Tratamento da Neofobia Alimentar em pacientes com obesidade associada ou não à compulsão alimentar

Tendo como base a visão evolucionista e a abordagem terapêutica cognitivo-comportamental, o objetivo deste trabalho foi propor um protocolomodificado de tratamento para pessoas obesas com compulsão alimentar periódica.A idéia norteadora é que estratégias que foram úteis para a sobrevivência daespécie poderiam estar influenciando no ganho de peso. Entre estas estratégias,destacam-se: a tendência a consumir uma grande quantidade de alimentos, facilitando o consumo de alimentos hipercalóricos; e a neofobia alimentar, dificultando o consumo de frutas, legumes e verduras. Obedecendo à lógicaancestral herdada pela espécie, a primeira proporciona reservas para momentos deescassez de alimentos e a segunda implica em uma recusa em consumir alimentosdesconhecidos evitando que substâncias tóxicas sejam ingeridas. Ambos os fatores poderiam contribuir para a obesidade. Os tratamentos convencionais buscam controlar a ingestão calórica. O que aqui se propõe, além desse controle, é tentardiminuir o nível de neofobia alimentar. Com essa hipótese de trabalho espera-se aumentar o consumo de alimentos, principalmente os mais saudáveis e hipocalóricos, contribuindo para reduzir a ingestão de alimentos hipercalóricos. Otratamento incluiu técnicas de exposição, modelação e imitação adicionadas a umtratamento já utilizado para obesos com compulsão alimentar periódica. Foram criados dois grupos, o primeiro com 4 participantes funcionando como grupo decontrole, que recebeu um tratamento convencional de TCC; o outro, com 6 participantes aqui denominado grupo de intervenção, que recebeu o tratamento deTCC modificado. A pesquisa foi qualificada como quase-experimental. O resultadoobtido foi uma redução do índice de neofobia alimentar, do Índice de massa corporal, um aumento no consumo de alimentos saudáveis e a redução de gordurase açúcares no chamado grupo de intervenção. Embora tenha alcançado estes resultados, o tratamento ainda precisa ser reformulado e ampliado.

Efeitos da programação por nicotina durante a lactação nos níveis de comportamentos associados à ansiedade, busca por novos estímulos e aprendizagem/memória em ratos Wistar adolescentes e adultos

A exposição materna à nicotina durante a lactação em ratos programa para hiperleptinemia e hipotireoidismo na prole adulta. Alterações nos níveis desses hormônios alteram o comportamento. Por isso, resolvemos investigar os efeitos comportamentais a curto e a longo prazo da programação neonatal pela nicotina em ratos Wistar. Foram implantadas minibombas em ratas lactantes contendo nicotina (NIC = 6mg/Kg/Dia) ou uma solução com uma concentração equivalente de solução salina (CON) do 2o dia ao 19o dia de vida pós natal. Sessenta e dois ratos NIC e 48 CON foram testados de acordo com o seguinte protocolo: 1) Em PN30 ou PN75 foram avaliados os níveis de ansiedade no labirinto em cruz elevado (LCE). Entradas em cada área do labirinto (braços abertos e fechados e centro) foram gravadas por um período de 10 minutos; 2) Uma hora após, os animais foram testados no campo vazado (CV) para analisarmos o comportamento de busca por novos estímulos. Os animais tinham 10 minutos para explorar o aparelho. O número de orifícios explorados foi anotado. 3) Em PN31-35 ou PN76-80 o animal foi submetido ao labirinto aquático radial de oito braços (LAROB) para avaliarmos a memória e o aprendizado. Cada animal foi testado 4 vezes por dia durante 5 dias consecutivos sendo a plataforma mantida no mesmo braço durante os 4 primeiros dias e trocada no quinto dia. Eles tinham 2 minutos para encontrar a plataforma de escape. A latência para encontrar a plataforma foi anotada. O percentual de tempo gasto no braço aberto no LCE para os animais NIC em PN30 (6,41,1 %) foi significativamente (ANOVA: P=0,024) menor que o grupo controle PN30 (9,91,4 %). O percentual de entradas no braço aberto foi significativamente menor (ANOVA: P=0,04) para os animais do grupo NIC em PN30 (32,42,9 %) quando comparados com o grupo controle PN30 (38,51,8 %). Não foi observada diferença (ANOVA: P>0,1) entre os grupos no número de entradas no braço fechado para as duas idades. Para o CV não houve diferença entre os grupos para as duas idades (ANOVA: P>0,1). No LAROB, os animais PN75 NIC (27424 s) tiveram uma diminuição significativa (ANOVA: P<0,006) na latência para encontrar a plataforma quando comparado ao grupo controle PN75 nos 4 primeiros dias (41045 s), não havendo diferença no 5o dia. Não houve diferença em PN30 (ANOVA:P>0,1). A programação neonatal pela nicotina resultou em um efeito a curto prazo no aumento dos níveis de ansiedade na adolescência. Não foi observada diferença no comportamento de busca por novos estímulos. Entretanto a programação neonatal por nicotina resultou em um efeito a longo prazo no comportamento-cognitivo observado pelo melhor desempenho na memória/aprendizado quando adulto.

运动距离效应的认知编码机制

Among the cognitive studies of action, an important behavioral method is used to observe Reaction Time (RT) and Movement Time (MT) as the functions of motor parameters. RT is measured from the beginning of target presentation to the initiation of a movement, which is regarded as the programming of the ongoing movement. MT is measured from the initiation to the end of the movement, which is regarded as the execution of the movement. However, the relationship between RT and motor parameters remains uncertain till now. Under the uncertainty many related issues cannot be settled for long period, especially the issues as whether the amplitude effect appears during RT, or what should the amplitude effect be during RT. The present study aimed to find out the amplitude effect and the related cognitive process under different experimental conditions. First, we discussed the potential composition of RT and suggested that RT that normally measured in previous experiments might not reflect motor programming very well. Then we designed a series experiments to observe the relationship between RT and motor programming by using different Index of Difficulty (ID), different instructions in which speed and accuracy were emphasized respectively, different vision condition during movement execution and Go/NoGo paradigm. Meanwhile, we compared the amplitude effect under the respective RT to make the specific conclusion about the amplitude effect, and the relationship between RT and MT as well. The main findings are showed as following. 1) Because of the existing of “preview”, “visual feedback control” and “speed-accuracy tradeoff”, RT reflects motor programming differently under different experimental conditions. 2) Under different experimental conditions, the amplitude effect on RT varies. RT could be too short to exhibit the amplitude effect. Or the amplitude effect could be that more RT is needed for shorter movement when RT is prolonged. Or the amplitude effect could be that more RT is needed for longer movement when RT is further prolonged. 3) Under the present experimental conditions, the amplitude effect on MT showed consistently that longer movement needs longer MT. 4) Under the present experimental conditions, the relationship between RT and MT is a kind of compensation. The present study has important theoretic significance. The cognitive process of action is an important part of human cognitive behavior. The related studies could be very helpful for human people to know about themselves and the relation between themselves and the surroundings as well. Keywords motor programming; amplitude effect; Reaction Time (RT); Movement Time (MT)

Can Genetics Predict Response to Complex Behavioral Interventions? Evidence from a Genetic Analysis of the Fast Track Randomized Control Trial.

Early interventions are a preferred method for addressing behavioral problems in high-risk children, but often have only modest effects. Identifying sources of variation in intervention effects can suggest means to improve efficiency. One potential source of such variation is the genome. We conducted a genetic analysis of the Fast Track randomized control trial, a 10-year-long intervention to prevent high-risk kindergarteners from developing adult externalizing problems including substance abuse and antisocial behavior. We tested whether variants of the glucocorticoid receptor gene NR3C1 were associated with differences in response to the Fast Track intervention. We found that in European-American children, a variant of NR3C1 identified by the single-nucleotide polymorphism rs10482672 was associated with increased risk for externalizing psychopathology in control group children and decreased risk for externalizing psychopathology in intervention group children. Variation in NR3C1 measured in this study was not associated with differential intervention response in African-American children. We discuss implications for efforts to prevent externalizing problems in high-risk children and for public policy in the genomic era.

Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.

BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTIVE: To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases. DESIGN: The study was designed as a patient-level randomized controlled trial. PARTICIPANTS: Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c] ≥ 7.5%) but could have well-controlled HTN. INTERVENTIONS: All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM- and HTN- focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention). MAIN OUTCOMES AND MEASURES: Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point. RESULTS: Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55% female and 50% white; the mean baseline A1c was 9.1% (SD = 1%) and mean SBP was 142 mmHg (SD = 20). Eighty-two percent of scheduled interviews were conducted; 69% of intervention patients and 70% of control patients reached the 24-month time point. Expressing model estimated differences as (intervention--control), at 24 months, intervention patients had similar A1c [diff = 0.1 %, 95 % CI (-0.3, 0.5), p = 0.51] and SBP [diff = -0.9 mmHg, 95% CI (-5.4, 3.5), p = 0.68] values compared to control patients. Likewise, DBP (diff = 0.4 mmHg, p = 0.76), weight (diff = 0.3 kg, p = 0.80), and physical activity levels (diff = 153 MET-min/week, p = 0.41) were similar between control and intervention patients. Results were also similar at the 6- and 12-month time points. CONCLUSIONS: In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.

Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial - Cell Phone Intervention for You (CITY).

BACKGROUND: The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population. PURPOSE: To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You (CITY) study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1) a behavioral intervention that is delivered almost entirely via cell phone technology (Cell Phone group); and 2) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone (Personal Coaching group), each compared to 3) a usual care, advice-only control condition. METHODS: A total of 365 community-dwelling overweight/obese adults aged 18-35 years were randomized to receive one of these three interventions for 24 months in parallel group design. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 24 [corrected] months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014. CONCLUSIONS: If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss. ClinicalTrial.gov: NCT01092364.

Reducing the incidence of coronary heart disease

The incidence of coronary heart disease (CHD) has been significantly reduced by the introduction of the National Service Framework in 2000 but has not yet reached set targets. This article analyses the adverse effects of specific CHD risk factors to the cardiovascular system and proposes local and national strategies for further reduction in the incidence, morbidity and mortality of CHD. It provides an example of how nurses can use a health promotion programme to support patients in giving up smoking, a major contributing factor in CHD. The programme uses cognitive behaviour therapy to improve patients' uptake and adherence.

ABA-Based Programs for Children Diagnosed With Autism Spectrum Disorder: Parental and Professional Experiences at School and at Home

Having a child diagnosed with Autism Spectrum Disorder (ASD) poses a range of challenges to families, many of which can be addressed through appropriate intervention. A study of parental (n = 95) and professional (n = 67) experiences was carried out in relation to two settings: (a) schools that provided intensive interventions based on the science of Applied Behavior Analysis (ABA), and (b) non-intensive ABA-based home programs. Results show that parents whose children attend ABA-based schools were generally more satisfied with their child's educational provision, monitoring procedures, and level of staff training, than parents who were not offered ABA-based education in schools. © 2012 Copyright Taylor and Francis Group, LLC.

Comparing a trauma focused and non trauma focused intervention with war affected Congolese youth: a preliminary randomised trial

While there is broad consensus about the need for interventions to help psychologically distressed, war affected youth, there is also limited research and even less agreement on which interventions work best. Therefore, this paper presents a randomised trial of trauma focused, and non trauma focused, interventions with war affected Congolese youth. Fifty war affected Congolese youth, who had been exposed to multiple adverse life events, were randomly assigned to either a Trauma Focused Cognitive Behavioural Therapy group or a non trauma based psychosocial intervention (Child Friendly Spaces). Non clinically trained, Congolese facilitators ran both groups. A convenience sample, waiting list group was also formed. Using blind assessors, participants were individually interviewed at pre intervention, post intervention and a 6-month follow-up using self-report posttraumatic stress and internalising symptoms, conduct problems and pro social behaviour. Both treatment groups made statistically significant improvements, compared to the control group. Large, within subject, effect sizes were reported at both post intervention and follow-up. At the 6-month follow-up, only the Child Friendly Spaces group showed a significant decrease in pro social behaviour. The paper concludes that both trauma focused and non trauma focused interventions led to reductions in psychological distress in war affected youth.

Psychological interventions for children and young people affected by armed conflict or political violence: a systematic literature review.

