Supressão de pensamentos de preocupação idiossincráticos num grupo de sujeitos com altos e baixos níveis de preocupação

Dissertação de mestrado, Psicologia Clínica e da Saúde, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2014A supressão de pensamentos é uma das estratégias cognitivas utilizadas pelas pessoas para controlar os pensamentos que provocam emoções desagradáveis. Alguns estudos experimentais (e.g. Wegner, Schneider, Carter & White, 1987; Salkovskis & Reynolds, 1994; Macrae, Bodenhausen, Milne & Jetten, 1994; Belloch & Morillo, 2002) indicam que a tentativa de suprimir um pensamento pode fazer com que este volte com maior frequência à consciência, produzindo efeitos paradoxais. Nos estudos mencionados têm sido encontrados dois tipos de efeitos principais: um aumento da frequência dos pensamentos desagradáveis durante o próprio momento de supressão (aumento imediato), e um aumento durante o período que se segue à supressão (efeito ricochete). A presente investigação teve como objetivo analisar a eficácia da supressão de pensamentos de preocupação idiossincráticos em dois grupos de indivíduos: um grupo com altos níveis, e outro grupo com baixos níveis de tendência para se preocupar de forma excessiva. A amostra foi constituída por 56 participantes (28 com altos níveis de preocupação e 28 com baixos), previamente selecionados a partir de uma amostra de 84 sujeitos que responderam ao Questionário de Preocupação de Pensilvânia (PSWQ). Os indivíduos de ambos os grupos participaram numa experiência com três fases (expressão inicial, supressão e expressão final). Durante a fase de supressão, foi solicitado aos participantes que tentassem suprimir o pensamento que mais os tinha preocupado durante os últimos dias. Os resultados sugerem que o sucesso ou insucesso da supressão de pensamentos de preocupação idiossincráticos depende da tendência para a preocupação excessiva manifestada pelos sujeitos no PSWQ. Os indivíduos com elevada tendência para a preocupação excessiva manifestaram uma maior frequência relativa de pensamentos, durante a fase de supressão e expressão final: foram encontrados efeitos paradoxais (aumento imediato e ricochete) no grupo com elevada tendência para a preocupação excessiva

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London