Estudo sobre o insight em pessoas com psicose

Para além das variáveis clínicas e sociodemográficas existem concerteza importantes componentes individuais que desempenham um contributo importante no nível de insight apresentado por cada pessoa doente, por exemplo, o nível de inteligência, personalidade, cultura, experiências passadas, memória, etc. A natureza clínica, emocional e/ou intelectual do termo ajuda-nos a compreender a complexidade da dificuldade que existe na sua tradução e, inclusive, na sua compreensão. Daí que as definições atribuídas ao conceito sejam muito distintas e variem consoante a formação teórica do autor/investigador. Pretende-se, a partir dessa identificação/compreensão, promover a qualidade de vida destas pessoas através do desenvolvimento de novas aprendizagens que possibilitem uma cooperação activa. É igualmente fundamental ir ao encontro das capacidade intactas de maneira a possibilitar a aquisição de novos(s) comportamento(s) que tenham um impacte positivo nas queixas, sinais, sintomas, incapacidade e disfuncionalidade apresentados pelo/a utente. Uma vez que a própria conceptualização do termo traduzirá aquilo que se pretende avaliar,será efectuada uma reflexão detalhada acerca dos instrumentos e definições que têm sido mais utilizadas para explorar o insight nas psicoses.Procurei, no meu trabalho de investigação, realçar e promover a importância que cada sujeito, alvo de intervenção, desempenha ao longo do seu processo de recuperação e na prevenção de recaídas. No seguimento dos objectivos acima descritos, para além da revisão teórica efectuada ao fenómeno em termos de conceptualização e estudos desenvolvidos na área de investigação, foi,neste estudo, realizada a contribuição para a validação do instrumento “Assessment of Insight in Psychosis: a re-standartization of a New Scale” de Marková & Berrios (2003).O fenómeno de insight escolhido pela Insight Scale, relata menos as mudanças vividas em relação à doença mental, e mais a actual consciência e articulação de tais mudanças. Tendo como base uma abordagem psicopedagógica, o fenómeno do insight aqui explorado assentou numa perspectiva reabilitativa, actual e multidimensional, que fosse para além das dimensões clínicas tradicionais. Neste sentido é apresentada uma escala original, intitulada “Escala de Avaliação do Insight e Identificação das Necessidades em Pessoas com Psicose”, bem como um modelo de intervenção psicopedagógico breve, assente nos pressupostos descritos ao longo do trabalho.-----------------------------------------ABSTRACT: The importance of insight in people with mental illnesses was first studied in psychiatry, in the first decades of the 20th century, by people as important as Lewis (1934) and Jaspers (1959). However, this field of investigation was left unexplored for many years. Only in the last decade has this phenomenon become the object of numerous scientific investigations, having been given special attention by its investigators. For this reason a significant number of instruments for evalauting insight in psychotic disorders were developed. Since then many papers have been published, which has allowed for a more in depth knowledge on the subject. Therefore, in recent years, the concept of insight has been developed in an attempt to clarify its compexity. A once dichotomic phenomenon, described in terms of presence or absence, became considered multidimensional, which made the identification of different levels of insight and different dimensions possible. Current concepts categorize insight into five dimensions: the awareness of the patient in relation to his/her mental illness, the awareness of the patient in relation to the social consequences of his/her illness, the awareness of the need for treatment, the awareness of the symptoms and the explanation of those symptoms in relation to the illness. The lack of insight in psychiatry, in general terms, and as this phenomenon has been described, the lack of awareness of having a mental illness, represents one of the most common symptoms of schizophrenia and affects a big part of the population that suffer from this illness. It is estimated that bewteen 50 and 80 per cent of patients with schizophrenia do not believe that they are ill, which, consequently has a big impact in the process of adherence to treatment. It is still not possible, however, to identify all the factors that determine the lack of insight in schizophrenics. There are psychological, social and cultural influences that almost certainly play their role in the lack of insight registered in this pathology.Since the impact of scizophrenia is felt in many aspects of the individual’s life, its effective treatment should be directed at various levels, including the improvement of insight. One of the objectives of this study is to explore the relationship between the level of insight in psychosis and the clinical and sociodemographic variables, the psychopathology and its global functioning. As well as the clinical and sociodemographic variables, there are of course important individual components that contribute to the level of insight seen in each patient, for example, their level of inteligence, personality, culture, past experiences, memory, etc. The clinical, emotional and/or intelectual nature of the term helps us understand the difficulty that lies in its interpretation as well as in its comprehension. Therefore, the definitions attributed to the term are very different and vary according to the theoretical training of the investigator. It is intended, from this identification/understanding, to promote the quality of life of these people through the development of new findings that might enable an active cooperation. It is equally fundamental to observe their unimpaired capacities in order to enable the acquisition of new behaviour(s) that have a positive impact on the complaints, signs, symptoms, incapacity and disfunctioning seen in the patient.As the actual comprehension of the term explains what we intend to evaluate, a detailed reflection is made on the instruments and definitions that have been used the most to explore insight in psychosis.In this investigation I tried to underline and promote the importance that each subject, undergoing medical intervention, plays during his/her process of recovery and prevention of relapses. Considering the above mentioned objectives, as well as a theoretical review of the phenomenon in terms of conceptualization and investigative studies developed, this study contributed to the validation of the instrument.The insight phenomenon chosen by the “Insight Scale”, records less changes experienced in relation to the mental illness and more actual awareness and articulation of these changes. Based on a psychopedagogical approach, the insight phenomenon explored here settled on a rehabilitation, current and multidimensional perspective that would go beyond the traditional clinical dimensions. For this reason an original scale entitled “Insight Evaluation Scale and Need Identification in Psychosis Patients” is presented, as well as a psychopedagogical intervention model soon to be used with admitted patients based on the presuppositions described in this study.

Catalytic oxidation of alcohols: recent advances

This review concerns metal-catalyzed reactions of oxidation of alcohols to the respective products, mainly ketones and aldehydes, mostly within the period of 2010–2014. Both conventional and unconventional systems, not only with usual reagents, but also with uncommon and prospective ones, are overviewed, with recently achieved developments.

Comparing wind generation profiles: A circular data approach

The importance of wind power energy for energy and environmental policies has been growing in past recent years. However, because of its random nature over time, the wind generation cannot be reliable dispatched and perfectly forecasted, becoming a challenge when integrating this production in power systems. In addition the wind energy has to cope with the diversity of production resulting from alternative wind power profiles located in different regions. In 2012, Portugal presented a cumulative installed capacity distributed over 223 wind farms [1]. In this work the circular data statistical methods are used to analyze and compare alternative spatial wind generation profiles. Variables indicating extreme situations are analyzed. The hour (s) of the day where the farm production attains its maximum daily production is considered. This variable was converted into circular variable, and the use of circular statistics enables to identify the daily hour distribution for different wind production profiles. This methodology was applied to a real case, considering data from the Portuguese power system regarding the year 2012 with a 15-minutes interval. Six geographical locations were considered, representing different wind generation profiles in the Portuguese system.In this work the circular data statistical methods are used to analyze and compare alternative spatial wind generation profiles. Variables indicating extreme situations are analyzed. The hour (s) of the day where the farm production attains its maximum daily production is considered. This variable was converted into circular variable, and the use of circular statistics enables to identify the daily hour distribution for different wind production profiles. This methodology was applied to a real case, considering data from the Portuguese power system regarding the year 2012 with a 15-minutes interval. Six geographical locations were considered, representing different wind generation profiles in the Portuguese system.

