Monoamines and cortisol as potential mediators of the relationship between exercise and depressive symptoms.

A randomized controlled trial was conducted to assess the effects of exercise plus pharmacotherapy on monoamine neurotransmitters (dopamine, noradrenaline, adrenaline, serotonin) and cortisol levels. A total of 26 women with clinical depression were randomly assigned to one of the two groups: aerobic exercise plus pharmacotherapy or only pharmacotherapy. The exercise program consisted of aerobic exercise, 45-50 min/session, three times/week, for 16 weeks. The biological parameters were measured before and after the exercise program. Adding exercise to pharmacotherapy had no additional effects on monoamines and cortisol plasma levels. These data are preliminary outcomes from a small sample and should be replicated.

Using Heart Rate Variability for Comparing the Effectiveness of Virtual vs Real Training Environments for Firefighters.

The use of Virtual Reality (VR) technology to train professionals has increased over the years due to its advantages over traditional training. This paper presents a study comparing the effectiveness of a Virtual Environment (VE) and a Real Environment (RE) designed to train firefighters. To measure the effectiveness of the environments, a new method based on participants' Heart Rate Variability (HRV) was used. This method was complemented with self-reports, in the form of questionnaires, of fatigue, stress, sense of presence, and cybersickness. An additional questionnaire was used to measure and compare knowledge transfer enabled by the environments. The results from HRV analysis indicated that participants were under physiological stress in both environments, albeit with less intensity on the VE. Regarding reported fatigue and stress, the results showed that none of the environments increased such variables. The results of knowledge transfer showed that the VE obtained a significant increase while the RE obtained a positive but non-significant increase (median values, VE: before - 4 after - 7, p = .003; RE: before - 4 after - 5, p = .375). Lastly, the results of presence and cybersickness suggested that participants experienced high overall presence and no cybersickness. Considering all results, the authors conclude that the VE provided effective training but that its effectiveness was lower than that of the RE.

Studying the Influence of Multisensory Stimuli on a Firefighting Training Virtual Environment.

How we perceive and experience the world around us is inherently multisensory. Most of the Virtual Reality (VR) literature is based on the senses of sight and hearing. However, there is a lot of potential for integrating additional stimuli into Virtual Environments (VEs), especially in a training context. Identifying the relevant stimuli for obtaining a virtual experience that is perceptually equivalent to a real experience will lead users to behave the same across environments, which adds substantial value for several training areas, such as firefighters. In this paper, we present an experiment aiming to assess the impact of different sensory stimuli on stress, fatigue, cybersickness, Presence and knowledge transfer of users during a firefighter training VE. The results suggested that the stimulus that significantly impacted the user's response was wearing a firefighter's uniform and combining all sensory stimuli under study: heat, weight, uniform, and mask. The results also showed that the VE did not induce cybersickness and that it was successful in the task of transferring knowledge.

Do Multisensory Stimuli Benefit the Virtual Reality Experience? A Systematic Review.

The majority of virtual reality (VR) applications rely on audiovisual stimuli and do not exploit the addition of other sensory cues that could increase the potential of VR. This systematic review surveys the existing literature on multisensory VR and the impact of haptic, olfactory, and taste cues over audiovisual VR. The goal is to identify the extent to which multisensory stimuli affect the VR experience, which stimuli are used in multisensory VR, the type of VR setups used, and the application fields covered. An analysis of the 105 studies that met the eligibility criteria revealed that 84.8 percent of the studies show a positive impact of multisensory VR experiences. Haptics is the most commonly used stimulus in multisensory VR systems (86.6 percent). Non-immersive and immersive VR setups are preferred over semi-immersive setups. Regarding the application fields, a considerable part was adopted by health professionals and science and engineering professionals. We further conclude that smell and taste are still underexplored, and they can bring significant value to VR applications. More research is recommended on how to synthesize and deliver these stimuli, which still require complex and costly apparatus be integrated into the VR experience in a controlled and straightforward manner.

Confirmatory factorial analysis of the Brazilian version of the Competitive State Anxiety Inventory-2 (CSAI-2).

