QUALIDADE DE VIDA E EFIC��CIA ADAPTATIVA DE PESSOAS COM OBESIDADE

A obesidade �� uma doen��a cr��nica que vem acometendo, progressivamente, cada vez mais pessoas no mundo. Por ser uma patologia de dif��cil controle que favorece a eclos��o de outros agravos �� sa��de, �� premente a necessidade de realiza����o de pesquisas que possam contribuir para o aperfei��oamento dos tratamentos, bem como para a melhoria da qualidade de vida e efic��cia adaptativa. Sendo assim, a presente pesquisa visou avaliar a percep����o da qualidade de vida (QV), a efic��cia adaptativa (EDAO) e o funcionamento global (AGF) de pessoas com obesidade, relacionando os resultados obtidos na avalia����o da percep����o da QV com os da efic��cia adaptativa, bem como aos do funcionamento global (AGF). Para tanto, utilizou-se o question��rio WHOQOL-100 vers��o em portugu��s para avalia����o da percep����o de qualidade de vida, a Entrevista Diagn��stica Preventiva Escala Diagn��stica Adaptativa Operacionalizada (EDAO) para a efic��cia adaptativa e a Escala de Avalia����o do Funcionamento Global (AGF) para o funcionamento global. Este estudo contou com a participa����o de trinta mulheres obesas (��ndice de Massa Corporal IMC >=30 kg/m2), com idade m��dia de 52,33 anos, que utilizavam os servi��os de um ambulat��rio situado na regi��o do Grande ABC, estado de SP. A maioria das participantes se encontrava no grau I de obesidade - 46,70%, situava-se no grau II 33,30% e 20,00% no grau III. O aumento de peso da maioria teve in��cio nas gesta����es (43,30%), o segundo per��odo onde ocorreu o in��cio do descontrole do peso corporal foi entre os 40 aos 50 anos (20,00%). Na avalia����o geral da QV, observou-se que no dom��nio VI Aspectos Espirituais/Religi��o/Cren��as Pessoais foi encontrado o maior escore m��dio (16,17 - DP=2,95 [equivalente a 80,83% do escore m��ximo que poderia ser obtido]), comparando-o com os demais dom��nios avaliados. Em oposi����o, o dom��nio I F��sico foi o que apresentou o menor escore m��dio (11,77 - DP=2,78 - 58,83%). Todas as participantes se encontravam em inefic��cia adaptativa: Grupo 2 Ineficaz Leve (26,7%), no Grupo 3 Ineficaz Moderada (33,3%) e no Grupo 4 Ineficaz Severa (30,0%). Quanto �� avalia����o do funcionamento global (AGF), notou-se que 36,67% se situavam no intervalo entre 51-60 pontos. 23,33% das participantes no intervalo entre 31-50 pontos. Apenas 23,33% tiveram pontua����o acima de 70 pontos. Relacionando os resultados das avalia����es, foram encontradas correla����es fortes, positivas e significativas entre a avalia����o da percep����o de qualidade de vida, da efic��cia adaptativa e do funcionamento Global.

Impact of stressful life event on the global functioning outcome after an assertive community treatment

Background: Assertive community treatment (ACT) was reported to be an effective treatment to improve global functioning of ultra-high risk (UHR) adolescents. However, the infl uence of stressful life event (SLE) was not extensively studied which represent our objective. Method: The SLE (encompassing adoption, migration, family member's deceased, sexual or physical abuse, etc.) of 20 UHR adolescents, treated with an ACT model, were rated. 10 adolescents having 0 to 1 SLE (mainly parents' divorce; low SLE group) were compared 10 adolescents with 2 to 5 SLE (high SLE group). The adolescents were assessed at baseline and after treatment with the Health of Nation Outcome Scale for Children and Adolescents (HoNOSCA). The HoNOSCA allowed rating different diffi culties such as behavior, symptoms, disorders and social. Results: First, results on the whole sample indicated signifi cant improvement after ACT (compared to baseline) on the total (P = .04), symptoms (P = .025) and social (P = .009) scores of the HoNOSCA. Second, the improvement on the HoNOSCA's score of the high SLE group were signifi cantly higher for the total (P = .016), symptoms (P = .019) and behavior (P = .033) scores compared to the low SLE group. Discussion/Conclusion: Globally, ACT seems to be an appropriate treatment to enhance global functioning and more specifi cally the social and symptoms diffi culties of UHR adolescents. Additionally, UHR adolescents with a high numbers of SLE were observed to have a better benefi t of the ACT on global, symptoms and behavioral diffi culties.

