Incidência de malária no Estado do Pará e suas relações com a variabilidade climática regional

O objetivo deste trabalho consiste em realizar um estudo diagnóstico sobre a incidência de malária em quatro diferentes regiões do Pará (Anajás, Itaituba, Santana do Araguaia e Viseu) na Amazônia oriental, buscando suas relações com a variabilidade climática regional, com o crescimento populacional e taxas de desmatamento. Utilizou-se uma série de 35 anos de dados anuais (1970-2005) e 14 anos de dados mensais (1992-2005). Aplicou-se a técnica dos percentis para se estabelecer cinco categorias ou classes da taxa de incidência da malária e precipitação para cada município. Os resultados das análises com os dados anuais mostraram que os municípios apresentam fatores diferenciados que contribuem para o perfil da endemia. O crescimento da população tem relação direta com o aumento da incidência de malária em Anajás, Itaituba e Santana do Araguaia. Em Anajás, o fator precipitação não é determinante na ocorrência da parasitose. Em Santana do Araguaia e Viseu os maiores índices de incidência de malária ocorreram em anos de déficit hídrico. Para Viseu o padrão normal de precipitação também categorizou altas incidências de malária. Em relação ao desmatamento, de 1988 até 1995, as curvas de incidência de malária acompanham as taxas de desmatamento. A partir de 1995, evidenciaram-se anos consecutivos com altos índices de incidência logo após os anos de altas taxas de desmatamento, como registrado em 1995, 2000 e 2004. Análises de composições observacionais montadas com base na seleção objetiva dos índices de ocorrência da malária categorizados pelos percentis, permitiram definir a caracterização anual da variabilidade climática regional em cada um dos quatro municípios. Em geral, anos com altos índices de malaria relacionam-se com a presença de El Niño no Pacífico e Atlântico norte mais quente do que o normal, enquanto que anos com baixos índices de malária associa-se com a ocorrência de La Niña sobre o Pacífico e nenhum sinal significativo no Oceano Atlântico. Os resultados das análises com os dados mensais, usando a técnica de composições de canários montados com base nos eventos climáticos observados nos Oceanos Pacífico e Atlântico, possibilitaram a investigação da resposta destes mecanismos na evolução mensal da incidência de malária no Pará. A composição dos eventos El Niño demonstrou a ocorrência de impactos "negativos" (aumento significativo e sistemático dos casos de malária) ocorrendo numa seqüência de meses nas regiões de Itaituba e Santana do Araguaia. Para as regiões de Anajás e Viseu, o cenário de El Niño associa-se com impactos "positivos" (incidência de malária nas categorias média e baixa). Para o cenário La Niña , a resposta ocorreu de forma mais generalizada ao longo do Pará, com o predomínio de alta incidência de malária nos quatro municípios e se processando persistentemente durante os meses consecutivos de dezembro a maio. Nas composições para os eventos de dipolo positivo no Atlântico intertropical, o comportamento dos índices de malária no Pará ocorreu de forma diferenciada intra-regionalmente, com Anajás e Itaituba apresentando o predomínio de aumento nos casos da doença, enquanto que em Santana do Araguaia e Viseu verificaram-se vários meses com índices médios e abaixo do normal. Com exceção de Itaituba, as composições para os eventos de dipolo negativo sobre o Atlântico intertropical, mostraram um sinal dominante na incidência de malária nas categorias média e baixa, evoluindo em praticamente todos os meses de novembro a maio.

Towards a post-traumatic subtype of obsessive-compulsive disorder

We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS. (C) 2011 Elsevier Ltd. All rights reserved.

Does ragging play a role in medical student depression - Cause or effect?

Background: Medical students experience a lot of stress what may contribute to symptoms of depression. In this study we set out to look at the environmental factors which may be contributing in one medical school in Brazil. Methods: We assessed depressive symptoms using Beck's Depression Inventory in 465 and 267 medical students in 2001 and 2006 respectively. We explored possible social and environmental causes using qualitative data. Results: Nearly 15% scored above the cut off for depression in both the samples. Males in the pre-clinical stage in 2006 showed an increase in depressive symptoms than males in the same cycle in 2001 (aOR = 7.36 [95% CI = 0.85-63.5] p = 0.07). Qualitative data confirmed that factors such as ragging and low social involvement were correlated with depressive symptoms in pre-clinical stage males. Limitations: The sample size was small both for quantitative and qualitative aspects of the study. Conclusions: It appears that ragging plays an important role in the genesis of depressive symptoms in medical students. (C) 2012 Elsevier B.V. All rights reserved.

Coping Style and Depressive Symptomatology during Pregnancy in a Private Setting Sample

Aim: to evaluate the association of antenatal depressive symptomatology (AD) with life events and coping styles, the hypothesis was that certain coping strategies are associated to depressive symptomatology. Methods: we performed a cross sectional study of 312 women attending a private clinic in the city of Osasco, Sao Paulo from 27/05/1998 to 13/05/2002. The following instruments were used: Beck Depression Inventory (BDI), Holmes and Rahe Schedule of Recent Events (SSRS), Folkman and Lazarus Ways of Coping Questionnaire and questionnaire with social-demographic and obstetric data. Inclusion criteria: women with 110 past history of depression, psychiatric treatment, alcohol or drug abuse and no clinical-obstetrical complications. Odds ratios and 95% CI were used to examine the association between AD (according to BDI) and exposures variables. Hypothesis testing was done with chi(2) tests and a p value < .05. Results: AD occurred in 21.1% of pregnant women. By the univariate analyses, education, number of pregnancies, previous abortion, husband income, situation of marriage and score of SSRS were associated with AD. All coping styles were associated with AD, except seeking support and positive reappraisal. By the multivariate analyses, four coping styles were kept in the final model: confront (p = .039), accepting responsibility (p < .001), escape-avoidance (p = .002), problem-solving (p = .005). Conclusions: AD was highly prevalent and was associated with maladaptive coping styles.

Inflammation as a psychophysiological biomarker in chronic psychosocial stress

The measurement of inflammation by biomarkers not only documents clinically relevant infections but also offers an important tool to pin point potentially harmful effects of chronic psychosocial stressors. This article focuses firstly on basic biology of inflammation and lists main biomarkers currently used in psycho-physiologic research. In the second part, the effects of the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system as pathways modulating stress-related inflammation are discussed. Furthermore, current evidence of how chronic psychosocial stressors are related to alterations in inflammatory activity is presented. In summary, job stress, low socioeconomic status, childhood adversities as well as life events, caregiver stress, and loneliness were all shown to exert effects on immunologic activity.

Cultural and migration aspects in functional abdominal pain

Compared to Europe's mean immigrant contingent of 7.3 to 8.6 % Switzerland holds the highest contingent of foreign population with 23.5 %. Therefore it is of utmost importance that physicians have a knowledge of the specific characteristics of immigrant patients. The influence of personality factors (experience, behavior) is not independent from the influence of culturally-related environmental factors (regional differences in diet, pollutants, meanings, etc.). In addition, different cultural groups rate their quality of life differently. Psychological reasons for recurrent abdominal pain are stress (life events), effects of self-medication (laxatives, cocaine) and sexual abuse but also rare infectious diseases are more common among immigrants (e.g. tuberculosis, histoplasmosis, etc.). Migration-specific characteristics are mainly to find in the semiotics of the symptoms: not every abdominal pain is real pain in the abdomen. Finally, it is crucial to make the distinction between organic, functional and psychological-related pain. This can, however, usually only be accomplished in the context of the entire situation of a patient and, depending on the situation, with the support of a colleague from the appropriate cultural group or an experienced interpreter. In this review we limit ourselves to the presentation of the working population of the migrants, because these represent the largest group of all migrants. The specific situation of asylum seekers will also be refrained to where appropriate.

Beta-Endorphin Modulates the Effect of Stress on Novelty-Suppressed Feeding

Although stress is implicated in the pathophysiology of mood and anxiety disorders, not all individuals who suffer stressful life events develop psychopathology. Differential susceptibility to stress may be influenced by genetically mediated differences in hypothalamic-pituitary-adrenal (HPA) axis activity and moderation of the stress response by the opioid peptide beta-endorphin (beta-E). The present study investigated genetic contributions to coping behavior by examining anxious behavior of transgenic mice with varying capacities to synthesize beta-E [B6.129S2-Pomc(tm1Low)/J; regulated by insertion of a premature stop codon into one or both copies of the proopiomelanocortin (POMC) gene], both under normal conditions and following 3 min of forced swim (FS). Ten minutes after this stress exposure or a control manipulation, acutely food-deprived female and male transgenic mice were subjected to a novelty-suppressed feeding (NSF) test, during which their interaction with an almond slice located in the center of an open field box was measured. There was an interaction between genotype and stress for latency to approach the almond and whether or not the almond was approached, such that mice with low or absent beta-E displayed a stronger aversion to novelty-feeding after stress exposure than did mice with normal levels. These data provide evidence for a moderating effect of beta-E on the behavioral response to stress. Genotypic differences in anxious behavior emerged when mice were stressed prior to behavioral assessment, suggesting that beta-E plays a role in coping behavior. These findings indicate that genetic variability in sensitivity of the beta-E system to stress may contribute, at least in part, to heritable differences in stress reactivity as well as vulnerability to stress-related psychopathology.

Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: identification of risk factors, preventive factors and key elements for treatment--a cohort study

Background Chronic localized pain syndromes, especially chronic low back pain (CLBP), are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP). Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP) in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months). Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly) for pain generalization (outcome: incident CWP). Discussion This cohort study will be the largest study which prospectively analyzes predictors for transition from CLBP to CWP in primary care setting. In contrast to the typically researched risk factors, which increase the probability of pain generalization, this study also focus intensively on protective factors, which decrease the probability of pain generalization.

Motives for cannabis use as a moderator variable of distress among young adults

This study examined the moderating effect of social and coping motives on distress among young cannabis-using adults. A random sample of 2031 young Swiss adults was interviewed by means of a computer-assisted telephone interview. Cannabis users showed more distress, less positive health behaviour and higher hedonism compared to non-users. Taking motive for use as a moderator variable into consideration, it became evident that only cannabis users with coping motives showed lower mental health, more symptoms of psychopathology, more psychosocial distress and more life events than non-users. Young adults with social motives for use on the other hand did not differ from non-users in terms of distress. These differences between cannabis users with social and those with coping motives remained stable over two years. In both subgroups, participants with regular cannabis use at baseline did not increase distress nor did participants with higher distress at baseline increase the frequency of their cannabis use. Our results suggest that secondary prevention for cannabis users should target especially young adults with coping motives for use.

The Current Discussion on Men and Masculinities

In the past gender specific problems were mainly discussed in a female perspective. In the meantime there is a rising attentiveness in the living conditions of men and their coping strategies within critical life events. In this paper an appropriate frame of reference is outlined which can be used in those areas of social work where men are already discovered as a target group with special difficulties and needs.

"Fact versus Fiction – How paratextual information shapes our reading processes"

Our life is full of stories: some of them depict real-life events and were reported, e.g. in the daily news or in autobiographies, whereas other stories, as often presented to us in movies and novels, are fictional. However, we have only little insights in the neurocognitive processes underlying the reading of factual as compared to fictional contents. We investigated the neurocognitive effects of reading short narratives, labeled to be either factual or fictional. Reading in a factual mode engaged an activation pattern suggesting an action-based reconstruction of the events depicted in a story. This process seems to be past-oriented and leads to shorter reaction times at the behavioral level. In contrast, the brain activation patterns corresponding to reading fiction seem to reflect a constructive simulation of what might have happened. This is in line with studies on imagination of possible past or future events.

Multilingualism and age:The consequences of retirement on multilingual competence

OBJECTIVES: The research question for this project mainly concentrates on the sociolinguistic aspects of a socalled “language related major life event” (De Bot, 2007): retirement. “Language related major life events” are events in the lifespan that are important for changes happening in the linguistic setting which influence the language development. In my paper I will explore changes happening around retirement in regard to multilingual competence. The focus will be on two groups: Italian migrants living in the city of Berne and Swissgerman-speakers, both at the age around retirement. The above mentioned changes can take place on two levels. (1) On the one hand, people have more time for curricular activities after retirement, which they can use in order to learn new languages or to improve their language skills. In this case we are dealing with the concept of “lifelong learning”. (2) On the other hand, language competence can be lost due to the (partial) loss of the retiree’s social network at their former workplace. METHODS: I will first examine these processes by using quantitative questionnaires in order to obtain general information on demographic data, the social situation, and a self-assessment of linguistic skills. Secondly, I will use qualitative interviews to gain in-depth information on the linguistic changes happening around retirement and their link to different factors, such as social networks, education, gender or the language biography. RESULTS: Since the project is still in its early stages of development, clear results can’t be mentioned yet. By May 2012 I will be able to present results of the quantitative study as well as a first glance into the results of the qualitative part of the project. CONCLUSION: The results of this project are meant to benefit the better insight into different aspects that haven’t been looked at in detail till this point. (1) What is the general and linguistic situation of Italian migrants who decided to remain in Switzerland after retirement and how can their linguistic skills affect their quality of living? (2) Who decides to learn a new language after retirement and how should language courses for older people be designed?

Le conseguenze del pensionamento sulle competenze plurilingui di immigrati italiani in Svizzera

La nostra proposta presenta alcuni aspetti e risultati di un progetto dell'Università di Berna che si occupa delle conseguenze del pensionamento sulle competenze plurilingui di immigrati italiani nella Svizzera tedesca. Rifacendoci a De Bot (2007), che ha definito come “language related major life events” i momenti nella vita rilevanti per mutamenti delle competenze linguistiche, ipotizziamo che il pensionamento possa costituire un punto di svolta nella biografia linguistica di migranti (ma non solo) anche se finora mancano gli studi sull’argomento. Nel caso delle persone prese in considerazione il pensionamento rappresenta un momento fondamentale, quasi paragonabile, per le conseguenze che implica, al momento della migrazione. Se quest'ultima è stata, nella maggior parte dei casi, caratterizzata dalla ricerca di lavoro, la nuova fase della vita dopo il pensionamento comporta mutamenti nelle reti sociali e ha conseguenze anche per l'uso delle lingue. Un punto centrale della ricerca è la domanda di come i migranti affrontino questo momento all’interno della situazione diglossica della Svizzera tedesca, in cui lo svizzero tedesco è stato imparato attraverso il contatto strumentale e accanto ad esso si è mantenuta la lingua d'origine (cfr.Berruto 1991). La metodologia applicata consiste in due fasi: nella prima si utilizzano questionari per ottenere informazioni generali sui dati demografici e sulla situazione sociale, e per elicitare autovalutazioni delle competenze linguistiche. Nella seconda si effettuano interviste semiguidate per ottenere informazioni più approfondite sulla vita e sulle biografie linguistiche. Per ottenere dati relativi alle competenze linguistiche, viene inoltre utilizzato un test di competenza dello svizzero tedesco, sviluppato all’interno del progetto sulla base del SOPI (cfr.Kenyon 2000).

“Jo wunderbar so im apriu kann man nicht mehr erwarten, capisci?” Multilingualism in a German language class for retired Italian migrants in Berne

Our proposal presents some aspects and results of a project of the University of Bern dealing with the consequences of retirement on multilingual competences. Referring to De Bot (2007), who defined "language related major life events" as moments in life relevant for changes in multilingual competences, we assume that retirement can be a turning point in a language biography. Firstly, there are phenomena, such as the cessation of the use of a foreign language, which was formerly related to work. Secondly, retirement might elicit the improvement of foreign language skills as a way to spend excess time after retirement or as a “cognitive exercise”. Many language schools have identified the people of advanced age as a group of major interest and increasingly offer so-called 50+ (fifty plus) courses in their curriculum. Furthermore, the concept of lifelong learning is increasingly gaining importance, as the reference by the European commission (LLP) indicates. However, most of the programs are intended for educated middle-class people and there are considerably fewer offers for people who are less familiar with learning environments in general. The present paper aims at investigating the multilingual setting of an offer of the second kind: a German language course designed for retired, established Italian workforce migrants living in the city of Berne, Switzerland. The multilingual setting is given by the facts that migrants living in Berne are confronted with diglossia (Standard German and Swissgerman dialects), that the Canton of Berne is bilingual (German and French) and that the migrants' mother tongue, Italian, is one of the Swiss national languages. As previous studies have shown, most of the Italian migrants have difficulties with the acquisition of Standard German due to the diglossic situation (Werlen, 2007) or never even learnt any of the German varieties. Another outcome of the linguistic situation the migrants are confronted with in Berne, is the usage of a continuum of varieties between Swissgerman dialect and Standard German (Zanovello-Müller, 1998). Therefore, in the classroom we find several varieties of German, as well as the Italian language and its varieties. In the present paper we will investigate the use of multilingual competences within the classroom and the dynamics of second language acquisition in a setting of older adults (>60 years old), learning their host country’s language after 40 years or more of living in it. The methods applied are an ethnographic observation of the language class, combined with qualitative interviews to gain in-depth information of the subjects’ life stories and language biographies.

„chöid ir mir säge was diir hüt anneheit?“ – die Hürden bei der Entwicklung eines Sprachkompetenz-Indikators

Ein soziolinguistisch angelegtes Projekt der Universität Bern greift die Idee der „language related major life events“ – die neue sprachliche und soziale Räume schaffen – auf. Das Forschungsprojekt besteht aus drei Modulen. Module 1 und 2 untersuchen Personen, die beim Übergang von der Grundausbildung in eine weiterführende Ausbildung mit einem Wechsel der Umgebungssprache konfrontiert sind: und zwar (1) frankofone Lernende in Biel/Bienne, die – im Kontext dieser zweisprachigen Stadt – neben ihrer Herkunftssprache mit Schweizerdeutsch konfrontiert sind, und (2) frankofone und italofone Studierende, die an Universitäten und Hochschulen der deutschen Schweiz studieren müssen, weil es das betreffende Fach weder in der Romandie noch im Tessin gibt. Im Modul 3 werden zwei Personengruppen untersucht (italienische MigrantInnen und Deutsch-schweizerInnen), die sich vor, im und nach dem Prozess der Pensionierung befinden, die bestehende berufliche Netzwerke verlieren, eventuell neue aufbauen und denen sich neue kommunikative Anforderungen stellen. Im Rahmen dieses Forschungsprojekts wurden wir mit der Frage konfrontiert, wie die Sprachkenntnisse erfasst und analysiert werden könnten. Die erste Hürde bestand darin, dass wir als Ausgangslage nur ein bis zwei Interviews in der Muttersprache der Probanden (Italienisch oder Französisch) führen würden und nicht klar war, wie wir in diesem Kontext zu zuverlässigen Sprachdaten auf Schweizerdeutsch kommen: - Sollten wir selbst oder eine zweite Person die Fragen stellen? oder - Wie standardisieren wir den Fragenkatalog? Nach langer Suche nach einem geeigneten Testinstrument entschieden wir uns eine eigene Methode zu entwickeln die auf SOPI/OPI basiert. Auch hier stellten sich mehrere Fragen, wie zum Beispiel: - Welchen Schweizerdeutsch Dialekt wird verwendet? - Welche Fragen stellen wir (unterschiedliche Probandengruppen)? - Wie stellen wir einen wachsenden Schwierigkeitsgrad her? Während der Durchführung der Tests begegneten wir neuen Problematiken. Aufgrund der negativ konnotierten Testsituation fühlten sich einzelne Probanden z.B. angegriffen. Weiter wurden wir mit dem Beobachterparadoxon konfrontiert und konnten bei wiederholten Tests Gewöhnungseffekte feststellen. Zusätzlich erwiesen sich einige Fragen als problematisch (z.B. in diesem Kontext nicht sinnvoll oder verschieden interpretierbar). Am Ende werden wir mit den verschieden Problemen der Analyse konfrontiert sein. Wir fragen uns aufgrund welcher Kriterien eine Analyse sinnvoll ist und ob unsere Daten überhaupt vergleichbar sind. In unserem Paper möchten wir die oben genannten methodischen Probleme darstellen und unsere Lösungsansätze diskutieren.