Obsessive-compulsive symptoms, polygenic risk score, and thalamic development in children from the Brazilian High-Risk Cohort for Mental Conditions (BHRCS)

Background: Thalamic volume measures have been linked to obsessive-compulsive disorder (OCD) in children and adolescents. However, it is unclear if alterations in thalamic volumes occur before or after symptom onset and if there is a relation to the presence of sub-clinical obsessive-compulsive symptoms (OCS). Here, we explore the relationship between OCS and the rate of thalamic volume change in a cohort of children and youth at high risk to develop a mental disorder. A secondary aim was to determine if there is a relationship between OCS and the individual’s OCD polygenic risk score (OCD-PRS) and between the rate of thalamic volume change and the OCD-PRS. Methods: The sample included 378 children enrolled in the longitudinal Brazilian High-Risk Cohort for Mental Conditions. Participants were assessed for OCS and the symmetrized percent change (SPC) of thalamic volume across two time-points separated by 3 years, along with the OCD-PRS. Zero-altered negative binomial models were used to analyze the relationship between OCS and thalamic SPC. Multiple linear regressions were used to examine the relationship between thalamic SPC and OCD-PRS. Results: A significant relationship between OCS and the right thalamus SPC (p = 0.042) was found. There was no significant relationship between changes in thalamic volume SPC and OCD-PRS. Conclusions: The findings suggest that changes in the right thalamic volume over the course of 3 years in children may be associated to OCS. Future studies are needed to confirm these results and further characterize the specific nature of OCS symptoms associated with thalamic volumes

Cimentos em betões refractários LCC e ULCC: síntese, mecanismo de hidratação e interação com os microenchedores

