Depression und Suizidalität

Even if the freedom to suicide is part of our human existence, about 90% of all suicides occur in the context of psychiatric disorders and thus in states of limited power of judgment. Depressive disorders represent the most frequent cause for suicides. Thus, optimization of medical care for depressive patients is one of the most promising strategies to prevent suicides. In the context of the `Nuremberg Alliance Against Depression' it came to an obvious reduction of suicidal acts compared to a baseline year and compared to the control region of Wurzburg. The reduction could be reached by a cooperation with GPs, multipliers such as teachers, priests, geriatric caregivers and the media, through intensive public relations work and through support of self help activities. This approach is carried forward within the Germany-wide `Alliance Against Depression' and within the `European Alliance Against Depression' ( EAAD) which is funded by the European Commission. In the last part of the article the suicide- preventive, but also the possible suicide-inducing effect of antidepressants is discussed

Progressão de cárie e necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos : um estudo retrospectivo de base universitária

Objective: To assess the caries progression and the need for reintervention on occlusal ICDAS 4 lesions after different treatments. Material and Methods: The sample consisted of records of children treated in a public setting who had at least an occlusal ICDAS 4 lesion in primary and/or permanent molars. The radiographic images of ICDAS 4 lesions at the first and last appointments were classified as absence of radiolucency, radiolucent image at the enamel–dentin junction, at the outer half or inner of the dentin. The need for retreatment after different treatments (non-invasive - topical fluoride applications, oral hygiene instructions and dietary guidance, micro-invasive - resin-based sealant, or invasive - restoration) was assessed by reviewing clinical and radiographic records. The need for retreatment was defined as any complication requiring mending (e.g., caries progression, total loss of sealant, or restoration failure). The Poisson regression model was used to investigate the association between individual and tooth-related variables and the outcome. Results: Among the 111 lesions in 81 patients, most (73.0%) lesions were in primary molars. Most lesions (52.3%) did not exhibit radiolucency, whereas 29.7% had radiolucency at the outer half of the dentin. The mean follow-up was 18.8 ± 6.5 months. After follow-up, 82.9% of the lesions did not require retreatment. The prevalence of ICDAS 4 lesions that did not need retreatment was higher among lesions with radiolucency at dentin (p=0.01). Conclusion: Most occlusal ICDAS 4 lesions did not require reintervention, especially those exhibiting radiolucency in the outer half of the dentin.Objetivo: Avaliar a progressão de cárie e a necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos. Material e Métodos: A amostra consistiu de prontuários de crianças atendidas em ambiente público que apresentavam pelo menos uma lesão oclusal ICDAS 4 em molares decíduos e/ou permanentes. As imagens radiográficas de lesões ICDAS 4 na primeira e última consultas foram classificadas como ausência de radiolucidez, imagem radiolúcida na junção esmalte-dentina, em metade externa ou interna da dentina. A necessidade de retratamento após diferentes tratamentos (não invasivo – aplicações tópicas de flúor, orientações de higiene e dieta, micro-invasivo – selante resinoso ou invasivo – restauração) foi avaliada por meio da revisão dos registros clínicos e radiográficos. A necessidade de retratamento foi definida como qualquer complicação que requer intervenção (por exemplo, progressão da lesão, perda total do selante ou falha na restauração). O modelo de regressão de Poisson foi utilizado para investigar a associação entre as variáveis individuais e dentárias e o desfecho. Resultados: Entre as 111 lesões em 81 pacientes, a maioria (73,0%) das lesões eram em molares decíduos. A maioria das lesões (52,3%) não exibiu radiolucidez, enquanto que 29,7% apresentaram radiolucidez em metade externa de dentina. O tempo de acompanhamento médio foi de 18,8 ± 6,5 meses. Após o acompanhamento, 82,9% das lesões não necessitaram de retratamento. A prevalência de lesões ICDAS 4 que não necessitaram de retratamento foi maior entre as lesões com radiolucidez em dentina (p=0,01). Conclusão: A maioria das lesões oclusais ICDAS 4 não requerem reintervenção, especialmente aquelas que exibem radiolucidez em metade externa da dentina

Práticas parentais percebidas, autoestima, otimismo e resiliência em futuros professores

The first expectations created by adolescents regarding their professional future arise based on their family context. At this moment in life, adolescents decide about their future and make their decisions with the help of their families. The purpose of this study was to investigate relationships between perceived parenting practices and choice of profession, self-esteem, optimism and resilience in adolescents attending a technical teacher training course. Two hundred adolescents with an average age of 15.8 years took part in this study. The instruments used were: a sociodemographic questionnaire, the Rosenberg Self-Esteem scale, the Life Orientation Test, the Resilience Scale and the Family Interaction Quality Scales. The majority of students in this study are female, have few siblings and live with their parents. When asked about the university course they would like to take in the future, the absolute majority (51%) chose degree courses providing teacher training.With regard to the reason why they chose to take a technical teacher training course, “making a dream come true” was the most frequent answer given by the respondents, followed by identification with this area. When asked about the characteristics of a good teacher, they mentioned dedication to the profession, dedication to students (involving aspects such as patience and affection).With regard to behaviours to be avoided by teachers, emphasis was placed on behaviours such as shouting, sarcasm, lack of teaching ability and arrogance. Significant and positive correlations were found between parenting practices perceived by the adolescents and scores for optimism, resilience and self-esteem, thus revealing the importance of parent involvement for the development of the personal strengths of these young people who, from an early age, defined an objective in life and are on their way to achieving it.As primeiras expectativas criadas pelos adolescentes acerca do seu futuro profissional são tomadas com base no contexto familiar. Esta pesquisa objetivou investigar relações entre as práticas educativas parentais percebidas e a escolha profissional, a autoestima, o otimismo e a resiliência em adolescentes que frequentam um curso técnico de formação de professores. Participaram 200 adolescentes, maioria do sexo feminino e idade média de 15,8 anos. Os instrumentos foram: questionário sociodemográfico, Escala de autoestima de Rosenberg, Life Orientation Test, Escala de Resiliência, Escalas de Qualidade na Interação Familiar. Os dados mostram que os jovens têm interesse em cursos universitários de licenciaturas e revelam identificação com a área do magistério.Sobre características boas de um professor, a maioria indicou comportamentos ligados à interação, seguido de cuidado com a profissão, e comportamentos relacionados ao domínio do conteúdo e didática. No caso dos comportamentos do professor a serem evitados, os mais citados foram o controle aversivo, a seguir foram comportamentos do professor que pudessem comprometer a aprendizagem, como a falta de planejamento e desorganização. Foram encontradas correlações significativas e positivas entre as práticas parentais percebidas pelos adolescentes e os escores de otimismo, resiliência e autoestima, revelando a importância do envolvimento dos pais para o desenvolvimento de forças pessoais desses jovens que, desde cedo, definiram um objetivo de vida e estão no caminho para realizá-lo

Differences in pain, function and coping in Multidimensional Pain Inventory subgroups of chronic back pain: a one-group pretest-posttest study

Contains fulltext : 97819.pdf (publisher's version ) (Open Access)BACKGROUND: Patients with non-specific back pain are not a homogeneous group but heterogeneous with regard to their bio-psycho-social impairments. This study examined a sample of 173 highly disabled patients with chronic back pain to find out how the three subgroups based on the Multidimensional Pain Inventory (MPI) differed in their response to an inpatient pain management program. METHODS: Subgroup classification was conducted by cluster analysis using MPI subscale scores at entry into the program. At program entry and at discharge after four weeks, participants completed the MPI, the MOS Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Coping Strategies Questionnaire (CSQ). Pairwise analyses of the score changes of the mentioned outcomes of the three MPI subgroups were performed using the Mann-Whitney-U-test for significance. RESULTS: Cluster analysis identified three MPI subgroups in this highly disabled sample: a dysfunctional, interpersonally distressed and an adaptive copers subgroup. The dysfunctional subgroup (29% of the sample) showed the highest level of depression in SF-36 mental health (33.4 +/- 13.9), the interpersonally distressed subgroup (35% of the sample) a modest level of depression (46.8 +/- 20.4), and the adaptive copers subgroup (32% of the sample) the lowest level of depression (57.8 +/- 19.1). Significant differences in pain reduction and improvement of mental health and coping were observed across the three MPI subgroups, i.e. the effect sizes for MPI pain reduction were: 0.84 (0.44-1.24) for the dysfunctional subgroup, 1.22 (0.86-1.58) for the adaptive copers subgroup, and 0.53 (0.24-0.81) for the interpersonally distressed subgroup (p = 0.006 for pairwise comparison). Significant score changes between subgroups concerning activities and physical functioning could not be identified. CONCLUSIONS: MPI subgroup classification showed significant differences in score changes for pain, mental health and coping. These findings underscore the importance of assessing individual differences to understand how patients adjust to chronic back pain

Responsiveness of SF-36 Health Survey and Patient Generated Index in people with chronic knee pain commenced on oral analgesia: analysis of data from a randomised controlled clinical trial

