Antropologia Funerária e Paleobiologia das Populações Pós-Medievais Portuguesas: Os Casos de Nossa Senhora da Anunciada e Espírito Santo

As desigualdades sociais na saúde constituem a problemática abordada nesta dissertação, tendo sido escolhidas para explorar esta questão duas séries esqueléticas – igreja de Nossa Senhora da Anunciada (Setúbal) e capela do Espírito Santo (Loures) – cronologicamente enquadradas no período pós-medieval, entre os séculos XVI e XIX, e cujos indivíduos apresentavam estatutos socioeconómicos diferenciados. Na concretização deste objectivo foi realizada uma primeira abordagem que incidiu no estudo integral – contexto funerário e Paleobiologia – das respectivas séries. Do manancial de resultados obtidos foram seleccionados e explorados na segunda abordagem indicadores de estatuto social e de estatuto biológico (ou esqueléticos de stress fisiológico) capazes de responder à problemática enunciada, procurando demonstrar-se que as desigualdades sociais podem actuar sobre factores fundamentais ao desenvolvimento normal e saúde dos indivíduos, manifestando-se, consequentemente, de forma diferencial entre indivíduos de estatutos socioeconómicos contrastantes. A caracterização geral do contexto funerário revelou que no interior da igreja de N. Sra. da Anunciada, localizada no bairro do Troino, habitado por um segmento da população socialmente mais desfavorecido, registaram-se 93 inumações primárias e 155 secundárias, as quais foram realizadas em covas abertas no subsolo e revelando a quase ausência de espólio votivo e de caixão. Por outro lado, na capela do Espírito Santo foram exumadas 46 inumações primárias e 30 secundárias que foram exclusivamente encontradas em criptas, tendo os indivíduos sido inumados em caixão e identificando-se, igualmente, a presença de espólio votivo associado. A documentação histórica refere o nome de mecenas e benfeitores do respectivo convento com direito a sepultura na sua capela. Na caracterização paleobiológica geral foram revelados os perfis biológicos básicos, tendo sido identificados indivíduos de ambos os sexos e diferentes classes etárias, constatando-se em ambas séries esqueléticas a predominância de indivíduos do sexo feminino. A análise morfológica evidenciou os caracteres discretos e métricos, bem como a estatura dos indivíduos, sendo esta última, igualmente, referida no estudo das desigualdades sociais. Por fim, o estudo paleopatológico revelou a presença de diversas alterações dentárias e ósseas, incluindo condições enquadradas nos indicadores esqueléticos de stress fisiológico. Na segunda abordagem que se centrou no objectivo específico desta investigação, os indicadores de estatuto social – local de inumação, caixão e espólio votivo – mostraram uma associação dos indivíduos com o seu estatuto socioeconómico clara e inequívoca, enquanto os indicadores esqueléticos de stress fisiológico – crescimento, estatura, cáries, perda de dentes ante mortem, hiperostose porótica, cribra orbitalia, hipoplasias lineares do esmalte dentário, formação de osso novo bilateral nas tíbias, fracturas, osteoartrose, discartrose, alterações nas áreas das enteses e DISH – revelaram que a sua interpretação é muito complexa. Concluiu-se que a interpretação das desigualdades sociais na saúde com base em indicadores de estatuto biológico deve ser prudente, já que não é evidente uma associação ii directa com o estatuto socioeconómico dos indivíduos. Esta investigação corroborou a informação histórica e arqueológica que permite aludir ao estatuto socioeconómico dos indivíduos destas séries esqueléticas, mas a associação deste estatuto a uma saúde diferenciada entre grupos revelou-se inconclusiva.

