Estilo parental, filhos adolescentes e transplante hepático

Los cambios biopsicosociales de la adolescencia sitúan a los adolescentes trasplantados de hígado en mayor riesgo de no adherencia al tratamiento y al empeoramiento de la evolución en comparación con otros grupos de edad. Nuestro objetivo es determinar si la influencia del modelo parental afecta a la tolerancia tras el trasplante hepático. Método: La escala de exigencia y responsabilidad se aplicó a 30 adolescentes trasplantados de hígado y adultos jóvenes (12-30 años). La correlación entre la frecuencia del modelo parental con la tolerancia, el rechazo clínico y el rechazo en la biopsia fue hecho siguiendo el test de Chi-cuadrado. Resultados: Los resultados indican que el 57% de los adolescentes calificaron sus padres como autoritarios o sensibles, el 43% de los adolescentes definieron a sus padres como no sensibles, subdivididos en varios grupos de: 30% negligentes, permisivos el 10% y autoritarios el 3%. En correlación, no se observó ninguna diferencia significativa en el modelo parental comparando los grupos adherentes y no adherentes (X2 = 0,52, p = 0,37) y entre los grupos con y sin rechazo clínico (X2 = 0,34, p = 0,42) y entre los grupos con y sin rechazo confirmado por biopsia (X2 = 0,81, p = 0,30). Conclusiones: El estilo de crianza no tenía ninguna influencia en la adherencia, el rechazo clínico y el rechazo de la biopsia en este grupo de pacientes jóvenes con trasplante de hígado, ya que la adherencia a los inmunosupresores y el rechazo pueden ser modificados por múltiples factores. Es necesario analizar una muestra mayor para confirmar estos datos.The biological, psychological and social developmental changes that occur during adolescence place the transplanted adolescent at an even higher risk of non-adherence and poor outcome than other age groups. Our aim is check whether parenting style influences the post-liver transplant outcome after liver transplantation. Participantsand Methods: Exigency and responsiveness scale was applied to 30 liver transplanted adolescents and young adults (12-30 years old). Chi square test was used to correlate frequency of parental style with adherence, clinical rejection and rejection in biopsy. Results: 57% parents were classified as authoritative or responsive.13/30 were non responsive, which were further sub classified as negligent 30%, permissive 10% and authoritarian 3%. There was no significant difference in parenting style comparing the compliant and noncompliant groups (X2 = 0.52, p = 0.37), as well as between groups with and without clinical rejection (X2=0,34, p=0,42) and between groups with and without biopsy proven rejection (X2=0,81, p=0,30). Conclusions: Parenting style had no influence in adherence, clinical or biopsy proven rejection in this group of young patients that underwent liver transplantation. Since compliance and rejection may be modified by multiple factors, a larger sample analyses would be necessary to confirm these data.As transformações biopsicossociais da adolescência colocam os adolescentes transplantados de fígado em maior risco de não aderência ao tratamento e piora da evolução quando comparados a outros grupos etários. Objetivo: Verificar se o estilo parental influencia na adesão ao tratamento do pós-transplante hepático. Método: A escala de exigência e responsividade foi aplicada para 30 adolescentes transplantados de fígado e adultos jovens (12-30 anos). A correlação da freqüência do estilo parental com a adesão, rejeição clínica e rejeição na biópsia foi feito pelo teste do Qui-quadrado. Resultados: os achados apontam que 57% adolescentes classificaram seus pais como autoritativos ou responsivos, 43% adolescentes apontaram os pais como não responsivos, subdivididos nos subgrupos: negligente 30%, permissivo 10% e autoritário 3%. Na correlação, não foi observada diferença significativa no estilo parental comparando os grupos aderentes e não aderentes (X2 = 0,52, p = 0,37), assim como entre os grupos com e sem rejeição clínica (X2 = 0,34, p = 0,42) e entre os grupos com e sem rejeição comprovada por biópsia (X2 = 0,81, p = 0,30). Conclusões: O estilo parental não teve influência na adesão, rejeição clínica e rejeição à biópsia neste grupo de pacientes jovens transplantados de fígado, uma vez que a aderência aos imunossupressores e a rejeição podem ser modificadas por múltiplos fatores. É necessário analisar amostra maior para confirmar estes dados.peerReviewe