Realidade Imersiva Aplicada a Espaços Culturais

Informação é o conceito genérico de tudo que possa representar, conhecimento ou comunicação. Trata-se de conhecimento registado de forma impressa ou digital, oral ou audiovisual, mas ainda pode ser registada em suporte físico. Desde o início da civilização que o Ser Humano tenta criar novas formas de transmitir informação, antes da invenção da forma escrita era utilizado o método do desenho para descrever a realidade, este método ao longo do tempo foi evoluindo, ganhando mais qualidade, pormenor e suportes mais evoluídos. Mas sempre com a mesma intenção, a de conseguir transmitir de forma mais direta e percetível informação a qualquer individuo. Dado isto, o Ser Humano sempre produziu arte e a foi preservando para mostrar aos vindouros. Neste processo, os museus em conjunto com espaços culturais e artísticos, foram assumindo um papel de relevo na sociedade. Mas inicialmente o objetivo principal dos museus era o de preservar e expor artefactos históricos e culturais. A grande evolução tecnológica dos últimos anos veio dotar o Ser Humano com formas de aceder à informação tão simples e diversificadas, que no passado eram completamente impensáveis e certamente que no futuro irão ser descobertas ainda mais formas de registar e propagar a informação. Assim o presente trabalho descreve a investigação realizada, através de uma recolha de bibliografia, levantamento do estado-da-arte, que pretende descobrir se a construção de visitas virtuais imersivas é uma boa forma para mostrar um espaço cultural ao público, que está cada vez mais exigente e disperso geograficamente. Além do levantamento são estudados alguns exemplos de visitas virtuais existentes, de modo a detetar boas praticas e formas mais usuais para a criação de uma visita. Finalmente foi descrito todo o processo desde a recolha de informação até à própria implementação, construção de um protótipo para apresentar ao utilizador o espaço de uma fundação, a do escultor José Rodrigues. Este protótipo tem por objetivo mostrar ao utilizador a fundação o mais aproximado do real possível.

A passagem à reforma : um estudo exploratório sobre mulheres profissionalizadas na sociedade portuguesa

RESUMO: Devido às mudanças políticas e sociais que ocorreram no passado, a proporção de mulheres activas no mercado de trabalho tem vindo a aumentar, e neste sentido, cada vez mais mulheres têm vindo a entrar na reforma. As recentes evoluções demográficas mostram um crescente envelhecimento populacional caracterizado por um aumento da proporção de pessoas idosas e pela sua maior longevidade. As mulheres são em número superior, no entanto, a realidade da mulher portuguesa reformada tem sido pouco avaliada sob o ponto de vista em que decorre esta transição. A passagem à reforma é um momento fulcral para conhecer como se adaptam os indivíduos a uma nova etapa da sua vida que é actualmente vivida por mais tempo, e que representa também a passagem para outra categoria social, a categoria de reformado. Condicionantes sociais, culturais e individuais, contribuem para modelar esta transição e o ajustamento à mesma. A reforma para as mulheres deverá corresponder a uma etapa com características únicas, devido às particularidades em termos profissionais e sociais que as distinguem dos homens. Pretende-se neste trabalho “dar voz” às mulheres portuguesas que tiveram uma carreira profissional e conhecer as suas experiências de transição para a reforma e a forma como vivem esta condição. Foram realizadas entrevistas em profundidade com mulheres portuguesas profissionais reformadas, cujos conteúdos foram analisados em torno das seguintes categorias: sentimentos vividos; planeamento e motivações para a passagem à reforma; relação com o trabalho; noção de si própria; gestão de tempo e organização quotidiana e interacções familiares e sociais.-------- ABSTRACT: Due to past political and social changes the number of women working actively in the labor market is growing. This implies that, more women are also entering in the retirement period. Recent demographic trends show an increasing ageing population, characterized by a higher proportion of elderly people, and a higher longevity. Women’s proportion outnumbers older men, yet the reality of Portuguese retired women has been poorly evaluated in regard to this transition process. Retirement transition is a crucial period to understand how individuals adapt to a new stage in their life, that is actually being enjoyed for a longer period and that also represents the transition to retiree’s social role. Social, cultural and individual conditions help to shape this transition and adjustment to it. Retirement for women should be an event with unique features, mostly because of the peculiarities in professional and social relationships, distinct from men. Through in-depth interviews, we explored how Portuguese women, who had a professional career, experience the retirement transition and how they live this new condition. The women’s narratives were analyzed within the following categories: experienced feelings, planning and motivation for retirement; notion of self; time management and daily organization; family and social interactions.

MICROCIRCULATION AND CHAGAS' DISEASE: HYPOTHESIS AND RECENT RESULTS

This review focuses on studies that support the microvascular hypothesis, as well as on immunological and neurogenic mechanisms, and the role of the parasite itself, to explain further the pathology and clinical course of myocardial involvement in chagasic cardiomyopathy. The salient features of coronary microcirculation and Chagas' disease are discussed.

