Efficacy of a cognitive and behavioural psychotherapy applied by primary care psychologists in patients with mixed anxiety-depressive disorder: a research protocol

Background: In contrast with the recommendations of clinical practice guidelines, the most common treatment for anxiety and depressive disorders in primary care is pharmacological. The aim of this study is to assess the efficacy of a cognitive-behavioural psychological intervention, delivered by primary care psychologists in patients with mixed anxiety-depressive disorder compared to usual care. Methods/Design: This is an open-label, multicentre, randomized, and controlled study with two parallel groups. A random sample of 246 patients will be recruited with mild-to-moderate mixed anxiety-depressive disorder, from the target population on the lists of 41 primary care doctors. Patients will be randomly assigned to the intervention group, who will receive standardised cognitive-behavioural therapy delivered by psychologists together with usual care, or to a control group, who will receive usual care alone. The cognitive-behavioural therapy intervention is composed of eight individual 60-minute face-to face sessions conducted in eight consecutive weeks. A follow-up session will be conducted over the telephone, for reinforcement or referral as appropriate, 6 months after the intervention, as required. The primary outcome variable will be the change in scores on the Short Form-36 General Health Survey. We will also measure the change in the frequency and intensity of anxiety symptoms (State-Trait Anxiety Inventory) and depression (Beck Depression Inventory) at baseline, and 3, 6 and 12 months later. Additionally, we will collect information on the use of drugs and health care services. Discussion: The aim of this study is to assess the efficacy of a primary care-based cognitive-behavioural psychological intervention in patients with mixed anxiety-depressive disorder. The international scientific evidence has demonstrated the need for psychologists in primary care. However, given the differences between health policies and health services, it is important to test the effect of these psychological interventions in our geographical setting.

Response of the topological surface state to surface disorder in TlBiSe2

Through a combination of experimental techniques we show that the topmost layer of the topological insulator TlBiSe2 as prepared by cleavage is formed by irregularly shaped Tl islands at cryogenic temperatures and by mobile Tl atoms at room temperature. No trivial surface states are observed in photoemission at low temperatures, which suggests that these islands cannot be regarded as a clear surface termination. The topological surface state is, however, clearly resolved in photoemission experiments. This is interpreted as direct evidence of its topological self-protection and shows the robust nature of the Dirac cone-like surface state. Our results can also help explain the apparent mass acquisition in S-doped TlBiSe2.

Injeção de sangue autógeno no tratamento da luxação recidivante da articulação temporomandibular

A articulação temporomandibular (ATM) é uma articulação complexa com características e funções únicas. Certamente é uma das articulações mais utilizadas e seu uso inadequado e excessivo consequentemente promove inúmeros transtornos. Dentre as alterações de hipermobilidade articular, o deslocamento mandibular refere-se ao posicionamento, geralmente anterior, do côndilo mandibular sobre a eminência articular, com completa separação das superfícies articulares e consequente travamento. Quando os episódios se tornam frequentes, algum método de tratamento, seja conservador ou cirúrgico, deve ser utilizado, devido ao grande transtorno funcional e social gerados. A injeção de sangue autógeno na articulação temporomandibular é uma técnica minimamente invasiva, com escassos relatos na literatura e que foi recentemente reintroduzida. Onze pacientes diagnosticados com luxação recidivante da articulação da cabeça mandibular receberam injeções bilaterais de sangue autógeno no compartimento articular superior e região pericapsular. Em acompanhamento, que variou de 24 a 35 meses (média de 29,6 meses), 3 (27,3%) pacientes apresentaram recidivas. O mesmo protocolo de tratamento foi repetido para estes três casos, porém sem sucesso, sendo então encaminhados para procedimento cirúrgico de eminectomia. Dessa forma, dos 11 pacientes inicialmente tratados, 8 (72,7%) não apresentaram episódios de deslocamento mandibular recorrente após o procedimento proposto. Trata-se de um procedimento simples, rápido, pouco invasivo, de baixo custo e com mínima possibilidade de complicações, sendo uma alternativa de tratamento viável, antes de se indicar procedimentos cirúrgicos.

Defect and disorder reduction by annealing in hydrogenated tetrahedral amorphous carbon

Hydrogenated tetrahedral amorphous carbon (ta-C:H) is a form of diamond-like carbon with a high sp3 content (>60%), grown here using a plasma beam source. Information on the behaviour of hydrogen upon annealing is obtained from effusion measurements, which show that hydrogen does not effuse significantly at temperatures less than 500 °C in films grown using methane and 700 °C in films grown using acetylene. Raman measurements show no significant structural changes at temperatures up to 300 °C. At higher temperatures, corresponding to the onset of effusion, the Raman spectra show a clustering of the sp2 phase. The density of states of ta-C:H is directly measured using scanning tunnelling spectroscopy. The measured gradients of the conduction and valence band tails increase up to 300 °C, confirming the occurrence of band tail sharpening. Examination of the photoluminescence background in the Raman spectra shows an increase in photoluminescence intensity with decreasing defect density, providing evidence that paramagnetic defects are the dominant non-radiative recombination centres in ta-C:H.