Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study

Background: Adjustment disorders (also known as mental distress in response to a stressor) are among the most frequently diagnosed mental disorders in psychiatry and clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate self-harm and in those consulting general practitioners. However, their reputation in research-oriented mental health remains weak since they are largely underresearched. This may change when the International Statistical Classification of Diseases-11 (ICD-11) by the World Health Organization is introduced, including a new conceptualization of adjustment disorders as a stress-response disorder with positively defined core symptoms. Objective: This paper provides an overview of evidence-based interventions for adjustment disorders. Methods: We reviewed the new ICD-11 concept of adjustment disorder and discuss the the rationale and case study of an unguided self-help protocol for burglary victims with adjustment disorder, and its possible implementation as an eHealth intervention. Results: Overall, the treatment with the self-help manual reduced symptoms of adjustment disorder, namely preoccupation and failure to adapt, as well as symptoms of depression, anxiety, and stress. Conclusions: E-mental health options are considered uniquely suited for offering early intervention after the experiences of stressful life events that potentially trigger adjustment disorders.

Dimensional approaches to schizophrenia: A comparison of the Bern Psychopathology scale and the five-factor model of the Positive and Negative Syndrome Scale

The aim was to examine to what extent the dimensions of the BPS map the five factors derived from the PANSS in order to explore the level of agreement of these alternative dimensional approaches in patients with schizophrenia. 149 inpatients with schizophrenia spectrum disorders were recruited. Psychopathological symptoms were assessed with the Bern Psychopathology Scale (BPS) and the Positive and Negative Syndrome Scale (PANSS). Linear regression analyses were conducted to explore the association between the factors and the items of the BPS. The robustness of patterns was evaluated. An understandable overlap of both approaches was found for positive and negative symptoms and excitement. The PANSS positive factor was associated with symptoms of the affect domain in terms of both inhibition and disinhibition, the PANSS negative factor with symptoms of all three domains of the BPS as an inhibition and the PANSS excitement factor with an inhibition of the affect domain and a disinhibition of the language and motor domains. The results show that here is only a partial overlap between the system-specific approach of the BPS and the five-factor PANSS model. A longitudinal assessment of psychopathological symptoms would therefore be of interest.

Ethnic differences in adolescents' mental distress

Objectives. The aims of this cross-sectional study were to (1) examine differences among four ethnic groups of middle school students (Anglos, African Americans [AAs], Hispanics, and Asians) on (a) three indicators of mental distress (depression, somatic symptoms, suicidal ideation) (b) social stress (general social stress, process-oriented stress, discrimination) and resources (family relationships, coping, self-esteem) and (2) identify significant risk factors and resources for each ethnic group by examining the moderating effects of ethnicity. ^ Methods. Respondents included 316 students from three schools (144 Anglos, 66 AAs, 77 Hispanics, 29 Asians/Others) who completed self-administered questionnaires. Social stress and somatic symptoms were measured by using the SAFE-C and Somatic Symptom Scale, respectively. The DSD was used to assess depression and suicidal ideation. Resources were measured by using the FES, age-appropriate adaptations of two existing coping scales, and Rosenberg's Self-Esteem Scale. For specific aims, descriptive statistics, ANOVA, ANCOVA, and logistic regression analysis were used. ^ Findings. No statistically significant ethnic group or gender differences were observed in depression and somatic symptoms, but the odds of experiencing depression symptoms were about 9.7 times greater for Hispanic females than for the referent group, Anglo males. Hispanics were also 2.04 times more likely to have suicidal ideation than Anglos ( P < 0.05). AAs and Hispanics reported significantly higher levels of stress than Anglos (OR: 2.2���4.3, 0.00 ��� P ��� 0.03). These findings imply that adolescents in these ethnic groups may be exposed to considerable amounts of stress even if they do not exhibit significant symptoms of mental distress yet. Negative moderating effects for ethnicity were found by the significant interaction between ethnicity and social stress in somatic symptoms among AAs and Hispanics. This finding indicates that AA and Hispanic adolescents may require higher levels of social stress to exhibit the same amount of somatic symptoms as Anglo adolescents. Observed ethnic differences in social stress and interaction between social stress and ethnicity in relation to somatic symptoms demonstrated a need for subsequent longitudinal studies, and provided a rationale for incorporating social stress as a critical component not only in research but also in culturally sensitive prevention programs. ^