Evaluation of obesity interventions targeting adults in the occupational setting

The study of obesity and its causes has evolved into one of the most important public health issues in the United States (Office of Disease Prevention and Health Promotion, 2007). Obesity is linked to several chronic conditions, such as cardiovascular disease, diabetes and some cancers (National Center for Chronic Disease Prevention and Health Promotion, 2008b) and the public health concern resides in the present morbidity and mortality associated with obesity and related conditions (National Heart, Lung and Blood Institute, 1998). Furthermore, obesity and its related conditions present economic challenges to employers in terms of medical health care, sick leave, short-term disability and long-term disability benefits utilized by employees (��stbye, Dement, and Krause, 2007). Recently, articles covering intervention programs targeting obesity in the occupational setting have surfaced in the body of scientific literature. The increased interest in this area stems from the fact that employees in the United States spend more time in the work environment than many industrialized nations, including Japan and most of Western Europe (Organisation for Economic Co-operation and Development, 2006). Moreover, scientific literature supports the idea of investing in healthy human capital to promote productivity and output from employees (Berger, Howell, Nicholson, & Sharda, 2003). The time spent in the work environment, the business need for healthy employees, and the public health concern create an opportunity for planning, implementation and analysis of interventions for effectiveness. This paper aims to identify those intervention programs that focus on the occupational setting related to obesity, to analyze the overall effect of diet, physical fitness and behavioral change interventions targeting overweight and obesity in the occupational setting, and to evaluate the details and effectiveness of components, such as, intervention setting, target participant group, content, industry and length of follow up. Once strengths and weaknesses of the interventions are evaluated, ideas will be suggested for implementation in the future.^

Autistic and Schizotypal Traits and Global Functioning in Bipolar I Disorder

Objective: To determine the expression of autistic and positive schizotypal traits in a large sample of adults with bipolar I disorder (BD-I), and the effect of co-occurring autistic and positive schizotypal traits on global functioning in BD-I. Method: Autistic and positive schizotypal traits were self-assessed in 797 individuals with BD-I recruited by the Bipolar Disorder Research Network. Differences in global functioning (rated using the Global Assessment Scale) during lifetime worst depressive and manic episodes (GASD and GASM respectively) were calculated in groups with high/low autistic and positive schizotypal traits. Regression analyses assessed the interactive effect of autistic and positive schizotypal traits on global functioning. Results: 47.2% (CI=43.7-50.7%) showed clinically significant levels of autistic traits, and 23.22% (95% CI=20.29-26.14) showed clinically significant levels of positive schizotypal traits. In the worst episode of mania, the high autistic, high positive schizotypal group had better global functioning compared to the other groups. Individual differences analyses showed that high levels of co-occurring traits were associated with better global functioning in both mood states. Limitations: Autistic and schizotypal traits were assessed using self-rated questionnaires. Conclusions: Expression of autistic and schizotypal traits in adults with BD-I is prevalent, and may be important to predict illness aetiology, prognosis, and diagnostic practices in this population. Future work should focus on replicating these findings in independent samples, and on the biological and/or psychosocial mechanisms underlying better global functioning in those who have high levels of both autistic and positive schizotypal traits.