The aim of this study was to assess the factorial structure of the Brazilian version of CSAI-2, using several structures suggested in previous studies. Two samples consisted of Brazilian soccer players, 266 from regional level (age 22.87 +/- 4.08 years; athletic experience 11.32 +/- 4.15 years) and 263 from national level (age 23.16 +/- 4.37 years; athletic experience 11.11 +/- 4.78 years) were used. The CSAI-2 is a 27-item inventory that measures negativism, physiological activation and self-confidence in a competitive setting. The results of CFA according to the original structure showed some inadequacy of the model. The model proposed by Cox, Martens, Russell (2003), composed of three factors (17-item), demonstrated better adjustment to the regional level sample (chi2/df = 1.871, CFI = .934, GFI = .916, RMSEA = .057), while the model suggested by Coelho, Vasconcelos-Raposo, Fernandes (2007), composed of two factors (18-item), adapted better to the national level sample (chi2/df = 1.701, CFI = .924, GFI = .914, RMSEA = .052). When we analyzed the two samples together, Coelho et al. (2007) was the better model, because it displayed greater invariance. The use of this model was suggested in the assessment of intensity of negative thoughts and the subsequent confirmation of its psychometric properties is recommended.

Preliminary analysis of the psychometric properties of Ryff's scales of psychological well-being in Portuguese adolescents.

This article presents a set of research studies that aim to adapt Carol Ryff's scales of psychological wellbeing (SPWB) and to analyze its psychometric properties in adolescents. The first two studies focused on the reliability and factorial validity of different Portuguese short versions of SPWB, revealing measurement models inadequacies and low internal consistency. In the third study we developed a shortened version (30 items), taking into account the application of psychometric criteria suggested by van Dierendonck (2005). The scales of this version revealed better reliability and adequate goodness of fit indices for the six-factor model, as proposed by Carol Ryff's PWB theory. Although further research focused on the psychometrical properties reanalysis of this shortened version of SPWB is needed, this article provides a contribution to the research and intervention on positive mental health during adolescence.

Impact of Different Sensory Stimuli on Presence in Credible Virtual Environments.

Multiple factors can affect presence in virtual environments, such as the number of human senses engaged in a given experience or the extent to which the virtual experience is credible. The purpose of the present work is to study how the inclusion of credible multisensory stimuli affects the sense of presence, namely, through the use of wind, passive haptics, vibration, and scent. Our sample consisted of 37 participants (27 men and 10 women) whose ages ranged from 17 to 44 years old and were mostly students. The participants were divided randomly into 3 groups: Control Scenario (visual and auditory - N = 12), Passive Haptic Scenario (visual, auditory, and passive haptic - N = 13) and Multisensory Scenario (visual, auditory, wind, passive haptic, vibration, and scent - N = 12). The results indicated a significant increase in the involvement subscale when all multisensory stimuli were delivered. We found a trend where the use of passive haptics by itself has a positive impact on presence, which should be the subject of further work.

Portuguese and Brazilian guidelines for the treatment of depression: exercise as medicine.

Depression is a psychiatric disorder and major contributor to the burden of disease worldwide. The strength of evidence of the benefits of exercise as a therapeutic intervention for patients with depression has expanded in the last 30 years. In fact, the available evidence indicates exercise can not only help manage depressive symptoms, but also effect significant improvements in other health outcomes. Clinical guidelines including such recommendations have been issued by different agencies, namely the UK National Institute for Health and Clinical Excellence (NICE), the American Psychiatric Association (APA), and the Royal Australian and New Zealand College of Psychiatrists (RANZCP). With increasing recognition of the benefits of exercise and shortcomings of healthcare systems, other countries, such as Sweden and Canada, have included exercise in their national guidelines for treating depression. Unfortunately, progress in incorporating exercise guidelines into clinical practice has been slow, and Portugal and Brazil reflect this reality. In this update, we reemphasize the importance of bridging this gap and integrating exercise into clinical practice guidelines as an essential component of depression treatment.

Impact of physical exercise on catechol-O-methyltransferase activity in depressive patients: A preliminary communication.

BACKGROUND: Catechol-O-methyltransferase (COMT) is a catabolic enzyme involved in the degradation of bioactive molecules including the neurotransmitters epinephrine, norepinephrine, and dopamine. Higher COMT activity in depressive patients in comparison to non-depressed individuals has been reported. The effect of aerobic exercise on depressive patients has been studied and a number of researchers and clinicians believe it to be effective in the treatment of depression and to be involved in several molecular underlying mechanisms. However, the effect of physical exercise on this enzyme activity is unknown, and it remains to be elucidated if chronic exercise changes COMT activity. This randomized control trial evaluates the effects of chronic exercise on peripheral COMT (S-COMT) activity in women with depressive disorder. METHODS: Fourteen women (aged: 51.4±10.5 years) diagnosed with depression (according to International Classification of Diseases-10) were randomized to one of two groups: pharmacotherapy plus physical exercise (n=7) or only pharmacotherapy (n=7). The aerobic exercise program was supervised, lasting between 45-50min/session, three times/week for 16 weeks. Erythrocyte soluble COMT were assessed prior to and after the exercise program. RESULTS: Exercise group when compared to a control group presented a significant decrease (p=0.02, r=-0.535) in S-COMT activity between baseline and post-intervention. LIMITATIONS: These data are preliminary outcomes from a small sample and should be replicated. CONCLUSIONS: Chronic exercise therapy combined with pharmacotherapy leads to significant decrease in S-COMT activity. Our results provide evidence that exercise interferes with S-COMT activity, a molecular mechanism involved in depression.

Effects of structured exercise and pharmacotherapy vs. pharmacotherapy for adults with depressive symptoms: A randomized clinical trial.

OBJECTIVE: Physical exercise has been consistently documented as a complementary therapy in the treatment of depressive disorders. However, despite a higher prevalence among women compared to men, the trials developed in women are scarce. In addition, the optimal dosage of exercise capable of producing benefits that reduce depressive symptoms remains unclear. This clinical trial is designed to measure the effect of a structured physical exercise program as a complement to antidepressant medication in the treatment of women with depression. METHODS: From July 2013 to May 2014, we implemented a randomized controlled trial (HAPPY BRAIN study). A total of 26 women (aged 50.16 ± 12.08) diagnosed with clinical depression were randomized either to a supervised aerobic exercise group (45-50 min/week three times a week for four months) plus pharmacotherapy (intervention group), or only antidepressant medication (control group). RESULTS: The exercise group presented a decrease in BDI-II and DASS-21 total score scales. Relatively to DASS-21, it showed a significant decrease in anxiety and stress. The exercise group when compared to a control group showed improvement in relation to physical functioning parameters between baseline and post-intervention. Moreover, anthropometric parameters presented only significant differences between groups in fat mass percentage. Nonetheless, no differences were found between groups in weight, body mass index, waist circumference, and self-esteem. CONCLUSION: Our results showed that supervised structured aerobic exercise training could be an effective adjuvant therapy for treating women with depression, reducing depressive symptomatology and improving physical fitness. A key factor of this improvement included strict control of exercise workload parameters and adjustment to each subject's capacity. In our study, due to the sample size there is an increase in the probability of type II errors.

Factorial validity and invariance of the GHQ-12 among clinical and nonclinical samples.

The purpose of this study was to examine the internal reliability, factorial validity, and measurement invariance of a Brazilian-Portuguese version of the General Health Questionnaire-12 (GHQ-12) across clinical and nonclinical groups. The clinical sample consisted of 228 chronic hemodialysis patients (41.7% female), with a mean age of 48.23 (SD = 16.02) years, whereas the nonclinical sample comprised 350 university students (59.1% female), with a mean age of 21.15 (SD = 2.04) years. Initial model fit comparison of 16 factor structures reported in the literature, through confirmatory factor analysis (CFA), provided mixed results. Additional revisions based on CFA modification indices demonstrated that a reduced (8-item) one-factor model with three error covariances provided the best fit to the data in both samples (comparative fit index > .98 and root mean square error of approximation < .05) and acceptable internal reliability estimates (>.70). Pearson's correlations between the original and the reduced scale was .96 for both samples. Multigroup analysis supported partial strong measurement equivalence across groups. Latent mean differences showed an expected higher factor mean for the clinical sample. Overall results demonstrated that the 8-item one-factor of the GHQ-12 showed good psychometric properties in both samples and provided preliminary support for meaningful comparisons of factor means across clinical and nonclinical groups.

Factor structure and reliability of the depression, anxiety and stress scales in a large Portuguese community sample.

