Integrating life design counseling and psychotherapy: Possibilities and practices.

The debate on the relation between career counseling and psychotherapy revealed the close relation between psychosocial and career issues. The connection between these two approaches paves the way for the integration of career counseling into psychotherapy. One of the key challenges of integrating career counseling into psychotherapy is to avoid discontinuities and inconsistencies in the psychotherapeutic intervention. The aim of this article is, therefore, to present the Systematic Treatment Selection perspective as a framework for an effective integration of psychotherapy and career counseling. Then, Life Design Counseling is described, highlighting its possibilities to fit the psychotherapeutic approach. Finally, an illustrative case is presented and discussed.

A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients

Fibromyalgia (FM) is a chronic, rheumatic disease characterized by widespread myofascial pain, of unknown aetiology, having a major impact on quality of life (QOL). Available pharmacotherapy for FM is marginally effective. FM is associated with co-morbidities of gastrointestinal (GI) disorders and Irritable Bowel Syndrome (IBS). There is growing evidence that diets low in FODMAPs, “fermentable oligo-, di- or mono-saccharides and polyols” [Low FODMAP Diet (LFD)], are effective in treating IBS. The aim of this pilot study was to examine the effects of LFDs on symptoms of FM, especially with regard to pain, QOL and GI disorders. Methods A longitudinal study using LFD intervention was performed on 38, 51 ± 10 year-old, female patients diagnosed with FM for an average of 10 years, based on ACR (American College of Rheumatology) 2010 criteria. The study was conducted from January through May, 2015, using a four-week, repeated-assessment model, as follows: Moment 0 – introduction of the protocol to participants; Moment 1 – first assessment and delivery of individual LFD dietary plans; Moment 2 – second assessment and reintroduction of FODMAPs; Moment 3 – last assessment and final nutritional counselling. Assessment tools used were the following: RFIQ (Revised Fibromyalgia Impact Questionnaire), FSQ (Fibromyalgia Survey Questionnaire), IBS-SSS (Severity Score System), EQ-5D (Euro-QOL quality of life instrument), and VAS (Visual Analogue Scale). Daily consumption of FODMAPs was quantified based on published food content analyses. Statistical analyses included ANOVA, non-parametric Friedman, t-student and Chi-square tests, using SPSS 22 software. Results The mean scores of the 38 participants at the beginning of the study were: FSQ (severity of FM, 0–31) – 22 ± 4.4; RFIQ (0–100) – 65 ± 17; IBS-SSS (0–500) – 275 ± 101; and EQ-5D (0–100) – 48 ± 19. Mean adherence to dietary regimens was 86%, confirmed by significant difference in FODMAP intakes (25 g/day vs. 2.5 g/day; p < 0.01). Comparisons between the three moments of assessment showed significant (p < 0.01) declines in scores in VAS, FSQ, and RFIQ scores, in all domains measured. An important improvement was observed with a reduction in the severity of GI symptoms, with 50% reduction in IBS scores to 138 ± 117, following LFD therapy. A significant correlation (r = 0.36; p < 0.05) was found between improvements in FM impact (declined scores) and gastrointestinal scores. There was also a significant correlation (r = 0.65; p < 0.01) between “satisfaction with improvement” after introduction of LFDs and “diet adherence”, with satisfaction of the diet achieving 77% among participants. A significant difference was observed between patients who improved as compared to those that did not improve (Chi-square χ2 = 6.16; p < .05), showing that the probability of improvement, depends on the severity of the RFIQ score. Conclusions Implementation of diet therapy involving FODMAP restrictions, in this cohort of FM patients, resulted in a significant reduction in GI disorders and FM symptoms, including pain scores. These results need to be extended in future larger studies on dietary therapy for treatment of FM. Implications According to current scientific knowledge, these are the first relevant results found in an intervention with LFD therapy in FM and must be reproduced looking for a future dietetic approach in FM.

ADDITION OF VINEGAR TO EXTEND THE SHELF-LIFE OF CABEÇA DE XARA

Cabeça de xara is a ready-to-eat meat product, whose production is very characteristic in Alentejo, a particular region of Portugal. It is a galantine usually moulded into parallelepiped shape made with various meats obtained from the Alentejano pig breed reared in the same region, namely deboned pork heads, tongue and connective tissue to which a number of condiments like salt, parsley, wine and pepper, are added. This work intended to test the feasibility of adding vinegar in order to increase the shelf-life of cabeça de xara, by reducing the contaminating microbiota responsible for spoilage, as well as controlling the pathogen Listeria monocytogenes. Three independent batches were produced and proximate composition, pH, aw, microbiological parameters and biogenic amines content evaluated. A sensory analysis was also performed throughout the storage period. No significant differences between control and vinegar samples was found regarding the proximate composition of cabeça de xara. As expected, pH is lower in the vinegar samples, however no differences in aw were observed between the two treatments. L. monocytogenes was present from the first month on only in one batch in the control treatment. However, it is inhibited by the addition of vinegar until the third month of storage, where L. monocytogenes is present but below the limit established in the 2073/2005 regulation. The presence of vinegar significantly decreased the content in biogenic amines, particularly cadaverine, putrescine and tyramine, throughout the storage period. Concerning sensory evaluation, no vinegar taste was reported by the panellists in a depreciating way.

Aspects Related to Venous Ulcer Healing and its Influence on Quality of Life

Nowadays, the varicose ulcers (VUs) are one of the most worrying leg ulcers and are an important problem in global public health, with high costs related to the treatment and its complications. Moreover, the quality of life (QOL) of the patient could be affected by pain, sleep disorders, functional impairment, depression and isolation. The VUs patient care is complex and it is necessary to know the aspects that contribute to the healing process for developing effective strategies. The members of the multidisciplinary health team should identify sociodemographic, clinical and care aspects that interfere in tissue repair and therefore impacting the QOL. Self-efficacy, adherence to treatment and self-esteem are other important aspects also related to healing and QOL, with implications for health care and the multidisciplinary team. To sum up, the use of multidisciplinary protocols allows the systematization of care for people with VUs in order to standardize therapeutic interventions with the aim to decrease the healing process time and, as a consequence, to improve the QOL.