Avaliação cognitivo-comportamental em pacientes fibromiálgicos: um estudo comparativo

A fibromialgia é uma síndrome caracterizada por dor musculoesquelética, crônica e difusa, em locais específicos sensíveis à palpação. Sua etiologia, embora ainda desconhecida, vem sendo amplamente explorada. Estudos têm demonstrado o impacto de variáveis de ordem emocional na manutenção e exacerbação da dor, afetando a qualidade de vida dos indivíduos portadores deste transtorno. Objetivo: investigar se as reações emocionais e afetivas definidas como stress, raiva, ansiedade e depressão são mais expressivas, e se correlacionam, em pacientes com fibromialgia comparando com indivíduos sem este diagnóstico. Métodos: Participaram do estudo 50 mulheres, sendo a amostra constituída por 25 mulheres, adultas, com diagnóstico de fibromialgia segundo os critérios do American College of Rheumatology (ACR) e 25, sem o diagnóstico de fibromialgia, pareadas por idade. Para avaliar as variáveis emocionais foram utilizados os seguintes instrumentos: Inventário de Sintomas de Stress de Lipp (ISSL), Inventário de Ansiedade Traço e Estado (IDATE), Inventário de Depressão de Beck (BDI), Inventário de Expressão de Raiva como Estado e Traço (STAXI) e o Questionário de Impacto da Fibromialgia (FIQ). Os instrumentos foram aplicados, individualmente, em uma única sessão, com duração média de 40 minutos. A pesquisa foi realizada em uma sala de atendimento designada pela instituição de ensino ou em local definido pelo participante e pesquisador. Foram realizadas análises estatísticas para analisar o desempenho dos participantes nos diferentes instrumentos. Resultados: A média de idade das participantes do grupo com fibromialgia foi de 49,36 anos, e a do grupo sem fibromialgia, 49,20 anos. Quanto à variável depressão, o grupo com fibromialgia apresentou média de 21,48 pontos no BDI, com desvio-padrão de 11,87. Já o grupo controle (sem fibromialgia), apresentou média de 7,36 pontos, com desvio-padrão de 8,12. Quanto ao stress, 96% do grupo experimental apresentou sintomas de stress, enquanto no grupo controle foi de 20%. As ansiedades estado e traço foram superiores no grupo com fibromialgia, em média, 8,8 e 16,3 pontos, respectivamente. O traço de raiva foi superior 7,2 pontos quando comparado com o grupo controle. O emprego do teste t de Student para amostras não relacionadas mostrou que os grupos se diferenciaram nas variáveis stress, depressão e ansiedades estado e traço e traço de raiva analisadas. Foram observadas correlações entre as variáveis stress, depressão, ansiedade-traço e traço de raiva. No FIQ, a média foi de 70,32 de um total de 100. Conclusão: Pode-se inferir o impacto negativo desta síndrome afetando a qualidade de vida destes indivíduos, indicando a necessidade de investigação do stress, ansiedade e depressão em programas de intervenção. Deve-se, ainda, ressaltar a necessidade de uma abordagem interdisciplinar no seu tratamento

Women Crack Users, Pregnancy and Motherhood: Potential Periods for Health Care

This study aimed to understand how women relate their behaviors concerning drug use during pregnancy and breastfeeding. This is a qualitative study, conducted in the Metropolitan Area of Santos. Twelve women who have used crack were interviewed through a semi-structured interview. The interviews were analyzed from the perspective of content analysis. Our data indicate that pregnancy is a critical time to sensitize these women and try to lessen the damage and risks associated with the consumption of crack among them.Esse estudo objetivou compreender como as mulheres reportam seus comportamentos em relação ao uso de drogas durante a gravidez e a amamentação. Trata-se de um estudo qualitativo, realizado na Região Metropolitana de Santos. Doze mulheres usuárias de crack foram entrevistadas por meio de entrevista semiestruturada. As entrevistas foram analisadas a partir da análise de conteúdo. Os dados indicam que a gravidez é um momento crítico para sensibilizar essas mulheres e tentar diminuir danos e riscos associados ao consumo de crack entre elas