Autistic and Schizotypal Traits and Global Functioning in Bipolar Disorder

Background and Aims To determine the expression of autistic and positive schizotypal traits in a large sample of adults with bipolar disorder (BD), and the effect of co-occurring autistic and positive schizotypal traits on global functioning in BD. Methods Autistic and positive schizotypal traits were assessed in 797 individuals with BD recruited by the Bipolar Disorder Research Network (BDRN), using the Autism-Spectrum Quotient and Kings Schizotypy Questionnaire (KSQ), respectively. Differences in global functioning (rated using the Global Assessment Scale) during lifetime worst depressive and manic episodes (GASD and GASM respectively) were calculated in groups with high/low autistic and positive schizotypal traits. Regression analyses assessed the interactive effect of autistic and positive schizotypal traits on global functioning. Results 47.2% (CI = 43.7���50.7%) showed clinically significant levels of autistic traits. Mean of sample on the KSQ-Positive scale was 11.98 (95% CI: 11.33���12.62). In the worst episode of mania, the high autistic, high positive schizotypal group had better global functioning than the low autistic, low positive schizotypal group (mean difference = 3.72, p = 0.004). High levels of co-occurring traits were associated with better global functioning in both mood states in individuals with a history of psychosis (GASM: p < 0.001; GASD: p = 0.055). Conclusions Expression of autistic and schizotypal traits in adults with BD is prevalent, and may be important to predict course of illness, prognosis, and in devising individualised therapies. Future work should focus on replicating these findings in independent samples, and on the biological and/or psychosocial mechanisms underlying better global functioning in those who have high levels of both autistic and positive schizotypal traits.

