Cortisol e testosterona no plasma da grávida e no líquido amniótico: variação com o relaxamento e correlação com o rácio digital 2D:4D no recém-nascido

RESUMO: Conclusão - Este estudo sugere que mulheres grávidas beneficiam da prática rotineira de 30 min de relaxamento perante a eminência de um acontecimento indutor de stress. O benefício será tanto psicológico como fisiológico e será mais marcado de manhã do que de tarde. As mulheres com maior tendência ansiosa, tipicamente as mais jovens e com menos idade gestacional, serão as que mais beneficiam. Entre os tipos de intervenção experimentados, todos eles não dispendiosos, a audição de música foi globalmente o mais eficaz para o propósito pretendido. A variação do cortisol e a variação da testosterona estão altamente correlacionadas, e este efeito poderá ser explorado em futuras intervenções relaxantes. Programas curtos de relaxamento poderão conduzir a benefícios para o bem-estar psicológico e para a saúde da grávida, com benefícios adicionais no desfecho da gravidez. O rácio digital 2D:4D do recém-nascido apresenta características sexualmente dimórficas, sendo mais baixo em rapazes que em raparigas, confirmando a influência dos androgénios pré-natais, mas há grande sobreposição entre os sexos pelo que, isoladamente, não pode ser utilizado como marcador de risco. No entanto, se associado a outros marcadores biológicos, como o peso ao nascer e a circunferência cerebral, entre outros, poderá ser um parâmetro a valorizar desde cedo, possivelmente no acompanhamento pediátrico. Nas raparigas, o RD da mãe e a testosterona no LA explicam uma proporção significativa do seu 2D:4D. Em ambos os sexos, o rácio 2D:4D aumenta após o nascimento e o dimorfismo sexual observado com base em amostras de crianças com mais de dois anos de idade, é afectado pela testosterona pós-natal, especialmente no que se refere à mão direita.----------ABSTRACT: Conclusions - This study suggests that pregnant women would benefit from the routine practice of 30min relaxation when at the imminence of a stressful event. The benefit would be both psychological and physiological and would be more pronounced in the morning than in the afternoon. Women tending to be more anxious, typically younger and at a lower gestational age, are the ones that benefit the most. Among the interventions investigated, all being non-expensive and easy to implement, listening to relaxing music was globally the most efficient for the benefit intended. The variation of cortisol and the variation of testosterone are significantly correlated, an association that might be used in future relaxation interventions. It is feasible to conceive short relaxation programs aimed at benefiting psychological well-being and health in pregnancy, with additional benefits for pregnancy outcome. The digital ratio 2D:4D is sexually dimorphic, being lower in males than in females, confirming the influence of pre-natal androgens. There is however large overlap between sexes, rendering the 2D:4D a risk marker not to be used in isolation but rather in association with other markers, like for instance the weight at birth and the head circumference, wherein it may be a relevant parameter for pediatric follow-up. In newborn females, a significant amount of variability in 2D:4D is accounted for by their mother’s digital ratio and AF testosterone. In both sexes, the 2D:4D ratio increases following birth and sexual dimorphism,as assessed from samples of subjects with more than 2 years of age, is affected by post-natal testosterone, especially in what concerns the right hand

Doença crónica: intervenção do médico de família para limitar as repercussões na pessoa e na família