Depressive symptoms and sexual risk behaviors in adolescents

The purpose of this study was to determine whether depression is a factor in explaining the difference in sex behaviors among adolescents with different ethnic backgrounds, family and school contexts. We hypothesize that adolescents with a higher number of depressive symptoms are more likely to engage in sexual risk behaviors than adolescents with fewer depressive symptoms. Further, adolescent depression and sexual behaviors are mediated or moderated by individual characteristics, family and school contexts. ^ Background. large ethnic disparities exist in adolescent engagement in risky sexual behaviors, yet, there is little in the literature that explains these disparities. Studies of sexual behavior of youths abound; yet, there is little literature on the prevalence and correlates of depression or the association between depression and sexual behaviors among different ethnic groups. Objectives. (1) To determine ethnic differences in the prevalence of depressive symptoms using data collected through the National Longitudinal Study of Adolescent Health (Add Health). (2) To determine predictors of sex risk behaviors among adolescents, including the role of depression. (3) To identify predictors of depression among these adolescents. Methods. Add Health data from wave 1 and wave 2 interviews of 7th���12th graders were analyzed using multivariate models constructed with both depression and sexual behavior as outcome variables. Logistic regression models determined whether and to what extent the independent variables, including depression, sex behaviors, demographic factors, individual and family characteristics, and school context were related to the probability of engaging in risky sexual behaviors. Results. Ethnic differences in depressive symptoms did not persist after demographic and contextual variables were included in the model. Sex behaviors all shared the hypothesized relationship with depressive symptoms. The odds of risky sex behaviors increased as number of depressive symptoms increased. Depression was predicted by marijuana use and having a serious argument with father for males at Wave 1 and by age and future orientation for females. Wave 2 depression was predicted by Wave 1 depression. ^

Persisting abdominal symptoms after travelers' diarrhea: Is there a genetic predisposition?

