DO VIRTUAL AO REAL: COMUNICAÇÃO, SEXO E INTERNET

Este trabalho é um estudo exploratório sobre o Ambiente Comunicacional Internet que investiga tanto a possibilidade da influência de suas ferramentas de interação/comunicação sobre o comportamento sexual e de risco quanto o desenvolvimento de comportamento compulsivo no uso destas ferramentas na busca de parceiros sexuais. A metodologia adotada é, além da pesquisa bibliográfica, a da pesquisa exploratória, um levantamento e análise de dados quantitativos e pode ser considerada como pertencente ao paradigma tradicional empírico, pois a coleta de dados foi baseada em respostas a questionários semi-estruturados, aplicados a um grupo de informação composto por 428 estudantes universitários dos cursos ligados à área de Computação e Informática de uma instituição particular de Ensino Superior do município de São Paulo SP, Brasil. Para isso, obedece à Resolução do Conselho Nacional de Saúde CNS 196/96 e conta com o TCLE. Os resultados indicam que as práticas sexuais, a exposição a DST e vírus HIV e, particularmente, a tendência ao desenvolvimento do Transtorno de Adicção à Internet se distinguem de modo irrefutável. Os participantes que alegaram buscar parceiros sexuais reais na Internet são diretos nos seus objetivos, pois quando encontram esse parceiro concretizam o ato sexual, em ambientes impessoais, como por exemplo, o motel, e muitas vezes de modo arriscado no que toca à prevenção e à segurança no contato com outro. Destaca-se, ainda, que a compulsão não é reconhecida pelo grupo e que a procura de parceiros por intermédio das mídias digitais, para esse grupo, não está relacionada a itens negativos quanto a sua qualidade de vida o que suscita o estudo e a discussão mais aprofundada sobre a interação comunicação, sexo e Internet .(AU)

Uso do protocolo no serviço de psicologia e avaliação psicodinâmica em candidatos à cirurgia bariátrica

A clínica da Obesidade Mórbida e a Cirurgia Bariátrica exige estudos e acompanhamentos do paciente. Os benefícios e riscos do emagrecimento por tratamento cirúrgico devem servir como ponto de alerta aos profissionais da saúde. O uso do questionário no serviço de psicologia é norteado pela escuta psicológica. Objetivos: 1) Descrever o perfil sócio-demográfico candidatos à cirurgia bariátrica. 2) Analisar a percepção dos pacientes sobre características de personalidade associadas à obesidade e transtornos alimentares. 3) Descrever os conteúdos psicodinâmicos da narrativa do sujeito e avaliar o sistema tensional inconsciente de dois pacientes por meio do Teste das Relações Objetais de Phillipson (TRO). Método: O delineamento metodológico com análise de dados pelo método epidemiológico e estudo de caso clínico, orientação psicanalítica. Na primeira etapa foram consultados 300 questionários do serviço de psicologia e na segunda dois pacientes com ganho de peso após 24 meses. São pacientes que procuraram tratamento em clínica especializada, em uma metrópole do sudeste brasileiro, sob consentimento pós-informado. Os questionários foram preenchidos por 227 mulheres e 73 homens; com média de idade igual a 36 anos; escolaridade ensino médio e superior, 53%; maioria casados; IMC entre grave e super mórbido (94,3%). Técnicas cirúrgicas indicadas Capella Bypass e Fobi-Capella (67%). Resultados: características psicológicas referidas pelos pacientes, a ansiedade apontou em 93,7% das respostas, seguidas por impulsividade, depressão, tolerância à frustração, baixa auto-estima, resolvedor de problemas dos outros (mais de 50%). No histórico familiar da obesidade está em mais de 70% depressão e uso do álcool em 30%; realização de psicoterapia (30%) e medicamentos para depressão e ansiedade (10%). Na segunda etapa, foi realizado o diagnóstico psicodinâmico, por meio do Teste das Relações Objetais de Phillipson com duas pacientes, cuja análise indicou necessidade de psicoterapia psicanalítica, pois tinham fixações na posição esquizoparanóide e apresentavam dificuldade em lidar com perdas e baixa motivação para mudança e insigth. Conclusões: Com a aplicação do questionário e o registro das observações empíricas, este questionário de entrevista semidirigida preenche condições de melhor acessar e avaliar os conteúdos revelados pelos pacientes. As contradições entre as respostas e o discurso, no contato individual com o psicólogo, apontam a necessidade de investimento no preparo do paciente para a cirurgia e mais acentuadamente o acompanhamento psicológico no primeiro ano do pós-operatório. Há um pensamento mágico a ser trabalhado durante a aplicação do questionário sobre as crenças frente à cirurgia e o emagrecimento e assim convocar o paciente a ocupar o lugar do sujeito implicado em seu processo pré e pós-operatório. O TRO contribuiu na compreensão do diagnóstico psicodinâmico de pacientes com ganho de peso após cirurgia e reforçou a necessidade de maior investimento no pré-operatório.(AU)