Investigation of stress, anxiety and depression in women with fibromyalgia: a comparative study

Introduction:Depression has emerged as the most prevalent mental disorder in patients with fibromyalgia. Stress, whose stages are alarm, resistance, near-exhaustion and exhaustion, constitutes a physical reaction to a threatening situation.Objective:To investigate the levels of stress, anxiety and depression in women with fibromyalgia, comparing them with those of healthy women.Patients and methods:Participants were 50 women, 25 with a diagnosis of fibromyalgia according to the criteria of the American College of Rheumatology, and 25 without this diagnosis, matched for age. Instruments used: Lipp Inventory of Stress Symptoms for Adults (LISS), State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI).Results:The mean age was 49.36 years for the group with fibromyalgia (FM) and 49.20 years for the group without fibromyalgia (non-FM). FM showed a higher incidence of stress (96%) compared with non-FM (5%). The resistance phase was predominant in both groups, FM (42%) and non-FM (100%). In FM there was distribution of the four stages (alarm, resistance, near-exhaustion and exhaustion). The differences between phases in the analyzed groups were significant (p < 0.001). FM showed predominance of psychological symptoms (54%); non-FM did show the same frequency of psychological and physical/psychological (40%) symptoms. Symptoms of state and trait anxiety and of depression in FM were significantly higher, when compared with non-FM (p < 0.01).Conclusion:Stress index (96%), trait anxiety (over 50) and clinically relevant depression (greater than 20) in FM were relevant. The understanding of the emotional variables involved in fibromyalgia is important to define the therapeutic strategy.Introdução:A depressão tem se apresentado como o transtorno mental mais prevalente em pacientes com fibromialgia. O estresse, cujas fases são alarme, resistência, quase-exaustão e exaustão, constitui importante reação do organismo frente a uma situação ameaçadora.Objetivo:Investigar os índices de estresse, ansiedade e depressão em mulheres com fibromialgia, comparando-os com os de mulheres saudáveis.Pacientes e métodos:Participaram 50 mulheres, 25 com o diagnóstico de fibromialgia, segundo os critérios do American College of Rheumatology, e 25 sem o diagnóstico, pareadas por idade. Instrumentos utilizados: Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário de Ansiedade Traço-Estado (IDATE) e Inventário de Depressão Beck (BDI).Resultados:Idade média de 49,36 anos para o grupo com fibromialgia (FM) e 49,20 anos para o grupo sem fibromialgia (não FM). O FM apresentou maior incidência de estresse (96%) quando comparado com o não FM (5%). A fase de resistência foi predominante nos dois grupos, FM (42%) e não FM (100%). No FM verificou-se distribuição nas quatro fases (alerta, resistência, quase-exaustão e exaustão). As diferenças entre as fases nos grupos analisados foram significativas (p<0,001). O FM apresentou predominância de sintomas psicológicos (54%), o não FM apresentou a mesma frequência de sintomas psicológico e físico/psicológico (40%). Os sintomas de ansiedade estado e traço e depressão do FM foram significativamente superiores, quando comparados com o não FM (p<0,01).Conclusão:Constatou-se índice de estresse (96%), traço de ansiedade (superior a 50) e depressão clinicamente (superior a 20) relevantes no FM. O entendimento das variáveis emocionais envolvidas na fibromialgia é importante na definição da terapêutica.Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de Ciências do Movimento HumanoUniversidade Federal de São Paulo (UNIFESP) Departamento de BiociênciasUniversidade Metropolitana de SantosUniversidade Federal de São Paulo (UNIFESP) Departamento de Saúde, Educação e SociedadeUNIFESP, Depto. de Ciências do Movimento HumanoUNIFESP, Depto. de BiociênciasUNIFESP, Depto. de Saúde, Educação e SociedadeSciEL

Comparação do diagnóstico endoscópico com o histopatológico em crianças portadoras de esofagite

The gastroesophageal reflux means the retrograde flow from the gastric content to the esophagus. The gastroesophageal reflux disease is the condition in which symptoms and/or digestive complications are present, including the esophagitis. The diagnosis of the esophagitis is made through the upper gastrointestinal endoscopy (UGE) and through the histopathologic evaluation of the esophageal mucosa. This study aimed at comparing endoscopical and histopathologic findings of that area in children with esophagitis. The results of 125 children’s UGEs and biopsies, aging 0 to 18 years old with esophagitis, from 1997 to 2001, were reviewed. Among those patients, 69 (52,20 %) were female. In the endoscopical results, 104 (83,20%) patients had edematous esophagitis; in the histological study, 48 (33,40%) children presented chronic esophagitis and there were no alterations in 29 (23,20%). When compared to the histopathology, the UGE results are not so trustful that one may only rely on that evaluation. It is mandatory the accomplishment of the biopsy for diagnosing this pathology and for future comparisons with the patient’s evolution. Multiple biopsies must be made in order to analyze comprehensively the whole process and to identify Barrett esophagus early.O refluxo gastroesofágico representa o fluxo retrógrado do conteúdo gástrico para o esôfago. A doença do refluxo gastroesofágico é a condição na qual estão presentes sintomas e/ou complicações digestivas, dentre elas a esofagite. O diagnóstico da esofagite é realizado através da endoscopia digestiva alta (EDA) e do exame histopatológico da mucosa esofágica. O presente estudo teve como objetivo comparar os achados endoscópicos e histopatológicos da região esofágica em crianças portadoras de esofagite. Foram revisados resultados de EDA e de biópsias de 125 crianças com idade entre 0 a 18 anos com esofagite, no período de 1997 a 2001. Destes pacientes, 69 (52,20%) eram do sexo feminino. Nos resultados endoscópicos, 104 (83,20%) pacientes tiveram o diagnóstico de esofagite edematosa; na histologia, 48 (33,40%) das crianças apresentaram esofagite crônica, enquanto na de 29 (23,20%) não ocorreram alterações. Quando correlacionados à histopatologia, os resultados da EDA não são fidedignos a ponto de justificar-se o uso isolado desta. É fundamental a realização da biópsia para esclarecimento diagnóstico desta patologia e para acompanhamento dos pacientes. Há ainda a necessidade de múltiplas biópsias para análise adequada do processo e para identificação precoce do esôfago de Barrett

Horta é Saúde: plantar e colher alimentos é o melhor remédio para viver bem

Ao analisar o atual cenário agrícola mundial, é possível perceber a necessidade de pensar e desenvolver um novo paradigma que atenda à produção de alimentos seguros, saudáveis e sustentáveis, seja de uma família, comunidade ou sociedade. Este projeto de extensão universitária teve como objetivo difundir a agroecologia e contribuir para a promoção da segurança e da soberania alimentar através da implantação e condução de uma horta doméstica na Associação Hospital de Caridade Três Passos (AHCTP)/Rio Grande do Sul (RS). Para o desenvolvimento desta proposta, diversas atividades foram conduzidas de 2017 até o final do ano de 2019 na AHCTP, com a participação da comunidade acadêmica da Uergs Unidade Três Passos e demais parceiros de trabalho. Foram realizadas atividades como entrevistas, implantação, condução e ampliação da horta, reforma e construção dos canteiros, plantio de hortaliças, entre outras ações que visaram a difusão do aprendizado acadêmico integrado à prática sustentável e à valorização das potencialidades do local, tendo-se como premissa básica em todas as ações, a promoção da sustentabilidade e da segurança alimentar da comunidade hospitalar e a valorização ambiental. Como resultados principais pode-se destacar a produção de alimentos saudáveis e de qualidade, a difusão da agroecologia e a promoção da segurança alimentar, a valorização do meio ambiente, e a integração social na Região Celeiro do RS, além da integração Universidade – sociedade. Sendo assim, conclui-se que o trabalho na horta é uma importante ação de promoção da saúde e do bem viver

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost