrated care that is sensitive to the particularities of this population.

Therefore, HIV-positive pregnant women can be doubly vulnerable due to their biological condition and social exclusion, which directly affects their adherence to treatment and, consequently, the health of the baby. This dual vulnerability is related to different structural axes, such as poverty, low education, regional inequality, racism, gender inequality, and institutional violence, which intertwine and intensify the obstacles to full access to reproductive health.

2.4. Multidimensional Coping

The advances in science and biotechnology were fundamental in transforming HIV from an almost always lethal condition to a controllable chronic disease. With

the sequencing of the viral genome and the deepening of knowledge about the biology of the virus, it became possible to develop not only more effective antiretrovirals but also prophylactic strategies, such as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), which have expanded prevention in at-risk populations. Scientific research has also explored the potential of therapeutic vaccines as demonstrated in the RV-144 clinical trial conducted in Thailand, which reduced the risk of HIV infection by about 31% (RERKSNGARM et al., 2009) and even the genetic editing of immune cells resistant to infection, as seen in studies using the CRISPR/Cas9 technique applied to the CCR5 gene in human hematopoietic stem cells, which showed viral resistance in preclinical models (XU et al., 2017).

Misinformation and stigma continue to represent significant barriers to HIV testing and diagnosis. Studies indicate that the fear of the test result and the association of the virus with morally judged behaviors are related to lower testing rates and delays in seeking care (HEREK, 1999; MAHAJAN et al., 2008). Despite ART making the viral load undetectable and untransmittable, ignorance about this fact is widespread, which reinforces prejudices and socially isolates those living with the virus.

In view of this, combating the issue can only be effective if it is coordinated on multiple fronts. The isolated action of the health sector is insufficient in the face of an epidemic that interacts with poverty, exclusion, racism, gender inequality, and violence. Public policies need to integrate health, education, social assistance, housing, and food

security, creating care networks that respect the complexity of the lives affected by this condition. Initiatives such as strengthening Testing and Counselling Centers (CTAs), providing continued psychosocial support, ensuring confidentiality and respect in care, and community mobilization have shown effectiveness in various regions. Moreover, partnerships with social movements, NGOs, and local collectives are essential to reach populations that the State has historically not reached. Intersectorality, in this sense, is not just a technical guideline, but an ethical necessity: it is the only way to build fair and lasting responses to a challenge that is, above all, a reflection of our social inequalities.

3. CONCLUSION

The objective of the analysis was to understand how biomedical advances and Brazilian public policies impact the reproductive health of women living with HIV, considering social inequalities and regional barriers. The study conducted highlights that addressing the viral infection requires a multidimensional perspective, which articulates biomedical advances with social inequalities and the specific needs of the most vulnerable populations. The progress achieved with Antiretroviral Therapy and the universal access guaranteed by the public health system represent achievements for the transformation of the disease into a controllable chronic condition. However, the effectiveness of these advances depends on strict adherence to treatment, which is influenced by factors such as stigma, social exclusion, regional access difficulties, and unfavorable socioeconomic conditions.

The vulnerability of pregnant women living with the virus, in turn, reveals the intersection between biological and social factors, reinforcing the importance of humanized and multidisciplinary care to ensure maternal and child health and the right to reproductive health. Territorial inequality and the lack of infrastructure in specialized services further highlight the need for actions based on social justice and equity.

Thus, controlling the epidemic goes beyond scientific and technological development, requiring the integration of actions that combat structural barriers, promote health education, and ensure the dignity and rights of affected individuals.

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Ozempic® and the culture of the ideal body: eating disorders and body dysmorphia, medicalization of esthetics, and the influence of social media

Isadora de Oliveira Martins e Sofia Sayuri Ishizawa

This article presents an analysis of the off-label use of semaglutide (Ozempicβ) as an esthetic and weight loss strategy among individuals without formal clinical indication. Through a literature review, it investigates how the medicalization of esthetics, together with idealized body standards, has encouraged the indiscriminate consumption of this drug. The study emphasizes the influence of social media, especially Instagram, in the propagation of unattainable body ideals. The relationships between the use of semaglutide and the development of eating disorders, such as binge eating disorder, as well as body image disorders, such as body dysmorphia, are discussed. The results indicate that the unsupervised use of the medication is directly linked to dynamics of psychological suffering, body image distortion, and excessive body surveillance.

1. INTRODUCTION

OzempicⓇ (Novo Nordisk, Bagsværd, Denmark) is the brand name of a medication based on semaglutide, a synthetic drug belonging to the class of GLP-1 receptor agonists (glucagon-peptide1). It works by stimulating glucosedependent insulin secretion, inhibiting glucagon release, and delaying gastric emptying, which contributes to glycemic control in people with type 2 diabetes mellitus (T2DM), a chronic condition characterized by insulin resistance and/or relative deficiency in its secretion (WILDING, J. P. H. et al., 2021). Moreover, semaglutide promotes appetite reduction and weight loss, effects that have led to its common off-label prescription for obesity treatment (HAN S.H. et al., 2023; GOMES, H. K. B. C. ; TREVISAN, M, 2021).

Obesity is a noncommunicable disease fostered by an imbalance between the excess calories consumed by an individual, compared to those expended, resulting in long-term accumulation of body fat. In view of this, obese individuals may resort to the off-label use of semaglutide, aiming for a cure

for their condition. This search, however, is influenced primarily by the harmful idealization of the slim body in traditional and digital media (RODRIGUES, W. L. ; SILVA, T. M., 2024), may exceed the treatment of obesity itself, reflecting an esthetic pressure responsible for triggering body image disorders and eating disorders, such as Body Dysmorphic Disorder (BDD), also known as body dysmorphia, and periodic binge eating.

BDD is an obsessive and distorted concern with imaginary or minimal defects in physical appearance (APA, 2014), which leads to compulsive behaviors, such as excessively checking the mirror and avoiding social interactions (LEONE, J. E., et al., 2005; SCHNEIDER, C., et al., 2017). In this sense, periodic binge eating is also highlighted, classified as a behavioral eating disorder, characterized by frequent episodes of consuming a large amount of food in an uncontrolled manner (APA, 2003). Consequently, the off-label use of semaglutide is considered a potential compulsive behavior stemming from the aforementioned disorders and their main causes,

substantially esthetic pressures generated by emotional traumas and low self-esteem and disseminated mainly through social networks, such as Instagram.

The pursuit of a slim body is responsible for the corrosive culture of esthetic pressures that subjects the individual to social exclusion if they do not conform to the imposed standard (AMÉRICO, K. A. P. ; OLIVEIRA, R. C. A. ; BAQUIÃO, L. A., 2022). Moreover, on media platforms like Instagram, there is not only the dissemination of unrealistic faces and bodies but also of unrealistic lifestyles that showcase productive and healthy routines that flaunt happiness. In this way, the viewer may become frustrated when comparing themselves to the unattainable standards constantly published on social media (SOUZA, L., 2021). In this ideal lifestyle, the promotion of radical diets and other weight loss methods, such as the offlabel use of semaglutide, is included (BRASIL AND BERNARDES, A. C. ; VILELA,

2023).

G. C. ; MACHADO M. C. F.,

use of semaglutide for obesity treatment and behavioral disorders especially those fostered by the propagation of unattainable esthetic standards on digital platforms, particularly Instagram. Thus, its aim is to relate the use of the medication to possible psychological disorders resulting from its indiscriminate use, mainly BDD and binge eating.

2. LITERATURE REVIEW

2.1.

Obesity

Obesity is a chronic, multifactorial, and complex medical condition, characterized by the excessive accumulation of body fat to the point of compromising the individual's physical, mental, and social health (WHO, 2004; BRAY, G. A., et al., 2017). A., et. al, 2017). Classified as a disease by the World Health Organization (WHO) and various other medical entities around the globe (AMA, 2013), obesity is associated with an imbalance between caloric intake and long-term energy expenditure (HALL, K. D. et al., 2012).

This article aims to establish, through a literature review, a relationship between the off-label

The main diagnostic criterion for obesity is the body mass index (BMI) (WHO, 2004; BRAZIL, 2023).

Although it is not sufficient by itself to diagnose someone with obesity since factors such as measuring abdominal circumference, analyzing body composition (fat and muscle mass), family history, dietary habits, and the presence of obesity-related diseases are also necessary for diagnosis BMI is a fundamental tool, an initial premise, in evaluating the relationship between a person's weight and height, allowing for the identification of whether they are below, within, or above the recommended weight. It is a calculation that relates weight (in kilograms) divided by height (in meters) squared, used to classify an individual's weight condition and health (WHO, 2004):

● Obesity grade I: BMI between 30 and 34.9;

● Grade II obesity: BMI between 35 and 39.9;

● Grade III obesity (morbid): BMI ≥ 40 (WHO, 2004; SBEM, 2022).

Regarding the regulation of body mass, genetics plays a determining and exacerbating role in an environment where there is an excess of caloric foods (FAROOQI, I. S. ; O’RAHILLY, S., 2007). The genes of an individual influence

basal metabolism, levels of satiety and hunger, and the response to physical exercise (LOOS, R. J. F. ; YEO, G. S. H., 2022). Moreover, there are rare genetic syndromes, such as Prader-Willi syndrome, responsible for severe obesity from childhood (BUTLER, M. G. et al., 2019).

Hormonal and metabolic factors are also responsible for regulating body mass (AHIMA, R. S. ; FLIER, J. M., 2000; MYERS, M. G. Jr. et al., 2008). The body regulates hunger and energy expenditure through hormones, and when these hormonal systems become dysregulated, obesity can arise or worsen, even if the individual eats properly and maintains a physically active routine. Leptin, which signals satiety to the brain, ghrelin, the hunger hormone, and insulin, responsible for controlling blood glucose levels, constitute the main hormones regulating body weight (KLOK, M. D. et al., 2007). Moreover, thyroid problems, especially hypothyroidism, and polycystic ovary syndrome (both related to human hormonal action) can also affect a person's weight (PASQUALI, R. et al., 2006; PEARCE, E. N. et al., 2017). N. et al., 2017).

Furthermore, when exposed to an obesogenic environment, individuals tend to adopt more hypercaloric diets and, consequently, become obese (MONDINI, L. et al., 2018). Urban environments that are competitive, unsafe, and lack adequate public spaces lead people to choose easily consumable ultra-processed meals –since ultra-processed foods, rich in calories, sugars, fats, and sodium, tend to be cheaper and more accessible compared to fresh and nutritious options, which particularly affects the social strata most exposed to socioeconomic vulnerabilities – and hinder the practice of physical exercise (SANTOS, P. H. ; ALMEIDA, C. R., 2019). Finally, the sedentariness of modern routines – sitting at work, long hours in front of screens, and motorized transportation – also favors the existence of an obesogenic environment (FERREIRA, A. P. et al., 2020).

In addition to the factors causing obesity, its physiological and psychological consequences are fundamental for understanding the clinical, personal, and social impact of the disease. Among the main physical consequences of obesity,

cardiovascular diseases and osteoarticular problems stand out. Conditions such as hypertension (the heart needs to pump harder to supply a larger body), atherosclerosis (buildup of fat in the arteries, leading to blood vessel blockage), myocardial infarction (heart attack), and stroke (CVA) are common complications resulting from obesity (WHO, 2021; BRASIL, 2020; SILVA, R. M. et al., 2019). M. et al., 2019).

Osteoarthritis (joint wear), herniated disks, chronic back pain due to overload, and difficulty in locomotion are also consequences of obesity (FREITAS, A. C. et al., 2018).

Moreover, liver, respiratory, gastrointestinal, and dermatological disorders are also included in this list of consequences. In the liver, hepatic steatosis (fatty liver) is the main effect, and it can progress to hepatitis, fibrosis, and even cirrhosis – even without alcohol consumption (CARR, R. M. et al., 2019). The human respiratory system, on the other hand, is affected by excess body fat in the airways, causing involuntary apneas and making it difficult for the lungs to expand, which leads to shortness of breath with minimal effort and a greater propensity for asthma attacks and

respiratory infections (XAVIER, D. S. et al., 2020). In the gastrointestinal tract, problems such as gastroesophageal reflux (constant heartburn) and a higher risk of gallstones (biliary calculi) are common (MORAIS, C. R., 2020). Finally, frequent chafing in fold areas (armpits, groin, and under the breasts), fungal and bacterial infections, and changes in skin texture stand out among the dermatological problems derived from obesity (SILVA, E. A. da et al., 2019).

Psychological factors are also associated with obesity, both as causes and as consequences. Many people turn to food as a way to cope with emotions such as anxiety, boredom, loneliness, sadness, and stress, which, involuntarily, leads to overweight and, subsequently, obesity (MACHADO, P. P. et al., 2012). In this context, emotional eating stands out, and especially eating disorders, such as periodic binge eating – characterized by the intake of large quantities of food without control (CORDÁS, T. A. ; CAIS, C., 2007; HAY, P. J. et al., 2018). This type of behavior can be triggered by traumatic experiences, a history of bullying, and abuse (HAY,

P. J. et al., 2018). Obesity itself, in turn, can generate depression, low self-esteem, and other mental conditions, creating a vicious cycle: eating to relieve emotional pain, feeling guilty after the episode, and again seeking comfort in food (CORDÁS, T. A. ; CAIS, C., 2007). Among these factors, the internalization of fatphobia and social prejudice experienced by those who do not fit esthetic standards especially extreme thinness propagated on digital media stand out, contributing to feelings of failure, inadequacy, and self-deprecation (LIMA, L. A. et al., 2021).

The constant exposure to unrealistic lifestyles, widely disseminated by social networks like Instagram – a social network popularly used in contemporary times, where users can communicate through a chat channel, hold live streams, and share photos and videos – can fuel this feeling of inferiority and promote the development of disorders such as BDD and binge eating (SOUZA, V. O. de et al., 2023; FERREIRA, G. dos S. et al., 2023). This digitalmedia influence can also drive the search for extreme solutions, such as radical diets and the use of

medications without scientific backing, like semaglutide used offlabel, without proper medical prescription (SILVA, R. O. da et al., 2023), reinforcing the social pressure for rapid weight loss and the maintenance of a body considered ideal (FERREIRA, G. dos S. et al., 2023)

2.2. Medicalization of esthetics

OzempicⓇ (Novo Nordisk, Bagsværd, Denmark) is the trade name of an injectable medication – in its most common formulation –originally manufactured for the treatment of type 2 diabetes mellitus (T2DM), a chronic metabolic disease characterized by ineffective use of insulin, or insufficient production of it (NOVA NORDISK, 2023). However, currently, the drug is frequently prescribed for the treatment of obesity (off-label use) (SINGH, A. et al., 2022), which caused Danish public investments in the production of the medication to reach 200 million dollars in 2023 a growth of more than 50% compared to the previous year as shown in figure 1.

Figure 1 – Evolution of public spending on OzempicⓇ in Denmark (2020-2023)

DANISH REGIONS, 2023 apud BLOOMBERG, 2024.

Regarding the chemical composition of the drug, its active ingredient is semaglutide, a modified synthetic peptide with 94% homology to glucagon-like peptide-1 (GLP-1) –which allows it to mimic the action of the hormone naturally produced and released by the human intestine after eating –, whose main function is to stimulate insulin production by pancreatic beta cells (NOVAES, A. B. et al., 2023). Its modifications increase its half-life (about a week), binding to plasma albumin (prolonging the action), and resistance to degradation by the DPP-4 enzyme (dipeptidyl peptidase-4), which would result in a rapid lysis of natural GLP-1 (NOVAES, A. B. et al., 2023).

In addition to its active ingredient, the medication is composed of a series of excipients,

among them, phenol, which acts as an antimicrobial preservative and prevents the growth of microorganisms after the vial or applicator pen is opened; propylene glycol, whose function is to dissolve semaglutide and maintain the stability of the solution; monobasic sodium phosphate dihydrate, which regulates the pH of the formulation to keep it compatible with the body; sodium chloride, which adjusts the tonicity of the solution, avoiding pain or adverse reactions during subcutaneous administration; and water for injection, which acts as the vehicle for the solution, that is, the medium in which the other components are dissolved (NOVA NORDISK, 2023).

The most common pharmaceutical model of semaglutide is the pre-filled pen for weekly subcutaneous injection – due to its long half-life, semaglutide allows for a simple dosing regimen, with weekly injections that ensure a stable and continuous therapeutic effect over the days – available in concentrations of 0.25mg, 0.5mg, 1mg, and 2mg per dose. After the application of the medication in the subcutaneous regions of the abdomen, thigh, or arm, it circulates

steadily in the body for days, thanks to its strong binding with plasma albumin. This slow absorption is directly related to its prolonged action. In the pancreas, semaglutide stimulates the release of insulin – but only in situations where blood glucose levels are elevated – which reduces the risk of hypoglycemia (low blood sugar). Simultaneously, the compound inhibits glucagon secretion, leading to a decrease in hepatic glucose production and better glycemic control, especially after meals (NOVA NORDISK, 2023; BRAZIL, 2023).

In addition to its blood and pancreatic actions, semaglutide partially crosses the blood-brain barrier and acts on specific regions of the hypothalamus responsible for appetite control. Its action mainly occurs on the arcuate and paraventricular nuclei, where it binds to GLP-1 receptors, promoting the reduction of hunger, the search for highly caloric foods, and compulsive eating behavior. Consequently, satiety is increased even with a lower food intake. This is, therefore, the main mechanism by which the use of semaglutide leads to weight loss, resulting from the decrease in caloric intake and the increase in basal

energy expenditure – however, as presented by Muller, T. D. et al. (2019) and Sevilla, L. J. et al. (2021), this hypothesis lacks further studies. Additionally, semaglutide exerts significant effects on the gastrointestinal tract, delaying gastric emptying and thus keeping food in the stomach for a longer period. Moreover, in the liver, semaglutide acts indirectly as a consequence of glucagon inhibition promoted in the pancreas, which prevents the liver from releasing excess glucose into the bloodstream, reducing processes such as glycogenolysis and gluconeogenesis. Consequently, there is a decrease in endogenous glucose production, which helps maintain adequate glycemic levels –whether fasting or not. However, semaglutide is not metabolized in the liver, as occurs with several other medications. Instead, its degradation occurs slowly in the bloodstream through proteolysis processes (MULLER, T. D. et al., 2019; SEVILLA, L. J. et al., 2021).

The use of semaglutide generates various physical and psychological effects, especially related to eating disorders and body dysmorphic disorders. Among the

possible psychological consequences are:

● Anxiety, associated with rapid changes in glucose levels and metabolism, which can affect the autonomic nervous system and result in symptoms such as tachycardia, tremors, and restlessness, similar to those observed in anxiety attacks, intensified by rapid weight loss and social pressures related to body esthetics (SOUZA, R. H. ; FERREIRA, P. G., 2021);

● Depression, potentially related to abrupt weight changes and alterations in body perception, which may involve feelings of isolation, alienation, or discomfort with the new image (ALMEIDA, J. C. de; LOPES, M. F., 2019);

● Eating disorders and obsession with weight, associated with drug-induced dietary restriction, with the possibility of manifestation of behaviors compatible with periodic compulsive eating disorder (binge eating) (MARTINS, C. R. ; PEREIRA, F. A, 2020);;

● Body image distortion, identified in cases where there is no psychological support accompanying the physical transformation and which may be related to the

development of BDD and persistent dissatisfaction with one's own appearance (GOMES, A. B. ; SANTOS, R. L. dos, 2018).

3. DEVELOPMENT

3.1. Culture of the ideal body and its propagation on social media

The combination of physical suffering, frustration with one's own body, social exclusion, and constant emotional pain leads many individuals with obesity to a state of chronic discouragement, compromising sleep, motivation, productivity, and self-care, fueling a cycle that is difficult to break (MORAES, L. H. de; SOUSA, A. L. de, 2020). In the view that individuals are inserted in a society that uses digital means of communication to associate thinness with acceptance and success, the exclusion of bodies outside the esthetic standard is noticeable, thus generating cases of mental disorders, such as BDD and periodic binge eating (COSTA, F. O. ; ALVES, M. V., 2019). It is observed, as an usual development, a consequent search for the treatment of obesity with semaglutide, aiming for a quick change (PEREIRA, C. S. ; SILVA, R. H., 2022).

In addition to being frequently exposed to the promotion of radical diets and alternative medications for rapid weight loss – via social media, especially Instagram – many people encounter, voluntarily or involuntarily, photos and videos of users who supposedly have the ideal appearance, fostering in them a feeling of inferiority and comparison. In this context, Instagram stands out as a conducive medium for the dissemination of unrealistic and unattainable body types and esthetic standards, as it provides filters and effects in its own settings that can significantly alter users' appearances resources widely used worldwide thus overvaluing the culture of the ideal body (SILVA, D. V. da; BRASIL, T. S., 2022).

Currently, Instagram has over 2 billion active users worldwide, ranking as the fourth most used social network globally behind only Facebook, WhatsApp, and YouTube. According to international studies conducted by Yahoo! Labs, in partnership with Georgia Tech University, manipulated images through filters receive, on average, 21% more views and 45% more comments than those without edits. It is possible to consider that social

media has been consolidating as unfavorable environments for individuals who do not conform to the dominant esthetic standard, centered on extreme thinness (AMÉRICO, K. A. P. et al., 2022). Moreover, Instagram is a communication platform that is not completely regulated, meaning people can send negative comments directed at individuals who do not fit the esthetic standard (AMÉRICO, K. A. P. et al., 2022) and, therefore, the targets of this negativity may experience greater emotional stress, anxiety, depression, social isolation, and loneliness (PESSOA, J. et. al., 2019). As the focus of this work, it is possible to analyze the relationship between the culture of the perfect body propagated by Instagram and the condition of Body Dysmorphic Disorder and periodic binge eating.

3.2. Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD), commonly known as body dysmorphia, is a psychiatric condition in which the affected person develops an excessive and abnormal concern with defects in their own appearance – minimal, barely noticeable, or non-existent

imperfections, which only they perceive as something serious (FREITAS, L. S. de; LIMA, R. H., 2021). This distortion of image causes the individual afflicted by such a disorder to see themselves in a warped manner, not in accordance with reality, feeling ugly, deformed, and inadequate, even though other people do not notice their supposed defects (SANTOS, A. P. et al., 2020). This disorder affects both the way the individual sees themselves in the mirror and how they feel about their body. The person affected by such a disorder may spend hours a day observing themselves, hiding parts of their body, comparing themselves to others, or seeking ways to correct what they consider a flaw – such as extreme diets, plastic surgeries, and the use of alternative medications –like semaglutide – or supplements, and even avoiding social interactions out of shame for their own appearance (ARAÚJO, M. C. ; GOMES, P. C., 2023).

3.3. Periodic binge eating

Besides Binge Eating Disorder (BED), eating disorders, especially periodic binge eating, stand out among the corrosive psychological effects of the perfect

body culture propagated on Instagram. Eating disorders are frequent and harmful physical and dietary behaviors, related to situations that involve exacerbated emotional conditions, generating consequences for the physical, social, and psychological well-being of the affected individual (BRAZ, W. M. ; AQUINO, M. C. ; OLIVEIRA, G. F., 2023). In particular, binge eating is characterized by persistent episodes of uncontrolled consumption of large quantities of food, related to esthetic pressure and feelings of inferiority, generating a repetitive cycle: eating to relieve emotional pain, but feeling guilty afterward, which leads to more binge eating (ATTIA, E. ; WALSH, B. T.: 2002).

For its diagnosis, the respective clinical criteria are necessary: episodes of binge eating an average of once a week for at least three months and having at least three or more of the characteristics during the binge period, which are eating more rapidly than normal, eating until feeling uncomfortably full, eating excessively without feeling hungry, eating in secret or alone due to embarrassment, and feeling guilt

after eating (APA, 2003). The factors that lead to this disorder are multifaceted: body dysmorphia, low self-esteem, anxiety, and depression (OPENHEIMER, R. et al., 2024).

The spread of semaglutide on Instagram can encourage individuals who are obese and/or affected by BDD and binge eating to seek measures for immediate body transformation, such as the inappropriate use of medications. In this way, the off-label use of semaglutide as a quick path to weight loss emerges as a possibility and a route. Although this drug was produced to treat type 2 diabetes mellitus (T2DM), its use outside of the ideal medical prescription for esthetic purposes has become popular among obese individuals substantially due to the esthetic pressure imposed on them (MACEDO, P. A. de et al., 2023). The relentless pursuit of thinness can intensify and even generate a compulsive body and eating disorder, causing the individual to never feel thin enough, even if they have lost weight (FREITAS, L. S. de; LIMA, R. H., 2021).

3.4. Analysis of the established relationship

Given the above, it is evident that the off-label use of semaglutide for esthetic purposes represents a concerning phenomenon that goes beyond a simple individual choice to lose weight. Although the medication has proven efficacy in weight reduction for people with obesity and type 2 diabetes (WILDING, J. P. H. et al., 2021; GOMES, H. K. B. C. ; TREVISAN, M., 2021), its use without clinical indication and proper monitoring can bring serious psychological consequences, still little discussed within and outside the academic community (MACEDO, P. A. de et al., 2023; SILVA, R. O. da et al., 2023).

The way Instagram has amplified body dissatisfaction and the search for quick solutions, such as the indiscriminate use of semaglutide, is alarming. The culture of filters, edited images, and the constant display of bodies considered ideal creates an environment of continuous comparison, which can affect users' self-esteem and mental health (AMÉRICO, K. A. P. et al., 2022; FERREIRA, G. dos S. et al., 2023). Several studies indicate that this exposure can worsen cases of eating disorders, such as periodic binge

eating, and body image disorders, such as BDD (SOUZA, V. O. de et al., 2023; COSTA, F. O. ; ALVES, M. V., 2019).

Besides the individual impacts, it is necessary to reflect on the ethical and social aspects of this process. The medicalization of esthetics transforms emotional, social, and cultural issues into a problem that seems to have only a pharmacological solution, making the real causes of psychological suffering invisible (MACEDO, P. A. de et al., 2023). This process focuses solely on the body and disregards the emotional and social context in which these individuals are situated, which can further exacerbate anxiety and depression (ALMEIDA, J. C. de; LOPES, M. F., 2019; SOUZA, R. H. ; FERREIRA, P. G., 2021).

