Depression in children and adolescents: family narratives in Brazilian primary attention

Background: The incidence of depression in children and adolescents still increasing and this disorder is now a major public health challenge worldwide. The Psychiatric Reform suggested an end to the fragmented and inefficient service by proposing integrated and quality care. In this context, family narratives are a way to recognize vulnerabilities and provide psychopathology prevention in primary care. Methods: Two medical databases (LILACS and SciELO) were surveyed and 14 texts published between 2004 and 2011 were selected and reviewed. Results and discussion: Children and adolescents are nowadays exposed to several stressing factors, in addition to natural vulnerabilities of this age group. Prevention is associated with a qualified hearing of family narratives in primary care and healthcare professionals should be able to perceive said and unsaid elements across the speech. Conclusion: In spite of the advances about children and adolescents mental health, some procedures must be adapted to achieve an efficient mental health policy though analyzing family discourse.

Prodromal Questionnaire: translation, adaptation to Portuguese and preliminary results in ultra-high risk individuals and first episode psychosis

OBJECTIVE: The Prodromal Questionnaire (PQ) is a 92-item self-report screening tool for individuals at ultra-high risk (UHR) to develop psychosis. This study aims to present the translation to Portuguese and preliminary results in UHR and first episode (FE) psychosis in a Portuguese sample. METHODS: The PQ was translated from English to Portuguese by two bilingual researchers from the research program on early psychosis of the Instituto de Psiquiatria HCFMUSP, São Paulo, Brazil (ASAS - "Evaluation and Follow up of Adolescents and Young Adults in São Paulo") and back translated by two other researchers. The study participants (n = 11-) were evaluated through the Portuguese version of the Prodromal Questionnaire (PQ) and SIPS. RESULTS: The individuals at UHR (n = 7) presented a lower score than first episode patients (n = 4). The UHR mean scores and standard deviation on Portuguese version of the PQ were: 13.0 ± 10.0 points on positive symptoms subscale, and FE patients: 33.0 ± 10.0. CONCLUSION: The UHR and FE patients' of this study presented PQ scores similar to the ones found in the literature; what suggests that it is possible to use the PQ in Brazilian help-seeking individuals as a screening tool.

Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug

Objectives: To review and describe studies of the non-psychotomimetic constituent of Cannabis sativa, cannabidiol (CBD), as an anxiolytic drug and discuss its possible mechanisms of action. Method: The articles selected for the review were identified through searches in English,articles, and book chapters were handsearched for additional references. Experimental animal and human studies were included, with no time restraints. Results: Studies using animal models of anxiety and involving healthy volunteers clearly suggest an anxiolytic-like effect of CBD. like", and "cannabidiol and anxiety". The reference lists of the publications included, review Portuguese, and Spanish in the electronic databases ISI Web of Knowledge, SciELO, PubMed, and PsycINFO, combining the search terms "cannabidiol and anxiolytic", "cannabidiol and anxiolytic-articles, and book chapters were handsearched for additional references. Experimental animal and human studies were included, with no time restraints. Results: Studies using animal models of anxiety and involving healthy volunteers clearly suggest an anxiolytic-like effect of CBD. Moreover, CBD was shown to reduce anxiety in patients with social anxiety disorder. Conclusion: like", and "cannabidiol and anxiety". The reference lists of the publications included, review Future clinical trials involving patients with different anxiety disorders are warranted, especially of panic disorder, obsessive-compulsive disorder, social anxiety disorder, and post-traumatic stress disorders. The adequate therapeutic window of CBD and the precise mechanisms involved in its anxiolytic action remain to be determined.

