Evaluating the efficacy of psychodynamic treatment on a single case of autism. A qualitative research.

Autism spectrum disorder refers to a group of diseases determined by multiple conditions and primarily defined on the basis of behavioral patterns. The literature and guidelines provide indications regarding adequate treatments, underlying how psychologically and behaviorally structured interventions, should be considered the best programs. Anyway, there is still a scarcity of studies evidencing the effectiveness of therapeutic and developmental approaches situated in a psychodynamic framework and researches aimed to evaluate the quality of psychodynamic interventions on autism are rare. The present study illustrate a qualitative research on the single-case intervention with an autistic adolescent, admitted to the Educational - Rehabilitation Centre Antenna 112. The Centre bases its intervention on a specific psychodynamic approach, Lacanian Psychoanalysis, named Pratique \ue0 Plusieurs. The efficacy of the psychodynamic intervention is evaluated by monitoring the therapeutic process with the adolescent from his admission. The evaluation took place in three different stages of the intervention: at the beginning of the treatment, after 6 months and after 12 months. In particular, the level of adaptive behaviors (Vineland Adaptive Behavior Scale), Social Communication (Social Communication Questionnaire), and the seriousness of behavioral patterns, specific for the autism disorders (Childhood Autism Rating Scale) have been assessed. Results highlight that the psychodynamic setting of the Centre and the therapeutic intervention, which takes place in it, foster an improvement of adaptive behavior, such as life skills and socialization. Limitations of the present study and clinical implications regarding residential psychodynamic treatments in cases of autism disorders are discussed

Heterogeneity: the issue of apples, oranges and fruit pie.

Heterogeneity refers to any kind of variation among studies contributing to the same outcome in a systematic review. There are three broad types of heterogeneity: clinical heterogeneity, methodological heterogeneity and statistical heterogeneity. In this paper, we describe these three types of heterogeneity and the main statistical approaches to measure heterogeneity

Using the needs of WHO to prioritise Cochrane reviews: The case of antipsychotic drugs

ABSTRACT: BACKGROUND: This study aimed to investigate existing trialling activity relating to three antipsychotic drugs from the WHO List of Essential Medicines (chlorpromazine, fluphenazine decanoate, haloperidol), link existing trials to existing Cochrane reviews, identify gaps in reviewing activity on accessible treatments for people with schizophrenia. METHOD: S We used the Cochrane Schizophrenia Group's register searching for all studies comparing the three antipsychotic drugs with each other and with all other pharmacological interventions listed on the Essential Medicines List (with the addition of 'placebo or no drug'). For each we also considered studies that focussed on administration, dose, withdrawal and use of that drug in specific circumstances administration.Data were then extracted on a number of studies, number of participants within those studies, and as to whether a maintained review already exists. Finally, every effort was made to consider as to whether there were possibilities for missing comparisons that no one had ever investigated. RESULTS: There has been considerable research activity involving the three 'essential' antipsychotics and also comparing those three drugs to others on the 'essential' list. We found 490 studies with 77957 participants for haloperidol, 316 studies with 29179 participants for chlorpromazine and 33 studies with 4503 participants for fluphenazine decanoate. Reviewing activity has also been considerable in this area but there are notable omissions which would necessitate new reviews to comprehensively cover the area. CONCLUSIONS: We have used the 'sample frame' of the WHO Essential drug list as a starting point. WHO prioritises for us those drugs that have universal accessibility but they may not be the compounds that are first choice if others are available. It is encouraging to see how many maintained reviews already exist to service those undertaking WHO guidelines. The needs of those guiding care can be taken as a means of prioritising research. For largest global impact WHO Essential Medicine list provides clear direction. By using this technique workload can be anticipated, prioritising can take place for new reviews and updates