Maneio do cão geriátrico nas 48 horas pós-cirúrgicas

Dissertação de Mestrado Integrado em Medicina Veterinária

A constructivist grounded theory of firefighter perceptions of stress, coping and the relationship to health

This qualitative research was a constructivist grounded theory designed to develop an understanding of how firefighters perceive and cope with stressful situations and the impact this has on their perceptions of health. This study was framed in a social ecological perspective with the community of firefighting providing the environment within which to explore stress and coping. Of particular concern here are the stressors associated with firefighting. Prior research with firefighters has often been epidemiological and statistical in nature, focusing on measures of cardiovascular disease, cancer, and depression (Baker & Williams, 2001 ; Brown et al., 2002; Murphy et al.,1999; Regehr et al., 2002; Regehr et al., 2003). Qualitative research examining the perception of stress among firefighters that includes personal stories allows firefighters the opportunity to describe what it is like to be met with physically and mentally challenging situations on a daily basis. Twelve in-depth, semi-structured, face-to-face interviews with a brief questionnaire were conducted with firefighters from a Southern Ontario Fire Department. Four main themes emerged describing the persona of the firefighter, the stressors of firefighters, coping strategies of firefighters, and firefighters' perceptions of health. Stressors include requirements of the job, traumatic calls, tensions with co-workers, the struggle between the family at home and the family at work, political stressors with the City, and the inner struggle. Avoidance coping, approach coping, and gaining perspective emerged as the three coping styles of firefighters. Health was defined as including physical, mental, social and spiritual aspects. A model of the findings is provided that depicts the cyclical nature of the stress-coping-health relationship among firefighters.

Les effets d’un traitement au corticostérone sur la transmission dopaminergique mésocorticale du rat en période de stress

L’axe hypothalamo-hypophyso-surrénalien joue un rôle essentiel dans l’adaptation et la réponse au stress. Toutefois, l’hyperactivation de cet axe ou des niveaux chroniquement élevés de glucocorticoïdes (GC) entraînent des conséquences pathologiques. Le système dopaminergique mésocortical, qui se projette dans le cortex préfrontal médian (CPFm), joue un rôle adaptatif en protégeant contre le stress. Jusqu’à présent, les interactions fonctionnelles entre les GC (ex : corticostérone) et le système dopaminergique mésocortical ne sont pas élucidées. Dans ce mémoire, nous avons évalué les effets des GC sur les fonctions dopaminergiques préfrontales en élevant chroniquement, à l’aide de minipompes osmotiques, les niveaux de corticostérone aux concentrations physiologiques maximales (1 mg/kg/h pendant 7 jours). Ce traitement n’a pas modifié significativement, chez les rats stressés ou non, les niveaux post mortem de dopamine et de son métabolite dans le tissu du CPFm. Toutefois, l’évaluation par voltamétrie in vivo des changements de dopamine extracellulaire dans le CPFmv a permis d’observer que la corticostérone augmente significativement la libération de dopamine en réponse à l’exposition à l’odeur de renard et au pincement de la queue. Nos études nous permettent de conclure que la corticostérone potentialise la fonction dopaminergique mésocorticale qui, à son tour, facilite la régulation négative en période de stress.

Inflammation, stress oxydant, profil métabolique : influence des apports alimentaires et de la dépense énergétique