O presente trabalho tem como tema "Cimentos em Betões Refractários LCC e ULCC: Síntese, Mecanismo de Hidratação e Interação com os Microenchedores". Dada a importância da composição mineralógica destes cimentos nas propriedades finais das argamassas ou dos betões, o estudo versa essencialmente sobre o comportamento das várias fases que compõem os cimentos aluminosos para fins refractários, na sua interação com a água e com os microenchedores, nomeadamente a microsílica. A tese contém quatro capítulos principais, que são: - Os betões refractários - Síntese dos aluminatos de cálcio - Hidratação dos aluminatos de cálcio - Conclusões gerais O capítulo sobre os betões refractários é uma revisão bibliográfica que, além de um breve historial sobre estes materiais, define-os e classifica-os. Segue-se o ordenamento das propriedades mais importantes que apresentam, subdivididas em reológicas e físico-mecânicas. O ordenamento dos dois capítulos subsequentes inclui uma revisão bibliográfica, realização experimental, resultados e discussão e conclusões. Cada um dos capítulos termina com o suporte bibliográfico correspondente. A tese termina num quarto capítulo sobre conclusões gerais. O capítulo sobre síntese dos aluminatos debruça-se sobre os métodos convencionais e não convencionais de síntese de pós, com a consequente particularização para o sistema em estudo, o sistema cálcia-alumina, incluindo a descrição da evolução dos diagramas de fases deste sistema. Depois de descrever o suporte teórico para cada um dos métodos incluindo o adaptado para o caso presente, a síntese por reacção de combustão, que não deve ser confundida com combustão sólida autosustentada (SHS), segue-se a descrição da realização experimental, onde se deu primazia, nos métodos de caracterização de pós, à Difracção de Raios-X, à medição da superfície específica por BET e à Microscopia Electrónica de Varrimento e de Transmissão. Os resultados obtidos, como o elevado grau de finura dos pós policristalinos, rigorosamente monofásicos ou bifásicos conforme o pretendido, a rapidez e eficiência da síntese, justificam plenamente a escolha do método que é um forte concorrente a métodos mais sofisticados como o sol -gel ou as modificações de Pechini. A parte concernente à hidratação, em que o sistema binário cálcia-alumina passa a incluir a água transformando-se no ternário cálcia-alumina-água; versa sobre o processo de hidratação individualizada das diversas fases que compõem os cimentos aluminosos, fases essas que como se referiu foram produzidas por reacções de combustão. Especial atenção foi dedicada ao estudo do mecanismo de hidratação usando para a sua determinação o já referido DRX, a Microscopia de Varrimento com recurso à análise química por espectroscopia (EDS), aos métodos de análise térmica como a Análise Térmica Gravimétrica (ATG) e Calorimetria Diferencial de Varrimento e ainda a análise da fase líquida por Espectrometria de Plasma. As análises térmicas e a difracção de Raios-X foram ainda usadas no estudo posterior da hidratação. As condições higrométricas em que se procedeu ao estudo incluem as ambientais, e controladas a 25 e 50ºC numa atmosfera saturada de vapor de água. Em todos estes sistemas estudou-se a influência da razão W/C, da composição em termos do mineral hidráulico e da sílica amorfa. Os resultados da hidratação mostram que os pós produzidos por combustão são altamente reactivos e foi possível determinar a contribuição de cada uma das fases anidras na evolução de formação de fases durante a hidratação e consequentemente na resistência mecânica das pastas bem como a influência dos aditivos, no caso a sílica amorfa. Globalmente as misturas estudadas e os produtos das suas reacções com a água podem ser localizadas no diagrama de composições CA2-C3A-H2O-SiO2 que, por isso, ilustra a capa desta tese.The subject of the present work is "Cements in Refractory LC and ULC Castables: Synthesis, Hydration Mechanism and Interaction with the Microfillers". Given the relevance of the mineralogical composition of these cements in the final properties of both mortars and concretes, this study deals mainly with the behaviour of the various phases present in the aluminous cements for refractory use, and their interaction with water and the microfillers, namely microsilica. The Thesis has four major chapters, which are: - Refractory castables - Synthesis of calcium aluminates - Hydration of calcium aluminates - General conclusions The chapter on Refractory Castables is a literature review which, besides a short chronological note on these materials, defines and classifies them. A description of their most important properties follows, subdivided into rheological and physical-mechanical properties. The next two chapters include a literature review, experimental methods, results and discussion and conclusions. Each chapter ends with the corresponding references list. A chapter on general conclusions ends the thesis. The chapter on the synthesis of the aluminates describes the conventional and nonconventional powder synthesis methods, with emphasis on the system under investigation, the lime-alumina system, and includes the changes reported for the corresponding phase diagrams. After describing the fundamentals of each method, particularly the combustion method selected for this work, which should not be mistaken for the self-propagating solid state synthesis (SHS), there is a description of the experimental techniques used for the powder characterisation, namely X-ray diffraction, BET specific surface area measurements, scanning and transmission electron microscopy. The results obtained, such as the fineness and crystallinity of the powders, strictly single phase or containing two phases when desired, the quickness and efficiency of the synthesis, constitute ample justification for the selection of this synthesis method, a strong contestant to other more sophisticated techniques such as sol-gel or Pechini modifications. As for the hydration studies, carried out within the ternary system water-lime-alumina, the individual hydration processes of the various phases present in the aluminous cements were investigated. As already mentioned, those phases were synthesised by combustion reaction. Special care was devoted to the hydration mechanism, which was investigated by XRD, scanning electron microscopy aided by energy dispersive spectroscopy (EDS) for chemical analysis, thermal analysis such as thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC), and liquid phase analysis by inductively coupled plasma spectroscopy (ICP). Thermal analysis and X-ray diffraction were also used in the study of the later stages of the hydration. The investigation was carried out under various hygrometric conditions, namely ambient and controlled water vapour saturated atmosphere at 25 and 50°C. In all cases, the effect of the water/cement ratio (W/C), and the hydraulic mineral and silica contents was studied. The results obtained show that combustion synthesised powders are highly reactive and it was possible to single out the contribution of each anhydrous phase, as well as the effect of the added microsilica, on the phase formation during hydration and, hence, the mechanical strength of the hydrated pastes. Overall, the mixtures investigated and the products of their reactions with water can all be located within the compositional diagram CA2-C3A-H2O-SiO2 which, and for that reason, was chosen to illustrate the cover of this Thesis.Programa Doutoral em Ciência e Engenharia de Materiai

