This master thesis focuses on atopic eczema in children and adolescents from a psychological perspective. The aim of this text is to describe and emphasize the psychological aspects of this disease and characterize the areas it may concern and affect. Regarding the structure, the thesis is divided into three parts. The introductory theoretical part is focused on a description of the explored subject-matter, the aim was to submit a comprehensive perspective on this disease and outline a relevant psychological basis for the empirical enquiry. The second empirical part is focused on the intrinsic aspects of the experience of this disease in children and adolescents. The quantitative research was designed to map out the specific phenomena, incidence of depressive symptoms and family upbringing style. The quantitative research is complemented by a qualitative inquiry with the aim to get further into depth of the issue by means of two case studies. These were focused on the overall experience related to the diagnosis of atopic eczema. The final part reflects acquired findings and the conclusive discussion summarizes the results of the exploratory assumptions including the limits and the possibilities of future psychological work with this disease. Keywords Atopic eczema, psychosomatic approach,...

The objective of the study is to analyze the factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis. The methodology used is based on a cross-sectional study in patients receiving hemodialysis at the Centro Nacional de Salud Renal. Severe pruritus was defined as a score on the visual analogue scale greater than or equal to 7, and the strength of association with the possible risk factors was assessed by calculating prevalence ratios. Regarding the results, 264 patients were included, 59.9% were male, with a mean time on hemodialysis of 10.26 ± 7.14 years. 75% experienced pruritus, of this group, 1 in 3 presented severe pruritus. Hyperphosphatemia and the use of antihistamines were associated with a higher prevalence of severe pruritus (RP 1.71, 95% CI 1.09-267 and RP 2.39, 95% CI 1.51-3.75, respectively). The positive serology for Hepatitis C Virus was described as a protective factor for presenting severe pruritus (RP 0.55, 95% CI 0.33 - 0.89). In conclusion, severe uremic pruritus is a frequent problem in patients with chronic terminal kidney disease who have hyperphosphatemia and treatment with antihistamines independently of the time they have been on hemodialysis. / Revisión por pares

Bakgrund: Klåda nämns vanligen i samma andetag som hudbesvär och har sedan länge fått stå i skuggan av begreppet smärta. Betydande forskning rörande klådans bakomliggande fysiologi har dock givit detta ämne ett uppsving och även distingerat det från smärta. Klåda är mer än ett trivialt symptom i samband med hudsjukdom och kan även vara ett tidigt tecken på många allvarliga sjukdomar, däribland HIV och cancer. Således kan klåda vara en källa till stor ohälsa i samhället, då den leder till lidande och sänkt livskvalitet – något som ofta underskattas av vårdpersonal. Sjuksköterskans attityd rörande detta är dock till synes outforskat, varför denna studie ämnade att undersöka detta. Syfte: Denna studies syfte var att undersöka attityd och kunskap rörande begreppet klåda hos sjuksköterskor verksamma vid vårdcentraler. Metod: Empirisk tvärsnittsstudie med enkät som instrument och deskriptiv statistik som dataanalys. Urvalet bestod av 31 sjuksköterskor från fem offentliga vårdcentraler i södra delen av Region Skåne. Resultat: Enkäten visade att patienter med klåda tas på allvar och att 14/31 informanter mer än tre gånger/månad träffar på patienter som primärt söker vård för detta besvär. Kunskapen om ämnet är i högre utsträckning ett resultat av praktisk erfarenhet, än lärdom från sjuksköterskeutbildningen. På vårdcentralen diskuterades dock inte området i någon större utsträckning, men majoriteten menade ändå att klåda som omvårdnadsområde förtjänar mer uppmärksamhet. Konklusion: Resultatet av denna enkätstudie gav en inblick i sjuksköterskors attityder gentemot klåda, vilket till synes är ett nytt perspektiv. Dock kvarstår fortfarande många frågetecken och forskningsområdet behöver utvidgas med både kvalitativa och kvantitativa studier för att fullt kunna förstå klådans komplexitet. / Background: Itch is often mentioned in relation to skin disorders and throughout the years it has received less attention in comparison to pain. However, new and important research regarding physiological mechanisms behind itch has given the subject a renewed importance and has even distinguished it from pain. Itch is more than a trivial symptom related to skin diseases and may even be an early warning sign of many serious conditions, including HIV and cancer. Accordingly itch is a major health problem in the society, causing suffering and a reduced quality of life –which is often underestimated by healthcare staff. Nurses’ attitudes regarding the subject remain unexplored and was thus the intentions of this thesis. Aim: The aim of this study was to investigate the attitudes towards itch among nurses at healthcare centers. Methods: Empirical cross-sectional study with a questionnaire as a tool and descriptive statistics as the data analysis. The sample consisted of 31 nurses from five public healthcare centers in the southern part of Skåne, Sweden. Results: The questionnaire indicated that patients with itch are taken seriously and that 14/31 respondents encounter patients who primarily seek treatment for the symptom more than three times per month. The knowledge obtained in regards to itch was largely due to practical experience and not to nursing education. Itch was not frequently discussed at the healthcare center, but the majority still agreed that itch, in relation to the science of nursing care, deserves more attention. Conclusion: The results of this questionnaire study gave insight into the attitudes among nurses in regards to itch, which was found to be a new perspective. Nevertheless, many questions remain unanswered and the research needs to be enlarged with both qualitative and quantitative studies in order to fully understand the complexity of itch.

Patient-reported outcomes are important in nonalcoholic fatty liver disease (NAFLD). Pruritus is of special interest for evolving therapies with farnesoid X receptor (FXR) agonists. The aim of this study was to investigate the prevalence of pruritus in a real-life NAFLD cohort and analyze associations with anxiety and depression. Pruritus was assessed using a visual analogue- (VAS) and 5-D itch-scale (5-D). Anxiety and depression were evaluated by Beck’s-Depression-Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS-A, HADS-D). An optimal logistic regression model was found with a stepwise procedure to investigate variables associated with pruritus. In total, 123 NAFLD patients were recruited. VAS and 5-D were highly correlated (Spearman’s correlation coefficient 0.89). Moderate/severe pruritus was reported in 19% (VAS) and 21% (5-D) of patients. Anxiety and depression were present in 12% and 4% (HADS-A and HADS-D, respectively) and 12% (BDI) of cases. There was a significant association between VAS and BDI (p = 0.019). The final multivariate model for 5-D included diabetes mellitus (OR 4.51; p = 0.01), BDI (OR 5.98; p = 0.024), and HADS-A (OR 7.75; p = 0.011). One-fifth of NAFLD patients reported moderate or severe pruritus. 5-D was significantly associated with diabetes mellitus, depression, and anxiety. These findings should be tested in larger populations and considered in candidates for treatment with FXR agonists.

Neste trabalho investigamos o efeito de doadores de H2S no prurido agudo mediado por PAR-2 em camundongos. A injeção i.d. do agonista PAR-2 SLIGRL-NH2, induziu prurido que não foi afetado pelo pré-tratamento com o antagonista H1 pirilamina. A coinjeção dos doadores de H2S GYY4137 (lento) ou NaHS (espontâneo) com SLIGRL-NH2 reduziu significativamente o prurido (P<0,05). A glibenclamida (bloqueador de canais KATP) e o SNP (doador de NO), mas não o ODQ (inibidor da sGC), evitaram estes efeitos. O antagonista TRPA1 HC-030031 reduziu significativamente o prurido induzido pelo SLIGRL-NH2 (P<0,05), mas o prurido induzido pelo agonista TPRA1 AITC não foi afetado por NaHS. Ensaios de Western blot mostraram que ambos PAR-2 e TRPA1 são expressos constitutivamente na pele de camundongos. Nossos dados mostram que o prurido secundário à ativação do PAR-2 pode ser reduzido por H2S, atuando via a abertura dos canais KATP e ativação da via NO-GMPc. Ademais, o receptor TRPA1 pode mediar o prurido induzido por SLIGRL-NH2, mas o H2S não interfere nesta via. / In this study we investigated the effect of H2S donors in PAR-2-mediated acute pruritus in mice. The i.d. injection of the PAR-2 agonist SLIGRL-NH2 induced itching that was unaffected by pre-treatment with the H1 antagonist pyrilamine. Co-injection of the H2S donors GYY4137 (slow) or NaHS (spontaneous) with SLIGRL-NH2 significantly reduced pruritis (P <0.05). Glibenclamide (a KATP channel blocker) and SNP (a NO donor), but not ODQ (a sGC inhibitor) prevented these effects. The TRPA1 antagonist HC-030031 significantly reduced SLIGRL-NH2-induced pruritus (P<0.05), but the pruritus induced by the TPRA1 agonist AITC was unaffected by NaHS. Western blot assays showed that both TRPA1 and PAR-2 are constitutively expressed in the mouse skin. Our data show that itching secondary to PAR-2 activation can be reduced by H2S which acts via the opening of KATP channels and activation of the NO-cGMP pathway. Furthermore, TRPA1 receptors may mediate SLIGRL-NH2-induced pruritus, however, H2S does not interfere with this pathway.

O prurido, assim como a dor, é uma experiência sensorial aversiva, associada ao desejo de coçar-se. Resultados prévios deste grupo demonstraram que a injeção i.d. de moléculas doadoras do sulfeto de hidrogênio (H2S), um novo mediador endógeno, reduziu o prurido agudo e a inflamação cutânea induzidos por histamina ou composto 48/80 (C48/80) na pele dorsal de camundongos, sugerindo o envolvimento do H2S no controle do prurido mediado por aminas. Todavia, pouco se conhece sobre os mecanismos envolvidos na indução ou inibição dessa percepção sensorial (aguda ou crônica), e a participação do H2S. A fim de aprofundar esse conhecimento, os objetivos deste estudo foram:i) testar e caracterizar os mecanismos envolvidos nos efeitos protetores de diferentes moléculas doadoras de H2S (liberação rápida e lenta) sobre o prurido agudo e inflamação associada, induzidos por estímulos dependente e independente de histamina, ii) averiguar a capacidade de produção endógena de H2S e as enzimas envolvidas em sua síntese na pele murina saudável e doente, iii) padronizar um modelo de prurido crônico associado ao escore de intensidade da área inflamada na psoríase (PASI), e investigar o efeito protetor de um doador de H2S de liberação lenta (GYY4137). Utilizando camundongos Balb/C, foi realizada a avaliação do comportamento de prurido agudo e inflamação cutânea (extravasamento plasmático, influxo de neutrófilos), frente a diversos estímulos, na ausência e vigência do co- tratamento (i.d.) com doadores de H2S. A psoríase experimental foi induzida pela aplicação tópica do creme imiquimode (IMQ 5%) na pele dorsal destes, por 5 dias consecutivos, e grupos paralelos com a doença foram tratados pela via intraperitoneal (i.p.) com o GYY4137 em diferentes doses (25-100 mg/kg). Os registros do prurido e PASI foram obtidos durante a indução da psoríase e as análises bioquímicas e moleculares foram realizadas ao término do experimento. O tratamento com doses crescentes de GYY4137 (0,3 30 nmol/sitio, i.d.) inibiu o prurido agudo induzido por histamina ou cloroquina e reduziu o influxo de neutrófilos frente ao C48/80, mas não afetou o extravasamento plasmático induzido por histamina ou C48/80. O bloqueio das enzimas geradoras de H2S maximizou o prurido e o influxo de neutrófilos desencadeado por C48/80. O pré-tratamento com a glibenclamida (10 mg/kg; i.p, -30 min), bloqueador dos canais de KATP, não reverteu o efeito do doador de H2S de liberação rápida sobre o prurido agudo e inflamação induzidos por histamina. Em animais com psoríase, o tratamento (i.p.) com o GYY4137 reduziu (P<0,05) a inflamação cutânea (escores PASI) e o prurido, assim como inibiu o eixo NF-<font face = \"symbol\">k B-caspase-1-IL-1<font face = \"symbol\">b , e aumentou a atividade das enzimas antioxidantes (catalase, GST, GR e GPx). A pele de animais com psoríase exibiu menor capacidade na síntese de H2S, que foi paralela à menor expressão da enzima Cistationina-<font face = \"symbol\">b-sintetase (CBS). O bloqueador da enzima Cistationina-<font face = \"symbol\">g-liase (CSE) não interferiu no escore PASI ou prurido. Conclui-se que moléculas doadoras de H2S representam novos alvos terapêuticos no controle da inflamação aguda ou imunomediada associada à percepção de prurido agudo ou crônico. No microambiente inflamatório agudo, o mecanismo envolvido é independente da ativação de canais de KATP, enquanto no crônico (psoríase) é dependente, em parte, da inibição da ativação do eixo NF-<font face = \"symbol\">k B- caspase-1-IL-1<font face = \"symbol\">b e aumento das defesas antioxidantes. / Pruritus, like pain, is an aversive sensory experience associated with the scratching desire. Previous findings from this group demonstrated that hydrogen sulphide (H2S) donor molecules, a new endogenous mediator, when intra-dermal injected, reduced acute histamine and cutaneous inflammation induced by histamine or compound 48/80 (C48/80) on the dorsal skin of mice, suggesting the involvement of H2S in the control of amine-mediated pruritus. However, little is known about the mechanisms involved in the induction or inhibition of this sensorial perception (acute or chronic) and the participation of H2S. In order to get a better understanding, the objectives of this study were: i) to test and characterize the mechanisms involved in the protective effects of different H2S donors molecules (fast and slow release) on acute pruritus and associated inflammation induced by histamine dependent and independent stimuli; ii) to investigate the endogenous production of H2S and the enzymes involved in its synthesis in healthy and unhealthy/disease murine skin; and iii) to standardize a model of chronic pruritus associated with the psoriasis area severity index (PASI) in the inflamed skin, and to investigate the protective effect of a slow release H2S donor (GYY4137). The behaviour evaluation of acute pruritus and cutaneous inflammation (plasma extravasation, neutrophil influx) was performed alongside with different stimuli with or without the co-treatment (i.d.) with H2S donors in Balb/C mice. Experimental psoriasis was induced by topical application of imiquimod cream (IMQ 5%) on the dorsal skin, for 5 consecutive days, and at the same time, groups with the disease were treated intraperitoneally (i.p.) with GYY4137 at different doses (25 100 mg/kg). Records of pruritus and PASI were obtained during psoriasis induction, and biochemical and molecular analyses were performed at the end of the experiment. Firstly, treatment with increasing doses of GYY4137 (0.3 30 nmol/site, i.d.) inhibited acute pruritus induced by histamine or chloroquine and reduced the neutrophils influx induced by C48/80, without affecting histamine or C48/80 plasma-induced extravasation. Secondly, blocking the H2S-generating enzymes potentiated pruritus and the neutrophils influx triggered by C48/80. Pretreatment with glibenclamide (10 mg/kg; i.p., -30 min.), a KATP channel blocker, did not reverse the effect of the fast-release H2S donor on acute pruritus and inflammation induced by histamine. Finally, psoriatic animals, treated with GYY4137 (i.p.) showed a lower skin inflammation (PASI scores) and pruritus as well as the NF<font face = \"symbol\">kB-Caspase1-IL-1<font face = \"symbol\">b axis inhibited (P>0.05), and increased activity of antioxidant enzymes (catalase, GST, GR and GPx). The skin of psoriatic animals exhibited a lower capacity to synthetize H2S, which was parallel to expression of the enzyme Cystathionine-<font face = \"symbol\">b-synthetase (CBS). The Cystathionine-<font face = \"symbol\">g-lyase (CSE) enzyme blocker did not interfere with the PASI or pruritus score. We may conclude that H2S donor molecules represent new therapeutic targets to the control of acute or immune- mediated inflammation associated with the perception of acute or chronic pruritus. Also, in the acute inflammatory microenvironment, the mechanism involved is independent of KATP channels activation, whereas in the chronic condition it is partly dependent on the inhibition of NF-<font face = \"symbol\">kB-caspase-1-IL-1<font face = \"symbol\">b axis activation and increased antioxidants defence.

Introdução: A candidíase vulvovaginal recorrente (CVVR) afeta aproximadamente 138 milhões de mulheres mundialmente. Motivo frequente de consultas em ginecologia, é definida como a ocorrência de quatro ou mais episódios em um período de 12 meses. Manifesta-se por sintomas extremamente desagradáveis como prurido, corrimento, irritação vulvovaginal, dor, comprometendo as atividades diárias e laborais, vida sexual e relacionamentos sociais. Objetivo: Avaliar a influência da candidíase vulvovaginal recorrente na qualidade de vida de mulheres com essa afecção, comparativamente à mulheres saudáveis. Método: O estudo foi realizado no Setor de Imunologia, Genética e Infecções do Trato Reprodutivo do Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo no período de Julho de 2016 à dezembro de 2017, após aprovação pelo comitê de Ética para Análise de Projetos de Pesquisa do Hospital das Clínicas da FMUSP. Foram avaliadas 100 mulheres com diagnóstico de candidíase vulvovaginal recorrente, confirmado clínica e laboratorialmente (grupo estudo) e 101 mulheres saudáveis (grupo controle), em um estudo transversal analítico caso controle. Para avaliação da qualidade de vida foi utilizado o questionário validado World Health Quality of Life Abbreviated Assessment (WHOQOL-bref), autoadmininstrado, em ambos os grupos. Tal questionário é constituído por quatro domínios (físico, psicológico, social e meio ambiente) e contem 26 questões. A consistência interna foi avaliada pelo coeficiente de alfa de Cronbach. Para a análíse estatística foram utilizados o teste qui-quadrado e o teste T de Student. Resultados: As médias etárias das mulheres com candidíase vulvovaginal recorrente e das do grupo controle foram 34,0 e 32,2 anos respectivamente. Os escores médios das dimensões do WHOQOL-bref para a percepção da qualidade de vida (59,7), satisfação com a saúde (46,7), físico (54,4), psicológico (56,8), social (51,5), meio ambiente (43,5) para mulheres com candidíase vulvovaginal recorrente foram menores do que os do grupo controle: qualidade de vida (71,3), satisfação com a saúde (67,1), físico (68,5), psicológico (65,8), social (69,1) e meio ambiente (57,4).O coeficiente alfa de Cronbach resultou maior do que 0,8 para as questões gerais e maior do que 0,65 para questões específicas, indicando uma consistência interna quase perfeita e substancial respectivamente. Assim, a percepção da qualidade de vida e a satisfação com a saúde estiveram muito reduzidas nas mulheres com CVVR (p < 0,001). No domínio físico a percepção de dor, falta de energia, problemas com o sono, redução da atividade diária, dependência de medicações ou tratamentos apresentaram-se aumentados em mulheres com candidíase vulvovaginal recorrente (p < 0,001). No domínio psicológico tais mulheres referiram pouca afetividade, baixa autoestima, dificuldade na cognição e depreciação da imagem corporal (p < 0,001). Todos os aspectos sociais, incluindo atividade sexual também se mostraram reduzidos. No domínio meio ambiente apresentaram menor satisfação em seu local de moradia, poucos recursos financeiros, menos atividades recreativas e alto índice de desemprego (p < 0,001). Conclusão: Candidíase vulvovaginal recorrente impactou de maneira negativa múltiplos aspectos do bem-estar das mulheres afetadas. Mulheres com esta condição merecem especial atenção dos profissionais de saúde e também o incentivo de novas pesquisas, que possam melhor elucidar aspectos de susceptibilidade, prevenção e tratamento / Background: Recurrent vulvovaginal candidiasis (RVVC) affects about 138 million women annually worldwide. A frequent reason for gynecologist consults, RVVC is defined as four or more episodes of culture positive symptomatic episodes in a 12 month period. Vulvovaginal itching, irritation, pain, discharge and problems with their sexual and emotional relationships are frequent complaints. We evaluated the influence of RVVC on aspects of quality of life in affected women in comparison to a control group. METHODS: This study was conducted at University of Sao Paulo Hospital of Medicine between July 2016- December 2017. The study was approved by Ethical Committee of University Sao Paulo Medical School. The cross sectional study consisted of 100 women with RVVC and 101 epidemiologically healthy matched women with no history of RVVC. Each subject completed a selfadministrated validated World Health Organization Quality of Life Abbreviated Assessment (WHOQOL-bref) questionnaire, consisting of four domains (physical, psychological, social relations, environment) and composed of 26 questions. Internal consistency of responses was evaluated by Cronbach alpha. Data was analyzed by Chi square and student T test. RESULTS: The mean age of women with RVVC and controls was 34,0 years and 32,2 years, respectively. The mean WHOQOL-bref dimension scores for general health (59,7), life satisfaction (46,7), physical well being (54,5), social relations (51,5), psychological (56,8) and environment (43,5) for women with RVVC were all lower than in the control group: general health (71,3), life satisfaction (67,1), physical (68,5), social relations (69,1),psychological (65,8), and environment (57,4). Cronbach alpha coefficient was > 0.8 for general questions and > 0.65 for specific questions, indicating almost perfect and substantial internal consistency, respectively. In total, perception of quality of life and satisfaction with their health was greatly reduced in the RVVC group (p < 0.001). In the physical dominion, perception of pain, lack of energy, sleep problems, reduced daily activity, reliance on medications or treatments was increased in women with RVVC (p < 0.001). Psychologically, RVVC patients reported lowered affection, cognition, self-esteem and body image (p < 0.001). All aspects of social relations including sexual activity were also reduced (p < 0.001). Patients reported a less satisfactory home environment, lower financial resources, lower frequency of recreational activities and higher unemployment (p < 0.001). CONCLUSION: RVVC affects multiple aspects of affected women\'s well being. Women with this condition deserve serious attention from clinicians and research into susceptibility, prevention and treatment of this infection should receive much greater support

Introdução: A candidíase vulvovaginal recorrente (CVVR) afeta aproximadamente 138 milhões de mulheres mundialmente. Motivo frequente de consultas em ginecologia, é definida como a ocorrência de quatro ou mais episódios em um período de 12 meses. Manifesta-se por sintomas extremamente desagradáveis como prurido, corrimento, irritação vulvovaginal, dor, comprometendo as atividades diárias e laborais, vida sexual e relacionamentos sociais. Objetivo: Avaliar a influência da candidíase vulvovaginal recorrente na qualidade de vida de mulheres com essa afecção, comparativamente à mulheres saudáveis. Método: O estudo foi realizado no Setor de Imunologia, Genética e Infecções do Trato Reprodutivo do Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo no período de Julho de 2016 à dezembro de 2017, após aprovação pelo comitê de Ética para Análise de Projetos de Pesquisa do Hospital das Clínicas da FMUSP. Foram avaliadas 100 mulheres com diagnóstico de candidíase vulvovaginal recorrente, confirmado clínica e laboratorialmente (grupo estudo) e 101 mulheres saudáveis (grupo controle), em um estudo transversal analítico caso controle. Para avaliação da qualidade de vida foi utilizado o questionário validado World Health Quality of Life Abbreviated Assessment (WHOQOL-bref), autoadmininstrado, em ambos os grupos. Tal questionário é constituído por quatro domínios (físico, psicológico, social e meio ambiente) e contem 26 questões. A consistência interna foi avaliada pelo coeficiente de alfa de Cronbach. Para a análíse estatística foram utilizados o teste qui-quadrado e o teste T de Student. Resultados: As médias etárias das mulheres com candidíase vulvovaginal recorrente e das do grupo controle foram 34,0 e 32,2 anos respectivamente. Os escores médios das dimensões do WHOQOL-bref para a percepção da qualidade de vida (59,7), satisfação com a saúde (46,7), físico (54,4), psicológico (56,8), social (51,5), meio ambiente (43,5) para mulheres com candidíase vulvovaginal recorrente foram menores do que os do grupo controle: qualidade de vida (71,3), satisfação com a saúde (67,1), físico (68,5), psicológico (65,8), social (69,1) e meio ambiente (57,4).O coeficiente alfa de Cronbach resultou maior do que 0,8 para as questões gerais e maior do que 0,65 para questões específicas, indicando uma consistência interna quase perfeita e substancial respectivamente. Assim, a percepção da qualidade de vida e a satisfação com a saúde estiveram muito reduzidas nas mulheres com CVVR (p < 0,001). No domínio físico a percepção de dor, falta de energia, problemas com o sono, redução da atividade diária, dependência de medicações ou tratamentos apresentaram-se aumentados em mulheres com candidíase vulvovaginal recorrente (p < 0,001). No domínio psicológico tais mulheres referiram pouca afetividade, baixa autoestima, dificuldade na cognição e depreciação da imagem corporal (p < 0,001). Todos os aspectos sociais, incluindo atividade sexual também se mostraram reduzidos. No domínio meio ambiente apresentaram menor satisfação em seu local de moradia, poucos recursos financeiros, menos atividades recreativas e alto índice de desemprego (p < 0,001). Conclusão: Candidíase vulvovaginal recorrente impactou de maneira negativa múltiplos aspectos do bem-estar das mulheres afetadas. Mulheres com esta condição merecem especial atenção dos profissionais de saúde e também o incentivo de novas pesquisas, que possam melhor elucidar aspectos de susceptibilidade, prevenção e tratamento / Background: Recurrent vulvovaginal candidiasis (RVVC) affects about 138 million women annually worldwide. A frequent reason for gynecologist consults, RVVC is defined as four or more episodes of culture positive symptomatic episodes in a 12 month period. Vulvovaginal itching, irritation, pain, discharge and problems with their sexual and emotional relationships are frequent complaints. We evaluated the influence of RVVC on aspects of quality of life in affected women in comparison to a control group. METHODS: This study was conducted at University of Sao Paulo Hospital of Medicine between July 2016- December 2017. The study was approved by Ethical Committee of University Sao Paulo Medical School. The cross sectional study consisted of 100 women with RVVC and 101 epidemiologically healthy matched women with no history of RVVC. Each subject completed a selfadministrated validated World Health Organization Quality of Life Abbreviated Assessment (WHOQOL-bref) questionnaire, consisting of four domains (physical, psychological, social relations, environment) and composed of 26 questions. Internal consistency of responses was evaluated by Cronbach alpha. Data was analyzed by Chi square and student T test. RESULTS: The mean age of women with RVVC and controls was 34,0 years and 32,2 years, respectively. The mean WHOQOL-bref dimension scores for general health (59,7), life satisfaction (46,7), physical well being (54,5), social relations (51,5), psychological (56,8) and environment (43,5) for women with RVVC were all lower than in the control group: general health (71,3), life satisfaction (67,1), physical (68,5), social relations (69,1),psychological (65,8), and environment (57,4). Cronbach alpha coefficient was > 0.8 for general questions and > 0.65 for specific questions, indicating almost perfect and substantial internal consistency, respectively. In total, perception of quality of life and satisfaction with their health was greatly reduced in the RVVC group (p < 0.001). In the physical dominion, perception of pain, lack of energy, sleep problems, reduced daily activity, reliance on medications or treatments was increased in women with RVVC (p < 0.001). Psychologically, RVVC patients reported lowered affection, cognition, self-esteem and body image (p < 0.001). All aspects of social relations including sexual activity were also reduced (p < 0.001). Patients reported a less satisfactory home environment, lower financial resources, lower frequency of recreational activities and higher unemployment (p < 0.001). CONCLUSION: RVVC affects multiple aspects of affected women\'s well being. Women with this condition deserve serious attention from clinicians and research into susceptibility, prevention and treatment of this infection should receive much greater support

