Staging evaluation of posttraumatic stress disorder : a machine learning study

Os transtornos de estresse relacionados a um evento traumático, como o transtorno de estresse agudo (TEA) e o transtorno de estresse pós-traumático (TEPT), são caracterizados por alta morbidade e prejuízo social significativo. No Brasil, estima-se que 80% da população já foi exposta a pelo menos um evento traumático ao longo da vida em grandes centros urbanos, como São Paulo e Rio de Janeiro; o crescente problema da violência urbana mostra-se fator importante para a gênese dos transtornos relacionados ao trauma. Devido à etiologia do TEPT ser multicausal e complexa, técnicas de Machine Learning (Aprendizado de Máquina – ML) tem sido usadas para desenvolver escores de risco, para predição diagnóstica e para definição de tratamento. Contudo, considerando sua heterogeneidade clínica e etiológica, realizar o diagnóstico e definir um tratamento adequado pode ser muitas vezes desafiador. O uso do estadiamento clínico surge como um método mais refinado de diagnóstico, procurando definir a progressão do transtorno em momentos específicos durante o continuum da enfermidade. Esta abordagem pode auxiliar em um diagnóstico mais aprimorado, conhecer melhor o prognóstico e escolher o melhor tratamento de acordo com o estágio do transtorno. Assim, o TEPT aparece como um exemplo importante de como um método de estadiamento pode trazer benefícios. O objetivo desta tese é avaliar como os aspectos pessoais, clínicos e relacionados ao trauma dos pacientes atendidos em ambulatórios especializados em trauma psíquico podem estar relacionados à predição do estadiamento clínico de TEPT usando técnicas de ML.Stress disorders related to a traumatic event, such as acute stress disorder (ASD) and posttraumatic stress disorder (PTSD), are characterized by high morbidity and significant social impairment. In Brazil, it is estimated that 80% of the population has already been exposed to at least one traumatic event throughout life in large urban centers, such as São Paulo and Rio de Janeiro; the growing problem of urban violence proves to be an important factor in the genesis of trauma-related disorders. The etiology of PTSD is multicausal and complex; techniques of Machine Learning (ML) have been used to develop PTSD risk scores, to predict its diagnosis and to choose better treatments. However, considering its clinical and etiological heterogeneity, making the diagnosis and defining an appropriate treatment can often be challenging. The use of clinical staging appears as a refined method of diagnosis, aiming to define the progression of the disorder at specific times during the continuum of the illness. This approach may provide improved diagnosis, better understand the prognosis and choose the best treatment according to the stage of the disorder. Thus, PTSD appears as an important example of how a staging method can bring benefits. The objective of this thesis is to evaluate how the personal, clinical and trauma-related aspects of patients who sought care at outpatient clinics specialized in emotional trauma can be related to the prediction of the PTSD staging using ML techniques

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life

Introduction: A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. Methods: The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. Results: Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. Conclusions: This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy

COVID-19 pandemic and social distancing : economic, psychological, family, and technological effects

Introduction: The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. Objective: The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. Method: This study is a narrative review of the literature on social isolation in the context of the COVID19 pandemic. Results: 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. Conclusions: It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families

Neuroprogression in post-traumatic stress disorder : a systematic review

Introduction: Neuroprogression has been proposed as the pathological rewiring of the brain that takes place in parallel with clinical and neurocognitive deterioration in the course of psychiatric disorders. This study aims to review the biological underpinnings and clinical outcomes related to neuroprogression in post-traumatic stress disorder (PTSD). Methods: We performed a systematic review by searching PubMed, Embase, and Web of Science for articles published between January 1, 1960, and January 6, 2020. Inclusion criteria were met when articles assessed brain changes, neurocognition, functioning, inflammation, oxidative stress, and neurotrophins in patients with PTSD. Narrative review articles, case reports, and preclinical studies were excluded. Results: A total of 965 abstracts were identified and 15 articles were included in our systematic review. It seems that for a subset of patients whose symptoms worsen or are maintained at a high intensity there is a progressive change in the frontal lobe, especially the prefrontal cortex, and worsening of both neurocognition (verbal memory and facial recognition) and functioning (physical, psychological, social and environmental). Conclusion: Although current findings associate progressive reduction in frontal lobe size with neurocognitive impairment, further research is needed to characterize PTSD as a neuroprogressive disorder

Validation of the Brazilian-Portuguese version of the Clinician Administered Post Traumatic Stress Disorder Scale-5

Objectives: The aim of this study was to validate CAPS-5 for the Brazilian-Portuguese language on a sample of 128 individuals from two centers (from the cities of São Paulo and Porto Alegre) who have been recently exposed to a traumatic event. Methods: We performed a reliability analysis between interviewers (with a subset of 32 individuals), an internal consistency analysis, and a confirmatory factorial analysis for the validation study. Results: The inter-rater reliability of the total PTSD symptom severity score was high [intraclass correlation coefficient =0.994, 95% CI (0.987–0.997), p < 0.001]. Cohen’s Kappa for individual items ranged between 0.759 and 1. Cronbach’s alpha coefficients indicated high internal consistency for the CAPS-5 full scale (α = 0.826) and an acceptable level of internal consistency for the four symptom clusters. The confirmatory factorial analysis for the 20-item original CAPS-5 did not fit the data well. A 15-item model with better results was then established by excluding the following CAPS-5 items: dissociative amnesia, recklessness, distorted cognitions, irritability, and hypervigilance. Conclusion: Despite the limitation of the predominance of female victims, and the high number of sexually assaulted women in our sample, the model with only 15 items provided a good fit to the data with high internal consistency (α = 0.835)

Rarity of monodominance in hyperdiverse Amazonian forests.

Tropical forests are known for their high diversity. Yet, forest patches do occur in the tropics where a single tree species is dominant. Such "monodominant" forests are known from all of the main tropical regions. For Amazonia, we sampled the occurrence of monodominance in a massive, basin-wide database of forest-inventory plots from the Amazon Tree Diversity Network (ATDN). Utilizing a simple defining metric of at least half of the trees ≥ 10 cm diameter belonging to one species, we found only a few occurrences of monodominance in Amazonia, and the phenomenon was not significantly linked to previously hypothesized life history traits such wood density, seed mass, ectomycorrhizal associations, or Rhizobium nodulation. In our analysis, coppicing (the formation of sprouts at the base of the tree or on roots) was the only trait significantly linked to monodominance. While at specific locales coppicing or ectomycorrhizal associations may confer a considerable advantage to a tree species and lead to its monodominance, very few species have these traits. Mining of the ATDN dataset suggests that monodominance is quite rare in Amazonia, and may be linked primarily to edaphic factors

Manual de boas práticas e sustentabilidade no turismo

info:eu-repo/semantics/publishedVersio

Entre a poeira e o silêncio: sobre exposições e construções da memória no Museu do Ceará (1932-1997)

This article discusses some manners to construct the meanings of the past into Museu do Ceará's exhibitions between 1932 and 1997. Based on issues of Social History of Memory, the meanings of dust and silence are highlighted in a way that the past is configured in the space of the exhibitions. The artifacts are treated taking into account underlying values and expectations that guide, in certain circumstances, connections and separations between past and present

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio