Shame, Self-Criticism, Perfectionistic Self-Presentation and Depression in Eating Disorders

Costa, J., Marôco, J., Pinto-Gouveia, J., & Ferreira, C. (2016). Shame, Self-Criticism, Perfectionistic Self-Presentation and Depression in Eating Disorders. International Journal of Psychology and Psychological Therapy, 16(3), 317-328. http://www.ijpsy.com/volumen16/num3/449.htmlThe complexity of eating disorder (ED) manifestations has increased the interest in understanding the mechanisms underlying the eating psychopathology and it is now widely accepted that there are multiple risk pathways for both the development and maintenance of eating psychopathology. This study examined the association between external shame and depression. We also investigated the possible mediation effect of self-criticism in the relation between shame and depression. Further to that, the current cross-sectional study inspected whether this mediation exists for different conditional values of perfectionistic self-presentation. One hundred and twenty one women diagnosed with eating disorder according to the Eating Disorder Examination (EDE 16.0D) completed a battery of self-report questionnaires to assess external shame, self-criticism, perfectionistic self-presentation and depression. A mediated-moderation analysis was performed. Results showed that the path from external shame to self-criticism depends on the level of perfectionistic self-presentation whereas the effect of self-criticism on depression is constant. Thus, there is an interaction between external shame and perfectionistic self-presentation on self-criticism which, in turn, affects depression. The internalization of an ideal-self sets up a standard that once compared to the actual self, displays negative self-evaluations and feelings that individuals see as reflecting a bad, inferior and flawed self. In this context, a perfectionistic self-presentation is used to create positive images on the minds of others. Although this style of organization is an adaptive way to deal with specific social contexts once it functions as a buffer in the relationship between shame and self-criticism, perfectionistic self-presentation seems to be a useless strategy since it does not prevent them from depression. Implications for future research are discussed

Cost-Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Portugal

Pneumococcal infections are the leading cause of vaccine-preventable death in children. In June 2015, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the Portuguese Immunization Program. We evaluated the cost-effectiveness of children vaccinated with PCV13 versus no vaccination for preventing pneumococcal diseases.info:eu-repo/semantics/publishedVersio

Water management in University of Minho sustainable politics

As Instituições de Ensino Superior têm um papel fundamental na resposta aos desafios que a humanidade se tem vindo a defrontar, principalmente no que confere ao desafio do desenvolvimento sustentável. Dentro deste paradigma, o uso sustentável da água é um tema critico por via da sua relação com o desenvolvimento humano, mas também da sua relação com o meio ambiente. Este documento apresenta uma proposta para uma gestão sustentável da água em campus universitários. Para tal, usou-se o exemplo da Universidade do Minho, enquanto instituição de referência nacional da incorporação dos desígnios da sustentabilidade nas suas políticas. Procura-se assim dar um contributo para aumentar o desempenho sustentável dos campi da Universidade do Minho.Universities have a key role in addressing the challenges that humanity have to face, in particular those related to sustainable development. Within this paradigm, the sustainable management of water is a critical issue, since it is an essential resource to human development and to the life of related ecosystems. This document presents a proposal for a sustainable water management on the Universities campus. For this matter the example of the University of Minho, a reference in the incorporation of sustainable development in institutional policies, is used. This analysis pretends to give a contribution for the improvement of the sustainable performance of University of Minho campus

Real-world evidence on heart failure: findings from 25 thousand patients in a portuguese primary care database

Background: Heart failure (HF) is a major health problem in developed coun- tries, accounting for a significant social and economic burden. Published estimates of costs associated with HF patients in the primary care setting are scarce. Purpose: To determine the clinical and demographic characteristics of adult patients with a HF diagnosis in a Portuguese primary care comprehen- sive administrative database and to estimate the associated annual costs per patient. Methods: Population-based study with real data covering a population of 3.6 million patients attending primary care services in a large health region in Portugal. All adult users coded for HF with at least one visit in 2014 were selected. We analyzed patients’ characteristics, comorbidities (anemia, diabetes, hypertension, cere- brovascular disease, atrial fibrillation, ischemic heart disease, cardiomyopathies, valve disease, chronic obstructive pulmonary disease, pulmonary embolism, alco- hol abuse), and resource use in 2014 related to medical tests and cardiovascular diagnostic procedures, visits and cardiovascular or anticoagulant medication. Unit costs estimates were based on national sources. Results: We identied 25,337 patients, with an estimated HF prevalence of 1.4%. This is approximately 30% of number expected according to a previously conducted national community-based epidemiological survey. The difference may be explained by both underdiagnosis and underregistration. Patients with HF are mostly women (58%) and on average 77 ± 11 years old. The large majority of patients (93%) had at least one of the selected comorbidities present, 70% had 2 or more and 38% had 3 or more. About two thirds of patients (65%) had at least one medical test or diagnostic procedure done during 2014. Blood tests, echocardiogram, elec- trocardiogram and chest x-ray were performed in 61%, 16%, 14% and 11% of patients, respectively. The majority of patients (56%) had at least four office visits during one year. Angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, beta-blockers, and aldosterone blockers were prescribed for 80%, 48% and 20% of patients, respectively. Only 12% of patients were prescribed all three drug classes. The average annual cost per patient was estimated at €552 ± 348, of which 54%, 40% and 6% was associated to medications, medical visits and medical tests or diagnostic procedures, respectively. Conclusions: This study provides a characterization of patients with HF in a large population in a primary care setting. Surprisingly 70% of the expected number of patients are either not diagnosed or not registered. HF patients are old, mostly women and characterized by multimorbidity. The average annual cost per patient was estimated to be about €550.info:eu-repo/semantics/publishedVersio

