Psychological and Social Perspectives on Malingering and Symptom Exaggeration: Conceptualization and Interventions Using Acceptance and Commitment Therapy

Malingering and the production of false symptoms seen in such disorders as Factitious Disorder are an ongoing mystery to medical and mental health professionals. Historically, these presentations have been difficult to identify and treat. As might be expected, individuals with such symptomology rarely agree to participate in research, possibly because of a reluctance to admit to the feigning or exaggerating behaviors and a fear of reprisals. Many different etiologies have been proposed, including the assumption of roles in order to manage impressions, taking control of symptoms in order to gain attention or other rewards or avoid aversive events, and even the production of symptoms that is largely out of awareness such as is seen in conversion or somatoform presentations. By examining historical and present-day beliefs about etiology and treatment interventions, professionals can explore what new types of effective treatment might look like. The behaviorist philosophy that underlies Acceptance and Commitment Therapy proposes a perspective emphasizing effective working in context. This philosophy also suggests individuals sometimes engage in behavior in order to escape from or avoid aversive experiences. Utilizing case examples and fresh behavioral perspectives provides insight and ideas for conceptualization of these behaviors of interest. Using the above conceptualizations, an ACT based treatment of those who produce false symptoms is introduced.

Understanding Mastectomy from a Self Psychology Perspective: The Breast as a Self Object

For many women, if not all, breasts are an important component of bodyself-image; a woman may love them or dislike them, but she is rarely neutral" (Young, 2003, p.152). Breast cancer may be one of the oldest forms of cancer known to humans (American Cancer Society, 2010), and in 2008 in the United States over 182,000 women and almost 2,000 men were diagnosed with some form of breast cancer (American Cancer Society, 2008). In that same year 40,480 women and 450 men died from the disease. While any type of cancer diagnosis can instill a fear of mortality and incapacitation in the recipient, breast cancer holds a special meaning for women because of the significance placed on the breast both personally and societally. Removal of the breast tissue and muscle, or mastectomy, remains one of the primary forms of treatment for this disease. The breast plays an important role in a woman's identity, and the loss of one or both breasts due to breast cancer can have a monumental impact on her sense of self. A mastectomy affectsnot only a woman's relationship with herself, but with her family, friends, and society. It changes her outlook on life, her perception of her roles in the world, and her interest in interacting with others. Exploring these issues is important to understanding how doctors, nurses, mental health professionals, family members and support networks can best assist patients in coping with their illness. This paper attempts to understand the psychological issues and injuriesassociated with mastectomy through the lens of Self Psychology. It postulates that the breast itself is a selfobject for most women, and that its loss results in the fragmentation of the self. I will focus particularly on women between the ages of 25 and 40 years of age, in the marital and parental phases of developmental (Wolf, 1988), as the effect of a mastectomy on body image, sexuality, and genderbased roles such as motherhood has been shown to differ according to the age of the patient, with younger patients experiencing more distress (Ashing-Giwa et al, 2004).