RESUMO: Perante a doença crónica de um dos seus elementos, a família enfrenta dificuldades e é pressionada a mobilizar mecanismos que não pertencem ao seu repertório habitual. Durante o processo de adaptação a esta situação, as reações da pessoa doente e dos outros elementos da sua família influenciam-se mutuamente, num processo que pode tornar-se em si próprio um problema, induzindo novos riscos para os familiares e para a própria pessoa doente. Assim, a família não deve ser excluída do processo de prestação de cuidados. A presente dissertação foca-se no impacte da doença crónica na pessoa doente e na sua família, analisa fatores de contexto que o influenciam e identifica tipologias de intervenções médicas promotoras de respostas adaptativas à doença. Estruturada em sete partes, na primeira parte desta dissertação demonstra-se a importância das doenças crónicas, focando o seu peso no padrão de morbilidade vigente e o seu impacte nos custos com a saúde, diretos e indiretos, na organização dos cuidados de saúde, na família e na pessoa doente, sendo neste dois últimos níveis de impacte que se centra a presente dissertação. Na segunda parte, fazemos uma revisão sobre as definições em questão nesta dissertação e as teorias que a enquadram, designadamente a teoria geral dos sistemas e o modelo bioecológico de desenvolvimento de Bronfenbrenner. Na terceira parte, justificam-se a opções metodológicas desta dissertação. Inserida no paradigma interpretativo, é grounded e utiliza dados qualitativos e quantitativos, numa triangulação de métodos e de análise. Para apoiar a fundamentação das opções feitas, descrevemos o diálogo entre paradigmas alternativos, incluindo a definição dos respetivos conceitos e normativos. Dado a retórica não se circunscrever à investigação quantitativa versus investigação qualitativa, mas também acontecer entre as diversas correntes desta última, passamos em revisão os seus distintos momentos históricos, uma vez que perduram e coexistem nas investigações atuais, bem como os seus critérios de cientificidade, envoltos em diversas polémicas que se arrastam no tempo, com uso de multiplicidade terminológica para conceitos afins, a que procurámos dar clareza, identificando os termos com conceitos subjacentes equivalentes e sistematizando-os. No tipo de investigação desta dissertação, a complexidade é aumentada pela inclusão do contexto, pelo que este é estudado em dois estudos empíricos que consituem a sua quarta parte e que caraterizam: a freguesia Santo Condestável, constituída por três bairros heterogéneos, com uma população envelhecida, sobretudo no bairro Campo de Ourique, onde predominam as famílias unitárias, potenciando fenómenos de isolamento; a morbilidade na prática clínica da Unidade de Saúde Familiar Santo Condestável, verificando-se que a população inscrita na unidade de saúde aproxima-se da população da comunidade de influência e que os problemas de saúde codificados mais frequentes entre as pessoas inscritas não são, necessariamente, os que mais vezes são objeto de intervenção médica nas consultas. A quinta parte é constituída pelo estudo nuclear da dissertação, “Doença Crónica: Intervenção do Médico de Família para Limitar as suas Repercussões na Pessoa e na Família”, que pretende investigar como os processos sociais, psicológicos e biológicos interagem para produzir repercussões diferenciadas da doença crónica na pessoa doente e nos seus familiares, resultando em trajetórias distintas de doença; e dar visibilidade às intervenções médicas de promoção de uma adaptação salutar à doença crónica. O estudo foi orientado para a descoberta, pelo que não colocámos hipóteses prévias e não definimos, à partida, as questões que delimitam os seus âmbito e foco, por estas serem suscetíveis de reformulação com a evolução do estudo, resultante do aprofundamento da familiarização e da reflexão sobre os fenómenos em análise. O estudo identificou 19 repercussões possíveis da doença crónica e 26 fatores condicionantes da adaptação à doença crónica modificáveis por intervenções médicas, tendo estas sido sistematizadas em 15 tipologias. Analisou, ainda, os processos pelos quais as variáveis demográficas, assim como o tempo histórico, podem modular a expressividade dos fatores condicionantes da adaptação à doença crónica identificados, entrelaçando-se com eles. O estudo evidenciou que, para não adoecer também funcional e psicologicamente, a pessoa doente e sua família devem evitar entregar-se à doença, dando apenas o que a doença precisa, e ter flexibilidade para promover as mudanças adequadas às exigências da nova situação e da fase do ciclo de vida em que se encontra. Mostrou, ainda, que a adaptação da família à doença crónica depende do tipo e fase da doença, das caraterísticas do seu tratamento, bem como de vários outros fatores intrínsecos e extrínsecos da pessoa doente e da família, podendo assumir padrões disfuncionais. As intervenções médicas nos estudos de caso que integram o estudo nuclear remetem para a importância do médico de família detetar problemas e favorecer a adaptação funcional ao longo do tempo, produzindo mudança, não só do ponto de vista orgânico, mas também pessoal e relacional. Na sexta parte, discutem-se os resultados da dissertação nas suas implicações para a prática médica e ensino da Medicina. Apresentam-se, ainda, algumas hipóteses de trabalhos futuros sobre o tema. Por último, a sétima parte é constituída por um glossário de conceitos utilizados no texto da