The purpose of the present study was to assess the factor structure and reliability of the Depression, Anxiety and Stress Scales (DASS-21) in a large Portuguese community sample. Participants were 1020 adults (585 women and 435 men), with a mean age of 36.74 (SD = 11.90) years. All scales revealed good reliability, with Cronbach's alpha values between .80 (anxiety) and .84 (depression). The internal consistency of the total score was .92. Confirmatory factor analysis revealed that the best-fitting model (*CFI = .940, *RMSEA = .038) consisted of a latent component of general psychological distress (or negative affectivity) plus orthogonal depression, anxiety and stress factors. The Portuguese version of the DASS-21 showed good psychometric properties (factorial validity and reliability) and thus can be used as a reliable and valid instrument for measuring depression, anxiety and stress symptoms.

Consumo de Canábis: craving e a relação com ansiedade, stresse e depressão / Cannabis use: craving and the relationship with anxiety, stress and depression

Resumo. A canábis é a substância ilícita mais consumida em Portugal com um início de consumo muito precoce. O craving é considerado um dos factores fundamentais ligados ao consumo de canábis, associando-se à depressão, a ansiedade e ao stresse. Espera-se que nível de craving e sexo se relacionem com a depressão, ansiedade e stresse numa amostra de consumidores portugueses. A amostra foi constituída por 143 consumidores da zona Norte do país e os dados recolhidos através de questionários online (DASS-21 e o MCQ-SF). Os resultados permitem concluir que a emocionalidade, a intencionalidade e a compulsividade relacionaram-se positivamente com o nível do craving, bem como, com o stresse e a depressão. Quanto ao número de anos de consumo, constatou-se um efeito significativo, de dimensão média, na ansiedade.

Abstract. Cannabis is the most used illicit substance in Portugal and is the one, which presents, on average, na earlier onset of consumption. Craving is considered one of the fundamental factors linked to the cannabis use, associating anxiety, stress and depression. The sample consisted of 143 individuals from the northern area of the country and the data was gathered through two online questionnaires (DASS-21 and the MCQ-SF). The obtained results allow us to conclude that emotionality, purposefulness and compulsivity are positively associated with the level of craving and, combined, as well to stress and depression. The number of years of consumption presents a significant effect in anxiety, with a medium effect size.

Correlation between symptoms and course duration of upper aerodigestive tract cancer at early and advanced stages.

UNLABELLED: There still are many clinical and biological aspects of the natural history of cancer of the upper aerodigestive tract to be unveiled; which in Brazil is a direct consequence of the failure of systematic prevention and early diagnosis campaigns. OBJECTIVE: To analyze the signs and symptoms presented by patients with the disease at initial and advanced stages. Other variables such as disease duration, general and nutritional status were considered. METHOD: A historical cohort study with a cross-section involving 895 subjects with cancer of the upper aerodigestive tract. RESULTS: Clinical findings were not statistically correlated with disease progression, nor with the disease in early stages, but it showed rapid disease development. CONCLUSION: The results suggest a disease of insidious onset in the early stages and fast course afterwards. The long disease duration - greater than three months, was associated with worsening in general and nutritional states of patients.

Portuguese and Brazilian guidelines for the treatment of depression: exercise as medicine

Depression is a psychiatric disorder and major contributor to the burden of disease worldwide. The strength of evidence of the benefits of exercise as a therapeutic intervention for patients with depression has expanded in the last 30 years. In fact, the available evidence indicates exercise can not only help manage depressive symptoms, but also effect significant improvements in other health outcomes. Clinical guidelines including such recommendations have been issued by different agencies, namely the UK National Institute for Health and Clinical Excellence (NICE), the American Psychiatric Association (APA), and the Royal Australian and New Zealand College of Psychiatrists (RANZCP). With increasing recognition of the benefits of exercise and shortcomings of healthcare systems, other countries, such as Sweden and Canada, have included exercise in their national guidelines for treating depression. Unfortunately, progress in incorporating exercise guidelines into clinical practice has been slow, and Portugal and Brazil reflect this reality. In this update, we reemphasize the importance of bridging this gap and integrating exercise into clinical practice guidelines as an essential component of depression treatment.

Effects of a Process-Oriented Goal Setting Model on Swimmer's Performance.