This trivialization of the use of medications like semaglutide also reveals a failure in the democratization of information and in proper professional guidance. Consequently, the need for stricter regulation on the dissemination of solutions considered miraculous on social media is perceived (SILVA, D. V. da; BRASIL, T. S., 2022), which is anchored in social pressures and beauty standards imposed by digital

media on fat bodies

(AMÉRICO, K. A. P. et al., 2022; FERREIRA, G. dos S. et al., 2023).

Thus, it becomes clear that the discussion about the off-label use of semaglutide needs to go beyond the medical aspect. It involves social, psychological, cultural, and ethical issues, requiring a more critical perspective from society, the media, healthcare professionals, and, above all, the digital platforms themselves, which continue to promote unattainable esthetic standards (FERREIRA, G. dos S. et al., 2023; SILVA, D. V. da; BRASIL, T. S., 2022). The construction of a culture of body acceptance and holistic health, which values physical and emotional well-being above esthetics, is a challenge (PEREIRA, C. S. ; SILVA, R. H., 2022).

4. FINAL CONSIDERATIONS

This work, through an extensive literature review, aimed to establish and analyze a relationship between the physical and psychological factors associated with obesity, the off-label use of semaglutide for the treatment of obesity and psychological disorders, especially Body Dysmorphic Disorder (BDD) and periodic binge

eating – mainly fueled by the overvaluation of the slim body in digital communication media, especially Instagram. Given the above, it can be stated that fatphobia and insecurity can generate vulnerability and lead to the development of body dysmorphia or binge eating disorder. Thus, in a cycle of psychological suffering, in which obesity is associated with individual guilt, weight loss becomes pursued compulsively, and body dissatisfaction persists both in relation to external perception and self-image.

Finally, it is possible to affirm that the medicalization of esthetics, combined with the constant pressure from social media, requires a more careful look from society and public health authorities. For this reason, it is suggested that future studies delve deeper into the analysis of the responsibility of digital platforms in the propagation of unattainable body standards, as well as evaluate the ethical and social impact of the commercialization and dissemination of medications with potential esthetic use. Future investigations could also explore educational strategies and regulatory policies capable of reducing the psychological damage

caused by this culture of idealized thinness, contributing to the creation of a healthier and more inclusive digital environment.

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Digital Childhood: The Impact of Social Media on the Development of Children and Adolescents

Amanda Lessa, Beatriz Gregolin, Julia Turini e Sophia Fernandes

The present study investigates the impacts of internet and social media use on children and adolescents, analyzing both the benefits and the associated risks. Questionnaires were administered to 217 participants, with 11 questions about digital habits, devices used, and behavior perceptions. The results showed that 49.3% consider it appropriate to start using a cell phone only after the age of 13, and 93.1% believe that early access to social networks can harm a healthy childhood. The smartphone was the most used device (91.7%), and a significant association was observed between the type of device and frequency of use (β²(12)=21.73; p=0.0406; V=0.123). The negative correlation between the age of starting cell phone use and access frequency (β = −0.407; p < 0.001) indicated that starting earlier is related to more time online. A positive correlation was also identified between the age of first use and the ideal age for the first cell phone (β = 0.361; p < 0.001), as well as the association between concern with appearance and advanced topics (β = 0.379; p < 0.001), highlighting processes of early adultification. It is concluded that the balanced use of social networks depends on family guidance and digital education, making it essential to promote screen limits and parental mediation practices for healthy development in the digital age.

1. INTRODUCTION

Social media, although it has brought numerous benefits in the field of communication and access to information (Pezzella & Camargo, 2012), has also been generating negative consequences in the lives of adolescents and, especially, children (Park, et al. 2024). Among the main impacts are digital addictions, such as compulsive use of social media, online gaming, excessive browsing, and even virtual pornography (Azevedo & Torres, 2023). These behaviors directly affect daily life, interfering with sleep, academic performance, social interaction, and emotional development (Tchicusse, 2025). Recent studies also indicate that excessive use of social media is related to the release of dopamine and the reinforcement of compulsive behaviors during the use of digital platforms (Montag, Dack & Reuter, 2021), in addition to negative impacts on sleep and academic performance (Cao, Sun & Wan, 2020). The internet became more accessible to children and adolescents starting in the 2010s (Regional Center for Studies on the Development of the Information Society, 2025).

According to the TIC Kids Online Brazil survey (2023), 95% of young people aged 9 to 17 access the internet daily, with 89% using social networks (Regional Center for Studies on the Development of the Information Society, 2023). Many start using it even before the recommended minimum age (13 years) (Nagata, et al. 2025). These data reinforce the urgency of reflecting on the limits and conscious use of digital platforms.

An important and current example on this topic is the article published in FT Magazine, written by Ester Oliveira Cavalcante and collaborators, titled "The Impact of Social Media on the Mental Health of Children and Adolescents – A Literature Review Study." The publication points out that the continuous use of these platforms is directly related to symptoms of anxiety, depression, low self-esteem, and social isolation, especially in adolescents. The study explains that the pleasure sensation system (the released dopamine), activated by the number of likes, followers, and interactions, can generate psychological dependence similar to other forms of addictions such as

gambling, pornography, ultra processed foods, legal substances, and even illicit ones.

Although the internet also brings positive effects, such as facilitated access to knowledge, the development of communication and expression skills, business and entrepreneurship opportunities, or even global connection, which allows us to contact various people around the world, opening up opportunities for work and networking (Zimei Liu, et al, 2022), the emergence of negative impacts is also evident, such as self-esteem issues, eating disorders, emotional dependence on virtual approval, cyberbullying, and exposure to inappropriate content (Miguel & Theodore, 2024). These effects are closely linked to digital addiction and low emotional selfregulation observed in young social media users (Kuss & Griffiths, 2021). Digital addiction is characterized by excessive internet use that harms other areas of life, such as family and school interactions. About 95% of children and adolescents (ages 9–17) who use the internet daily report having been offended online (cyberbullying or verbal assaults) in 29% of cases, while another 22% experienced loss of sleep, negative

impacts on their studies, or even on family interactions due to browsing (Deborah Prkno, 2024).

In the article by Mariana L. Nascimento Júnior, for the Jornal da USP, titled "Social networks encourage inappropriate behaviors for children's age," discusses how early exposure to content aimed at adults has promoted a forced "adultification," interfering with children's emotional and social development. Experts warn that, without parental mediation and proper regulation of platforms, children become vulnerable to behaviors that are not appropriate for their developmental stage, such as adultization. An example is the video by influencer Felca, published on August 7, 2025, which denounced some influencers involved in cases of child exploitation, adultization, and sexualization of children and adolescents on the internet (Rebeca Suárez-Álvarez, 2022). It also addresses a "P Algorithm," a recommendation system that identifies users who interact with children's content in suggestive situations (such as short, tight, or transparent clothing, sensual choreography, camera focus on parts of the child's body in a

sexualized manner, among others), in addition to criticizing those involved, such as the guardians of the children and the content of the application.

Although social media is part of reality, it is necessary to understand it as a tool that, without proper use, can compromise the mental and emotional well-being of children and adolescents. Awareness, education, and regulation are fundamental paths to protect future generations from the risks of this digital universe. In other words, this article aims to discuss the impacts of social media on child development, comparing the responses from questionnaires by the school community in the Ipiranga neighborhood of São Paulo, Brazil, with the data presented in the literature, in order to assess the community's understanding of the relevance of the issue and propose ways for more conscious and protective development.

2. METHODOLOGY

The methodology adopted in this work was an exploratory questionnaire with 11 questions about internet habits, devices used, perceived benefits, ages, topics

covered in the digital realm, and changes in attitudes. The target audience consisted of people aged 13 and older. The questions presented were closed-ended. The survey was conducted online, with 217 valid participants. The data were organized and analyzed in a spreadsheet, allowing for the observation of response patterns and the identification of the main trends regarding internet and social media usage among the public.

In addition to the analysis of percentages and graphs, some statistical tests were also conducted to better understand the relationship between the responses. First, chisquare tests (χ²) were applied, which are used to verify if there is any association between two variables, such as the type of device used and the time a person spends on social media. When a significant relationship was found, we used Cramér's V to understand whether this connection was weak, moderate, or strong.

Then, we also used Spearman's correlation (ρ), which helps to see if there is a relationship between variables that have a certain order, such as the age at which a

person started using a cell phone and the frequency of social media use. This type of analysis allows us to see, for example, if those who started earlier tend to use social networks more today.

The confidence level considered was 5% (α = 0.05), which means that the results found have a very small chance of having occurred by chance.

These tests were important because they helped make the work more comprehensive, showing not only the percentages but also how the variables relate to each other, strengthening the discussion about the impacts of early digital use in childhood and adolescence.

3. RESULTS

responses, it was possible to identify very clear trends regarding the use of technology and social media among the participants. people and showed that 49.3% believe that cell phone use should start only after the age of 13, while 37.3% think it can happen between the ages of 9 and 12. Another 12% said between 6 and 8 years, and

1.4% between 3 and 5 years (Figure 1a).

These results reinforce the perception that the majority understands that contact with mobile phones should occur at an older age, which is in line with expert recommendations and recent studies on the subject.

When asked if early access to social media can affect a healthy childhood, 93.1% answered "Yes," showing strong agreement regarding the risks of this early use (Figure 1b).

Figure 1 - (a) Percentage distribution of the ideal age to start using a cell phone among participants. (b) Participants' perception of the impact of early access to social media in childhood.

Moreover, 96.3% stated that they know children who already use technology, and 96.8% believe that parents and guardians should be the main guides in this usage, which shows the recognition of the importance of family presence in this process.

The results also showed that 88.5% of the participants have noticed children concerned about appearance and body due to the influence of the internet, and 85.3% said that they talk about topics considered advanced for their age, such as fame, relationships, and sexuality. These two aspects are strongly linked, which was confirmed by the Spearman correlation analysis, indicating a positive and moderate relationship between these variables (ρ = 0.379; p < 0.001) (Figure 2).

Figure 2 – Correlation between concern for appearance and interest

in advanced topics (ρ = 0.379; p < 0.001).

This means that the more people notice that children talk about advanced topics, the greater the chance they will perceive concerns about appearance, indicating a process of early adultification and esthetic pressure that has been highlighted by different authors in the literature.

Despite these warning points, the participants also recognized benefits in using the internet: 51.6% pointed to access to educational resources, 24% highlighted the stimulation of creativity, and others mentioned language learning and autonomy as positive aspects.

Regarding the most used devices, the smartphone emerged as the main one, with 91.7% of the responses (Figure 3a).

This choice showed a significant association with the frequency of social media use (χ²(12)=21.73; p=0.0406; V=0.123) (Figures 3b and 4), that is, the type of device is linked to the time the person spends online and the smartphone, being always at hand, tends to favor more intense use.

Figure 3 – (a) Devices most commonly used by participants to access the internet. (b) Daily frequency of social media use among participants.

Figure 4 – Association between type of device and frequency of social media use (χ²(12)=21.73; p=0.0406; V=0.123).

Regarding the frequency of access, 36.9% said they spend 2 hours per day on social networks, 34.1% use it for 5 hours per day,

18.4% for more than 8 hours, and 10.6% stated they do not use it every

When these data were compared he age at which the participants started using the cell phone, a negative and moderate correlation was observed (ρ = −0.407; p < 0.001), showing that the earlier a person started using the cell phone, the longer their current usage tends to be.

It was also identified that those who started using the cell phone later tend to advocate for older ages as ideal for starting its use (ρ = 0.361; p < 0.001). On the other hand, those who spend more time on social media tend to prefer younger ages to start (ρ = −0.241; p = 0.0003) (Figure 5).

Figure 5 – Correlation between the age of first cell phone use and the frequency of social media use (ρ = −0.407; p < 0.001).

These results reinforce that personal experiences directly influence how people perceive the risks and limits of technology.

Finally, 98.2% stated that they use social media, which shows how access is practically universal among the participants.

Based on all these analyzes, both the percentages and the statistical tests, it is possible to conclude that early and prolonged use of social media is associated with behavioral changes, including greater exposure to inappropriate content, concern with appearance, and increased screen time, factors that, together, can impact the emotional well-being and healthy development of children and adolescents.

4. DISCUSSION

The analysis of the data obtained from the questionnaire clearly showed that the use of social media causes both positive and negative effects on the emotional, social, and cognitive development of children and adolescents. The results confirm what other studies have already pointed out: early and intense use of social media is linked to changes in behavior and

perception of oneself and the world (Park, et al., 2024; Cavalcante, 2024).

The graphs and statistical tests presented reinforce this duality. One of the most striking results was the relationship between children who talk about topics considered advanced for their age and those concerned with appearance and body. The Spearman correlation (ρ = 0.379; p < 0.001) showed a moderate positive link between these two factors. This means that the more participants perceive "adult" speech in children, the more they also observe concerns about appearance something that reinforces the idea of early adultification, described by Suárez-Álvarez (2022) and by Cavalcante (2024), and which has been growing with the free access to influencer content and esthetic standards on social media.

Another important point was the connection between the type of device and the frequency of social media use, which showed a significant association (χ² (12) = 21.73; p=0.0406; V=0.123). The smartphone was the main means of access (91.7%), and this data helps explain why the exposure time is so high: the cell phone is always

available and encourages continuous use, something that has already been pointed out by Tchicusse (2025) as a factor of digital dependence and impact on sleep and concentration.

The correlation between the age of starting to use a cell phone and the frequency of access also caught attention. The result (ρ = −0.407; p < 0.001) showed that the earlier someone starts using a cell phone, the more time they currently spend on social networks. This indicates that early use tends to create a more intense habit over the years, something that is related to the increase in symptoms of anxiety and emotional dependence described by Park et al. (2024) and Prkno et al. (2025).

Moreover, a positive relationship was observed between the age at which the participant started using a cell phone and the age they consider ideal for a child to have their first device (ρ = 0.361; p < 0.001). In other words, those who started later tend to advocate for older ages to begin. The reverse is also true: those who have used networks for a longer time tend to find it normal to start earlier (ρ = −0.241; p = 0.0003). This perception

shows that personal experiences shape the way people understand the limits of digital use.

The results also engage with the research of Azevedo and Torres (2023), which discusses digital vulnerability and the role of the family as a mediator. The majority of the respondents in this study (96.8%) indicated parents and guardians as the main guides for internet use, confirming what authors like Odgers and Jensen (2020) and the American Psychological Association (APA, 2023) highlight: parental mediation is one of the most important factors in reducing the risks of social media use. This family mediation is fundamental to balancing the use of technology and emotional development, as also pointed out by Livingstone & Blum-Ross (2020), who highlight the importance of active digital parenting strategies.

On the other hand, it is important to remember that not all effects are negative. The participants also acknowledged that the internet can bring important benefits, such as access to educational resources (51.6%) and stimulation of creativity (24%). These data align with what UNESCO (2023) and Liu et al. (2022) point out about the role of

technologies in learning and the expansion of global knowledge. Therefore, the results obtained based on the questionnaire and statistical analyzes show that the use of social networks is a complex phenomenon, which greatly depends on the context and the way it is conducted. When there is monitoring and guidance, social networks can serve as tools for learning, socialization, and creativity. But, when the use is early, uncontrolled, and unsupervised, the negative impacts, such as adultification, excessive exposure, and low selfesteem, become evident. These findings reinforce the importance of digital education in schools, screen time limits, active family participation, and public policies aimed at the conscious use of the internet, ensuring that the digital environment can be a space for healthy development and not a risk.

5. CONCLUSION

The majority of participants (49.3%) believe that cell phone use should start only after the age of 13, which demonstrates awareness of the importance of maturity at this stage. Moreover, 93.1% recognize that early access to social media can harm a healthy childhood, confirming the concern for the emotional wellbeing of the new generations.

The statistical results helped to make these perceptions even clearer. The negative correlation between the age of first cell phone use and the frequency of access to networks (ρ = −0.407; p < 0.001) showed that those who start using it earlier tend to spend more time online. The positive relationship between the age of first use and the ideal age for the first cell phone (ρ = 0.361; p < 0.001) reinforces that personal experiences directly influence how each individual perceives the use of technology.

Another important point was the association between the type of device and the frequency of use (χ²(12)=21.73; p=0.0406; V=0.123), indicating that the smartphone, being

According to the results obtained, it was possible to perceive that the use of social networks has a dual role in the lives of children and adolescents: while it offers opportunities for learning, creativity, and socialization, it can also bring significant risks when used prematurely, excessively, or without supervision.

the most used device, is related to more intense use of social networks. Moreover, the correlation between "concern with appearance" and "advanced topics" (ρ = 0.379; p < 0.001) showed that early exposure to certain content can stimulate adultification and social comparison, which is consistent with recent studies (Cavalcante, 2024; SuárezÁlvarez, 2022).

Despite the identified risks, the interviewees also highlighted positive aspects, such as access to educational content (51.6%) and the stimulation of creativity (24%), reinforcing that the internet can be a development tool when used properly.

Thus, it is concluded that the balanced use of social networks mainly depends on family guidance and digital education. The majority of participants (96.8%) identified parents and guardians as the main mediators, which highlights the essential role of the family in ensuring that the digital experience is positive.

Therefore, the study reinforces the importance of teaching the conscious use of technology, establishing clear boundaries, and encouraging dialog between parents,

children, and schools. With guidance, social networks can become spaces for exchange, learning, and expression, but without supervision, they can generate negative emotional and behavioral impacts.

For future research, it would be interesting to broaden the target audience, including different age groups and social contexts, and to deepen the analyzes on the longterm effects of social media use. In this way, it will be possible to understand more clearly how the digital world influences the development of new generations and how we can make it a healthier and safer environment for everyone.

6. REFERENCES

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KUSS, D. J.; GRIFFITHS, M. D. Social Networking Sites and Addiction: Ten Lessons Learned. International Journal of Environmental Research and Public Health, v. 18, n. 4, 180, 2021.

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Parenting for a Digital Future: How Hopes and Fears about Technology Shape Children’s Lives. Oxford: Oxford University Press, 2020.

MIGUEL, L.; THEODORE, A. Efeitos

das redes sociais na autoestima e na construção da imagem corporal em adolescentes. Revista de Psicologia Contemporânea, v. 18, n. 2, p. 45–59, 2024.

MONTAG, C.; DACK, C.; REUTER, M. The role of dopamine in social media use and addiction. Addictive Behaviors Reports, v. 14, p. 100373, 2021.

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ODGERS, C. L.; JENSEN, M. R.

Annual Research Review: Adolescent mental health in the digital age: Facts, fears, and future directions. Journal of Child Psychology and Psychiatry, v. 61, n. 3, p. 336–348, 2020.

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1. INTRODUCTION

Social media, although it has brought numerous benefits in the field of communication and access to information (Pezzella & Camargo, 2012), has also been generating negative consequences in the lives of adolescents and, especially, children (Park, et al. 2024). Among the main impacts are digital addictions, such as compulsive use of social media, online gaming, excessive browsing, and even virtual pornography (Azevedo & Torres, 2023). These behaviors directly affect daily life, interfering with sleep, academic performance, social interaction, and emotional development (Tchicusse, 2025). Recent studies also indicate that excessive use of social media is related to the release of dopamine and the reinforcement of compulsive behaviors during the use of digital platforms (Montag, Dack & Reuter, 2021), in addition to negative impacts on sleep and academic performance (Cao, Sun & Wan, 2020). The internet became more accessible to children and adolescents starting in the 2010s (Regional Center for Studies on the Development of the Information Society, 2025).

According to the TIC Kids Online Brazil survey (2023), 95% of young people aged 9 to 17 access the internet daily, with 89% using social networks (Regional Center for Studies on the Development of the Information Society, 2023). Many start using it even before the recommended minimum age (13 years) (Nagata, et al. 2025). These data reinforce the urgency of reflecting on the limits and conscious use of digital platforms.

An important and current example on this topic is the article published in FT Magazine, written by Ester Oliveira Cavalcante and collaborators, titled "The Impact of Social Media on the Mental Health of Children and Adolescents – A Literature Review Study." The publication points out that the continuous use of these platforms is directly related to symptoms of anxiety, depression, low self-esteem, and social isolation, especially in adolescents. The study explains that the pleasure sensation system (the released dopamine), activated by the number of likes, followers, and interactions, can generate psychological dependence similar to other forms of addictions such as

Therapeutic approaches for Alzheimer’s Disease: green chemistry, stem cells, and music therapy

Gabriel Rio, Giovana Borali, Vinícius Massao e Yasmim Dreos

Alzheimer’s Disease (AD) is a neurodegenerative disorder characterized by the progressive loss of cognitive functions, generally associated with aging. This article aims to analyze experimental and unconventional therapies — green chemistry, stem cell therapy, and music therapy — in the treatment and improvement of the quality of life of patients with Alzheimer’s disease, through a literature review. Green chemistry investigates natural compounds, such as alkaloids, flavonoids, chalcones, and coumarins, with the potential to inhibit enzymes linked to the degradation of acetylcholine and the aggregation of tau protein. These compounds may represent safer and more sustainable alternatives to synthetic drugs. Stem cell therapy aims to regenerate neural tissues and restore synaptic connections. Induced pluripotent stem cells (iPSCs) and embryonic stem cells (ESCs) demonstrate promising potential, although challenges such as immune rejection and tumor risk still limit their application. Music therapy, in turn, acts complementarily, stimulating cognitive, emotional, and social aspects. Studies indicate improvement in memory, attention, and well-being in some cases. Overall, these approaches may broaden therapeutic perspectives for AD, but they require more research to assess their efficacy, safety, and clinical applicability.

INTRODUCTION

Alzheimer's disease (AD) is a neurodegenerative disorder that consists of the progressive deterioration of cognitive functions. This pathology is associated with the accumulation of beta-amyloid plaques and tau protein tangles in the brain. These anomalies interfere with communication between neurons, cause inflammation, lead to gradual cell death, and damage the myelin sheath (FERREIRA, 2013). Initially characterized by signs such as memory lapses, confusion, anxiety, sadness, and the impairment of new memory formation. As it progresses, it impacts other areas, such as attention, language, and thinking, which affects autonomy and creates the need for assistance with basic daily activities.

Moreover, it causes changes in personality and behavior, which can make the individual more agitated and aggressive (FONSECA, 2023).

According to the World Health Organization (WHO), approximately 50 million people are affected by some type of dementia, with 50 to 70% of these cases related to AD. Among these cases, the majority are caused by exogenous factors, such as chronic stress and traumatic experiences, and only 5% of the cases are attributed to hereditary mutations (VASIC, 2019). Thus, different factors such as advanced age, genetic predisposition, and an unhealthy lifestyle contribute to a higher likelihood of developing the disease (FERREIRA, 2013).

Conventional treatments for AD aim to improve functional quality of life through the relief of cognitive, behavioral, and neuropsychiatric symptoms. They include cholinesterase inhibitors, NMDA antagonists, and psychotropic drugs. The advances in the development of treatments for AD are modest, even though they are relevant to cognition and behavior, and the available medications have significant side effects on the human body. It is worth noting that there are still no treatments capable of curing AD or preventing its progression, only palliative treatments (FONSECA, 2023).

In this scenario, experimental treatments, such as green chemistry, which, in the context of AD, aim to develop treatments that are less harmful to the body, through the development and implementation of chemical products and processes that minimize or eliminate substances harmful to human health (LENARDÃO, 2003). In addition to green chemistry, treatment with stem cells - which are not specialized - has the ability to form specific tissues and shows potential for treating neurodegenerative diseases through tissue engineering (SHAH, 2024). Among the unconventional approaches, there is music therapy, which uses musical elements to promote the physical, emotional, cognitive, and social well-being of the individual, through the influence that music has on various areas of the brain, such as the hippocampus, the amygdala, and the prefrontal cortex, associated with memory,

emotions, focus, social interaction, and promoting a better quality of life (SOUSA, 2021; GÓMEZ, 2017).

For this reason, in the face of the challenges imposed by Alzheimer's Disease, it is necessary to understand the importance of implementing complementary therapeutic approaches in order to optimize conventional treatments and contribute to a constant improvement in the patient's psychological-clinical condition and quality of life (VELLOSA, 2022). This article aims to address the efficacy of these therapies and their importance in the treatment of the aforementioned pathology.

2. DEVELOPMENT

2.1. AD and experimental therapies

Alzheimer's Disease (AD) is a condition that progressively affects vital cognitive functions, such as memory, language, and logical reasoning (VELLOSA, 2022). These characteristics are related to the significant process of reduction in the brain volume of patients due to the loss of neurons and degeneration of synapses, linked to the process of hippocampal formation (XU, 2020).

Moreover, the degradation of acetylcholine (ACh) by cholinesterase enzymes (AChE and BuChE) and the formation of neurofibrillary tangles abnormal clusters of hyperphosphorylated Tau protein within neurons, which compromise the structure and

function of nerve cells are among the factors associated with the progression of AD. AChE and BuChE originate when the Tau protein, a microtubule stabilizer in neurons, undergoes hyperphosphorylation, detaches from the cytoskeleton, and begins to form toxic structures, compromising cellular integrity (VELLOSA, 2022).

Amid the lack of knowledge about the causes and cure of AD diagnosis (FERREIRA, 2013), neurodegenerative disease therapies, which promise not only to combat symptoms but also to positively influence the fight against disease progression and improve patients' quality of life (FONSECA, 2023), become even more relevant in light of the increasing incidence of AD and the need for personalized treatments for better efficacy in combating the manifestations of the disease (FONSECA, 2023).

The experimental therapy method is employed in biotechnology as a preliminary stage to the development of new treatments, aiming to evaluate their efficacy and safety before application in patients. This investigative phase corresponds to the beginning of the therapeutic innovation process and aims to provide parameters on the possible positive and negative impacts of the proposed interventions, in order to ensure greater reliability in their use (ROSA, 2021).

2.2. The use of Green Chemistry

Among the pharmacological approaches in the experimental phase, the application of green chemistry principles stands out in the search for safer and more sustainable treatments. This approach proposes the development of substances and chemical processes that minimize negative impacts on human health and the environment, prioritizing the reduction of toxicity and the use of renewable raw materials (ANASTAS; EGHBALI, 2010).

In the context of Alzheimer's disease treatment, these principles have been incorporated into the development of new drugs that target specific aspects of the disease, such as cholinesterases, but with a lower risk of adverse effects compared to conventional synthetic medications.

In this sense, the application of the general principles of green chemistry guides pharmacological research focused on AD, which enhances the safety of the developed compounds and directs scientific efforts toward more sustainable alternatives compatible with human health.

In this scenario, alkaloids emerge as one of the most promising classes of natural compounds within the green chemistry approach for developing safer therapies for AD. Present in approximately 25% of plant species, these nitrogenous compounds have demonstrated significant pharmacological activity. Studies such as Viayna et al. (2014) have demonstrated that hybrid

derivatives of alkaloids exhibit inhibitory activity on the enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), which are responsible for the degradation of acetylcholine (ACh). In addition to contributing to the increased availability of ACh, these substances are associated with the inhibition of tau protein aggregation, implicated in the neuronal degeneration characteristic of AD (VELLOSA, 2022).

In line with this approach (or it could be 'Within the same context,' I tried to be more formal), flavonoids reinforce the potential of natural substances as strategic tools in the treatment of AD. Present in various plants, fruits, and roots, these polyphenolic compounds stand out for their diverse pharmacological properties, especially for their inhibitory action on the enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), responsible for the degradation of acetylcholine (ACh). This characteristic allows for an improvement in neuronal communication, a crucial factor in the treatment of AD. Studies, such as that of Sevindik and collaborators (2015), demonstrated the efficacy of flavonoids extracted from Achillea millefolium L. in in vitro and in silico tests, confirming their interaction with the catalytic sites of these enzymes, as well as indicating relevant neuroprotective effects (VELLOSA, 2022).

Another compound that exhibits similar properties is

chalcones, found in plant species and recognized as precursors in the biosynthesis of flavonoids themselves, stand out for adding multiple pharmacological functions relevant to combating AD. Evidence presented by Zhang and collaborators revealed that some synthetic chalcone derivatives exert a selective action in inhibiting acetylcholinesterase (AChE), in addition to possessing antioxidant activity and significantly inhibiting monoamine oxidase B (MAO-B), an enzyme linked to the progressive loss of cognitive abilities. This more complex action contributes to the preservation of neuronal function, complementing the benefits observed with flavonoids (VELLOSA, 2022).

Following this same line of exploration of natural compounds with pharmacological potential, coumarins emerge as yet another class of substances of interest in the development of therapeutic strategies for AD. Found in a wide variety of plant sources and even in animal products, such as honey, these molecules are not only limited to cosmetic or food uses but also to advances in research indicating that coumarin derivatives have a significant ability to inhibit the enzyme acetylcholinesterase (AChE); those modified with specific subunits, such as Nphenylpiperazine, stand out in particular, contributing to the increased availability of acetylcholine (ACh) (VELLOSA, 2022).

In addition to these promising pharmacological properties, the analyzed natural compounds present significant advantages over synthetic drugs, particularly regarding reduced toxicity and selectivity for therapeutic targets. Being obtained from natural and renewable sources, these substances are aligned with the principles of green chemistry, which aims to minimize environmental impacts and human health risks through the development of cleaner, more sustainable, and safer chemical processes. Thus, the incorporation of these natural compounds in the development of new therapies for Alzheimer's Disease represents not only a biomedical advancement but also an ecologically responsible approach.

Despite the promising potential of green chemistry in the development of safer and more sustainable therapies, the implementation of its principles faces significant challenges. The adaptation of synthesis and formulation processes to meet the demands of green chemistry can lead to increased costs and operational complexity. Moreover, the transition from traditional methods to more ecological alternatives requires significant investments in research and development, as well as adjustments in infrastructure and regulatory compliance. Such factors somewhat limit the widespread application of green chemistry in the pharmaceutical industry, especially in contexts of restricted financial

resources and high regulatory rigidity (AHMAD, 2024).

2.3 .The role of Stem Cells

The synthetic pharmacological approaches and those associated with green chemistry, although used to stabilize the cognitive behaviors of those affected by the disease, do not prevent the destruction of neurons. So far, combating the causes of Alzheimer's symptoms is unfeasible to be treated with conventional medications. Accordingly, the creation of experimental stem cell therapy for the treatment of AD aims to enhance synaptic reconnection and immune modulation, in order to achieve neural replacement and delay cell death. (SOUSA, 2022).

Stem cells consist of unspecialized and undifferentiated cells capable of distinguishing themselves in the composition of particular tissues. Their plasticity allows them to be classified as totipotent, pluripotent, and multipotent (MELLO, 2004). The use of this type of cell in the treatment of neurodegenerative diseases seeks to develop alternatives that enhance the well-being of Alzheimer's disease patients. The cells are used in the creation and repair of damaged tissues in the human body and are responsible for delaying the progression of more acute symptoms of the disease (PAIM, 2007).

Among the three most commonly used cells, mesenchymal stem cells (MSCs), when compared to embryonic stem cells (ESCs) and induced pluripotent stem cells

(iPSCs), have lower plasticity and proliferation capacity, thus limiting their use in the human brain. Although ESCs possess greater pluripotency, their use in research and studies is hindered because their extraction occurs through human embryos. Even though it is possible to identify them through biopsies that do not affect the embryos, these alternatives face ethical issues within science (FERREIRA, 2019).

The extraction of induced pluripotent stem cells (iPSCs) is carried out through the reprogramming of adult cells that were already specialized (BOSI, 2010). With the use of transcription factors such as OCT4, SOX2, and KLF4, it is possible to revert differentiated cellular structures to a more plastic and potent form, allowing the generation of functionally mature neurons and their modification into neuronal subtypes (RECCHIA, 2020).

The purpose of using stem cells in the treatment of neurodegenerative diseases, such as Alzheimer's, is part of a long process of discoveries and advancements in biotechnology over the decades. One of the major advances consists of the constant demonstration of the importance of the Notch and PI3k/AKT pathways, which can promote more precise determination in the results of the differentiation of embryonic and induced pluripotent stem cells (ZHENG, 2024).

In research conducted on mice with AD, the animals that

received hematopoietic stem cells demonstrated a lower accumulation of β-amyloid and reduced neuroinflammation, thus exhibiting better-preserved memory (SHAH, 2024). Since both ESCs and iPSCs can differentiate into hematopoietic cells, their use demonstrates results in the reduction of β-amyloid plaques, contributing to a positive impact in preventing the worsening of the disease (ZHAO, 2020).

Furthermore, studies with mice have demonstrated a relationship between the level of Brain-Derived Neurotrophic Factor (BDNF), a neurotrophin important for neural survival and strengthening, and the application of neural stem cells (NSCs). Among the actions of NSCs in affected animals, the cell was responsible for recovering the loss of synapses and supplementing the set of BDNF proteins. From the discovery of this property of NSCs, BDNF has been highlighted as a therapeutic strategy, as it enhances the potential of stem cells in the treatment of neurodegenerative diseases (WU, 2016).

However, due to being in an experimental and preclinical phase, regenerative therapy in AD still has limitations. Among them, the risks of tumor formation (teratomas) and adverse immune responses are clinical challenges that the treatment presents, especially when the cells are not fully differentiated (MENDES, 2024). Moreover, there is also the possibility of alterations in patients' neural circuits during treatment that can generate symptoms and adverse reactions (KRISHNA, 2023).

Immunological rejection can be a consequence of the use of a homotransplantation, a transplant of tissues from the same species that are genetically different, in which the implanted cells are seen as a threat by the immune system and are fought against, compromising the effectiveness of the treatment. Moreover, this incompatibility may be caused by the fact that AD consists of a chronic inflammatory state that hinders the implantation of stem cells (ORLANDO, 2019).

2.4. Music therapy as an unconventional therapy.

Despite regenerative strategies, such as stem cell therapy, showing great potential for repairing neuronal damage, challenges like immune rejection and the chronic inflammatory context of AD still limit the effectiveness and broad viability of these interventions (ORLANDO, 2019). These barriers demonstrate that, no matter how advanced the therapies that act directly at the cellular level are, it is still necessary to consider complementary alternatives to ensure the patient's quality of life.

In this sense, it is possible to highlight unconventional approaches aimed at promoting the preservation of cognitive functions and the wellbeing of Alzheimer's disease patients. These therapies seek to go beyond purely physiological action, acting on mental, emotional, and social stimulation, and establish themselves as strategies in the construction of more humane,

comprehensive care aligned with the needs of patients (PEIXOTO, 2023).

Music therapy is an unconventional therapeutic practice that, through the intervention of qualified professionals, uses sound and musical resources with the aim of promoting the biopsychosocial well-being of patients (MIRADOURO, 2015).

Regarding clinical applications, it is a therapy recommended to assist in the treatment and rehabilitation of various conditions such as neurodegenerative diseasesAlzheimer's Disease (AD) and Parkinson's Disease (PD) -, mental disorders - anxiety and depression, Stroke (CVA), and Autism Spectrum Disorder (ASD) (GÓMEZ, 2017).

In the context of AD, it can be recommended mainly for elderly individuals in mild to moderate stages, and given the scenario of population aging - in which, according to the 2022 Demographic Census, the elderly population recorded a significant increase compared to 2010 (IBGE, 2022) - its application becomes increasingly relevant (MIRADOURO, 2015). Thus, it can be recommended as a complementary treatment for patients facing cognitive and emotional impairments, with the aim of improving their quality of life without exclusively resorting to medications.

In this way, the treatment can occur through two distinct techniques: the active one, in which the patient participates directly by singing, playing instruments, and

dancing; or the receptive one, in which the patient listens to selected music to stimulate emotions and memories (MIRADOURO, 2015).

However, the effects of music therapy can vary depending on factors such as the regularity of the sessions - it is important to highlight that the continuity of treatment is essential, as its possible benefits tend to disappear after a few weeks of therapy interruption - the environment in which they are conducted - which should be welcoming, calm, and conducive to concentration and interaction - and the participation dynamics (collective or individual) - promoting socialization and the strengthening of emotional bonds, which are so affected by AD (MIRADOURO, 2015).

In this sense, this therapy through music and its elements is capable of acting by activating various regions of the brain, possibly stimulating areas fundamental to the cognitive, emotional, motor, and physiological functions of individuals with AD. In this way, to understand the potential benefits of this treatment, it is important to analyze how it influences distinct brain areas, which mediate different essential functions for quality of life (GÓMEZ, 2017).

In the hippocampus, a crucial region for the formation and retrieval of memories, music therapy can stimulate the evocation of autobiographical memories, preserved even in the more advanced stages of the disease. This can contribute to reconnecting with

one's own life story and lead to the reinforcement of the patient's identity, which is lost as the pathology progresses (MIRADOURO, 2015).

The limbic system, which includes structures such as the amygdala, is activated by music, possibly promoting neurochemical balance and favoring emotional stabilization without the use of medications, as well as improving mood and self-esteem. This occurs as it evokes affective memories and positive emotions, consequently promoting well-being and reducing emotional symptoms such as anxiety, irritability, and agitation. (PEIXOTO, 2023).

In turn, areas of the cortex, such as the prefrontal cortex, respond to musical stimuli through the possible enhancement of executive functions, such as attention, planning, and emotional control, which gradually improves the cognitive capacity of patients. The temporal lobe is directly involved in auditory and linguistic processing and, when stimulated by music therapy, can promote the improvement of communication, language, and prosody. In the social sphere, this promotes verbal and non-verbal communication, restores the personal expression of the person with DA, and strengthens their emotional bonds (GÓMEZ, 2017). Another area of the cortex directly impacted by music therapy is the parietal lobe, responsible for sensory and spatial integration, possibly resulting in greater attention and perception of the environment.

The motor regions of the brain, such as the motor cortex and the cerebellum, are in turn activated especially in techniques that involve movement, which can contribute to the improvement of motor coordination and rhythm (GÓMEZ, 2017).

Moreover, the action of music therapy on the cortical and subcortical circuits involved in mediating emotional and cognitive responses can activate the autonomic nervous system and the neuroendocrine system, which possibly leads to the release of sex hormones (testosterone and estradiol), which can exert a neuroprotective effect and assist in cell protection. In this way, it can contribute to hormonal and physiological regulation, which may favor emotional stability and the preservation of brain functions (MIRADOURO, 2015).

In this sense, keeping in mind the benefits provided by music therapy, it is relevant to highlight that it has some limitations - issues that, although they do not constitute the focus of the article, represent opportunities for future investigations - such as reduced efficacy in advanced stages of the pathology, the need for continuity, lack of standardization in the techniques and protocols used, and the scarcity of studies with long-term follow-up (MIRADOURO, 2015).

3. Final considerations

Therefore, this article aims to analyze the use of experimental

therapies, which encompass green chemistry and regenerative stem cell therapy, as well as the unconventional therapy of music in the treatment and benefit of Alzheimer's disease patients. In order to develop techniques that are less harmful to the body and promote well-being and improve the quality of life of the patient.

Green chemistry, by using natural compounds such as alkaloids, flavonoids, chalcones, and coumarins, is part of a safe and sustainable treatment. Stem cells also stand out as a regenerative therapy due to the efficacy of iPSCs and ESCs, in a non-pharmacological therapy aimed at preventing disease progression. Although there are benefits, there are also limitations, such as the risk of tumor formation, adverse immune responses, and alterations in the neural circuit during treatment.

Moreover, unconventional music therapy is responsible for stimulating multiple brain areas, potentially promoting cognitive and emotional benefits in patients with AD. Despite these effects, its efficacy depends on the consistency of this approach and faces limitations in the advanced stages of the disease.

From this, these therapeutic approaches function as complementary measures to conventional treatments, as, although they present positive results, they still have many limitations that prevent their full effectiveness, such as the lack of long-term follow-up studies.

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12.

Family emotional environment and child development: neural, hormonal, and emotional impacts in early childhood

Ana Luiza Alvarez Frugoli, Fernanda Fagundes Camara, Luiza Midori Florio Tsukamoto e Maitê Pádua Galindo

Childhood constitutes a critical period of neurobiological and psychological development, characterized by high brain plasticity and sensitivity to environmental stimuli. This study reviews the influence of the family emotional environment on children’s mental health, considering risk factors such as toxic stress, poorly managed parental divorce, and excessive performance pressure, and protective factors such as consistent affection and interaction with pets. Evidence from neuroscience indicates that prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis and elevated cortisol levels can compromise essential brain structures, such as the prefrontal cortex, the amygdala, and the hippocampus, impacting emotional regulation, behavior, and the formation of affective bonds. On the other hand, stable and enriched environments promote the consolidation of neural connections related to empathy, emotional self-regulation, and resilience. The literature indicates that early interventions, consistent emotional support, and positive stimuli within the family context are fundamental to preventing adverse effects of stress and promoting holistic development. It is concluded that the quality of experiences lived in childhood is determinant for emotional balance and mental health throughout life, reinforcing the need for preventive strategies and the promotion of children’s psychological well-being.

1. INTRODUCTION

Childhood is a delicate and decisive period of human life. More than just a phase marked by physical changes, it is a moment when the child begins to form their first impressions of who they are, of the people around them, and of the world they live in. It is a construction that occurs intensely and depends on daily experiences, especially those involving affection, security, and emotional stability. Therefore, understanding how external factors influence this process can help ensure a healthier childhood and a more balanced emotional and behavioral development throughout life (SHONKOFF; PHILLIPS, 2000).

The emotional environment in which the child is immersed has a direct impact on brain function, especially during the most sensitive phases of childhood. When frequently exposed to situations of instability, such as family fights, lack of emotional support, or affective insecurity, the child may suffer physiological and hormonal changes. The prolonged increase of hormones such as cortisol and adrenaline, for example, can compromise areas of the brain like the prefrontal cortex and the amygdala, which are responsible for regulating emotions, developing empathy, and controlling impulses (LUPIEN et al., 2009; McEWEN, 2012).

In this scenario, parental divorce appears as one of the compromising factors for the child's emotional well-being when it occurs in a conflictual manner and without the necessary support. Although

separation can represent a relief in family contexts marked by constant conflicts, when it occurs without dialog, support, or psychological follow-up, it can awaken feelings of fear, abandonment, and insecurity in the children. These impacts, often silent, manifest not only in childhood but also in later stages, influencing the ways of relating and dealing with one's own emotions in adulthood (KELLY, 2000; AMATO, 2000).

Moreover, family interactions themselves, even in well-structured households, can exert pressure on the child's emotional development. The family can impose high expectations by demanding results or specific behaviors, thereby creating an environment where mistakes are not accepted. This type of demand can trigger anxiety, low self-esteem, and difficulty in dealing with frustrations (GINSBURG; SCHLOSSBERG, 2002; BAUMRIND, 1966). It is important to highlight that this pattern can perpetuate across generations and create a situation where parents who experienced a lot of pressure during their childhood reproduce the same demands with their children (GRUSEC; DAVIDOV, 2010).

On the other hand, there are experiences that serve as emotional adjustments: living with pets is one of them. Recent studies show that interactions with dogs, cats, or other domestic animals can reduce stress, stimulate empathy, and strengthen emotional bonds (BEETZ et al., 2012). For children, especially in contexts of vulnerability, the bond with an animal can represent a form of emotional support, helping to express feelings, develop affection, and responsibility. These experiences can function as

protective factors by promoting balance and well-being even in the face of challenges (PUREWAL et al., 2017).

Considering these elements, both those that represent risksfamily conflict, lack of affection, or poorly managed divorce - and those that function as protectioninteraction with animals -, this research investigates how children's mental health can be influenced by such contexts, bringing together different perspectives and contributing to practices that help build environments prepared to meet the emotional needs of childhood.

2 DEVELOPMENT

Childhood is a phase of accelerated brain development, marked by the formation of millions of neural connections at every moment a process known as synaptic exuberance (Araújo & Carvalho, 2014). These connections are shaped by the child's experiences, especially in the family environment. Positive interactions strengthen circuits related to emotional regulation, language, and selfcontrol, while negative or unstable experiences can compromise this development (Souto, 2017).

Over time, the brain undergoes what is called neural pruning, eliminating underused connections and consolidating the most active ones. This selection depends on the quality and consistency of the stimuli received. Regions such as the prefrontal cortex and the amygdala are particularly

sensitive in this process, as they are influenced by factors such as affection, predictability, and emotional security (Vilela, 2016).

The brain's plasticity in childhood makes this stage a window of opportunity for learning, but also a period of vulnerability to adverse experiences, whose effects can last a lifetime (Ministry of Health, 2015).

The child's brain records not only positive stimuli but also negative ones, such as neglect, rejection, physical punishments, and chronic exposure to stress. Such experiences can trigger what is known as toxic stress, a prolonged activation of the hypothalamicpituitary-adrenal (HPA) axis, which harms brain architecture (Center on the Developing Child, 2016). This axis functions as a communication circuit between the brain and the body, and it is activated whenever the organism perceives some type of threat (GUNNAR; QUEVEDO, 2007). The process begins in the hypothalamus, a brain structure that identifies the stressor and sends signals to the pituitary gland, which releases chemical substances responsible for stimulating the adrenal glands, located above the kidneys. These glands release cortisol, the main hormone related to stress (LUPIEN et al., 2009).

When a child lives in contexts marked by constant stress, shouting, instability, or lack of emotional care, the HPA axis remains hyperactivated, raising cortisol levels and negatively affecting the development of areas such as the hippocampus and the prefrontal cortex (Souto, 2017; McCrory, De Brito & Viding, 2011). This configuration increases emotional

vulnerability and can compromise mental health throughout life.

Neuroimaging studies indicate that children exposed to unfavorable contexts exhibit structural and functional changes in brain regions critical for mental health. The hippocampus, for example, tends to have its volume reduced, which impairs memory and learning; the amygdala can become hyperreactive, increasing sensitivity to threats; and the prefrontal cortex can have its development compromised, affecting inhibitory control and decision-making (McCrory, De Brito & Viding, 2011; Teicher & Samson, 2016).

Given this scenario, the relevance of safe, stable, and emotionally nurturing family environments during childhood becomes evident. Research indicates that the family emotional environment not only influences daily behavior but also shapes the organization and development of the child's brain ("Safe, stable, nurturing environments for children," 2020; "Parental influences on neural mechanisms underlying emotion regulation," 2019). In positive contexts, neuroplasticity favors the acquisition of socio-emotional skills and resilience, and beside offering stability and support, the child finds security to explore the world, develop empathy, learn to deal with difficult emotions, and build self-esteem. On the other hand, in adverse contexts, when this environment is marked by constant fights, lack of affection, or emotional coldness, the effect on the child's brain can be quite negative (SHONKOFF; PHILLIPS, 2000), potentially consolidating dysfunctional patterns of emotional response and stress, with

repercussions throughout their entire life (Souto, 2017).

Frequent stress situations at home, such as conflicts between parents, excessive demands, or emotional neglect, activate the HPA axis in the child's body. In some situations, cortisol has an important function: to prepare the body to respond to challenges, increasing alertness, heart rate, and energy release. However, when the production of this hormone becomes constant, as happens with children exposed daily to emotionally unstable environments, the body enters a state of permanent alert and begins to function as if it were under constant threat, even when the danger is not real (McEWEN; STELLAR, 1993).

Continuous exposure to high levels of cortisol interferes with brain development because, when excreted in excess, it can impair the maturation of the prefrontal cortex, which is involved in functions such as decision-making, planning, impulse control, and emotional regulation. The cortex, which continues to develop until the early adulthood, is sensitive to environmental influences during childhood (CASEY; JONES; HARE, 2008) and exposure to the hormone makes it more difficult for the child to think before acting, maintain attention, organize thoughts, and deal with intense emotions.

At the same time, excess cortisol not only affects the prefrontal cortex but also the functioning of the amygdala, which acts as a cognitive processor of threat stimuli. It analyzes the environment and identifies signs of threat, danger, or tension, located deeper in the brain,

within the limbic system - a fundamental system for emotional balance, and for regulating emotions, affective memories, and basic motivations - the amygdala analyzes the environment and identifies signs of danger, threat, or tension. In situations of continuous stress, such as when a child lives in a tense or unstable family environment, the amygdala begins to work excessively, meaning it identifies any circumstance as threatening, even when there is no real danger. Thus, the child may react with fear, nervousness, or irritation to simple everyday situations, such as a parent's correction or an unexpected noise. The brain remains in a constant state of hypervigilance, anticipating the possibility of adverse events, a condition intensified by cortisol. When it is released in large quantities and for a long time, it strengthens these brain alarms, making the amygdala even more sensitive. Over time, the child may grow up interpreting the world as an unsafe place, which affects their way of relating, trusting, and dealing with people and their emotions. (TOTTMAN et al., 2019; DAVIDSON; JACKSON; KALIN, 2000). These changes in the brain are reflected in the child's behavior: they begin to exhibit more reactive and sometimes aggressive behavior.

The family environment is the first setting where the child observes and learns about affection, boundaries, and emotional security, as well as how to deal with frustrations, how to react to criticism, and how to trust those around them (GINSBURG; SCHLOSSBERG, 2002; SHONKOFF; PHILLIPS, 2000). Homes that welcome, validate feelings, and allow the child to make mistakes without fear tend to

strengthen the child's ability to know themselves, trust, and relate to others (GRUSEC; DAVIDOV, 2010). In spaces where constant criticism, emotional distancing, or rigid demands occur, it is common for the child to develop feelings of insecurity, inadequacy, and shame about themselves, as if it were necessary to hide who they really are just to be accepted (BAUMRIND, 1966; CICCHETTI; TUCKER, 1994).

When a child is exposed to an adverse environment, the experiences they go through do not remain in the past: they turn into emotional scars that can extend into adulthood, fostering the emergence of anxiety, depression, aggression, and difficulties in emotional bonds (CICCHETTI; TUCKER, 1994; RUTTER, 2000). Caring for emotional health in childhood is a protective act, capable of building foundations for well-being in the present and future. What happens inside the home, in the words, the looks, the gestures of affection or their absence, shapes the way the brain organizes itself and can define how the child will relate to themselves and the world around them.

In this context, specific events that alter the family structure, such as parental divorce, can represent delicate moments for the children. Although it is currently more recognized as a form of family reorganization, this transition can affect the child's emotional wellbeing if not conducted carefully. Studies indicate that, even when parents believe they are acting in the family's best interest, separation can have negative impacts on children (Eymann et al., 2019; Brito, 2007).

When separation occurs amidst fights or in the absence of affection, some children may sense that something is wrong, and even if they cannot express it in words, their immature brains interpret this instability as a threat (Gunnar & Quevedo, 2007). This process is directly linked to neuroplasticity, a capacity that the brain has to adapt and learn from lived experiences (Kolb & Gibb, 2011). In childhood, this ability can be positive when the environment is marked by affection, stability, and support. However, when reality is surrounded by conflicts, insecurity, or emotional absence as can occur in divorces conducted in a contentious manner and without adequate support the brain also adapts, but with a focus on survival. In these contexts, it begins to build pathways based on fear, distrust, and self-protection (Cicchetti & Tucker, 1994). These patterns do not disappear over time: they can become ingrained and accompany the child for many years, profoundly influencing the way they feel, think, and relate to the world. Thus, behaviors such as anxiety, difficulty trusting people, fear of rejection, or the need to control everything around them to feel safe may arise (Rutter, 2000; Kelly, 2000). These emotional responses are not "tantrums" or conscious choices, but marks left by a brain that tried to protect itself as best it could in a moment of pain.

However, it is necessary to reiterate that the mere separation of parents does not cause this impact, and what determines the emotional effect is the way this process is conducted (Kelly & Emery, 2003). When adults manage to maintain care, presence, affection, and active dialog, the child feels secure even

amidst the change and can understand that the new family configuration does not necessarily represent an effective threat.

Therefore, regardless of the context of the separation, what really matters is ensuring that the child does not feel alone in this process. The care for the child's emotional health during divorce is not limited to the affective field but also directly influences physiological processes. An environment of support and stability can reduce the recurrent activation of the hypothalamicpituitary-adrenal (HPA) axis, responsible for the release of cortisol in stressful situations (Gunnar & Quevedo, 2007). Thus, by avoiding prolonged exposure to these hormonal triggers, the likelihood of the child developing more adaptive emotional resources increases, which can foster healthy attachments and a more balanced self-perception throughout life.

In addition to specific situations, such as parental divorce, stable homes can exert other forms of pressure on children that influence their emotional development. Evaluations indicate that high parental expectations, related to academic performance and behavior, may be associated with higher levels of anxiety and fear of failure in childhood (Grolnick & Ryan, 1989; McLeod et al., 2007). Children in the process of identity formation may associate their personal worth with achievements, leading to continuous concern with parental approval and reluctance to take risks or make mistakes (Ryan & Deci, 2000; Chorpita & Barlow, 1998).

