Sentimentos de Paranóia e de Vergonha nos Sem-Abrigo

A população “sem-abrigo” e todos os problemas envolventes, como a pobreza e a exclusão social apresentam uma complexidade cada vez mais inquietante e preocupante na nossa sociedade. O fenómeno multifacetado dos sem-abrigo constitui um grave problema social. A pertinência deste estudo prende-se com a escassez de investigação relativa à população sem-abrigo e perceber melhor a sua complexidade, nomeadamente no que respeita à caracterização psicológica dos indivíduos sem-abrigo. Neste sentido, o presente estudo tem como objectivo conhecer melhor esta população através da recolha de informação relativa aos seus receios, valores, prazeres, percepção do motivo da sua situação, consumo de substâncias psicotrópicas, contacto com a família e amigos. Paralelamente pretendemos avaliar os sentimentos de vergonha (em função de experiências negativas precoces), de paranóia e emoções negativas (depressão, ansiedade e stress) nesta população específica e analisar a relação entre estas variáveis. A amostra é constituída por 56 sujeitos na condição de sem-abrigo, com uma média de idade de 40,86 e de 7 anos de escolaridade, sendo a maioria (n=49) do sexo masculino. O protocolo de avaliação, para além do questionário psicossocial desenvolvido para o efeito, incluía ainda escalas para medir a Depressão, Ansiedade e Stress (DASS-21), Vergonha Externa (OAS), Vergonha Interna (ISS) e Paranóia (GPS). Os dados do nosso estudo permitiram pôr em evidência algumas das dificuldades mais significativas dos sem-abrigo, nomeadamente, as rupturas dos laços familiares, o desemprego e a toxicodependência entre outros. Constatámos que os sem-abrigo da nossa amostra apresentam valores médios mais elevados de paranóia, vergonha externa e interna, quando comparados com os valores da população normal. Verifica-se ainda que quando mais escolarizada é a nossa amostra, menor sintomatologia depressiva e relacionada com o stress apresenta. Encontrámos correlações significativas positivas e moderadas entre as variáveis em estudo. Dada a escassez de investigação em indivíduos sem-abrigo, e apesar das limitações inerentes a este estudo, esperamos ter dado um contributo para alargar o conhecimento deste complexo fenómeno, nomeadamente no que respeita à caracterização psicológica destes indivíduos. / The homeless population and all the related issues such as poverty and social exclusion are a complex and increasingly worrying concern of our society. The multifaceted phenomenon of homelessness is a serious social problem. The relevance of this study relates to the scarcity of research on the homeless population and to better understand its complexity, particularly the psychological characteristics of the homeless individuals. As such, this study aims to better understand this population by collecting information on their fears, values, pleasures, perception of the reason for their situation, consumption of psychotropic substances, contact with family and friends. Simultaneously we intend to evaluate the feelings of shame (due to early negative experiences), paranoia and negative emotions (depression, anxiety and stress) in this specific population as well as analyse the relationship between these variables. The study sample is based on 56 individuals in the condition of homelessness, mostly male (n = 49), with an average age of 40.86 and 7 years of schooling. In addition to the psychological questionnaire developed for this purpose, the evaluation protocol also included scales to measure Depression, Anxiety and Stress (DASS-21), External Shame (OAS), Internal Shame (ISS) and Paranoia (GPS). The data in our study allowed to highlight some of the most significant problems of homelessness, including disruption of family ties, unemployment, drug abuse and others. We learnt that the homeless in our sample have a higher average number of paranoia, internal and external shame, when compared to the normal population. We have also found that the more educated our sample is, the less are the depressive symptoms and stress-related features. Among the studied variables, we have found significant positive and moderate correlations. Given the scarcity of research on homeless individuals and despite the limitations of this study, we hope to have contributed to increase the knowledge on this complex phenomenon, especially concerning the psychological characterization of these individuals.