Functional gastrointestinal disorders (FGIDs) are defined as ailments of the mid or lower gastrointestinal tract which are not attributable to any discernable anatomic or biochemical defects.1 FGIDs include functional bowel disorders, also known as persisting abdominal symptoms (PAS). Irritable bowel syndrome (IBS) is one of the most common illnesses classified under PAS.2,3 This is the first prospective study that looks at the etiology and pathogenesis of post-infectious PAS in the context of environmental exposure and genetic susceptibility in a cohort of US travelers to Mexico. Our objective was to identify infectious, genetic and environmental factors that predispose to post infectious PAS. ^ Methods. This is a secondary data analysis of a prospective study on a cohort of 704 healthy North American tourists to Cuernavaca, Morelos and Guadalajara, Jalisco in Mexico. The subjects at risk for Travelers' diarrhea were assessed for chronic abdominal symptoms on enrollment and six months after the return to the US. ^ Outcomes. PAS was defined as disturbances of mid and lower gastrointestinal system without any known pathological or radiological abnormalities, or infectious, or metabolic causes. It refers to functional bowel disease, category C of functional gastrointestinal diseases as defined by the Rome II criterion. PAS was sub classified into Irritable bowel syndrome (IBS) and functional abdominal disease (FAD). ^ IBS is defined as recurrent abdominal pain or discomfort present at least 25% and associated with improvement with defecation, change in frequency and form of stool. FAD encompasses other abdominal symptoms of chronic nature that do not meet the criteria for IBS. It includes functional diarrhea, functional constipation, functional bloating: and unspecified bowel symptoms. ^ Results. Among the 704 travelers studied, there were 202 cases of PAS. The PAS cases included 175 cases of FAD and 27 cases of IBS. PAS was more frequent among subjects who developed traveler's diarrhea in Mexico compared to travelers who remained healthy during the short term visit to Mexico (52 vs. 38; OR = 1.8; CI, 1.3���2.5, P < 0.001). A statistically significant difference was noted in the mean age of subjects with PAS compared to healthy controls (28 vs. 34 yrs; OR = 0.97, CI, 0.95���0.98; P < 0.001). Travelers who experienced multiple episodes, a later onset of diarrhea in Mexico and passed greater numbers of unformed stools were more likely to be identified in PAS group at six months. Participants who developed TD caused by enterotoxigenic E.coli in Mexico showed a 2.6 times higher risk of developing FAD (P = 0.003). Infection with Providencia ssp. also demonstrated a greater risk to developing PAS. Subjects who sought treatment for diarrhea while in Mexico also displayed a significantly lower frequency of IBS at six months follow up (OR = 0.30; CI, 0.10���0.80; P = 0.02). ^ Forty six SNPs belonging to 14 genes were studied. Seven SNPs were associated with PAS at 6 months. These included four SNPs from the Caspase Recruitment Domain-Containing Protein 15 gene (CARD15), two SNPs from Surfactant Pulmonary-Associated Protein D gene (SFTPD) and one from Decay-Accelerating Factor For Complement gene (CD55). A genetic risk score (GRS) was composed based on the 7 SNPs that showed significant association with PAS. A 20% greater risk for PAS was noted for every unit increase in GRS. The risk increased by 30% for IBS. The mean GRS was high for IBS (2.2) and PAS (1.1) compared to healthy controls (0.51). These data suggests a role for these genetic polymorphisms in defining the susceptibility to PAS. ^ Conclusions. The study allows us to identify individuals at risk for developing post infectious IBS (PI-IBS) and persisting abdominal symptoms after an episode of TD. The observations in this study will be of use in developing measures to prevent and treat post-infectious irritable bowel syndrome among travelers including pre-travel counseling, the use of vaccines, antibiotic prophylaxis or the initiation of early antimicrobial therapy. This study also provides insights into the pathogenesis of post infectious PAS and IBS. (Abstract shortened by UMI.)^

Frequency, severity and distress of dialysis-related symptoms reported by patients on hemodialysis

Purpose. To determine which symptoms are the most reported, occur most frequently, have the greatest severity, and cause the most bother for hemodialysis (HD) patients and to determine if the symptoms experienced differ between the first (HD 1) and second (HD 2) treatments of the week. ^ Design. An observational, comparative design was used to determine participants' HD symptoms experience on HD 1 and HD 2, and the effect of the symptom experience on Quality of Life (QOL). One hundred subjects were recruited from five dialysis centers. ^ Methods. The adapted Dialysis Frequency, Severity and Symptom Burden Index (DFSSBI) and the Medical Outcomes Study Short Form 36 (MOS SF 36) were administered (N = 99) on HD 1 and the DFSSBI again on HD 2. Data were analyzed for significance among symptoms experience test scores in relation to HD 1 and HD 2, QOL, and gender and age. ^ Results. Of 31 symptoms assessed, respondents reported an average of 9.69 symptoms on HD 1 and 7.51 symptoms on HD 2. Overall, more symptoms were reported, and were more frequent, severe and bothersome on HD 1 when the level of metabolic waste is highest. The most reported symptoms included tiredness, dry skin, difficulty falling asleep, itching, numbness/tingling, difficulty staying asleep, decreased interest in sex, and bone/joint pain. Females scored consistently higher than males in the four symptom dimensions. The respondents reported about the same as the population norm (50) on the physical component summary score of the MOS SF 36 and higher than the norm (65.23) on the mental component summary score. ^ Conclusion. The study findings highlighted the fact that hemodialysis patients experience multiple symptoms that can be frequent, severe, and bothersome. Interventions should be developed and tested to reduce symptom burden and improve QOL. ^