This fear, in turn, directly interferes with their freedom to

experiment, explore, and learn. According to studies such as those by Sorkkila and Aunola (2020), highly demanding family environments are associated with the emergence of chronic stress in children and adolescents, as well as symptoms of emotional exhaustion even during childhood.

Over time, this dynamic influences the way the child perceives themselves and the world around them. Upon noticing that their recognition depends mainly on results, rather than their attempts or efforts, they tend to evaluate their worth based solely on performance, which can weaken their self-esteem. (SOENENS; VANSTEENKISTE, 2010). This process can contribute to the construction of a fragile and unstable self-esteem, which depends on external factors to maintain itself. Soenens and Vansteenkiste (2010) highlight that this form of psychological control exerted by parents – even if subtle –contributes to the emergence of a pattern of dysfunctional perfectionism and heightened selfcriticism. Moreover, in some cases, anxiety can develop in evaluative situations, such as school exams or public activities (FRIEDBEN; SMITH; JOHNSON, 2017).

This cycle of pressure and self-demand can perpetuate into adulthood. Grusec and Davidov (2010) point out that the parental models experienced in childhood shape future caregiving practices, reinforcing patterns that often cause suffering, even if unintentionally. Individuals who grow up under intense pressure may become adults who maintain high standards of demand on themselves, with difficulty recognizing their own

achievements. Moreover, they repeat the internalized pattern of pressure with their own children, perpetuating a generational logic.

In more severe cases, the impact of this continuous pressure can trigger serious emotional disorders, such as school phobia, where the child avoids the school environment out of fear of failing, and generalized anxiety, characterized by excessive worry, constant tension, and difficulty relaxing. Ginsburg and Schlossberg (2002) emphasize that children exposed to constant pressure and the fear of disappointing their parents are more likely to develop performance-related anxiety symptoms, which can directly interfere with learning and socialization.

Valuing effort, accepting mistakes as part of growth, and building relationships based on listening and emotional support are actions that strengthen the child's mental health and create a more secure emotional foundation for the future.

This emotional support, important for healthy development, can occur in other experiences beyond the family relationship. In this sense, the contact between children and animals emerges as a valuable way to provide companionship and security, contributing to the child's development of socio-emotional skills in a more balanced manner.

This interaction between children and pets can serve as a resource for emotional regulation and as a protective factor in contexts of vulnerability. Moreover, caring for the animal requires dedication, time, and attention through play and

affection. The benefits extend to the owner: petting an animal can reduce cortisol levels and increase the production of serotonin and dopamine, associated with happiness. The release of oxytocin during contact with animals, for example, is associated with calming effects and improved emotional regulation, reinforcing the role of animals as facilitators of healthy psychological development. Thus, the combination of an enriched environment, family emotional support, and protective factors such as contact with animals can enhance the positive effects of early interventions, ensuring holistic and resilient development.

Moreover, the presence of an animal can promote a relationship of trust, acceptance, and responsibility. It is also possible to identify that the animal is capable of providing the child with love, affection, and attention, and as a result, it becomes easier for them to feel enthusiastic about interpersonal relationships (MUELLER; FINE; GEE; BURES; CURL; JOHNSON, 2023). In addition to providing relief from the daily routine, as well as moments of leisure, feeling less isolated, opportunities for companionship, and even communication with the animal and motivation. In terms of emotional benefits, one can identify a reduction in anxiety, spontaneity of emotions such as love and attention, moments of relaxation and joy, recognition of value, and exchange of affection (CROSSMAN; KAZDIN; MATIJCZAK; KITT; SANTOS, 2020).

In situations of hostile or unstable family environments, animals represent a consistent source of affection and unconditional acceptance, functioning as a secure

attachment figure, which helps in the emotional self-regulation of the child and the strengthening of self-esteem (Sable, 2013). These emotional bonds are capable of alleviating the negative impacts of adverse contexts, promoting resilience and greater psychological stability, as well as fostering the emotional balance necessary for healthy development (Nimer & Lundahl, 2007). Thus, the constant presence of a pet can act as a tangible emotional support, enhancing the child's internal resources to cope with daily challenges and adversities in the family environment.

Another important factor that has been gaining prominence in the scientific literature is contact with pets as an element of emotional protection. Studies indicate that interaction with animals can significantly reduce levels of stress, anxiety, and depressive symptoms, as well as promote a sense of companionship and emotional security, especially in children and adolescents (Beetz et al., 2012).

3. CONCLUSION

Childhood is a period marked by intense neuroplasticity, which makes the brain highly sensitive to environmental experiences, especially within the family setting. This plasticity, on the one hand, can favor emotional learning, but, on the other hand, it makes the child vulnerable to traumas such as neglect, rejection, and emotional violence. When exposed to unfavorable contexts such as unstable environments, excessive demands, lack of affection, or family conflicts — the child's brain

negatively registers these experiences, potentially causing changes in fundamental areas such as the hippocampus, the amygdala, and the prefrontal cortex. This can result in cases of toxic stress, anxiety, depression, low self-esteem, and difficulties in forming emotional bonds.

On the other hand, safe, predictable, and affectionate family environments promote the strengthening of neural connections related to empathy, emotional selfregulation, and resilience. Emotional support, nurturing, and respecting the child's pace including valuing effort and accepting mistakes are fundamental for their healthy development. When there is dialog and emotional stability, even in adverse situations like parental divorce, it is possible to minimize negative impacts and protect the child's mental health.

Moreover, the presence of a pet can serve as a protective factor. In hostile or emotionally distant homes, animals offer affection, acceptance, and stability, aiding in emotional regulation and strengthening self-esteem. Physical contact with pets, for example, helps reduce cortisol and stimulates the release of serotonin and dopamine, promoting well-being.

4. REFERENCES

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The psychosexual development of children and the consumption of pornography: implications for adult affective relationships

Anne Cardozo, César da Costa, Natália Freitas e Rafaela Mees

This article addresses the relationship between the development of child psychosexuality and the specific phases that compose it (oral, phallic, and latency), showing how it can be affected by early exposure to pornography (given the excessive release of dopamine in the child’s brain) and the poor resolution of the Oedipus Complex, in case there is a lack of sexual and emotional education - which should be based on the reception and establishment of a mutual trust bond between the caregiver and the child - during childhood. Therefore, the main objective of the research was based on an analysis of how this impact, during sexual maturation, can reflect on the child’s adulthood, taking into account, mainly, their affective relationships and sexual life, whether they are of the female or male gender. Thus, through a literature review, it is concluded that emotional education is a key factor for the development of healthier relationships, based on trust, intimacy, mutual engagement, and less driven by stereotypes.

1. INTRODUCTION

Human sexuality begins during the childhood of each individual. Within this context, according to Freud, there are stages that involve the psychosexual development of each child (FURTADO; VIEIRA, 2014).

The oral stage - during the first twelve months of the baby's life (EUZÉBIO, 2023) - is responsible for the first manifestation of the infant's unconscious desires. Meanwhile, the phallic stage - which occurs from 4 to 6 years old (EUZÉBIO, 2023) - marks the entry of the child into the Oedipus Complex (MOLINARI, 2012), a period characterized by the idealization of the mother, leading to a subconscious feeling of spontaneous love, while simultaneously confronting the paternal figure. The latency phase - from 6 years old until puberty (EUZÉBIO, 2023)represents the moment when curiosity about one's own body is awakened, thus causing a yearning in the child to explore their particular sexuality.

Throughout the first four years of life, until the onset of puberty,

emotional and sexual education serves as an alibi (DO ESPÍRITO SANTO; ARAÚJO, 2016) to assist in a healthy elaboration of the Oedipus Complex. It is at this moment, during the phallic stage, that the child must renounce the incestuous desire for the mother and come to understand the father as a figure of respect, as the threat of deprivation of the object of desire emerges, as elaborated in the Theory of Castration (FURTADO; VIEIRA, 2014). Moreover, the functional integration of the Oedipus Complex, combined with such guidance, proves to be important as a way to prevent the child from seeking pornographic content in order to have their doubts resolved. If such affective-sexual guidance is not properly conveyed during childhood, the child tends to inadequately idealize the maternal and paternal figures. Moreover, they may start accessing pornography excessively - when something is consumed by an individual in a quantity much greater than what is considered healthy, impacting their physical, social, and mental health (MACIEL, 2023) - since the recurrent consumption of this material releases

a large amount of dopamine in the brain, which alters the functions of the reward system and can cause changes in the child's prefrontal cortex, which is in the process of maturation.

Unlike erotic materials which, in addition to exploring the subtlety and sensuality of the sexual act, prioritize respect for both genders, male and female pornographic content, with its scripted and idealized scenarios created by a traditional and hegemonic industry, can lead to the reaffirmation of certain stereotypes. This is because, in addition to imposing an idea of submission and inferiority on the female figure, it encourages controlling and macho behavior in men, thereby reinforcing the ideal of virile masculinity (CONNELL; MESSERSCHMIDT, 2013). In this sense, when the consumption of this type of content occurs prematurely, during the third childhood (DE JESUS RODRIGUES; JÚNIOR, 2022), the child may end up facing certain issues that can manifest throughout their life, as they are still undergoing a process of sexual maturation. Exposure to pornography can cause a distortion of their view on sex and relationships,

negatively affecting their affective relationships in the future (CECCARELLI, 2013).

The present study seeks to investigate, through a bibliographic review, how the lack of sexual education drives the consumption of pornographic content during the psychosexual development of children, delving into the Oedipus Complex and its consequences on male hegemony. In this way, the analysis aims to contribute to a more egalitarian understanding of sexual dynamics, to problematize the excessive consumption of pornography, and to highlight the importance of sexual education during childhood.

2. DEVELOPMENT

2.1

Childhood

Childhood is the time when the social, cognitive, and emotional development of the human being occurs, through the expansion of their relationships with the people who make up their daily life. It is during this scenario that sexuality begins to be constructed, as there is also a psychosexual development of the infant at this stage (FURTADO;

VIEIRA, 2014). With this, Freud's work (1970) proposed a division of this formation into several stages, with the aim of understanding how different experiences shape the constitution of each individual and, consequently, their affective relationships.

Although the psychoanalyst made such a delineation into five stages (EUZÉBIO, 2023) for the purposes of theoretical focus and analytical depth, this study will address only three of these phases: oral, phallic, and latency.

2.1.1

Oral Stage

This stage occurs within the pregenital phase and presents itself during the child's first year of life. It is a phase marked by the early manifestation of infant sexuality, which can be recognized, for example, during the breastfeeding period (FURTADO; VIEIRA, 2014).

The mother invests all her devotion and exclusive attention in the baby during the breastfeeding moment. The baby, in turn, obtains oral sexual pleasure in addition to satisfying their needs and feeling cared for, protected, and loved by the mother. Love

necessarily involves a relationship with the other, initially the mother. She constitutes an image of a helpless being who provides the baby with loving care, which momentarily completes him and frees him from the feeling of helplessness. (Amado, 2003, p. 31).

It is at this moment that the affective bond with the mother develops, since, according to Freud (1914), the mother, in addition to performing indispensable functions for the baby's survival, establishes with him a symbiotic relationship of mutual dependence, in which the child experiences the first forms of sexual satisfaction.

2.1.2

Phallic phase

Occurring between the ages of 4 and 6, it marks the child's entry into the Oedipus Complex (MOLINARI, 2012), a period shaped by the idealization of the maternal model, generating a genuine feeling of love, and at the same time, rivaling the paternal figure.

Such theory originated from Sophocles, a playwright, writer of the classic tragedy Oedipus Rex, in

which the protagonist, unknowingly, kills his father and marries his own mother, fulfilling the prophesy. With this, Freud developed the Oedipus Complex, which refers to the phase of child psychosexual development. At the beginning of life, the child sees themselves as the object and center of the world, that is, they go through a moment called primary narcissism, a period in which the child recognizes their first object of love: the maternal breast (MOLINARI, 2012).

Considering that, [...]the first sexual objects of a child are the people who care for their nourishment, care, and protection: that is, in the first case, their mother or whoever replaces her. (Freud, 1914/2006, p.94)

Consequently, this object expands to the mother, causing the baby to recognize her as an object of satisfaction. Such a bond constructs a model of happiness that remains as a reference in the choice of subsequent loving objects. Thus, "the child learns to love other people who help them in their helplessness and satisfy their needs" (Freud, 1905/2006, p.210).

At this stage, the boy desires to connect lovingly with the mother, while at the same time harboring hostile feelings toward the father

(SOARES, 2017), considering that he possesses her. Such incestuous desire, not being satisfied, makes the child seek another way to achieve total satisfaction and a complement to what he felt was lost; therefore, this desire is redirected to another object of love.

Thus, the apex of the Oedipus Complex occurs when the boy must make a choice out of fear of castration (DE ULHÔA CINTRA, 2021): to abandon the sexual desire he has for his mother, accepting that she "belongs" to the father, in exchange for the preservation of his penis. In an ideal resolution of the Oedipal conflict, the boy chooses to protect the penis and abandon the maternal figure. In this way, he stops desiring the mother sexually and seeks to repress impulses and fantasies. Simultaneously, he begins to mirror his father, adopting him as a model of masculine behavior, as well as taking him as an ideal.