Estudo sobre o insight em pessoas com psicose

Para al��m das vari��veis cl��nicas e sociodemogr��ficas existem concerteza importantes componentes individuais que desempenham um contributo importante no n��vel de insight apresentado por cada pessoa doente, por exemplo, o n��vel de intelig��ncia, personalidade, cultura, experi��ncias passadas, mem��ria, etc. A natureza cl��nica, emocional e/ou intelectual do termo ajuda-nos a compreender a complexidade da dificuldade que existe na sua tradu����o e, inclusive, na sua compreens��o. Da�� que as defini����es atribu��das ao conceito sejam muito distintas e variem consoante a forma����o te��rica do autor/investigador. Pretende-se, a partir dessa identifica����o/compreens��o, promover a qualidade de vida destas pessoas atrav��s do desenvolvimento de novas aprendizagens que possibilitem uma coopera����o activa. �� igualmente fundamental ir ao encontro das capacidade intactas de maneira a possibilitar a aquisi����o de novos(s) comportamento(s) que tenham um impacte positivo nas queixas, sinais, sintomas, incapacidade e disfuncionalidade apresentados pelo/a utente. Uma vez que a pr��pria conceptualiza����o do termo traduzir�� aquilo que se pretende avaliar,ser�� efectuada uma reflex��o detalhada acerca dos instrumentos e defini����es que t��m sido mais utilizadas para explorar o insight nas psicoses.Procurei, no meu trabalho de investiga����o, real��ar e promover a import��ncia que cada sujeito, alvo de interven����o, desempenha ao longo do seu processo de recupera����o e na preven����o de reca��das. No seguimento dos objectivos acima descritos, para al��m da revis��o te��rica efectuada ao fen��meno em termos de conceptualiza����o e estudos desenvolvidos na ��rea de investiga����o, foi,neste estudo, realizada a contribui����o para a valida����o do instrumento ���Assessment of Insight in Psychosis: a re-standartization of a New Scale��� de Markov�� & Berrios (2003).O fen��meno de insight escolhido pela Insight Scale, relata menos as mudan��as vividas em rela����o �� doen��a mental, e mais a actual consci��ncia e articula����o de tais mudan��as. Tendo como base uma abordagem psicopedag��gica, o fen��meno do insight aqui explorado assentou numa perspectiva reabilitativa, actual e multidimensional, que fosse para al��m das dimens��es cl��nicas tradicionais. Neste sentido �� apresentada uma escala original, intitulada ���Escala de Avalia����o do Insight e Identifica����o das Necessidades em Pessoas com Psicose���, bem como um modelo de interven����o psicopedag��gico breve, assente nos pressupostos descritos ao longo do trabalho.-----------------------------------------ABSTRACT: The importance of insight in people with mental illnesses was first studied in psychiatry, in the first decades of the 20th century, by people as important as Lewis (1934) and Jaspers (1959). However, this field of investigation was left unexplored for many years. Only in the last decade has this phenomenon become the object of numerous scientific investigations, having been given special attention by its investigators. For this reason a significant number of instruments for evalauting insight in psychotic disorders were developed. Since then many papers have been published, which has allowed for a more in depth knowledge on the subject. Therefore, in recent years, the concept of insight has been developed in an attempt to clarify its compexity. A once dichotomic phenomenon, described in terms of presence or absence, became considered multidimensional, which made the identification of different levels of insight and different dimensions possible. Current concepts categorize insight into five dimensions: the awareness of the patient in relation to his/her mental illness, the awareness of the patient in relation to the social consequences of his/her illness, the awareness of the need for treatment, the awareness of the symptoms and the explanation of those symptoms in relation to the illness. The lack of insight in psychiatry, in general terms, and as this phenomenon has been described, the lack of awareness of having a mental illness, represents one of the most common symptoms of schizophrenia and affects a big part of the population that suffer from this illness. It is estimated that bewteen 50 and 80 per cent of patients with schizophrenia do not believe that they are ill, which, consequently has a big impact in the process of adherence to treatment. It is still not possible, however, to identify all the factors that determine the lack of insight in schizophrenics. There are psychological, social and cultural influences that almost certainly play their role in the lack of insight registered in this pathology.Since the impact of scizophrenia is felt in many aspects of the individual���s life, its effective treatment should be directed at various levels, including the improvement of insight. One of the objectives of this study is to explore the relationship between the level of insight in psychosis and the clinical and sociodemographic variables, the psychopathology and its global functioning. As well as the clinical and sociodemographic variables, there are of course important individual components that contribute to the level of insight seen in each patient, for example, their level of inteligence, personality, culture, past experiences, memory, etc. The clinical, emotional and/or intelectual nature of the term helps us understand the difficulty that lies in its interpretation as well as in its comprehension. Therefore, the definitions attributed to the term are very different and vary according to the theoretical training of the investigator. It is intended, from this identification/understanding, to promote the quality of life of these people through the development of new findings that might enable an active cooperation. It is equally fundamental to observe their unimpaired capacities in order to enable the acquisition of new behaviour(s) that have a positive impact on the complaints, signs, symptoms, incapacity and disfunctioning seen in the patient.As the actual comprehension of the term explains what we intend to evaluate, a detailed reflection is made on the instruments and definitions that have been used the most to explore insight in psychosis.In this investigation I tried to underline and promote the importance that each subject, undergoing medical intervention, plays during his/her process of recovery and prevention of relapses. Considering the above mentioned objectives, as well as a theoretical review of the phenomenon in terms of conceptualization and investigative studies developed, this study contributed to the validation of the instrument.The insight phenomenon chosen by the ���Insight Scale���, records less changes experienced in relation to the mental illness and more actual awareness and articulation of these changes. Based on a psychopedagogical approach, the insight phenomenon explored here settled on a rehabilitation, current and multidimensional perspective that would go beyond the traditional clinical dimensions. For this reason an original scale entitled ���Insight Evaluation Scale and Need Identification in Psychosis Patients��� is presented, as well as a psychopedagogical intervention model soon to be used with admitted patients based on the presuppositions described in this study.

Assessment of groundwater contamination in an agricultural peri-urban area (NW Portugal): an integrated approach

The excessive use of pesticides and fertilisers in agriculture has generated a decrease in groundwater and surface water quality in many regions of the EU, constituting a hazard for human health and the environment. Besides, on-site sewage disposal is an important source of groundwater contamination in urban and peri-urban areas. The assessment of groundwater vulnerability to contamination is an important tool to fulfil the demands of EU Directives. The purpose of this study is to assess the groundwater vulnerability to contamination related mainly to agricultural activities in a peri-urban area (Vila do Conde, NW Portugal). The hydrogeological framework is characterised mainly by fissured granitic basement and sedimentary cover. Water samples were collected and analysed for temperature, pH, electrical conductivity, chloride, phosphate, nitrate and nitrite. An evaluation of groundwater vulnerability to contamination was applied (GOD-S, Pesticide DRASTIC-Fm, SINTACS and SI) and the potential nitrate contamination risk was assessed, both on a hydrogeological GIS-based mapping. A principal component analysis was performed to characterised patterns of relationship among groundwater contamination, vulnerability, and the hydrogeological setting assessed. Levels of nitrate above legislation limits were detected in 75 % of the samples analysed. Alluvia units showed the highest nitrate concentrations and also the highest vulnerability and risk. Nitrate contamination is a serious problem affecting groundwater, particularly shallow aquifers, especially due to agriculture activities, livestock and cesspools. GIS-based cartography provided an accurate way to improve knowledge on water circulation models and global functioning of local aquifer systems. Finally, this study highlights the adequacy of an integrated approach, combining hydrogeochemical data, vulnerability assessments and multivariate analysis, to understand groundwater processes in peri-urban areas.