Psychosocial factors and musculoskeletal symptoms in a vulnerable working population in Nicaragua

This research is a secondary data analysis of the CUPID-INCA Nicaragua study, a cross-sectional study comparing psychosocial and physical factors on musculoskeletal symptoms among nurses, office workers and maquiladoras in Nicaragua. There were three objectives for this thesis. (1) To describe the study population according to their socio-demographic, psychosocial (i.e. work organization and health beliefs) and physical factors. (2) To estimate the prevalence of musculoskeletal disorders (MSDs) in the study population (nurses, office workers and maquilas). (3) To analyze and compare the trends of association between psychosocial factors and MSDs to that of physical factors and MSDs in the study population. Trends of association between MSDs and psychosocial factors were also compared between nurses, office workers and maquilas. ^ Majority of the total study population were females, middle aged, non smokers and had been on the job for more than five years. Prevalence rates of low back pain and upper extremity pain were 28% and 37% respectively in nurses, 17% and 34% in office workers and 18% and 31% in maquilas. Workers' health belief was significantly associated with MSDs in all three occupational groups. Psychosocial factors were not consistently associated more with MSDs than physical factors. Maquilas had more psychosocial factors statistically significantly associated with musculoskeletal symptoms than nurses and office workers. ^ The findings of this research suggest that both psychosocial and physical risk factors play a role on the prevalence of musculoskeletal symptoms in the three working populations in Nicaragua. Future research in this area should explore further, the risk of developing MSDs from workers' exposure to psychosocial factors as well as physical factors.^

INTERVEN����ES L��DICAS COM M��ES DE REC��M-NASCIDOS PR��-TERMO HOSPITALIZADOS

Esta pesquisa investiga a influ��ncia de interven����es l��dicas na diminui����o da ansiedade materna com m��es de rec��m-nascidos pr��-termo hospitalizados, em um hospital universit��rio da Grande S��o Paulo. S��o estudadas 30 m��es que tiveram parto prematuro, com faixa et��ria entre 16 e 40 anos e escolaridade at�� 2�� grau, por meio de estudo avaliativo-interventivo-evolutivo. Inicia-se por uma entrevista psicol��gica semidirigida, com o objetivo de tra��ar o hist��rico gestacional, seguida de aplica����o da Escala de Ansiedade, Depressão e Irritabilidade IDA, visando identificar o n��vel de ansiedade materna e do Invent��rio de Percep����o Neonatal IPN-I para verificar a expectativa das m��es em rela����o ao comportamento de choro, alimento e v��mito de seus beb��s pr��-termo. A seguir s��o efetuadas interven����es grupais l��dicas em 16 encontros, um a cada semana, de 60 minutos, segundo modelo piagetiano, que estimula processos afetivosemocionais e cognitivos. Os dados relativos ao hist��rico gestacional revelam que 75% das m��es encontram-se na segunda gesta����o e j�� sofreram aborto ou ��bito fetal; t��m ida de gestacional m��dia de 31 semanas; peso m��dio do beb�� ao nascer de 1.640g. e tempo de interna����o m��dio de 39,93 dias. Na an��lise do IDA em rela����o �� ansiedade, 75% delas apresentam escore de alta intensidade (11,25), tamb��m alto quanto �� depressão (10); o escore m��dio (3,73) da irritabilidade exteriorizada acompanha o da irritabilidade interiorizada (3,23). A correla����o entre depressão e ansiedade indica que uma rea����o emocional segue a outra, n��o havendo diferen��a significativa importante entre ambas (p=0,306). O IPN-I comprova que as 30 m��es t��m expectativas em rela����o ao pr��prio filho similares aos beb��s em geral, mostrando escores m��dios de 8,63 e 9,20, respectivamente, confirmados pelo escore 10,0 apontado em 75% da amostra, o que configura uma alta expectativa quanto aos aspectos de sono, alimenta����o e v��mito dos beb��s. A an��lise qualitativa revela que a cria����o de grupos l��dicos mostra-se favor��vel, com alta ades��o e motiva����o das m��es, favorecendo a diminui����o da ansiedade, a adapta����o �� realidade vivida e a intera����o m��e-beb�� de forma saud��vel durante a interna����o. O estudo apresenta a trajet��ria interventiva de tr��s casos emblem��ticos de diferentes n��veis de ansiedade, ilustrando esta evolu����o. Estes dados sugerem que esta modalidade de interven����o caracterize-se como uma medida de preven����o, promo����o e preserva����o da sa��de f��sica e ps��quica da m��e e do rec��mnascido prematuro, com repercuss��es na fam��lia e na sociedade.(AU)

INTERVEN����ES L��DICAS COM M��ES DE REC��M-NASCIDOS PR��-TERMO HOSPITALIZADOS

Esta pesquisa investiga a influ��ncia de interven����es l��dicas na diminui����o da ansiedade materna com m��es de rec��m-nascidos pr��-termo hospitalizados, em um hospital universit��rio da Grande S��o Paulo. S��o estudadas 30 m��es que tiveram parto prematuro, com faixa et��ria entre 16 e 40 anos e escolaridade at�� 2�� grau, por meio de estudo avaliativo-interventivo-evolutivo. Inicia-se por uma entrevista psicol��gica semidirigida, com o objetivo de tra��ar o hist��rico gestacional, seguida de aplica����o da Escala de Ansiedade, Depressão e Irritabilidade IDA, visando identificar o n��vel de ansiedade materna e do Invent��rio de Percep����o Neonatal IPN-I para verificar a expectativa das m��es em rela����o ao comportamento de choro, alimento e v��mito de seus beb��s pr��-termo. A seguir s��o efetuadas interven����es grupais l��dicas em 16 encontros, um a cada semana, de 60 minutos, segundo modelo piagetiano, que estimula processos afetivosemocionais e cognitivos. Os dados relativos ao hist��rico gestacional revelam que 75% das m��es encontram-se na segunda gesta����o e j�� sofreram aborto ou ��bito fetal; t��m ida de gestacional m��dia de 31 semanas; peso m��dio do beb�� ao nascer de 1.640g. e tempo de interna����o m��dio de 39,93 dias. Na an��lise do IDA em rela����o �� ansiedade, 75% delas apresentam escore de alta intensidade (11,25), tamb��m alto quanto �� depressão (10); o escore m��dio (3,73) da irritabilidade exteriorizada acompanha o da irritabilidade interiorizada (3,23). A correla����o entre depressão e ansiedade indica que uma rea����o emocional segue a outra, n��o havendo diferen��a significativa importante entre ambas (p=0,306). O IPN-I comprova que as 30 m��es t��m expectativas em rela����o ao pr��prio filho similares aos beb��s em geral, mostrando escores m��dios de 8,63 e 9,20, respectivamente, confirmados pelo escore 10,0 apontado em 75% da amostra, o que configura uma alta expectativa quanto aos aspectos de sono, alimenta����o e v��mito dos beb��s. A an��lise qualitativa revela que a cria����o de grupos l��dicos mostra-se favor��vel, com alta ades��o e motiva����o das m��es, favorecendo a diminui����o da ansiedade, a adapta����o �� realidade vivida e a intera����o m��e-beb�� de forma saud��vel durante a interna����o. O estudo apresenta a trajet��ria interventiva de tr��s casos emblem��ticos de diferentes n��veis de ansiedade, ilustrando esta evolu����o. Estes dados sugerem que esta modalidade de interven����o caracterize-se como uma medida de preven����o, promo����o e preserva����o da sa��de f��sica e ps��quica da m��e e do rec��mnascido prematuro, com repercuss��es na fam��lia e na sociedade.(AU)

Uso do protocolo no servi��o de psicologia e avalia����o psicodin��mica em candidatos �� cirurgia bari��trica

A cl��nica da Obesidade M��rbida e a Cirurgia Bari��trica exige estudos e acompanhamentos do paciente. Os benef��cios e riscos do emagrecimento por tratamento cir��rgico devem servir como ponto de alerta aos profissionais da sa��de. O uso do question��rio no servi��o de psicologia �� norteado pela escuta psicol��gica. Objetivos: 1) Descrever o perfil s��cio-demogr��fico candidatos �� cirurgia bari��trica. 2) Analisar a percep����o dos pacientes sobre caracter��sticas de personalidade associadas �� obesidade e transtornos alimentares. 3) Descrever os conte��dos psicodin��micos da narrativa do sujeito e avaliar o sistema tensional inconsciente de dois pacientes por meio do Teste das Rela����es Objetais de Phillipson (TRO). M��todo: O delineamento metodol��gico com an��lise de dados pelo m��todo epidemiol��gico e estudo de caso cl��nico, orienta����o psicanal��tica. Na primeira etapa foram consultados 300 question��rios do servi��o de psicologia e na segunda dois pacientes com ganho de peso ap��s 24 meses. S��o pacientes que procuraram tratamento em cl��nica especializada, em uma metr��pole do sudeste brasileiro, sob consentimento p��s-informado. Os question��rios foram preenchidos por 227 mulheres e 73 homens; com m��dia de idade igual a 36 anos; escolaridade ensino m��dio e superior, 53%; maioria casados; IMC entre grave e super m��rbido (94,3%). T��cnicas cir��rgicas indicadas Capella Bypass e Fobi-Capella (67%). Resultados: caracter��sticas psicol��gicas referidas pelos pacientes, a ansiedade apontou em 93,7% das respostas, seguidas por impulsividade, depressão, toler��ncia �� frustra����o, baixa auto-estima, resolvedor de problemas dos outros (mais de 50%). No hist��rico familiar da obesidade est�� em mais de 70% depressão e uso do ��lcool em 30%; realiza����o de psicoterapia (30%) e medicamentos para depressão e ansiedade (10%). Na segunda etapa, foi realizado o diagn��stico psicodin��mico, por meio do Teste das Rela����es Objetais de Phillipson com duas pacientes, cuja an��lise indicou necessidade de psicoterapia psicanal��tica, pois tinham fixa����es na posi����o esquizoparan��ide e apresentavam dificuldade em lidar com perdas e baixa motiva����o para mudan��a e insigth. Conclus��es: Com a aplica����o do question��rio e o registro das observa����es emp��ricas, este question��rio de entrevista semidirigida preenche condi����es de melhor acessar e avaliar os conte��dos revelados pelos pacientes. As contradi����es entre as respostas e o discurso, no contato individual com o psic��logo, apontam a necessidade de investimento no preparo do paciente para a cirurgia e mais acentuadamente o acompanhamento psicol��gico no primeiro ano do p��s-operat��rio. H�� um pensamento m��gico a ser trabalhado durante a aplica����o do question��rio sobre as cren��as frente �� cirurgia e o emagrecimento e assim convocar o paciente a ocupar o lugar do sujeito implicado em seu processo pr�� e p��s-operat��rio. O TRO contribuiu na compreens��o do diagn��stico psicodin��mico de pacientes com ganho de peso ap��s cirurgia e refor��ou a necessidade de maior investimento no pr��-operat��rio.(AU)

Uso do protocolo no servi��o de psicologia e avalia����o psicodin��mica em candidatos �� cirurgia bari��trica