Sistemas de gerenciamento de bibliotecas: riscos decorrentes do processo de migração de dados

This work aims to analyze risks related to information technology (IT) in procedures related to data migration. This is done considering ALEPH, Integrated Libray System (ILS) that migrated data to the Library Module present in the software called Sistema Integrado de Gestão de Atividades Acadêmicas (SIGAA) at the Zila Mamede Central Library at the Federal University of Rio Grande do Norte (UFRN) in Natal/Brazil. The methodological procedure used was of a qualitative exploratory research with the realization of case study at the referred library in order to better understand this phenomenon. Data collection was able once there was use of a semi-structured interview that was applied with (11) subjects that are employed at the library as well as in the Technology Superintendence at UFRN. In order to examine data Content analysis as well as thematic review process was performed. After data migration the results of the interview were then linked to both analysis units and their system register with category correspondence. The main risks detected were: data destruction; data loss; data bank communication failure; user response delay; data inconsistency and duplicity. These elements point out implication and generate disorders that affect external and internal system users and lead to stress, work duplicity and hassles. Thus, some measures were taken related to risk management such as adequate planning, central management support, and pilot test simulations. For the advantages it has reduced of: risk, occurrence of problems and possible unforeseen costs, and allows achieving organizational objectives, among other. It is inferred therefore that the risks present in data bank conversion in libraries exist and some are predictable, however, it is seen that librarians do not know or ignore and are not very worried in the identification risks in data bank conversion, their acknowledge would minimize or even extinguish them. Another important aspect to consider is the existence of few empirical research that deal specifically with this subject and thus presenting the new of new approaches in order to promote better understanding of the matter in the corporate environment of the information units

Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: the RECOVER randomized clinical trial.

Importance: critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective: to evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post–intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants: a parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions: during the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures: the Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results: median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, −0.2 [95% CI, −1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, −0.1 [95% CI, −3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, −3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance: post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.

Predictors of stress and depressive mood in portuguese middle-aged women

This cross-sectional study investigates the predictors of psychological symptoms-stress and depressive mood-in a sample of middle-aged women. A community sample of 1,003 women filled in the questionnaires and instruments, which included the Depression, Anxiety and Stress Scales and the Life Events Survey; sociodemographic, health, and menopause-related and lifestyle information was also collected. Structural equation modeling was used to build the model that had stress and depressive mood as dependent variables. Health status (both physical and psychological), recent life events, income and menopausal phase were significantly associated with the frequency of stress and depressive symptoms. Additionally, educational level and parity were also significant predictors of depressive mood. This study emphasizes that psychological symptoms occurrence in midlife depends not only on personal variables (such as health and menopausal status) but also on contextual ones (including recent stressful events) that can be a strong influence on how middle-aged women feel.

Sistemas de gerenciamento de bibliotecas: riscos decorrentes do processo de migração de dados

This work aims to analyze risks related to information technology (IT) in procedures related to data migration. This is done considering ALEPH, Integrated Libray System (ILS) that migrated data to the Library Module present in the software called Sistema Integrado de Gestão de Atividades Acadêmicas (SIGAA) at the Zila Mamede Central Library at the Federal University of Rio Grande do Norte (UFRN) in Natal/Brazil. The methodological procedure used was of a qualitative exploratory research with the realization of case study at the referred library in order to better understand this phenomenon. Data collection was able once there was use of a semi-structured interview that was applied with (11) subjects that are employed at the library as well as in the Technology Superintendence at UFRN. In order to examine data Content analysis as well as thematic review process was performed. After data migration the results of the interview were then linked to both analysis units and their system register with category correspondence. The main risks detected were: data destruction; data loss; data bank communication failure; user response delay; data inconsistency and duplicity. These elements point out implication and generate disorders that affect external and internal system users and lead to stress, work duplicity and hassles. Thus, some measures were taken related to risk management such as adequate planning, central management support, and pilot test simulations. For the advantages it has reduced of: risk, occurrence of problems and possible unforeseen costs, and allows achieving organizational objectives, among other. It is inferred therefore that the risks present in data bank conversion in libraries exist and some are predictable, however, it is seen that librarians do not know or ignore and are not very worried in the identification risks in data bank conversion, their acknowledge would minimize or even extinguish them. Another important aspect to consider is the existence of few empirical research that deal specifically with this subject and thus presenting the new of new approaches in order to promote better understanding of the matter in the corporate environment of the information units

IVG: Um indutor de alterações psicológicas? Estudo dos níveis de depressão, ansiedade e stress em mulheres no pré e pós I.V.G.

