Observance en début de psychose : acceptation, refus ou processus?

Objectifs: Les études quantitatives ont documenté l’ampleur des problèmes d’observance en début de psychose et les conséquences cliniques qui en découlent. La compréhension du phénomène demeure toutefois limitée. Notre étude propose d’explorer, à partir de trois perspectives (celles des patients, des proches et des cliniciens), les raisons pour lesquelles les patients en début de psychose acceptent ou refusent les traitements. Méthode: La collecte des données s’est faite à l’aide d’entrevues individuelles semi-structurées auprès de 18 patients d’une clinique spécialisée en psychose débutante classifiés comme étant observants, ambivalents ou non observants, et auprès de 13 de leurs proches, ainsi qu’à l’aide d’un focus group réunissant 8 cliniciens de la clinique. Résultats: L’observance semble s’inscrire dans un processus marqué par une certaine ambivalence pour la plupart des sujets. Cette ambivalence est modulée par: des enjeux identitaires, des enjeux relationnels, la compréhension du diagnostic et la signification du traitement. Conclusion: L’ambivalence et l’inobservance seraient des étapes normales du processus au cours duquel le patient lutte pour reconstruire son identité. La présence d’un lien de confiance permet la résolution progressive de l’ambivalence, facilitant ainsi le processus de réappropriation du traitement par le patient.

Impact of the ego-dystonic nature of obsessions on treatment outcome in eating disorders

Il s'agit d'une hypothèse largement répandue que l’égo-dystonie et l’égo-syntonie caractérisent les obsessions dans les troubles des conduites alimentaires (TCA) et que ces facteurs sont cliniquement pertinents pour la conceptualisation et le traitement des TCA. Cependant, les résultats empiriques sur ce sujet sont rares. Compte tenu du chevauchement reconnu entre les TCA, notamment l'anorexie et la boulimie (BN), et le trouble obsessionnel-compulsif (TOC) dans la phénoménologie et les caractéristiques psychologiques, un programme de thérapie cognitive basée sur les inférences (TBI) de 24 semaines, démontré efficace dans le traitement des TOC, a été adapté pour traiter les TCA. La recherche sur le TOC suggère que la transformation des pensées intrusives en obsessions est liée à la mesure dans laquelle les pensées intrusives menacent des perceptions fondamentales du soi et de l’identité. Cette thèse a pour objectif d'examiner le lien entre l’égo-dystonie et les TCA. Pour se faire, nous avons exploré le lien entre la nature égo-dystone des obsessions chez les patients souffrant d'un TCA et la peur de l'image de soi. Nous avons également étudié la relation entre la sévérité des symptômes TCA et l’égo-dystonie dans les obsessions. En outre, nous avons investigué les différences dans la présence de pensées égo-dystones et de peur face à son identité entre des sujets non-cliniques et des personnes atteintes d’un TCA. Enfin, nous avons comparé le degré d’égo-dystonie dans les pensées de personnes atteintes d’un TCA à celui dans les pensées d’individus souffrant d’un TOC. L’égo-dystonie dans les pensées a été mesurée par l'Ego Dystonicity Questionnaire (EDQ) et le degré de peur face à l’identité a été mesuré par le Fear of Self Questionnaire (FSQ) d’une part dans un échantillon de femmes souffrant d’un TCA (n = 57) et d’autre part dans un échantillon de participantes non-cliniques (n = 45). Les résultats révèlent que l’égo-dystonie et la peur face à l’identité étaient fortement corrélées à la fois dans l’échantillon clinique et non-clinique. Les scores de l’EDQ n’étaient pas significativement corrélés à la sévérité des symptômes TCA à l'exception de la sous-échelle d’irrationalité de l’EDQ qui était fortement associée à la sévérité des comportements compulsifs compensatoires. Les participantes souffrant d'un TCA avaient des scores significativement plus élevés à l’EDQ et au FSQ que les sujets non-cliniques. Ensuite, une étude de cas décrit l’application du programme de thérapie cognitive TBI pour une femme de 35 ans avec un diagnostic de BN. La pathologie TCA s’est significativement améliorée au cours de la TBI et six mois suivant la thérapie. Cette étude de cas met en évidence l'importance de cibler les idées surévaluées, les doutes et le raisonnement face au soi et à l’identité dans le traitement psychologique pour les TCA. Enfin, l’objectif final de cette thèse était d’examiner les changements au niveau (1) des symptômes TCA, (2) du degré d’égo-syntonie dans les obsessions, et (3) des mesures de peur face à l’identité, de motivation, d’humeur et d’anxiété au cours de la TBI et au suivi post six mois. L’égo-dystonie, la peur face à l’identité, les symptômes TCA et le stade motivationnel ont été mesurés chez 15 femmes souffrant de BN au cours du traitement et six mois après la TBI. Quatre vingt pourcent de l’échantillon, soit 12 des 15 participantes, ont démontré une diminution cliniquement significative des symptômes TCA et 53% ont cessé leurs comportements compensatoires au suivi post six mois. Les retombées cliniques relatives au traitement des TCA sont discutées.

L’Office des Nations Unies contre la drogue et le crime et la lutte internationale contre la corruption : perceptions des professionnels

Travail dirigé présenté à la Faculté des études supérieures et postdoctorales en vue de l’obtention du grade de Maître ès sciences (M.Sc) en Criminologie – Option sécurité intérieure

Institutions, Behavior and Evolution

The three articles constituting this thesis are for reasons of content or method related to the following three fields in economics: Behavioral Economics, Evolutionary Game Theory and Formal Institutional Economics. A core element of these fields is the concept of individual preferences. Preferences are of central importance for the conceptional framework to analyze human behavior. They form the foundation for the theory of rational choice which is defined by the determination of the choice set and the selection of the most preferred alternative according to some consistency requirements. The theory of rational choice is based on a very simplified description of the problem of choice (object function and constraints). However, that choices depend on many more factors is for instance propagated by psychological theories and is supported by many empirical and experimental studies. This thesis adds to a better understanding of individual behavior to the extent that the evolution of certain characteristics of preferences and their consequences on human behavior forms the overarching theme of the dissertation. The long-term effect of evolutionary forces on a particular characteristic of importance in the theoretical, empirical and experimental economic literature, the concept of inequality aversion, is subject of the article “The evolution of inequality aversion in a simplified game of life” (Chapter 4). The contribution of the article is the overcoming of a restriction of former approaches to analyze the evolution of preferences in very simple environments. By classifying human interaction into three central economic games, the article provides a first step towards a simplified and sufficiently complete description of the interaction environment. Within such an environment the article characterizes the evolutionary stable preference distribution. One result shows, that the interaction of the aforementioned three classes can stabilize a preference of inequality aversion in the subpopulation which is favored in the problem of redistribution. The two remaining articles are concerned with social norms, which dissemination is determined by medium-run forces of cultural evolution. The article “The impact of market innovations on the evolution of social norms: the sustainability case.“ (Chapter 2) studies the interrelation between product innovations which are relevant from a sustainability perspective and an according social norm in consumption. This relation is based on a conformity bias in consumption and the attempt to avoid cognitive dissonances resulting from non-compliant consumption. Among others, it is shown that a conformity bias on the consumption side can lead to multiple equilibria on the side of norm adoption. The article “Evolution of cooperation in social dilemmas: signaling internalized norms.” (Chapter 3) studies the emergence of cooperation in social dilemmas based on the signaling of social norms. The article provides a potential explanation of cooperative behavior, which does not rely on the assumption of structured populations or on the unmotivated ability of social norms to restrict individual actions or strategy spaces. A comprehensive result of the single articles is the explanation of the phenomenon of partial norm adaption or dissemination of preferences. The plurality of the applied approaches with respect to the proximity to the rational choice approach and regarding the underlying evolutionary mechanics is a particular strength of the thesis. It shows the equality of these approaches in their potential to explain the phenomenon of cooperation in environments that provide material incentives for defective behavior. This also points to the need of a unified framework considering the biological and cultural coevolution of preference patterns.

A controlled trial of sip-feed supplements in elderly orthopaedic patients

The potential nutritional and clinical benefits of sip-feed supplements were investigated by means of a controlled trial in elderly female patients admitted for orthopaedic surgery. A nutritional risk assessment procedure (Nutritional Risk Questionnaire, NRQ) was used to identify patients who might benefit from supplementation. Patients identified as high risk who did not receive supplements showed significant losses in triceps skinfold thickness (TSF) and mid-upper arm muscle circumference (MUAMC) measurements during hospitalization. Such changes were not observed in high-risk supplemented patients, but significant losses of MUAMC were also recorded in a group of patients who failed to comply with the supplement. No differences in biochemical parameters, muscle function, or clinical outcome were observed between supplemented and unsupplemented and non-compliant patients. The problems of poor compliance to sip-feed supplements and failure to observe clinical benefit in supplemented patients are discussed.

