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This is a cross-sectional analysis of data obtained in the baseline of the Longitudinal Study on the Lifestyle and Health of University Students (n=685), carried out in a public Brazilian university. Food intake was assessed using a 24-hour dietary recall. Dietary patterns (DP) for breakfast, lunch, and dinner were identified using principal component analysis. Generalized linear models were used to analyze the variables associated with each DP. Three DP were extracted for each meal: breakfast: “White bread and butter/margarine”, “Coffee and Tea”, “Sausages, whole wheat bread and cheese”; lunch: “Traditional”, “Western”, “Vegetarian”; dinner: “Beans, rice and processed juice”, “White bread and butter/margarine”, “White meat, eggs and natural juice”. Students who had meals at the campus showed greater adherence to the “White bread and butter/margarine” (exp(βadj)=1.15, 95% CI: 1.11;1.19) and “Coffee and Tea” (exp(βadj)=1.06, 95% CI: 1.02;1.10) breakfast patterns; “Western” lunch pattern (exp(βadj)=1.04, 95% CI: 1.01;1.08) and to the “Beans, rice and processed juice” dinner pattern (exp(βadj)=1.10, 95% CI: 1.06;1.14). Having meals at the campus was associated with lower adherence to the “Sausages, whole wheat bread and cheese” breakfast pattern (exp(βadj)=0.93, 95% CI: 0.89;0.97), “Traditional” lunch pattern (exp(βadj)=0.96, 95% CI: 0.93;0.99) and to the “White bread and butter/margarine” (exp(βadj)=0.96, 95% CI: 0.93;0.99) and “White meat, eggs and natural juice” (exp(βadj)=0.96, 95% CI: 0.93;0.99) dinner pattern. Food environment at campus may influence students’ DP. Recognizing meal eating patterns is important to support healthy eating promotion strategies on campus. Adjustments in the University Canteen menu could contribute to healthier eating choices among students.
Accurate estimates of methane (CH4) production by cattle in different contexts are essential to developing mitigation strategies in different regions. We aimed to: (i) compile a database of CH4 emissions from Brazilian cattle studies, (ii) evaluate prediction precision and accuracy of extant proposed equations for cattle and (iii) develop specialized equations for predicting CH4 emissions from cattle in tropical conditions. Data of nutrient intake, diet composition and CH4 emissions were compiled from in vivo studies using open-circuit respiratory chambers, SF6 technique or the GreenFeed® system. A final dataset containing intake, diet composition, digestibility and CH4 emissions (677 individual animal observations, 40 treatment means) obtained from 38 studies conducted in Brazil was used. The dataset was divided into three groups: all animals (GEN), lactating dairy cows (LAC) and growing cattle and non-lactating dairy cows (GCNL). A total of 54 prediction equations available in the literature were evaluated. A total of 96 multiple linear models were developed for predicting CH4 production (MJ/day). The predictor variables were DM intake (DMI), gross energy (GE) intake, BW, DMI as proportion of BW, NDF concentration, ether extract (EE) concentration, dietary proportion of concentrate and GE digestibility. Model selection criteria were significance (P < 0.05) and variance inflation factor lower than three for all predictors. Each model performance was evaluated by leave-one-out cross-validation. The Intergovernmental Panel on Climate Change (2006) Tier 2 method performed better for GEN and GCNL than LAC and overpredicted CH4 production for all datasets. Increasing complexity of the newly developed models resulted in greater performance. The GCNL had a greater number of equations with expanded possibilities to correct for diet characteristics such as EE and NDF concentrations and dietary proportion of concentrate. For the LAC dataset, equations based on intake and animal characteristics were developed. The equations developed in the present study can be useful for accurate and precise estimation of CH4 emissions from cattle in tropical conditions. These equations could improve accuracy of greenhouse gas inventories for tropical countries. The results provide a better understanding of the dietary and animal characteristics that influence the production of enteric CH4 in tropical production systems.
Less is known about the relationship between conduct disorder (CD), callous–unemotional (CU) traits, and positive and negative parenting in youth compared to early childhood. We combined traditional univariate analyses with a novel machine learning classifier (Angle-based Generalized Matrix Learning Vector Quantization) to classify youth (N = 756; 9–18 years) into typically developing (TD) or CD groups with or without elevated CU traits (CD/HCU, CD/LCU, respectively) using youth- and parent-reports of parenting behavior. At the group level, both CD/HCU and CD/LCU were associated with high negative and low positive parenting relative to TD. However, only positive parenting differed between the CD/HCU and CD/LCU groups. In classification analyses, performance was best when distinguishing CD/HCU from TD groups and poorest when distinguishing CD/HCU from CD/LCU groups. Positive and negative parenting were both relevant when distinguishing CD/HCU from TD, negative parenting was most relevant when distinguishing between CD/LCU and TD, and positive parenting was most relevant when distinguishing CD/HCU from CD/LCU groups. These findings suggest that while positive parenting distinguishes between CD/HCU and CD/LCU, negative parenting is associated with both CD subtypes. These results highlight the importance of considering multiple parenting behaviors in CD with varying levels of CU traits in late childhood/adolescence.