Financiamento de parques tecnológicos: um estudo comparativo de casos brasileiros, portugueses e espanhóis

O mercado globalizado e de competição intensiva, no qual países e empresas estão inseridos, demanda uma busca constante por inovação. Entre os habitats de estímulo à inovação com diversas iniciativas pelo mundo, e também no Brasil, estão os chamados parques tecnológicos. Um dos grandes desafios para a implantação e a operacionalização desses empreendimentos é a obtenção de recursos. Surge, então, a questão: quais os mecanismos de financiamento de que a organização gestora de um parque tecnológico dispõe para realizar as fases de planejamento, implantação e operacionalização dos elementos constitutivos e serviços oferecidos por esse tipo de empreendimento? O objetivo neste trabalho é levantar e comparar os mecanismos de financiamento utilizados nas etapas citadas dos empreendimentos: Tecnopuc, Polo de Informática de São Leopoldo e Sapiens Parque, instalados no Brasil; Biocant Park e Taguspark, instalados em Portugal; Parque Tecnológico de Cartuja 93, Parque Tecnológico de Andalucia, Parque Científico de Barcelona, Parque Tecnológico de Bizkaia e Parque Tecnológico de Álava, instalados na Espanha. O que se pode observar em todos os casos estudados é que, mesmo apresentando organizações gestoras, atores e estruturas diferenciadas, o financiamento das fases de implantação não se deu somente por meio de recursos públicos ou privados, mas também por meio de parcerias. Além disso, verificou-se que as diferenças encontradas nos modelos de financiamento podem ser atribuídas, principalmente, a cinco fatores: participantes da organização gestora; modelo jurídico da organização gestora; elementos constitutivos de propriedade da organização gestora; atração de infraestruturas tecnológicas e empresas âncoras; disponibilidade de fundos públicos de fomento ao desenvolvimento tecnológico e econômico.

Family Health Strategy Professionals Facing Medical Social Needs: difficulties and coping strategies

Professionals of Family Health Strategy (FHS) work in communities where there are complex medical social problems. These contexts may lead them to psychological suffering, jeopardizing their care for the users, and creating yet another obstacle to the consolidation of FHS as the primary health care model in Brazil. The study investigated the difficulties and coping strategies reported by health professionals of the FHS teams when they face medical social needs of the communities where they work. Focus groups and semi-structured interviews were carried out with 68 professionals of three primary care units in the city of Sao Paulo (Southeastern Brazil). Drug dealing and abuse, alcoholism, depression and domestic violence are the most relevant problems mentioned by the study group. Professionals reported lack of adequate training, work overload, poor working conditions with feelings of professional impotence and frustration. To overcome these difficulties, professionals reported collective strategies, particularly experience sharing during team meetings and matrix support groups. The results indicate that the difficulties may put the professionals in a vulnerable state, similar to the patients they care for. The promotion of specialized and long term support should be reinforced, as well as the interaction with the local network of services and communities leaders. That may help professionals to deal with occupational stress related to medical and social needs present in their routine work; in the end, it may as well contribute to the strengthening of FHS.

Cooperative interventions and the interaction of Community Health Agents within the Family Health team

This qualitative study examines the social relationships between the Community Health Agents (CHAs) and the Family Health team (FH), highlighting cooperative interventions and interactions among workers. A total of 23 participant observations and 11 semi-structured interviews were conducted with an FH team in a city in the interior of Sao Paulo, Brazil. The results revealed that CHAs function as a link in the development of operational actions to expedite teamwork. These professionals, while creating bonds, articulate connections of teamwork and interact with other workers, developing common care plans and bringing the team and community together, as well as adapting care interventions to meet the real needs of people. In communication practice, when talking about themselves they talk about the community itself because they are the community's representatives and spokespersons on the team. The conclusion is that the CHA may be a strategic worker if his/her actions include more political and social dimensions of work in healthcare.

Denominal Verbs in Brazilian Portuguese: distinguishing between diachronic and synchronic structures within Distributed Morphology approach

Recent work on argument structure has shown that there must be a synchronic relation between nouns and derived verbs that can be treated in structural terms. However, a simple phonological/morphological identity or diachronic derivation between a verb and a noun cannot guarantee that there is a denominal structure in a synchronic approach. In this paper we observe the phenomenon of Denominal Verbs in Brazilian Portuguese and argue for a distinction between etymological and synchronic morphological derivation. The objectives of this paper are 1) to identify synchronic and formal criteria to define which diachronic Denominal Verbs can also be considered denominal under a synchronic analysis; and 2) to detect in which cases the label "denominal" can be justifiably abandoned. Based on results of argument structure tests submitted to the judgments of native speakers, it was possible to classify the supposed homogenous Denominal Verbs class into three major groups: Real Denominal Verbs, Root-derived Verbs, and Ambiguous Verbs. In a Distributed Morphology approach, it was possible to explain the distinction between these groups based on the ideia of phases in words and the locality of restriction in the interpretation of roots.

Hearing loss and acquired immune deficiency syndrome: systematic review

PURPOSE: To investigate the occurrence of hearing loss in individuals with HIV/AIDS and their characterization regarding type and degree. RESEARCH STRATEGY: It was conducted a systematic review of the literature found on the electronic databases PubMed, EMBASE, ADOLEC, IBECS, Web of Science, Scopus, Lilacs and SciELO. SELECTION CRITERIA: The search strategy was directed by a specific question: "Is hearing loss part of the framework of HIV/AIDS manifestations?", and the selection criteria of the studies involved coherence with the proposed theme, evidence levels 1, 2 or 3, and language (Portuguese, English and Spanish). DATA ANALYSIS: We found 698 studies. After an analysis of the title and abstract, 91 were selected for full reading. Out of these, 38 met the proposed criteria and were included on the review. RESULTS: The studies reported presence of conductive, sensorineural, and mixed hearing loss, of variable degrees and audiometric configurations, in addition to tinnitus and vestibular disorders. The etiology can be attributed to opportunistic infections, ototoxic drugs or to the action of virus itself. The auditory evoked potentials have been used as markers of neurological alterations, even in patients with normal hearing. CONCLUSION: HIV/AIDS patients may present hearing loss. Thus, programs for prevention and treatment of AIDS must involve actions aimed at auditory health.

Development of site-specific sediment quality guidelines for North and South Atlantic littoral zones: Comparison against national and international sediment quality benchmarks

We aimed to develop site-specific sediment quality guidelines (SQGs) for two estuarine and port zones in Southeastern Brazil (Santos Estuarine System and Paranagua Estuarine System) and three in Southern Spain (Ria of Huelva, Bay of Cadiz, and Bay of Algeciras), and compare these values against national and traditionally used international benchmark values. Site-specific SQGs were derived based on sediment physical-chemical, toxicological, and benthic community data integrated through multivariate analysis. This technique allowed the identification of chemicals of concern and the establishment of effects range correlatively to individual concentrations of contaminants for each site of study. The results revealed that sediments from Santos channel, as well as inner portions of the SES, are considered highly polluted (exceeding SQGs-high) by metals, PAHs and PCBs. High pollution by PAHs and some metals was found in Sao Vicente channel. In PES, sediments from inner portions (proximities of the Ponta do Mix port`s terminal and the Port of Paranagua) are highly polluted by metals and PAHs, including one zone inside the limits of an environmental protection area. In Gulf of Cadiz, SQGs exceedences were found in Ria of Huelva (all analysed metals and PAHs), in the surroundings of the Port of CAdiz (Bay of CAdiz) (metals), and in Bay of Algeciras (Ni and PAHs). The site-specific SQGs derived in this study are more restricted than national SQGs applied in Brazil and Spain, as well as international guidelines. This finding confirms the importance of the development of site-specific SQGs to support the characterisation of sediments and dredged material. The use of the same methodology to derive SQGs in Brazilian and Spanish port zones confirmed the applicability of this technique with an international scope and provided a harmonised methodology for site-specific SQGs derivation. (C) 2009 Elsevier B.V. All rights reserved.

Phylogenetic and host-parasite relationship analysis of Henneguya multiplasmodialis n. sp infecting Pseudoplatystoma spp. in Brazilian Pantanal wetland