��valuation d���un programme novateur de r��adaptation par les arts de la sc��ne pour des jeunes pr��sentant un trouble psychiatrique stabilis�� : le programme Espace de Transition

L���objectif de cette th��se ��tait d�����valuer Espace de Transition (ET), un programme novateur d���intervention par les arts de la sc��ne visant �� favoriser la r��adaptation psychosociale d���adolescents et de jeunes adultes pr��sentant des troubles mentaux stabilis��s et �� diminuer la stigmatisation des individus aux prises avec des probl��mes de sant�� mentale. Ce programme a ��t�� con��u par une ��quipe de cliniciens du d��partement de psychiatrie du Centre hospitalier universitaire Ste-Justine, en collaboration avec des artistes professionnels, et est livr�� depuis le printemps 2009. L�����valuation du programme ET a ��t�� conduite de mani��re ind��pendante, selon des approches collaborative et naturaliste et en usant de m��thodes mixtes. Les donn��es de recherche ont ��t�� recueillies avant pendant et apr��s le programme aupr��s de l���ensemble des participants �� deux sessions distinctes (N = 24), de m��me qu���aupr��s des deux artistes instructeurs, de la psycho��ducatrice responsable du soutien clinique, ainsi que des psychiatres et autres intervenants ayant r��f��r�� des participants (N=11). Des entrevues semi-structur��es individuelles et de groupe, des observations directes et des questionnaires ont servi �� recueillir les donn��es n��cessaires �� l�����valuation. Des analyses quantitatives de variance, ainsi que des analyses qualitatives th��matiques ont ��t�� r��alis��es et leurs r��sultats ont ��t�� interpr��t��s de mani��re int��gr��e. Le premier chapitre empirique de la th��se relate l�����valuation de la mise en ��uvre du programme ET. Cette ��tude a permis de constater que le programme avait rejoint des participants correspondant de pr��s �� la population vis��e et que ceux-ci pr��sentaient globalement des niveaux ��lev��s d���assiduit��, d���engagement et d���appr��ciation du programme. L�����valuation de la mise en ��uvre a en outre permis de conclure que la plupart des composantes du programme identifi��es a priori comme ses param��tres essentiels ont ��t�� livr��es tel que pr��vu par les concepteurs et que la plupart d���entre elles ont ��t�� largement appr��ci��es et jug��es pertinentes par les participants et les autres r��pondants consult��s. Le second chapitre empirique consiste en un article portant sur l�����valuation des effets du programme ET relativement �� l���atteinte de trois de ses objectifs interm��diaires, soient l���am��lioration 1) du fonctionnement global, 2) du confort relationnel et des comp��tences sociales, ainsi que 3) de la perception de soi des participants pr��sentant des troubles mentaux. Les r��sultats de cette ��tude ont r��v��l�� des changements significatifs et positifs dans le fonctionnement global des participants suite au programme, tel qu�����valu�� par les cliniciens r��f��rents et partiellement corrobor�� par les participants eux-m��mes. Des am��liorations en ce qui concerne le confort relationnel, les comp��tences sociales et la perception de soi ont ��galement ��t�� objectiv��es chez une proportion substantielle de participants, bien que celles-ci ne se soient pas traduites en des diff��rences significatives d��cel��es par les analyses quantitatives de groupe. Le troisi��me et dernier chapitre empirique de la th��se relate une ��tude exploratoire des m��canismes sous-tendant les effets du programme ET ayant conduit �� l�����laboration inductive d���une th��orie d���action de ce programme. Cette investigation qualitative a r��v��l�� quatre cat��gories de m��canismes, soient des processus de 1) gain d���exp��rience et de gratification sociales, 2) de d��sensibilisation par exposition graduelle, 3) de succ��s et de valorisation, et 4) de normalisation. Cette ��tude a ��galement permis de sugg��rer les caract��ristiques et composantes du programme qui favorisent la mise en place ou l���impact de ces m��canismes, tels l���environnement et l���animation non cliniques du programme, la composition h��t��rog��ne des groupes de participants, le recours aux arts de la sc��ne, ainsi que la poursuite d���une r��alisation collective et son partage avec un public ext��rieur au programme. Globalement, les ��tudes pr��sent��es dans la th��se appuient la pertinence et le caract��re prometteur du programme ET, tout en sugg��rant des pistes d���am��lioration potentielle pour ses versions ult��rieures. Par extension, la th��se soutient l���efficacit�� potentielle d���interventions r��adaptatives mettant en ��uvre des composantes apparent��es �� celles du programme ET pour soutenir le r��tablissement des jeunes aux prises avec des troubles mentaux.