Even though the impact of COVID-19 in metropolitan areas has been extensively studied, the geographic spread to smaller cities is also of great concern. We conducted an ecological study aimed at identifying predictors of early introduction, incidence rates of COVID-19 and mortality (up to 8 May 2020) among 604 municipalities in inner São Paulo State, Brazil. Socio-demographic indexes, road distance to the state capital and a classification of regional relevance were included in predictive models for time to COVID-19 introduction (Cox regression), incidence and mortality rates (zero-inflated binomial negative regression). In multivariable analyses, greater demographic density and higher classification of regional relevance were associated with both early introduction and increased rates of COVID-19 incidence and mortality. Other predictive factors varied, but distance from the State Capital (São Paulo City) was negatively associated with time-to-introduction and with incidence rates of COVID-19. Our results reinforce the hypothesis of two patterns of geographical spread of SARS-Cov-2 infection: one that is spatial (from the metropolitan area into the inner state) and another which is hierarchical (from urban centres of regional relevance to smaller and less connected municipalities). Those findings may apply to other settings, especially in developing and highly heterogeneous countries, and point to a potential benefit from strengthening non-pharmaceutical control strategies in areas of greater risk.
To update the estimation of the prevalence of anaemia in Brazilian children according to four different epidemiological scenarios.
A new systematic review was conducted with a meta-analysis of the results published between 2007 and May 2019. Literature search was carried out in the PubMed and LILACS databases using keywords anaemia, child and Brazil. A total of thirty-seven articles (17 741 children) were selected and categorised according to the origin of their respective samples: childcare centres (Childcare; n 13 studies/2697 individuals), health services (Services; n 4/755), populations with social inequities (Inequities, n 7/6798) and population-based studies (Populations; n 13/7491). Assuming a prevalence of 20·9 % as reference (Health National Survey; n 3455), the combined prevalence ratios (PR) were calculated. A random-effects model was used.
Brazilian children 6–60 months of age.
The prevalence of anaemia, by scenario, was: Childcare 24·8 % (PR 1·06; 95 % CI 0·81, 1·40); Services 39·9 % (PR 1·76, 95 % CI 1·33, 2·35); Inequities 51·6 % (PR 2·02, 95 % CI 1·87, 2·18); and Populations 35·8 % (PR 1·42, 95 % CI 1·23, 1·64). Therefore, the values were all higher than the national prevalence; the Inequities had the highest prevalence, and only Childcare did not reach statistical significance. Concerning the previous meta-analysis, there was a reduction in anaemia prevalence in all scenarios: –52·3, –33·7, –22·4 and –10·7 %, respectively.
Compared to the situation revealed in the previous meta-analysis, anaemia, although observed to a lesser extent, remains an important public health problem in the different scenarios analysed, especially for children living in Inequities. Access to Childcare mitigates the risk for this condition.
The co-infection between visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) has increased in several countries in the world. The current serological tests are not suitable since they present low sensitivity to detect the most of VL/HIV cases, and a more precise diagnosis should be performed. In this context, in the present study, an immunoproteomics approach was performed using Leishmania infantum antigenic extracts and VL, HIV and VL/HIV patients sera, besides healthy subjects samples; aiming to identify antigenic markers for these clinical conditions. Results showed that 43 spots were recognized by antibodies in VL and VL/HIV sera, and 26 proteins were identified by mass spectrometry. Between them, β-tubulin was expressed, purified and tested in ELISA experiments as a proof of concept for validation of our immunoproteomics findings and results showed high sensitivity and specificity values to detect VL and VL/HIV patients. In conclusion, the identified proteins in the present work could be considered as candidates for future studies aiming to improvement of the diagnosis of VL and VL/HIV co-infection.
This study aimed to determine the motivations for the consumption of alcohol by young adults in higher education.
In a cross-sectional study, of a quantitative nature, we have worked with a sample of 354 students (61.60% women), aged between 18 and 35 (M = 20.86 years, Dp = 3.52).
It was a daily consumption of alcohol in 28.6% of students. The motivations described as being associated with the consumption of alcoholic beverages are: because gives you pleasure (25.7%), to be happy (24.0%), for uninhibited (18.7%), to forget the problems of everyday life (13.3%), to relate to others who also drink (7.9%), to calm (7.4%), because they miss family and friends (6.8%), to forget problems / angry with her boyfriend or friends (5.9%).
Evidence presented here based guidelines for preventive and health promotion in the university context.
The authors have as a goal to conduct a reflection about an important public health problem that is the influence of neuro-psychiatric disease in a patient sexual behaviour. Thus, a case study is described of a patient, of 49 years old, hospitalized with bipolar affective disorder diagnosis – depressive phase, in which unprotected sexual intercourse was predominant with several partners.
Clinical observation, conducted during three months of hospitalization, showed a sexual behavioural inadequacy, which was not justified by decompensation of the psychiatric feature previously referred. We also verified a cognitive dysfunction.
The results of this clinical evaluation, including neuropsychological evaluation and organic complementary study (ACT-CE and SPECT), suggest the diagnosis of front-temporal dementia.
The authors finish emphasising the existence of psychiatric disorders, functional and organic, with sexual risk behaviours. For several reasons, the psychiatric patients are more vulnerable to the STDs, namely because of clinical situations that for temporary or permanent ways determine the diminishing or absence of insight related to sexual behaviour.
Corticobasal degeneration is a rare neurodegenerative disorder affecting both cortex and basal ganglia with clinical and underlying pathological heterogeneity. Although motor features of CBD were emphasized in earlier descriptions psychiatric symptoms, including cognitive impairment and mood disorders, have been consistently reported during the course of the disease. Clinical diagnosis of CBD is challenging and can be difficult to differentiate from other neuropsychiatric disorders with overlapping features. This can lead to significant underdiagnosis of CBD particularly during its early stages.
We report a case of a 48 year-old female patient presenting with insidious orofacial dystonia co-occurring with depression which remained controlled for five years. Later, while experiencing major psycho-social stress factors, she presented with a rapidly progressive clinical syndrome compatible with the diagnosis of cortico-basal degeneration with severe motor, cognitive and behavioural symptoms, including alien limb phenomenon, nonfluent aphasia and personality changes. Neuropsychological assessment revealed significant frontal lobe dysfunction and SPECT imaging showed asymetrical fronto-parietal hypoperfusion.
This case illustrates the difficulties in the clinical diagnosis of CBD both in early and late stages due to its clinical overlap with mood and movement disorders as well as with Fronto-Temporal Dementia. At the same time, it highlights the influence of psycho-social stress factors in the manifestation of degenerative disorders.
Trichobezoar was first described by Baudomant in 1779. This rare entity consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome.
It is only reliably diagnosed by CT scan and its size may require removal by open surgery.
Albeit trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but scarce reports on psychiatric literature. It is estimated that 30% of cases of trichotillophagia are of patients suffering from tricotillomania, and that 1% of those will eventually require surgical treatment.
The authors report a clinical case of trichobezoar without known trichotillomania, and revise the existing relevant literature, focusing on psychiatric evaluation and management.
The goal of the authors is to stimulate reflection on the distribution in continuum of compulsive and impulsive behaviours and highlight how important it is to constantly question psychiatric diagnoses, to avoid running the risk of dangerous categorisations.
They describe the case of a 31 year-old patient who attended the Emergency department of Coimbra University Hospitals complaining of depression and obsessive-compulsive symptoms that interfered with his daily life and with his sleep. He said that he used to attend psychiatry appointments and that he was “antisocial”, but added: “I'm as impulsive as much as I'm emotional”.
The patient's records show that he was always diagnosed with antisocial personality disorder, established by the first consultant he saw,specifically mentioning: “problems obeying rules”, “impulsiveness”, “getting into fights and brawls entailing legal action” with the obsessive-compulsive symptoms being secondary. However, the follow-up of the patient conduced by me revealed obsessive-compulsive symptoms in special compulsive checking rituals (which began in childhood), excessive concern with the size of his nose (and other parts of the body) that started in adolescence, as well as a personality marked by impulsiveness and a poor frustration tolerance, leading to highly aggressive episodes triggered by events/circumstances that he himself did not regard as particularly relevant. The results of the studies on the relationship between impulsiveness and compulsiveness could have a strong impact on reformulating the psychiatric nosology. Whenever we come across a new patient, as complete a clinical history as possible should be taken and easy diagnoses should be avoided.
The objective of the authors is to make a reflection about the causes of tianeptine abuse and dependence. In the scientific literature we can find case studies of anti-depressive dependence, which show amphetaminergic effects. In what concerns other anti-depressives, the information is rare, specifically about tianeptine. The few case studies reported until now, focus the psychostimulant effect as being the cause of the abuse and dependence. Though, a study case is described of a female patient, with 40 years old, previous history of alcohol abuse, who takes approximately 40 cigarettes per day and 10 cofee per day. She presents an history of tianeptine abuse for several years, which has become more severe in the last six months (1286 mg/day) and resulted in the third psychiatric hospitalization. The patient experiences and seeks for a psychostimulant effect and physically energizing through the excessive consumption of the drug. This tianeptine abuse is also accompanied by an excessive consumption of benzodiazepines (30 mg/day of bromazepam). Over the course of the hospitalization, we did not find physical symptoms and signs of withdrawal. Hepatic parameters were not affected. The authors conclued that the abuse and dependence of tianeptine seems to be an important problem in patients with history of abuse and/or dependence of other substances. Thus, this treatment and the implications that it may have in this population need more investigation.
The objective of this paper is to make a reflection about how the comorbidity of psychiatric and organic disorders can create several difficulties for the diagnostic and therapeutic approach of the both situations. The portuguese type of paramiloidosis disease was for the first time observed in 1939 by Corino de Andrade. In Portugal, the major focus of the disease, it presents a geographic distribution that must be known by the clinician. A thirty five's patient clinical case is described, who was hospitalized in the psychiatry hospital with the diagnosis of paranoid schizophrenia. After two months of hospitalization and four years after the beginning of the neurological symptoms, a complete organic study was developed, including gastroenterology and neurology evaluations. A diagnosis of Familial Amyloid Polyneuropathy (transthyretin-methionine 30 positive) was established, co - morbid with the diagnosis of paranoid schizophrenia. The authors conclued that the comorbidity with a mental disorder, in which delirious interpretation of the organic clinical situation was predominant in the clinical feature, and that took some time to be pharmacologically stabilized, associated with the fact that the patient hide that his mother and relatives of the mother side died because PAF, contributed significantly to the delay of the diagnosis. Beyond this, the clinical diagnosis of paranoid schizophrenia and the poor family and social background do not make him a potential candidate for a hepatic transplant. Influencing negatively the patient's coping, they can compromise the success of the transplant.
The term somatoparaphrenia was firstly used by Gerstmann to describe a form of asomatognosia in which unawareness of ownership is accompanied by delusional misidentification and/or confabulation. This is a rare phenomenon and the few published case reports showed an association of this psychopathological entity with brain-damage. We present a patient with schizophrenia who believed his right arm and right foot were not his own. According to his delusion of foreign ownership, his foot didn’t belong to him because it was a “big foot only suited for work” and his right arm belonged to Maria, a woman from his neighbourhood. Remarkably, no organic causes were found to exist. To our knowledge, this is one of the rare cases of schizophrenia in which somatoparaphrenia can be identified. We further elaborate on the phenomenology of this particular patient.
The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.
Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.
The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.
Combination therapy of peginterferon and ribavirin for HCV has been recommended as a first choice for chronic hepatitis C. INF therapy has been associated with various IFN-related adverse events, such as psychological disturbances. Beyond that preexisting mental disorders are considered risk factors for INF-alfa-induced severe psychiatric side effects such as depression and/or suicidality, consequently many of these patients remain untreated even tough they fulfil the medical criteria for antiviral treatment of chronic hepatitis C.
The authors relate the case of a patient, 56 year's old, sent to infecciology consultation because she had alterations in abnormal liver function tests. She had a previous history of mental disorder with neurotic personality traits and she was treated with psychiatric medication.
She had treatment for chronic hepatitis C with peginterferon and ribavirin as well psychiatric and psychotherapeutic support.
A low sustained virologic response was obtained however the depressive picture has been difficult to handle so she had had already had a psychiatric hospitalization. There were several adverse life events that can not be forgotten as they certainly trigger and exacerbate the depressive symptomatology.
We assume that psychiatric patients have more depressive symptoms before and during treatment compared with patients without no psychiatric history. This shows that this patients have an increase need for treatment with antidepressants and that a close cooperation with a psychiatrist is always needed.
Rehabilitation or terciary prevention refers to the set of appropriate measures to minimize the consequences of disease and reintegration the patients in their home environment, social and professional. Patients with severe mental illness need of psychosocial rehabilitation programs through the training of activities of daily life, especially in areas that present the greatest difficulties.
