Análise Qualitativa de uma intervenção adaptada de Treinamento de Habilidades da Terapia Comportamental Dialética para mulheres com obesidade

The present study aimed to explore the perceptions about the experience of participating in an intervention based on Dialectical Behavior Therapy (DBT) Skills Training. Three participants with obesity of an intervention group agree to answer a semi-structured interview two month after the group. The semi structured interview focused on three areas: (1) experience of participating in an adapted DBT protocol; (2) treatment impact; (3) helpful or unhelpful aspects. The interviews were transcribed, and a thematic analysis was performed by three independent judges to evaluate treatment outcome in the sample. The results of the thematic analysis are divided in three domains: group experience, perceived effects and skills. Participants perceived impact on interpersonal environment and personal changes in self-control, dialectic vision, self-awareness and attention to eating context. The experience of group sharing is perceived as validating, however participants also referred anxiety in the group, especially regarding learning the skills. Recommendations on conductions of Skills Training groups for this population are discussed.Keywords: Dialectical Behavior Therapy; Qualitative Study; Obesity.O presente estudo tem como objetivo explorar as percepções sobre a experiência de participar em uma intervenção adaptada do Treinamento de Habilidades da Terapia Comportamental Dialética (TCD). Três participantes com obesidade de um grupo de intervenção concordaram em responder uma entrevista semiestruturada dois meses após o término do grupo. A entrevista semiestruturada focou em três áreas: (1) experiência de participar em um protocolo adaptado da TCD; (2) impacto do tratamento; (3) aspectos que ajudaram ou não ajudaram. As entrevistas foram transcritas e uma análise temática foi conduzida por três juízes independentes para avaliar os efeitos do treinamento na amostra. Os resultados da análise temática estão divididos em três domínios: experiência no grupo, efeitos percebidos e habilidades. As participantes perceberam impactos do treinamento no ambiente interpessoal e mudanças pessoais no autocontrole, visão dialética, autoconsciência e atenção ao contexto da alimentação. A experiência de compartilhar em grupo foi percebida como validante, porém as participantes também referiram ansiedade no grupo, especialmente em relação a aprendizagem das habilidades. Recomendações para a condução de grupos de Treinamento de Habilidades são discutidas.Palavras-chave: Terapia Comportamental Dialética; Estudo Qualitativo; Obesidade

Problematic and adaptive eating in people with obesity after a DBT-based skills training intervention : 3- and 8-month follow-up and mediation analysis

Background: Dialectical behavior therapy conceptualizes problematic behaviors as attempts to regulate emotions that occur when the individual lacks effective skills with which to manage his or her emotions and cope with distress. Problematic eating behaviors, e.g., binge and emotional eating, may serve to alleviate aversive emotional states, being highly associated with overweight and obesity. Dialectical behavior therapy skills training has been proven effective in reducing binge eating in several clinical studies. However, few studies reveal the effects of DBT on adaptive eating behaviors or the stability of outcomes. Objectives: This study aimed to test the effect of a brief DBT-based skills training intervention, and the stability of outcomes at 3- and 8-month follow-ups. Methods: Self-report measures of binge eating, emotional eating, intuitive eating, and mindful eating were taken on 5 timepoints before and after a 10-session DBT skills training intervention (2 baseline measures, 1 post-test, and 2 follow-ups). Data were analyzed using a mixed-model intention-to-treat approach and mediation analysis was conducted with path analysis. Results: After the intervention, intuitive eating and mindful eating scores were significantly higher than before the intervention, while emotional eating and binge eating scores were lower. The results remained stable during the follow-up period, with minor fluctuations and small trends towards returning to baseline values for binge eating and emotional eating. Mindful eating partially mediated the improvements in all outcomes. Limitations: Given that results are entirely based on self-report measures and that some instruments showed poor reliability, in addition to the high attrition rates, the results should be interpreted as preliminary. Conclusions: The results provide evidence that a brief DBT intervention is effective not only in reducing problematic eating but also in increasing adaptive eating, achieving reasonably stable results. Also, the mediation analysis results support the hypothesis that mindful eating partially explains the effects of the intervention on binge and emotional eating. Future research should address the limitations of this study by investigating a more diverse sample, triangulating different measurement strategies, and including other putative mediators

DESENHO DE UMA METODOLOGIA DE INTERVENÇÃO A DISTÂNCIA PARA APROPRIAÇÃO E USO DOS MAPAS CONCEITUAIS EM ATIVIDADES EDUCACIONAIS

Este trabalho apresenta o desenho de uma metodologia deintervenção interativa a distância que visa a potencialização de espaços de aprendizagem coletivas disponibilizados por um portal educacional que visa a apropriação e uso de uma abordagem construtivista dos mapas conceituais. Os resultados desta pesquisa consistem em um conjunto de atividades e procedimentos utilizados bem como a descrição das condutas adotadas pelos docentes nas intervenções a distância. Tais condutas estão categorizadas tanto em relação aos dispositivos usados quanto em relação ao feedback dos educadores em formação nos curso

Feline Prostatic Carcinoma

Background: Prostatic cancer is a rare condition in cats but should be included as a differential diagnosis whenever middle-aged cats present lower urinary tract signs, such as dysuria and hematuria. Abdominal ultrasound can indicate the disease, but fine-needle aspiration cytology and histopathology are necessary to establish the neoplastic origin and the therapeutic plan. Because of the limited data, no standard-of-care treatment or prognostic information exists in cats with prostate carcinoma. This report describes the clinical signs, diagnosis and surgical approach in a case of prostatic carcinoma in a cat. Case: A 6-year-old, intact male, domestic short-haired cat was presented with a 3-day history of dysuria, hematuria, inappetence, constipation, lethargy and prostration. On physical examination, the cat was in a very poor general condition and abdominal palpation revealed firm mass located caudally to the urinary bladder. The urinary bladder presented high repletion degree, while the large bowel was distended and presented soft faecal content. Blood count, serum biochemistry and urinalysis showed neutrophilic leukocytosis, hypoalbuminemia and high serum creatinine level, and severe hematuria, respectively. Abdominal ultrasound showed a mass located in the prostatic area with hypoechogenic and slightly heterogeneous parenchyma, measuring 3.3 x 3.0 cm. Echo-guided trans-abdominal fine-needle aspiration of the prostate was performed. Microscopically, the cells were round with basophilic cytoplasm, and had round to ovoid nuclei, dense chromatin and prominent nucleoli. Some cells were binucleated and mild anisocytosis and marked anisokaryosis were documented. These findings were compatible with malignant prostatic neoplasia. After initial clinical stabilization, the patient underwent an exploratory laparotomy for tumor resection. Cystotomy followed by pubic osteotomy was performed to access the tumor. Urethral anastomosis was necessary due to adherence of the neoplasm to adjacent structures. However, the patient died during the immediate postoperative period. No complications related to surgery were observed at necropsy. Tissue specimens were collected and stained by hematoxylin and eosin. Prostatic carcinoma was confirmed by immunohistochemistry tests using streptavidin-biotin-peroxidase complex method, and primary antibodies against vimentin, cytokeratin AE1/AE3 and 7. Discussion: Prostatic neoplams are rare in cats and clinical signs are suggestive of lower urinary tract disease, such as dysuria and/or hematuria, associated with tenesmus. Abdominal or rectal palpation seems to be essential to detect the prostatic enlargement. Ultrasound imaging was more sensitive than radiography, since it brings more information about structure, size, form and prostatic internal architecture. The patient’s serum creatinine value above the normal range for cats indicated partial urethral obstruction, due to neoplastic concentric growth. Echo-guided trans-abdominal fine needle aspiration cytology was an effective method to confirm neoplastic etiology. The advanced stage of the disease and poor clinical condition probably contributed to death at the immediate postoperative period, even though the surgical technique seemed to be appropriate as demonstrated at necropsy. Also, the immunohistochemistry tests allowed to confirm the diagnosis and excluded the main differential diagnoses, such as urothelial carcinoma and prostatic sarcomatoid carcinoma

Strangeness Enhancement in Cu+Cu and Au+Au Collisions at \sqrt{s_{NN}} = 200 GeV

We report new STAR measurements of mid-rapidity yields for the $\Lambda$, $\bar{\Lambda}$, $K^{0}_{S}$, $\Xi^{-}$, $\bar{\Xi}^{+}$, $\Omega^{-}$, $\bar{\Omega}^{+}$ particles in Cu+Cu collisions at \sNN{200}, and mid-rapidity yields for the $\Lambda$, $\bar{\Lambda}$, $K^{0}_{S}$ particles in Au+Au at \sNN{200}. We show that at a given number of participating nucleons, the production of strange hadrons is higher in Cu+Cu collisions than in Au+Au collisions at the same center-of-mass energy. We find that aspects of the enhancement factors for all particles can be described by a parameterization based on the fraction of participants that undergo multiple collisions