Comparison of Nasopharyngeal Samples for SARS‐CoV ‐2 Detection in a Paediatric Cohort

Aim: The diagnosis of coronavirus disease 2019 (COVID-19) depends on accurate and rapid testing. Choosing an appropriate sample may impact diagnosis. Naso-oropharyngeal swabs (NOS) are most frequently used, despite several limitations. Since studies suggest nasopharyngeal aspirate (NPA) as a superior alternative in children, we hypothesised collecting both nasopharyngeal swab and aspirate would improve our diagnostic accuracy. Methods: Observational, longitudinal, prospective study from 7 March to 7 May in a tertiary paediatric hospital in Lisbon. The objective was to compare the rate of detection of SARS-CoV-2 between NOS and NPA samples collected simultaneously. Results: A total of 438 samples collected from 85 patients with confirmed COVID-19. There were 47.7% overall positive specimens - 32% (70/219) positive NOS and 63.5% (139/219) positive NPA. The tests were 67.6% concordant (k = 0.45). 50.3% had positive NPA with negative NOS, while 1.3% had positive NOS with negative NPA. NPA proved to be more sensitive (98.6% with 95% confidence interval 91.2-99.9% vs. 49.6% with 95% confidence interval 41.1-58.2%, P < 0.001). Additionally, the difference between NPA and NOS positive samples was statistically significant across all population groups (age, health condition, clinical presentation, contact with COVID-19 patients or need for hospitalisation), meaning NPA is more sensitive overall. Conclusions: Nasopharyngeal aspirates had greater sensitivity than naso-oropharyngeal swabs in detecting SARS-CoV-2. Our results suggest paediatric patients would benefit from collecting nasopharyngeal aspirates in hospital settings, whenever feasible, to improve diagnosis of COVID-19.info:eu-repo/semantics/publishedVersio

The cost of illness of heart failure in Portugal

Objectives: To estimate direct and indirect costs associated to adult Portuguese patients with heart failure (HF) in 2014.MethOds: A prevalence-based approach was adopted to estimate costs associated to HF. Prevalence in 2014 by the New York Heart Association (NYHA) Functional Classification was estimated using micro-data from a previously conducted national community-based epidemiological survey. Only patients at NYHA classes II-IV were considered to have costs and it was conservatively assumed that patients were either followed in hospital ambu-latory care or in primary care. Primary care costs were estimated using a data-base covering a large population, with records of medications, medical visits and medical tests or diagnostic procedures for 25,337 patients with a HF diagnosis in 2014. Hospital resource consumption was estimated using national DRG microdata. Resource utilization in hospital ambulatory care and in emergency department (ED) episodes was estimated according to experts’ opinion and the national lit-erature, respectively. Unit costs were based on the official NHS tariffs. The indirect costs associated to patients’ absenteeism and early exit from the labour force were based on national sources and conservative assumptions.Results: The class II-IV prevalence rate in the population aged 25+ was estimated at 3.4%, corresponding to 249,592 patients in 2014. HF patients have about 1.1 million medical visits, over 36,000 hospitalizations and approximately 53,000 ED episodes. In 2014, the overall direct and indirect costs were estimated at €289.4M with an average annual cost per patient of €1,159. Medication, medical visits, exams/diagnostic procedures, hospitalization and ED episodes accounted for 29%, 20%, 21%, 26% and 2% of the €244.9M direct costs, respectively. The indirect costs associated to absenteeism and premature exit from the labour market were estimated at €16.4M and €28.1M, respectively.cOnclusiOns: Heart failure is a costly condition and should receive adequate attention from the Portuguese health policy makers.info:eu-repo/semantics/publishedVersio

The N terminus of the peroxisomal cycling receptor, Pex5p, is required for redirecting the peroxisome-associated peroxin back to the cytosol