COMPARATIVE EFFICACY AND ACCEPTABILITYOF PHARMACOLOGICAL TREATMENTSFOR ACUTE MANIA:A MULTIPLE TREATMENTS META-ANALYSIS

Background: La mania \ue8 la caratteristica clinica che contraddistingue il disturbo bipolare. Ad oggi, non vi sono in letteratura evidenze forti e indicazioni chiare rispetto a quale trattamento farmacologico sia pi\uf9 adatto nella fase maniacale acuta del disturbo bipolare. L\u2019obiettivo del presente lavoro \ue8 stato quello di condurre una revisione sistematica della letteratura per confrontare i farmaci pi\uf9 comunemente utilizzati in ambito clinico per il trattamento della mania, sia in termini di efficacia che di tollerabilit\ue0. I risultati degli studi inclusi sono stati inoltre analizzati utilizzando la tecnica della multiple treatments meta-analysis, che permette di effettuare una stima complessiva con confronti diretti e indiretti tra farmaci, ed arrivare ad avere una gerarchia dei trattamenti basata sulle evidenze. Metodi: Sono stati inclusi studi clinici controllati e randomizzati (randomized controlled trial \u2013 RCT) in doppio cieco, che confrontavano un farmaco antimaniacale (antipsicotico o stabilizzante dell\u2019umore) con un altro farmaco antimaniacale o placebo, come terapia in acuto della mania. Sono state raccolte evidenze per 14 farmaci, oltre al placebo: aripiprazolo, asenapina, carbamazepina, valproato, gabapentin, aloperidolo, lamotrigina, litio, olanzapina, paliperidone, quetiapina, risperidone, topiramato e ziprasidone. Sono stati inclusi solo studi che confrontassero trattamenti somministrati per via orale, sia in monoterapia che in associazione tra loro. Risultati: Delle 582 referenze potenzialmente rilevanti, in totale 68 trial (tra cui 9 RCT non pubblicati) sono stati inclusi nella multiple treatments meta-analysis. Tutti i farmaci studiati sono risultati in maniera statisticamente significativa pi\uf9 efficaci rispetto al placebo, ad eccezione di gabapentin, lamotrigina e topiramato. In termini di acceptability, solo olanzapina, risperidone e quetiapina sono risultati significativamente meglio del placebo. Riguardo l\u2019efficacia comparativa tra farmaci antimaniacali, l\u2019aloperidolo \ue8 risultato essere il farmaco pi\uf9 efficace, rispetto a litio, quetiapina, aripiprazolo, carbamazepina, asenapina, valproato, ziprasidone, lamotrigina, topiramato e gabapentin. Risperidone e olanzapina hanno mostrato un profilo di efficacia molto simile, essendo entrambi pi\uf9 efficaci di valproato, ziprasidone, lamotrigina, topiramato e gabapentin. Topiramato e gabapentin hanno rivelato una minore efficacia rispetto a tutti gli altri farmaci antimaniacali. Riguardo alla tollerabilit\ue0, l\u2019aloperidolo ha mostrato rispetto all\u2019olanzapina un maggior tasso di drop-out dopo 3 settimane di trattamento. Il litio \ue8 risultato peggio di olanzapina, risperidone e quetiapina; la lamotrigina peggio di olanzapina e risperidone; il topiramato \ue8 stato peggio tollerato di molti altri trattamenti antimaniacali, come aloperidolo, olanzapina, risperidone, quetiapina, aripiprazolo, carbamazepina e valproato. Conclusioni: Questa multiple treatments meta-analysis \ue8 il primo lavoro che effettua confronti diretti e indiretti tra trattamenti farmacologici per la mania acuta. I risultati di questa analisi hanno importanti implicazioni cliniche che dovrebbero essere considerate nella costruzione di linee-guida e raccomandazioni sui trattamenti farmacologici.Background: Mania is the hallmark feature of bipolar disorder. Clinically, mania can quickly escalate out of control, and cause severe disruption to the lives of individuals with the disorder. This is particularly important as mania can result in disturbed behavior that, when extreme, can be a risk to the safety of the patient and others. Mood stabilizers and antipsychotic agents have long been the mainstay of treatment of acute mania. In recent years several atypical antipsychotics agents have been licensed to treat mania (aripiprazole, olanzapine, risperidone and quetiapine). However, conventional meta-analyses have shown inconsistent results for efficacy of pharmacological treatments for acute mania. The aim of this study was to compare the efficacy and acceptability of pharmacological treatments for acute mania, in order to inform clinical practice and mental health policies. We carried out a multiple-treatments meta-analysis (MTM), a statistical technique that allows both direct and indirect comparisons to be undertaken, even when two of the treatments have not been directly compared. Methods: Double-blind randomized controlled trials (RCTs) comparing one active drug (antipsychotic, mood stabiliser or benzodiazepine) with another active drug (antipsychotic, mood stabiliser or benzodiazepine) or placebo as oral therapy in the treatment of acute mania were included. All combination and augmentation studies were included as well. Participants were patients aged 18 or older of both sexes with a primary diagnosis of acute mania or bipolar disorder (manic or mixed episode) according to the standardised diagnostic criteria used by the study authors. Overall efficacy was primarily measured as the mean change of the total score of the Young Mania Rating Scale (YMRS) from baseline to endpoint. We also estimated efficacy as the proportion of patients who responded to treatment (reduction of at least 50% on the total score between baseline and endpoint on a standardized rating scale for mania possibly YMRS). Acceptability was defined as the proportion of patients who left the study early for any reason, out of the total number of randomized patients. Results: We systematically reviewed 68 RCTs (16 073 participants) from 1980 to 2010, which compared any of the following 14 drugs at therapeutic dose range: aripiprazole, asenapine, carbamazepine, valproate, gabapentin, haloperidol, lamotrigine, lithium, olanzapine, quetiapine, risperidone, topiramate, and ziprasidone. 15 673 patients contributed to the efficacy analysis as continuous outcome (63 studies), 15 626 to the acceptability analysis (65 studies); for secondary outcome 12 649 patients (47 studies) contributed to efficacy analysis as dichotomous data. All anti-manic drugs \u2013with exception of topiramate and gabapentin- showed significant efficacy than placebo. Antipsychotic drugs were significantly more effective than mood stabilizers. In terms of efficacy, haloperidol, risperidone, and olanzapine outperformed other drugs. In terms of dropouts, olanzapine, risperidone, and quetiapine were better than haloperidol. Risperidone, olanzapine, and haloperidol seem to be the best of the available options for the treatment of manic episodes. Conclusions: This MTM is the first analysis that incorporates direct and indirect comparisons between pharmacological treatments for acute mania. These findings have potential clinical implications that should be considered in the development of clinical practice guideline

Epigallocatechin-3-gallate Delivered in Nanoparticles Increases Cytotoxicity in Three Breast Carcinoma Cell Lines

The anticancer act i v i t y of epigallocatechin-3-gallate (EGCG), orally administrated, is limited by poor bioavailabi l i t y , absorption, and unpredictable distribution in human tissues. EGCG charged nanoparticles may represent an opportunity to overcome these limitations. We assayed two different kinds of lipid nanoparticles (LNPs and LNPs functionalized with folic acid) charged with EGCG on three breast carcinoma cell lines (MCF-7, MDA-MB-231, and MCF-7TAM) and the human normal MCF10A mammary epithelial cells. Both LNPs loaded with EGCG, at low concentrations, induced a significant cytotoxicity in the three breast carcinoma cells but not in MCF10A cells. In view of a future application, both LNPs and LNPs-FA were found to be very suitable for in vitro studies and usef u l to improve EGCG administration in vivo. Since they are produced by inexpensive procedures using bioavailable, biocompatible, and biodegradable molecules, t h e y represent an applicable tool for a more rationale use of EGCG as an anti-cancer agent

Predicted Electronic Shifts in Flourinated Naphthalenes

BACKGROUND: In recent years there has been a progressive rise in the number of asylum seekers and refugees displaced from their country of origin, with significant social, economic, humanitarian and public health implications. In this population, up-to-date information on the rate and characteristics of mental health conditions, and on interventions that can be implemented once mental disorders have been identified, are needed. This umbrella review aims at systematically reviewing existing evidence on the prevalence of common mental disorders and on the efficacy of psychosocial and pharmacological interventions in adult and children asylum seekers and refugees resettled in low, middle and high income countries. METHODS: We conducted an umbrella review of systematic reviews summarizing data on the prevalence of common mental disorders and on the efficacy of psychosocial and pharmacological interventions in asylum seekers and/or refugees. Methodological quality of the included studies was assessed with the AMSTAR checklist. RESULTS: Thirteen reviews reported data on the prevalence of common mental disorders while fourteen reviews reported data on the efficacy of psychological or pharmacological interventions. Although there was substantial variability in prevalence rates, we found that depression and anxiety were at least as frequent as post-traumatic stress disorder, accounting for up to 40% of asylum seekers and refugees. In terms of psychosocial interventions, cognitive behavioral interventions, in particular narrative exposure therapy, were the most studied interventions with positive outcomes against inactive but not active comparators. CONCLUSIONS: Current epidemiological data needs to be expanded with more rigorous studies focusing not only on post-traumatic stress disorder but also on depression, anxiety and other mental health conditions. In addition, new studies are urgently needed to assess the efficacy of psychosocial interventions when compared not only with no treatment but also each other. Despite current limitations, existing epidemiological and experimental data should be used to develop specific evidence-based guidelines, possibly by international independent organizations, such as the World Health Organization or the United Nations High Commission for Refugees. Guidelines should be applicable to different organizations of mental health care, including low and middle income countries as well as high income countries

Survey and diversity of Calliphoridae and Sarcophagidae (Diptera) species in fragments of the biome Mata Atlântica, SP

Orientador: Arício Xavier LinharesTese (doutorado) - Universidade Estadual de Campinas, Instituto de BiologiaResumo: Devido aos variados hábitos alimentares tais como coprofagia, necrofagia parasitismo, dípteros das famílias Calliphoridae e Sarcophagidae apresentam relevância nas áreas médica, veterinária e forense. Algumas espécies podem ainda estar associadas a ambientes bem característicos, como por exemplo, o silvestre ou rural, tornando-se boas indicadoras biológicas de preservação ambiental. O Brasil, um dos países de maior extensão territorial, apresenta variados biomas ricos em biodiversidade. Dentre esses biomas, a Mata Atlântica destaca-se por ser um importante "hotspot" e por apresentar o menor e mais fragmentado bioma preservado atualmente. Em função do acelerado desmatamento, estudos que foquem no levantamento e na diversidade de espécies entre fragmentos de mata são importantes para avaliar como os padrões de biodiversidade podem ser afetados pela fragmentação do bioma. Dessa forma, o presente estudo objetivou: (i) inventariar as espécies das famílias Calliphoridae e Sarcophagidae (Diptera) presentes em fragmentos do Bioma Mata Atlântica do estado de São Paulo; (ii) avaliar possíveis variações na frequência, diversidade, dominância, equitabilidade e riqueza em cada fragmento estudado e avaliar a similaridade da composição faunística das espécies entre as unidades de conservação e (iii) avaliar a possível atratividade seletiva das iscas escolhidas para a coleta de dípteros da família Calliphoridae e Sarcophagidae nestes fragmentos. Coletas foram realizadas utilizando armadilhas com iscas apropriadas para a captura de dípteros necrófagos nos fragmentos analisados. O local que apresentou a maior abundância de dípteros coletados foi a Mata de Santa Genebra (N=866) e o maior número de espécies encontrados para a família Calliphoridae, foi no Parque Estadual da Vassununga (N=10). Todas as localidades apresentaram resultados semelhantes nos parâmetros ecológicos analisados (diversidade, dominância, equitabilidade, riqueza e similaridade). Com relação ao segundo capítulo, o local que apresentou o maior numero de coletados foi o Parque Estadual Morro do Diabo (N=1754). O maior número de espécies de Calliphoridae e Sarcophagidae foram registrados no Parque Estadual Serra do Mar, núcleo Bertioga (N=8) e Parque Estadual da Vassununga (N=6), respectivamente. A isca que apresentou o maior número de coletados foi rim (N=827). Não houve preferência marcante por nenhuma das iscas utilizadas, embora as iscas compostas por tecidos animais tenham atraído um maior número de exemplares adultos das duas famílias. Conclui-se, desta maneira, a necessidade de que novos estudos sejam realizados com um maior esforço amostral para corroborar ou refutar os valores dos parâmetros ecológicos analisados e, com relação à atratividade da isca, dípteros necrófagos adultos possivelmente não tenham uma preferência marcante para um determinado tecido animal e, como estas moscas utilizam-se de recursos efêmeros, talvez a disponibilidade do recurso possa ser mais importante que o tipo de recurso em siAbstract: Because of wide range of feeding habits such as coprophagy, necrophagy and parasitism, Diptera of the families Calliphoridae and Sarcophagidae are of importance in the medical, veterinary and forensic fields. Some species can also be linked to characteristic environments, becoming good biological indicators of environmental preservation. Brazil is the fifth country on Earth in territorial extension, and presents several biomes rich in biodiversity. Among these biomes, the Atlantic Forest stands out for its importance as a "biodiversity hotspot" and for currently presenting the smallest and most fragmented area of preserved forest. Due to the rapid deforestation, studies focusing on the survey species diversity among forest fragments is essential to determine how biodiversity patterns may be affected by biome fragmentation. Thus, the present study aimed to: (i) present an inventory of species of Calliphoridae and Sarcophagidae (Diptera) colleted in fragments of the Atlantic Forest Biome of the State of São Paulo; (ii) evaluate the eventual variations in frequency, diversity, dominance, equitability and richness in each fragment studied, and to evaluate the faunal composition of species among protected areas through similarity analysis, and (iii) evaluate the possible selective attractiveness of the baits chosen for the sampling of Calliphoridae dipterans in the Atlantic Forest conservation fragments. Collections were made using traps with baits to collect necrophagous dipterans in Atlantic Forest fragments of the State of São Paulo. The site with the highest number of collected Diptera was the Santa Genebra Forest (N = 866) and the highest number of collected Diptera specimens found was in Vassununga State Park (N = 10). All localities presented similar ecological parameters (diversity, dominance, evenness, richness and similarity). Regarding the second chapter, the location that had the largest number of collected was the Morro do Diabo State Park (N = 1754). The largest number of species of Calliphoridae and Sarcophagidae were registered in the Serra do Mar State Park, Bertioga nucleus (N = 8) and Vassununga State Park (N = 6), respectively. The bait that presented the largest number of collected was kidney (N = 827). There was no significant preference for any of the baits used, although baits composed of animal tissues attracted greater number of adult specimens of both families. In conclusion, there is a need for further research with increased sampling efforts to further test the ecological parameters analyzed and, regarding the attractiveness of the bait; necrophagous diptera may not have a pronounced preference for a given type of animal tissue and because these flies use ephemeral resources, it is possible that resource availability is more important than the type of resource itselfDoutoradoBiodiversidade AnimalDoutora em Biologia Animal88882.435378/2019-01CAPE

The contribution of "individual participant data" meta-analyses of psychotherapies for depression to the development of personalized treatments: a systematic review

While randomized trials typically lack sufficient statistical power to identify predictors and moderators of outcome, "individual participant data" (IPD) meta-analyses, which combine primary data of multiple randomized trials, can increase the statistical power to identify predictors and moderators of outcome. We conducted a systematic review of IPD meta-analyses on psychological treatments of depression to provide an overview of predictors and moderators identified. We included 10 (eight pairwise and two network) IPD meta-analyses. Six meta-analyses showed that higher baseline depression severity was associated with better outcomes, and two found that older age was associated with better outcomes. Because power was high in most IPD meta-analyses, non-significant findings are also of interest because they indicate that these variables are probably not relevant as predictors and moderators. We did not find in any IPD meta-analysis that gender, education level, or relationship status were significant predictors or moderators. This review shows that IPD meta-analyses on psychological treatments can identify predictors and moderators of treatment effects and thereby contribute considerably to the development of personalized treatments of depression

Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials

Dose equivalence of antidepressants is critically important for clinical practice and for research. There are several methods to define and calculate dose equivalence but for antidepressants, only daily defined dose and consensus methods have been applied to date. The purpose of the present study is to examine dose equivalence of antidepressants by a less arbitrary and more systematic method