A new species of the genus Henneguya (Henneguya multiplasmodialis n. sp.) was found infecting the gills of three of 89 specimens (3.3%) of Pseudoplatystoma corruscans and two of 79 specimens (2.6%) of Pseudoplatystoma reticulatum from rivers in the Pantanal wetland, Brazil. Partial sequencing of the 18S rDNA gene of the spores obtained from one plasmodium from the gills of P. corruscans and other one from the gills of P. reticulatum, respectively, resulted in a total of 1560 and 1147 base pairs. As the spores of H. multiplasmodialis n. sp. resemble those of Henneguya corruscans, which is also a parasite of P. corruscans, sequencing of the 18S rDNA gene of the spores of H. corruscans found on P. corruscans caught in the Brazilian Pantanal wetland was also provided to avoid any taxonomic pendency between these two species, resulting in 1913 base pairs. The sequences of H. multiplasmodialis n. sp. parasite of P. corruscans and P. reticulatum and H. corruscans did not match any of the Myxozoa available in the GenBank. The similarity of H. multiplasmodialis n. sp. obtained from P. corruscans to that from P. reticulatum was of 99.7%. Phylogeny revealed a strong tendency among Henneguya species to form clades based on the order and/or family of the host fish. H. multiplasmodialis n. sp. clustered in a clade with Henneguya eirasi and H. corruscans, which are also parasites of siluriforms of the family Pimelodidae and, together with the clade composed of Henneguya spp. parasites of siluriforms of the family Ictaluridae, formed a monophyletic clade of parasites of siluriform hosts. The histological study revealed that the wall of the plasmodia of H. multiplasmodialis n. sp. were covered with a stratified epithelium rich in club cells and supported by a layer of connective tissue. The interior of the plasmodia had a network of septa that divided the plasmodia into numerous compartments. The septa were composed of connective tissue also covered on both sides with a stratified epithelium rich in club cells. Inflammatory infiltrate was found in the tissue surrounding the plasmodia as well as in the septa. (C) 2011 Elsevier B.V. All rights reserved.

Global health competencies for nurses in the Americas

This article reports the findings from an online survey of nursing faculty from the United States, Canada, Latin America, and Caribbean countries to identify their perceptions about global health competencies for undergraduate nursing students. A list of global health competencies for medical students developed by the Association of Faculties of Medicine of Canada Resource Group on Global Health and the Global Health Education Consortium was adapted for nurses and translated from English to Spanish and Portuguese. The competencies were divided into six subscales, and respondents rated each competency on a 4-point Likert scale, with high scores reflecting strong agreement that the competency was essential for undergraduate nursing students. E-mail invitations and links to the online survey were distributed using a nonprobability convenience sampling strategy. This article reports findings only from the respondents to the English and Spanish surveys. The final sample included 542 responses to the English survey and 51 responses to the Spanish survey. Cronbach's alpha reliability coefficients for the subscales ranged from .78 to .96. The mean values for all 6 subscales and for each of the 30 items were greater than 3.0 for the respondents to the Spanish survey, and the mean values for 27 of the items were greater than 3.0 for the respondents to the English survey. These findings suggest that respondents perceived the competencies as essential global health competencies for undergraduate nursing students in the Americas. Narrative comments written by respondents indicate additional competencies and specific concerns about adding additional content to an already full curricula. Results of this study can be used to guide faculty deliberations about global health competencies that should be incorporated in the nursing curricula.

Combined oral contraceptives and increasing cardiovascular risk: thromboembolism and hypertension

Background: Hormonal contraceptive pills are the most used reversible method for familiar planning in Brazil. The combined pill, with synthetic analogs of estrogen and progestin, is employed by 25% of Brazilian female population. Its use provokes an increase of blood pressure levels, takes patient to a hipercoagulability state and predisposes her to thromboembolic events. Purposes: We aimed to describe mechanisms of hypercoagulability promoted by oral combined contraceptives, to analyze the relative risk of cardiovascular events within users and to list the most common circulatory pathologies in these patients. Methods: Three virtual medical databases were surveyed (Pubmed/Medline, BVS/LILACS and Scielo). Twelve studies were selected: clinical trials, case reports and articles of indexed medical periodic originally published in Portuguese and English about synthetic hormones, oral contraception, coagulation disorders and cardiovascular morbimortality. Results: Synthetic estrogen promotes an increase of some clotting factors' levels (VII, VIII, IX, X, XII, XIII and fibrinogen), such as a reduction of their inhibitors (S protein and antithrombin). Because of this, etinilestradiol is the component most related to venous thrombosis and ischemic diseases of brain and heart. It also improves the releasing of hepatic angiotensinogen, taking to a increase of blood pressure levels. Conclusions: The prescription of oral combined contraceptives needs criteria, notably due to adverse effects of etinilestradiol. It is recommended to avoid the administration of these drugs for patients elder than 35 year-old or with risk factors. For these patients, the use of progestagen-only pills seems to be safer.