Inserimento eterofamigliare supportato di adulti sofferenti di disturbi psichici: Valutazione degli esiti

L���Inserimento Eterofamigliare Supportato di Adulti (IESA) sofferenti di disturbi psichici consiste nell���accogliere persone in cura presso i servizi psichiatrici territoriali, nel proprio domicilio, integrandole nelle proprie relazioni famigliari. Obiettivo �� migliorare la qualit�� di vita dell���utente e favorirne l���integrazione nella comunit��. Obiettivo. Valutare gli esiti dello IESA, con un disegno di ricerca longitudinale, considerando: psicopatologia, benessere psicologico, funzionamento sociale e familiare. Metodologia. 40 soggetti: 20 pazienti e 20 ospitanti. La valutazione clinica �� stata effettuata all���inizio della convivenza e al follow-up di 1, 3, 6 e 12 mesi. Strumenti utilizzati: BPRS, VGF, PWB, SQ, FAD. Analisi statistica: Modello Lineare Generale (GLM) con l���Analisi della Varianza per prove ripetute e calcolo dell���effect-size. Risultati. 15 pazienti maschi e 5 femmine, 17 italiani. 11 soddisfano i criteri diagnostici (DSM-IV-TR) per schizofrenia e disturbi psicotici, 5 per i disturbi dell���umore e 4 per i disturbi di personalit��. Dopo l���inserimento 3 sono stati i ricoveri e 4 le visite psichiatriche urgenti. 8 pazienti modificano/diminuiscono la terapia e 3 la sospendono. Aumenta il benessere psicologico (PWB); diminuiscono i sintomi psicopatologici (BPRS ed SQ) e migliora il funzionamento globale (VFG). Il gruppo dei famigliari composto da 11 uomini e 9 donne, 19 di nazionalit�� italiana; con et�� media di 55 anni. 8 sono coniugati, 6 celibi/nubili, 4 divorziati e 2 vedovi. 9 hanno figli, 11 lavorano e 8 sono pensionati. Nei famigliari aumenta il benessere psicologico (PWB), migliora il funzionamento famigliare (FAD) e la valutazione del funzionamento globale (VGF) rimane costante nel tempo. Discussioni e conclusioni. Il progetto IESA sembra migliorare la psicopatologia, con una diminuzione dei comportamenti maladattativi e un aumento delle capacit�� relazionali dell���ospite favorendone l���integrazione. Inoltre, lo IESA sembra diminuire i costi della cronicit�� psichiatrica: diminuzione degli accessi al Pronto Soccorso, delle visite psichiatriche urgenti e delle giornate di ricovero.

Estudo de associa����o entre disfun����o neurocognitiva, estresse oxidativa e polimorfismos em pacientes jovens com Transtornos Bipolar tipo I

O Transtorno Bipolar (TB) tipo I �� uma doen��a caracterizada por epis��dios de mania e depress��o recorrentes com importante preju��zo do funcionamento global e comprometimento das fun����es cognitivas. Al��m disso, sabe-se que o n��mero de epis��dios de humor patol��gico ao longo da vida pode tamb��m influenciar o funcionamento cognitivo destes sujeitos. Neste cen��rio, ocorreu a necessidade de se investigar marcadores gen��ticos para disfun����o cognitiva no TB com o objetivo de estudar este fen��meno. Dentre os potenciais genes respons��veis por influenciar a cogni����o destacam-se os polimorfismos funcionais do fator neurotr��fico derivado do c��rebro (BDNF), da catecol-O-metiltransferase (COMT), da apolipoprote��na-E (APOE) e do canal de c��lcio de baixa voltagem subunidade 1-C (CACNA1C). Sabe-se, tamb��m, que no TB os marcadores de estresse oxidativo est��o aumentados durante todas as fases da doen��a, entretanto, n��o �� claro qual impacto destes na disfun����o cognitiva de indiv��duos com TB. O objetivo dessa tese foi avaliar o desempenho cognitivo de pacientes jovens com bipolaridade tipo I e sua associa����o com o gen��tipo de BDNF, COMT, APOE e CACNA1C e tamb��m com os n��veis plasm��ticos de oxida����o da guanosina (8-OHdG) e citosina (5-Mec) durante os epis��dios de humor, eutimia e em controles. Para investigar essa associa����o foram inclu��dos 116 pacientes (79 em epis��dio de humor patol��gico e 37 eut��micos) com diagn��stico de TB tipo I (DSMIV-TR); 97 controles saud��veis foram submetidos �� avalia����o neuropsicol��gica e coleta de sangue para extra����o de DNA visando genotipagem para BDNF (rs6265), COMT (rs4680; rs165599), APOE (rs429358 e rs7412), CACNA1C (rs1006737), 8-OhdG e 5-Mec. A an��lise dos dados obtidos revelou que pacientes portadores do gen��tipo Met/Met rs4680/rs165599 do COMT apresentam comprometimento cognitivo mais grave (fun����o executiva, flu��ncia verbal, mem��ria e intelig��ncia) comparado ao gen��tipo Val/Met ou Val/Val durante epis��dios man��acos ou mistos. Na mesma dire����o destes resultados, verificou-se que pacientes portadores do alelo Met rs4680 do COMT apresentam comprometimento do reconhecimento de emo����es faciais em epis��dios de mania e depress��o. Nenhum efeito do COMT foi observado em controles. O alelo de risco Met do CACNA1C se associou a um pior comprometimento executivo independente dos sintomas man��acos ou depressivos no TB, por��m nenhum efeito se observou nos controles. O alelo Met do BDNF rs6265 ou a presen��a do alelo 4 da APOE n��o representa um fator que identifique um grupo com desempenho cognitivo diferenciado durante as fases do TB ou em controles. Sujeitos com TB apresentaram n��veis mais elevados de 8-OHdG e tais n��veis eram diretamente proporcionais ao n��mero de epis��dios man��acos ao longo da vida, sugerindo um papel dos epis��dios hiperdopamin��rgicos na oxida����o das bases de DNA. Concluiu-se que a genotipagem para COMT e CACNA1C em pacientes com TB pode identificar um grupo de pacientes associados a pior disfun����o cognitiva durante as fases man��acas e mistas do TB. Tal dado pode ser um indicador do envolvimento do sistema dopamin��rgico e dos canais de c��lcio de baixa voltagem na fisiopatologia da disfun����o cognitiva no TB e deve ser explorado em outros estudos

Evaluation of flood preparedness in public health facilities in Eastern Province, Sri Lanka

Thesis (Master's)--University of Washington, 2016-06

Rethinking the "diseases of affluence" paradigm: Global patterns of nutritional risks in relation to economic development

Background Cardiovascular diseases and their nutritional risk factors-including overweight and obesity, elevated blood pressure, and cholesterol-are among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development. Methods and Findings We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about I$5,000 (international dollars) and peaked at about I$12,500 for females and I$17,000 for males. Cholesterol's point of inflection and peak were at higher income levels than those of BMI (about I$8,000 and I$18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not correlated or only weakly correlated with the economic factors considered, or with cholesterol and BMI. Conclusions When considered together with evidence on shifts in income-risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low-income and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by population-level and personal interventions for blood pressure and cholesterol.