A MEMÓRIA DE CURTO PRAZO DO UNIVERSITÁRIO E A PRÁTICA DE JOGOS: UM ESTUDO EXPLORATÓRIO

Este estudo avalia inicialmente a memória de curto prazo de estudantes universitários; verifica a seguir as modalidades de jogos por esses universitários e a frequência com que os mesmos são praticados e, finalmente, relaciona o nível de memória de curto prazo verificado com a prática de jogos. Parte da hipótese de que a prática de jogos influencia na memória de curto prazo. Utiliza-se do Teste Pictórico de Memória TEPIC-M de Rueda, F. J. M. e Sisto, F. F., devidamente validado para nossa realidade e de escala auto-avaliativa de prática de jogos de lazer/esporte, a qual visa verificar o tipo de jogo praticado, de movimentação física, raciocínio lógico ou conhecimento e os jogos digitais. Desenvolve-se junto a 100 universitários, de ambos os sexos. Os resultados são analisados por meio do Statistical Package for Social Sciences for Windows, SPSS, versão 12.0. Os níveis de memória de curto prazo encontrados foram muito baixos: Inferior (66%), Médio Inferior (25%); Médio (2%); Médio Superior (6%) e Superior (1%). A prática de jogos em suas diversas modalidades também foi reduzida em Jogos de Movimento, JM, e em Jogos Digitais, JD (25%) e maior em Jogos de Raciocínio, JR (61%). A comparação entre os resultados do TEPIC-M e a frequência de participação em JM, revelou-se positiva, uma vez que os que não praticam nunca JM, 74%, não atingiram sequer o nível médio de memória; o mesmo sendo observado em relação à JD, com 70% dos participantes que não praticam esses jogos, sem atingir o nível médio de memória; e, em relação a JR, uma porcentagem menor (44%) dos que não praticam esses jogos, sem atingir o nível médio de memória, dados que indiretamente, comprovam a hipótese deste estudo.

The influence of learning styles, enrolment status and gender on academic performance of optometry undergraduates

Purpose: This cross-sectional study was designed to determine whether the academic performance of optometry undergraduates is influenced by enrolment status, learning style or gender. Methods: Three hundred and sixty undergraduates in all 3 years of the optometry degree course at Aston University during 2008–2009 were asked for their informed consent to participate in this study. Enrolment status was known from admissions records. An Index of Learning Styles (http://www4.nscu.edu/unity/lockers/users/f/felder/public/Learning-Styles.html) determined learning style preference with respect to four different learning style axes; active-reflective, sensing-intuitive, visual-verbal and sequential-global. The influence of these factors on academic performance was investigated. Results: Two hundred and seventy students agreed to take part (75% of the cohort). 63% of the sample was female. There were 213 home non-graduates (entrants from the UK or European Union without a bachelor’s degree or higher), 14 home graduates (entrants from the UK or European Union with a bachelor’s degree or higher), 28 international non-graduates (entrants from outside the UK or European Union without a bachelor’s degree or higher) and 15 international graduates (entrants from outside the UK or European Union with a bachelor’s degree or higher). The majority of students were balanced learners (between 48% and 64% across four learning style axes). Any preferences were towards active, sensing, visual and sequential learning styles. Of the factors investigated in this study, learning styles were influenced by gender; females expressed a disproportionate preference for the reflective and visual learning styles. Academic performance was influenced by enrolment status; international graduates (95% confidence limits: 64–72%) outperformed all other student groups (home non graduates, 60–62%; international non graduates, 55–63%) apart from home graduates (57–69%). Conclusion: Our research has shown that the majority of optometry students have balanced learning styles and, from the factors studied, academic performance is only influenced by enrolment status. Although learning style questionnaires offer suggestions on how to improve learning efficacy, our findings indicate that current teaching methods do not need to be altered to suit varying learning style preferences as balanced learning styles can easily adapt to any teaching style (Learning Styles and Pedagogy in Post-16 Learning: A Systematic and Critical Review. London, UK: Learning and Skills Research Centre, 2004).