Skin picking treatment with the Rothbaum cognitive behavioral therapy protocol : a randomized clinical trial

Introduction: Although behavioral therapies can effectively treat skin picking disorder (SPD), there is no standardized treatment for improving SPD and its comorbidities and there is no group intervention option. This trial aimed to adapt the Rothbaum trichotillomania protocol to SPD (Study 1) and test its efficacy for treating SPD and comorbidities in individual and group formats (Study 2). Methods: The adapted protocol was applied to 16 SPD patients, who were allocated to group or individual treatment (Study 1). Afterwards, 54 patients were randomly allocated to treatment in an individual (n=27) or group format (n=27) (Study 2). In both studies, assessments of SPD severity, anxiety, depression, clinical status and skin lesion severity were performed at baseline and the endpoint. Results: The adapted protocol was feasible in both treatment modalities (Study 1) and led to high SPD remission rates (individual 63%; group 52%), with no significant difference between intervention types (p = 0.4) (Study 2). SPD, anxiety, and depression symptoms and objective patient lesion measures improved after treatment. There was large effect size for SPD symptom improvement in both treatment types (Cohen’s d: group = 0.88; individual = 1.15) (Study 2). Conclusion: The adapted Rothbaum protocol was effective for SPD remission, comorbidities, and skin lesions, both in individual and group formats

Estilo parental, filhos adolescentes e transplante hepático

Los cambios biopsicosociales de la adolescencia sitúan a los adolescentes trasplantados de hígado en mayor riesgo de no adherencia al tratamiento y al empeoramiento de la evolución en comparación con otros grupos de edad. Nuestro objetivo es determinar si la influencia del modelo parental afecta a la tolerancia tras el trasplante hepático. Método: La escala de exigencia y responsabilidad se aplicó a 30 adolescentes trasplantados de hígado y adultos jóvenes (12-30 años). La correlación entre la frecuencia del modelo parental con la tolerancia, el rechazo clínico y el rechazo en la biopsia fue hecho siguiendo el test de Chi-cuadrado. Resultados: Los resultados indican que el 57% de los adolescentes calificaron sus padres como autoritarios o sensibles, el 43% de los adolescentes definieron a sus padres como no sensibles, subdivididos en varios grupos de: 30% negligentes, permisivos el 10% y autoritarios el 3%. En correlación, no se observó ninguna diferencia significativa en el modelo parental comparando los grupos adherentes y no adherentes (X2 = 0,52, p = 0,37) y entre los grupos con y sin rechazo clínico (X2 = 0,34, p = 0,42) y entre los grupos con y sin rechazo confirmado por biopsia (X2 = 0,81, p = 0,30). Conclusiones: El estilo de crianza no tenía ninguna influencia en la adherencia, el rechazo clínico y el rechazo de la biopsia en este grupo de pacientes jóvenes con trasplante de hígado, ya que la adherencia a los inmunosupresores y el rechazo pueden ser modificados por múltiples factores. Es necesario analizar una muestra mayor para confirmar estos datos.The biological, psychological and social developmental changes that occur during adolescence place the transplanted adolescent at an even higher risk of non-adherence and poor outcome than other age groups. Our aim is check whether parenting style influences the post-liver transplant outcome after liver transplantation. Participantsand Methods: Exigency and responsiveness scale was applied to 30 liver transplanted adolescents and young adults (12-30 years old). Chi square test was used to correlate frequency of parental style with adherence, clinical rejection and rejection in biopsy. Results: 57% parents were classified as authoritative or responsive.13/30 were non responsive, which were further sub classified as negligent 30%, permissive 10% and authoritarian 3%. There was no significant difference in parenting style comparing the compliant and noncompliant groups (X2 = 0.52, p = 0.37), as well as between groups with and without clinical rejection (X2=0,34, p=0,42) and between groups with and without biopsy proven rejection (X2=0,81, p=0,30). Conclusions: Parenting style had no influence in adherence, clinical or biopsy proven rejection in this group of young patients that underwent liver transplantation. Since compliance and rejection may be modified by multiple factors, a larger sample analyses would be necessary to confirm these data.As transformações biopsicossociais da adolescência colocam os adolescentes transplantados de fígado em maior risco de não aderência ao tratamento e piora da evolução quando comparados a outros grupos etários. Objetivo: Verificar se o estilo parental influencia na adesão ao tratamento do pós-transplante hepático. Método: A escala de exigência e responsividade foi aplicada para 30 adolescentes transplantados de fígado e adultos jovens (12-30 anos). A correlação da freqüência do estilo parental com a adesão, rejeição clínica e rejeição na biópsia foi feito pelo teste do Qui-quadrado. Resultados: os achados apontam que 57% adolescentes classificaram seus pais como autoritativos ou responsivos, 43% adolescentes apontaram os pais como não responsivos, subdivididos nos subgrupos: negligente 30%, permissivo 10% e autoritário 3%. Na correlação, não foi observada diferença significativa no estilo parental comparando os grupos aderentes e não aderentes (X2 = 0,52, p = 0,37), assim como entre os grupos com e sem rejeição clínica (X2 = 0,34, p = 0,42) e entre os grupos com e sem rejeição comprovada por biópsia (X2 = 0,81, p = 0,30). Conclusões: O estilo parental não teve influência na adesão, rejeição clínica e rejeição à biópsia neste grupo de pacientes jovens transplantados de fígado, uma vez que a aderência aos imunossupressores e a rejeição podem ser modificadas por múltiplos fatores. É necessário analisar amostra maior para confirmar estes dados.peerReviewe

Down syndrome: Prevalence and distribution of congenital heart disease in Brazil

ABSTRACT CONTEXT AND OBJECTIVE: Down syndrome is the most common genetic disorder, affecting 1/700 live births. Among the clinical findings, one constant concern is the high prevalence of congenital heart disease. The objective of this study was to determine the prevalence and profile of congenital heart disease among patients attended at a Down syndrome outpatient clinic in southern Brazil between 2005 and 2013. DESIGN AND SETTING : Cross-sectional study conducted in a referral center. METHODS : Data were retrospectively gathered from the medical files of 1,207 patients with Down syndrome, among whom 604 (50.0%) had been diagnosed with congenital heart disease. These data were subjected to descriptive analysis using the Statistica software. RESULTS : Among the 604 patients with congenital heart disease, 338 (55.8%) were male and 269 (44.5%) were female. The most common heart diseases were atrial septal defect in 254 patients (42.1%); total atrioventricular septal defect in 91 (15.1%); atrial septal defect and ventricular septal defect in 88 (14.6%); ventricular septal defect in 77 (12.7%); patent ductus arteriosus in 40 (6.6%); patent foramen ovale in 34 (5.6%) patients; tetralogy of Fallot in 12 (2%); and other diseases in 8 (1.3%). Pulmonary hypertension was present in 57 (9.4%). Out of the total, 150 patients (24.8%) underwent cardiac surgery. CONCLUSION : The high prevalence of congenital heart disease among the patients at the Down syndrome outpatient clinic (50%) was similar to findings from other studies and justifies investigation during the neonatal period, so as to decrease mortality and morbidity

大臺北地區選民人口變項.政治態度.傳播行為與投票決定型態之研究 : 以民國74年地方公職人員選舉為例

Objective: Anxiety and depression are prevalent among medical students. Brazilian medical students have higher levels of depression and lower quality of life than their U.S. counterparts, and no preventive intervention exists for this risk group in Brazil. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral treatment protocol for neuroticism, was recently adapted into a single-session, preventive intervention. This study tested the impact of this protocol on psychiatric symptoms and quality of life in Brazilian medical students. Methods: In this open trial, the intervention protocol was translated and adapted to Brazilian Portuguese. Medical students over 18 years of age without psychotic symptoms, severe depressive episodes, or acute psychiatric risk were included, undergoing a psychiatric clinical interview (MiniInternational Neuropsychiatric Interview [MINI]) and evaluation at baseline and at 7 and 30 days after a single-session UP that included experimental avoidance, quality of life, self-esteem, empathy, and anxiety symptom scales. A new evaluation was performed 90 days after the intervention. Results: Sixty-two students participated. Ninety days after the intervention, there were significant reductions in the number of students who met the criteria for social anxiety disorder (p = 0.013) or panic disorder (p = 0.001). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p o 0.001) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire, p o 0.001). Conclusion: UP improved anxiety and depressive symptoms in medical students. The single-session group format could reduce costs and facilitate application. Future placebo-controlled studies are necessary to confirm these findings