Evaluation of an in-house specific immunoglobulin G (IgG) avidity ELISA for distinguishing recent primary from long-term human cytomegalovirus (HCMV) infection

This article describes the standardization and evaluation of an in-house specific IgG avidity ELISA for distinguishing recent primary from long-term human cytomegalovirus (HCMV) infection. The test was standardized with the commercial kit ETI-CYTOK G Plus (Sorin Biomedica, Italy) using 8 M urea in phosphate-buffered saline to dissociate low-avidity antibodies after the antigen-antibody interaction. The performance of the in-house assay was compared to that of the commercial automated VIDAS CMV IgG avidity test (bioMérieux, France). Forty-nine sera, 24 from patients with a recent primary HCMV infection and 25 from patients with a long-term HCMV infection and a sustained persistence of specific IgM antibodies, were tested. Similar results were obtained with the two avidity methods. All 24 sera from patients with recently acquired infection had avidity indices compatible with acute HCMV infection by the VIDAS method, whereas with the in-house method, one serum sample had an equivocal result. In the 25 sera from patients with long-term infection, identical results were obtained with the two methods, with only one serum sample having an incompatible value. These findings suggest that our in-house avidity test could be a potentially useful tool for the immunodiagnosis of HCMV infection.

Skin Prick Tests and Allergy Diagnosis

Skin testing remains an essential diagnostic tool in modern allergy practice. A signifi cant variability has been reported regarding technical procedures, interpretation of results and documentation. This review has the aim of consolidating methodological recommendations through a critical analysis on past and recent data. This will allow a better understanding on skin prick test (SPT) history; technique; (contra-) indications; interpretation of results; diagnostic pitfalls; adverse reactions; and variability factors.

Autoimmune Thyroiditis Presenting as Palmoplantar Keratoderma

Palmoplantar keratoderma is a heterogeneous group of hereditary and acquired disorders characterized by abnormal thickening of palms and soles. Hypothyroidism is an unusual cause of palmoplantar keratoderma, rarely reported in the literature. We report a case of a 43-year-old woman presented with a 3-month history of a diffuse palmoplantar hyperkeratosis unresponsive to topical keratolytics and corticosteroids. Her past medical and family histories were unremarkable. She complained of recent asthenia, mood changes and constipation. Laboratory evaluation revealed an autoimmune thyroiditis with hypothyroidism. Other causes of acquired palmoplantar keratoderma were excluded. After hormonal replacement therapy institution, a gradual improvement of skin condition was observed. The diagnosis of underlying causes for acquired palmoplantar keratoderma can be a difficult task; however its recognition is essential for successful treatment results. Although a very rare association, hypothyroidism must be suspected in patients with acquired palmoplantar keratoderma, particularly when it occurs in association with systemic symptoms.

Recent advances into vanadyl, vanadate and decavanadate interactions with actin

Metallomics. 2012 Jan 3;4(1):16-22

“The past is a foreign country”? Acculturation theory and the anthropology of globalization

Etnográfica, 15 (2): 313-336

Epidemiologic features of HIV infection in three municipalities of inner Rio de Janeiro State, Brazil

In Brazil relatively little attention is being paid to the study of the features of the spread of the AIDS epidemic towards small cities and rural areas. We report a descriptive study on the epidemiological features of HIV infection among 208 adult patients seen between July 1999 and May 2006 in the municipal HIV/AIDS Programs of three cities of inner Rio de Janeiro State: Saquarema, Santo Antonio de Pádua and Miracema. A portrait of a heterosexual epidemic emerged, with an overall male to female ratio of 1.1. More than 90% were residents of the studied cities, demonstrating a local demand for HIV-related assistance and the importance of municipal HIV/AIDS Programs. Past or current use of snorted cocaine was reported by a quarter of the patients. Older age and male gender were independent predictors of having a diagnosis of AIDS at presentation. The latter is in accordance with a more recent wave of epidemic spread towards female gender. A low frequency of male circumcision, an important determinant of heterosexual HIV transmission, was recorded. Almost 60% of the patients first presented in advanced stages of HIV infection, suggesting the existence of a large pool of undiagnosed cases in the community.

Animal helminths in human archaeological remains: a review of zoonoses in the past

The authors present a review of records of intestinal parasitic helminths from animals in human archaeological remains, reported since the emergence of paleopathological studies. The objective was to relate paleoparasitological findings to geographic, biotic, and abiotic factors from the environment in which the prehistoric populations lived, and understand some aspects related to the process of human dispersion and biological and cultural evolution. Modification of eating habits and the incorporation of new cultural practices are analyzed from the perspective of zoonoses from prehistory to the present day, especially in Brazilian indigenous populations. Three tables identifying the helminths, their natural hosts, dates, and sites of archaeological findings complete this review. In conclusion, various zoonoses known today have occurred since antiquity, and these data, combined with studies on the emergence and reemergence of diseases, could make possible to compose scenarios for the future.

Review of genitourinary tuberculosis with focus on end-stage renal disease

Tuberculosis (TB) is a current public health problem, remaining the most common worldwide cause of mortality from infectious disease. Recent studies indicate that genitourinary TB is the third most common form of extra-pulmonary disease. The diagnosis of renal TB can be hypothesized in a non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia in the absence of bacteriuria. We report on the case of a 33-year-old man who presented on admission end stage renal disease (ESRD) secondary to renal TB and a past history of pulmonary TB with important radiologic findings. The diagnosis was based on clinical findings despite all cultures being negative. Empiric treatment with tuberculostatic drugs was started and the patient became stable. He was discharged with no symptom, but without renal function recovery. He is on maintenance hemodialysis three times a week. TB is an important cause of kidney disease and can lead to irreversible renal function loss.

Determinação da tenacidade à fratura em corte (GIIc) de adesivos estruturais pelo ensaio End-Notched Flexure (ENF)

Os adesivos têm sido alvo de estudo ao longo dos últimos anos para ligação de componentes a nível industrial. Devido à crescente utilização das juntas adesivas, torna-se necessária a existência de modelos de previsão de resistência que sejam fiáveis e robustos. Neste âmbito, a determinação das propriedades dos adesivos é fundamental para o projeto de ligações coladas. Uma abordagem recente consiste no uso de modelos de dano coesivo (MDC), que permitem simular o comportamento à fratura das juntas de forma bastante fiável. Esta técnica requer a definição das leis coesivas em tração e corte. Estas leis coesivas dependem essencialmente de 2 parâmetros: a tensão limite e a tenacidade no modo de solicitação respetivo. O ensaio End-Notched Flexure (ENF) é o mais utilizado para determinar a tenacidade em corte, porque é conhecido por ser o mais expedito e fiável para caraterizar este parâmetro. Neste ensaio, os provetes são sujeitos a flexão em 3 pontos, sendo apoiados nas extremidades e solicitados no ponto médio para promover a flexão entre substratos, o que se reflete numa solicitação de corte no adesivo. A partir deste ensaio, e após de definida a tenacidade em corte (GIIc), existem alguns métodos para estimativa da lei coesiva respetiva. Nesta dissertação são definidas as leis coesivas em corte de três adesivos estruturais através do ensaio ENF e um método inverso de ajuste dos dados experimentais. Para o efeito, foram realizados ensaios experimentais considerado um adesivo frágil, o Araldite® AV138, um adesivo moderadamente dúctil, o Araldite® 2015 e outro dúctil, o SikaForce® 7752. O trabalho experimental consistiu na realização dos ensaios ENF e respetivo tratamento dos dados para obtenção das curvas de resistência (curvas-R) através dos seguintes métodos: Compliance Calibration Method (CCM), Direct Beam Theory (DBT), Corrected Beam Theory (CBT) e Compliance-Based Beam Method (CBBM). Os ensaios foram simulados numericamente pelo código comercial ABAQUS®, recorrendo ao Métodos de Elementos Finitos (MEF) e um MDC triangular, com o intuito de estimar a lei coesiva de cada um dos adesivos em solicitação de corte. Após este estudo, foi feita uma análise de sensibilidade ao valor de GIIc e resistência coesiva ao corte (tS 0), para uma melhor compreensão do efeito destes parâmetros na curva P- do ensaio ENF. Com o objetivo de testar adequação dos 4 métodos de obtenção de GIIc usados neste trabalho, estes foram aplicados a curvas P- numéricas de cada um dos 3 adesivos, e os valores de GIIc previstos por estes métodos comparados com os respetivos valores introduzidos nos modelos numéricos. Como resultado do trabalho realizado, conseguiu-se obter uma lei coesiva única em corte para cada um dos 3 adesivos testados, que é capaz de reproduzir com precisão os resultados experimentais.