Vulnerabilidade à queda de árvores por meio de simulações microclimáticas

Muitos são os benefícios provenientes da arborização de vias públicas, como aumento da vida útil do asfalto por meio do sombreamento, filtragem de poluentes, absorção de CO2, interceptação da água da chuva e da radiação solar e mitigação de ilhas de calor; porém, por questões culturais, é considerada muitas vezes pela população como algo negativo, cujas folhas entopem calhas, raízes destroem calçadas, troncos e folhas atrapalham fiação elétrica e, principalmente, elas estão susceptíveis às quedas. A pesquisa teve como objetivo estudar o comportamento das quedas de árvores no município de Piracicaba/SP, Brasil, com atenção especial ao regime de ventos na cidade, baseado em dados fornecidos pelo Corpo de Bombeiros de Piracicaba, Secretaria de Defesa do Meio Ambiente de Piracicaba (SEDEMA) e Estação Meteorológica da Escola Superior de Agricultura \"Luiz de Queiroz\" (ESALQ). De caráter inédito, o principal resultado foi a relação direta entre quedas e zonas urbanizadas, que, em constantes alterações no uso do solo, acabam por danificar a sustentação das árvores (raízes), fato justificado pela alta concentração de quedas na parte central (36,7%), com destaque para as estações da primavera e do verão, ou seja, ventos e chuvas, na qual, juntas, somaram 78,0% do total. O período de retorno esperado para ventos superiores a 75 km h-1, classificados como temporais na Escala de Vento de Beaufort, foi de 2,8 eventos por ano. Enquanto verificou-se o predomínio de ventos alísios de sudeste, pertencentes ao quarto quadrante, a direção das rajadas de vento teve maior variação e, assim, com predomínio daqueles ventos, é recomendável instalações de parques industriais nas zonas norte, noroeste e oeste, haja vista a importância de evitar que os poluentes adentrem a cidade. As espécies de maior vulnerabilidade foram: Pachira aquatica Aubl. (monguba), Handroanthus sp. (ipê roxo) e Tipuana tipu (Benth.) Kuntze (tipuana). Por meio de simulação microclimática computacional, utilizando o programa ENVI-met versão 3.1, em dois estudos de caso, sendo um em bairro residencial e outro na Praça José Bonifácio, foi possível identificar locais de maior atenção quanto às quedas de árvores, em função da rugosidade do local, capaz de alterar a velocidade e a direção do vento.

Los ensayos de Joaquín de Villalba (1752-1807) sobre la vacuna de la viruela en la Escuela de Veterinaria de Madrid

La rápida propagación del método empírico para combatir la viruela dado a conocer por Edward Jenner conllevó algunas dificultades. A la necesidad de obtener la máxima aceptación posible entre la población, se añadió la de ejecutar con rigor la técnica así como la de producir, transportar y conservar el fluido vacunal con garantías de calidad. Abastecerse de vacuna era una preocupación solventada en parte gracias a los envíos realizados desde instituciones radicadas en Londres o París. Tras su recepción se iniciaban cadenas de vacunaciones mediante la técnica del brazo a brazo. El temor a la extinción del fluido vacunal, no obstante, despertó el interés por la producción autóctona. Era necesario encontrar vacas afectadas por viruela vacuna o en su defecto aprender a conservar la materia vacunal en las propias vacas u otros animales. Varias iniciativas exploraron esta posibilidad. El fondo documental de la Biblioteca Nacional de España conserva un texto que refleja 2 de estos ensayos realizados en la Real Escuela Veterinaria de Madrid a cargo del médico Joaquín de Villalba y el albéitar Antonio Roura en 1802 y 1803. La tentativa no obtuvo el éxito deseado.

Aceptabilidad de la vacuna contra el virus del papiloma humano en madres de la provincia de Valencia (España)

Introducción: La Comunidad Valenciana inició en octubre del 2008 el programa de vacunación contra el virus del papiloma humano (VPH) en niñas de 14 años. El objetivo de este estudio es evaluar los conocimientos sobre la infección por VPH y su vacuna en madres de adolescentes e identificar los factores asociados a la predisposición de vacunar a sus hijas. Material y métodos: Estudio observacional transversal mediante cuestionario dirigido a madres de alumnas nacidas en 1995 matriculadas en centros de secundaria de la provincia de Valencia durante 2010-2011. Muestra aleatoria estratificada por conglomerados (n = 1.279). Análisis estadístico: porcentajes, intervalos de confianza, OR, contrastes chi al cuadrado y regresión logística multivariante. Resultados: Ochocientos treinta y tres cuestionarios completados (65,1%). El 76,6% de las madres habían vacunado a sus hijas contra el VPH. El 93,8% conocía la vacuna, sobre todo a través de la televisión (71,5%). El 78,5% recibió consejo favorable de un profesional sanitario, lo que mejoró la vacunación de sus hijas (OR: 2,4). Los conocimientos globales sobre la infección por VPH y la vacuna fueron bajos. La confianza de las madres en las vacunas como método preventivo mejora la vacunación contra VPH (OR: 3,8). El miedo a los efectos adversos (45,6%) fue el primer motivo de rechazo. Conclusiones: No parece que los medios de comunicación influyan en la decisión de vacunar. Sería conveniente minimizar la percepción de riesgo ante esta vacuna. El consejo del profesional sanitario actúa a favor de la vacunación si este interviene activamente en sentido positivo. Existe una brecha entre nivel de conocimientos y toma de decisión para vacunar.