Inclusive charged hadron elliptic flow in Au + Au collisions at sNN\sqrt{s_{NN}} = 7.7 - 39 GeV

A systematic study is presented for centrality, transverse momentum ($p_T$) and pseudorapidity ($\eta$) dependence of the inclusive charged hadron elliptic flow ($v_2$) at midrapidity($|\eta| < 1.0$) in Au+Au collisions at $\sqrt{s_{NN}}$ = 7.7, 11.5, 19.6, 27 and 39 GeV. The results obtained with different methods, including correlations with the event plane reconstructed in a region separated by a large pseudorapidity gap and 4-particle cumulants ($v_2{4}$), are presented in order to investigate non-flow correlations and $v_2$ fluctuations. We observe that the difference between $v_2{2}$ and $v_2{4}$ is smaller at the lower collision energies. Values of $v_2$, scaled by the initial coordinate space eccentricity, $v_{2}/\varepsilon$, as a function of $p_T$ are larger in more central collisions, suggesting stronger collective flow develops in more central collisions, similar to the results at higher collision energies. These results are compared to measurements at higher energies at the Relativistic Heavy Ion Collider ($\sqrt{s_{NN}}$ = 62.4 and 200 GeV) and at the Large Hadron Collider (Pb + Pb collisions at $\sqrt{s_{NN}}$ = 2.76 TeV). The $v_2(p_T)$ values for fixed $p_T$ rise with increasing collision energy within the $p_T$ range studied ($< 2 {\rm GeV}/c$). A comparison to viscous hydrodynamic simulations is made to potentially help understand the energy dependence of $v_{2}(p_{T})$. We also compare the $v_2$ results to UrQMD and AMPT transport model calculations, and physics implications on the dominance of partonic versus hadronic phases in the system created at Beam Energy Scan (BES) energies are discussed.Comment: 20 pages, 12 figures. Version accepted by PR

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Estudo de desfecho e manuten??o dos efeitos de uma interven??o baseada na terapia comportamental dial?tica para pessoas com obesidade

