Exaggerating, mislabeling or simulating obsessive-compulsive symptoms: Case reports of patients claiming to have obsessive-compulsive disorder

Background: There are no reported cases of factitious or simulated obsessive compulsive disorder (OCD). However, over the last years, our clinic has come across a number of individuals that seem to exaggerate, mislabel or even intentionally produce obsessive and/or compulsive symptoms in order to be diagnosed with OCD.Methods: In this study, experienced clinicians working on a university-based OCD clinic were requested to provide clinical vignettes of patients who, despite having a formal diagnosis of OCD, were felt to display non-genuine forms of this condition.Results: Ten non-consecutive patients with a self-proclaimed diagnosis of OCD were identified and described. Although patients were diagnosed with OCD according to various structured interviews, they exhibited diverse combinations of the following features: (i) overly technical and/or doctrinaire description of their symptoms, (ii) mounting irritability, as the interviewer attempts to unveil the underlying nature of these descriptions; (iii) marked shifts in symptom patterns and disease course; (iv) an affirmative yes pattern of response to interview questions; (v) multiple Axis I psychiatric disorders; (vi) cluster B features; (vii) an erratic pattern of treatment response; and (viii) excessive or contradictory drug-related side effects.Conclusions: In sum, reliance on overly structured assessments conducted by insufficiently trained or naive personnel may result in invalid OCD diagnoses, particularly those that leave no room for clinical judgment. (C) 2014 Elsevier Inc. All rights reserved.

Leg Amputation for an Extensive, Severe and Intractable Sickle Cell Anemia Ulcer in a Brazilian Patient

A 35-year-old African Brazilian patient had sickle cell anemia complicated with recurrent vasoocclusive (VOC) crises and refractory painful leg ulcers for 16 years. The ulcers started over both medial malleoli and expanded gradually. The ulcer on the left leg spread from the foot to the knee circumferentially and was refractory to all forms of therapy within the frame work of multi-disciplinary care. The patient agreed to a below the knee amputation of the left leg. He felt much better after the amputation but developed severe neuropathic phantom pain that was well controlled medically. He could differentiate the sickle cell anemia and ulcer pain from the neuropathic pain. About 6 months after the amputation he had dengue fever with fatal outcome. This is the first report of treatment of refractory sickle cell anemia leg ulcer with amputation and probably the first report of a Brazilian patient with sickle cell anemia and dengue fever.

A formação continuada em serviço de professores e as atividades do horário de trabalho pedagógico coletivo nas escolas dos anos iniciais do ensino fundamental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Muito Prazer!? discussões sobre sexualidade, gênero e educação sexual a partir da análise de revistas femininas e masculinas

Pós-graduação em Educação Escolar - FCLAR

Air versus saline in the loss of resistance technique for identification of the epidural space

