M.A. / In the Western world, anorexia nervosa has long been regarded as an age-old medical syndrome and was conceded to have reached epidemic proportions in white South African females by the 1970s. On the contrary, it has been deemed to be non-existent in indigenous African females, this being attributed to the African socio-cultural preference for the fuller figure. The first clinical case in an indigenous female was reported in Nigeria (Nwaefuna, 1981). In South Africa, the first diagnosis in 1993 and earliest reporting of three cases by Szabo, Berk, Tlou and Allwood (1995) coloured the face of prevailing conceptualisation and was viewed as a nascent indication of global acculturation to a Western lifestyle and value system. This research represents the researcher’s invitation to the reader to embark on an exploratory journey into the biographically situated experience of anorexia nervosa as revealed through the personal experience stories of three black South African female participants. With the researcher’s quest to explore this as a uniquely human, lived experience, it became essential to open up the life of each participant as the arena in which this experience unfolded, so that seminal vicissitudes as well their sense of self in the course of this experience could be gleaned. Further, the researcher shied away from a fait accompli acceptance of the acculturation discourse and sought to interrogate it by giving voice to participants’ lived sense of the relationship between this experience and their cultural identity and affiliation. As its dialectic, the researcher also allowed participants to give voice to the cultural scrutiny of their experience through the lens of their culturally-referent others. Finally, the researcher opened up some of the seminal vicissitudes of her personal experience as the space for introspection and reflection on nuances and resonance between her experience and that of participants, without a concomitant attempt to generalise about either. Through post-modernist interpretive interactionism (Denzin, 1989), the researcher undertook a comprehensive deconstructive review of biopsychosocial discourses on the experience of anorexia nervosa, which sought to uncover and juxtapose various underlying models of human action. This review also included a feminist lens, which allowed that images and conceptions of women that exist within these discourses could be revealed, while simultaneously offering a critique of inherent culturally gendered dynamics. Through metaphoric simultaneity, the crystallised use of personal stories, drawings and naïve sketches sought to provide deepened, complexified and, if it be so, competing accounts of participants’ experience. The researcher drew a number of conclusions pursuant to participants’ experience of anorexia nervosa. First, that although biological factors could not be excluded, especially the role of genetics and hormones in adolescence, the exact nature thereof was beyond the scope of this inquiry and therefore inferential. Second, that although there were varying degrees of resonance in participants’ experience with some of the macro socio-cultural discourses considered, these did not appear to have been pathogenically pre-eminent. Third, that in the exploration of particular vicissitudes of participants’ family relational dynamics, the embryonic seeds and gestalt effect of their susceptibility matrix was vividly exposed. All factors considered, the researcher stands strongly in the opinion that gleaning this as the personal experience of three black female participants and drawing in sediments of her own personal experience, anorexia nervosa is ultimately a uniquely individual experience that stands as a covert and metaphoric language of personal distress. While it may sometimes overlap with some of the dynamics that have coloured the socio-cultural landscape in different epochs, it has its own dynamics and internal logic that is uniquely and inextricably tied to the specific vicissitudes of each person’s biographically constructed self. The specific probing of participants’ cultural identity and affiliation served to confirm that while the evolving cultural identity and affiliation of black females may be undeniable, the prevalent causal attribution of anorexia nervosa to acculturation appears to have been compellingly shown in this case to be an external and cursory one. Finally, the specific probing of participants’ experience through the eye of their culturally-referent others revealed that anorexia nervosa is culturally enigmatic. Its attribution, in participants’ socio-cultural context, to witchcraft, acculturation and especially to HIV and AIDS and attendant stigmatisation and shaming of an already deeply wounded person serves to indicate the degree of distress, isolation and rejection experienced by sufferers. By the same token, it also serves to illumine the felt equivalence of this period in participants’ socio-cultural context with HIV and AIDS. This study represents the researcher’s endeavour to convey participants’ experience of anorexia nervosa in its richness, in an attempt to render it understandable, without any concomitant attempt to foreclose or pretence of being exhaustive. Therefore, it recognises that the understanding presented here inalienably represents the researcher’s hermeneutic circle. The reader is thus invited, if not challenged, to discern their own understanding. Finally, it offers itself as a signpost for future research into what by all accounts, stands starkly as an untapped minefield.

INTRODUÇÂO: Fibromialgia é caracterizada como síndrome, a qual inclui dor muscular, fadiga e distúrbio do sono. Ansiedade e depressão estão freqüentemente associados, porém a causa é desconhecida. A intensidade da dor piora ao se deitar, durante a noite e no despertar. Normalmente a dor se difunde na região lombar e cervical. A TENS é um método não medicamentoso, estabelecido para controle da dor, o qual minimiza o consumo de analgésicos. OBJETIVOS: Este estudo visou avaliar a utilização de dispositivos de TENS simultâneos em pacientes portadores de Fibromialgia. MÉTODOS: Após aprovação do Comitê de Ètica em Pesquisa e consentimento, 39 pacientes portadores de Fibromialgia foram avaliados de forma prospectiva, aleatória e duplamente-encoberta. Avaliou-se a utilidade clínica de um novo, muito pequeno e leve dispositivo de a TENS (TANYX). Dois dispositivos de TENS, foram aplicados de forma simultânea em cada paciente: 1) na região lombar (perpendicular à coluna sobre L5), e 2) na região cervical (perpendicular à coluna, entre C7 e T1), durante 20-min, a cada 12 horas, durante 7 dias consecutivos (antes de se deitar, à noite, e antes de se levantar, pela manhã). Os pacientes foram divididos em 3 grupos (n=13). O grupo placebo (GP) utilizou adesivos que não transmitiam estímulo elétrico, semelhantes aos originais. O grupo de únicoTENS (TENS-1) (n=13), utilizou um adesivo de TENS ativo na área mais dolorida (cervical ou lombar) e placebo na área menos doloroa. O terceiro grupo (TENS-2) utilizou dois adesivos ativos de TENS nas áreas cervical e lombar, simultaneamente. Para controlar a dor, diclofenaco (50mg) foi utilizado como analgésico de resgate, até três vezes ao dia. Foram avaliados a intensidade da dor através da escala numérica visual (ENV 0-10 cm), consumo de analgésicos de resgate, qualidade do sono e fadiga. RESULTADOS: Os pacientes foram demograficamente semelhantes. 36 pacientes completaram o estudo. Três pacientes do grupo placebo desistiram no 4o dia de ausência de alívio da dor. A avaliação entre cada grupo antes e após o tratamento revelou que pacientes do grupo placebo não apresentaram alívio da dor (ENV 8 cm, p>0,05), da fatiga, ou melhora do padrão de sono, enquanto o grupo TENS-1 apresentou diminuição de 2,5 cm na ENV para dor (ENV anterior 8,5 cm e após 6 cm) (p<0,05). Finalmente, o grupo TENS-2 referiu redução de 4 cm na intensidade da dor (ENV anterior ao tratamento 8,5 cm e 4,3 cm após tratamento) (p<0,02). O consumo de analgésicos diários foi menor para TENS-1 (p<0,05) e TENS-2 (p<0,02). A comparação entre os 3 grupos revelou que a analgesia, qualidade de sono e melhora da fadiga foi: grupo TENS-2 > TENS-1 > GP (p<0,05). Os participantes consideraram os aparelhos ativos úteis. Não foram observados efeitos adversos. CONCLUSÕES: enquanto a aplicação de um dispositivo de TENS na área dolorida, lombar ou cervical, amenizou a dor em pacientes portadores de fibromialgia, a fadiga e a qualidade do sono foram minimizadas apenas quando dois dispositivos foram utilizados, demonstrando que este novo dispositivo pode ser adjuvante para dor da fibromialgia. / BACKGROUND: Fibromyalgia is characterized by a range of symptoms that include muscle pain, fatigue and sleep disorders. Anxiety and depression are often also present, and the cause is unknown. Worst pain is normally felt during bedtime, at night and before waking up in the morning, and pain is normally widespread at the low back and cervical area. Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief, which does not involve the use of medication and can be advantageous, as adjuvant, for pain control. OBJECTIVES: The purpose of the study was to evaluate the effectiveness and safety of the use of two simultaneously new TENS devices for Fibromyalgia pain. METHODS: The local Ethics Committee approved the study, and informed consent was obtained. This prospective, double-blind randomized study evaluated the clinical utility of a new, very small and light, high frequency TENS device (TANYX) in 39 patients suffering from Fibromyalgia. Two TENS device were applied simultaneously in each patient: 1) at the lower back (perpendicular to the vertebrae canal, at the level of the 5th lumbar vertebrae), and 2) centrally above and below the space between the C7 and T1 spinous processes, perpendicular to the spine. The two devices were applied during 20-min at 12-hour interval during 7 consecutive days (Before bed-time and just after waking up in the morning). Patients were randomly divided into three groups (n=13): For the placebo group (PG), the two devices did not transmitted electrical stimulus, although they were externally similar to the active ones. The single-TENS group (STG) had applied one active TENS device at the worst area of pain (low back or cervical), and the placebo device at the less painful area. The third group double-TENS group (DTG) applied both active TENS devices at the low back and cervical areas. Diclofenac (50 mg) up to three times daily was used as rescue analgesic if necessary for pain control. The efficacy measures were pain relief evaluated on a visual analogue scale (VAS 0-10 cm),, reduction in use of daily analgesic tablets, quality of sleep, and fatigue. MAIN RESULTS: Patients were demographically similar. 36 patients completed the study. Three patients from the PG give up the study on the fourth day for absence of any pain relief. The evaluation within groups revealed that patients from DPG refereed no pain relief when compared to their previous VAS pain score (8-cm, p>0.05), while patients from the STG refereed improvement of 2.5 cm in the pain VAS (previous 8.5 cm compared to 6-cm after treatment) (p<0.05); and the DPG refereed daily maintained reduction of 4 cm in the VAS-pain (previous 8.5-cm to 4.3-cm) (p<0.02). Concurrent daily consumption of analgesic tablets was reduced in both STG (p<0.05) and DTG (p<0.02). Comparison among groups revealed that analgesia, as well as quality of sleep and disposition was: DTG > STG > PG (p<0.05). Participants subjectively found the active device useful. No adverse effects were observed. CONCLUSIONS: while the application of one active TENS device at either the lower back or cervical area improved pain relief in patients suffering from Fibromyalgia pain, the pain and fatigue were further improved when two actives devices were simultaneously applied, reflecting this new device an useful adjuvant for Fibromyalgia pain.

Thesis advisor: Barbara E. Wolfe / Background: Anorexia nervosa (AN) is a serious mental illness with physical and emotional consequences. Currently, there are limited effective treatments available to address this devastating condition. One possible biomarker implicated in this condition is brain derived neurotrophic factor (BDNF), a member of the neuron growth family. Pre-clinical studies indicate administration of BDNF is associated with decreased food intake and weight loss. Serum BDNF levels also have been shown to be reduced in AN compared to healthy controls (HC). In studies of selective serotonin reuptake inhibitors (SSRI's), blood levels of BDNF have been shown to increase following SSRI administration. This study sought to examine the possible relationship between peripheral BDNF levels and influence of an SSRI, and augmentation with 5-hydroxytryptophan (5-HTP) in persons with AN and HC's. Methods: This study examined previously collected samples from an investigation assessing the influence of SSRI administration and augmentation with 5-HTP on serotonin function in AN. The original study utilized a randomized double-blind placebo-controlled design. AN (n=16) and HC (n=49) subjects were randomized to 1 of 3 treatment conditions (fluoxetine, fluoxetine plus 5-HTP, and placebo) for 7 days of drug administration. Blood samples were collected following an overnight fast and stored at -70°C prior to batch analysis (ELISA). Results: Plasma BDNF levels in AN subjects (59.7 (SD 43.3) pg/ml) were not significantly (p=0.24) different from HC's (76.2 (SD 49.0) pg/ml). There were no significant differences between SSRI, SSRI plus 5-HTP, and placebo treatment groups within or between AN and HC groups. Conclusions: Although BDNF levels in AN subjects were lower than HC, the difference was not statistically significant. After 7 days of SSRI, SSRI plus 5-HTP, or placebo, there were no differences in BDNF levels between or within groups. The possibility exists that 7 days is not long enough to see an expressed effect of SSRI's on BDNF. Future studies would benefit from longer duration of SSRI's, assessing potential covariates (e.g. BMI, depression), and a larger sample. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Barbara E. Wolfe / The core defining features of bulimia nervosa (BN) are repeated binge eating episodes and compensatory purging behavior. The biobehavioral aspects of binge eating are complex and not fully understood. One area of recent interest is the role of the satiety-signaling peptide cholecystokinin (CCK). Previous research observed a blunted postprandial plasma CCK response in those with BN, therefore suggesting this may be a cause, consequence, or maintenance factor in binge eating. It is unknown whether this altered response is due to a state versus trait phenomenon, thus having implications in the development of clinical treatment strategies. To examine the nature of this altered response, this study assessed whether CCK normalizes following remission from BN (RBN). This biobehavioral study utilized a comparative design to prospectively evaluate the biological CCK response and the corresponding behavioral ratings of satiety and other eating-related sensations in individuals with BN (n=10), RBN (n =14), and healthy controls (CON, n=13). CCK and behavioral ratings were assessed at baseline, +15, +30, and +60 minutes following the ingestion of a standardized liquid test meal. The BN group's CCK response was blunted and approached significance (p =.052) when compared to the RBN and CON groups. As predicted the RBN and CON groups' CCK response did not significantly differ. This finding supports the premise that CCK may normalize following abstinence from binge and purge (vomit) episodes and that this is a state versus trait related phenomenon. A significant positive relationship between CCK response and ratings of satiety occurred in the RBN group only (r=.59, p<.05). A new and unanticipated finding in the BN group was a significant relationship (r=.86, p < .01, two-tailed) between their CCK response and urge to vomit. A greater urge to vomit was reported by those individuals who had increased CCK response. Therefore, it is unknown whether the normalization of CCK functioning is a protective or liability factor in the stabilization and recovery process. Replication studies utilizing a larger sample size are needed to understand the role of CCK in recovery and the subsequent development of novel treatment strategies for those suffering with BN. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Esta tese teve por objetivo validar e pesquisar a confiabilidade da Sessão de Transtornos Alimentares do DAWBA (“Development and Well-Being Assessment"), um pacote de entrevistas e técnicas de avaliação planejado para ser aplicado por entrevistadores sem experiência clínica prévia, para rastrear e diagnosticar transtornos alimentares em crianças e adolescentes do sexo feminino, de 7 a 17 anos, em estudos epidemiológicos. Participaram deste estudo 174 crianças e adolescentes de 8 a 17 anos, do sexo feminino, procedentes de três grupos: (1) 48 meninas com transtornos alimentares; (2) 55 controles clínicos – 21 em tratamento para depressão unipolar, 14 em tratamento para transtorno obsessivo-compulsivo e 20 em tratamento para doença gastrointestinal – e (3) 71 controles comunitários. Um dos pais de cada menina também foi entrevistado com o instrumento. Foram eleitos sujeitos destes três grupos para pesquisar a validade discriminante do instrumento quanto à sua capacidade de diferenciar jovens com transtornos alimentares e outros transtornos físicos ou psiquiátricos mimetizantes. O diagnóstico da presença ou não de transtorno alimentar – anorexia e bulimia nervosas e síndromes parciais - em cada sujeito, foi gerado utilizando-se três métodos diferentes independentes: (1) diagnóstico padrão-ouro, baseado no DSM-IV e CID-10, estabelecido através de entrevista clínica livre do pai e da menina juntos, realizada por psiquiatra infantil especialista em transtornos alimentares, cego para o grupo de origem da menina; (2)diagnóstico preliminar do computador gerado por algoritmo específico baseado na CID-10 e DSM-IV levando em considerando a informação estruturada coletada pelo instrumento e (3) diagnóstico final DAWBA, estabelecido por especialista treinado, baseado na CID-10 e DSM-IV, através da revisão cuidadosa dos relatórios fornecidos pelo software DAWBA com o resumo das informações colhidas com o instrumento. A validade concorrente dos diagnósticos DAWBA (preliminar do computador e final) foi pesquisada mediante comparação com o diagnóstico padrão ouro. A confiabilidade teste-reteste foi pesquisada reaplicando o instrumento duas ou três semanas após a primeira utilização, em 55 sujeitos (7 com transtornos alimentares, 20 controles clínicos e 28 controles comunitários). Os aplicadores estiveram cegos (tanto no teste quanto no reteste) para o grupo de origem do sujeito. Pesquisou-se a consistência interna (Alfa de Crombach) e os melhores pontos de corte das cinco questões de rastreamento, bem como sua sensibilidade e especificidade. Houve diferença significativa na média de idade entre os grupos com transtornos alimentares (média de 16,0 anos) e controles clínicos (média de 14,5 anos). Para a detecção de qualquer transtorno alimentar segundo o DSM-IV e a CID-10, o diagnóstico final pelo DAWBA apresentou sensibilidade de 100% e especificidade de 94%. Houve boa concordância teste-reteste (Kappa de 0,81) e boa consistência interna das questões de rastreamento, sendo o Alfa de Crombach de 0,76 na entrevista com as meninas e 0,81 na entrevista dos pais. Os melhores pontos de corte nas questões de rastreamento foram de dois e três, observando que, para um ponto de corte de três a sensibilidade foi de 89,8% em ambas as entrevistas (meninas e pais) e a especificidade de 85,6% na entrevista das meninas e 85,5% na entrevista dos pais. Foram limitações do estudo a diferença significativa na média de idade entre os grupos ‘com transtornos alimentares’ e ‘controles clínicos’, a não inclusão de crianças com transtornos alimentares menores de 11 anos e a impossibilidade de estabelecer comparações entre os grupos com relação a variáveis sócio-econômicas. Desta forma, pode-se concluir com o presente estudo que a Sessão de Transtornos Alimentares do DAWBA apresenta boa validade e confiabilidade no rastreamento e diagnóstico de transtornos alimentares em crianças e adolescentes do sexo feminino e tem aplicabilidade tanto em pesquisa clínica quanto em estudos epidemiológicos comunitários. / This thesis concerns the validation and investigation of the reliability of The Eating Disorders Section of The Development and Well-eing Assessment (DAWBA), a package of interviews and assessment techniques designed to be administered by trained interviewers without previous experience in eating disorders, for screening and diagnosis in epidemiological studies of eating disorders in female children and adolescents, from 7 to 17 years old. This study was carried out with the participation of 174 female children and adolescents, from 8 to 17 years old, recruited from three groups: (1)48 girls with eating disorders; (2) 55 clinical controls – 21 in treatment for unipolar depression, 14 for obsessive compulsive disorder and 20 for gastrointestinal disease – and (3) 71 community controls. One of the parents of each girl was also interviewed with the measure. Subjects were recruited from the three groups to assess the discriminant validity of the measure concerning its ability in discriminate girls with eating disorders from other mimicking psychiatric or physic disorders. The diagnosis of the presence or not of eating disorder in each subject – anorexia, bulimia nervosa and partial syndromes – was made using three different independent methods – (1) gold standard diagnosis, based on DSM-IV and ICD-10, assigned through free clinical interview of the parent and the girl together, made by a child and adolescent psychiatrist specialized in eating disorders, blind to the group of origin of the girl; (2) preliminary computer diagnosis, generated by a specific algorithm based on ICD-0 and the DSM-IV, using the structured information collected with the measure and (3) final DAWBA diagnosis, established by a trained specialist, based on DSM-IV and ICD-10, through the careful review of the information on the reports provided by the DAWBA software, containing the abstracts of the information collected by the measure. The concurrent validity of the DAWBA diagnoses (computer preliminary and final) was assessed through the comparison with the gold standard. The test-retest reliability was assessed reassessing 55 subjects (7 with eating disorders, 20 clinical controls and 28 community controls) with the measure two or three weeks after the first assessment. The DAWBA interviewers were blind (both in test and retest) for the origin group of the subject. Internal consistency (Crombach Alpha), best cutoffs in the screening questions, sensibility and specificity were assessed. There was a significant difference in mean age between the eating disorder (mean = 16 years) and clinical control (mean = 14,5 years) groups. For the detection of any eating disorder according the DSM-IV and ICD-10, the final DAWBA diagnosis presented sensibility of 100% and specificity of 94%. There was good test-retest agreement (Kappa = 0,81) and good internal consistency in the screening questions, being the Crombach Alpha of 0,76 in the girls interview and 0,81 in the parent interview. The best cutoffs on the screening questions were two and three, noting that for a cutoff of three the sensibility was 89,8% in both interviews (girls and parents) and the specificity was 85,6% for the girls interview and 85,5% for the parent interview. The significant difference in mean age between the eating disorder and clinical control groups, not including children with eating disorders younger than 11 years old and the absence of comparisons of social economic variables between groups were limitations of this study. In summary, the present study shows that The Eating Disorders Section of the DAWBA has good validity and reliability for the screening and diagnosis of female children and adolescents with eating disorders and has applicability both in clinical and community settings.

Introdução: O estado nutricional da gestante constitui importante fator para o desenvolvimento do feto e da gravidez saudável. Mulheres que apresentam ingestão inadequada de nutrientes têm maior probabilidade de desenvolver gestação de risco. Essa problemática é especialmente intensa quando a mulher apresenta quadro de transtorno alimentar (TA). Este trabalho abordou aspectos históricos, etiologia e epidemiologia dos TA, contemplou os critérios diagnósticos, concebeu os TA no período gravídico puerperal e dissertou sobre TA, sintomatologia ansiosa e depressiva. Os objetivos deste estudo foram determinar a prevalência de TA em gestantes com intercorrências clínicas e verificar a associação com sintomatologia ansiosa, depressiva e atitudes alimentares. Método: Estudo prospectivo transversal foi realizado com 913 gestantes com intercorrências clínicas que estavam no 2° ou 3° trimestre gestacional no ambulatório da Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foi utilizada entrevista dirigida, para avaliação de picacismo; o EAT-26, para avaliar as atitudes alimentares; Structured Clinical Interview for DSM Disorders, para diagnóstico clínico de TA e a escala Hospital Anxiety and Depression, para análise da sintomatologia ansiosa e depressiva. Os dados deste estudo foram submetidos à análise quantitativa e avaliados por meio do programa IBM SPSS for Windows versão 20.0. Resultados: constatou-se prevalência de transtorno alimentar em 7,6% (n=69) (IC 95%: 5,84%-9,28%), sendo 0,1% (n=1), anorexia nervosa; 0,7% (n=6), bulimia nervosa; 1,1% (n=10), transtorno da compulsão alimentar e 5,7% (n=52), picacismo. Encontrou-se significância estatística quando associado TA com as variáveis: religião (p=0,02), abortamento provocado anterior (p < 0,01), tempo de relacionamento (p=0,01), renda per capita (p=0,04), número de gestações (p < 0,01) e número de filhos vivos (p < 0,01). Quanto às atitudes alimentares, observou-se significância estatística com \"sentir-se mal após comer doces\" (p=0,02) e \"passar muito tempo pensando em comida\" (p < 0,01). Constatou-se ainda associação positiva com sintomatologia ansiosa (p < 0,01) e com sintomatologia depressiva (p < 0,01). Conclusão: a prevalência de TA encontrada (7,6%) e sua associação com sintomatologia ansiosa e depressiva, durante a gestação, apontam para a necessidade de cuidados especializados no que diz respeito à prevenção, diagnóstico e tratamento. Dada a importância da alimentação adequada no período gestacional, tanto no que diz respeito à saúde materna, quanto ao desenvolvimento fetal, torna-se necessário implementar, pelos profissionais de saúde, avaliação específica com protocolo predeterminado para diagnóstico de TA no período gestacional / Introduction: The nutritional status of the pregnant woman represents an important factor for the development of the fetus and for a healthy pregnancy. Women who have inadequate nutrient intake are more likely to develop a risky pregnancy. This problem is particularly severe when the woman presents an eating disorder (ED). This paper discusses the historical aspects, etiology and epidemiology of ED, considers the diagnostic criteria, delineates ED in the puerperal pregnancy period and addresses ED, anxiety and depression symptoms. The aims of this study were to estimate the prevalence of ED in pregnant women with clinical complications and to assess the relationship between anxiety and depression symptoms and eating attitudes. Methods: A transversal and prospective study was conducted with 913 women between 2nd and 3rd trimester with high-risk pregnancies in the Obstetrics Clinic Division of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. We conducted structured interviews for the assessment of pica, Structured Clinical Interview for DSM Disorders for diagnostic of ED and Hospital Anxiety and Depression Scale for anxiety and depression symptoms, and applied the EAT-26 questionnaire for eating attitudes. The data analysis was quantitative and conducted with the IBM SPSS for Windows, version 20.0. Results: Lifetime prevalence of ED was 7.6% (n=69) (95% CI: 5.84%-9.28%), 0.1% (n=1) for anorexia nervosa; 0.7% (n=6) for bulimia nervosa; 1.1% (n=10) for binge eating disorder, and 5.7% (n=52) for pica. ED was statistically significant with respect to the following variables: religion (p=0.02), previous induced abortion (p < 0.01), being in a relationship (p=0.01), per capita income (p=0,04), number of previous pregnancies (p<0.01) and number of children (p < 0.01). For the eating attitudes, statistical significance was found with \"feeling ill after eating sweets\" (p < 0.02) and \"spend too much time thinking about food\" (p=0.05), as well as between ED and anxiety (p < 0.01) and depressive symptoms (p < 0.01). Conclusion: The prevalence of ED (7.6%) and its association with anxiety and depression symptoms during pregnancy highlights the need for specialist care for prevention, diagnosis and treatment. Given the importance of proper nutrition during pregnancy, both with regard to maternal health and fetal development, it is necessary to have specific predetermined evaluation protocols implemented by health care professionals for the diagnosis of ED during pregnancy

Encontramos no bulbo diversos núcleos, assim como diversos neurotransmissores, relacionados com a manutenção da pressão arterial. Dentre os núcleos, o núcleo do trato solitário se destaca por ser um dos principais moduladores do sistema nervoso autônomo, sendo o primeiro a receber aferências dos barorreceptores e encaminhá-los para diversos outros núcleos. Dentre estes neurotransmissores, encontramos o glutamato e as catecolaminas, sendo ambos essenciais para a manutenção da pressão arterial. É sabido que a atuação de transmissores em células do sistema nervoso pode levar a alterações em outras vias de neurotransmissão, alterando assim a resposta das células a estímulos. Levando em consideração a importância do glutamato e das catecolaminas na modulação da pressão arterial, e que tanto os receptores glutamatérgicos quanto catecolaminérgicos podem interferir no metabolismo celular e gerar mudanças estruturais nos neurônios, cogitamos que a atuação do sistema glutamatérgico poderia modular o sistema catecolaminérgico. Neste trabalho, avaliamos se o sistema glutamatérgico e catecolaminérgico podem interagir em culturas de células do bulbo de ratos neonatos, a partir de tratamentos das culturas com glutamato ou noradrenalina. Observamos que o tratamento destas culturas com glutamato leva a uma redução nos níveis de proteína e de mRNA da enzima tirosina hidroxilase e do receptor _2 adrenérgico. A modulação do sistema glutamatérgico a partir de tratamentos com noradrenalina não mostrou variações significativas. Concluímos que o sistema glutamatérgico pode modular o sistema catecolaminérgico em células do bulbo de ratos neonatos, e que esta modulação pode ser importante na regulação da pressão arterial pelos núcleos bulbares. / It is found in the medulla oblongata several nuclei, as well as several neurotransmitters, related with the maintenance of the arterial pressure. Among these nuclei, the nucleus of the solitary tract stands aside for being one of the main modulators of the autonomic nervous system, being the first to receive afferences from baroreceptors and to send their stimuli to other nuclei. Among these neurotransmitters, glutamate and the catecholamines are both essentials to the maintenance of the arterial pressure. It is known that the stimulation of brain cells by neurotransmitters can result in changes in other neurotransmitter pathways, changing the cell response to certain stimuli. Taking in consideration the importance of glutamate and the catecholamines in the modulation of the arterial pressure, and that both of them can interfere in the cellular metabolism and create structural changes in neurons, we have speculated that the stimulation of the glutamatergic system could modulate the catecholaminergic system. In this work, it was evaluated if the glutamatergic and catecholaminergic systems could interact in cell cultures of the medulla oblongata of newborn rats, from treatments of the cultures with glutamate or noradrenaline. It was found that the treatment of these cultures with glutamate leads to a reduction in the protein and mRNA levels of the enzyme tyrosine hydroxylase and the receptor _2 adrenergic. The modulation of the glutamatergic system from treatments with noradrenaline did not show significative variation. We concluded that the glutamatergic system can modulate the catecholaminergic system in medulla oblongata cell cultures, and that this modulation can be important in the regulation of the arterial pressure by nuclei present in the medulla oblongata.

Bakgrund: Anorexia Nervosa (AN) är en allvarlig psykisk sjukdom som drabbar främst unga kvinnor. AN innebär att personerna har en rädsla för viktuppgång och en skev kroppsuppfattning. Rädslan för viktuppgång resulterar till en allvarlig viktminskning. Den skeva kroppsuppfattningen kan påverkas av samhällets skönhetsideal. Sjukdomen påverkar inte bara den drabbade utan hela familjen drabbas. Sjuksköterskan bör skapa en god vårdrelation till personer med AN eftersom det är betydelsefullt för den fortsatta vården. Syfte: Syftet med studien var att belysa unga kvinnors upplevelse av att leva med Anorexia Nervosa. Metod: En kvalitativ litteraturstudie med induktiv ansats. Data analyserades utifrån en manifest innehållsanalys som baseras på fem självbiografier. Resultat: Unga kvinnors upplevelser av att leva med AN innebar ett stort lidande. Livsvärlden förändrades samtidigt eftersom de kände en ökad livskraft med hjälp från vårdpersonal och familjen. Resultatet presenteras i tre kategorier och tillhörande underkategorier. Kategorierna är: Leva med röstens kommentarer, Sjukdomen påverkar ständigt och Bevara kontrollen i sjukdomen. Slutsats: Personer med AN finner det jobbigt att förlora sitt självbestämmande till sjukdomen och andra vilket kan medföra ett ökat lidande. Det är viktigt att sjuksköterskan skapar tillit hos de unga kvinnorna med AN i syfte att öka livskraften för att bli fri från sjukdomen.

Background: It is posited that attachment difficulties in infancy may result in reduced mentalisation capacity (understanding self and others’ subjective thoughts/mental processes), leading to potentially deleterious psychopathological outcomes such as eating disorders. The exact nature of the relationship between mentalisation and eating disorders/disordered eating is unclear however. Objectives: A systemic review examined whether those with Anorexia Nervosa (AN) experience mentalisation deficits compared to those without EDs. An empirical study, examining the link between mentalisation and disordered eating (DE) in an adolescent sample, was conducted to assess whether borderline trait features mediated the relationship between the two constructs. Method: A systematic search of 6 databases was conducted, and articles were assessed against predetermined inclusion/exclusion criteria. Included articles were assessed against 14 quality criteria and study findings were reported. For the empirical study, 162 participants aged 12-18 completed a questionnaire pack including mentalisation, borderline traits, impulsivity, emotion dysregulation and depression scales, and sociodemographic questions. Results: Results from 10 articles indicated those with AN may experience subtle mentalisation deficits, particularly in recognising negative emotions in others. Mentalisation ability may also vary according to interpersonal context. Mediation analyses found mentalisation ability exerted a significant effect on DE indirectly through borderline trait features, and partially through emotion dysregulation, but not impulsivity. Conclusion: More robust empirical studies are required in order to assess the relationship between mentalisation and AN. Findings regarding the link between mentalisation, borderline traits and DE may further aid psychological assessment/treatment. Therapies where the main focus is improving mentalisation capacity may be useful.

Este estudo apresenta a criação e análise da Sessão de Transtornos Alimentares do DAWBA, um instrumento construído para rastrear e fornecer, em estudos epidemiológicos, o diagnóstico de transtorno alimentar (TA) - anorexia e bulimia nervosas e síndromes parciais - em meninas de 8 a 17 anos. O estudo ocorreu em 3 fases: (1) criação do instrumento, (2) aprimoramento aplicando-o em 45 mulheres e seus familiares e (3) aprimoramento testando-o em 30 meninas e seus pais. Participaram das fases 2 e 3 sujeitos com TA, transtornos obsessivo-compulsivo e depressivo unipolar e com doenças de acometimento gastrintestinal. Dessa forma, produziu-se a versão final do instrumento, que está pronta para validação / This study presents the creation and analysis of The Eating Disorders Section of The DAWBA, a measure designed for epidemiological studies to screen and diagnose eating disorders (ED) - anorexia and bulimia nervosa and partial syndromes - in 8 to 17 year-old girls. The study was carried out in 3 phases: (1) measure creation, (2) refinement by applying it to 45 women and their relatives and (3) fine-tuning by testing it in 30 girls and their parents. Phases 2 and 3 involved subjects with ED, obsessive-compulsive and unipolar depression disorders and gastrointestinal disease, producing the final version of the measure, which is ready for validation