Pediatric chronic pain is a common developmental health problem with negative effects that can influence youth throughout their lives. Cognitive behavioral therapy is an efficacious treatment for pain management; however, treatment compliance among adolescents is a major problem. Emerging research suggests that some family-level factors play a role in treatment engagement and outcomes. Moreover, adolescents with greater coping and resilience strategies are more likely to benefit from treatment. However, it is not clear to what extent (a) other family factors predict short-term (3-month) and long-term (6-month) treatment compliance among adolescents with chronic pain, (b) adolescent-level factors predict treatment compliance, and (c) family-level factors interact with adolescent-level factors to predict treatment compliance (i.e., through moderating pathways). In addition, the association of family-level risk factors and adolescent-level resilience factors with functional impairment needs to be further investigated. To address these gaps, the current study explored factors that may predict treatment compliance and functional impairment within a multidisciplinary pediatric pain management program. Sixty-four adolescents (M = 15.00 ± 1.69 years; 85.9% female; 84.4% Caucasian, 6.3% African American/Black, 1.6% Hispanic/Latino, 1.6% Asian, 4.7% Mixed Race, 1.6% “Other”) diagnosed with chronic pain and their primary caregivers were assessed at three time points: their initial intake in the program (N=64), 3-months post-intake (n=62), and 6-months post-intake (n=61). Most family-level and adolescent-level factors, as well as the interaction of these factors, did not predict improved treatment compliance. However, consistent with prior research, several family-level and adolescent-level factors were associated with increased functional impairment among this sample. Study limitations and statistical concerns warrant that these findings be interpreted with caution. Results contribute to our understanding of the importance of family-level factors within the developmental context of adolescence, while also highlighting the need for investigating other relevant influences towards treatment compliance and functional impairment. Delineating such characteristics can inform assessment, as well as tailor treatment targets, recommendations, and outcomes among adolescents with chronic pain within a multidisciplinary treatment setting. / Psychology