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Child Abuse and Mental Disorders in Iranian Adolescents

Background: Child abuse is a serious social health problem all over the world with important adverse effects. Objectives: The aim of this study was to extend our understanding of the relation between mental disorders and child abuse. Materials and Methods: The study was designed as a cross-sectional survey on 700 students in secondary schools using multiple cluster sampling in Yazd, Iran in 2013. We applied 2 self reported questionnaires: DASS (depression anxiety stress scales)-42 for assessing mental disorders (anxiety, stress and depression) and a standard self-reported valid and reliable questionnaire for recording child abuse information in neglect, psychological, physical and sexual domains. The collected data was analyzed using SPSS software. P-values < 0.05 were considered as significant. Results: There was a statically significant correlation between mental disorder and child abuse score (Spearman rho: 0.2; P-value < 0.001). The highest correlations between mental disorders and child abuse were found in psychological domain, Spearman’s rho coefficients were 0.46, 0.41 and 0.36 for depression, anxiety and stress respectively (P-value < 0.001). Based on the results of logistic regression for mental disorder, females, last born adolescents and subjects with drug or alcohol abuser parents had mental disorder odds of 3, 0.4 and 1.9 times compared to others; and severe psychological abuse, being severely neglected and having sexual abuse had odds 90, 1.6 and 1.5 respectively in another model. Conclusions: Programming for mandatory reporting of child abuse by physicians and all health care givers e.g. those attending schools or health centers, in order to prevent or reduce its detrimental effects is useful and success in preventing child abuse could lead to reductions in the prevalence of mental disorders.

Coping as a moderator of the influence of economic stressors on psychological health

Since 2008, there has been a decline in the economy of several European countries, including Portugal. In the literature, it is emphasized that periods of economic uncertainty propitiate the appearance of mental health problems and diminish populations’ well-being. The aim of the present study, with 729 Portuguese participants, 33.9% (n=247) males and 66.1% (n=482) females with an average age of 37 years old (M=36.99; SD=12.81), was to examine the relationship between economic hardship, financial threat, and financial well-being (i.e., economic stressors) and stress, anxiety, and depression (i.e., psychological health indicators), as well as to test the moderation effect of coping in the aforementioned relationship. To achieve these goals, a cross-sectional design was implemented and structural equation modeling (SEM) was used to analyze the obtained data. Our results underline that coping affects the relationship between economic stressors and psychological health since subjects with lower coping levels are more vulnerable to economic stress factors than those with higher coping levels. The moderation effect was more evident in the relationships between economic hardship and stress, anxiety, and depression. The main implications of this study are presented, as well as its’ limitations and suggestions for future research.

Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study.

Aim: To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations. Participants: PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI). Method: A cross-sectional postal questionnaire was sent to PCa survivors 2–18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into ‘late disease’ (stage III/IV and any Gleason grade (GG) at diagnosis) and ‘early disease’ (stage I/II and GG 2–7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression. Results: 3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score. Conclusions: Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.

Impacto de la resiliencia en pacientes con Artritis Reumatoide

Introducción: La artritis reumatoide (AR) es una enfermedad autoinmune-inflamatoria, que compromete las articulaciones diartrodiales. Tiene una importante repercusión sistémica que incluye la depresión; por lo tanto, tiene un severo impacto sobre la calidad de vida. Es posible que mecanismos de defensa, tales como la resiliencia, puedan amortiguar dicho impacto. Metodología: estudio de corte transversal, multicéntrico (análisis inicial dentro del grupo AR, con muestra no probabilística de 66 pacientes, posterior selección aleatoria simple de 16 pacientes de la muestra inicial y selección de 16 individuos sanos pareados). Posteriormente, se comparó la resiliencia entre sujetos con AR y sujetos sanos, mediante las escalas RS y CD-RISC25. Adicionalmente, se aplicaron las escalas EEAE, EADZ, SF-36 y PANAS. Los datos fueron evaluados mediante el coeficiente de correlación de Spearman, las pruebas U Mann-Whitney, Kruskall-Wallis, T de Student y análisis de varianza. Resultados: se encontraron diferencias significativas en las estrategias de afrontamiento no espirituales en grupos de resiliencia baja, media y alta; diferencias en las medianas de resiliencia en los grupos de depresión por EAZD en los pacientes. No se encontraron resultados significativos en las variables clínicas de la AR ni en la comparación con sujetos sanos. Conclusiones: el uso de estrategias de afrontamiento no espirituales y la ausencia de depresión, se asoció a mayores niveles de resiliencia en los pacientes con AR, por lo cual, los componentes emocionales y cognitivos se asocian a la resiliencia.