Sodré (2025) states that the quality of the first affective relationships that the child internalizes will directly influence the success of their future romantic relationships. Therefore, the affective choices made during childhood serve as a foundation for

romantic decisions throughout life. Thus, the unresolved Complex can have consequences in adulthood, stemming from the gaps left during childhood.

The development of neuroses, difficulties in accepting authority figures, and stigmas related to gender identity are present, especially because the way castration is treated directly impacts the formation of the Superego (EUZÉBIO, 2023) - a structural element of the psychic apparatus, responsible for the imposition of sanctions, norms, and standards. If there is identification and respect for the father, it leads to the strengthening of the father figure, functioning as a protector of moral and ethical norms. On the other hand, if there is inadequate processing, one may observe the formation of a weak or excessively punitive Superego.

Therefore, the healthy elaboration of the Complex presents its effects throughout the young person's life, as it helps develop the constitution of a structured ego, sexual identity, and the capacity to love. Moreover, the individual is able to distinguish and integrate emotions without remaining fixated on parental

figures (KAST, 2022), considering that once the child recognizes that they cannot possess their parents as objects of desire, they take them as objects of their self, unconsciously wishing to be or have someone like them, and thus internalizes their parents.

Thus, when poorly developed, the individual ends up having unconscious fixations and dysfunctional relational patterns. This becomes evident through the difficulty in establishing mature romantic relationships and in differentiating love from desire (FREUD, 1909), as if it were impossible to sexually desire and deeply love the same person. Such effects are considered a consequence of a failure in the symbolization of the place of the father and mother in the child's psyche (FREUD, 1912), which ultimately harms the personal development of the individual who finds it difficult to relate in an ethical and affective manner.

Although the elaboration of the complex generates moments of conflict, it is also essential for the child to begin organizing their emotions, internalizing boundaries, and building the foundation of their

future affective relationships. Thus, it can be stated that the Oedipal experience makes the child learn to deal with intense and, in a way, contradictory feelings - such as love and rivalry. Hence, it is recommended that caregivers play an active role during this stage of the child's life (through emotional support and security), as it depends on how they mediate and embrace such emotions.

Since the child is going through a moment of psychosexual maturation, when there is a lack of emotional and sexual education from parents or caregivers, which can be marked by silencing or denial of what the child feels, the constitution of this complex is compromised.

2.1.3 Latency period

Lastly, there is the latency period, a phase experienced by the child from the age of 6 until the onset of puberty. It is at this stage that the child must deal with repressed sexual impulses, channeling their sexual desires in an asexual manner, which are reflected in their daily relationships (EUZÉBIO, 2023). It is during this period that the child begins to understand their

sexuality through their gender identification as a girl or boy, triggering bodily curiosities and those related to sexual acts, which awakens their desire to explore this unknown field.

However, this process of maturation occurs within a socially taboo subject (PERA; CORREA, 2015) - due to the prejudices accumulated throughout the history of sexuality - sexual relations, since childhood sexuality generates a certain embarrassment for adults, who believe that the child's innocent nature should be preserved (DE JESUS RODRIGUES; JÚNIOR, 2022). And, therefore, as presented by Schindhelm (2011), some parents (DE JESUS RODRIGUES; JÚNIOR, 2022) end up associating sex with something forbidden and inappropriate for the child's age, marginalizing an unconscious desire and, consequently, repressing childhood sexuality (PERA; CORREA, 2015).

When the awakened feelings are ignored or repressed, the child loses the opportunity to develop psychic resources to deal with frustrations, desires, and affections. This failure can contribute, in the future, to the construction of a

sexuality marked by anxieties, idealizations, and external references, such as pornography, which can take the place of family dialog. Given this, a child's first contact with sexual life may occur through the consumption of pornographic content, which ends up becoming the only form of sex education accessible to them (PINTO et al., 2024).

2.2 Pornography

Before puberty, there is a natural desire to explore the sexual dimension. Given this, pornography presents itself as an accessible means for the child to understand their personal sexuality, and potentially influences the way young people comprehend sex and relationships, distorting their view of what a healthy relationship would be (BRAUN-COURVILLE; ROJAS, 2009), where marital satisfaction is based on positive aspects within the relationship (COSTA; MODESTO, 2020) - such as good communication, commitment, and intimacy (BAUMEL et al., 2020) -. In this sense, it is observed that such distortion occurs when pornography is consumed excessively and prematurely, due to the high release of dopaminergic neurotransmitters in the brain of the viewer.

Dopamine is responsible for the functioning of the brain's reward system. It is related to activities that awaken pleasure in humans, such as eating, sun exposure, having sex, and others. When dopamine is released in the brain, it also stimulates the organism to understand that certain activities should be repeated, reinforcing such behaviors. This same mechanism is activated during the consumption of pornographic content, as the moment there is exposure, the release of these neurotransmitters in the brain occurs, since the images and videos cause pleasure to the viewer (DE JESUS RODRIGUES; JÚNIOR, 2022). The recurrent access to this type of material causes changes in the brain's reward circuit. If the functions of this circuit are altered, the prefrontal cortex is also affected. The cortex, during the preadolescent period, is still evolving and is responsible for impulse control, decision-making, and emotion regulation, aspects that are part of the cognitive and emotional development of young people (KÜHN; GALLINAT, 2014). That is, if the pre-adolescent accesses adult

materials during a time when brain maturation is still occurring, this can alter their view of sex in general and culminate in problems in their future relationships.

Moreover, such distortion also depends on the type of pornographic content accessed, that is, which gender produces the content and for which gender it is intended. Thus, a distinction is made between male pornography (produced and intended for men) and female pornography (produced and intended for women).

The pornographic content created by men (MESSIAS, 2024)which represents a portion of the hegemonic pornographic industry - is characterized by the objectification and submission of women, thereby holding them responsible for the man's complete pleasure and consequently suggesting their inferiority (ARNAUD DE SÁ; DIAS OLIVEIRA; PENA PEREIRA, 2021).

With this, men who endorse such a conception can recognize themselves in a position of superiority, dominance, and control (MESSIAS, 2024).

Within this context, there is a reinforcement of a type of masculinity, namely hegemonic

masculinity (CONNEL, 1995) - since male hegemony places men in a position of superiority within society, justifying the subordination of women to a masculine and dominant figure (MESSIAS, 2024) - which refers to a configuration of masculine behaviors and practices that normalize the subordination of women to a masculine and virile figure (FREUD, 1909). Such actions, when applied in the pornographic context, end up influencing boys who watch it to follow the idea that they need to always be in control, as they understand that a power relationship where the male figure is at the top is established from the moment there is domination over the woman. Consequently, the boy may begin to exhibit sexist attitudes - such as spreading female oppression, treating such a figure as inferior (DAU, 2011) - and more easily accept even sexual violence (GRUBBS et al., 2015).

This same pornographic niche, when consumed by girls, due to the hypersexualization of the female figure and scripted sexual performances, can be responsible for causing insecurities, as the fictional standards of sexuality propagated within this type of pornography can

create unattainable expectations regarding sexual performance and physical appearance, which negatively compromises the sexual and emotional experiences of those involved in a relationship (ARAÚJO et al., 2023).

Thus, it is perceived that the consumption of pornographic content brings negative aspects for both genders, considering that there is a reinforcement of female fear regarding sex, which strengthens certain insecurities and also leads the male figure to idealize an ideal type of woman during sexual relations - being objectifiedstrengthening sexist and dominating attitudes (GRUBBS et al., 2015).

In this context, there is the possibility of a specific niche scripted and directed by women with the aim of achieving gender equality within pornographic productions, known as feminist or female pornography. Its purpose is, in addition to demystifying objectification, to place women in a leading role without being treated in a hostile and disrespectful manner, showing that both men and women are relevant in intimate relationships (PEREIRA, 2023).

2.3 Consequences

The poor resolution of the Oedipal experience results in the strengthening of the feeling of passion, in its pure, innocent, and irrational form, toward the maternal figure. The pornographic industry, on the other hand, intensifies a female image constructed by macho ideals that define women as submissive, inferior, and objects of pleasure.

When a certain man, who did not have a healthy resolution of the Oedipus Complex, ages, he may seek in the women he wishes to relate to characteristics that resemble his mother (FREUD, 1912), as he attributes values related to care, nurturing, protection, and nourishment to them, understanding the object of love as a sanctified figure. This perception, based on the analysis of psychologist Verena Kast, understands such projections as harmful, as they promote a superficial perception of women (KAST, 2022). However, if this same man consumes pornography excessively and prematurely, he may develop a specific idealization of female partners with bold sexual availability (FREUD, 1909), viewing them merely as objects of pleasure

and without emotional involvement, distancing himself from what was projected onto him by the maternal relationship.

Taking such a scenario into consideration, there may be a split between feelings of love and desire (PEREIRA, 2023), as this portion of men cannot love chaste and desire erotically the same woman, precisely because of the view of a saintly mother and a partner who fulfills their sexual desires, conceptions built by the marginalization of emotional and sexual education and the poor or incomplete resolution of the Oedipus Complex.

Such a perspective can have its impacts on the life of a man with unstable relationships, betrayals, and emotional devaluation, which ultimately compromise intimacy and trust in the relationship (CONNELL; MESSERSCHMIDT, 2013). This compromise also has repercussions on the life of the female figure, mainly related to the sexual aspect, as with the breakdown of emotional connection and security between partners, the woman may develop a distorted view of pleasure (ARAÚJO et al., 2023), becoming anxious during intimate relations and even developing sexual dysfunctions,

such as anorgasmia - which, even when stimulated, results in difficulty reaching orgasm (ESTUPARU, 2020).

Moreover, there are other psychological consequences regarding women who are attributed a sanctified vision - that is, female figures seen as pure, maternal, and virtuous - which consequently devalues other women, who end up being considered corrupted or unworthy of love. This contrast occurs precisely due to the male gaze, which sees two types of idealized women: those who, unconsciously, resemble their mother - and therefore are considered innocent - and those who are deemed unsuitable for an affectionate relationship (SANTANA, 2016), since such idealization stems solely from sexual desire. Therefore, while women judged as sacred end up being excluded from sexual relations and ignored regarding their own pleasure, developing feelings of rejection and abandonment, which promotes a conducive scenario for the establishment of low self-esteem and insecurity about their own bodies (COSTA; SILVA, 2023). The othersdeemed profane - are invalidated in

personal and professional areas, as by not playing the same role as the woman seen as traditional (the one who is dominated and submissive to her husband), the idea is constructed that, in addition to being incapable of possessing intellect, they also cannot take care of a family.

In summary, the split between love and desire—fueled by the poor resolution of the Oedipus Complex, early and distorted consumption of pornography, and the marginalization of parental sexual education (SCHIDHELM15, 2011) compromises the construction of healthy emotional bonds, both for men and women. On one hand, it promotes unstable relationships, marked by unrealistic and fragmented idealizations; on the other, it reinforces a logic of devaluation of women, whether in the emotional, sexual, or social sphere. With this, dysfunctional affective patterns are consolidated that hinder the development of intimacy, mutual respect, and emotional autonomy within relationships (BATISTA, 2023).

3. CONCLUSION

The present study aimed to discuss childhood and the three

symbolic stages through the analysis and association of different articles, namely, the oral, phallic, and latency phases, in order to understand the psychosexual development of the child and to properly address the child's contact with pornography during this maturation period and its stigmas and future impacts.

The phallic stage is responsible for introducing the child to the Oedipus Complex and is an individual experience. As previously discussed, a poor resolution of this complex compromises the ability to recognize authoritative figures, generates difficulty in selfunderstanding of gender, negatively affecting future relationships - such as a poor understanding of female sexuality - effects that are avoided if a good resolution of the Oedipus Complex occurs. Moreover, it is through castration that the child begins to recognize paternal authority and renounces the incestuous desire for the mother.

The latency phase is characterized by the repression of infantile sexual impulses, a moment when the child begins to deal with the understanding of the distinction between the female and male sexes, leading to curiosities related to the

body and, consequently, to sexual relations. However, being considered a social paradigm (FREUD, 1912), there is a lack of adequate sexual guidance, leading children to seek their own answers. The literature review highlighted the child's possible search for pornographic content, as such cultural traditions hinder proper sexual education. Such marginalization, combined with excessive consumption of pornography, can impair the way the dopamine hormone is released in the child's brain, which can cause changes in the prefrontal cortex that is still developing, culminating in a distorted perception of sexual relationships.

Pornography aimed at men approaches the values of a male hegemony, placing them as superior and dominant in relation to women. Therefore, when boys are exposed to such content excessively, it can lead to macho and manipulative practices in their future relationships. Similarly, when girls access this type of pornography, when exposed to a reinforcement of women's submission and unrealistic esthetic standards, there is a possible formation of insecurities and

idealized expectations. With this, feminist pornography enters as an agent in the equal understanding of sexuality.

Finally, based on the analysis conducted on psychosexual development throughout childhood and how it reflects in human affective relationships, it is observed that the poor resolution of the Oedipus Complex, combined with early pornographic consumption and the absence of emotional and sexual education, impacts and influences the future relationships of individuals facing this situation, in addition to triggering personal disturbances and stigmas, which generates difficulties in establishing healthy bonds.

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