Trastorno depresivo y su asociación con la edad en pacientes de la Cátedra y Servicio de Psiquiatría, FCM-UNA

Introducción: Según la organización mundial de la salud, en el mundo hay más de 350 millones de personas con depresión. 5% de la población adulta padece depresión. Los trastornos mentales severos afectan a 1,5 % de la población paraguaya total. El objetivo del presente trabajo fue establecer si existe asociación entre la presentación del trastorno depresivo y la edad del paciente (mayor o menor a 45 años de edad). Materiales y métodos: Se realizó un estudio observacional, analítico de cohortes, con muestreo no probabilístico de casos consecutivos, de pacientes tratados en la Cátedra y Servicio de Psiquiatría de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, en quienes se seleccionó la presencia o no de trastorno depresivo, entre los periodos 2011 y 2012. Las variables independientes fueron la edad, el sexo y la procedencia y la dependiente fue la presencia o no de trastorno depresivo. Se incluyó a pacientes mayores de edad con historia clínica completa, excluyéndose a aquellos con historia clínica incompleta. Resultados: La hipótesis nula, que indicaba que los pacientes con edades iguales o mayores a 45 años no tenían una mayor prevalencia de trastorno depresivo, queda rechazada con el valor de Chi cuadrado que fue de 31, 9356 (p<0,05). Un Odds ratio (OR) estimado de 2,10 indica que la probabilidad de presentar un trastorno depresivo es el doble para aquellos de 45 años o más, que para los menores de 45 años. El riesgo relativo (RR) indica que los de 45 años o más de edad están 1,43 veces más expuestos que los de menor a 45 años a presentar un trastorno depresivo. Se realizó un análisis estratificado demostrando que el sexo no es un factor de confusión, este interactúa con la edad siendo mayor el riesgo de padecer trastornos depresivos si el paciente es de sexo femenino. Discusión: Existe asociación entre la presentación del trastorno depresivo y la edad del paciente, específicamente si este es mayor o menor de 45 años. Esto podría guiar el médico psiquiatra hacia el diagnóstico y posibles causas de los trastornos, ayudando en la prevención mediante técnicas acordes a ese grupo etario

YOUTH EMPLOYMENT IN AFRICA: NEW EVIDENCE AND POLICIES FROM SWAZILAND

Drawing on the 2007 and 2010 Swaziland Labor Force Surveys, this paper provides first systematic evidence on recent youth employment challenges in Swaziland, a small, land-locked, middle-income country with one of the highest youth unemployment rates in Africa. The paper first documents the various labor market disadvantages faced by the Swazi youth, such as high unemployment and discouragement, and how they changed from 2007 to 2010. A multinomial logit regression analysis is then carried out to analyze the socio-economic drivers of the unfavorable youth labor market outcomes on the supply side. Since many of the factors that can unlock the employment potential of the Swazi youth are on the demand side of the labor market, the paper examines the barriers to job creation and youth entrepreneurship. It concludes with experiences of other countries that could inform design of more effective interventions for youth employment in Swaziland.http://deepblue.lib.umich.edu/bitstream/2027.42/133071/1/wp1052.pd

From DPSIR the DAPSI(W)R(M) Emerges… a Butterfly – ‘protecting the natural stuff and delivering the human stuff’

The complexity of interactions and feedbacks between human activities and ecosystems can make the analysis of such social-ecological systems intractable. In order to provide a common means to understand and analyse the links between social and ecological process within these systems, a range of analytical frameworks have been developed and adopted. Following decades of practical experience in implementation, the Driver Pressure State Impact Response (DPSIR) conceptual framework has been adapted and re-developed to become the D(A)PSI(W)R(M). This paper describes in detail the D(A)PSI(W)R(M) and its development from the original DPSIR conceptual frame. Despite its diverse application and demonstrated utility, a number of inherent shortcomings are identified. In particular the DPSIR model family tend to be best suited to individual environmental pressures and human activities and their resulting environmental problems, having a limited focus on the supply and demand of benefits from nature. We present a derived framework, the “Butterfly”, a more holistic approach designed to expand the concept. The “Butterfly” model, moves away from the centralised accounting framework approach while more-fully incorporating the complexity of social and ecological systems, and the supply and demand of ecosystem services, which are central to human-environment interactions

Mechanical adaptation of trabecular bone morphology in the mammalian mandible

Alveolar bone, together with the underlying trabecular bone, fulfils an important role in providing structural support against masticatory forces. Diseases such as osteoporosis or periodontitis cause alveolar bone resorption which weakens this structural support and is a major cause of tooth loss. However, the functional relationship between alveolar bone remodelling within the molar region and masticatory forces is not well understood. This study investigated this relationship by comparing mammalian species with different diets and functional loading (Felis catus, Cercocebus atys, Homo sapiens, Sus scrofa, Oryctolagus cuniculus, Ovis aries). We performed histomorphometric analyses of trabecular bone morphology (bone volume fraction, trabecular thickness and trabecular spacing) and quantified the variation of bone and tooth root volumes along the tooth row. A principal component analysis and non-parametric MANOVA showed statistically significant differences in trabecular bone morphology between species with contrasting functional loading, but these differences were not seen in sub-adult specimens. Our results support a strong, but complex link between masticatory function and trabecular bone morphology. Further understanding of a potential functional relationship could aid the diagnosis and treatment of mandibular diseases causing alveolar bone resorption, and guide the design and evaluation of dental implants

Evaluation of a group based cognitive behavioural therapy programme for menstrual pain management in young women with intellectual disabilities: protocol for a mixed methods controlled clinical trial

BACKGROUND: Menstrual pain which is severe enough to impact on daily activities is very common amongst menstruating females. Research suggests that menstrual pain which impacts on daily functioning may be even more prevalent amongst those with intellectual disabilities. Despite this, little research attention has focused on pain management programmes for those with intellectual disabilities. The aims of this pilot study were to develop and evaluate a theory-based cognitive behavioural therapy (CBT) programme for menstrual pain management in young women with intellectual disabilities. METHODS/DESIGN: The study utilised a mixed methods controlled clinical trial to evaluate elements from a CBT programme called Feeling Better (McGuire & McManus, 2010). The Feeling Better programme is a modular, manualised intervention designed for people with an intellectual disability and their carers. The programme was delivered to 36 young women aged 12 – 30 years who have a Mild - Moderate Intellectual Disability, split between two conditions. The treatment group received the Feeling Better intervention and the control group received treatment as usual. To evaluate the effectiveness of the programme, measures were taken of key pain variables including impact, knowledge, self-efficacy and coping. Process evaluation was conducted to examine which elements of the programme were most successful in promoting change. DISCUSSION: Participants in the intervention group were expected to report the use of a greater number of coping strategies and have greater knowledge of pain management strategies following participation in the intervention and at three month follow-up, when compared to control group participants. A significant advantage of the study was the use of mixed methods and inclusion of process evaluation to determine which elements of a cognitive behavioural therapy programme work best for individuals with intellectual disabilities. TRIAL REGISTRATION: Current Controlled Trials ISRCTN7556775

Supraorbital morphology and social dynamics in human evolution

Uniquely, with respect to Middle Pleistocene hominins, anatomically modern humans do not possess marked browridges, and have a more vertical forehead with mobile eyebrows that play a key role in social signalling and communication. The presence and variability of browridges in archaic Homo and their absence in ourselves have led to debate concerning their morphogenesis and function, with two main hypotheses being put forward; that browridge morphology is the result of the spatial relationship between the orbits and the braincase, and that browridge morphology is significantly impacted by biting mechanics. Here we virtually manipulate browridge morphology of an archaic hominin (Kabwe 1), showing that it is much larger than the minimum required to fulfil spatial demands and that browridge size has little impact on mechanical performance during biting. Since browridge morphology in this fossil is not driven by spatial and mechanical requirements alone, the role of the supraorbital region in social communication is a potentially significant factor. We propose that conversion of the large browridges of our immediate ancestors to a more vertical frontal in modern humans allowed highly mobile eyebrows to display subtle affiliative emotions

Supporting the education and wellbeing of children looked-after: what is the role of the virtual school?

The Children and Families Act (2014) placed a statutory responsibility on local authorities in the United Kingdom to establish a Virtual School Headteacher with the role of championing the education of all children looked-after within that authority. The current research was designed to illuminate how Virtual Schools are currently supporting educational outcomes for children looked-after, not only through educational interventions, but also through supporting broader psychological factors that might impact on attainment such as attachment, relationships and mental health. Virtual School Head Teachers from 29 local authorities completed an online survey about the services they provided to three target groups – children looked-after, foster carers and schools – with a particular focus on the transition years from primary to secondary school, which have been identified as being a difficult time for children looked-after. Using inductive thematic analysis four overarching themes to service provision were identified: Enhanced learning opportunities; Specific Transition Support; Wellbeing and Relationships, and Raising Awareness. Direct work, interprofessional working and the development of supportive environments, particularly guided by attachment theory, were identified as important areas of practice. Practice is discussed in relation to resilience and ecological systems theory and suggestions for future research are identified