Improving EU biofuels policy? Greenhouse gas emissions, policy efficiency, and WTO compatibility

Both the EU’s Renewable Energy Directive (RED) and Article 7a of its Fuel Quality Directive (FQD) seek to reduce greenhouse gas (GHG) emissions from transport fuels. The RED mandates a 10% share of renewable energy in transport fuels by 2020, whilst the FQD requires a 6% reduction in GHG emissions (from a 2010 base) by the same date. In practice, it will mainly be biofuels that economic operators will use to meet these requirements, but the different approaches can lead to either the RED, or the FQD, acting as the binding constraint. A common set of environmental sustainability criteria apply to biofuels under both the RED and the FQD. In particular, biofuels have to demonstrate a 35% (later increasing to 50/60%) saving in life-cycle GHG emissions. This could be problematic in the World Trade Organization (WTO), as a non-compliant biofuel with a 34% emissions saving would probably be judged to be ‘like’ a compliant biofuel. A more economically rational way to reduce GHG emissions, and one that might attract greater public support, would be for the RED to reward emission reductions along the lines of the FQD. Moreover, this modification would probably make the provisions more acceptable in the WTO, as there would be a clearer link between policy measures and the objective of reductions in GHG emissions; and the combination of the revised RED and the FQD would lessen the commercial incentive to import biofuels with modest GHG emission savings, and thus reduce the risk of trade tension.

Cognitive vulnerability to postnatal depressive symptomatology

Understanding the factors involved in the development of postpartum depressive disorders has important implications for the detection of women at risk, and the development of theory‐driven preventative treatments. In the current study, recent innovations in the assessment of idiographic cognitive functioning among adult, non‐pregnant samples were administered to a sample of healthy primiparous women to investigate their predictive utility in the onset of low mood following childbirth. Cognitive biases using autobiographical material, and the degree of self‐devaluation during brief episodes of naturally occurring low mood were assessed in 94 concurrently well women in the third trimester of their first pregnancy. The degree of depressive symptomatology at 2 and 8 weeks postpartum was assessed subsequently. Antenatal self‐devaluative tendencies and a lack of specificity in autobiographical retrieval were not associated with low mood in the initial weeks following delivery, when biological factors are believed to play an important role, but did predict depressive symptoms more distally at 8 weeks after childbirth. This relationship was demonstrated after controlling for educational level, variations in antenatal dysphoria, previous emotional difficulties, neuroticism and the woman's own experience of mothering. The theoretical and clinical implications of the findings are discussed.

Do Cognitive Models of Obsessive Compulsive Disorder Apply to Children and Adolescents?

Cognitive models of obsessive compulsive disorder (OCD) have been influential in understanding and treating the disorder in adults. Cognitive models may also be applicable to children and adolescents and would have important implications for treatment. The aim of this systematic review was to evaluate research that examined the applicability of the cognitive model of OCD to children and adolescents. Inclusion criteria were set broadly but most studies identified included data regarding responsibility appraisals, thought-action fusion or meta-cognitive models of OCD in children or adolescents. Eleven studies were identified in a systematic literature search. Seven studies were with non clinical samples, and 10 studies were cross-sectional. Only one study did not support cognitive models of OCD in children and adolescents and this was with a clinical sample and was the only experimental study. Overall, the results strongly supported the applicability of cognitive models of OCD to children and young people. There were, however, clear gaps in the literature. Future research should include experimental studies, clinical groups, and should test which of the different models provide more explanatory power.

Production and properties of casein hydrolysate microencapsulated by spray drying with soybean protein isolate

The aim of this work was to encapsulate casein hydrolysate by spray drying with soybean protein isolate (SPI) as wall material to attenuate the bitter taste of that product. Two treatments were prepared: both with 12 g/100 g solids and containing either two proportions of SPI: hydrolysate (70:30 and 80:20), called M1 and M2, respectively. The samples were evaluated for morphological characteristics (SEM), particle size, hygroscopicity, solubility, hydrophobicity, thermal behavior and bitter taste with a trained sensory panel using a paired-comparison test (non-encapsulated samples vs. encapsulated samples). Microcapsules had a continuous wall, many concavities, and no porosity. Treatments M1 and M2 presented average particle sizes of 11.32 and 9.18 mu m, respectively. The wall material and/or the microencapsulation raised the hygroscopicity of the hydrolysate since the free hydrolysate had hygroscopicity of 53 g of water/100 g of solids and M1 and M2 had 106.99 and 102.19 g of water/100 g of solids, respectively. However, the hydrophobicity decreases, the absence of a peak in encapsulated hydrolysates, and the results of the panel sensory test considering the encapsulated samples less bitter (p < 0.05) than the non-encapsulated, showed that spray drying with SPI was an efficient method for microencapsulation and attenuation of the bitter taste of the casein hydrolysate. (c) 2008 Elsevier Ltd. All rights reserved.