Youths exposed to armed conflict have a higher prevalence of mental health and psychosocial difficulties. Diverse interventions exist that aim to ameliorate the effect of armed conflict on the psychological and psychosocial wellbeing of conflict affected youths. However, the evidence base for the effectiveness of these interventions is limited. Using standard review methodology, this review aims to address the effectiveness of psychological interventions employed among this population. The search was performed across four databases and grey literature. Article quality was assessed using the Downs and Black Quality Checklist (1998). Where possible, studies were subjected to meta-analyses. The remaining studies were included in a narrative synthesis. Eight studies concerned non clinical populations, while nine concerned clinical populations. Review findings conclude that Group Trauma Focused-Cognitive Behavioural Therapy is effective for reducing symptoms of posttraumatic stress disorder, anxiety, depression and improving prosocial behaviour among clinical cohorts. The evidence does not suggest that interventions aimed at non clinical groups within this population are effective. Despite high quality studies, further robust trials are required to strengthen the evidence base, as a lack of replication has resulted in a limited evidence base to inform practice.

A terapia de grupo na doença oncológica

Existem milhões de sobreviventes de cancro da mama no mundo, em exponencial crescimento. Esta população pode apresentar preocupações relevantes acerca do futuro, depressão, ansiedade, sintomas pós-traumáticos, e comprometimento da qualidade de vida. As intervenções de grupo breves, estruturadas, especialmente as que incluem estratégias cognitivo-comportamentais, têm sido indicadas para esta população. O presente trabalho surge neste contexto, em que os estudos são escassos, especialmente em Portugal. Um conjunto de 5 estudos foi conduzido com o intuito de avaliar a eficácia de dois programas de intervenção de grupo breves e estruturadas de inspiração cognitivo-comportamental, um de tipo psicopedagógico e outro de terapia cognitivo-comportamental, em sobreviventes de cancro da mama. Nos primeiros dois estudos procedeu-se ao estudo das caraterísticas psicométricas de dois instrumentos de avaliação, o Questionário de Formas de Lidar com o Cancro (CCQ) e o Questionário de Saúde do Paciente (PHQ-9).Os dois estudos seguintes referem-se ao desenvolvimento dos programas de intervenção de grupo, acompanhados dos resultados preliminares. No último estudo avaliou-se a eficácia dos dois programas de intervenção na promoção do ajustamento psicossocial de 62 sobreviventes de cancro da mama, num estudo quasi-experimental, com pré e pós-testes e duas avaliações de seguimento (3 e 6 meses após a intervenção). Foram utilizados os seguintes instrumentos de avaliação: o CCQ; o PHQ-9; a Escala de Controlo Emocional (CEC); a Escala de Ansiedade e Depressão Hospitalar (EADH); o questionário de qualidade de vida da Organização Europeia de Investigação e Tratamento de Cancro com o módulo suplementar de cancro da mama (EORTC QLQ-C30 e BR-23); o Inventário Clínico de Autoconceito (ICAC); o Teste de Orientação de Vida - Revisto (TOV-R); o Perfil dos Estados de Humor (POMS); a Subescala de Crescimento Pessoal da Escala de Bem-Estar Psicológico (EBEP); a sub-escala de espiritualidade e o Inventário de estado-traço de ansiedade (STAI). Resultados: As sobreviventes que não tiveram intervenção apresentaram deterioração de dois domínios da qualidade de vida, a função cognitiva e a dor, para além de piores resultados na subescala de vigor. A deterioração dos domínios da qualidade de vida manteve-se aos 3 meses e extendeu-se aos sintomas da mama, o que não se verificou com o vigor. O grupo com intervenção psicoeducativa apresentou melhoria do autoconceito até aos 6 meses. Neste grupo também se observou um aumento do controlo emocional até aos 3 meses. O grupo de terapia cognitivo-comportamental apresentou aumento do estado de ansiedade e diminuição do funcionamento de papel no final da intervenção, diminuição do funcionamento emocional aos 3 meses e aumento na hostilidade e na confusão aos 6 meses. Ambos os grupos com intervenção apresentaram diminuição do traço de ansiedade aos 6 meses. Foram encontradas diversas correlações significativas destes efeitos com variáveis demográficas, clínicas e psicossociais. Conclusão: As intervenções de grupo breves, de inspiração cognitivo-comportamental, mostraram contribuir para a redução do traço de ansiedade a longo prazo e para a manutenção da função cognitiva, da dor, do vigor, e dos sintomas da mama nas sobreviventes. O programa psicopedagógico parece ser mais indicado para as sobreviventes, pelos efeitos no autoconceito, com maior extensão a longo prazo. São referidas implicações para a prática clínica e para a promoção da saúde mental desta população.

