Childhood maltreatment and adult psychopathology: pathways to hypothalamic-pituitary-adrenal axis dysfunction

OBJECTIVE: The aim of this paper was to examine the relationship between childhood maltreatment and adult psychopathology, as reflected in hypothalamic-pituitary-adrenal axis dysfunction. METHOD: A selective review of the relevant literature was undertaken in order to identify key and illustrative research findings. RESULTS: There is now a substantial body of preclinical and clinical evidence derived from a variety of experimental paradigms showing how early-life stress is related to hypothalamic-pituitary-adrenal axis function and psychological state in adulthood, and how that relationship can be modulated by other factors. DISCUSSION: The risk for adult psychopathology and hypothalamic-pituitary-adrenal axis dysfunction is related to a complex interaction among multiple experiential factors, as well as to susceptibility genes that interact with those factors. Although acute hypothalamic-pituitary-adrenal axis responses to stress are generally adaptive, excessive responses can lead to deleterious effects. Early-life stress alters hypothalamic-pituitary-adrenal axis function and behavior, but the pattern of hypothalamic-pituitary-adrenal dysfunction and psychological outcome in adulthood reflect both the characteristics of the stressor and other modifying factors. CONCLUSION: Research to date has identified multiple determinants of the hypothalamic-pituitary-adrenal axis dysfunction seen in adults with a history of childhood maltreatment or other early-life stress. Further work is needed to establish whether hypothalamic-pituitary-adrenal axis abnormalities in this context can be used to develop risk endophenotypes for psychiatric and physical illnesses.OBJETIVO: A meta deste artigo foi a de estudar as relações ente maus-tratos na infância e psicopatologia no adulto, como reflexo de uma disfunção do eixo hipotálamo-pituitária-adrenal. MÉTODO: Uma revisão seletiva da literatura relevante foi feita para identificar achados-chave e ilustrativos. RESULTADOS: Existe atualmente um volume significativo de achados científicos pré-clínicos e clínicos derivados de paradigmas experimentais, que demonstram que o estresse precoce está relacionado à função do eixo hipotálamo-pituitária-adrenal e a estados psicológicos no indivíduo adulto, e como esta relação pode ser modulada por outros fatores. DISCUSSÃO: O risco para o desenvolvimento de psicopatologia no adulto e disfunções do eixo hipotálamo-pituitária-adrenal está relacionado à complexa interação de múltiplos fatores vivenciais, assim como a genes que levam a uma susceptibilidade, que interagem com estes fatores. Embora as respostas agudas do eixo hipotálamo-pituitária-adrenal sejam geralmente adaptativas, as respostas excessivas podem levar a efeitos deletérios. O estresse precoce pode alterar a função do eixo hipotálamo-pituitária-adrenal assim como o comportamento, porém, o padrão da disfunção do eixo hipotálamo-pituitária-adrenal e a evolução psicológica na vida adulta refletem ambas as características do estressor e outros fatores modificadores. CONCLUSÃO: A pesquisa atual identificou múltiplos determinantes da disfunção do eixo hipotálamo-pituitária-adrenal encontrados em adultos com história de maus-tratos na infância ou outros estressores precoces. Trabalhos futuros são necessários para estabelecer se as anormalidades do eixo hipotálamo-pituitária-adrenal neste contexto podem ser usadas para o desenvolvimento de endofenótipos de risco para doenças físicas ou psiquiátricas.Universidade Federal de São Paulo (UNIFESP) Instituto PROVEBrown University Warren Alpert Medical School Butler HospitalUNIFESP, Instituto PROVESciEL

Diferentes olhares sobre o esporte para pessoas com deficiência: desafios, inovações e realidade

Research on people with disabilities can create, per times, strangeness and discomfort. However, it is necessary to encourage and bring to the fore debates about how the lives of people with disabilities in society are thought. In this sense, this special issue brings to our readers original articles on relevant topics in health sciences and sports for people with disabilities. Within this large area, the reader can go through themes such as: public policies for people with disabilities; social and sports programs for people with disabilities; physical activity and health for people with disabilities; high performance sports for people with disabilities; technological innovations in favour of new teaching-learning processes for people with disabilities; universities and their role in training human resources to work with people with disabilities; disabilities, women and sports; the media's view on the disability and the para-athlete; and the social legacy of the sport for people with disabilities. In this section we also bring a presentation of the Brazilian Journal of Education, Technology and Society (BRAJETS) and its main evaluation processes for the publication of scientific articles. We invite all our readers to check out this special issue which was prepared and written by researchers and professors with expertise in sport to people with disabilities studies. We wish you an enjoyable reading!A pesquisa sobre as pessoas com deficiência paira sobre um ar de estranheza e desconforto. Todavia se faz mister incentivar e trazer à tona debates sobre como são pensadas as principais medidas que influenciam a vida das pessoas com deficiência na sociedade. Neste sentido, esta edição especial traz aos nossos leitores artigos originais sobre temas pertinentes na área das ciências da saúde e do esporte para pessoas com deficiência. Dentro desta grande área o leitor pode percorrer por temas como políticas públicas para pessoas com deficiência, programas sociais e esportivos para pessoas com deficiência, atividade física e saúde para pessoas com deficiência, esporte de alto rendimento para pessoas com deficiência, inovações tecnológicas a favor da deficiência, novos processos de ensino-aprendizagem para pessoas com deficiência, as universidades e seu papel na formação de recursos humanos para atuar com pessoas com deficiência, deficiência, mulher e esporte, o olhar da mídia sobre a deficiência e o atleta com deficiência e o legado social do esporte para pessoas com deficiência. Ainda nesta seção trazemos uma apresentação da Revista Brasileira intitulada Brazilian Journal of Education, Technology and Society (BRAJETS) e seus principais processos de avaliação para a publicação de artigos científicos. Convidamos a todos nossos leitores para conferir esta edição especial que foi preparado e escrito por pesquisadores e professores especialistas na área dos estudos do esporte para pessoas com deficiência. Desejamos uma boa leitura a todos

Heart rate responses during isometric exercises in patients undergoing a phase III cardiac rehabilitation program

CONTEXTUALIZAÇÃO: A magnitude das respostas cardiovasculares depende dos componentes estático e dinâmico bem como da duração e intensidade da contração realizada. OBJETIVO: Avaliar as respostas da frequência cardíaca (FC) frente a diferentes percentuais de contração isométrica em 12 pacientes (63±11,6 anos; média±dp) com doença da artéria coronária e/ou fatores de risco para ela, participantes de um programa de reabilitação cardíaca fase III. MÉTODOS: A variação da frequência cardíaca (&#916;FC) foi avaliada durante as contrações voluntárias máximas (CVM; 5" e 10" de duração) e submáximas (CVSM; 30 e 60% da CVM-5, até exaustão muscular) de preensão palmar, utilizando-se um dinamômetro (hand grip). Adicionalmente, o RMSSD dos iR-R em ms (índice representante da modulação vagal cardíaca) foi calculado em repouso (pré-contração) nos últimos 30 segundos da CVSM e na recuperação (pós-contração). RESULTADOS: A &#916;FC apresentou maiores valores em CVM-10 vs CVM-5 (17±5,5 vs 12±4,2 bpm, p<0,05) e no CVSM-60 vs CVSM-30 (19±5,8 vs 15±5,1 bpm, p<0,05). No entanto, os resultados para CVM-10 mostraram &#916;FC similar quando comparados aos resultados obtidos para CVSM (p&gt;0,05). RMSSD de repouso reduziu-se (p<0,05) durante a CVSM-30 (30%=29,9±17,1 vs 12,9±8,5ms) e CVSM-60 (60%=25,8±18,2 vs 9,96±4,2 ms), mas retornou aos valores basais quando a contração foi interrompida. CONCLUSÕES: Em pacientes com doença da artéria coronária e/ou fatores de risco para ela, a contração isométrica de baixa intensidade mantida por longos períodos de tempo apresenta os mesmos efeitos sobre as respostas da FC, quando comparada à contração isométrica de alta ou máxima intensidade, porém de breve duração.BACKGROUND: The magnitude of cardiovascular responses is dependent on the static and dynamic components as well as the duration and intensity of the contraction performed. OBJECTIVE: To evaluate the heart rate responses to different percentages of isometric contractions in 12 patients (63±11.6 years) with coronary artery disease and/or risk factors for coronary artery disease that were participating in a phase III cardiac rehabilitation program. METHODS: Heart rate variation (&#916;HR) was evaluated during maximum (MVC, five and ten seconds in duration) and submaximal (SMVC, 30 and 60% of MVC-5, until muscle exhaustion) voluntary contraction, using a handgrip dynamometer. Additionally, the representative index of cardiac vagal modulation (RMSSD index) was calculated at rest (pre-contraction), at the final 30 seconds of SMVC and during recovery (post-contraction). RESULTS: &#916;HR showed higher values in MVC-10 versus MVC-5 (17±5.5 vs 12±4.2 bpm, p<0.05) and the SMVC-60 vs SMVC-30 (19±5.8 vs 15±5.1 bpm, p<0.05). However, results for CVM-10 showed similar &#916;HR compared to results for CVSM (p&gt; 0.05). RICVM at rest decreased (p<0.05) during SMVC-30 (30% = 27.9±17.1 vs 12.9±8.5 ms) and SMVC-60 (60% =25.8±18.2 vs 9.96±4.2 ms), but returned to the baseline values when the contraction was interrupted. CONCLUSIONS: In patients with coronary artery disease and/or risk factors for coronary heart disease, low intensity isometric contraction, maintained over long periods of time, presents the same effect on the responses of HR, compared to a high intensity or maximal isometric contraction of briefly duration.Conselho Nacional de Pesquisa e Desenvolvimento Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A)

Objective: Sleep disturbances play a fundamental role in the pathophysiology posttraumatic stress disorder (PTSD), and are not only a secondary feature. The aim of this study was to validate and assess the psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A-BR), a self-report instrument designed to assess the frequency of seven disruptive nocturnal behaviors, in a sample of participants with and without PTSD. Methods: PSQI-A was translated into Brazilian Portuguese and applied to a convenience sample of 190 volunteers, with and without PTSD, who had sought treatment for the consequences of a traumatic event. Results: The PSQI-A-BR displayed satisfactory internal consistency (Cronbach's coefficient of 0.83 between all items) and convergent validity with the Clinician Administered PTSD Scale (CAPS), even when excluding sleep-related items (r = 0.52). Test-retest yielded high agreement in the global PSQI-A-BR, with good stability over time (r = 0.88). A global PSQI-A-BR cutoff score of 7 yielded a sensitivity of 79%, specificity of 64%, and a global score of 7 yielded a positive predictive value of 93% for discriminating participants with PTSD from those without PTSD. Conclusion: The PSQI-A-BR is a valid instrument for PTSD assessment, applicable to both clinical and research settings.Universidade Federal de São Paulo (UNIFESP) Department of PsychiatryUniversity of Pittsburgh School of Medicine Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP) Department of PsychobiologyUNIFESP, Department of PsychiatryUNIFESP, Department of PsychobiologySciEL

Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting

Objective: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver's depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring's psychopathology in a Brazilian sample. Methods: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children's symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Results: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. Conclusion: These results substantiate our hypothesis that child psychopathology correlates with caregivers' psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2012/17485-4]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Instituto LemannNIMH [D43 TW009675, T32 MH096724, T32-MH19139, K01MH104514]Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Columbia University Department of Psychiatry/New York State Psychiatric Institute [T32MH096724]Univ Fed Sao Paulo UNIFESP, Dept Psiquiatria, Sao Paulo, SP, BrazilNew York State Psychiat Inst & Hosp, Div Epidemiol, New York, NY 10032 USAColumbia Univ Coll Phys & Surg, Dept Psychiat, 722 W 168th St, New York, NY 10032 USANew York State Psychiat Inst & Hosp, Div Child Psychiat, New York, NY 10032 USAUniv Fed Sao Paulo UNIFESP, Dept Psiquiatria, Sao Paulo, SP, Brazil(FAPESP) [2012/17485-4]NIMH [D43 TW009675, T32 MH096724, T32-MH19139, K01MH104514]Columbia University Department of Psychiatry/New York State Psychiatric Institute [T32MH096724]Web of Scienc

Childhood Sexual Abuse and Indicators of Immune Activity: A Systematic Review

Background: Childhood sexual abuse (CSA) is a prevalent subtype of early life stress associated with changes in immunological and neuroendocrine systems leading to inflammatory responses of the organism and increasing several inflammatory and immune markers. We aimed to conduct a systematic review concerning the association between CSA and indicators of immune activity.Methods: We conducted a search for articles in PubMed, Scopus, PsycINFO, and Web of Science, using the key words: (“Child sexual abuse” OR “childhood maltreatment” OR “sexual violence” OR “posttraumatic stress disorder” OR “rape”) AND (“cytokines” OR “inflammatory markers” OR “interleukin” OR “tumor necrosis factor” OR “C-reactive protein”). PRISMA guidelines were used in order to improve the quality of this research, and MeSH terms were used in PubMed.Results: A total of 3,583 studies were found and, after application of the exclusion criteria, 17 studies were included in this review. Most studies reported an increase of inflammatory activity associated with the presence of early abuse. IL-6, TNF- α, and C-reactive protein were the most frequently analyzed markers and some studies showed higher levels in individuals that suffered CSA compared with controls, although the results were heterogeneous, as was the assessment of CSA, repeated trauma, and time of occurrence. It was not possible to perform a meta-analysis because the results were diversified.Conclusion: CSA is associated with changes in inflammatory markers levels. Improving the assessment of subtypes of trauma is important to further understand the complex correlations of CSA and its biological consequences such as psychiatric and physical illness in later life

Root Decomposition of Elephant Grass Pastures Grazed at Different Management Intensities

Grazing management may alter chemical composition of plant components affecting nutrient cycling. Among pasture management tools, adjustment of stocking rate (SR) and N fertilization have potential to affect nutrient cycling in the grassland ecosystem (Dubeux et al. 2007). Excreta from grazing animal and litter are the two major pathways of nutrient return on grazed pastures (Thomas 1992). Fertilization and SR may alter these pathways by different forms. Increasing fertilization generally increases pasture net primary productivity. Stocking rate affects different pasture and animal responses. Regarding nutrient cycling, increasing SR will likely increase proportion of nutrient returned through excreta as opposed to litter, increasing as a result nutrient losses (Dubeux et al. 2006). Root system may also be affected by management intensity. Frequent defoliation and low plant nutrition level may reduce root biomass (Richards 1993) and affect its decomposition. This study evaluated the effect of different SR´s and N fertilization levels on the decomposition of elephant grass roots

Healthy maternal bonding as a resilience factor for depressive disorder

INTRODUCTION: Depressive disorders (DDs) are very prevalent disorders particularly in women, a high-risk gender group. Determining the risk and protective factors associated with the development of DDs is fundamental to planning preventive and therapeutic strategies. In this study, we evaluated the correlations between healthy maternal attachment and the development of DDs in adulthood. METHODS: We evaluated 52 women at 6 months to 1 year after premature childbirth at Maternidade Vila Nova Cachoeirinha. They were evaluated using the following instruments: Brazilian Criteria of Economic Classification,Parental Bonding Inventory (PBI),Center for Epidemiologic Studies Depression Scale (CES-D), and Edinburgh Postnatal Depression Scale (EPDS). Cut-off scores on the CES-D and EPDS were used to classifythe subjects as currently having a DD or having probable postpartum disorder (PPD) after childbirth. Multiple logistic regression was used to evaluate the risk factors associated with DDs. RESULTS: We found that 49.1% of the sample had a current depressive episode, and 73.6% had probable PPD. Based on logistic regression, current depression (odds ratio = 1.092 [confidence interval: 1.005; 1.186]), and a PPD (odds ratio = 1.108 [confidence interval: 1.011; 1.21]) were negatively correlated with affective maternal relationships. CONCLUSIONS: Women who reported healthy attachment with their mothers did not develop DDs when faced with stressful situations such as premature childbirth

Health promotion and education: a diagnosis of sanitation conditions using participatory research and community education (São João dos Queiróz, Quixadá, Ceará, Brazil)

This study was conducted in a rural community, São João dos Queiróz, a township in the county of Quixadá, Ceará, Brazil, using a combination of participatory research and community education in compliance with the health promotion reference and principles of the 1986 Ottawa Charter. The project was joined by representatives of several local government institutions and organizations from the grassroots community movement. The theme generating the research, as defined by an assembly meeting of the community association, was a diagnosis of sanitation conditions in the community. The starting point was the assessment of local conditions. Results showed adverse local conditions in sanitation, literacy, income, and employment. Suggestions for solving the problems were organized so as to be included in the planning agenda for local health policies. Evaluation was procedural and enriched with daily research activities. The problem-solving pedagogical approach developed during the educational process contributed to a critical reconstruction, appropriation, and sharing of the resulting knowledge.Este trabalho foi desenvolvido em uma comunidade rural ­ vila de São João dos Queiróz, Distrito do Município de Quixadá, Ceará, através da pesquisa participante articulada à educação popular, tendo como referencial a promoção à saúde de acordo com os princípios da Carta de Ottawa, 1986. Participaram do projeto representantes das diversas instituições públicas do distrito e entidades associativas ligadas ao movimento popular. O tema gerador, definido em assembléia da associação comunitária, foi o diagnóstico de saneamento, e o ponto de partida, o levantamento da condição situacional. Os resultados obtidos mostraram as precárias condições locais de saneamento, escolaridade, renda e trabalho. As sugestões para resoluções dos problemas foram organizadas para subsidiar a agenda de planejamento das políticas locais de saúde. A avaliação foi processual e enriquecida com práticas do cotidiano da pesquisa. A pedagogia problematizadora, desenvolvida durante o processo educativo, contribuiu para a construção e a reconstrução crítica dos conceitos de promoção à saúde e de saneamento, assim como para a efetivação da construção, apropriação e socialização dos conhecimentos produzidos