HIV AND SURGERY: AN ISSUE ONLY FOR DEVELOPED COUNTRY? AN OVERVIEW FROM MOZAMBIQUE

The high incidence of HIV, especially in sub-Saharan African countries, and the increase of life expectancy due to effectiveness antiretroviral therapies, have led to an increase of patients undergoing surgery interventions. To date there is still no definitive data on role, outcome and management of HIV positive surgical subjects. This paper reviews the more recent literature about HIV infection, highlighting the main pathologies treated by thoracic, abdominal and orthopedic surgery, without forgetting about other surgery branches. Particular attention was paid to Mozambique, a developing country with one of the highest levels of HIV incidence

Family characteristics as protective factors for mental disorders in children and adolescents

Introdução: De acordo com a Organização Mundial da Saúde, cerca de 8% das crianças/adolescentes com idades entre 5 e 14 anos e 14% com idades entre 10 e 19 anos tiveram transtornos mentais em 2019. A probabilidade de desenvolvimento de transtorno mental resulta da interação de fatores individuais, familiares e estruturais. O contexto familiar é importante para o desenvolvimento de características comportamentais e emocionais das crianças. Crianças e adolescentes que vivem em famílias com altos níveis de coesão, baixos níveis de controle e conflito têm menor chance de desenvolver transtornos mentais. Pais com estilos autoritativos têm filhos com menos transtornos mentais. Vários estudos investigam fatores de risco/proteção, porém poucos abordam o impacto das características familiares como fator de proteção de transtornos mentais em crianças e adolescentes em uma amostra comunitária acompanhada longitudinalmente. Objetivo: Investigar características do ambiente familiar e estilos parentais como fatores de proteção para transtornos mentais em crianças e adolescentes. Método: Foram realizadas análises transversais e longitudinais do Estudo de Coorte de Alto Risco Brasileiro em 2511 participantes de 6 a 14 anos. Foi utilizado o Questionário de Avaliação do Desenvolvimento e Bem-Estar (DAWBA), na linha de base e após 3 anos de seguimento, para diagnosticar transtornos mentais e diferentes questionários para determinar fatores de proteção e risco na linha de base. O estilo parental e o ambiente familiar foram investigados com o Instrumento de Ligação Parental e a Escala do Ambiente Familiar, respetivamente. Realizou-se análise de componentes principais com as variáveis da Escala de Ambiente Familiar para a obtenção de uma variável denominada Fator de Ambiente Familiar. Razões de chances foram obtidas por regressão logística múltipla na linha de base e 3 anos depois. Resultado: Na linha de base, 652 (26%) dos participantes pontuaram para pelo menos um transtorno mental. A frequência de transtornos mentais foi maior em crianças com mães com estilo negligente comparado a mães com controle afetuoso (permissivo) e cuidado ótimo (autoritativo). Na regressão múltipla, os fatores que aumentam a chance de transtorno mental foram: 1) nível socioeconômico baixo; 2) mães que beberam na gestação; 3) mães que tiveram condição médica na gestação; 4) crianças que sofreram Bullying; 5) crianças que sofreram algum tipo de abuso (sexual, físico ou negligência) e 6) filhos de pais com transtorno mental. O Fator de Ambiente Familiar apresentou uma associação negativa com presença de transtornos mentais (OR=0,87, 95% IC [0,84-0,91], p<0,001), isto é, para cada aumento no valor do Fator do Ambiente Familiar, a chance de ter transtorno mental diminui em 26%. Tanto os estilos parentais como o Fator do Ambiente Familiar não se mostraram associados com a manutenção da ausência dos transtornos mentais no seguimento de 3 anos. Conclusão: A presença de transtornos mentais em crianças e adolescentes está associada a inúmeros fatores de risco e um ambiente familiar saudável pode minimizar o efeito desses fatores. Estudos de intervenção devem ser realizados para identificar as melhores estratégias para melhorar o ambiente familiar e o impacto dessas intervenções no desenvolvimento de transtornos mentais em crianças e adolescentesIntroduction: According to the World Health Organization, approximately 8% of children/adolescents aged between 5 and 14 years and 14% aged between 10 and 19 years had mental disorders in 2019. The likelihood of developing a mental disorder result from the interaction of individual, family, and structural factors. The family context is important for the development of behavioral and emotional characteristics of children. Children and adolescents who live in families with high levels of cohesion, low levels of control and conflict are less likely to develop mental disorders. Parents with authoritative styles have children with fewer mental disorders. Several studies have investigated risk and protective factors, but few have addressed the impact of family characteristics as a protective factor for mental disorders in children and adolescents in a longitudinally monitored community sample. Objective: To investigate characteristics of the family environment and parenting styles as protective factors for mental disorders in children and adolescents. Method: Cross-sectional and longitudinal analysis of the Brazilian High Risk Cohort Study were carried out in 2511 participants aged 6 to 14 years. The Development and Well-Being Assessment Questionnaire (DAWBA) was used at baseline and after 3 years of follow-up to diagnose mental disorders and different questionnaires to determine protective and risk factors at baseline. Parenting style and family environment were investigated with the Parental Attachment Instrument and the Family Environment Scale, respectively. Principal component analysis was carried out with the variables of the Family Environment Scale to obtain a variable called Family Environment Factor. Odds ratios were obtained by multiple logistic regression at baseline and 3 years later. Outcome: At baseline, 652 (26%) of participants scored for at least one mental disorder. The frequency of mental disorders was higher in children with mothers with neglectful style compared to mothers with affectionate control (permissive) and great care (authoritative). In the multiple regression, the factors that increase the chance of having a mental disorder were: 1) low socioeconomic status; 2) mothers who drank during pregnancy; 3) mothers who had a medical condition during pregnancy; 4) children who suffered Bullying; 5) children who suffered some type of abuse (sexual, physical or negligence) and 6) children of parents with mental disorders. The Family Environment Factor showed a negative association with the presence of mental disorders (OR=0.87, 95% CI [0.84-0.91], p<0.001), that is, for each increase in the value of the Family Environment Factor, the chance of having a mental disorder decreases by 26%. Both parenting styles and the Family Environment Factor were not associated with maintaining the absence of mental disorders at the 3-year follow-up. Conclusion: The presence of mental disorders in children and adolescents is associated with numerous risk factors and a healthy family environment can minimize the effect of these factors. Intervention studies should be carried out to identify the best strategies to improve the family environment and the impact of these interventions on the development of mental disorders in children and adolescent

Conhecimentos, atitudes e prácticas dos agentes comunitários de saúde sobre a epilepsia em Sofala, centro de Moçambique

Abstract: Background: Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has been task-sharing the identification and care for epilepsy by community health workers (CHWs). The present study aimed to assess the knowledge, attitudes, and practices (KAPs) of CHWs towards epilepsy in Mozambique. Methods: One hundred and thirty-five CHWs completed a questionnaire that included socio-demographic characteristics and 44-items divided into six subscales pertaining to KAPs towards epilepsy (QKAP-EPI) across nine districts of Sofala, Mozambique. The internal consistency was examined to evaluate the reliability of the instrument (QKAP-EPI). The association between sociodemographic variables and QKAP-EPI subscales was examined using linear regression models. Results: The internal consistency was moderate for two subscales (causes of epilepsy, α = 0.65; medical treatment, α = 0.694), acceptable for cultural treatment (α = 0.797) and excellent for 2 subscales (safety and risks, α = 0.926; negative attitudes, α = 0.904). Overall, CHWs demonstrated accurate epilepsy knowledge (medical treatment: mean = 1.63, SD = 0.28; safety/risks: mean = 1.62, SD = 0.59). However, CHWs reported inaccurate epilepsy knowledge of the causes, negative attitudes, as well as culturally specific treatments for epilepsy, such as: “if a person with epilepsy burns when set on fire they cannot be treated”. Knowl- edge about how to manage epileptic seizures varied across the different emergency care practices, from the accurate belief that it is not advisable to place objects in the individual’s mouth during an epileptic seizure, to the wrong perception of the need to hold the person in seizures to control seizures. Heterogeneity in the level of epilepsy knowledge was observed among CHWs, when consid- ering epilepsy according to the local names as treatable (“Dzumba”) and other forms as untreatable (“Nzwiti”). Conclusion: CHWs knowledge of medical treatment and epilepsy safety/risks were adequate. However, information on the causes of epilepsy, stigmatizing attitudes, cultural treatment, and some knowledge of epileptic seizure management were low. These areas of poor knowledge should be the focus of educating CHWs in increasing their ability to provide quality care for patients with epilepsy in Mozambique.Project 41—8th Call from the National Fund of Investigation in Mozambique (FNI), 2017