Survival after severe burns has improved in recent decades, but there is limited information on the course of recovery after surviving a burn and on factors that can affect recovery. The aims of this thesis were to investigate the occurrence of physical and psychological problems after burns, and to examine the consequences of psychological problems for the clinical management of burn patients. Three groups of consecutive patients who were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2005 were included in the studies. The Burn Specific Health Scale (BSHS) was used for self-report of burn-specific aspects of health. Personality traits and coping strategies as psychological factors during recovery were examined with the Swedish universities Scales of Personality (SSP) and the Coping with Burns Questionnaire (CBQ). Presence of symptoms of posttraumatic stress were assessed with the Impact of Event Scale-Revised (IES-R), and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used to determine the concurrent validity of the IES-R as a measure of Posttraumatic Stress Disorder (PTSD). Furthermore, the effect of pre-injury psychiatric morbidity on perceived health one year after injury was assessed. Both pruritus and nightmares were common problems after burns; 59% of the individuals in the study reported pruritus and 43% reported nightmares. Neuroticism-related personality traits and avoidant coping strategies were associated with an increased risk of having pruritus or nightmares. The presence of nightmares could be used as a screening tool for high scores in the IES-R. The IES-R was in turn shown to be a good, although overly inclusive, test for the diagnosis of PTSD. Pre-injury psychiatric morbidity predicted perceived outcome in six out of nine burn-specific health domains. These studies show that psychological factors and psychiatric morbidity affect outcome after burns.

Neste trabalho investigamos o efeito de doadores de H2S no prurido agudo mediado por PAR-2 em camundongos. A injeção i.d. do agonista PAR-2 SLIGRL-NH2, induziu prurido que não foi afetado pelo pré-tratamento com o antagonista H1 pirilamina. A coinjeção dos doadores de H2S GYY4137 (lento) ou NaHS (espontâneo) com SLIGRL-NH2 reduziu significativamente o prurido (P<0,05). A glibenclamida (bloqueador de canais KATP) e o SNP (doador de NO), mas não o ODQ (inibidor da sGC), evitaram estes efeitos. O antagonista TRPA1 HC-030031 reduziu significativamente o prurido induzido pelo SLIGRL-NH2 (P<0,05), mas o prurido induzido pelo agonista TPRA1 AITC não foi afetado por NaHS. Ensaios de Western blot mostraram que ambos PAR-2 e TRPA1 são expressos constitutivamente na pele de camundongos. Nossos dados mostram que o prurido secundário à ativação do PAR-2 pode ser reduzido por H2S, atuando via a abertura dos canais KATP e ativação da via NO-GMPc. Ademais, o receptor TRPA1 pode mediar o prurido induzido por SLIGRL-NH2, mas o H2S não interfere nesta via. / In this study we investigated the effect of H2S donors in PAR-2-mediated acute pruritus in mice. The i.d. injection of the PAR-2 agonist SLIGRL-NH2 induced itching that was unaffected by pre-treatment with the H1 antagonist pyrilamine. Co-injection of the H2S donors GYY4137 (slow) or NaHS (spontaneous) with SLIGRL-NH2 significantly reduced pruritis (P <0.05). Glibenclamide (a KATP channel blocker) and SNP (a NO donor), but not ODQ (a sGC inhibitor) prevented these effects. The TRPA1 antagonist HC-030031 significantly reduced SLIGRL-NH2-induced pruritus (P<0.05), but the pruritus induced by the TPRA1 agonist AITC was unaffected by NaHS. Western blot assays showed that both TRPA1 and PAR-2 are constitutively expressed in the mouse skin. Our data show that itching secondary to PAR-2 activation can be reduced by H2S which acts via the opening of KATP channels and activation of the NO-cGMP pathway. Furthermore, TRPA1 receptors may mediate SLIGRL-NH2-induced pruritus, however, H2S does not interfere with this pathway.