Most newly synthesized peroxisomal matrix proteins are transported to the organelle by Pex5p, a remarkable multidomain protein involved in an intricate network of transient protein-protein interactions. Presently, our knowledge regarding the structure/function of amino acid residues 118 to the very last residue of mammalian Pex5p is quite vast. Indeed, the cargo-protein receptor domain as well as the binding sites for several peroxins have all been mapped to this region of Pex5p. In contrast, structural/functional data regarding the first 117 amino acid residues of Pex5p are still scarce. Here we show that a truncated Pex5p lacking the first 110 amino acid residues (DeltaN110-Pex5p) displays exactly the peroxisomal import properties of the full-length peroxin implying that this N-terminal domain is involved neither in cargo-protein binding nor in the docking/translocation step of the Pex5p-cargo protein complex at the peroxisomal membrane. However, the ATP-dependent export step of DeltaN110-Pex5p from the peroxisomal membrane is completely blocked, a phenomenon that was also observed for a Pex5p version lacking just the first 17 amino acid residues but not for a truncated protein comprising amino acid residues 1-324 of Pex5p. By exploring the unique properties of DeltaN110-Pex5p, the effect of temperature on the import/export kinetics of Pex5p was characterized. Our data indicate that the export step of Pex5p from the peroxisomal compartment ( in contrast with its insertion into the organelle membrane) is highly dependent on the temperature

The impact of ageing on the future costs and burden of heart failure in Portugal

Objectives: To estimate, the impact of population ageing on the costs and burden of Heart Failure (HF) in Portugal over a twenty-year horizon, between 2014 and 2034. MethOds: HF costs were estimated using a prevalence-based approach. Costs and disability were assumed zero for patients in class I of the New York Heart Association (NYHA) Functional Classification. The prevalence rate was estimated using microdata from a previous epidemiological survey. Average direct costs per patient were estimated using: 1) a primary care national database with records of 25,337 patients registered with HF; 2) National DRG microdata; 3) expert panel; 4) national literature, reports and legislation. Indirect costs associated to patients’ absenteeism and early exit from the labour force were considered. The burden was measured in Disability Adjusted Life Years (DALY) resulting from the sum of Years Lost due to Disability (YLD) and Years of Life Lost (YLL) due to premature death. For YLL, mortality rates reported in the European Detailed Mortality Database were considered. For YLD, disease duration and the overall incidence were estimated using the software DisMod II. Disability weights were retrieved from published literature. Population ageing was carried out by a shift-share analysis using the official demographic projections. Results: Considering only population ageing on a 20-year horizon, HF prevalence (class II-IV) is expected to increase by 25%, reaching over 312,000 patients in 2034. Total costs in 2014 and 2034 are estimated, respectively, at €289M and €364M (at today’s prices), with an increase in the costs per inhabitant of 34%. In 2034, total DALY are expected to be 25% higher than in 2014, from 21,162 to 26,521. The contribution of YLL will increase from 54% to 61%. cOnclusiOns: Population ageing will substantially increase the burden of HF in Portugal. Health policy makers should consider new strategies to deal with this problem.info:eu-repo/semantics/publishedVersio

Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia

Background: Prostatic artery embolisation (PAE) has been associated with an improvement of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH), but conclusive evidence of efficacy from randomised controlled clinical trials has been lacking. Objective: To assess the safety and efficacy of PAE compared with a sham procedure in the treatment of LUTS/BPH. Design, setting, and participants: A randomised, single-blind, sham-controlled superiority clinical trial was conducted in 80 males ≥45yr with severe LUTS/BPH refractory to medical treatment from 2014 to 2019 in a private clinic, with efficacy assessments at 6 and 12 mo after randomisation. One patient in the PAE group and three in the sham group did not complete the study. Intervention: Patients were randomised 1:1 upon successful catheterisation of a prostatic artery to either PAE or a sham PAE procedure without embolisation. After 6 mo, all 38 patients randomised to the sham group who completed the single-blind period underwent PAE, and both groups completed a 6-mo open period. Outcome measurements and statistical analysis: An intention-to-treat analysis of all randomised patients was performed. The coprimary outcomes were the change from baseline to 6 mo in the International Prostate Symptom Score (IPSS) and the quality of life (QoL) score at 6 mo, analysed with analysis of covariance and t test, respectively. Results and limitations: Mean age was 63.8±6.0yr, baseline IPSS 26.4±3.87, and QoL score 4.43±0.52. At 6 mo, patients in the PAE arm had a greater improvement in IPSS, with a difference in the change from baseline of 13.2 (95% confidence interval [CI] 10.2-16.2, p<0.0001), and a better QoL score at 6 mo (difference: 2.13; 95% CI 1.57-2.68, p<0.0001) than the patients in the sham arm. The improvements in IPSS and QoL in the sham group 6 mo after they performed PAE were, respectively, 13.6±9.19 (p<0.0001) and 2.05 ± 1.71 (p<0.0001). Adverse events occurred in 14 (35.0%) patients after PAE and in 13 (32.5%) after sham, with one serious adverse event in the sham group during the open period. No treatment failures occurred. Limitations include a single-centre trial, only severe LUTS/BPH, and follow-up limited to 12 mo. Conclusions: The improvements in subjective and objective variables after PAE are far superior from those due to the placebo effect. Patient summary: Clearly superior efficacy of prostatic artery embolisation (PAE) compared with a sham procedure was found in this study, which supports the use of PAE in patients with typical symptoms associated with benign prostatic hyperplasia.info:eu-repo/semantics/publishedVersio