A febre em pediatria : perspectiva de pais, médicos e enfermeiros

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

Diabetes mellitus e osteoporose

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

Taking stock after the Warsaw COP. CEPS Commentary, 4 December 2013

Drawing on his direct participation in the latest round of climate talks in Warsaw, Andrei Marcu looks at the results of the 19th COP through the lens of three basic questions, with a view to understanding how much progress was made and where we stand two years ahead of Paris. Are the targets adequate and how do we reach environmentally adequate targets? Can one understand and compare what other Parties are promising to do to ensure that the level of effort is comparable and equitable, and that companies are not asked to do more than their competitors in other jurisdictions? Is there comparability and equity in the eyes of the beholder? Do we understand what tools each country uses (what is available, what one gets as support) to ensure that no one country (and its companies) gets an easier ride or competitive advantage in meeting the commitment/promises that countries make. The author asserts that these questions need to be answered if an agreement is to be reached in 2015. And if they are not, he warns of mistrust, fear of carbon leakage and the temptation to resort to protectionist measures to compensate for competitive disadvantage.

What role for migration policy in the Ukraine crisis? CEPS Commentaries, 27 March 2014

While the geopolitics of the Ukraine crisis have dominated headlines, little attention has been paid to the potential challenges arising from the movement of people from the region to the EU. Yet recent history should tell us this could be a grave oversight. As we witnessed during the Arab Spring in 2011, political upheaval can result in people fleeing their state in fear of persecution or seeking to leave their state in search of new horizons and economic opportunities. The EU would do well to learn from that experience and the policy failures that resulted from the Union’s response of closing its borders and returning people to Africa. This Commentary argues that it is critical that – independently of the still uncertain outcome of the Ukraine crisis – the EU formulates and implements a credible policy strategy addressing the potential impact and benefits of mobility between Ukraine and the EU.

Helpless and lonely: Turkey's attitude towards the war in Syria. OSW Commentary No. 136, 09.05.2014

The conflict in Syria, which has lasted since 2011, has become the most significant test of the efficiency of Turkey’s foreign policy and the biggest challenge to Turkey’s security in recent decades. The lack of a clear prospect of an end to the war does not allow us to come to a final conclusion regarding the Syrian civil war’s importance for Turkey. However, it can be said today that with the exception of the initial phase of the conflict, Ankara’s influence over the course of events in Syria has been limited, and the war itself is evolving in a direction that is unfavourable for Turkey: the hostile regime of Bashar al-Assad is still in power, the opposition has proved to be an unreliable or even a dangerous ally, and in northern Syria militant jihadist groups and Kurds are gaining importance. It is also quite unlikely that the West will take any greater responsibility for stabilising the situation in the region. In response to such an unfortunate situation, and out of fear of risking deeper involvement in the conflict, during the past year Turkey’s policy towards Syria has been restrained, reactive and focused mainly on defending Turkey’s territory. However, this policy offers no security guarantees and does not prevent the country’s regional position from weakening, especially in the context of the reinforcement of the jihadist militants and the Kurdish autonomy in northern Syria. The arguments for Turkey continuing its defensive policy are strong: the country fears the possible results of an open confrontation with Assad’s forces; most probably it could not count on support for such actions from within its own society or its Western allies. It also does not have enough acceptance within the anti-Assad opposition circles. On the other hand, though, the risk of uncontrolled development of events is still present; the risk of confrontations with armed jihadist militants is growing; and the potential operation of Turkish forces, either against the jihadists or against Assad’s army, could be considered as a method of diverting attention from the political problems with which the AKP government has been struggling at home.