'He was like a zombie':off-label prescription of antipsychotic drugs in dementia

This paper explores the legal position of the off-label prescription of antipsychotic medications to people with dementia who experience behavioural and psychological symptoms of dementia (BPSD). Dementia is a challenging illness, and BPSD can be very difficult for carers to manage, with evidence that this contributes to carer strain and can result in the early institutionalisation of people with dementia. As a result, the prescription of antipsychotic and other neuroleptic medications to treat BPSD has become commonplace, in spite of these drugs being untested and unlicensed for use to treat older people with dementia. In recent years, it has become apparent through clinical trials that antipsychotic drugs increase the risk of cerebrovascular accident (stroke) and death in people with dementia. In addition, these types of medication also have other risk factors for people with dementia, including over-sedation and worsening of cognitive function. Drawing on recent questionnaire (n = 185), focus group (n = 15), and interview (n = 11) data with carers of people with dementia, this paper explores the law relating to off-label prescription, and the applicability of medical negligence law to cases where adverse events follow the use of antipsychotic medication. It is argued that the practice of off-label prescribing requires regulatory intervention in order to protect vulnerable patients. © The Author [2012]. Published by Oxford University Press; all rights reserved.

Controlling feeding practices:cause or consequence of early child weight?

INTRODUCTION. The exertion of control during child feeding has been associated with both underweight and overweight during childhood. What is as-yet unclear is whether controlling child feeding practices causally affect child weight or whether the use of control may be a reactive response to concerns about high or low child weight. The aims of this study were to explore the direction of causality in these relationships during infancy. METHODS. Sixty-two women gave informed consent to take part in this longitudinal study that spanned from birth to 2 years of child age. Mothers completed the Child Feeding Questionnaire at 1 year, and their children were weighed at 1 and 2 years of age. Child weight scores were converted into standardized z scores that accounted for child age and gender. RESULTS. Controlling for child weight at 1 year, the use of pressure to eat and restriction at 1 year significantly predicted lower child weight at 2 years. CONCLUSIONS. Controlling feeding practices in infancy have an impact on children's weight at 2 years. The use of restrictive child feeding practices during infancy predicts lower child weight at age 2 years, which may reinforce mothers' use of this strategy in the longer term despite its potential association with disinhibition and greater child weight in later childhood.

Pharmacy legislation:public protector or professional hindrance?

Pharmacy originates from a background of medication compounding and supply. More recently, this role has developed away from an absolute focus on the supply of pharmaceuticals with, for example, the advent of pharmacist prescribing. Nevertheless, for a majority of the profession, medication supply remains a core activity. Regulation of the pharmacy profession is now the responsibility of the General Pharmaceutical Council, although up until 27 September 2010, this role fell to the Royal Pharmaceutical Society of Great Britain (RPSGB). Before this change, in one of the most high-profile legal cases involving a pharmacist in a professional capacity, R. v Lee, a pharmacist was prosecuted firstly for gross negligence manslaughter, later revised to offences under the Medicines Act 1968, for a single error relating to medication supply, and was given a suspended custodial sentence. Offences against sections 64 or 85 of the Medicines Act are absolute offences and there is no due diligence defence. Prosecution of a pharmacist for the supply of incorrect medication may seem a measured course of action to protect the public from the wrongful supply of potent pharmacotherapeutic agents; however, further analysis of Lee indicates that this approach may be counterproductive. An appeal of the original conviction in the Lee case has resulted in a clarification of the interpretation of section 85(5); however currently, prosecutions under section 64 are still a possibility. Owing to the seriousness of a criminal conviction under section 64, this continuation will potentially stifle the profession's ability to learn from dispensing errors. © The Author [2013]. Published by Oxford University Press; all rights reserved.

Population pharmacokinetics of single-dose intravenous paracetamol in children

Background To determine the pharmacokinetics (PK) of a new i.v. formulation of paracetamol (Perfalgan) in children ≤15 yr of age. Methods After obtaining written informed consent, children under 16 yr of age were recruited to this study. Blood samples were obtained at 0, 15, 30 min, 1, 2, 4, 6, and 8 h after administration of a weight-dependent dose of i.v. paracetamol. Paracetamol concentration was measured using a validated high-performance liquid chromatographic assay with ultraviolet detection method, with a lower limit of quantification (LLOQ) of 900 pg on column and an intra-day coefficient of variation of 14.3% at the LLOQ. Population PK analysis was performed by non-linear mixed-effect modelling using NONMEM. Results One hundred and fifty-nine blood samples from 33 children aged 1.8–15 yr, weight 13.7–56 kg, were analysed. Data were best described by a two-compartment model. Only body weight as a covariate significantly improved the goodness of fit of the model. The final population models for paracetamol clearance (CL), V1 (central volume of distribution), Q (inter-compartmental clearance), and V2 (peripheral volume of distribution) were: 16.51×(WT/70)0.75, 28.4×(WT/70), 11.32×(WT/70)0.75, and 13.26×(WT/70), respectively (CL, Q in litres per hour, WT in kilograms, and V1 and V2 in litres). Conclusions In children aged 1.8–15 yr, the PK parameters for i.v. paracetamol were not influenced directly by age but were by total body weight and, using allometric size scaling, significantly affected the clearances (CL, Q) and volumes of distribution (V1, V2).

Perceptions and attitudes of Jordanian paediatricians towards off-label paediatric prescribing

Objective To assess current experiences and attitudes of hospital based paediatricians towards off-label medicine prescribing. Setting Paediatric hospital wards and out-patient clinics. Design A prospective, questionnaire based study. Results A 30 item questionnaire was sent to 300 hospital based paediatricians and 250 (83%) were returned completed. Over 69% of responders were familiar with the term off-label medicines. However, only 28% were knowingly prescribing off-label medicines to children. The majority of respondents (90%) expressed concerns about the safety and efficacy of off-label medicines. Only 15% had observed Adverse Drug Reactions, and 31% a treatment failure. The vast majority of respondents (83%) did not obtain informed consent or tell parents they were prescribing off label medicines to their children. Conclusions Off-label prescribing of medicines to children is a familiar concept to the majority of paediatricians in Jordan although only a smaller number are aware that it is common in their practice. Respondents showed concern about off label prescribing, although the majority do not consider it necessary to inform parents. More comprehensive research is needed in this area in Jordan and other Middle Eastern countries.

Sub-cortical sources of the somatosensory pathway are hypoactive in migraine interictally:a Functional Source Separation analysis

Background: Recent morpho-functional evidence pointed out that abnormalities in the thalamus could play a major role in the expression of migraine neurophysiological and clinical correlates. Whether this phenomenon is primary or secondary to its functional disconnection from the brainstem remains to be determined. We used a Functional Source Separation algorithm of EEG signal to extract the activity of the different neuronal pools recruited at different latencies along the somatosensory pathway in interictal migraine without aura (MO) patients. Methods: Twenty MO patients and 20 healthy volunteers (HV) underwent EEG recording. Four ad-hoc functional constraints, two sub-cortical (FS14 at brainstem and FS16 at thalamic level) and two cortical (FS20 radial and FS22 tangential parietal sources), were used to extract the activity of successive stages of somatosensory information processing in response to the separate left and right median nerve electric stimulation. A band-pass digital filter (450-750 Hz) was applied offline in order to extract high-frequency oscillatory (HFO) activity from the broadband EEG signal. Results: In both stimulated sides, significant reduced sub-cortical brainstem (FS14) and thalamic (FS16) HFO activations characterized MO patients when compared with HV. No difference emerged in the two cortical HFO activations between the two groups. Conclusions: Present results are the first neurophysiological evidence supporting the hypothesis that a functional disconnection of the thalamus from the subcortical monoaminergic system may underline the interictal cortical abnormal information processing in migraine. Further studies are needed to investigate the precise directional connectivity across the entire primary subcortical and cortical somatosensory pathway in interictal MO. Written informed consent to publication was obtained from the patient(s).