Long-term citalopram administration reduces responsiveness of HPA axis in patients with major depression: relationship with S-citalopram concentrations in plasma and cerebrospinal fluid (CSF) and clinical response.

RATIONALE: A dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is a well-documented neurobiological finding in major depression. Moreover, clinically effective therapy with antidepressant drugs may normalize the HPA axis activity. OBJECTIVE: The aim of this study was to test whether citalopram (R/S-CIT) affects the function of the HPA axis in patients with major depression (DSM IV). METHODS: Twenty depressed patients (11 women and 9 men) were challenged with a combined dexamethasone (DEX) suppression and corticotropin-releasing hormone (CRH) stimulation test (DEX/CRH test) following a placebo week and after 2, 4, and 16 weeks of 40 mg/day R/S-CIT treatment. RESULTS: The results show a time-dependent reduction of adrenocorticotrophic hormone (ACTH) and cortisol response during the DEX/CRH test both in treatment responders and nonresponders within 16 weeks. There was a significant relationship between post-DEX baseline cortisol levels (measured before administration of CRH) and severity of depression at pretreatment baseline. Multiple linear regression analyses were performed to identify the impact of psychopathology and hormonal stress responsiveness and R/S-CIT concentrations in plasma and cerebrospinal fluid (CSF). The magnitude of decrease in cortisol responsivity from pretreatment baseline to week 4 on drug [delta-area under the curve (AUC) cortisol] was a significant predictor (p<0.0001) of the degree of symptom improvement following 16 weeks on drug (i.e., decrease in HAM-D21 total score). The model demonstrated that the interaction of CSF S-CIT concentrations and clinical improvement was the most powerful predictor of AUC cortisol responsiveness. CONCLUSION: The present study shows that decreased AUC cortisol was highly associated with S-CIT concentrations in plasma and CSF. Therefore, our data suggest that the CSF or plasma S-CIT concentrations rather than the R/S-CIT dose should be considered as an indicator of the selective serotonergic reuptake inhibitors (SSRIs) effect on HPA axis responsiveness as measured by AUC cortisol response.

Generierung und Charakterisierung von in-vitro- und in- vivo-Modellsystemen zur Untersuchung des Skelettsystems