Estudo da ansiedade em alunos do ensino superior utilizando o Biofeedback

A ansiedade é reconhecidamente um fator que interfere no sucesso académico tendo implicações ao nível da saúde física e mental dos indivíduos. A literatura tem revelado a necessidade de intervir preventivamente de forma a minimizar a ocorrência de perturbações mais complexas com elevado impacto pessoal e social. Em Portugal são reduzidos os estudos que englobem a intervenção específica na ansiedade em contexto do ensino superior, pelo que o pretendemos com o nosso contributo colmatar uma lacuna especificamente ao nível da avaliação da ansiedade com instrumentos de medida psicofisiológicos. A presente investigação pretende: 1) caracterizar os estudantes quanto aos seus níveis de ansiedade, fatores de stresse e bem-estar e a relação destes com variáveis sociodemográficas e académicas (estudo tipo transversal); 2) avaliar a eficácia da intervenção na gestão da ansiedade, com programa de Biofeedback (BFB) e comparar com a Terapia Cognitivo Comportamental - TCC (Estudo do tipo quasi-experimental); 3) estudar e avaliar a intervenção específica com BFB. A amostra global envolveu 310 estudantes do 1º ano de áreas de saúde repartidos por três estudos. Os instrumentos utilizados foram o State Trait Anxiety Inventory (STAI), o Inventário de Stresse nos Estudantes Universitários (ISEU) e o Teste de Orientação de Vida (LOT, de Life Orientation Test), Patient’s Health Questionnaire (PHQ-9) e os Termómetros Emocionais (TE). Como instrumento de avaliação das variáveis psicofisiológicas foi usado o Biofeedback 2000x-pert. No primeiro estudo foi feita a caracterização dos níveis de ansiedade, de stresse e de bem-estar dos estudantes do primeiro ano da Escola Superior de Saúde da Universidade de Aveiro, os quais identificaram níveis elevados de ansiedade e de stress. O segundo estudo, a partir dos elementos encontrados no primeiro, incluiu uma intervenção comparativa entre o BFB e a TCC na gestão da ansiedade. No terceiro estudo, focalizado na avaliação da eficácia do Biofeedback, os resultados mostraram que o BFB é particularmente eficaz na redução desses níveis nos estudantes com níveis elevados de ansiedade e stresse. As conclusões desta investigação sugerem que o BFB apresenta possibilidades interessantes para ser utilizado num programa de redução do stresse e da ansiedade em estudantes do ES. São referidas implicações para o futuro, estratégias de intervenção que permitam potenciar o desempenho académico dos estudantes.

Men’s strategies for preserving emotional well-being in advanced prostate cancer: an interpretative phenomenological analysis

Objective This study explores men with advanced prostate cancers’ own practices for promoting and maintaining emotional well-being using Interpretative Phenomenological Analysis. Design Five men with advanced prostate cancer participated in face-to-face, semi-structured, in-depth interviews. Results Within rich narratives of lost and regained well-being, two super-ordinate themes emerged – ‘living with an imminent and uncertain death’ and ‘holding on to life.’ Well-being was threatened by reduced sense of the future, isolation and uncertainty. Yet, the men pursued well-being by managing their emotions, striving for the future whilst enjoying life in the present, taking care of their families and renegotiating purpose. Running through participant’s accounts was a preference for taking action and problem-solving. Sense of purpose, social connectedness and life-engagement were revealed as concepts central to improving well-being, indicating areas which practitioners could explore with men to help them re-establish personal goals and life-purpose. Conclusions The findings also add weight to the evidence base for the potential value of psychological interventions such as cognitive behaviour therapy and mindfulness in men with prostate cancer.

Training medical students to conduct motivational interviewing: a randomized controlled trial.

OBJECTIVE: To examine the effectiveness of motivational interviewing (MI) training among medical students. METHODS: All students (n=131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0. RESULTS: Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for "Empathy" [p<0.001] and "MI Spirit" [p<0.001]. Scores were similar between groups for "Direction", indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p<0.001], MI non-adherent behavior [p<0.001], Closed questions [p<0.001], Open questions [p=0.001], simple reflections [p=0.03], and Complex reflections [p<0.001]. Occurrences were similar between groups regarding "Giving information". CONCLUSION: An 8-h training workshop was associated with improved MI performance. PRACTICE IMPLICATIONS: These findings lend support for the implementation of MI training in medical schools.