Bipolar disorder comorbid with alcoholism: A (1)H magnetic resonance spectroscopy study

Alcoholism is highly prevalent among bipolar disorder (BD) patients, and its presence is associated with a worse outcome and refractoriness to treatment of the mood disorder. The neurobiological underpinnings that characterize this comorbidity are unknown. We sought to investigate the neurochemical profile of the dorsolateral prefrontal cortex (DLPFC) of BD patients with comorbid alcoholism. A short-TE, single-voxel (1)H spectroscopy acquisition at 1.5T from the left DLFPC of 22 alcoholic BD patients, 26 non-alcoholic BD patients and 54 healthy comparison subjects (HC) were obtained. Absolute levels of N-acetyl aspartate, phosphocreatine plus creatine, choline-containing compounds, myo-inositol, glutamate plus glutamine (Glu + Gln) and glutamate were obtained using the water signal as an internal reference. Analysis of co-variance was used to compare metabolite levels among the three groups. In the primary comparison, non-alcoholic BD patients had higher glutamate concentrations compared to alcoholic BD patients. In secondary comparisons integrating interactions between gender and alcoholism, non-alcoholic BD patients presented significantly higher glutamate plus glutamine (Glu + Gln) than alcoholic BD patients and HC. These results appeared to be driven by differences in male subjects. Alcoholic BD patients with additional drug use disorders presented significantly lower myo-inositol than BD patients with alcoholism alone. The co-occurrence of BD and alcoholism may be characterized by neurochemical abnormalities related to the glutamatergic system and to the inositol second messenger system and/or in glial pathology. These abnormalities may be the neurochemical correlate of an increased risk to develop alcoholism in BD, or of a persistently worse clinical and functional status in BD patients in remission from alcoholism, supporting the clinical recommendation that efforts should be made to prevent or early diagnose and treat alcoholism in BD patients. (C) 2009 Elsevier Ltd. All rights reserved.

Dietary habits, ethanol and tobacco consumption as predictive factors in the development of esophageal carcinoma in patients with head and neck neoplasms

Patients with primary head and neck cancers have a higher risk of developing esophageal cancer. The aim of this study was to investigate esophageal cancer prevalence, its risk factors (ethanol and tobacco consumption) and dietary habits in patients with head and neck cancer. Three hundred and twenty-six adults with primary head and neck cancer were followed by a retrospective observational study in a general university hospital in Sao Paulo, Brazil. Flexible videoendoscopy with lugol chromoscopy was the method used to investigate esophageal cancer prevalence. All subjects were interviewed face-to-face, revealing detailed information about their tobacco and alcohol use, as well as their dietary habits. Thirty-six patients with esophageal cancer were diagnosed and the overall prevalence rate was 11.04%. Patients who developed second esophageal tumors had the following characteristics: earlier age of initial ethanol consumption (P < 0.05), longer duration period of ethanol consumption (P < 0.05) and higher weekly consumption rate (P < 0.05). There was an increased risk of esophageal carcinoma in those patients who both smoked and drank (P < 0.05). There was no association between carcinoma of the esophagus and dietary habits in patients who developed esophageal neoplasms, compared with those who did not. Prevalence rate of esophageal neoplasms was 11.04% in patients with head and neck carcinoma, whose ethanol consumption was associated with esophageal cancer. There was an increased risk between ethanol and tobacco consumption and esophageal carcinoma development. On the other hand, there was no association regarding dietary habits between patients who developed esophageal cancer and those who did not.

Basal levels of DNA damage detected by micronuclei and comet assays in untreated breast cancer patients and healthy women

Breast cancer is the second most frequent type of cancer worldwide and is the most common malignant disease among women. Risk factors for breast cancer include early menarche, late menopause, hormonal therapies, exposure to environmental pollutants, smoking and alcohol use. However, increased or prolonged exposure to estrogen is the most important risk factor. It has been suggested that accumulation of DNA damage may contribute to breast carcinogenesis. Epidemiological studies suggest that cytogenetic biomarkers such as micronuclei in peripheral blood lymphocytes may predict cancer risk because they indicate genomic instability in target tissues. The objective of the present study was to evaluate the frequencies of micronuclei and the extent of DNA damage detected by comet assay in peripheral blood lymphocytes of untreated breast cancer patients and healthy women. The study was conducted using peripheral blood lymphocytes from 45 women diagnosed for Ductal ""in situ"" or invasive breast carcinoma and 85 healthy control women. Micronuclei and comet assays were performed to detect spontaneous DNA damage. The results showed that micronuclei frequencies and tail intensity, detected by comet assay, were significantly higher in the breast cancer group than in controls. The levels of DNA damage were similar in smokers and non-smokers, and aging did not influence the frequencies of micronuclei or tail intensity values observed in either group. In conclusion, the present work demonstrates higher levels of DNA damage in untreated breast cancer patients than in healthy women.

Diet, lifestyle and the risk of Type 2 Diabetes Mellitus in women

Background Previous studies have examined individual dietary and lifestyle factors in relation to type 2 diabetes, but the combined effects of these factors are largely unknown. Methods We followed 84,941 female nurses from 1980 to 1996; these women were free of diagnosed cardiovascular disease, diabetes, and cancer at base line. Information about their diet and lifestyle was updated periodically. A low-risk group was defined according to a combination of five variables: a body-mass index (the weight in kilograms divided by the square of the height in meters) of less than 25; a diet high in cereal fiber and polyunsaturated fat and low in trans fat and glycemic load (which reflects the effect of diet on the blood glucose level); engagement in moderate-to-vigorous physical activity for at least half an hour per day; no current smoking; and the consumption of an average of at least half a drink of an alcoholic beverage per day. Results During 16 years of follow-up, we documented 3300 new cases of type 2 diabetes. Overweight or obesity was the single most important predictor of diabetes. Lack of exercise, a poor diet, current smoking, and abstinence from alcohol use were all associated with a significantly increased risk of diabetes, even after adjustment for the body-mass index. As compared with the rest of the cohort, women in the low-risk group (3.4 percent of the women) had a relative risk of diabetes of 0.09 (95 percent confidence interval, 0.05 to 0.17). A total of 91 percent of the cases of diabetes in this cohort (95 percent confidence interval, 83 to 95 percent) could be attributed to habits and forms of behavior that did not conform to the low-risk pattern. Conclusions Our findings support the hypothesis that the majority of cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle.

Couple distress after sudden infant or perinatal death: A 30-month follow up

Objective: To examine, using a 30-month prospective study, patterns of anxiety, depression and alcohol use in couples following stillbirth, neonatal death or sudden infant death syndrome. Methodology: One hundred and thirty-eight bereaved and 156 non-bereaved couples completed standardized interviews at 2, 8, 15 and 30 months post-loss. Results: At all interviews, bereaved couples were significantly more likely than non-bereaved couples to have at least one distressed partner. Rarely were both partners distressed in either group. For bereaved couples, 'mother only' distress declined from 21% to 10% during the study. 'Father only' distress ranged from 7% to 15%, peaking at 30 months. Bereaved mothers who were distressed at 2 months reported significantly lower marital satisfaction at 30 months. Conclusions: At the couple level, the experience of a baby's death is multifaceted. Gender differences are common and partners' needs may change over time. Early recognition of these differences may facilitate longer-term adjustment for both partners.

D2 dopamine receptor gene polymorphism discriminates two kinds of novelty seeking

Cloninger's psychobiological model of personality as applied to substance misuse has received mixed support. Contrary to the model, recent data suggest that a combination of high novelty seeking (NS) and high harm avoidance (HA) represents a significant risk for the development of severe substance misuse. A genetic polymorphism previously implicated in severe substance dependence, the A1 allele of the D2 dopamine receptor (DRD2) gene, was examined in relation to NS and HA amongst 203 adolescent boys. Specifically, we hypothesized that subjects with the A1 + allele (A1/A1 and A1/A2 genotypes) would report stronger NS and would exhibit a more positive relationship between NS and HA than those with the A1-allele (A2/A2 genotypes). These predictions were supported. The correlation between NS and HA in 81 A1 + allelic boys (r = 0.27, P = 0.02), and that in the 122 A1- allelic boys (r = -0.15, P = 0.09), indicated that this relationship differed according to allelic status (F = 8.52, P < 0:004). Among those with the A1-allele, the present results are consistent with the traditional view that novelty seeking provides positive reinforcement, or the fulfillment of appetitive drives. In contrast, novelty seeking in those with the A1 + allele appears to include a negative reinforcement or self-medicating function. (C) 2002 Elsevier Science Ltd. All rights reserved.

O Impacto dos transtornos mentais no trabalho : resultados do estudo epidemiológico de transtornos mentais São Paulo Megacity

O objetivo deste estudo é estimar a prevalência de transtornos mentais de acordo com a situação de emprego por sexo, analisar associações entre os transtornos mentais e situação de emprego, bem como entre a busca de tratamento e situação de emprego dentre os respondentes com transtornos mentais nos últimos 12 meses. Além disso, pretende-se analisar a perda de dias de trabalho devido ao absenteísmo e ao presenteísmo associando-os com os transtornos mentais, dentre os trabalhadores. Os dados foram analisados a partir do Estudo São Paulo Megacity, um estudo de base populacional que avaliou os transtornos mentais em uma amostra probabilística de 5.037 adultos residentes na Região Metropolitana de São Paulo, utilizando a versão do Composite International Diagnostic Interview da Organização Mundial de Saúde. A amostra foi dividida em grupos de acordo com a situação de trabalho – trabalhadores, economicamente inativos e desempregados. A prevalência dos transtornos mentais foi estimada estratificada por sexo, bem como, as associações com as situações de emprego, características sócio-demográficas e procura por tratamento. O número médio de dias perdidos por absenteísmo e presenteísmo na população de trabalhadores foi estimado baseado na Escala de Avaliação de Incapacidade Organização Mundial de Saúde. Os efeitos a nível populacional e os custos financeiros também foram estimados. As associações foram medidas pelo Odds Ratio e calculada através do modelo de regressão logística multinomial. Do total da amostra (n= 5.035), 63% eram trabalhadores, 25% economicamente inativos e 12% desempregados. Os trabalhadores foram associados ao sexo masculino, menor idade, maior número de anos estudados e maior renda. As mulheres apresentaram maior prevalência de transtornos de humor e ansiedade. Os homens foram associados a qualquer transtorno mental, transtorno de humor e transtorno de ansiedade, as mulheres foram associadas a situação de emprego economicamente inactivas e desempregadas. Os homens cuja situação de emprego era trabalhador mostrou maiores prevalências nos transtornos de impulso-controle e nos transtornos por uso de substâncias psicoativas. As mulheres cuja situação de emprego era trabalhador e os homens cuja situação de emprego era economicamente inativos, tiveram maiores prevalências de transtornos mentais. Dentre respondentes com algum transtorno mental, os respondentes economicamente inativos apresentaram associação com a procura de tratamento de saúde geral e de saúde mental. A presença de algum transtorno mental foi associado com 26,8 dias/ano devido ao absenteísmo, 92,2 dias/ano devido ao presenteísmo e 125,9 dias/ano de perda total de trabalho. Os custos anuais da perda de trabalho foram estimados em R$ 2,6 bilhões por ano, correspondentes a R$ 690 milhões por ano devido ao absenteísmo, e R$ 1,9 bilhões por ano devido ao presenteísmo. Nossos resultados fornecem importantes informações epidemiológicas sobre os transtornos mentais e o impacto no trabalho que devem ser levadas em consideração na definição de prioridades para os cuidados em saúde e alocação de recursos.

Prevalence of health promotion programs in primary health care units in Brazil

OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.

Proof of Concept of the Electrochemical Sensing of 3-Iodothyronamine (T1AM) and Thyronamine (T0AM)

Recent studies have shown that, besides the well-recognized T3 and T4 hormones, there are other relevant thyroid hormones circulating in the human body. In particular, this is the case for 3-iodothyronamine (T1AM) and thyronamine (T0AM). One of the reasons for the lack of studies showing their precise importance is the absence of analytical methodologies available. Herein, for the first time, T1AM and T0AM are electrochemically characterized. T0AM was sensed by means of a glassy carbon electrode; furthermore, T1AM was sensed both with a graphitic surface (oxidatively) as well as with mercury (reductively). For both compounds, after oxidation, it was possible to observe the reversible redox reaction concerning the benzoquinone/hydroquinone couple, thus increasing the specificity of the electroanalysis. Therefore, this work provides the basis for an ‘at-point-of-use’ electrochemical strip test for T1AM and T0AM.

Auditoria de recursos humanos nas PME portuguesas

Ao longo dos tempos que a economia tem sofrido mudanças a nível global, e é possível verificar que as empresas estão constantemente a adaptar-se a essa mudança. Fruto dessa adaptação, os recursos humanos, que são uma das partes fundamentais de uma empresa pois representam a sua mão-de-obra, têm tido um papel junto da mesma significativamente alterado ao longo do tempo. De facto, não só o papel dos recursos humanos tem sido diferente ao longo do tempo, a própria gestão de recursos humanos evoluiu significativamente, a par da própria evolução das várias estruturas organizacionais. Tudo isto se relaciona com a necessidade de encontrar métodos de diferenciação, de adquirir vantagem competitiva, ou de conseguir obter mais valor num mercado cada vez mais competitivo a todos os níveis. Assim, embora hoje em dia se assuma de um modo geral que os recursos humanos são realmente uma fonte de valor, capazes de fazer com que a sua empresa se diferencie, e capazes de criar vantagem competitiva, a verdade é que para que tal seja possível é necessário uma gestão dos mesmos que o possibilite. A gestão de recursos humanos traduz-se sobretudo nas suas práticas, tais como o recrutamento ou a formação, e para que essas práticas tenham o melhor efeito possível é necessário que as mesmas sejam avaliadas de forma imparcial, ou seja, independente. É neste contexto que surge a Auditoria de Recursos Humanos, que se pode resumir a uma avaliação aos recursos humanos e à sua gestão dos pontos de vista legal, funcional, e estratégico. Com o objectivo de verificar se, no contexto português, as empresas pensam nos seus recursos humanos como um recurso que acrescenta valor se gerido adequadamente, e se apostam neste tipo de auditoria como forma de avaliar o paradigma dos seus recursos humanos, foi elaborado um questionário e enviado a empresas distinguidas com os estatutos PME Líder 2014 e PME Excelência 2014 pelo IAPMEI. As conclusões do estudo indicaram que embora as empresas acreditem que os recursos humanos acrescentam valor, apostando na sua motivação, formação, avaliação de desempenho e satisfação, as mesmas não fazem questão em obter a certificação dos seus sistemas de gestão de recursos humanos e não utilizam a auditoria de recursos humanos como uma ferramenta de gestão.

Is the Lunatic Detention Act of 1917 appropriate for modern Gambia?

RESUMO: OS distúrbios mentais, neurológicos e devidos ao abuso de substâncias tem uma grande prevalência e peso em todo o Mundo. O objetivo principal deste estudo é contribuir para a melhoria dos direitos humanos das pessoas com deficiências mentais na Gâmbia, através de uma revisão e análise críticas de uma obsoleta legislação de saúde mental do País o "Lunatic Act Detention (LDA) de 1917".----- ABSTRACT: Mental, neurological, and substance use disorders are highly prevalente and burdensome worlwide. The violations of human rights directed towards people with this disorders compound the problam. This study mainly aims to contribute do the improvement of human rights of people with mental disabilities in Gambia by doing a critical review and analysis to the countries outdated mental health legislation - Lunatic Detention ct (LDA) from 1917.

A Brazilian version of the "Children's Interview for Psychiatric Syndromes" (ChIPS)

OBJETIVE: The advance of research in child and adolescent psychiatry in Brazil heavily depends on the existence of instruments for the investigation of psychiatric syndromes adapted to Brazilian Portuguese. METHODS: This article describes a careful process of translation of the Children's Interview for Psychiatric Syndromes for the purpose of use in research in Brazil. The Children's Interview for Psychiatric Syndromes has a version for parents (P-ChIPs) and a version for children (ChIPS). In this article, the sections of P-ChIPS referring to attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, mania/hypomania, anorexia nervosa, bulimia nervosa and psychotic disorders were translated to Brazilian Portuguese. The sections of the ChIPS referring to substance use disorders, social anxiety disorder, specific phobias, obsessive-compulsive disorder, generalized anxiety disoder, separation anxiety disorder, post-traumatic disorders and depression/dysthimia were also adapted. Each section was translated by two independent translators and later discussed in a committee composed of experts in the field of Psychiatry and a professional of the field of linguistics. RESULT: A final version containing an interview for the main psychiatric syndromes was defined. CONCLUSION: The translated P-ChIPS is a helpful instrument in children and adolescent clinical evaluation.

Prévention des alcoolisations aiguës a l'adolescence: quel rôle pour le médecin de famille [Prevention of binge drinking in adolescents: do family doctors have a role to play?].

Binge drinking has nearly become the norm for young people and is thus worrying. Although alcohol use in males attracts more media attention, females are also frequently affected. A variety of preventive measures can be proposed: at the individual level by parents, peers and family doctors; at the school and community level, particularly to postpone age of first use and first episode of drunkenness; at the structural level through a policy restricting access to alcohol for young people and increasing its price. Family doctors can play an important role in identifying at risk users and individualising preventive messages to which these young people are exposed in other contexts.

Social contexts of sports-practicing youths' hazardous drinking.

Sports-practicing youths are at an elevated risk for alcohol use and misuse. Although much attention has recently been given to depicting subgroups facing the greatest threats, little evidence exists on the contexts in which their drinking takes place. Using data from a cross-sectional study on youth sports participation and substance use in the French-speaking part of Switzerland, this study focused on the social contexts associated with hazardous drinking of 894 sports-practicing adolescents aged 16 to 20. Divided between those who had been drunk in the last month (hazardous drinkers, n = 315) and those who had not (n = 579), sports-practicing adolescents were compared on reported gatherings (sports-related, sports-unrelated, mixed) likely linked to their drinking behaviour. Mixed social contexts, followed by sports-unrelated ones, were reported as the most common context by both male and female youths who practiced sports. After controlling for several possible confounders, male hazardous drinkers were more than 3 times more likely to report sports-unrelated social contexts as the most common, compared to sport-related ones, while females were more than 7 times more likely to do so. Our findings seem to indicate that, rather than focusing only on sports-related factors, prevention of alcohol misuse among sports-practicing youths should also pay attention to the social contextualisation of their hazardous drinking.

No healthy heart for heavy drinkers: a population-based study in Switzerland

Background: Low to moderate alcohol consumption has been associated with lower coronary heart disease (CHD) risk, an effect mainly mediated by an increase in HDL-cholesterol levels. However, data on the CHD risk associated with high alcohol consumption are conflicting. Methods: In a population-based study of 5,769 men and women, aged 35-75 years, without cardiovascular disease in Switzerland, last week alcohol consumption was categorized into 0, 1-6, 7-13, 14-20, 21-27, 28-34, 035 drinks/week and into nondrinkers (0 drink/week), moderate (1-13), high (14-34) and very high drinkers (035). Blood pressure, lipids and high sensitivity C-reactive protein (hs-CRP) were measured, and the 10-year CHD risk was calculated according to the Framingham risk score. Results: 73% (n = 4,214) of the participants consumed alcohol; 16% (n = 909) were considered as high drinkers and 2% (n = 119) as very high drinkers. In multivariate analysis, increasing alcohol consumption was associated with higher HDL-cholesterol (from 1.57 ± 0.01 [adjusted mean ± SE] in nondrinkers to 1.88 ± 0.03 mmol/L in very high drinkers); triglycerides (1.17 ± 1.01 to 1.32 ± 1.05 mmol/L), and systolic and diastolic blood pressure rose significantly (127.4 ± 0.4 to 132.2 ± 1.4 and 78.7 ± 0.3 to 81.7 ± 0.9 mm Hg, respectively, all p for trend <0.001). Predicted 10-year CHD risk increased from 4.31 ± 0.10 to 4.90 ± 0.37 (p = 0.03) with increasing alcohol use, with a J-shaped relationship. Conclusion: As measured by the 10-year CHD risk, the protective effect of alcohol consumption disappears in very high drinkers, namely because the beneficial increase in HDL-cholesterol may be blunt by a rise in blood pressure levels.