The aim of this work was to study the impact of the implementation of a mental training program on swimmers' chronometric performance, with national and international Portuguese swimmers, based on the goal setting model proposed by Vasconcelos-Raposo (2001). This longitudinal study comprised a sample of nine swimmers (four male and five female) aged between fourteen and twenty, with five to eleven years of competitive experience. All swimmers were submitted to an evaluation system during two years. The first season involved the implementation of the goal setting model, and the second season was only evaluation, totaling seven assessments over the two years. The main results showed a significant improvement in chronometric performance during psychological intervention, followed by a reduction in swimmers' performance in the second season, when there was no interference from the investigators (follow-up).

Factor structure and normative data of the Greene Climacteric Scale among postmenopausal Portuguese women.

OBJECTIVES: The purposes of the present study were to assess the factorial structure and reliability of the Greene Climacteric Scale (GCS), and provide normative data for a sample of postmenopausal Portuguese women. METHODS: A sample of 401 Caucasian women, with ages between 47 and 91 years, divided into four age groups (47-57: 31.4%, 58-68: 40.4%, 69-79: 21.4% and ≥80: 6.7%), voluntarily participated in the study. The Greene Climacteric Scale aims to measure psychological symptoms divided into anxiety and depression, somatic and vasomotor symptoms with a total of 21 items. Data were analyzed by reliability, correlation and confirmatory factor analyses. Age group differences in the raw and the standardized scores of symptoms clusters were investigated by means of ANOVA procedures. RESULTS: The CFA performed supported the 4-factor structure specified by Greene (*CFI=0.937; SRMR=0.046; *RMSEA (90%IC)=0.050 (0.042-0.058). The computed internal consistency estimates ranged from 0.73 to 0.90. Vasomotor symptoms (hot flushes and sweating at night) were experienced most frequently by the younger age group (47-57 years) while nonspecific symptoms (e.g. difficulty in concentrating, feeling tired or lacking in energy, breathing difficulties) were reported more frequently by the older age groups. CONCLUSIONS: Our results suggest that the Portuguese version of the GCS is a reliable and a valid instrument for the measurement of climacteric-related factors in postmenopausal women.

Sexual satisfaction in patients with cancer / Satisfacción sexual en enfermos de cáncer / Satisfação sexual em pacientes com câncer

Abstract This study aimed to compare the dimensions of sexual satisfaction in subjects with and without cancer. Independent variables were: different types of cancer, time elapsed since diagnosis, types of treatment and changes in body image. The dependent variable was level of satisfaction with sexual relations. The sample consisted of 184 participants, of whom 95 belonged to the cancer group (ages between 26 and 84 years) and 89 to the non-cancer group (ages between 19 and 67 years). The instrument used was the Sexual Satisfaction Questionnaire (QSRS, for its Portuguese acronym). The results showed significant differences between the cancer group and the non-cancer group. Individuals with a history of cancer disease had lower values (17.93 ± 9.67) at the level of sexual function compared to individuals with no history of the disease (30.19 ± 4.2). Individuals with cancer who had higher values of self-esteem were those with urological cancer (16.76 ± 2.85), followed by breast cancer (14.83 ± 3.34) and "other cancers" (14.41 ± 5.5), whereas those with digestive cancer presented the lowest values (5.68 ± 13.63). In sexual functioning, the group of "other cancers" showed the highest levels of satisfaction (23.53 ± 10.12), while people with breast cancer (19.54 ± 9.36), digestive cancer (18.50 ± 12.57), and urological cancer (29.12 ± 7.22) presented the lowest levels of satisfaction. Within the group of people with cancer, those who had less than one year and between three to five years of having been diagnosed reflected less satisfactory sexual performance values. On the other hand, radiation treatments, surgery and "other treatments" showed negative effects on sexual functioning, as well as changes in body image. All independent variables had a negative impact on sexual satisfaction and performance, with the exception of weight loss, vomiting, and hair loss.

Resumen Este estudio tuvo como objetivo comparar las dimensiones de satisfacción sexual en sujetos con y sin cáncer, específicamente al comparar los diferentes tipos de cáncer, el tiempo de diagnóstico y los tipos de tratamiento, con cambios en la imagen corporal y el nivel de satisfacción con las relaciones sexuales. La muestra estuvo compuesta por 184 participantes, de los cuales 95 pertenecieron al grupo con cáncer (edades entre los 26 y 84 años) y 89 al grupo sin cáncer (edades entre los 19 y 67 años). El instrumento utilizado fue el Questionário de Satisfação com o Relacionamento Sexual (QSRS). Los resultados mostraron diferencias significativas entre el grupo con cáncer y el grupo sin cáncer, los individuos con antecedentes de enfermedad de cáncer presentaron valores más bajos (17.93 ± 9.67) en el nivel de la función sexual en comparación con los individuos sin antecedentes de dicha enfermedad (30.19 ± 4.2). Los individuos con cáncer que presentaron valores más altos en autoestima fueron los de cáncer urológico (16.76 ± 2.85), seguidos por los de cáncer de mama (14.83 ± 3.34) y "otros tipos de cáncer" (14.41 ± 5.5); siendo los de cáncer digestivo quienes presentaron los valores más bajos (5.68 ± 13.63). En el funcionamiento sexual, el grupo de "otros tipos de cáncer" mostró niveles más altos de satisfacción (23.53 ± 10.12), mientras que las personas con cáncer de mama (19.54 ± 9.36), cáncer digestivo (18.50 ± 12.57) y cáncer urológico (29.12 ± 7.22) presentaron los niveles más bajos de satisfacción. Dentro del grupo de personas con cáncer, los que tienen menos de un año y de tres a cinco años después de haber tenido el diagnóstico reflejaron valores de funcionamiento sexual menos satisfactorios. Por otro lado, los tratamientos de radiación, cirugía y "otros tratamientos" mostraron efectos negativos en el funcionamiento sexual, así como cambios en la imagen corporal. Todas las variables independientes tuvieron un impacto negativo en la satisfacción y el desempeño sexual, con excepción de la pérdida de peso, el vómito y la pérdida de cabello. Palabras clave: Cáncer, sexualidad, funcionamiento sexual, enfermedad maligna.

Resumo O objetivo foi comparar indivíduos em função das seguintes variáveis independentes: cancro e sem cancro, diferentes tipos de cancro, tempo de diagnóstico, diferentes tipos de tratamento e mudanças na imagem corporal tendo por variável dependente o nível da satisfação da relação sexual. A amostra foi constituída por 184 participantes (95 com cancro com idades entre 26 e 84 anos; 89 sem cancro, com idades entre 19 e 67 anos). Foi utilizado o Questionário de Satisfação com o Relacionamento Sexual (QSRS). Verificaram-se efeitos significativos entre os indivíduos com historial de doença oncológica ao nível do funcionamento sexual, comparativamente com os indivíduos sem historial de doença oncológica. Indivíduos com cancro urológico apresentam valores mais elevados ao nível da autoestima (16.76 ± 2.85), seguidos pelo cancro de mama (14.83 ± 3.34) e outros tipos de cancro (14.41 ± 5.05). O cancro digestivo é o que apresenta os valores mais baixos (13.63 ± 5.68). Com relação ao funcionamento sexual, o grupo "outros tipos de cancro" apresenta maiores níveis de satisfação (23.53 ± 10.12). Seguem-se o cancro de mama (19.54 ± 9.36) e os digestivos (18.50 ± 12.57) e, por último, o cancro urológico, que apresenta os níveis mais baixos (12.29 ± 7.22). Dentro do grupo de indivíduos com cancro, o período inferior a um ano e de três a cinco anos apresenta valores menos satisfatórios na dimensão funcionamento sexual, e os tratamentos de radioterapia, cirurgia e "outros tipos de tratamento" produzem efeitos negativos ao nível do funcionamento sexual, assim como as mudanças na imagem corporal. No presente estudo, com a exceção de perda de peso, vómitos e perda de cabelos, todas as variáveis independentes têm um impacto negativo na satisfação/desempenho sexual.

[Association amongst physical activity, aging and dementia]. / Associação entre a actividade física, envelhecimento e demência.

The human possibility of becoming old - the so called Nestor Effect -, as an evolutionary adaptation, is beneficial only if there is some preservation of a certain cognitive character. Differing neuropathological conditions, such as neurodegenerative diseases, due to an abnormal aggregation of certain proteins, may induce chronic inflammatory processes. As so, physical activity increases aerobic fitness and the brain's blood flow capacity, contributing to the decrease of the central nervous system's chronic inflammation, promoting neuroplasticity, and neural circuitry's reorganisation.