Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-06-19T14:20:56Z No. of bitstreams: 1 mariaterezabrandi.pdf: 1443789 bytes, checksum: 458ed97b54aff4733a442f3ecafbbe88 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-06-29T12:26:23Z (GMT) No. of bitstreams: 1 mariaterezabrandi.pdf: 1443789 bytes, checksum: 458ed97b54aff4733a442f3ecafbbe88 (MD5) / Made available in DSpace on 2017-06-29T12:26:23Z (GMT). No. of bitstreams: 1 mariaterezabrandi.pdf: 1443789 bytes, checksum: 458ed97b54aff4733a442f3ecafbbe88 (MD5) Previous issue date: 2007-10-31 / Embora fatores psicológicos tenham sido inicialmente postulados como determinantes na etiologia da doença de Crohn (DC), atualmente esta hipótese foi descartada, embora distúrbios de ansiedade e depressão possam exacerbar ou desencadear atividade da doença. Entretanto, a prevalência das síndromes de ansiedade e depressão nas DC, assim como seus possíveis fatores associados às mesmas estão pouco definidos. Objetivos: Avaliar em pacientes portadores de DC a prevalência de síndrome depressivo-ansiosa, bem como os possíveis fatores de risco. Material e Métodos: 110 pacientes (55 homens e 55 mulheres) com média de idade de 38,2 anos (variação 18 a 64 anos) com diagnóstico estabelecido de DC foram avaliados durante o período de Dezembro 2005 a Abril de 2007 para a presença de síndrome depressivo-ansiosa. Registrou-se dados sócio-demográficos relevantes, características clínicas relacionadas às DII, e os antecedentes pessoais. Na avaliação do fenótipo da DC usou-se a classificação de Viena, enquanto a atividade da DC foi avaliada pelo índice de atividade da doença de Crohn (IADC). Para a avaliação psicológica dos pacientes foram utilizados dois instrumentos de auto-avaliação: o Inventário de Depressão de Beck e a subescala de ansiedade da Escala Hospitalar de Ansiedade e Depressão. Os mesmos questionários foram aplicados em grupo controle de 110 pacientes (52 homens e 58 mulheres) com média de idade de 39,9 anos (variação 18 a 65 anos) atendidos em um ambulatório de gastroenterologia geral por doenças cronicas gastrointestinais (exceto DC). Para fins comparativos, os pacientes com DC foram divididos em grupos com e sem síndromes depressiva (SD) e/ou ansiosa (SA). Resultados: Os pacientes com DC e grupo controle foram similares com relação ao sexo, estado civil, idade, raça, emprego atual, e consumo de álcool. Entretanto, pacientes com DC foram mais freqüentemente tabagistas (p= 0.05) e tinham maior nível de escolaridade (p<0.02). Síndrome depressiva foi significantemente mais freqüente em pacientes com DC que no grupo controle (25,4% vs. 8,2%; p<0.003), enquanto a prevalência de SA (33,6% vs. 22,7%) e disforia (13,6% vs.6,4%) foram similares em ambos os grupos. Os pacientes com DC e SD comórbida foram significantemente mais prováveis de apresentarem doença ativa na inclusão quando comparado aqueles não depressivos (71,4% vs. 34,1%, respectivamente; p=0.04). Adicionalmente, o escore basal do IADC foi significantemente maior nestes (282 ± 113) do que naqueles sem SD (138 ± 50; p= 0.001). Nos 37 pacientes com DC e SA comorbida, houve nítida tendência do predomínio de mulheres. Em comparação aos pacientes sem SA, significantemente mais pacientes com SA tinham historia familiar de depressão (56,7% vs. 16,4%; p=0.002). Conclusão : Nossos resultados mostram que SD e/ou SA são distúrbios altamente prevalentes em pacientes com DC. A atividade da DC foi o principal fator associado com a coocorrência de SD, enquanto que historia familiar de depressão mostrou ser um fator significantemente associado a SA nestes pacientes. A alta prevalência de síndrome depressivas e/ou ansiosas encontradas em pacientes com DC, junto com a disponibilidade do tratamento efetivo para estas condições, indica que é oportuno recomendar rastreamento rotineiro para SD/SA como parte da melhora da qualidade do cuidado aos sujeitos com DC. / Although psychological factors have been initially postulated as the key in the etiology of Crohn's Disease (CD), nowadays this hypothesis has been discarded, even though anxiety and depression disorders, can exacerbate or trigger activity of the disease. However, the prevalence of anxiety and depression syndromes in CD, as well as its possible factors associated with them are poorly defined. Objective: To evaluate the prevalence of the