Le risque cardiométabolique (RCM) représente l’ensemble de tous les facteurs de risque pour les maladies cardiovasculaires et le diabète de type 2, incluant les facteurs de risque traditionnels et ceux émergents. Les évidences indiquent que la résistance à l’insuline, l’inflammation et le stress oxydant jouent un rôle clé dans le RCM, bien que l’acteur initiateur des altérations métaboliques caractéristiques du RCM reste encore à définir. Les femmes post-ménopausées constituent un sous-groupe important de la population puisque le risque de complications cardiométaboliques augmente après la ménopause. Les facteurs de RCM peuvent être modulés par l’alimentation, l’activité physique et la perte de poids. Alors que l’étude de nutriments / aliments spécifiques a permis de mieux comprendre l’implication de l’alimentation dans le RCM, celle de la qualité de l’alimentation est prometteuse. L’activité physique a des effets bénéfiques sur le RCM bien démontrés chez des personnes actives. Cependant, la relation entre la dépense énergétique et le RCM chez des individus sédentaires a été moins investiguée. De même, peu ou pas de données existent quant à une interaction synergique possible entre l’alimentation et l’activité physique sur le RCM. L’objectif de la présente thèse est d’investiguer les relations entre l’alimentation, l’activité physique, le stress oxydant et le RCM chez des femmes post-ménopausées en surpoids ou obèses, sédentaires et sans autres complications métaboliques. Les résultats montrent que d’une part, chez ces femmes sédentaires, une dépense énergétique active (DÉAP) élevée est associée à un meilleur profil inflammatoire, indépendamment de l’adiposité. D’autre part, il existe une relation synergique entre la qualité alimentaire et la DÉAP associée à un meilleur RCM. Une qualité alimentaire élevée combinée à une DÉAP élevée est associée à un meilleur profil lipidique et lipoprotéique et à une inflammation sub-clinique moindre, indépendamment de l’adiposité. Par ailleurs, dans une étude pilote, seuls des effets indépendants des changements de la qualité alimentaire et de la DÉAP sur les changements dans les facteurs de RCM ont été observés suite à cette diète hypocalorique de 6 mois, indépendamment du changement de l’adiposité encouru. En effet, au-delà de la réduction de l’adiposité et de l’amélioration du profil lipoprotéique induites par l’intervention, l’amélioration de la qualité alimentaire et de la DÉAP est associée, indépendamment l’une de l’autre, à une meilleure pression artérielle et un meilleur profil lipidique. Par ailleurs, une modification du système glutathion, un des systèmes antioxydants les plus communs de l’organisme, est associée à un RCM élevé. Une activité élevée de la glutathion peroxydase est associée à une résistance à l’insuline et à une épaisseur plus importante de l’intima-media de la carotide. Ces relations pourraient être médiées par un stress réducteur. En conclusion, l’adoption d’une saine alimentation et la pratique d’activités physiques doivent être encouragées dans les interventions visant à contrer l’obésité et ses complications, même en absence d’un changement d’adiposité. D’autre part, l’activité de la glutathion peroxydase pourrait être un paramètre impliqué dans le développement de désordres cardiométaboliques sub-cliniques et asymptomatiques chez des femmes obèses. D’autres investigations sont requises pour confirmer ces observations et élucider les mécanismes d’action impliqués.

Dissection moléculaire de la sénescence cellulaire induite par le stress et la thérapie dans le cancer de l’ovaire et son impact sur la réponse des patientes

Le cancer de l’ovaire (COv) est le cancer gynécologique le plus létal chez la femme et les traitements existants, chirurgie et chimiothérapie, ont peu évolué au cours des dernières décennies. Nous proposons que la compréhension des différents destins cellulaires tels que la sénescence que peuvent choisir les cellules du cancer de l’ovaire en réponse à la chimiothérapie pourrait conduire à de nouvelles opportunités thérapeutiques. La sénescence cellulaire a été largement associée à l’activité de la protéine TP53, qui est mutée dans plus de 90% des cas de cancer de l’ovaire séreux de haut grade (COv-SHG), la forme la plus commune de la maladie. Dans nos travaux, à partir d’échantillons dérivés de patientes, nous montrons que les cultures primaires du cancer de l’ovaire séreux de haut grade exposées au stress ou à des drogues utilisées en chimiothérapie entrent en senescence grâce à l’activité d’un isoforme du gène CDKN2A (p16INK4A). Dans ces cellules, nous avons évalué les caractéristiques fondamentales de la sénescence cellulaire tels que les altérations morphologiques, l’activité béta galactosidase associée à la sénescence, les dommages à l’ADN, l’arrêt du cycle cellulaire et le phénotype sécrétoire associé à la sénescence. En utilisant des micromatrices tissulaires construites à partir d’échantillons humains de COv-SHG pré- et post-chimiothérapie, accompagnées de leurs données cliniques, nous avons quantifié des marqueurs de sénescence incluant une diminution de la prolifération cellulaire quelques semaines après chimiothérapie. De façon intéressante, l’expression de p16INK4A dans les échantillons de COv-SHG prétraitement corrèle avec une survie prolongée des patientes suite au traitement. Ceci suggère ainsi pour la première fois un impact biologique bénéfique pour la présence de cellules cancéreuses qui sont capable d’activer la sénescence, particulièrement pour le traitement du cancer de l’ovaire. Dans le but de complémenter les thérapies actuelles avec des approches de manipulation pharmacologique de la sénescence, nos résultats suggèrent qu’il serait important de déterminer l’impact positif ou négatif de la sénescence induite par la thérapie sur la progression de la maladie et la survie, pour chaque type de cancer de façon indépendante.

Décès pendant une simulation médicale : perspectives des apprenants et impacts sur le stress et la performance des réanimateurs

L’acceptabilité d’un décès lors d’une simulation médicale reste débattue mais il existe peu de données sur la perspective des apprenants. Des médecins résidents ont effectué une pratique de code et ont rempli un questionnaire pré et post-simulation. Ils ont été exposés à deux scénarios où un bébé naissait sans signe de vie: 1. Nouveau-né ne répondant pas aux manœuvres de réanimation (DCD); 2. Nouveau-né s’améliorant avec une réanimation adéquate (REA). Les performances étaient évaluées à l’aide de la grille standardisée du Programme de Réanimation Néonatale. Le stress objectif (cortisol salivaire) et subjectif a été mesuré après le code. La rétroaction («feedback»), individuelle et en groupe, fut analysée à l’aide de méthodologies qualitatives. 59/62 apprenants ont répondu au questionnaire et 42 ont participé à la simulation. Tous les résidents trouvent les simulations bénéfiques et souhaitent y être exposés davantage. Le type et l’ordre des scénarios n’ont pas eu d’impact sur la performance. Un seul résident a interrompu les manœuvres de réanimation après 10 minutes d’asystolie, tel que recommandé, et 31% ont poursuivi après 20 minutes. Les participants trouvaient le scénario DCD plus stressant. Les niveaux de cortisol salivaire ont augmenté après les simulations (p<0.001) et ce, pour les deux scénarios. Cette augmentation était indépendante du scénario (p=0.06) et n’était pas associée à la performance. Les réponses à la question « Comment a été votre expérience? », ont permis d’identifier deux thèmes: 1. Le mannequin ne meurt pas en simulation médicale; 2. Le décès lors de la simulation signifie une réanimation inadéquate. Le décès lors d’une pratique de code est stressant, mais n’interfère pas avec la performance des soignants. Les apprenants trouvent cet exercice acceptable et bénéfique à leur pratique future.

Acute salinity stress alters the haemolymph metabolic profile of Penaeus monodon and reduces immunocompetence to white spot syndrome virus infection

Influence of acute salinity stress on the immunological and physiological response of Penaeus monodon to white spot syndrome virus (WSSV) infection was analysed. P. monodon maintained at 15‰ were subjected to acute salinity changes to 0‰ and 35‰ in 7 h and then challenged orally with WSSV. Immune variables viz., total haemocyte count, phenol oxidase activity (PO), nitroblue tetrazolium salt (NBT) reduction, alkaline phosphatase activity (ALP), acid phosphatase activity (ACP) and metabolic variables viz., total protein, total carbohydrates, total free amino acids (TFAA), total lipids, glucose and cholesterol were determined soon after salinity change and on post challenge days 2 (PCD2) and 5 (PCD5). Acute salinity change induced an increase in metabolic variables in shrimps at 35‰ except TFAA. Immune variables reduced significantly (Pb0.05) in shrimps subjected to salinity stress with the exception of ALP and PO at 35‰ and the reduction was found to be more at 0‰. Better performance of metabolic and immune variables in general could be observed in shrimps maintained at 15‰ that showed significantly higher post challenge survival following infection compared to those under salinity stress. Stress was found to be higher in shrimps subjected to salinity change to lower level (0‰) than to higher level (35‰) as being evidenced by the better immune response and survival at 35‰. THC (Pb0.001), ALP (Pb0.01) and PO (Pb0.05) that together explained a greater percentage of variability in survival rate, could be proposed as the most potential health indicators in shrimp haemolymph. It can be concluded from the study that acute salinity stress induces alterations in the haemolymph metabolic and immune variables of P. monodon affecting the immunocompetence and increasing susceptibility to WSSV, particularly at low salinity stress conditions

A specific group of genes respond to cold dehydration stress in cut Alstroemeria flowers whereas ambient dehydration stress accelerates developmental senescence expression patterns

Petal development and senescence entails a normally irreversible process. It starts with petal expansion and pigment production, and ends with nutrient remobilization and ultimately cell death. In many species this is accompanied by petal abscission. Post-harvest stress is an important factor in limiting petal longevity in cut flowers and accelerates some of the processes of senescence such as petal wilting and abscission. However, some of the effects of moderate stress in young flowers are reversible with appropriate treatments. Transcriptomic studies have shown that distinct gene sets are expressed during petal development and senescence. Despite this, the overlap in gene expression between developmental and stress-induced senescence in petals has not been fully investigated in any species. Here a custom-made cDNA microarray from Alstroemeria petals was used to investigate the overlap in gene expression between developmental changes (bud to first sign of senescence) and typical post-harvest stress treatments. Young flowers were stressed by cold or ambient temperatures without water followed by a recovery and rehydration period. Stressed flowers were still at the bud stage after stress treatments. Microarray analysis showed that ambient dehydration stress accelerates many of the changes in gene expression patterns that would normally occur during developmental senescence. However, a higher proportion of gene expression changes in response to cold stress were specific to this stimulus and not senescence related. The expression of 21 transcription factors was characterized, showing that overlapping sets of regulatory genes are activated during developmental senescence and by different stresses.

Evidence for interplay between genes and maternal stress in utero: monoamine oxidase A polymorphism moderates effects of life events during pregnancy on infant negative emotionality at 5 weeks

The low activity variant of the monoamine oxidase A (MAOA) functional promoter polymorphism, MAOA-LPR, in interaction with adverse environments (G × E) is associated with child and adult antisocial behaviour disorders. MAOA is expressed during foetal development so in utero G × E may influence early neurodevelopment. We tested the hypothesis that MAOA G × E during pregnancy predicts infant negative emotionality soon after birth. In an epidemiological longitudinal study starting in pregnancy, using a two stage stratified design, we ascertained MAOA-LPR status (low vs. high activity variants) from the saliva of 209 infants (104 boys and 105 girls), and examined predictions to observed infant negative emotionality at 5 weeks post-partum from life events during pregnancy. In analyses weighted to provide estimates for the general population, and including possible confounders for life events, there was an MAOA status by life events interaction (P = 0.017). There was also an interaction between MAOA status and neighbourhood deprivation (P = 0.028). Both interactions arose from a greater effect of increasing life events on negative emotionality in the MAOA-LPR low activity, compared with MAOA-LPR high activity infants. The study provides the first evidence of moderation by MAOA-LPR of the effect of the social environment in pregnancy on negative emotionality in infancy, an early risk for the development of child and adult antisocial behaviour disorders.

Cognitive emotion regulation as a mediator between posttraumatic stress symptoms and hypomanic personality within a non-clinical population

Background: There is a high prevalence of traumatic life events within individuals diagnosed with bipolar disorder. However, currently there is limited theoretical understanding of this relationship. Aims: To explore whether non-clinical symptoms of posttraumatic stress have a direct effect on the non-clinical symptoms of bipolar disorder, or whether this relationship is mediated by cognitive emotion regulation strategies. Method: A cross-sectional design within non-clinical participants completing an online survey including the Impact of Events Scale, Cognitive Emotion Regulation Questionnaire and the Hypomanic Personality Scale. Results: Posttraumatic stress symptoms were associated with hypomanic personality. Intrusive memories contributed a small but significant proportion of the variance between these two measures. Rumination of negative emotions mediated the relationship between posttraumatic stress and hypomanic personality. Conclusions: The relationship between traumatic events and an increased prevalence of bipolar disorder remains poorly understood. Further research should explore rumination as a potential target for treatment within those suffering from both posttraumatic stress and bipolar disorder.