How innovative and conventional curricula prepare medical students for practice in Sub-Saharan Africa:A comparative study from Mozambique

BACKGROUND: Medical education in Sub-Saharan Africa is in need of reform to promote the number and quality of physicians trained. Curriculum change and innovation in this region, however, face a challenging context that may affect curriculum outcomes. Research on outcomes of curriculum innovation in Sub-Saharan Africa is scarce. We investigated curriculum outcomes in a Sub-Saharan African context by comparing students' perceived preparedness for practice within three curricula in Mozambique: a conventional curriculum and two innovative curricula. Both innovative curricula used problem-based learning and community-based education. METHODS: We conducted a comparative mixed methods study. We adapted a validated questionnaire on perceived professional competencies and administered it to 5th year students of the three curricula (n = 140). We conducted semi-structured interviews with 5th year students from these curricula (n = 12). Additional contextual information was collected. Statistical and thematic analyses were conducted. RESULTS: Perceived preparedness for practice of students from the conventional curriculum was significantly lower than for students from one innovative curriculum, but significantly higher than for students from the other innovative curriculum. Major human and material resource issues and disorganization impeded the latter's sense of preparedness. Both innovative curricula, however, stimulated a more holistic approach among students toward patients, as well an inquiring and independent attitude, which is valuable preparation for Sub-Saharan African healthcare. DISCUSSION: In Sub-Saharan Africa, risks and benefits of curriculum innovation are high. Positive outcomes add value to local healthcare in terms of doctors' meaningful preparedness for practice, but instead outcomes can be negative due to the implementation challenges sometimes found in Sub-Saharan African contexts. Before embarking on innovative curriculum reform, medical schools need to assess their capability and motivation for innovation

HIV and surgery: An issue only for developed country? an overview from Mozambique

The high incidence of HIV, especially in sub-Saharan African countries, and the increase of life expectancy due to effectiveness antiretroviral therapies, have led to an increase of patients undergoing surgery interventions. To date there is still no definitive data on role, outcome and management of HIV positive surgical subjects. This paper reviews the more recent literature about HIV infection, highlighting the main pathologies treated by thoracic, abdominal and orthopedic surgery, without forgetting about other surgery branches. Particular attention was paid to Mozambique, a developing country with one of the highest levels of HIV incidence

HIV incidence in a cohort of women at higher risk in Beira, Mozambique: prospective study 2009-2012

HIV is prevalent in Sofala Province, Mozambique. To inform future prevention research, we undertook a study in the provincial capital (Beira) to measure HIV incidence in women at higher risk of HIV and assess the feasibility of recruiting and retaining them as research participants. Women age 18-35 were recruited from schools and places where women typically meet potential sexual partners. Eligibility criteria included HIV-seronegative status and self-report of at least 2 sexual partners in the last month. History of injection drug use was an exclusion criterion, but pregnancy was not. Participants were scheduled for monthly follow-up for 12 months, when they underwent face-to-face interviews, HIV counseling and testing, and pregnancy testing. 387 women were eligible and contributed follow-up data. Most were from 18-24 years old (median 21). Around one-third of participants (33.8%) reported at least one new sexual partner in the last month. Most women (65.5%) reported not using a modern method of contraception at baseline. Twenty-two women seroconverted for a prospective HIV incidence of 6.5 per 100 woman-years (WY; 95% confidence interval (CI): 4.1-9.9). Factors associated with HIV seroconversion in the multivariable analysis were: number of vaginal sex acts without using condoms with partners besides primary partner in the last 7 days (hazard ratio (HR) 1.7; 95% CI: 1.2-2.5) and using a form of contraception at baseline other than hormonal or condoms (vs. no method; HR 25.3; 95% CI: 2.5-253.5). The overall retention rate was 80.0% for the entire follow-up period. We found a high HIV incidence in a cohort of young women reporting risky sexual behavior in Beira, Mozambique. HIV prevention programs should be strengthened. Regular HIV testing and condom use should be encouraged, particularly among younger women with multiple sexual partner

Students' and junior doctors' preparedness for the reality of practice in sub-Saharan Africa

Item does not contain fulltextBACKGROUND: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. AIM: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. METHODS: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. RESULTS: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors' motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. CONCLUSION: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors' motivation and preparedness to tackle the challenges of health care practice in this region