Submitted by PPG Psicologia ([email protected]) on 2018-05-17T18:50:07Z No. of bitstreams: 1 LUCAS_ANDRE_SCHUSTER_DE_SOUZA_DIS.pdf: 2165020 bytes, checksum: 83c14e87e569f3c0b94891c827f07ed3 (MD5)Rejected by Caroline Xavier ([email protected]), reason: Devolvido devido ao t?tulo da folha de rosto (p?gina 2) estar diferente do t?tulo da capa, ficha catalogr?fica e publica??o depositada. on 2018-05-30T17:58:52Z (GMT)Submitted by PPG Psicologia ([email protected]) on 2018-06-13T13:42:00Z No. of bitstreams: 1 LUCAS_ANDRE_SCHUSTER_DE_SOUZA_DIS.pdf: 2261551 bytes, checksum: 6d2ae6206b912e63a5477cc83923cef8 (MD5)Approved for entry into archive by Sheila Dias ([email protected]) on 2018-06-25T11:34:35Z (GMT) No. of bitstreams: 1 LUCAS_ANDRE_SCHUSTER_DE_SOUZA_DIS.pdf: 2261551 bytes, checksum: 6d2ae6206b912e63a5477cc83923cef8 (MD5)Made available in DSpace on 2018-06-25T11:54:40Z (GMT). No. of bitstreams: 1 LUCAS_ANDRE_SCHUSTER_DE_SOUZA_DIS.pdf: 2261551 bytes, checksum: 6d2ae6206b912e63a5477cc83923cef8 (MD5) Previous issue date: 2018-03-08Introduction: Obesity is a complex and multifactorial condition that represents a risk factor for several other health problems and reductions in quality of life. The high prevalence and growing incidence of obesity in the world makes it necessary to identify the predisposing factors and effective intervention strategies for its treatment. One of the most important aspects in the treatment of obesity is the promotion of more adaptive eating behaviors and the reduction of problematic eating behaviors. It is currently recognized that emotional regulation is an important element in the etiological equation and maintenance of problematic eating behaviors in obesity and in some eating disorders related to obesity, especially binge eating. Dialectical Behavioral Therapy (DBT) is a behavioral therapeutic approach whose effectiveness has been demonstrated for a wide range of psychopathological conditions in which difficulties with emotional regulation are present. Although there are already several studies demonstrating DBT's efficacy in the context of eating disorders and obesity, in Brazil, research with DBT is still scarce and there are no empirical studies to date about its application to eating disorders. Considering this scenario, two studies were proposed to identify the effectiveness and maintenance of the effects of a group intervention based on the training of TCD Skills for obese people. Goals: To verify the maintenance of effects on problematic and adaptive eating behaviors after a group intervention based on Dialectic Behavioral Therapy for obese people, and to explore relevant aspects of the participants' experience with the intervention. Method: sequential quantitative and qualitative design, using self-report measures and semi-directed interviews. On the quantitative stage, self-report measures of problematic eating behaviors (Binge Eating Scale - BES, Emotional Eating Scale - EES) and adaptive (Mindful Eating Eating Questionnaire - MEQ, Intuitive Eating Scale 2 - IES-2) were used. An intention-to-treat analysis (n = 121) was used with all participants who were assigned for the intervention. Measures were taken at pretest, post-test and 3 and 8 months follow-up. Descriptive analyzes and hierarchical linear modeling were used to verify the effectiveness and stability of the effects of the intervention. In the qualitative phase, semi-directed interviews were conducted with 3 participants who concluded the intervention, focusing on the experience with the intervention, perceived effects, 31 facilitators and difficulties with the participation and implementation of the strategies developed in the treatment. The interviews were analyzed by four researchers, using inductive thematic analysis. Results: There was a significant reduction in problematic eating behaviors after the intervention, with stable results at the three-month follow-up and slight return towards baseline at 8-month follow-up. As for adaptive eating behavior, there was improvement after the intervention, which was maintained at three months follow-up and tended to return to baseline at 8 months follow-up. Analysis of the interviews revealed that participants identified improvements in various aspects of their life after the intervention, especially in interpersonal functioning and in the ability to regulate their own behavior. They point the identification with other group members and the presence of a supportive family and social environment as facilitators of participation in the intervention. Experiences of anxiety and aversive emotions during the group and difficulty in maintaining skills practice outside the sessions were pointed out as obstacles to the effectiveness of the intervention. Discussion: Quantitative results are consistent with other literature findings on DBT interventions in the context of eating disorders and demonstrate that a brief intervention based on DBT and adapted to the Brazilian context may be effective in reducing problematic eating behaviors and promoting more adaptive behaviors in the short and medium term for obese people, however they are not conclusive as to the maintenance of these changes for 8 months or longer. Data from the qualitative study replicated in part other findings in the literature on DBT for people with emotional dysregulation and borderline personality disorder, stressing the importance that clinicians be attentive to aversive emotional experiences during the group and provide support as well as identify opportunities for application of the skills during the group sessions. In addition, the perception of improvement in interpersonal relationships reflects the importance of the interpersonal dimension in obesity and binge eating, highlighting the strong relationship between interpersonal aspects and emotional responses to which maladaptive coping strategies such as overeating may follow.Introdu??o: A obesidade ? uma condi??o complexa e multifatorial que representa um fator de risco para diversos outros problemas de sa?de e preju?zos ? qualidade de vida. A elevada preval?ncia e crescimento da quantidade de casos de obesidade no mundo, torna necess?rio que se identifiquem os fatores predisponentes e estrat?gias de interven??o eficazes para seu tratamento. Um dos aspectos mais importantes no tratamento da obesidade consiste na promo??o de comportamentos alimentares mais adaptativos e redu??o dos comportamentos alimentares problem?ticos. Reconhece-se atualmente que a regula??o emocional ? um elemento de grande import?ncia na equa??o etiol?gica e na manuten??o dos comportamentos alimentares problem?ticos na obesidade e em alguns transtornos alimentares correlatos da obesidade, em especial a compuls?o alimentar. A Terapia Comportamental Dial?tica (TCD) ? uma abordagem terap?utica de base comportamental cuja efic?cia vem sendo demonstrada para uma ampla gama de condi??es psicopatol?gicas nas quais est?o presentes dificuldades com a regula??o emocional. Apesar de j? haver diversos estudos demonstrando efic?cia da TCD no contexto dos transtornos alimentares e da obesidade, no Brasil, ainda ? escassa a investiga??o com aplica??es da TCD, e inexistente no caso de estudos emp?ricos sobre sua aplica??o a dist?rbios relacionados ao comportamento alimentar. Em face de tal cen?rio, prop?s-se a realiza??o de dois estudos com objetivo de identificar a efetividade e manuten??o dos efeitos de uma interven??o em grupo baseada no treinamento de Habilidades da TCD para pessoas obesas. Objetivos: verificar manuten??o dos efeitos sobre comportamentos alimentares problem?ticos e adaptativos ap?s uma interven??o em grupo baseada na Terapia Comportamental Dial?tica para pessoas obesas, e explorar aspectos relevantes da experi?ncia dos participantes com a interven??o. M?todo: desenho sequencial quantitativo e qualitativo, utilizando medidas de autorrelato e entrevista semidirigida. Na etapa quantitativa, utilizaram-se medidas de autorrelato de comportamentos alimentares problem?ticos (Escala de Compuls?o Alimentar Peri?dica - ECAP; Emotional Eating Scale - EES) e adaptativos (Mindful Eating Questionnaire - MEQ; Intuitive Eating Scale 2 - IES-2). Utilizou-se uma an?lise intention-to-treat (n=121) com participantes 28 selecionados para a interven??o. Foram realizadas medidas de pr?-teste, p?s-teste e seguimento de 3 e de 8 meses ap?s a interven??o. An?lises descritivas e modelagem linear hier?rquica foram utilizadas para verificar a efetividade e estabilidade dos efeitos da interven??o. Na fase qualitativa, entrevistas semidirigidas foram conduzidas com 3 participantes que conclu?ram a interven??o, enfocando a experi?ncia com a interven??o, efeitos percebidos, facilitadores e dificuldades com a participa??o e implementa??o das estrat?gias desenvolvidas no tratamento. As entrevistas foram analisadas por quatro pesquisadores, utilizando o procedimento de an?lise tem?tica indutiva. Resultados: verificou-se uma redu??o significativa nos comportamentos alimentares problem?ticos logo ap?s a interven??o, com resultados est?veis no seguimento de tr?s meses e levemente elevados no seguimento de 8 meses. Quanto ao comportamento alimentar adaptativo, houve melhora logo ap?s a interven??o, com resultados tamb?m est?veis aos tr?s meses de seguimento e tendendo a retornar aos valores iniciais aos 8 meses de seguimento. As entrevistas revelaram que os participantes identificaram melhoras em diversos aspectos de sua vida ap?s a interven??o, especialmente no funcionamento interpessoal e na capacidade de regular o pr?prio comportamento. Apontam a identifica??o com outros membros do grupo e a presen?a de um ambiente familiar e social suportivo como facilitadores da participa??o na interven??o. Experi?ncias de ansiedade e emo??es aversivas durante o grupo e dificuldade de manter a pr?tica das habilidades fora das sess?es foram apontadas como obst?culos para a efetividade da interven??o. Discuss?o: os resultados quantitativos s?o coerentes com outros achados da literatura sobre interven??es de TCD no contexto de dist?rbios da alimenta??o, e demonstram que uma interven??o breve baseada na TCD e adaptada ao contexto brasileiro pode ser efetiva para reduzir comportamentos alimentares problem?ticos e promover comportamentos mais adaptativos em curto e m?dio prazo, no entanto n?o s?o conclusivos quanto ? manuten??o em prazos superiores a 8 meses. Os dados do estudo qualitativo replicaram em parte outros achados da literatura sobre a TCD para pessoas com desregula??o emocional e transtorno limite de personalidade, ressaltando a import?ncia de que os cl?nicos estejam atentos ?s experi?ncias emocionais aversivas durante o grupo, oferecendo suporte e identificando oportunidades de aplica??o das habilidades treinadas durante o o pr?prio grupo. 29 Ademais, a percep??o de melhora nas rela??es interpessoais reflete a import?ncia da dimens?o interpessoal na problem?tica da obesidade e da compuls?o alimentar, dando realce ? forte rela??o entre aspectos interpessoais e respostas emocionais ?s quais podem se seguir estrat?gias maladaptativas de enfrentamento como a sobreingesta de alimentos