A cl��nica da Obesidade M��rbida e a Cirurgia Bari��trica exige estudos e acompanhamentos do paciente. Os benef��cios e riscos do emagrecimento por tratamento cir��rgico devem servir como ponto de alerta aos profissionais da sa��de. O uso do question��rio no servi��o de psicologia �� norteado pela escuta psicol��gica. Objetivos: 1) Descrever o perfil s��cio-demogr��fico candidatos �� cirurgia bari��trica. 2) Analisar a percep����o dos pacientes sobre caracter��sticas de personalidade associadas �� obesidade e transtornos alimentares. 3) Descrever os conte��dos psicodin��micos da narrativa do sujeito e avaliar o sistema tensional inconsciente de dois pacientes por meio do Teste das Rela����es Objetais de Phillipson (TRO). M��todo: O delineamento metodol��gico com an��lise de dados pelo m��todo epidemiol��gico e estudo de caso cl��nico, orienta����o psicanal��tica. Na primeira etapa foram consultados 300 question��rios do servi��o de psicologia e na segunda dois pacientes com ganho de peso ap��s 24 meses. S��o pacientes que procuraram tratamento em cl��nica especializada, em uma metr��pole do sudeste brasileiro, sob consentimento p��s-informado. Os question��rios foram preenchidos por 227 mulheres e 73 homens; com m��dia de idade igual a 36 anos; escolaridade ensino m��dio e superior, 53%; maioria casados; IMC entre grave e super m��rbido (94,3%). T��cnicas cir��rgicas indicadas Capella Bypass e Fobi-Capella (67%). Resultados: caracter��sticas psicol��gicas referidas pelos pacientes, a ansiedade apontou em 93,7% das respostas, seguidas por impulsividade, depressão, toler��ncia �� frustra����o, baixa auto-estima, resolvedor de problemas dos outros (mais de 50%). No hist��rico familiar da obesidade est�� em mais de 70% depressão e uso do ��lcool em 30%; realiza����o de psicoterapia (30%) e medicamentos para depressão e ansiedade (10%). Na segunda etapa, foi realizado o diagn��stico psicodin��mico, por meio do Teste das Rela����es Objetais de Phillipson com duas pacientes, cuja an��lise indicou necessidade de psicoterapia psicanal��tica, pois tinham fixa����es na posi����o esquizoparan��ide e apresentavam dificuldade em lidar com perdas e baixa motiva����o para mudan��a e insigth. Conclus��es: Com a aplica����o do question��rio e o registro das observa����es emp��ricas, este question��rio de entrevista semidirigida preenche condi����es de melhor acessar e avaliar os conte��dos revelados pelos pacientes. As contradi����es entre as respostas e o discurso, no contato individual com o psic��logo, apontam a necessidade de investimento no preparo do paciente para a cirurgia e mais acentuadamente o acompanhamento psicol��gico no primeiro ano do p��s-operat��rio. H�� um pensamento m��gico a ser trabalhado durante a aplica����o do question��rio sobre as cren��as frente �� cirurgia e o emagrecimento e assim convocar o paciente a ocupar o lugar do sujeito implicado em seu processo pr�� e p��s-operat��rio. O TRO contribuiu na compreens��o do diagn��stico psicodin��mico de pacientes com ganho de peso ap��s cirurgia e refor��ou a necessidade de maior investimento no pr��-operat��rio.(AU)

A Meta-Analysis of the Effectiveness of Military and Veterans Affairs (VA) Combat-Related PTSD Programs

A meta-analysis was conducted to examine the effectiveness of 55 treatment outcomes reported by military and Veterans Affairs (VA) treatment centers for combat-related posttraumatic stress disorder (PTSD). The analysis includes 46 tested treatment outcomes derived from 21 psychotherapy studies, and nine tested treatment outcomes derived from seven pharmacotherapy studies, which were obtained through PsychINFO and PsychARTICLES database searches, as well as a reference search. Analysis of all treatment outcomes suggested a statistically significant, and meaningful, decrease in PTSD symptoms between baseline and post-treatment time points, t(54) = 9.27, p < .001, d = 0.35. Additionally, analysis of outcomes between psychotherapy and pharmacotherapy treatments resulted in statistically significant differences in PTSD assessment scores at post-test, indicating a greater degree of change for psychotherapy than for pharmacotherapy.

Fatores de bioconcentra����o e disponibilidade de b��rio, c��dmio, cobre, n��quel e zinco em solos e em culturas de interesse agron��mico

Os elementos potencialmente t��xicos (EPTs) est��o presentes nos solos em concentra����es dependentes do material de origem e das a����es antr��picas. A adi����o de EPTs ao solo pelas atividades antr��picas pode ocasionar risco �� sa��de humana, j�� que estes elementos podem ser acumulados no organismo por meio do contato d��rmico com o solo, da inala����o de part��culas em suspens��o, de ingest��o de solo e de alimentos contaminados. A contamina����o dos alimentos ocorre pelo cultivo em ��reas com alta biodisponibilidade de EPTs, e nessa condi����o ocorre absor����o e transloca����o para a parte a��rea, com poss��vel ac��mulo dos metais nas por����es comest��veis, como ra��zes, frutos e gr��os. A biodisponibilidade dos EPTs �� regulada pelas caracter��sticas qu��micas dos elementos e por atributos do solo, como a CTC, o pH e a mat��ria org��nica (MO). Sintomas de toxicidade e altera����es morfol��gicas e fisiol��gicas podem aparecer dependendo da absor����o e da movimenta����o dos EPTs nas plantas. Objetivou-se neste trabalho avaliar o efeito da adi����o de b��rio (Ba), de c��dmio (Cd), de cobre (Cu), de n��quel (Ni) e de zinco (Zn) em amostras de um Neossolo Quartzar��nico e um Latossolo Vermelho distr��fico, sob duas condi����es de satura����o por bases (30% e 50 ou 70%, dependendo da cultura), no cultivo de arroz (Oryza sativa), alface (Lactuca sativa), girassol (Helianthus annuus) e tomate (Solanum lycopersicum). Os EPTs nos solos foram extra��dos com EPA 3051a, ��gua R��gia, DTPA, Mehlich 1, Mehlich 3, HNO3 (0,43 mol L-1) e CaCl2 (0,01 mol L-1), e seus teores correlacionados com os presentes nas ra��zes, na parte a��rea, nos frutos e com a quantidade acumulada pelas plantas. Os fatores de bioconcentra����o (FBC) e de transfer��ncia (FT) foram calculados para as culturas. O ��ndice SPAD (Soil Plant Analysis Development - Chlorophyll Meter) foi determinado na fase vegetativa da alface, do arroz e do girassol, enquanto a atividade fotossint��tica foi determinada pelo IRGA (Infrared gas analyzer). Os maiores teores de EPTs foram observados nas plantas cultivadas no Neossolo. As quantidades de Cu, Ni e Zn acumuladas nas plantas apresentaram correla����o positiva com os teores extra��dos pelo EPA 3051a e pela ��gua R��gia. Os teores extra��dos com HNO3 (0,43 mol L-1) apresentaram elevada correla����o positiva com os teores reativos extra��dos com DTPA e com Mehlich 3, e tamb��m com as quantidades de EPTs acumuladas pelas plantas. Os FBCs foram mais altos nos solos com baixa CTC, baixos teores de MO e baixos valores de pH. O arroz apresentou a menor transloca����o de Cd do sistema radicular para os gr��os. O Cu, o Ni e o Zn causaram altera����es no desenvolvimento da alface e do girassol, e diminu��ram a transpira����o e a condut��ncia estom��tica da alface. O arroz apresentou a menor absor����o de EPTs e a maior toler��ncia ao Ba, ao Cd, ao Ni e ao Zn, no entanto, as plantas apresentaram maiores condutividade estom��tica e transpira����o.

Quantas auras deve ter um status de aura?

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Alcoolismo e perturba����o da ansiedade

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014