Azerbaijan-a growing problem for the West. OSW Commentary No. 146, 15.09.2014

Azerbaijan’s cooperation with the West, launched two decades ago, has helped it become a relatively strong and ambitious actor on the international stage. It has become a key country in the region from the Western (USA and the EU) and Turkish points of view, as well as an important partner in the energy sector. The strategic EU concept of the Southern Gas Corridor, also supported by the United States, is among the initiatives based on cooperation with Azerbaijan. Surprisingly, however, Azerbaijan’s increased ambition and importance have caused its policy to diverge ever farther from the expectations and plans formulated by the West. The changes in the balance of power in the South Caucasus, occurring in the context of the conflict in Ukraine, have forced Azerbaijan to revise its assessment of its position in the region. The main impetus for Azerbaijan’s actions is fear of Russia, as well as the weakness of the West which has become particularly apparent in the recent stages of the Ukrainian crisis. Azerbaijan’s actions so far have displayed its tendency to deepen its self-isolation in foreign affairs and consolidate its authoritarian system. This comes as a challenge to the West, whose ability to shape its relations with Azerbaijan has weakened considerably. This state of affairs poses the threat that in the current situation, the Southern Gas Corridor concept, which Azerbaijan amended in 2012 in its own favour, might become totally blocked.

The need for a New Pact. CHALLENGE EUROPE Issue 22 - Challenges and new beginnings: Priorities for the EU’s new leadership, September 2014.

During the last political cycle (2009-2014), the European Union (EU) went through the worst crisis of its history. In the months and years to come, the new EU leadership and Member States will have to take major decisions if Europeans want to sustainably overcome the crisis, prepare themselves for the manifold internal and external tests ahead, and provide the grounds for Europe to exploit more of its potential and meet the needs and expectations of citizens. The outcome of this venture is unclear considering the 'state of the Union' and the current mood in Brussels and national capitals. But one thing seems rather certain: to generate active support from citizens and elites, future developments at European and national level need to be driven by confidence and renewed ambition and not, as in the past years, by fear first – fear of a euro implosion; or of an involuntary exit from the common currency with unforeseeable consequences. In order to take strategic decisions about the Union's future, there is a need to identify and address the key challenge(s) and provide a coherent and holistic response on the grounds of an ambitious but at the same time pragmatic 'package deal', taking into account the diverging interests of Member States and their citizens. But what is the state of affairs, what is the key strategic challenge and how can the new EU leadership cope with it in the next political cycle (2014-2019)?

Corporate Taxation in Europe: Let's get it together! CEPS Commentary, 16 February 2015

More comprehensive cooperation in corporate taxation at European level could significantly advance the region’s socio-economic prosperity, but its potential contribution is unfortunately overlooked in the current search for growth and job creation. Lucrative tax niches established in some member states and the fear of losing fiscal autonomy prevent several countries from accepting the move towards an EU single market for taxation. If ‘Lux leaks’ and other revelations of tax avoidance and evasion can succeed in changing the dominant attitudes in the European tax debate, this commentary outlines the steps that need to be taken to allow tax policy to play a positive role in promoting economic prosperity.

China's Confidence Issue: Hard or Smart Landing - What Can We Expect? Asia Policy Brief 2015/03, November 2015

A China whose economy is growing at a slower pace is something the world can cope with. But a China with doubts about whether the government can maintain control and implement reform – that would be a serious problem. The signals currently coming from the economic and political spheres are cause for concern. China is in danger of falling into a downward spiral of declining confidence. What are the consequences for Germany?

Avaliação dos efeitos de um programa de caminhada nos fatores de risco de queda em idosos: equilíbrio, força e agilidade.

Dissertação apresentada para a obtenção do grau de Mestre em Desporto com especialização em Condição Física e Saúde