Current management of obsessive and phobic states

Obsessional states show an average point prevalence of 1%–3% and a lifetime prevalence of 2%–2.5%. Most treatment-seeking patients with obsessions continue to experience significant symptoms after 2 years of prospective follow-up. A significant burden of impairment, distress, and comorbidity characterize the course of the illness, leading to an increased need for a better understanding of the nature and management of this condition. This review aims to give a representation of the current pharmacological and psychotherapeutic strategies used in the treatment of obsessive-compulsive disorder. Antidepressants (clomipramine and selective serotonin reuptake inhibitors) are generally the first-line choice used to handle obsessional states, showing good response rates and long-term positive outcomes. About 40% of patients fail to respond to selective serotonin reuptake inhibitors. So far, additional pharmacological treatment strategies have been shown to be effective, ie, administration of high doses of selective serotonin reuptake inhibitors, as well as combinations of different drugs, such as dopamine antagonists, are considered efficacious and well tolerated strategies in terms of symptom remission and side effects. Psychotherapy also plays an important role in the management of obsessive-compulsive disorder, being effective for a wide range of symptoms, and many studies have assessed its long-term efficacy, especially when added to appropriate pharmacotherapy. In this paper, we also give a description of the clinical and psychological features likely to characterize patients refractory to treatment for this illness, with the aim of highlighting the need for greater attention to more patient-oriented management of the disease

Blunted glucocorticoid and mineralocorticoid sensitivity to stress in people with diabetes.

Psychological stress may contribute to type 2 diabetes but mechanisms are still poorly understood. In this study, we examined whether stress responsiveness is associated with glucocorticoid and mineralocorticoid sensitivity in a controlled experimental comparison of people with type 2 diabetes and non-diabetic participants. Thirty-seven diabetes patients and 37 healthy controls underwent psychophysiological stress testing. Glucocorticoid (GR) and mineralocorticoid sensitivity (MR) sensitivity were measured by dexamethasone- and prednisolone-inhibition of lipopolysaccharide (LPS)-induced interleukin (IL) 6 levels, respectively. Blood pressure (BP) and heart rate were monitored continuously, and we periodically assessed salivary cortisol, plasma IL-6 and monocyte chemotactic protein (MCP-1). Following stress, both glucocorticoid and mineralocorticoid sensitivity decreased among healthy controls, but did not change in people with diabetes. There was a main effect of group on dexamethasone (F(1,74)=6.852, p=0.013) and prednisolone (F(1,74)=7.295, p=0.010) sensitivity following stress at 45 min after tasks. People with diabetes showed blunted stress responsivity in systolic BP, diastolic BP, heart rate, IL-6, MCP-1, and impaired post-stress recovery in heart rate. People with Diabetes had higher cortisol levels as measured by the total amount excreted over the day and increased glucocorticoid sensitivity at baseline. Our study suggests that impaired stress responsivity in type-2 diabetes is in part due to a lack of stress-induced changes in mineralocorticoid and glucocorticoid sensitivity

Práticas pedagógicas com tecnologias

O artigo aborda a experiência das bolsistas Adler Peggy Lima Aleixo e Lívia Lopes de Carvalho, em atividades do Projeto de Extensão de Ação Contínua Cátedra Unesco de Educação a Distância, do Departamento de Métodos e Técnicas da Faculdade de Educação (MTC/FE)

Os caminhos das crianças : a mobilidade ativa no trajeto escolar

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Pós-Graduação em Educação Física, 2019.Introdução: A sociedade contemporânea apresenta importantes mudanças no estilo de vida e na saúde das pessoas. Quando associadas aos processos de urbanização desordenados e mecanização/modernização sem precedentes, impactam diretamente na relação dos indivíduos e coletividades com seu corpo, resultando no aumento do sedentarismo e das doenças crônicas. Diante desse cenário, um desafio é a promoção da saúde e do desenvolvimento sustentável, para que as futuras gerações desfrutem de uma vida com qualidade e bem-estar. Para o campo da Educação Física, uma estratégia interessante que deve ser considerada é a mobilidade ativa, em particular a utilizada no trajeto escolar. Objetivo: O objetivo dessa pesquisa é refletir sobre aspectos da mobilidade ativa de crianças no trajeto escolar, em particular como prática corporal promotora da saúde e do desenvolvimento sustentável. Metodologia: A pesquisa tem abordagens quantitativa e qualitativa. A população participante da pesquisa foi constituída por crianças do quinto ano do ensino fundamental da rede municipal de ensino de Anápolis, Goiás, em escolas que possuem o professor graduado em educação física. A etapa quantitativa utilizou um questionário para coletar dados sociodemográficos e aspectos relacionados à mobilidade ativa no trajeto escolar. A etapa qualitativa contemplou a roda de conversa a partir de desenhos produzidos pelas crianças que praticam mobilidade ativa, buscando perceber o olhar da criança sobre o percurso. Resultados: 71,2% das crianças praticam mobilidade ativa no trajeto escolar e a maioria delas realiza o percurso cinco vezes por semana e em menos de dez minutos por trajeto. 68,5% desses estudantes gastam até 60 minutos por semana nesse deslocamento ativo, sendo que o tempo médio é de 73,2 minutos. 80% dos pesquisados relataram que gostariam de percorrer o trajeto escolar de forma ativa. Conhecemos o olhar das crianças para o caminho escolar: os facilitadores da mobilidade ativa escolar apresentados pelas crianças foram a presença de natureza, companhia dos amigos/família, casa bonita, mercadinhos, segurança, proximidade, rapidez, brincadeiras, aventuras, beleza, sentimentos positivos; as barreiras relatadas foram calçadas com mato e escorregadias, presença de cachorros, pessoas e casas estranhas, falta de segurança, bueiro aberto, muita subida, chuva, frio, demora mais, sentimentos negativos.Introduction: Contemporary society presents important changes in people's lifestyle and health. When associated with uncontrolled processes of urbanization and unprecedented mechanization/modernization, they directly impact on the relationship of individuals and collectivities with their bodies, resulting in increased sedentarism and chronic diseases. Given this scenario, a challenge is the promotion of health and sustainable development, so that future generations enjoy a life with quality and well-being. For the field of Physical Education, an interesting strategy that must be considered is active mobility, in particular that used in the school path. Objective: The objective of this research is to reflect on aspects of the active mobility of children in the school path, in particular as corporal practice promoting health and sustainable development. Methodology: The research has quantitative and qualitative approaches. The population that participates in the research are children of the fifth year of elementary school of the municipal school of Anápolis, Goiás, in schools that have the professor graduated in physical education. The quantitative stage used a questionnaire to collect sociodemographic data and aspects related to active mobility in school. The qualitative step used the conversation wheel from drawings produced by children who practice active mobility, seeking to perceive the child's gaze on the course. Results: 71,2% of the children practice active mobility on the school trip, and most of them travel five times a week and in less than ten minutes per trip. 68.5% of these students spend up to 60 minutes per week on this active trip, with an average time of 73.2 minutes. 80% of those surveyed reported that they would like to travel the school actively. We know the children's eyes on the school path: the facilitators of active school mobility presented by children were the presence of nature, company of friends / family, beautiful house, markets, security, closeness, speed, jokes, adventures, beauty, positive feelings; the reported barriers were paved with weeds and slippers, presence of dogs, strange people and houses, lack of security, manhole open, too much rise, rain, cold, delay more, negative feelings

Resiliência e Socialização Organizacional entre Servidores Públicos Brasileiros e Noruegueses