anxious-depressive-syndrome, as well as the possible risk factors, in patients with CD. Materials and Methods: 110 patients (55 men and 55 women) with a mean age of 38.2 years (range 18 to 64 years) with established diagnosis of CD were evaluated during the period of December 2005 to April 2007 for the presence of anxiety-depressive syndrome. Socio-demographic relevant data, clinical characteristics related to inflammatory bowel disease, and personal background were recorded. To assess the CD phenotype we used the Vienna´s Classification, while the activity of the CD was evaluated by the Activity Index in Crohn's Disease (AICD). Two instruments of self-assessment were used for the psychological evaluation of patients: the Beck Depression Inventory, and the anxiety subscale of the Hospital Anxiety and Depression Scale. The same questionnaires were applied in the control group of 110 patients (52 men and 58 women) with mean age of 39.9 years (range 18 to 65 years) attended in a general gastroenterology clinic for gastrointestinal cronic diseases (except CD). For comparative purposes, patients with CD were divided into groups: with and without depressive (DS) and / or anxiety syndrome (AS). Results: Patients with CD and the control group were similar with respect to sex, marital status, age, race, current employment, and alcohol consumption. Meanwhile, CD patient were more often smokers (p = 0.05) and had higher level of education (p <0.02). Depressive syndrome was significantly more often in CD patients that in the control group (25.4% vs. 8.2%, p <0.003), although the AS prevalence (33.6% vs. 22.7 %), and dysphoria (13.6% vs.6, 4%) were similars in both groups. Patients with CD and DS comorbidity were significantly more likely to present active disease in the inclusion when compared with the non-depressive patients (71.4% vs. 34.1%, respectively, p = 0.04). Additionally, the baseline score of the AICD was significantly higher in these (282 ± 113) than those without DS (138 ± 50, p = 0.001). In 37 patients with CD and AS comorbidity, there were clear trend of the predominance of women. Significantly more patients with AS had a depression family history when compared to patients without AS (56.7% vs. 16.4%, p = 0.002). Conclusion: Our results show that DS and / or AS are highly prevalent disorders in patients with CD. The activity of the CD was the main factor associated with the co-occurrence of DS, while depression family history proved to be a significantly factor associated with AS in these patients. The high prevalence of DS and / or AS found in patients with CD, along with the availability of effective treatment for these conditions, indicates that it is appropriate to recommend routine screening for DS / AS as part of improving the quality of care for subjects with CD .

Orientadores: Cíntia Alves Salgado Azoni, Sylvia Maria Ciasca / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T14:13:47Z (GMT). No. of bitstreams: 1 Capelatto_IuriVictor_M.pdf: 8643229 bytes, checksum: 14971a9b9fe40208e828e41e679176b8 (MD5) Previous issue date: 2013 / Resumo: O resumo poderá ser visualizado no texto completo da tese digital / Abstract: The abstract is available with the full electronic document / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Orientador: Neury José Botega / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T22:33:58Z (GMT). No. of bitstreams: 1 Gaspar_KarlaCristina_M.pdf: 55704980 bytes, checksum: 8bf30ea103190b09a7607399c8dd17f1 (MD5) Previous issue date: 2011 / Resumo: O Estudo de Intervenção Breve Oportuna (EIBO) realizou uma série de ensaios terapêuticos aleatorizados em pacientes internados no Hospital de Clínicas da Unicamp. Objetivo: descrever o perfil clínico e a evolução desses pacientes e decorridos seis meses da alta hospitalar, reavaliar todos os pacientes por meio de uma entrevista telefônica. Método: Após screening com a Hospital Anxiety and Depression Scale (HAD), os primeiros 50 casos com episódio depressivo confirmados pelo Mini International Neuropsychiatric Interview compuseram a amostra deste estudo da depressão e foram encaminhados para um serviço de saúde pública. Devido ao caráter naturalístico do presente estudo, não interferimos na conduta dos médicos durante a internação. Após 6 meses de alta hospitalar, todos os pacientes foram