BackgroundThe success of epidural anaesthesia depends on correct identification of the epidural space. For several decades, the decision of whether to use air or physiological saline during the loss of resistance technique for identification of the epidural space has been governed by the personal experience of the anaesthesiologist. Epidural block remains one of the main regional anaesthesia techniques. It is used for surgical anaesthesia, obstetrical analgesia, postoperative analgesia and treatment of chronic pain and as a complement to general anaesthesia. The sensation felt by the anaesthesiologist from the syringe plunger with loss of resistance is different when air is compared with saline (fluid). Frequently fluid allows a rapid change from resistance to non-resistance and increased movement of the plunger. However, the ideal technique for identification of the epidural space remains unclear.ObjectivesTo evaluate the efficacy and safety of both air and saline in the loss of resistance technique for identification of the epidural space.To evaluate complications related to the air or saline injected.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), MEDLINE, EMBASE and the Latin American and Caribbean Health Science Information Database (LILACS) (from inception to September 2013). We applied no language restrictions. The date of the most recent search was 7 September 2013.Selection criteriaWe included randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) on air and saline in the loss of resistance technique for identification of the epidural space.Data collection and analysisTwo review authors independently assessed trial quality and extracted data.Main resultsWe included in the review seven studies with a total of 852 participants. The methodological quality of the included studies was generally ranked as showing low risk of bias inmost domains, with the exception of one study, which did not mask participants. We were able to include data from 838 participants in the meta-analysis. We found no statistically significant differences between participants receiving air and those given saline in any of the outcomes evaluated: inability to locate the epidural space (three trials, 619 participants) (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.33 to 2.31, low-quality evidence); accidental intravascular catheter placement (two trials, 223 participants) (RR 0.90, 95% CI 0.33 to 2.45, low-quality evidence); accidental subarachnoid catheter placement (four trials, 682 participants) (RR 2.95, 95% CI 0.12 to 71.90, low-quality evidence); combined spinal epidural failure (two trials, 400 participants) (RR 0.98, 95% CI 0.44 to 2.18, low-quality evidence); unblocked segments (five studies, 423 participants) (RR 1.66, 95% CI 0.72 to 3.85); and pain measured by VAS (two studies, 395 participants) (mean difference (MD) -0.09, 95% CI -0.37 to 0.18). With regard to adverse effects, we found no statistically significant differences between participants receiving air and those given saline in the occurrence of paraesthesias (three trials, 572 participants) (RR 0.89, 95% CI 0.69 to 1.15); difficulty in advancing the catheter (two trials, 227 participants) (RR 0.91, 95% CI 0.32 to 2.56); catheter replacement (two trials, 501 participants) (RR 0.69, 95% CI 0.26 to 1.83); and postdural puncture headache (one trial, 110 participants) (RR 0.83, 95% CI 0.12 to 5.71).Authors' conclusionsLow-quality evidence shows that results do not differ between air and saline in terms of the loss of resistance technique for identification of the epidural space and reduction of complications. Applicability might be compromised, as most of the results described in this review were obtained from parturient patients. This review underlines the need to conduct well-designed trials in this field.

O impacto da implantação do sistema ERP na usinagem de moveis de uma empresa de medio porte

This paper analyzes the impact of implementing an information system, Enterprise Resource Planning - ERP, in a small business of the furniture industry. The goal this is show the impacts felt during and after implementation, showing behavioral and technological changes made by the study. The paper concludes by citing about the importance of cultural and behavioral changes for the good use of the system, besides showing the need to adapt to new technologies and ways of working to adapt to today's world of constant change and eternal conflict of the market

Gestão da qualidade na construção civil

Quality Management has become an essential requirement for all companies intending to compete and ensure its place in the labor market. Several tools have been created as a way of ensuring the effectiveness of quality management, in order to control and manage the quality of services and products to ensure a final product with a high degree of competition and quality, besides satisfaction and exceeding customer expectations. Due to the great importance it has at the presente time on the world stage and internationally, civil construction felt the need to eliminate the defects and the lack of quality that have become so common over time to ensure a quality product and it´s customers satisfaction. It was then that this industry began to implement and develop more modern techniques and tools for quality control in construction. Quality achieved position in global market, defining which companies would continue and which companies would leave it, not to mention it became insistently required by the customer. Some tools such as ISO 9000 guided companies seeking a quality management. This presentation will present some of these management tools and their applicability in the civil construction industry. Thus, it will be evident that despite the current resources it is necessary that civil construction professionals abandon the idea that considers quality management a problem and begin thinking about it as a solution to prevent future errors and ensure the quality of their services

A organização e seus relacionamentos: uma abordagem semiótica do conceito de público

The organizations now have felt some needs in regards to changes in attitudes in what refers to the relationship with their interest publics. In this way, this work has as objective approach different themes, like concepts of organizational culture and the interrelations with the profession of Public Relations, besides the contact with notions in the area of People Management and human capital. As all organizations are constituted by interest publics, it will also demonstrate theories that refer to the different kinds of publics which the organization maintains relationship with, although, giving special attention to the internal public, considered one of the main types of public. For better comprehension of the performance of the internal public it was used the greimassian narrative semiotics that allow an exploration and analysis os diverse procedures made by such public. Therefore, it was possible to observe a great contribution from the theory in what refers to the assertion of the importance in maintaining good relationships with the employees of an organization, specially to affirm the identity of the employee making use of factors such as culture, values, principals, norms etc. Thus, it is believed that the strategic communication must be used with the intention of proportioning personal and professional well being to the employees, in a way that they may feel more and more integrated and committed with the organization, granting, like so, the organizational development and recognition

Sincronia das bolsas de valores

This study aims to analyze various index stock exchanges around the world, with mathematical methods, analyzing the Product Distribution function (PDF), cumulative distribution and correlation. It is thought that the world economy is connected, as if the financial markets were a network, where the fluctuation of a market generates a variation on another and another, creating a pattern, that this change will affect the entire network, thus creating what we might call the domino effect. From this we intend to study, using as a basis the main index of the major stock exchanges around the world the relationship they have with each other, analyzing the influence and correlation that generates this effect, showing that markets are connected and influence each other. We can see this effect in the crisis of 2008, where the U.S. market from one moment to the other was shaken, affecting the whole world in a few days, creating effects that are felt in the present day

Morte e morrer: opinião dos profissionais de saúde de uma unidade de terapia intensiva pediátrica

Presently, the dying process and death most often occur in hospitals and, particularly, in Intensive Care Units (ICU), where patients’ lives are prolonged thanks to advanced technological devices and highly efficient medicines. To learn about the opinion of health care professionals working at a Pediatric Intensive Care Unit in relation to the dying process and dying. This is a descriptive quantitative study. A questionnaire was applied to the unit’s staff members from June to August, 2011. Data were statistically analyzed. Twenty-five professionals answered the questionnaire, and 72% faced death as a natural life process. 60% felt compassion, but that feeling did not interfere with how they cared for patients. Concerning their professional training, 52% reported not to have received any concerning patients’ caregivers in the dying process or death; therefore, they experienced such situation when they were already working, and 76% reported to be interested in updating courses on that theme. Further discussion about this topic during academic education is necessary. It is also necessary to provide health care professionals with specialization courses, debates and experience exchange so that they can better understand and deal with their feelings and limitations in face of death and thus give better care to patients and relate to patients’ families during the dying process of a loved one

Desenvolvimento de um smart meter: um estudo sobre eficiência energética através das redes inteligentes

Pós-graduação em Engenharia Elétrica - FEB

Impacto da saúde bucal na qualidade de vida de adolescentes grávidas

Pós-graduação em Odontologia Preventiva e Social - FOA

Entre eventos e episódios: as excepcionalidades das chuvas e os alagamentos no espaço urbano do Rio de Janeiro

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

À procura de (nossas próprias) palavras: filosofia e subjetividade

Writing about philosophical practice with children requires a memory of the body, a body that holds on to what is important to itself. My memory begins with my contact with the ideas of Matthew Lipman and the new ideas brought by his words, and continues with the need to change some of them and assign different meanings to others. Since my reading of the thinkers of the so called “Frankfurt School,” some words have taken new meanings to me, and have informed the way I now understand the practice of philosophy with children and its relationship to issues like educational “formation,” as well as others. Philosophical practice is unique, and needs to be thought, felt, and experienced; it has its own time and involves the construction and transformation of subjectivity itself. As such, to search for words in philosophy means to chose those words that can help us make sense and give meaning of what we do and think, allowing us to work with our thinking and with its forms of expression, beyond its technical dimension. In this sense, the usual emphasis of philosophy in its more technical dimension leads to an impoverishment of formation as experience, for the latter, which is a fundamental dimension of our lives, is rendered secondary. This has implications for the relationship between adults and children. When they reduce philosophy to a study of the formal capacity of thinking, teachers put students in the condition of a minority, and therefore in some way also put themselves in such a condition. In this paper, the activity of writing - as a way of expressing thought - allows me to conduct a tour my own subjectivity, and to encounter the words that express the meanings that inform what I think and do about my practice with philosophical novels, and about the value of generating texts related to philosophical practice, formation and assessment.

Bank efficiency in Brazil: the importance for economic sustainability

Studies on efficiency achieved greater relevance in organisations within an open market framework, which in Brazil began around 1990. The objective of this paper, applying the data envelopment analysis methodology, is to analyse the efficiency of banks operating in the country using the database termed 'the biggest banks', periodically divulged by the Central Bank of Brazil in 2010-2012. The methodology was applied to the 26 largest banking organisations via two approaches, one was financial intermediation and the other was results. In the financial intermediation approach, the efficiency increase was the highest among banks specialised in credit from 2010 to 2012. Retail banks, especially the large ones, felt most intensely the reaction of 2011, a year considered as the sector's low performance year. In the results approach, the efficiency increase was higher among retail banks. Factors such as retractions in the SELIC rate and bank spreads impacted all banks, regardless of the segment.