Evaluation of a Quality Improvement (QI) Intervention for Maternal, Newborn, and Child Health (MNCH) in Colombia: The Mil D��as Intervention of SINERGIAS in the Department of Bol��var

Thesis (Master's)--University of Washington, 2016-06

Evaluation of the impact of nursing clinics in the rheumatology services

Nursing clinics in rheumatology (NCRs) are organisational care models that provide care centred within the scope of a nurse���s abilities. To analyse the impact of NCR in the rheumatology services, national multicenter observational prospective cohort studied 1-year follow-up, comparing patients attending rheumatology services with and without NCR. NCR was defined by the presence of: (1) office itself; (2) at least one dedicated nurse; and (3) its own appointment schedule. Variables included were (baseline, 6 and 12 months): (a) test to evaluate clinical activity of the disease, research and training, infrastructure of unit and resources of NCR and (b) tests to evaluate socio-demographics, work productivity (WPAI), use of services and treatments and quality of life. A total of 393 rheumatoid arthritis and ankylosing spondylitis patients were included: 181 NCR and 212 not NCR, corresponding to 39 units, 21 with NCR and 18 without NCR (age 53 + 11.8 vs 56 + 13.5 years). Statistically significant differences were found in patients attended in sites without NCR, at some of the visits (baseline, 6 or 12 months), for the following parameters: higher CRP level (5.9 mg/l �� 8.3 vs 4.8 mg/l �� 7.8; p < 0.005), global disease evaluation by the patient (3.6 �� 2.3 vs 3.1 �� 2.4), physician (2.9 �� 2.1 vs 2.3 �� 2.1; p < 0.05), use of primary care consultations (2.7 �� 5.4 vs 1.4 �� 2.3; p < 0.001) and worse work productivity. The presence of NCR in the rheumatology services contributes to improve some clinical outcomes, a lower frequency of primary care consultations and better work productivity of patients with rheumatic diseases.

Crescer em fam��lia: A perman��ncia no acolhimento familiar

O acolhimento familiar oferece um contexto de vida �� crian��a retirada da sua fam��lia biol��gica, por um per��odo de tempo indeterminado que se pode prolongar, no limite, at�� �� maioridade ou independ��ncia. Um contexto familiar est��vel permite desenvolver sentimentos de seguran��a e de perman��ncia associados �� possibilidade de manuten����o dos contactos com a sua fam��lia biol��gica. A crian��a pode e deve, em muitas circunst��ncias, permanecer com os seus acolhedores e o reconhecimento deste papel parental �� um passo que pode contribuir para afastar ambiguidades e indefini����es que s��o prejudiciais para o sistema e para as pr��ticas que ele vai configurando. Em Portugal, todavia, o acolhimento familiar �� umamedida de car��cter tempor��rio, cuja aplica����o depende da previsibilidade do retorno da crian��a ou do jovem �� fam��lia de origem. O objetivo deste artigo ��, ap��s uma breve caracteriza����o do sistema de prote����o de crian��as e jovens portugu��s, analisar a perman��ncia no acolhimento familiar de 2006 a 2011, a partir dos relat��rios de caracteriza����o das crian��as e jovens emsitua����o de acolhimento. De seguida procedemos �� apresenta����o e discuss��o de dados recolhidos num estudo desenvolvido no distrito do Porto, englobando as 289 crian��as que se encontravamacolhidas emmaio de 2011, e que representavam52%das coloca����es familiares de crian��as em Portugal.Os resultados foram apurados com a aplica����o de um formul��rio de recolha de dados preenchido a partir dos registos oficiais de cada crian��a acolhida e atrav��s da realiza����o de 52 entrevistas a acolhedores. Entre os resultados principais destacam-se os longos per��odos de estadia, a perman��ncia da crian��a na fam��lia acolhedora inicial e a avalia����o global positiva dos resultados obtidos, o que nos permite identificar um conjunto de desafios que se colocam no futuro imediato ao acolhimento familiar portugu��s.