Purpose. (1) to assess the responsiveness of the Short Form 36 Health Survey (SF-36) and Patient Generated Index (PGI) in people with knee pain who were given oral analgesics; and (2) to perform content analysis of the SF-36 and PGI aiming to identify differences between the instruments and causes of different responsiveness. Methods. An observational study nested within a randomised controlled trial comparing oral paracetamol, ibuprofen or a combination of the two in 884 community-derived people with chronic knee pain. Each participant was given the SF-36 and PGI questionnaires to fill out at baseline, day 10, week 7 and week 13 after commencement on analgesia. Responsiveness was measured as a standardised response mean from baseline and contents of the instruments were analysed. Results. The PGI showed the greater responsiveness to analgesics than the SF-36 throughout the study period. Only the Bodily Pain Score of the SF-36 showed comparable responsiveness to the PGI. The standardised response mean of the PGI at 13 weeks was 0.61 (95% confidence interval 0.51 to 0.72), and that of the Bodily Pain Score of the SF-36 was 0.49 (95% confidence interval 0.39 to 0.58). Content analysis of the PGI identified multiple areas which are not represented in the SF-36 which may help explain its performance. Conclusions. Overall the PGI is more responsive than the SF-36 to commonly used oral analgesics taken for knee pain. The PGI is able to elicit areas of individualised health related quality of life which are not captured by the SF-36

Intestinal obstruction by tricobezoar in a dog : case report

Tricobenzoares são concreções de pelos formados no trato digestório, estando relacionada a alotriofagia. O corpo estranho causa principalmente vômito, regurgitação, tenesmo e pode levar a um quadro de obstrução intestinal. Pela sua consequência é de extrema importância o relato das ocorrências desta patologia, por hora infrequente em cães, no entanto, como está ligado às mudanças de hábitos e ao comportamento dos animais, cabe o acompanhamento de sua incidência. O caso deste relato teve a sua origem relacionada ao hábito de lambedura constante devido ao stress por ausência de companhia, no apartamento onde o cão permanecia. Após exames clínicos, laboratoriais e de imagem, foi diagnosticada obstrução intestinal, sendo realizada enterectomia do segmento intestinal afetado, o qual foi seccionado expondo a presença de tricobezoar.Trichobenzoars are hair concretions formed in the digestive tract, being related to allotriophagy. The foreign body mainly causes vomiting, regurgitation, tenesmus and can lead to a bowel obstruction. Due to its consequence, it is extremely important to report the occurrences of this pathology, which is an infrequent time in dogs, however, as it is linked to changes in habits and behavior of animals, its incidence should be monitored. The case of this report had its origin related to the habit of constant licking due to stress due to absence of companionship, in the apartment where the dog stayed. After clinical, laboratory and imaging exams, intestinal obstruction was diagnosed, and an enterectomy of the affected intestinal segment was performed, which was sectioned exposing the presence of tricobezoar

Diagnósticos citológicos de tumor venéreo transmissível (TVT) na região de Cruz Alta/RS: estudo retrospectivo / Cytological diagnoses of transmissible venereal tumor (TVT) in the Cruz Alta/RS region: a retrospective study

O Tumor Venéreo Transmissível (TVT) apresenta maior prevalência em cães jovens, sem predileção por raça e sexo, ocorrendo com mais frequência em regiões onde os cães circulam livremente. Surge como uma massa irregular hiperêmica e sanguinolenta, transmitido por meio da transferência muco-cutânea de células neoplásicas através do contato durante o coito ou por hábitos de cheirar ou lamber. Essa condição pode acarretar aos animais diminuição da qualidade de vida devido a dor em regiões acometidas, secreção vaginal ou peniana contínuas, prurido intenso, mudança de comportamento visualizados por apatia, anorexia e letargia, além de se tornarem os principais reservatórios dessa neoplasia podendo transmitir a outros animais. Após o diagnóstico conclusivo que pode ser realizado através da citologia, o tratamento quimioterápico com vincristina tem se mostrado eficaz e possibilita a remissão da massa neoplásica. Objetivando analisar a prevalência do TVT e sua distribuição quanto ao sexo, idade, raça, área corporal acometida e formas de coleta das amostras para diagnóstico, avaliou-se 89 caninos atendidos no Hospital Veterinário da Unicruz no período de janeiro de 2010 a janeiro de 2020. Com base nos dados obtidos concluiu-se que a maioria dos caninos diagnosticados com TVT na região de Cruz Alta, são fêmeas (69,31%), em idade reprodutiva de 1 a 8 anos (30,68%), sem raça definida (80,68%) e com maior número de lesões observadas em região genital (73,87%). A técnica de diagnóstico mais utilizada na rotina clínica foi o imprint (72,72%), seguido da citologia aspirativa por agulha fina (14,77%), swab (4,54%) e imprint associado a citologia (4,54%). Com isso destaca-se a importância desse estudo retrospectivo realizado na região de Cruz Alta e cidades vizinhas, a fim de possibilitar o estudo de dados importantes sobre a epidemiologia dessa neoplasia, formas de coleta de amostras para análise e da possibilidade de realização do diagnóstico definitivo a partir de interpretação citológica de baixo custo.