entrevistados novamente por telefone. Resultados: a média de idade foi 49,3 anos (desvio-padrão:14,5), com predominância do sexo feminino (68%). Infecções, neoplasias malignas, doenças gastrointestinais e renais foram às principais razões de internação, muitas vezes associadas a doenças de base (principalmente hipertensão arterial, diabetes e cardiopatias). Decorridos seis meses da alta, cinco pacientes faleceram, seis não puderam ser contatados e um recusou a nova entrevista. Dos 38 reavaliados, dois terços continuavam deprimidos. Apenas 12 pacientes foram tratados e desses 7 (58%) foram com antidepressivos. Continuar deprimido associou-se à ideação suicida e a reinternações. Banalização dos sintomas depressivos, medo de ficar dependente de psicofármacos e descrédito em antidepressivos e psicoterapias constituíram barreiras para que 21 pacientes (55%) não buscassem tratamento para depressão. Dos 17 que o fizeram, 5 não conseguiram tratamento. Conclusão: Este estudo inédito demonstrou que após seis meses da alta hospitalar, 66% dos pacientes continuam deprimidos e 15% recebem tratamento. E dos que continuam deprimidos 64% apresentam ideação suicida e 16% tiveram novas internações. As crenças que os pacientes têm sobre depressão e o tratamento também constituem fatores de impedimentos subjetivos para buscar tratamento / Abstract: The Study of Brief Opportunity Intervention (EIBO) performed a series of randomized clinical trials with patients admitted to Clinical Hospital of the State University of Campinas (Unicamp-Brazil). Objective: to describe both the clinical profile and evolution from the subjects, after 6-month discharge period and also to review ali the patients through a telephone call interview. Methodology: As part of this research project, the researchers screened ali patients using of Hospital Anxiety and Depression Scale (HAD). As part of this research project, the researchers screened ali patients using of Hospital Anxiety and Depression Scale (HAD). The first fifty (50) cases of depressive episode confirmed through Mini International Neuropsychiatric Interview (MINI) received standardized information about depression and were referred to a public health service to start the treatment. Due to the naturalistic nature of the present study, there was no interference on the assistant doctors' treatment provided to patients during hospitalization. After six-months of hospital discharge, ali the patients were reassessed through a telephone interview. Results: Patients' mean age was 49.3 years old (standard deviation: 14.5), being 68% females. Infections, malign neoplasias, renal and gastrointestinal diseases were the major reasons for hospitalization and they were many times associated with underlying diseases (mainly high blood pressure, diabetes and heart diseases). After six-month of discharge, five patients died, six could not be contacted by telephone and one of them refused to participate on a new interview. Out of 38 reassessed patients, two-thirds continued depressed. At the baseline assessment, this was the group that reported more frequently pain and suicidal behavior. Only one-third of the patients had received treatment for depression (from these 12 treated patients, 7 (58%) received antidepressive medication). Maintained depression was associated with suicidal ideation and rehospitalization. The discredit on depressive symptoms, the fear of becoming dependent on psychopharmacological medication and the disbelief on antidepressive drugs and psychotherapies were barriers that led 21 patients not to search treatment for depression. Out of 17 who search for treatment at public healthcare services, 5 could not get it. Although the patients were assessed by several physicians, only one out of three patients received some treatment for depression; only one, out of five, received an antidepressive medication. Conclusion: The findings show that after 6-month discharge period, 66% patients remained depressed and only 15% of them received treatment. The patients who continued depressed, they 64% showed suicidal ideation and 16% were rehospitalized. The beliefs that the patients have about depression and its treatment also constitute factors that impede them of looking for treatment / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

No description available.

Anxiety is the most commonly reported mental health problem among adolescents. Still, many adolescents in need of treatment are not detected and the clinical characteristics and etiological pathways of adolescent anxiety are under-researched topics. This thesis examined the clinical utility of the Swedish versions of the Spence Children’s Anxiety Scale (SCAS) and the clinical characteristics of multiple anxiety disorders among psychiatrically referred adolescents, and the influence of parenting and oxytocin gene (OXT) variants on anxiety among adolescents in the general population.  Studies employed cross-sectional and longitudinal designs and were based on questionnaire, interview, and genotype data. Support for the reliability and validity of both SCAS and SCAS-P was obtained. The overall ability to predict anxiety among referred adolescents ranged from fair to excellent for both scales.  Among adolescents psychiatrically referred for any reason, the prevalence of any anxiety disorder was 46%. Homotypic comorbidity was observed in 43%, and heterotypic comorbidity in 91%. Early adolescent anxiety influenced homotypic anxiety in late adolescence independent of parental rejection and control. The mediating role of parenting was small with indirect effect sizes no larger than one-tenth the size of direct effects, irrespective of the informant on parenting behavior. Significant interaction effects with positive and negative parenting were observed for OXT variants rs4813625 and rs2770378 in relation to social anxiety. The nature of the interactions was in line with the differential susceptibility framework for rs4813625, whereas for rs2770378, results indicated a diathesis–stress type of interaction. The findings suggest that psychiatrically referred adolescents with anxiety disorders are best characterized as a highly complex patient group and call attention to the necessity of structured assessment. For this purpose, this thesis provides evidence for the clinical utility of the SCAS; routine utilization of this questionnaire can improve detection of adolescents in need of anxiety treatment. Findings of this theses further suggest that the influence of positive and negative parenting behaviors on anxiety may be of greater importance among some adolescents than others, depending on individual differences in sensitivity to parenting. The etiology of anxiety among adolescents may therefore involve differential susceptibility effects of the interplay between genes and parenting behaviors.

Objetivo: Conocer si existen diferencias entre dos cohortes retrospectivas de pacientes con diagnóstico de tuberculosis pulmonar con y sin Diabetes Mellitus tipo 2 (DM2) en cuanto al sexo, la edad, tiempo de negativización del esputo, la presencia de cavitación, la tasa de curación, duración del tratamiento y la proporción del cambio en el esquema del tratamiento. Material y métodos: Estudio observacional, diseño cohorte retrospectiva. Se compararon las características de los pacientes con TB + DM2 vs los pacientes no expuestos a DM2 con TB pulmonar confirmado clínicamente, cultivo y/o un BK de esputo positivo. Se incluyeron en el estudio 34 expuestos y 133 no expuestos, atendidos por el Programa de Control de Tuberculosis entre 2010 y 2012 en la Red Asistencial Rebagliati (Lima, Perú). Se elaboró una base de datos en Microsoft Excel 2010, y el análisis se realizó en el programa Epi Info 7.0. Resultados: El promedio de edad entre los expuestos es 53,7 años, ± 15,2 y el promedio de edad entre los no expuestos es 42,9 años, ±18,5. Existen diferencias significativas en el análisis de supervivencia entre los expuestos y no expuestos en cuanto al tiempo de negativización mediante Log-rank (p-valor < 0.001). Se encontraron diferencias estadísticas significativas (p< 0,05) entre los pacientes con TB + DBM y los pacientes con TB en cuanto a la edad, la mediana en el número de síntomas, en la forma clínica de TB. Asimismo, existen diferencias significativas en la presencia de cavitación es más frecuente en los pacientes con TB-DM2 que en los pacientes solo con TB pulmonar. En el modelo de análisis de regresión ajustado de Cox, se identificó que ser paciente TB- DM2 retrasa la negativización del BK de esputo RR 0,24 IC 95 % (0,09 – 0,60) Conclusiones: Existen diferencias en las características demográficas, clínicas y radiológicas entre los expuestos y no expuestos. Además, el periodo de negativización del esputo es mayor en los pacientes expuestos. / Objetive: To observe if there are differences between two retrospective cohorts of patients with diagnosis of pulmonary tuberculosis with and without Diabetes Mellitus type 2(DM2) about sex, age, time of negativization of sputum, presence of cavitations, healing rate, duration of treatment and the proportion of change of treatment betweetn both groups. Materials and Methods: Observational study, retrospective cohort design. It was compared the characteristics of patients with TB and DM2 vs patients without DM2, TB was confirmed with clinical, culture and/or BK positive sputum smear. It was included in study 34 exposed and 133 not exposed, atended by Programa de Control de Tuberculosis between 2010 and 2012 in the Red Asistencial Rebagliati (Lima, Peru). It was made a database in Microsoft Excel 2010, and the analysis was made with STATA 10. It was estimated the hazard ratio (HR) of variables that adjusted in bivariate analysis from the Cox regression. Results: In the bivariate analysis was found that being younger than 45 years was associated with risk of having diabetes, also, having DM2 was associated to a lower expression of sympthoms of TB. Patients with DM2 have higher risk to develope cavitations, to change of treatment and a higher risk of duration of treatment for more than 6 months. The patients with TB and DM2 need a longer time for negativization of Bk sputum smear in comparison with patients with no DM2. In the analysis model adjusted Cox regression identified to be patient TB-DM2 delays negativization BK sputum RR 0,24 IC 95 % (0,09 – 0,60). Conclusions: There are demographical, clinical and radiological differences between exposed and not exposed patients. In addition, the period of negative sputum culture is higher in exposed patients.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第23118号 / 社医博第114号 / 新制||社医||11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 森田 智視, 教授 黒田 知宏 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

No description available.

Objective: Although patients with avoidant/restrictive food intake disorder (ARFID) often consult general pediatric services initially, existing literature mostly concentrated on ntensive eating disorder treatment settings. This cross-sectional study sought to describe symptoms of ARFID and their associations with eating disorder psychopathology, quality of life, anthropometry, and physical comorbidities in a general pediatric sample. Methods: In N = 111 patients (8-18 years) seeking treatment for physical diseases, prevalence of ARFID-related restrictive eating behaviors was estimated by self-report and compared to population-based data (N = 799). Using self-report and medical record data, further ARFID diagnostic criteria were evaluated. Patients with versus without symptoms of ARFID based on self-report and medical records were compared in diverse clinical variables. Results: The prevalence of self-reported symptoms of ARFID was not higher in the inpatient than population-based sample. Only picky eating and shape concern were more common in the inpatient than population-based sample. Although 69% of the inpatient sample reported any restrictive eating behaviors, only 7.2% of patients showed symptoms of ARFID based on medical records in addition to self-report, particularly those with underweight, without significant effects for age, sex, and medical diagnoses. Discussion: The study revealed the importance of considering ARFID within the treatment of children and adolescents with physical diseases, especially for those with underweight. Further research is needed to replicate the findings with interview-based measures and to investigate the direction of effects in ARFID and its physical correlates.

Följande studie undersöker speciallärare och specialpedagogers arbete med och kring elever vid komorbiditet; dyslexi och ADHD. Studien utgår från tre frågeställningar. Syftet är att frågeställningarna ska belysa vilken betydelse diagnoser har för speciallärare och specialpedagoger i arbetet för och med elever vid komorbiditet. Studien undersöker dessutom vilka insatser som underlättar skolsituationen för elever vid komorbiditet samt vilka arbetssätt som främjar lärandet vid komorbiditet. Studien utgår från en kvalitativ metodansats och baseras på semistrukturerade intervjuer med tre speciallärare och trespecialpedagoger från grundskolan årskurs-f6. Resultaten från studien visar att samtliga informanter menar att en diagnos aldrig får avgöra om elever har rätt till stöd och anpassningar i skolan. Diagnoser, menar informanterna, kan vara användbart som ett verktyg för åtgärder. Informanterna menar samtidigt att ett alltförstort fokus på diagnoser kan leda till ett kategoriskt perspektiv på skolsvårigheter. Speciallärare och specialpedagoger, som deltagit i studien, menar att de har en central och avgörande roll att, med sin kompetens, handleda personal och stötta skolelever vid komorbiditet. Det kan ske i form av utveckling av lärmiljön, extraanpassningar, kompensation och färdighetsträning. Resultaten i denna studie synliggör att det specialpedagogiska uppdraget, enligt informanterna, består i att ta hänsyn till olika perspektiv och behov som finns i skolan.