dissertação, mas que, por não serem centrais no foco do estudo, não foram definidos e discutidos na sua segunda parte.ABSTRACT: Given the chronic illness of one of its elements, the family has struggled and is pressed to mobilize mechanisms that do not belong to their usual repertoire. During the process of adapting to this situation, the reactions of the sick person and other members of his family influence each other, a process that can become in itself a problem, leading to new risks for the family and for the ill person. Thus, the family should not be excluded from the process of care. This dissertation focuses on the impact of chronic disease in the sick person and his family, it analyzes the context of factors that influence and identifies types of Medical interventions that promote adaptive responses to disease. Structured into seven parts, the first part of this dissertation demonstrates the importance of chronic diseases, focusing its weight in the pattern of current morbidity and its impact on health care costs, direct and indirect, in the organization of health care, and in the family and the sick person, the latter two levels of impact which focuses this thesis. In the second part, we review the definitions in question in this dissertation and the theories that fall, including the general systems theory and the Bronfenbrenner´s bioecological model of development. In the third part, we justified the methodological options of this dissertation. Inserted in the interpretive paradigm is grounded and uses qualitative and quantitative data, a triangulation of methods and analysis. To support the rationale for choices made, described the dialogue between alternative paradigms, including the definition of the respective concepts and standards. Given the rhetoric not be limited to quantitative research versus qualitative Research, but also occur between the different currents of the latter, passed in review their distinct historical moments, since persist and coexist on current investigations, as well as their scientific criteria, involved in several controversies that drag on time, with the use of terminology related to multiple concepts, that we want to clearly identify the terms of equivalent underlying concepts and outline them. In the type of research of this dissertation, the complexity is increased by the inclusion of context, so this is studied in two empirical studies that constitute its fourth part and featuring: Santo Condestável parish, consisting of three heterogeneous neighborhoods with aging population, especially in the Campo de Ourique neighborhood, dominated by unit families, enhancing isolation phenomena; morbidity in the clinical practice of Family Health Unit Santo Condestável, verifying that the population enrolled in the health unit approaches the community of influence and health problems population coded more frequent among those enrolled are not, necessarily, who more often are subject of medical intervention in consultations. The fifth part is constituted by the nuclear study of the dissertation, "Chronic Illness: Family Physician Intervention to Limit their Repercussions on the Person and Family", which aims to investigate how the social, psychological and biological processes interact to produce different effects of the disease in chronic ill person and their families, resulting in distinct pathways of disease; and give visibility to medical interventions to promote a healthy adaptation to chronic illness. The study was guided to the discovery, so we haven’t placed previous hypotheses and have not defined at the outset the issues that define its scope and focus, for these are susceptible to reformulate the evolution of the study resulting from deepening familiarization and reflection on the phenomena in question. The study identified 19 possible repercussions of chronic disease and 26 conditioning factors for adaptation to chronic disease modifiable by medical interventions, having these been systematized into 15 typologies. Also analyzed the processes by which demographic variables, as well as historical time, can modulate the expression of conditioning factors of adaption to chronic disease identified, intertwining with them. The study showed that, not to get sick also functional and psychologically, the sick person and his family should avoid indulging in the disease, giving only what the disease need, and have flexibility to promote the appropriate changes to the demands of the new situation and phase of the life cycle that is. Also showed that the adaptation of the family with chronic disease depends on the type and stage of the disease, the characteristics of their treatment, as well as several other intrinsic and extrinsic factors of the sick person and the family, and may take dysfunctional patterns. Medical interventions in the case studies that comprise the nuclear study point to the importance of the family doctor detect problems and encourage the functional adaptation over time, producing change, not only the organic point of view, but also personal and relational. In the sixth part, we discuss the results of the dissertation in its implications for medical practice and medical education. They present also some hypotheses for future work on the topic. Finally, the seventh part is composed of a glossary of terms used in the text of the dissertation, but because they are not central to the focus of the study, were not defined and discussed in the second part

