“PhenoWorld”: a new multidimensional strategy for studying behaviour in rodents

Tese de Doutoramento em Ciências da Saúde

Reliability and convergent validity of the Childhood Anxiety Sensitivity Index in children and adolescents

OBJECTIVE: The purpose of this study was to examine the reliability and the convergent validity of the Children Anxiety Sensitivity Index (CASI) with DSM-IV anxiety disorder symptoms, by comparison with the Screen for Child Anxiety Related Emotional Disorders (SCARED), in a community sample of Brazilian children and adolescents. METHODS: Children and adolescents from five schools were selected from a larger study that aimed to assess different aspects of childhood anxiety disorders. All participants completed the CASI and the SCARED. RESULTS: This study supported the reliability of the CASI total score. Girls reported higher total anxiety sensitivity scores than boys and there were no differences in total anxiety sensitivity scores between children and adolescents. This study showed moderate to high correlations between the CASI scores with SCARED scores, all correlations coefficients being positive and significant. CONCLUSIONS: Our findings demonstrate an appropriate reliability and evidence of convergent validity in the CASI in a sample of Brazilian children and adolescents.

Psychiatric comorbidities among adolescents with and without anxiety disorders: a community study

ABSTRACT Objective To evaluate, in a community sample of adolescents, the presence of comorbidities in different anxiety disorders. Methods This is a cross-sectional study, initially composed of 2,457 adolescents, aged between 10-17 years old, from public schools of the area covered by the Basic Health Unit of a university hospital. We applied the Screen for Child Anxiety Related Emotional Disorders (SCARED) to assess for anxiety disorders. Then, 138 positive cases in the screening were assessed for mental disorders through the Schedule for Affective Disorder and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL). Results Patients with anxiety disorders had more association with other anxiety disorders, as well as depression, and enuresis. The most common comorbidity described in our study was between generalized anxiety disorder and separation anxiety disorder (OR = 4.21, 95% CI 1.88, 9.58). Significant association was observed between other disorders such as enuresis and separation anxiety disorder (OR = 3.81, 95% CI 1.16, 12.49), as well as depression and generalized anxiety disorder (OR = 3.40; 95% CI 1.52, 7.61). Conclusion Our study showed a relevant presence of comorbidities adolescents with anxiety disorders, selected from a community sample, especially regarding other anxiety disorders. Nevertheless, further studies are needed to confirm our findings.

The positive effect on ketamine as a priming adjuvant in antidepressant treatment.

Ketamine is an anesthetic with antidepressant properties. The rapid and lasting effect of ketamine observed in preclinical and clinical research makes it a promising therapeutic to improve current major depression (MD) treatment. Our work intended to evaluate whether the combined use of classic antidepressants (imipramine or fluoxetine) and ketamine would improve the antidepressant response. Using an animal model of depressive-like behavior, we show that the addition of ketamine to antidepressants anticipates the behavioral response and accelerates the neuroplastic events when compared with the use of antidepressants alone. In conclusion, our results suggest the need for a reappraisal of the current pharmacological treatment of MD.

O papel dos vídeos promocionais na formação da imagem dos destinos turísticos culturais

Dissertação de mestrado em Património e Turismo Cultural

Lazer e autorregulação emocional: contributos para o bem-estar e felicidade dos adolescentes

Dissertação de mestrado em Psicologia Aplicada

Formação de professores: uma prática pedagógica frente aos desafios das necessidades educativas especiais: um estudo de caso numa IES Particular em Manaus-Am

Dissertação de mestrado em Educação Especial (área de especialização em Dificuldades de Aprendizagem Específicas)

Doppler echocardiographic evaluation of HIV-positive patients in different stages of the disease

OBJETIVE: To evaluate by Doppler echocardiography (DE) early abnormalities of ventricular function in HIV-positive patients, as well as other cardiac abnormalities that can be detected by this method, with special emphasis on mitral valve flow. METHODS: 84 HIV- positive patients, 59 with CD4 cell count >500/mm³ (Group A) and 25 with CD4 cell count <500/mm³ (Group B), were analyzed. CD4 cells were counted and matched with structural data and systolic and diastolic function of the left ventricle (LV), as analyzed by DE. The results were compared with those obtained in 47 healthy individuals (Group C). RESULTS: 8% of patients in Group B had mild pericardial effusion; 31.5% showed decreased systolic function of the LV, and 12% had moderate mitral regurgitation. A wave velocity from the mitral inflow was different among the 3 groups, being higher in Group B, where the deceleration time of the E wave of the mitral inflow and the E/A ratio were significantly lower with a normal value of the isovolumic relaxation time (IVRT). CONCLUSION: HIV-positive patients with a CD4 cell count >500/mm³ had no abnormalities by DE. Patients with a more advanced infection (those with a CD4 cell count <500/mm³), had a significantly abnormal LV systolic function and a higher incidence of pericardial effusion and mitral regurgitation. Mitral valve inflow by Doppler did not indicate diastolic dysfunction.

Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2), continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69±7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at begining, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05). Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05). CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.

Factors associated with the donation and non-donation of embryos for research: a systematic review

Background: Systematic knowledge on the factors that influence the decisions of IVF users regarding embryo donation for research is a core need for patient-centred policies and ethics in clinical practice. However, no systematic review has been provided on the motivations of patients who must decide embryo disposition. This paper fills this gap, presenting a systematic review of quantitative and qualitative studies, which synthesizes the current body of knowledge on the factors and reasons associated with IVF patients’ decisions to donate or not to donate embryos for research. Methods: A systematic search of studies indexed in PubMed, ISIWoK and PsycINFO, published before November 2013, was conducted. Only empirical, peer-reviewed, full-length, original studies reporting data on factors and reasons associated with the decision concerning donation or non-donation of embryos for research were included. Eligibility and data extraction were performed by two independent researchers and disagreements were resolved by discussion or a third reviewer, if required. The main quantitative findings were extracted and synthesized and qualitative data were assessed by thematic content analysis. Results: A total of 39 studies met the inclusion criteria and were included in the review. More than half of the studies (n ¼ 21) used a quantitative methodology, and the remaining were qualitative (n ¼ 15) or mixed-methods (n ¼ 3) studies. The studies were derived mainly from European countries (n ¼ 18) and the USA(n ¼ 11). The proportion of IVF users who donated embryos for research varied from 7% in a study in France to 73% in a Swiss study. Those who donate embryos for research reported feelings of reciprocity towards science and medicine, positive views of research and high levels of trust in the medical system. They described their decision as better than the destruction of embryos and as an opportunity to help others or to improve health and IVF treatments. The perception of risks, the lack of information concerning research projects and the medical system and the conceptualization of embryos in terms of personhood were the most relevant motives for not donating embryos for research. Results relating to the influence of sociodemographic characteristics and reproductive and gynaecological history were mostly inconclusive. Conclusions: Three iterative and dynamic dimensions of the IVF patients’ decision to donate or not to donate embryos for research emerged from this review: the hierarquization of the possible options regarding embryo disposition, according to the moral, social and instrumental status attributed to embryos; patients’ understanding of expectations and risks of the research on human embryos; and patients’ experiences of information exchange and levels of trust in the medical-scientific institutions.

Fathers’ emotional involvement with the neonate: impact of the umbilical cord cutting experience

Aims. This paper is a report on a study analysing the effect of the umbilical cord cutting experience on fathers’ emotional involvement with their infants. Background. Participation in childbirth offers an opportunity for father and mother to share the childbirth experience, so it is vital that midwives improve the fathers’ participation in this event. Design. A quasi-experimental study with a quantitative methodology was implemented. Methods. One hundred and five fathers were recruited as part of a convenience sample in a Maternity Public Hospital in a Metropolitan City in Portugal, between January and May of 2008. The Bonding Scale, the Portuguese version of the ‘Mother-to-Infant Bonding Scale’ was used to evaluate the fathers’ emotional involvement with the neonate at different moments: before childbirth, first day after childbirth and first month after childbirth. After childbirth, the fathers were divided into three separate groups depending on their umbilical cord cutting experience. Results. The results demonstrate that the emotional involvement between father and child tends to increase during the first days after childbirth and to decrease when evaluated 1 month after birth, for fathers who did not cut the umbilical cord. However, fathers who cut the umbilical cord demonstrate an improvement in emotional involvement 1 month later. Conclusion. Results suggest that the umbilical cord cutting experience benefits the father’s emotional involvement with the neonate, supporting the benefits of his participation and empowerment in childbirth.

Study of validation of the Portuguese version of the inventory «Experiences in Close Relationships»

The Experiences in Close Relationships Inventory permits to evaluate attachment in close relationships during adulthood based on two dimensions able to be present in this kind of relationships: the avoidance of proximity and the anxiety related with to abandonment. It is a self-report 7- points likert scale composed by 36 items. The Portuguese version was administered to a sample of 551 university students (60% female), the majority with ages between 19 and 24 years old (88%) in a dating relationship (86%). The principal components analysis with oblimin rotation was performed. The total scale has good internal consistency (α=.86), as also has the 2 sub-scales: anxiety (α=.86) and avoidance (α=.88). The two dimensions evaluated are significantly correlated with socio-demographics, relational characteristics (jealousy, relationship distress, and compromise), wishes (enmeshment versus differentiation) and fears (abandonment versus control) related to attitudes in significant relationships, which testify the construct validity of the instrument. The results obtained are coherent with the original version and other ECR‘s adaptations. Practitioners and researchers in the context of clinical psychology and related areas have now at their disposal the Portuguese version of the ECR inventory, which has shown its very high usefulness in the study of close relationships, and specifically attachment in adulthood.

Mother's stress, mood and emotional involvement with the infant: 3 months before and 3 months after childbirth

Adverse effects of maternal anxiety and depression are well documented, namely on the foetus/child behaviour and development, but not as much attention has been given to the mother's emotional involvement with the offspring. To study mother's prenatal and postpartum stress, mood and emotional involvement with the infant, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale and the Mother-to-Infant Bonding Scale were filled in and cortisol levels were measured, 3 months before and 3 months after childbirth, in a sample of 91 Portuguese women. From pregnancy to the postpartum period, mother's cortisol levels, anxiety and emotional involvement toward the child decrease. No significant change was observed regarding mother's depression. Mother's depression predicted a worse emotional involvement before childbirth, while mother's anxiety predicted a worse emotional involvement with the infant after childbirth. Additionally, pregnant women with a worse emotional involvement with the offspring are at risk of poorer emotional involvement with the infant and higher anxiety and depression at 3 months postpartum. It should be given more attention to mother's poor emotional involvement with the offspring during pregnancy, as it interferes with her emotional involvement with the infant and her psychological adjustment 3 months after childbirth.

Antecipação e experiência emocional de parto

Este estudo tem como objectivo geral analisar a forma como as mulheres por um lado antecipam e, por outro lado, experienciam emocionalmente o parto do seu primeiro filho. Foi também nosso interesse averiguar a relação entre a antecipação e a experiência real de parto. Para o efeito, 197 grávidas primíparas, com idades compreendidas entre 15 e 39 anos e utentes da Consulta Externa de Obstetrícia da Maternidade Júlio Dinis (Porto) participaram no estudo. Após consentimento informado as participantes preencheram um Questionário Socio-demográfico e o Questionário de Antecipação do Parto (QAP, Costa, Figueiredo, Pacheco, Marques, & Pais, 2005) no 2º trimestre de gravidez. Na primeira semana após o parto foram novamente contactadas as participantes na Unidade de Internamento na Maternidade de Júlio Dinis no sentido de responderem ao Questionário de Experiência e Satisfação com o Parto (QESP, Costa, Figueiredo, Pacheco, Marques, & Pais, 2005). Os resultados mostram que o planeamento do parto parece ser benéfico para algumas mulheres em termos do medo, dor e preocupação em relação ao bebé durante o parto. Deste modo, a implementação de medidas que promovam a informação, suporte emocional e envolvimento nas tomadas de decisão por parte dos serviços de saúde materno-infantis poderiam constituir uma mais-valia para o melhoramento das experiências dos pais.

Qualidade da vinculação e dos relacionamentos significativos na gravidez

O estudo apresentado neste artigo destinou-se a investigar a qualidade da vinculação e das relações significativas na gravidez. Mais precisamente, teve por objectivos (1) determinar as características sociais e demográficas e as condições anteriores de existência que se associam e permitem prever um estilo de vinculação (in)seguro e (2) estimar o impacto do estilo de vinculação na qualidade do relacionamento e do apoio por parte do companheiro e de uma outra pessoa significativa, na gravidez. Uma amostra de 130 grávidas (66 adolescentes e 64 adultas) foi avaliada no último trimestre de gestação quanto ao estilo de vinculação e à qualidade do relacionamento e do apoio por parte do companheiro e de uma outra pessoa significativa (com base na Attachment Style Interview, ASI; Bifulco, Figueiredo, Guedeney, Gorman, Hays et al., 2004; Bifulco, Moran, Ball & Bernazzani, 2002a; Bifulco, Moran, Ball & Lillie, 2002b). A amostra foi recolhida na Maternidade de Júlio Dinis (Porto) e é bastante heterogénea do ponto de vista social e demográfico, em características como: a idade, o nível educacional, o estado civil, o estatuto ocupacional e o tipo de agregado familiar, embora fundamentalmente constituída por grávidas primíparas. Os resultados mostram que um estilo inseguro de vinculação pode ser previsto na sequência de separação ou divórcio parental durante a infância ou adolescência e quando a grávida está desempregada, e que a gravidez na adolescência se associa ao estilo de vinculação desligado. Mostram ainda que um estilo inseguro de vinculação permite prever um pior relacionamento na gravidez, quer com o companheiro, quer com a outra pessoa significativa, principalmente a presença de relações discordantes com o companheiro e de relações apáticas com a outra pessoa significativa. As estratégias emaranhadas afectam a relação com o companheiro (em aspectos como menos confiança, menos suporte emocional e mais interacção negativa), mas não a relação com a outra pessoa significativa; enquanto as estratégias desligadas afectam a relação com a outra pessoa significativa (em aspectos como menos actividades partilhadas e menos interacção positiva), mas não a relação com o companheiro, e as estratégias amedrontadas afectam o relacionamento, tanto com o companheiro (em aspectos como menor sentimento de ligação) quanto com a outra pessoa significativa (em aspectos como menos confiança). De acordo com a Teoria da Vinculação, conclui-se que condições adversas de existência (anteriores e actuais) propiciam vinculação insegura e que o estilo de vinculação interfere na qualidade do relacionamento com o companheiro e com outras pessoas significativas, nomeadamente na capacidade da grávida recorrer a apoio.