Die Entstehung und Aufrechterhaltung von Knorpel- und Knochengewebe wird durch eine Vielzahl von hemmenden oder fördernden Faktoren hoch komplex reguliert, wobei die dabei involvierten physiologischen Prozesse bisher nur teilweise verstanden werden. Auch die Ursachen sowohl degenerativer Erkrankungen, aber auch durch Mutationen im FGFR3-Gen verursachter Chondrodysplasien sind in ihrer Ätiopathogenese noch nicht vollständig erforscht. In dieser Arbeit wurden verschiedene experimentelle Ansätze verfolgt, die zur weiteren Aufklärung der Pathophysiologie zweier unterschiedlicher Skeletterkrankungen beitragen sollten.rnEin relevantes Charakteristikum der degenerativen Gelenkserkrankung Osteoarthrose ist der Verlust an Aggrekan, hauptverantwortlich verursacht durch die Aggrekanase ADAMTS5. Es wurde ein Tiermodell generiert, bei dem gezielt mittels des Tet-ON-Systems die Aggrekanase mAdamts-5 überexprimiert werden kann. Nach Konstruktherstellung und Generierung als auch Charakterisierung des in vitro-Modells wurde das Tiermodell hergestellt, um die Folgen der Überexpression im Hinblick auf einen verstärkten Aggrekanabbau im Knorpel der Mäuse zu analysieren. Nach initialer Charakterisierung auf Induzierbarkeit zeigte eine Gründerlinie eine induzierbare transgene mAdamts5-Expression. Die Überprüfung auf Knorpelspezifität zeigte, sowohl embryonal als auch im adulten Tier, dass sich der verwendete, zusammengesetzte Kollagen-Typ II Promotor wie der endogene verhielt und somit funktional war. Nach Doxyzyklininduktion wurde bei der optimalen Dosis von 1 mg/ml im Vergleich zum induzierten Wildtyp-Tier eine 15%ige Abnahme des Gesamt-Glykosamino-glykan(GAG)-Gehaltes und eine um 120% erhöhte GAG-Abgabe ins Medium detektiert, was eine verstärkte Spaltung von Aggrekan bedeutete. Die transgene Aggrekanase wurde überexprimiert und spaltete verstärkt Aggrekan. Da aufgrund der histologischen Untersuchungen jedoch keine Knorpelerosionen feststellbar waren, konnte im Umkehrschluss gefolgert werden, dass der Knorpel einen Verlust an Glykosaminoglykanen bis zu einer gewissen Grenze tolerieren kann. Mit dem generierten und charakterisierten Tiermodell konnte mit dem Verlust an GAG eine Osteoarthrose-ähnliche Situation simuliert werden, insbesondere im Hinblick auf frühe Stadien der Erkrankung, bei denen noch keine makroskopisch eindeutig sichtbare Knorpelerosionen vorliegen. rnIm zweiten Teil der Arbeit wurden Zellkulturexperimente zur weiteren Aufklärung FGFR3-regulierter Prozesse durchgeführt. Nach Generierung und Verifizierung der stabilen Zelllinien, die mittels des Tet-ON-Systems das FGFR3-Gen mit jeweils einer Chondrodysplasie-assoziierten Mutation (Achondroplasie-Mutation G380R, Thanatophore Dysplasie Typ II-Mutation K650E) induzierbar überexprimieren, wurden die Auswirkungen der zwei verschiedenen Mutationen anhand bereits beschriebener Signalwege untersucht. Über die Rekrutierung des ERK-Signalweges konnte bei beiden Zelllinien die Funktionalität nachgewiesen werden, wobei die Zelllinie mit der einen schwereren Phänotyp beim Menschen verursachenden TDII-Mutation eine stärkere Aktivierung zeigte. Bei der Aktivierung von STAT1 wies nur die TDII-Zelllinie eine Phosphorylierung auf, nicht jedoch die ACH-Zelllinie; dies deckte sich mit bereits publizierten Untersuchungen. Beide Kaskaden zeigten eine unterschiedliche Signalantwort aufgrund der verschiedenen Mutationen. Des Weiteren konnte eine unterschiedliche MMP13-Zielgenexpression nachgewiesen werden, wobei lediglich die ACH-Zelllinie eine erhöhte MMP13-Expression (6-fach) zeigte. Zur Identifizierung neuer involvierter FGFR3-Zielgene wurde die differentielle Genexpression der TDII-Zelllinie im Vergleich induziert/nicht induziert mittels Microarray-Hybridisierung untersucht. Als interessantes Zielgen fiel STC1 auf, welches ebenfalls eine Rolle in der Chondrogenese spielt und bislang nicht mit FGFR3 in Verbindung gebracht wurde. Es konnte jedoch nur auf RNA-Ebene eine Regulation nachgewiesen werden. Nachfolgend durchgeführte transiente Experimente zeigten, dass die Wildtyp-Variante von FGFR3 möglicherweise eine Funktion in der Sekretion des Proteins STC1 hat und dass durch die beiden eingefügten Mutationen (ACH, TDII) diese aufgehoben ist. Der Einfluss von FGFR3 auf die Sekretion von STC1 stellt ein neues Ergebnis dar, insbesondere auch die Auswirkungen der beiden für die unterschiedlichen Krankheitsbilder stehenden Mutationen. Welche Relevanz allerdings die STC1-Sekretion im Rahmen FGFR3-assoziierter Erkrankungen hat, kann nicht eindeutig beurteilt werden. Weitere Faktoren aus dem hoch komplexen Zusammenspiel während der Knorpel/Knochenentwicklung müssen untersucht werden, um eine definitive Einordnung zu ermöglichen.