Child parent dyadic treatment for anxiety disorders in youths

There is evidence for the efficacy of treatments for childhood anxiety disorders; however, less is known about whether including parents in the child's treatment enhances child treatment response. There also are few studies that have examined predictors of treatment completion/non-completion and success/failure. In this dissertation, a child focused individual treatment was compared to a dyadic child-parent treatment. In dyadic, parent anxiety symptoms and child-parent relationships were targeted. Based on the Transfer of Control Model proposed by Silverman and Kurtines (1996a, b, 2005), it was hypothesized that treatment changes in parent anxiety symptoms and child-parent relationships would be related to positive child treatment response. ^ Participants were 119 youths (ages 6 to 16 years, M = 9.93 SD = 2.75; 68 girls) and their parents. All youth were born in the U.S. but had various backgrounds; 40 were European American, 73 were Latinos/as, 6 were of other ethnic backgrounds or did not report their ethnicity. Participants signed informed consent (assent for youths) and completed a pretreatment assessment. Participants were randomized to a child individual treatment or dyadic treatment, were assessed immediately after treatment and one year post treatment. Findings showed that treated youths improved across all measures over time. Comparison of treatment conditions across all measures showed no statistically significant differences between the child individual and dyadic treatment. Reductions in parent anxiety symptoms and improvements in child-parent relationships were significantly related to child treatment change at posttreatment and at one year follow-up across treatments. No factors differentiated completers from non-completers and only parent reported child internalizing behavior problems were significantly negatively related to child treatment response. ^ The study findings support a premise of the Transfer of Control Model that changes in parent anxiety symptoms and child-parent relationships are related to child treatment response. The study findings show that children can be successfully treated when parents are included as co-clients in dyadic treatment, thereby supporting the utility of this approach in practice. ^

High School Influences on the Selection of Athletic Training as a Career

Context: Research suggests internships, mentorship, and specialized school programs positively influence career selection; however, little data exists specific to athletic training. Objective: We identified high school (HS) experiences influencing career choice in college athletic training students (ATS). Design: Our survey included 35 Likert-type close-ended questions, which were reviewed by a panel of faculty and peers to establish content and construct validity. Setting: Participants completed an online questionnaire at their convenience. Participants: 217 college ATS (153 female, 64 male) from a random selection of accredited programs on the east coast. We excluded minors, freshmen, and undecided majors from the study. Informed consent was implied by proceeding to the questionnaire. Data Collection and Analysis: We used descriptive statistics to analyze the data collected via a secure website. Results: Mentors were most influential in the decision of career path (62.4%;n=131/210) with 85.2% (n=138/162) reporting mentors were readily available to answer questions regarding career options and 53.1% (n=86/162) counseled them regarding HS electives. Of participants involved in an internship (41.0%;n=86/210), most developed such opportunities independently (66.3%;n=57/86). Respondents who attended traditional HS suggested providing diverse electives (71.9%;n=133/185), additional internship (53.5%;n=99/185), and mentorship (33.0%;n=61/185) opportunities to effectively educate students regarding career options. Conclusions: College ATS that gained internship experience during HS report the opportunity positively influenced their career selection. Mentors support HS students by offering insight and expertise in guiding students’ career choices. Participants suggested HS afford diverse electives with internship and mentorship opportunities to positively influence interested students towards pursuing a career in athletic training.

Anxious children who received treatment grow -up: An 8-to-13 year follow-up study

This dissertation examined the long-term efficacy (8-to-13 years, M = 9.54, SD = 1.689) of exposure-based cognitive-behavioral therapy (CBT) for phobic and anxiety disorders in youths. Long-term efficacy was examined in terms of diagnostic recovery, symptom reductions, and clinically significant change. This dissertation also examined predictors of long-term efficacy (e.g., age, gender, and other clinical characteristics) as well as the relative long-term efficacy of CBT for Hispanic/Latino and European American youth. ^ Participants consisted of 67 youth (age range 15–26 years; M = 19.43, SD = 3.02 years at time of follow-up assessment), (47.8% females, 37.3% Hispanic/Latino) who had participated in one of two clinical trials (Silverman et al., 1999a, b). After providing informed consent to participate in the long term follow-up, youths completed a diagnostic interview and a battery of questionnaires. Results indicated that treatment gains were maintained about 9.5 years after treatment was completed. Maintenance of treatment gains was evident in terms of diagnostic recovery, symptom reductions, and clinically significant change. Long-term treatment gains extended to both ethnic groups and the two ethnic groups were functionally equivalent along most indices examined. Analyses of predictors of long-term outcome showed that parent self-reported pre-treatment depression, youth-reported pre-treatment depression, and youths retrospective reports of negative life events were significantly associated with less favorable long-term gains in terms of total symptoms of anxiety at long-term follow-up. In terms of long-term sequelae, youths with less successful post-treatment outcomes reported seeking-out additional treatment as well as using/abused substances and substance dependence significantly more than youths with successful post-treatment outcomes. Results are discussed in terms of the contribution of the present study to knowledge base about the long-term efficacy of exposure-based CBT procedures for phobic and anxiety disorders in youth. Findings also are discussed in terms of the need to modify CBT procedures to target youths with less successful post-treatment outcomes. Limitations and future directions are presented. ^

The association of depression and perceived stress with beta cell function between African and Haitian Americans with and without type 2 diabetes

Background: Diabetes and diabetes-related complications are major causes of morbidity and mortality in the United States. Depressive symptoms and perceived stress have been identified as possible risk factors for beta cell dysfunction and diabetes. The purpose of this study was to assess associations between depression symptoms and perceived stress with beta cell function between African and Haitian Americans with and without type 2 diabetes. Participants and Methods: Informed consent and data were available for 462 participants (231 African Americans and 231 Haitian Americans) for this cross-sectional study. A demographic questionnaire developed by the Primary Investigator was used to collect information regarding age, gender, smoking, and ethnicity. Diabetes status was determined by self-report and confirmed by fasting blood glucose. Anthropometrics (weight, and height and waist circumference) and vital signs (blood pressure) were taken. Blood samples were drawn after 8 10 hours over-night fasting to measure lipid panel, fasting plasma glucose and serum insulin concentrations. The homeostatic model assessment, version 2 (HOMA2) computer model was used to calculate beta cell function. Depression was assessed using the Beck Depression Inventory-II (BDI-II) and stress levels were assessed using the Perceived Stress Scale (PSS). Results: Moderate to severe depressive symptoms were more likely for persons with diabetes (p = 0.030). There were no differences in perceived stress between ethnicity and diabetes status (p = 0.283). General linear models for participants with and without type 2 diabetes using beta cell function as the dependent variable showed no association with depressive symptoms and perceived stress; however, Haitian Americans had significantly lower beta cell function than African Americans both with and without diabetes and adjusting for age, gender, waist circumference and smoking. Further research is needed to compare these risk factors in other race/ethnic groups.

Race/Ethnicity-, Gender- and Age-Specific Differences in Micronutrient Intakes of US Adults with and without Diabetes

Race/ethnicity-, gender- and age-specific differences in dietary micronutrient intakes of US adults ≥ 21 years were assessed from National Health and Nutrition Examination Survey, 2007–2008. The participants included Black non-Hispanics, Mexican-American and White non-Hispanics who signed an informed consent form for the interview and who completed the in-person 24-h recall. Micronutrient intakes were based on the Institute of Medicines' classifications of recommended dietary allowances specific for age and gender. Likelihood of many micronutrient insufficiencies was associated with being female, over 65 years, having diabetes and minority status. Younger and female adults had a greater likelihood of iron insufficiency than male and older adults. These findings demonstrate the importance of considering the intersection of age, gender and race in setting policies for micronutrient deficiency screening, particularly in young female adults and minorities.