Role of glutaredoxin 2 and cytosolic thioredoxins in cysteinyl-based redox modification of the 20S proteasome

The yeast 20S proteasome is subject to sulfhydryl redox alterations, such as the oxidation of cysteine residues (Cys-SH) into cysteine sulfenic acid (Cys-SOH), followed by S-glutathionylation (Cys-S-SG). Proteasome S-glutathionylation promotes partial loss of chymotrypsin-like activity and post-acidic cleavage without alteration of the trypsin-like proteasomal activity. Here we show that the 20S proteasome purified from stationary-phase cells was natively S-glutathionylated. Moreover, recombinant glutaredoxin 2 removes glutathione from natively or in vitro S-glutathionylated 20S proteasome, allowing the recovery of chymotrypsin-like activity and post-acidic cleavage. Glutaredoxin 2 deglutathionylase activity was dependent on its entry into the core particle, as demonstrated by stimulating S-glutathionylated proteasome opening. Under these conditions, deglutathionylation of the 20S proteasome and glutaredoxin 2 degradation were increased when compared to non-stimulated samples. Glutaredoxin 2 fragmentation by the 20S proteasome was evaluated by SDS-PAGE and mass spectrometry, and S-glutathionylation was evaluated by either western blot analyses with anti-glutathione IgG or by spectrophotometry with the thiol reactant 7-chloro-4-nitrobenzo-2-oxa-1,3-diazole. It was also observed in vivo that glutaredoxin 2 was ubiquitinated in cellular extracts of yeast cells grown in glucose-containing medium. Other cytoplasmic oxido-reductases, namely thioredoxins 1 and 2, were also active in 20S proteasome deglutathionylation by a similar mechanism. These results indicate for the first time that 20S proteasome cysteinyl redox modification is a regulated mechanism coupled to enzymatic deglutathionylase activity.

Visuellt & Auditivt korttidsminne

The aim of the present study was to investigate the effect of sensory modality on short-term memory recall. An exploratory, cross-sectional study was performed. A total of 119 individuals participated. There were 70 female and 49 male subjects, aged 4 to 80 years (M=34,3). The participants were presented with 12 different objects in auditory, visual or auditory/visual mode over a period of 24 seconds. The participants were then asked to recall as many of the 12 objects as possible in any order. The study took place at a day nursery, junior high schools, meetings with elderly and adults with house calls. Non-probability samples were used. The conclusion was that visual short-term memory generated the highest recollection and that adults had the highest mean on the different stimuli. A visual element is recommended at recollection.

Fatores associados ao controle metabólico em pacientes com diabetes melito tipo 2 não usuários de insulina

Introdução: a obtenção de um bom controle metabólico é essencial para a prevenção das complicações crônicas do Diabetes Melito (DM). O tratamento é complexo e depende da implementação efetiva das diferentes estratégias terapêuticas disponíveis. Para que isso seja possível, é necessário que o paciente entenda os princípios terapêuticos e consiga executá-los. A precária educação em diabetes é percebida como um dos obstáculos para o alcance das metas terapêuticas. Objetivo: analisar, os fatores associados ao controle metabólico, em pacientes com DM tipo 2 (DM2) não usuários de insulina. Métodos: foi realizado um estudo transversal em pacientes com DM2 não usuários de insulina, selecionados ao acaso entre aqueles que consultavam nos ambulatórios de Medicina Interna, Endocrinologia e Enfermagem do Hospital de Clínicas de Porto Alegre. Os pacientes foram submetidos à avaliação clínica, laboratorial e responderam um questionário que incluía o tipo de tratamento realizado para DM, outros medicamentos e co-morbidades, pesquisa de complicações em ano prévio e avaliação do conhecimento sobre DM. Os pacientes foram classificados em dois grupos, com bom ou mau controle glicêmico, de acordo com o valor da glico-hemoglobina de 1 ponto % acima do limite superior do método utilizado. As comparações entre variáveis contínuas, com distribuição normal, foram analisadas pelo teste t de Student para amostras não-pareadas e para as variáveis de distribuição assimétrica ou com variância heterogênea o teste U de Mann-Whitney. A comparação entre percentagem foi feita pelo teste de qui-quadrado ou exato de Fisher. Foi realizada uma análise logística múltipla para identificar os fatores mais relevantes associados ao controle metabólico (variável dependente). As variáveis independentes com um nível de significância de P < 0,1 na análise bivariada, foram incluídas no modelo. Resultados: foram avaliados 143 pacientes com DM2, idade de 59,3 ± 10,1 anos, duração conhecida do DM 7,5 ± 6,3 anos, índice de massa corporal (IMC) de 29,7 ± 5,2 kg/m².Destes, 94 pacientes (65,73%) apresentavam bom controle glicêmico. Os pacientes com mau controle glicêmico usavam mais anti-hiperglicemiantes orais como monoterapia (OR = 9,37; IC = 2,60-33,81; P=0,004) ou associados (OR = 31,08; IC = 7,42-130,15; P < 0,001). Da mesma maneira, não fizeram dieta em dias de festa (OR = 3,29; IC = 1,51-7,16; P = 0,012). A inclusão do conhecimento sobre diabetes não foi diferente entre os pacientes com bom ou mau controle glicêmico (OR = 1,08; IC = 0,97 - 1,21; P = 0,219). A análise multivariada demonstrou que a consulta com a enfermeira educadora (OR = 0,24; IC = 0,108-0,534; P = 0,003), com o endocrinologista (OR = 0,15 ; IC = 0,063-0,373; P = 0,001) e o uso de hipolipemiantes (OR = 0,10; IC = 0,016 - 0,72; P = 0,054) foram associados ao bom controle glicêmico, ajustados para a não realização de dieta em festas, uso de anti-hiperglicemiantes orais e conhecimento sobre diabetes. Conclusão: o controle metabólico em pacientes DM2 é influenciado pelas atividades de educação com enfermeira e endocrinologista. O tratamento do DM2 deve incluir atividades de educação de forma sistemática.

Superfícies de titânio modificadas termoquimicamente por plasma : avaliação da resposta biológica

This laboratory study involves the participation of a group with professionals from different areas that had contributed to the construction of a multidisciplinary knowledge, about biological response of titanium surfaces modified through thermochemical treatment by plasma. Thus, the crystalline phase was previously characterized in relation to the topography, roughness, molhability and nitrogen concentration in the samples surface. It s indispensable that materials implanted can influence in a good cellular response as well as promotes a bacteria action. Surfaces modified by plasma were exposed to different cultures such as: cellular (human osteoblastic) and bacteria (Staphylococcus epidermidis ATCC35984 and Pseudomonas aeruginosa ATCC 27853) in order to evaluate the biological response. It was evaluated the adhesion, proliferation, morphology and cellular preference of human ostheoblastic cells (HOST), as well as the formation of a biofilm and bacteria proliferation. It was still analyzed the bacteria selectivity ability in relation to the surfaces. The software Image Pro Plus was used to the counting of cells and bacteria adhered to the surface of disks. The results were submitted to the variance analysis (ANOVA), and then, by the Kruskal-Wallis test, using GraphPad Instat ® software, version 3.5 to Windows. The nitrided samples in spite of show a higher roughness and molhability showed a smaller bacteria growing and higher cellular proliferation, when compared to non treated samples, indicating that the treated material present a high efficiency to biomedical implants

Mutagenicity induced by the hydroalcoholic extract of the medicinal plant Plathymenia reticulata Benth

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Nanoindentation mechanical properties characterization of glassy polymeric carbon treated with ion beam

Phenolic resins when heat treated in inert atmosphere up to 1000 degreesC become glassy polymeric carbon (GPC), a chemically inert and biocompatible material useful for medical applications, such as in the manufacture of heart valves and prosthetic devices. In earlier work we have shown that ion bombardment can modify the surface of GPC, increasing its roughness. The enhanced roughness, which depends on the species, energy and fluence of the ion beam, can improve the biocompatibility of GPC prosthetic artifacts. In this work, ion bombardment was used to make a layer of implanted ions under the surface to avoid the propagation of microcracks in regions where cardiac valves should have pins for fixation of the leaflets. GPC samples prepared at 700 and 1500 degreesC were bombarded with ions of silicon. carbon, oxygen and gold at energies of 5, 6, 8 and 10 MeV, respectively, and fluences between 1.0 x 10(13) and 1.0 x 10(16) ions/cm(2). Nanoindentation hardness characterization was used to compare bombarded with non-bombarded samples prepared at temperatures up to 2500 degreesC. The results with samples not bombarded showed that the hardness of GPC increases strongly with the heat treatment temperature. Comparison with ion bombarded samples shows that the hardness changes according to the ion used, the energy and fluence. (C) 2002 Elsevier B.V. B.V. All rights reserved.