Descriptive analysis of maternal and neonatal characteristics in the maternity of the Dona Estefânia Hospital between 2005 and 2008

Between 2005 and 2008 there were 8413 newborns at the maternity of the Hospital Dona Estefânia (HDE), comprising about 8% of the total number of newborns in Portugal in the same period. Fetal mortality (0,20%) met the goal of the Portuguese National Health Plan (NHP) and was at the lowest levels reported in the European Union. The percentage of preterm deliveries (8,1%) and caesareans (31,9%), however, are still above the goals established by the NHP, respectively, 4,9% and 24,8%. In newborns, the odds ratio of a low Apgar index at five minutes was 1,35 for each 100 g of birth weight less and 1,33 for each gestational week less. Average maternal age was 30,4 years old, with 3,8% being adolescents. About 22% were foreign mothers, a number well above the Portuguese national average of 9%. The percentage of preterm births and caesareans were lower among Chinese mothers and quite variable among nationalities. Weight at birth was found to correlate significantly with gestational age, type of pregnancy (twins/singleton), foetus gender, maternal parity and age at delivery. On average, when everything else remained constant, one additional gestational week translated into more 176 g; a twin newborn was, on average, 381 g lighter than a singleton, and a female newborn was, on average, 48 g lighter than a male. We present percentile tables of weight at birth by sex and gestational age (36-41 weeks) for newborns at the HDE.publishersversionpublishe

Creencias irracionales en estudiantes de una Escuela Profesional de Psicología de una Universidad Privada de Huancayo 2020

En la actualidad los adolescentes del primer ciclo que cursan la carrera de psicología atraviesan por una etapa en sus vidas que significa pasar del nivel secundario al nivel superior, a la vez está presente la crisis sanitaria es por ello se plantea como problema general ¿Qué creencias irracionales existen en los estudiantes de una escuela profesional de psicología de una universidad privada de Huancayo? y el objetivo de este trabajo fue identificar las creencias irracionales en estudiantes de una escuela profesional de psicología de una Universidad Privada de Huancayo – 2020. El método general y específico que se usó fue el método científico y descriptivo respectivamente, el tipo de investigación es básica, el nivel es descriptivo, el diseño de investigación es descriptivo simple, la población se formó de 140 universitarios y la muestra por 68 estudiantes del primer ciclo de la carrera de psicología de ambos sexos, el tipo de muestreo es no probabilístico por conveniencia. La recolección de datos se hizo virtualmente haciendo uso de la plataforma Google Forms. El instrumento fue el cuestionario de creencias irracionales de Ellis (2008) para la confiabilidad se usó el estadístico de Kuder de Richardson y la validez por el criterio de jueces. Los resultados de la investigación indican que los universitarios no presentan creencias irracionales en un 82.4% y un 17,6% si presenta creencias irracionales. Se concluye que los estudiantes de primer ciclo no presentan creencias irracionales, pero si predominan algunas dimensiones, por ello se recomienda ejecutar talleres respecto a los siguientes temas: Dependencia, reacción a la frustración, ansiedad, irresponsabilidad emocional y altas autoexpectativas

Indeterminate Cell Histiocytosis in Association with Acute Myeloid Leukemia

Indeterminate cell histiocytosis (ICH) is a rare proliferative disorder, in which the predominant cells share morphologic and immunophenotypic features from both Langerhans and non-Langerhans cell histiocytosis. We describe a 62-year-old man presenting a 2-month history of firm nodular lesions on the upper lip. Histopathology, immunohistochemical, and ultrastructural analysis showed typical findings of ICH. The patient was treated with thalidomide and almost complete regression of the lesions was reached within 7 months. Nevertheless, one month after remission, he developed an acute myeloid leukemia of the subtype monocytic leukemia (M5). The patient's condition rapidly worsened and he died due to a respiratory failure four weeks later. We present this case because apart of being rare it joins the effectiveness of thalidomide and the association with an acute monocytic leukemia. A review of the literature is made

Prevalence of bullying in grassroots soccer in Spain : victims, bullies, and bystanders

Bullying is a social problem that has been studied most in schools but affects other social contexts. However, there is a general lack of studies on bullying in sports. The aim of this study was to determine the prevalence of bullying among youth soccer players. Participants were 1,980 soccer players (88.2% boys) aged 8 to 13 years (Mage = 10.5, SD = 1.68) from 25 clubs in Catalonia, Spain. An ad hoc questionnaire was administered to analyze the prevalence and characteristics of bullying from the perspective of victims, bullies, and bystanders. The overall bullying victimization rate was 8.9%, with higher rates observed in the younger categories (p < .001); 5.2% of victims experienced bullying in both their soccer club and at school. The bullying and bystander rates were 14.8% and 34.7%, respectively, with significant differences between boys and girls (15.5% of boys and 9% of girls were bullies [p < .05], while 36.4% of boys and 21.9% of girls were bystanders [p < .001]). Verbal bullying was the main type of bullying reported. The locker room and pitch were the most common locations, and victims were more likely to deal with bullying on their own than to ask for help. Bullying is present in grassroots soccer, and anti-bullying programs are needed to instill ethical and moral values in athletes and equip coaches with the necessary skills to prevent, detect, and address bullying situation

BRCA1/2 genetic background-based therapeutic tailoring of human ovarian cancer: hope or reality?

Ovarian epithelial tumors are an hallmark of hereditary cancer syndromes which are related to the germ-line inheritance of cancer predisposing mutations in BRCA1 and BRCA2 genes. Although these genes have been associated with multiple different physiologic functions, they share an important role in DNA repair mechanisms and therefore in the whole genomic integrity control. These findings have risen a variety of issues in terms of treatment and prevention of breast and ovarian tumors arising in this context. Enhanced sensitivity to platinum-based anticancer drugs has been related to BRCA1/2 functional loss. Retrospective studies disclosed differential chemosensitivity profiles of BRCA1/2-related as compared to "sporadic" ovarian cancer and led to the identification of a "BRCA-ness" phenotype of ovarian cancer, which includes inherited BRCA1/2 germ-line mutations, a serous high grade histology highly sensitive to platinum derivatives. Molecularly-based tailored treatments of human tumors are an emerging issue in the "era" of molecular targeted drugs and molecular profiling technologies. We will critically discuss if the genetic background of ovarian cancer can indeed represent a determinant issue for decision making in the treatment selection and how the provocative preclinical findings might be translated in the therapeutic scenario. The presently available preclinical and clinical evidence clearly indicates that genetic background has an emerging role in treatment individualization for ovarian cancer patients

Prevalence of bullying in grassroots soccer in Spain: Victims, bullies, and bystanders

Bullying is a social problem that has been studied most in schools but affects other social contexts. However, there is a general lack of studies on bullying in sports. The aim of this study was to determine the prevalence of bullying among youth soccer players. Participants were 1,980 soccer players (88.2% boys) aged 8 to 13 years (Mage = 10.5, SD = 1.68) from 25 clubs in Catalonia, Spain. An ad hoc questionnaire was administered to analyze the prevalence and characteristics of bullying from the perspective of victims, bullies, and bystanders. The overall bullying victimization rate was 8.9%, with higher rates observed in the younger categories (p < .001); 5.2% of victims experienced bullying in both their soccer club and at school. The bullying and bystander rates were 14.8% and 34.7%, respectively, with significant differences between boys and girls (15.5% of boys and 9% of girls were bullies [p < .05], while 36.4% of boys and 21.9% of girls were bystanders [p < .001]). Verbal bullying was the main type of bullying reported. The locker room and pitch were the most common locations, and victims were more likely to deal with bullying on their own than to ask for help. Bullying is present in grassroots soccer, and anti-bullying programs are needed to instill ethical and moral values in athletes and equip coaches with the necessary skills to prevent, detect, and address bullying situations

Efecto de la introducción de peces en la conservación de anfibios y crustáceos de lagos de alta montaña

Este capítulo contiene 16 páginas, 11 figuras y una tabla.La introducción de especies invasoras es un aspecto determinante relacionado con el cambio global que incide en la conservación de los ecosistemas. Actualmente, la gestión para la conservación (e.g., Parques Nacionales) se enfrenta a las incertidumbres creadas con la aparición de nuevas especies introducidas por el hombre, sobre todo las que pasan a desarrollar un papel clave en los ecosistemas. Para poder tomar políticas de gestión correctas es necesario conocer con detalle cuál es el impacto de estas especies y su papel en el ecosistema. Los lagos del Parque Nacional de Aigüestortes y Estany de Sant Maurici han sufrido la introducción de peces llegando a tener en la actualidad un 62% de lagos afectados. El objetivo general del proyecto fue estudiar el efecto de la introducción de peces en las comunidades planctónicas y bentónicas de los lagos de alta montaña del Parque Nacional. Para llevar a cabo tal objetivo nos centramos en el estudio de dos grupos de organismos indicadores, los crustáceos del plancton y los anfibios. Los resultados obtenidos nos muestran que los peces son el factor principal que explica la presencia de la mayor parte de las especies de anfibios en los lagos. En cambio el efecto de los peces sobre la presencia de crustáceos planctónicos se limita a las especies de mayor tamaño, afectando principalmente la biodiversidad y especialmente la abundancia de los crustáceos, que disminuye con la presencia de peces. La desaparición de los anfibios en los lagos con peces provoca un efecto en cascada cambiando biomasa y composición de las algas y procariotas (bacterias y arqueas) que viven en la superfície de las piedras del litoral de los lagos.Peer reviewe

Implementation of the MASK-Air® App for Rhinitis and Asthma in Older Adults: MASK@Puglia Pilot Study

Introduction: MASK-air® is an app whose aim is to reduce the global burden of allergic rhinitis and asthma. A transfer of innovative practices was performed to disseminate and implement MASK-air® in European regions. The aim of the study was to examine the implementation of the MASK-air® app in older adults of the Puglia TWINNING in order to investigate (i) the rate of acceptance in this population, (ii) the reasons for refusal and (iii) the evaluation of the app after its use. Methods: All consecutive geriatric patients aged between 65 and 90 years were included by the outpatient clinic of the Bari Geriatric Immunoallergology Unit. After a 1-h training session, older adults used the app for 6 months. A 6-item questionnaire was developed by our unit to evaluate the impact of the app on the management of the disease and its treatment. Results: Among the 174 recruited patients, 102 accepted to use the app (mean age, SD: 72.4 ± 4.6 years), 6 were lost to follow-up, and 63 had a low education level. The reasons given not to use the app included lack of interest (11%), lack of access to a smartphone or tablet (53%), low computer literacy (28%), and distrust (8%). At follow-up, the overall satisfaction was high (89%), the patient considered MASK-air® “advantageous” (95%), compliance to treatment was improved (81%), and the rate of loss to follow-up had decreased to 6%. Conclusion: Older adults with a low level of education can use the MASK-air® app after a short training session