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O Transtorno de Ansiedade Social (TAS) caracteriza-se pelo medo acentuado e persistente de situações sociais ou de desempenho, mostrando-se associado a prejuízos funcionais . Objetiva-se avaliar a associação do TAS a prejuízos funcionais nas atividades cotidianas, por meio da validação de duas escalas de auto e de hetero-avaliação, aplicadas a universitários brasileiros. Realizou-se dois estudos, um de comparação entre grupos TAS e Não TAS e outro de estudos de casos. Procedeu-se à tradução e adaptação da Escala de Liebowitz para auto-avaliação dos prejuízos funcionais (ELAPF) e da Escala de Liebowitz para hetero-avaliação dos prejuízos funcionais (ELHPF). Participaram do estudo de comparação entre grupos 173 universitários (TAS = 84 e Não TAS = 89), de ambos os sexos, com idade entre 17 e 35 anos. Procedeu-se a aplicação da Entrevista clínica semi-estruturada para o DSM-IV, para a confirmação diagnóstica e dos instrumentos: ELAPF, ELHPF, Questionário de Saúde Geral -12 (QSG-12), Inventário de Fobia Social (SPIN). Para os estudos de casos, selecionou-se três participantes do grupo TAS e procedeu-se a uma entrevista semi-estruturada sobre o impacto do transtorno nas atividades cotidianas, nos relacionamentos e na saúde geral. Os dados das escalas foram codificados e os grupos comparados por teste estatísticos não paramétricos (p 0,05) e para os estudos de casos foram integrados e analisados qualitativamente os dados das escalas e da entrevista,. Os grupos não apresentaram diferenças significativas quanto as variáveis demográficas. O grupo TAS apresentou no QSG-12 mais dificuldades quanto ao bem estar geral, e na ELAPF e na ELHPF apresentou, com significância estatística, mais dificuldades nas últimas semanas e no curso da vida. Observou-se para o grupo TAS: a) para a ELHPF, consistência interna de 0,68 no curso da vida e 0,67 nas duas últimas semanas, o coeficiente de correlação Kappa entre os avaliadores, variou de 0,75 a 0,93, caracterizando nível de concordância satisfatória e na análise dos componentes principais extrairam-se dois fatores para os dois parâmetros temporais; a validade concorrente realizada com o SPIN, mostrou valores que variaram entre 0,11 e 0,33 para o parâmetro no curso da vida e 0,17 a 0,39 nas duas últimas semanas, e b) para a ELAPF, a consistência interna foi de 0,85 para o parâmetro no curso da vida e 0,83 nas duas últimas semanas e na análise dos componentes principais extrairam-se três fatores, para o parâmetro temporal no curso da vida e dois fatores no parâmetro nas duas últimas semanas; a validade concorrente realizada em relação ao SPIN, mostrou valores no curso da vida de -0,14 a 0,25 e nas duas últimas semanas, a correlação variou de 0 a 0,38. Os estudos de casos evidenciaram que os prejuízos funcionais associados ao TAS têm impacto negativo para os relacionamentos, as atividades cotidianas, o bem estar e a percepção de saúde. As escalas , mostraram-se válidas para a avaliação dos prejuízos funcionais associados ao TAS, o que contribui para as práticas de saúde mental, em especial as de terapia ocupacional, que tem como foco as intervenções voltadas para a vida cotidiana. / Social Anxiety Disorder (SAD) is characterized by marked and persistent fear of social or performance situations and is associated with functional impairment. The objective of the present study was to assess the association of SAD with functional impairment in daily activities by means of the validation of two scales (auto and hetero-evaluation) applied to Brazilian university students. Two studies were conducted, one of them comparing SAD and Non SAD groups and the other consisting of cases studies. The Liebowitz Disability Self Rating Scale (LDSRS) and the Disability Profile /Clinician- Rated (DP) were translated and adapted. A total of 173 university students (SAD = 84 and Non-SAD = 89) of both genders, aged 17 to 35 years participated in the study of group comparison. A semi-structured clinical interview for DSM-IV was applied for confirmation of the diagnosis and the following instruments were applied: LDSRS, DP, General Health Questionnaire-12 (GHQ-12), and Social Phobia Inventory (SPIN). Three participants of the SAD group were selected for the case studies and submitted to a semi-structured interview about the impact of the disorder on daily activities, relationships, and general health. The scale data were coded and the groups were compared by a non-parametric test (p 0.05), and for the case studies the scale and interview data were integrated and analyzed qualitatively. The groups did not differ significantly in terms of demographic variables. For the SAD group, application of the GHQ-12 revealed more difficulties regarding general well-being, and application of the LDSRS and DP revealed significantly more lifetime difficulties and difficulties in the last weeks. The following observations were made for the SAD group: a) for the DP, the internal consistency was 0.68 during the life course and 0.67 during the last two weeks; the Kappa correlation coefficient for the two raters ranged from 0.75 to 0.93, characterizing a satisfactory level of concordance, and two factors for the two temporal parameters were extracted in the analysis of the principal components; concurrent validity performed with the SPIN showed values ranging from 0.11 to 0.33 for the lifetime parameter and from 0.17 to 0.39 for the last two weeks, and b) for the LDSRS, the internal consistency was 0.85 for the lifetime parameter and 0.83 for the last two weeks; concurrent validity performed with the SPIN showed lifetime values ranging from 0.14 to 0.25 and values ranging from 0 to 0.38 in the last two weeks. The case studies demonstrated that the functional impairment associated with SAD has a negative impact on relationships, daily activities, well-being, and health perception. The scales proved to be valid for the assessment of the functional impairment associated with SAD, a fact that contributes to mental health practices, especially those of occupational therapy, that focus on interventions in daily life.

There is considerable controversy in the research literature concerning meeting the needs of children and youth with Emotional and Behavioural Disorders (EBD). Collaborative models of service delivery have shown promising results in effectively meeting the needs of students with disabilities. The objective of this study was to examine the association between service providers adherence to the fundamental elements of a collaborative process called Wraparound and measures of students maladaptive behaviours, behavioural strengths, and functional impairment. <p>The current research investigated 23 students who were experiencing impaired functioning in the school, family, and/or community as a result of behavioural difficulties. Twelve of the students were engaged in Wraparound services and 11 were receiving conventional services. Adherence to the elements of Wraparound was determined using the Wraparound Fidelity Index (WFI; Bruns et al., 2005), a structured interview with the students primary caregivers. Maladaptive behaviours, behavioural strengths, and functional impairment were assessed via the students teachers completing the Behaviour Assessment System for Children (BASC; Reynolds & Kamphaus, 1992), Behavioural and Emotional Rating Scale (BERS-2; Epstein, 2004), and the Child and Adolescent Functional Assessment Scale (CAFAS; Hodges, 2005), respectively. Results of this research indicated that, overall, the students who received Wraparound services showed higher fidelity to the elements of Wraparound and more favourable behavioural outcomes than did the students engaged in the conventional model of service delivery. The correlation analysis of the association between adherence to the elements of Wraparound and the student outcome measures showed mixed results. A strong association was observed with statistical significance for the element of Youth and Family Team on all three outcome measures. This indicates the importance of an effective team in producing positive outcomes for the students and their families.

There is considerable controversy in the research literature concerning meeting the needs of children and youth with Emotional and Behavioural Disorders (EBD). Collaborative models of service delivery have shown promising results in effectively meeting the needs of students with disabilities. The objective of this study was to examine the association between service providers adherence to the fundamental elements of a collaborative process called Wraparound and measures of students maladaptive behaviours, behavioural strengths, and functional impairment. <p>The current research investigated 23 students who were experiencing impaired functioning in the school, family, and/or community as a result of behavioural difficulties. Twelve of the students were engaged in Wraparound services and 11 were receiving conventional services. Adherence to the elements of Wraparound was determined using the Wraparound Fidelity Index (WFI; Bruns et al., 2005), a structured interview with the students primary caregivers. Maladaptive behaviours, behavioural strengths, and functional impairment were assessed via the students teachers completing the Behaviour Assessment System for Children (BASC; Reynolds & Kamphaus, 1992), Behavioural and Emotional Rating Scale (BERS-2; Epstein, 2004), and the Child and Adolescent Functional Assessment Scale (CAFAS; Hodges, 2005), respectively. Results of this research indicated that, overall, the students who received Wraparound services showed higher fidelity to the elements of Wraparound and more favourable behavioural outcomes than did the students engaged in the conventional model of service delivery. The correlation analysis of the association between adherence to the elements of Wraparound and the student outcome measures showed mixed results. A strong association was observed with statistical significance for the element of Youth and Family Team on all three outcome measures. This indicates the importance of an effective team in producing positive outcomes for the students and their families.

Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Despite the severity of illness in this country, very few data have been reported previously regarding investigations of IE in the Czech Republic. Consequently, a retrospective evaluation of local IE cases at one of the country's largest medical centers was conducted. Our aim was to analyze the characteristics of this disease in our country. The greatest interest was devoted to Staphylococcus aureus (S. aureus), etiological agent that has been associated with the worst course of IE episodes. The hypothesis of our study was that infective endocarditis caused by S. aureus, in comparison with other etiological agents, is associated with worse course of the disease. We evaluated the structural (abscess formation, impaired integrity of heart valves, systemic embolism) and functional (incidence of heart failure and conduction disturbances, in-hospital mortality) manifestations of IE. Of all studied parameters, only embolism and S. aureus as the causative agent were...

O Transtorno de Ansiedade Social (TAS) caracteriza-se pelo medo acentuado e persistente de situações sociais ou de desempenho, mostrando-se associado a prejuízos funcionais . Objetiva-se avaliar a associação do TAS a prejuízos funcionais nas atividades cotidianas, por meio da validação de duas escalas de auto e de hetero-avaliação, aplicadas a universitários brasileiros. Realizou-se dois estudos, um de comparação entre grupos TAS e Não TAS e outro de estudos de casos. Procedeu-se à tradução e adaptação da Escala de Liebowitz para auto-avaliação dos prejuízos funcionais (ELAPF) e da Escala de Liebowitz para hetero-avaliação dos prejuízos funcionais (ELHPF). Participaram do estudo de comparação entre grupos 173 universitários (TAS = 84 e Não TAS = 89), de ambos os sexos, com idade entre 17 e 35 anos. Procedeu-se a aplicação da Entrevista clínica semi-estruturada para o DSM-IV, para a confirmação diagnóstica e dos instrumentos: ELAPF, ELHPF, Questionário de Saúde Geral -12 (QSG-12), Inventário de Fobia Social (SPIN). Para os estudos de casos, selecionou-se três participantes do grupo TAS e procedeu-se a uma entrevista semi-estruturada sobre o impacto do transtorno nas atividades cotidianas, nos relacionamentos e na saúde geral. Os dados das escalas foram codificados e os grupos comparados por teste estatísticos não paramétricos (p 0,05) e para os estudos de casos foram integrados e analisados qualitativamente os dados das escalas e da entrevista,. Os grupos não apresentaram diferenças significativas quanto as variáveis demográficas. O grupo TAS apresentou no QSG-12 mais dificuldades quanto ao bem estar geral, e na ELAPF e na ELHPF apresentou, com significância estatística, mais dificuldades nas últimas semanas e no curso da vida. Observou-se para o grupo TAS: a) para a ELHPF, consistência interna de 0,68 no curso da vida e 0,67 nas duas últimas semanas, o coeficiente de correlação Kappa entre os avaliadores, variou de 0,75 a 0,93, caracterizando nível de concordância satisfatória e na análise dos componentes principais extrairam-se dois fatores para os dois parâmetros temporais; a validade concorrente realizada com o SPIN, mostrou valores que variaram entre 0,11 e 0,33 para o parâmetro no curso da vida e 0,17 a 0,39 nas duas últimas semanas, e b) para a ELAPF, a consistência interna foi de 0,85 para o parâmetro no curso da vida e 0,83 nas duas últimas semanas e na análise dos componentes principais extrairam-se três fatores, para o parâmetro temporal no curso da vida e dois fatores no parâmetro nas duas últimas semanas; a validade concorrente realizada em relação ao SPIN, mostrou valores no curso da vida de -0,14 a 0,25 e nas duas últimas semanas, a correlação variou de 0 a 0,38. Os estudos de casos evidenciaram que os prejuízos funcionais associados ao TAS têm impacto negativo para os relacionamentos, as atividades cotidianas, o bem estar e a percepção de saúde. As escalas , mostraram-se válidas para a avaliação dos prejuízos funcionais associados ao TAS, o que contribui para as práticas de saúde mental, em especial as de terapia ocupacional, que tem como foco as intervenções voltadas para a vida cotidiana. / Social Anxiety Disorder (SAD) is characterized by marked and persistent fear of social or performance situations and is associated with functional impairment. The objective of the present study was to assess the association of SAD with functional impairment in daily activities by means of the validation of two scales (auto and hetero-evaluation) applied to Brazilian university students. Two studies were conducted, one of them comparing SAD and Non SAD groups and the other consisting of cases studies. The Liebowitz Disability Self Rating Scale (LDSRS) and the Disability Profile /Clinician- Rated (DP) were translated and adapted. A total of 173 university students (SAD = 84 and Non-SAD = 89) of both genders, aged 17 to 35 years participated in the study of group comparison. A semi-structured clinical interview for DSM-IV was applied for confirmation of the diagnosis and the following instruments were applied: LDSRS, DP, General Health Questionnaire-12 (GHQ-12), and Social Phobia Inventory (SPIN). Three participants of the SAD group were selected for the case studies and submitted to a semi-structured interview about the impact of the disorder on daily activities, relationships, and general health. The scale data were coded and the groups were compared by a non-parametric test (p 0.05), and for the case studies the scale and interview data were integrated and analyzed qualitatively. The groups did not differ significantly in terms of demographic variables. For the SAD group, application of the GHQ-12 revealed more difficulties regarding general well-being, and application of the LDSRS and DP revealed significantly more lifetime difficulties and difficulties in the last weeks. The following observations were made for the SAD group: a) for the DP, the internal consistency was 0.68 during the life course and 0.67 during the last two weeks; the Kappa correlation coefficient for the two raters ranged from 0.75 to 0.93, characterizing a satisfactory level of concordance, and two factors for the two temporal parameters were extracted in the analysis of the principal components; concurrent validity performed with the SPIN showed values ranging from 0.11 to 0.33 for the lifetime parameter and from 0.17 to 0.39 for the last two weeks, and b) for the LDSRS, the internal consistency was 0.85 for the lifetime parameter and 0.83 for the last two weeks; concurrent validity performed with the SPIN showed lifetime values ranging from 0.14 to 0.25 and values ranging from 0 to 0.38 in the last two weeks. The case studies demonstrated that the functional impairment associated with SAD has a negative impact on relationships, daily activities, well-being, and health perception. The scales proved to be valid for the assessment of the functional impairment associated with SAD, a fact that contributes to mental health practices, especially those of occupational therapy, that focus on interventions in daily life.

Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Despite the severity of illness in this country, very few data have been reported previously regarding investigations of IE in the Czech Republic. Consequently, a retrospective evaluation of local IE cases at one of the country's largest medical centers was conducted. Our aim was to analyze the characteristics of this disease in our country. The greatest interest was devoted to Staphylococcus aureus (S. aureus), etiological agent that has been associated with the worst course of IE episodes. The hypothesis of our study was that infective endocarditis caused by S. aureus, in comparison with other etiological agents, is associated with worse course of the disease. We evaluated the structural (abscess formation, impaired integrity of heart valves, systemic embolism) and functional (incidence of heart failure and conduction disturbances, in-hospital mortality) manifestations of IE. Of all studied parameters, only embolism and S. aureus as the causative agent were...

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness.The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. Results: Statistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness.The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. Results: Statistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.