Effects of oxidative stress on the cardiac myocyte proteome: modifications to peroxiredoxins and small heat shock proteins

Endogenous oxidative stress is a likely cause of cardiac myocyte death in vivo. We examined the early (0-2 h) changes in the proteome of isolated cardiac myocytes from neonatal rats exposed to H2O2 (0.1 mM), focussing on proteins with apparent molecular masses of between 20 and 30 kDa. Proteins were separated by two-dimensional gel electrophoresis (2DGE), located by silver-staining and identified by mass spectrometry. Incorporation of [35S]methionine or 32Pi was also studied. For selected proteins, transcript abundance was examined by reverse transcriptase-polymerase chain reaction. Of the 38 protein spots in the region, 23 were identified. Two families showed changes in 2DGE migration or abundance with H2O2 treatment: the peroxiredoxins and two small heat shock protein (Hsp) family members: heat shock 27 kDa protein 1 (Hsp25) and alphaB-crystallin. Peroxiredoxins shifted to lower pI values and this was probably attributable to 'over-oxidation' of active site Cys-residues. Hsp25 also shifted to lower pI values but this was attributable to phosphorylation. alphaB-crystallin migration was unchanged but its abundance decreased. Transcripts encoding peroxiredoxins 2 and 5 increased significantly. In addition, 10 further proteins were identified. For two (glutathione S-transferase pi, translationally-controlled tumour protein), we could not find any previous references indicating their occurrence in cardiac myocytes. We conclude that exposure of cardiac myocytes to oxidative stress causes post-translational modification in two protein families involved in cytoprotection. These changes may be potentially useful diagnostically. In the short term, oxidative stress causes few detectable changes in global protein abundance as assessed by silver-staining.

Sympatistress : En kvalitativ intervjustudie om socialarbetares upplevelser av sekundär traumatisk stress och utbrändhet

The purpose of the study is to investigate social workers experiences of compassion fatigue as well as their thoughts about health and risk factors in the area. The method used is a qualitative interview study in which eight social workers, investigating child welfare matters, were individually interviewed. The study shows that most of the social workers describe their own experiences of burnout but not of secondary traumatic stress. The most important support for not suffer from compassion fatigue is to be supported and the possibility to ventilate with colleagues and managers. However, the social workers consider that the risk of burnout is primarily due to a heavy workload in terms of the number of cases and high staff turnover. Finally, the study indicates that social workers do not have experience of secondary traumatic stress because they are using tools that prevent this. However, the risk of experiencing burnout is high since they have not found strategies for managing workplace stress.

Additive effect of interferential therapyover pelvic floor exercise alone in the treatment of female urinary stress and urge incontinence: A randomized controlled trial

This pilot study attempted to examine the additional efficacy of interferential therapy in reducing the symptoms of urinary stress and urge incontinence. Twenty-four subjects were randomly allocated to the experimental group, which received interferential therapy plus pelvic floor exercises, or the control group, which received pelvic floor exercises only. Treatment was given three times a week for 4 weeks. Subjects were given urinary diaries to record urinary symptoms (including frequency of passing urine and number of times woken by desire to pass urine) for 5 days prior to and after treatment. Perineometer readings, pad weighing test and start/stop test were also performed in a physiotherapy clinic before and at completion of treatment regimes. Significant improvements were observed in all the outcome variables in the experimental group, but in only the perineometer readings in controls. When the changes from pre- to post-treatment were compared between the two groups, four of the dependent variables did not reach statistical significance. Power analysis indicated that the sample size for each group needed to be 70 for all results to be statistically significant. This study shows that interferential therapy plus pelvic floor exercise appears to be a more effective treatment modality than pelvic floor muscle strengthening exercise alone for incontinence, but a larger trial with longer followup is needed before definitive conclusions can be reached.

Evaluation of a stress management course in adult education centres in rural Australia

Objective: To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression.

Design: Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up.

Setting and participants: One hundred and thirty-two adults (age range 18–73 years) living in a rural community who self-enrolled in the stress management course at adult education centres.

Intervention: The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress.

Main outcome measures: Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale).

Results: Results indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001).

Conclusion: Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.