Epidemiological, parasitological and molecular aspects of Giardia duodenalis infection in children attending public daycare centers in southeastern Brazil

The purpose of this study was to determine the prevalence, associated risk factors and genotype of Giardia duodenalis infection in children attending public daycare centers in the city of Araguari, state of Minas Gerais, Brazil. Fecal samples were collected from 245 children aged 0-5 years, and questionnaires were asked about sociodemographic and hygiene-related characteristics. At the daycare centers where children tested positive, fecal samples were collected from the staff handling food, and from family members and domestic animals. Positive samples were analyzed at the dehydrogenase glutamate (gdh) locus to determine the genotype. The prevalence of G. duodenalis was 51.8%, and drinking unfiltered and unboiled water (OR 2.12, CI 1.26-3.69, p<0.001) and washing hands only with water (OR 2.14, Cl 1.19-4.04, p<0.001) were related risk factors. No association was found between test-positive children anti their family members, domestic animals and food handlers. An analysis of the sequences of 30 samples revealed that they all belonged to genotype B. (C) 2012 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Spiritist Psychiatric Hospitals in Brazil: Integration of Conventional Psychiatric Treatment and Spiritual Complementary Therapy

In Brazil, during the XX century, dozens of Spiritist psychiatric hospitals emerged seeking to integrate conventional medical treatment with complementary spiritual therapy. This combined inpatient treatment is largely found in Brazil, where many psychiatric hospitals stem from the Spiritist movement. The present report describes the use of these spiritual practices, their operating structure, health professionals involved, modalities of care, and institutional difficulties in integrating spiritual practices with conventional treatment in six leading Brazilian Spiritist psychiatric hospitals. These hospitals combine conventional psychiatric treatment with voluntary-based spiritual approaches such as laying on of hands ("fluidotherapy"), lectures regarding spiritual and ethical issues, intercessory prayer, spirit release therapy ("disobsession") and "fraternal dialogue". The non-indoctrination and optional nature of these spiritual complementary therapies seem to increase acceptance among patients and their family members. In conclusion, the Spiritist psychiatric hospitals in Brazil have, for more than half a century, provided an integrative approach in the treatment of psychiatric disorders, associating conventional and spiritual treatments, more specifically Spiritist therapy. The lack of standardized treatment protocols and scientific studies remain a barrier to assessing the impact of this integrative approach on patients' mental health, quality of life, adherence, and perceived quality of treatment.

Toll-like receptor 1 N248S single-nucleotide polymorphism is associated with leprosy risk and regulates immune activation during mycobacterial infection

Conflicting findings about the association between leprosy and TLR1 variants N248S and I602S have been reported. Here, we performed case-control and family based studies, followed by replication in 2 case-control populations from Brazil, involving 3162 individuals. Results indicated an association between TLR1 248S and leprosy in the case-control study (SS genotype odds ratio [OR], 1.81; P = .004) and the family based study (z = 2.02; P = .05). This association was consistently replicated in other populations (combined OR, 1.51; P < .001), corroborating the finding that 248S is a susceptibility factor for leprosy. Additionally, we demonstrated that peripheral blood mononuclear cells (PBMCs) carrying 248S produce a lower tumor necrosis factor/interleukin-10 ratio when stimulated with Mycobacterium leprae but not with lipopolysaccharide or PAM3cysK4. The same effect was observed after infection of PBMCs with the Moreau strain of bacillus Calmette-Guerin but not after infection with other strains. Finally, molecular dynamics simulations indicated that the Toll-like receptor 1 structure containing 248S amino acid is different from the structure containing 248N. Our results suggest that TLR1 248S is associated with an increased risk for leprosy, consistent with its hypoimmune regulatory function.