The aim of this study is to analyze the relationship between resilience and organizational socialization among civil servants at two public universities in two different cultures, namely Brazil and Norway. Organizational socialization research has shown that an individual’s adjustment to a new job and organization tends to be a stressful event and resilience, defined as the ability to overcome stress or adversity, could be of importance when it comes to explaining the differences in socialization outcomes among individuals at the same organization. Based on this assumption, research was conducted with a sample of Brazilian and Norwegian professors and technical-administrative employees. Hierarchical regression analyses were carried out to observe and compare the predictive power of resilience in relation to organizational socialization. The results showed that overall resilience added a significant incremental prediction to organizational socialization, beyond nationality and occupation. The predictive power of resilience in relation to organizational socialization was higher among the Brazilians than the Norwegians. The practical implications, limitations and main contributions of the study are discussed, with suggestions for future research

The mediation of coronary calcification in the association between risk scores and cardiac troponin T elevation in healthy adults: Is atherosclerosis a good prognostic precursor of coronary disease?

BACKGROUND: Conventional cardiac risk scores may not be completely accurate in predicting acute events because they only include factors associated with atherosclerosis, considered as the fundamental precursor of cardiovascular disease. In UK in 2006-2008 (Whitehall II study) we tested the ability of several risk scores to identify individuals with cardiac cell damage and assessed to what extent their estimates were mediated by the presence of atherosclerosis. METHODS: 430 disease-free, low-risk participants were tested for high-sensitivity cardiac troponin-T (HS-CTnT) and for coronary calcification using electron-beam, dual-source, computed tomography (CAC). We analysed the data cross-sectionally using ROC curves and mediation tests. RESULTS: When the risk scores were ranked according to the magnitude of ROC areas for HS-CTnT prediction, a score based only on age and gender came first (ROC area=0.79), followed by Q-Risk2 (0.76), Framingham (0.70), Joint-British-Societies (0.69) and Assign (0.68). However, when the scores were ranked according to the extent of mediation by CAC (proportion of association mediated), their order was essentially reversed (age&gender=6.8%, Q-Risk2=9.7%, Framingham=16.9%, JBS=17.8%, Assign=17.7%). Therefore, the more accurate a score is in predicting detectable HS-CTnT, the less it is mediated by CAC; i.e. the more able a score is in capturing atherosclerosis the less it is able to predict cardiac damage. The P for trend was 0.009. CONCLUSIONS: The dynamics through which cardiac cell damage is caused cannot be explained by 'classic' heart disease risk factors alone. Further research is needed to identify precursors of heart disease other than atherosclerosis

Triple‐negative breast carcinomas are a heterogeneous entity that differs between young and old patients

OBJECTIVE: To compare the frequency and immunohistochemical profiles of triple-negative breast carcinomas in younger and older women. METHODS AND RESULTS: We selected patients diagnosed with triple-negative breast carcinomas. The groups examined were women who were 35 years old or younger between 1997 and 2007 (n = 74) and, for comparison, women who were 60 years old or older (n = 19, consecutive cases). All formalin-fixed and paraffin-embedded tumor samples were reviewed and immunohistochemically stained for ER, PR, HER2, Ki-67 antigen, epidermal growth factor receptor, cytokeratin 5/6, p53, vimentin, CD117, and p63 using tissue microarrays blocks. Triple-negative breast carcinomas corresponded to 34.6% (74/213) of the carcinomas from the younger patients and 16.2% (19/117) of the carcinomas from the older patients (p = 0.002). No significant differences in the frequency of the basal phenotype were observed in the two patient groups based on CK5/6 and/or epidermal growth factor receptor expression (74.3% vs. 68.4%). However, triple-negative breast carcinomas in the older patients presented a higher frequency of CK5/6 expression compared to those of younger patients (42.1% vs. 9.6%; p = 0.005), whereas triplenegative breast carcinomas of younger patients had a higher expression level of epidermal growth factor receptor (71.6% vs. 47.3%). CONCLUSIONS: These results show that there were significant molecular differences between the triple-negative basal-like breast carcinomas that were diagnosed in younger women and those that were diagnosed in older women. These findings may provide a basis for describing the more aggressive phenotype of the triple-negative breast carcinomas observed in younger women