The advantage in the group approach is that the patient is confronted with its limits and possibilities. This observation allows us to recognize another important similarities and contrasts, expanding your vision of treatment and enhancing its effect. Group assistance seems to be more motivating and can further reduce costs in attendance with good results.
The creation of this psychoeducational group appears to foster the promotion / preservation of independence and functional capacity of patients in its maximum exponent, mean they can live without assistance for activities of daily living. The rehabilitative scheme is performed without isolating the patient from his family and his social environment. Looking for a comprehensive care that meets individual needs and possibilities, centered on the patient, with a view to their rehabilitation and social reintegration. Involves both professionals and patients, actively, in the development of skills that may lead to a better quality of life.
Symptomatic neurosyphilis in immunocompetent patients is nowadays a rare diagnosis. Yet, if not properly diagnosed and treated, consequences for the patient's health are severe. Known as “the great imitator”, its detection involves both a high degree of suspicion and adequate diagnostic tests. Psychiatric symptoms are often the presenting symptoms of this illness.
The authors report four cases of neurosyphilis with psychiatric symptoms (general paresis) in immunocompetent patients. all four patients were initially referred for observation by a psychiatrist in the emergency room. Special diagnostic features of each case and potential diagnostic pitfalls are highlighted.
To raise awareness to the importance of this rare but highly disabling disease.
Review of clinical records and complementary exams.
All patients were male, two Caucasian and two African Black, with ages ranging from 41–56 years old. Clinical presentations were quite distinct, showing the symptomatic heterogeneity of paretic neurosyphilis. Blood VDRL test was negative in one case, CSF VDRL was negative in another case. TPHA was always positive in blood and CSF. White cell count and protein quantification in the CSF remains important to confirm diagnosis.
Current prevalence of symptomatic neurosyphilis in Western Europe is unknown. Atypical cases presenting with heterogeneous psychiatric and neurologic symptoms, with no previous history of mental illness, should undergo blood VDRL testing, and specific blood treponemal testing should be considered in specific situations. A high index of clinical suspicion is needed. Confirmation of diagnosis is only possible through further CSF analysis.
There is robust evidence recommending electroconvulsive therapy (ECT) in treating severe acute affective disorders. The clinical use of bitemporal electrode placement is still favoured to unilateral placement with just a relative disadvantage in cognitive side effects. Recently, bifrontal placement has gained popularity but there is still limited evidence on its relative benefits.
Compare bitemporal and bifrontal ECT efficacy in patients with pharmacologically resistant affective disorders, based on the number of acute phase treatments required to reach symptomatic remission.
Review of all patients' charts submitted to acute phase ECT, between June 2006 and June 2011. A total of 70 ECT treatment courses performed in a group of 67 patients met inclusion criteria. Thirty-eight of the total 70 courses received bitemporal ECT, and 32 received bifrontal ECT. A statistical analysis was performed. An attempt to use t-test was foiled due to breach of population variance homogeneity (p = 0,021). The non-parametric Mann-Whitney test was the alternative choice (M-W = 534;p = 0,377).
Bitemporal and bifrontal groups matched for age and sex. Bitemporal patients received on average five ECT treatments, while the average of bifrontal treatments to remission was six, but this difference was not statistically significant (p > 0.05).
Our results showed that bitemporal and bifrontal placements are equally effective. According to the largest randomised controlled trial conducted on ECT in depressive illness (Kellner et al,2010), bitemporal placement led to a faster rate of improvement. Additional studies and larger samples are required to understand if bifrontal placement's efficacy and cognitive advantages justify its popularity.
Self-harm is a major public health problem, being a frequent condition among youth and young adults. Psychiatric conditions, like borderline personality, depression, substance misuse and anxiety disorders, are commonly associated with self-harm. The effects of media and contagion are also important and the internet has an important role in divulging and sharing self-harm behaviors.
We pretend to study the role the internet in potentiating or preventing self-harm behaviors.
We used combined literature searches in PubMed and B-on using the terms “self-harm”, “self injury”, “self mutilation” and “internet” and we also present a clinical case from our service.
Most of the individuals that have self-harm behaviors may never present in psychiatric ward. Today, there is more information about self-harm available to the public domain than ever and web sites about self-harm include personal pages, forums, blogs, communities and even video-sharing sites. These web sites have supportive content that allow the users feeling that they are not alone, sharing feelings and narratives. However, most of them have potentially harmful material, including self-injury related tips, reinforcing messages and triggering material, normalizing or even glamorizing self-injury.
Most of the websites normalize and promote self-harm behaviors. Only the better knowledge of these phenomena would allow the use of internet as an effective tool for self-harm prevention, especially for socially-isolated and vulnerable individuals.