Infant processed food consumption and their interaction to breastfeeding and growth in children up to six months old.

BACKGROUND: Evidences suggest that early processed food (PF) consumption may cause harm to infant health. During the first 6 months of life, it is not known whether the timing and quantity of this food group can impact breastfeeding and growth. The aim of the study was to analyze the associations between time of introduction and quantity of infant PF consumption with duration of breastfeeding and infant growth at 6 months of age. METHODS: Data were longitudinally collected in six interviews, from birth to 6 months, in a sample of Brazilian newborns with adverse intrauterine environments. PF consumption was calculated by gravity score of processed foods (GSPF) in relation to feeding supply quality and time. For the analysis, the scores were divided into tertiles, making scores severities: Null, Mild, Moderate, and Severe. The interaction between GSPF and breastfeeding (exclusive and non-exclusive) and growth parameters (analyzed in Z-scores, by weight for height, weight for age, and body mass index for age) was tested. RESULTS: A total of 236 infants were included in the study. Greater GSPF were associated with better rates of breastfeeding practices and higher growth indicators scores in the sixth month of infants. These findings were confirmed after adjustment for family income, maternal age, pre-gestational body mass index, and growth z scores at birth. CONCLUSION: The harms of eating PF in relation to breastfeeding and infant growth are more evident the greater and earlier they are consumed. Future studies should explore interventions to reduce and delay the consumption of these foods to prevent adverse health outcomes in later life.

Anxiety Sensitivity and Panic Disorder: Evaluation of the Impact of Cognitive-Behavioral Group Therapy.

Anxiety sensitivity (AS) is a multidimensional construct associated with the etiology and maintenance of panic disorder (PD) symptoms. However, only a few studies have evaluated whether cognitive-behavioral group therapy (CBGT) can modify the condition. The objective of this study was to evaluate the impact of CBGT on AS in patients with PD and to analyze AS and its dimensions as predictors of response to CBGT. In the present clinical trial, an intervention group (n = 37) attended 12 CBGT sessions, while a control group (n = 52) did not receive any intervention. The severity of symptoms and of AS were evaluated before and after CBGT in the intervention group and once in the control group. Significant improvement occurred in all specific PD symptoms and in general anxiety and depressive symptoms. Furthermore, AS scores reduced significantly after intervention. This study confirmed that AS is higher in patients with more severe PD. The effectiveness of CBGT for reducing the physical, cognitive, and social dimensions of AS was also observed, supporting the hypothesis of a positive impact of therapy.

Markers for Severity of Problems in Interpersonal Relationships of Crack Cocaine Users from a Brazilian Multicenter Study.

Crack cocaine users frequently report difficulties regarding having healthy and rewarding relationships. Factors other than the use of crack cocaine itself may be at play when it comes to being able to develop healthier connections with partners, adult relatives and close friends. To verify which factors, including demographics, substance abuse related factors and psychiatric comorbidities could be markers for a higher severity of problems in interpersonal relationships of crack cocaine users seeking for treatment. This was a cross-sectional study, conducted between April 2011 and November 2012. Participants were 407 crack cocaine users seeking treatment in specialized public facilities of six Brazilian capitals. The relationship of severity of problems in the family/social area and the prevalence of psychiatric disorders, exposure to stressful events, substance use related factors and practice of illicit activities were explored through multivariate analyses. Number of days using crack cocaine in the last 30 days, age of first time using alcohol and feeling its effects, a diagnosis of alcohol abuse, posttraumatic stress disorder, antisocial personality disorder and attention-deficit/hyperactivity disorder were significantly associated with a higher severity of problems in interpersonal relationships with partners, adult relatives and friends. Problems in interpersonal relationships are strongly related to specific psychiatric comorbidities and the frequency of crack cocaine use. Factors identified by this study can make the paths to recovery more challenging. These results support psychosocial interventions that focus in the improvement of interpersonal relationships of crack cocaine users.

Gender and social mobility modify the effect of birth weight on total and central obesity.

BACKGROUND: Little is known about the interaction between gender and low birth weight (LBW) and lifelong social mobility as an explanation of the etiology of obesity. The aim of the present study was to evaluate total and central obesity according to gender, LBW and social mobility, within the context of the epidemiological transition in middle-income countries. We hypothesize that there are more pronounced metabolic consequences of social mobility for women born with LBW. METHODS: We used data from a birth cohort study conducted in Ribeirão Preto, São Paulo, Brazil. Data regarding anthropometric measurements, schooling and smoking status were collected at 23-25 years of age. Social mobility was determined based on maternal and adult offspring schooling and categorized as Low-Low, Low-High and High-High. Analysis of covariance was performed to assess the association between social mobility and body mass index (BMI) or waist circumference (WC) in adulthood, stratified by LBW and gender. RESULTS: Data on 6827 singleton pregnancies were collected at birth in 1978/79 and a sample was followed up in 2002/04. A total of 2063 subjects were included in the study. Mean age was 23.9 ± 0.7 years, 51.8% (n = 1068) were female and the LBW was 6.2% (n = 128). There was a triple interaction between social mobility, LBW and gender. Among women born without LBW, BMI and WC were higher in the Low-Low group compared to High-High schooling group. Among LBW women, BMI and WC were higher in the Low-Low group compared to the Low-High group. CONCLUSIONS: Women born with LBW belonging to the low schooling group in early adulthood had high BMI and WC, compared to the Low-High social mobility group.

Factors associated with smoking initiation among school-aged adolescents. / Fatores associados à iniciação tabágica em adolescentes escolares.

OBJECTIVE: To identify factors associated with smoking initiation in adolescent secondary school students. METHOD: This is a cross-sectional study conducted in 2014 with 864 adolescents at a secondary school in southern Brazil. Data were collected using an instrument with sociodemographic questions, application of the Fagerström Nicotine Dependence Scale, and Beck Depression Inventory, and analysed using descriptive statistics, Fisher's Exact test, Chi-square test, Mann-Whitney's test, and the Poisson Regression test. RESULTS: Fifty-four of the adolescents started smoking, of which 35 continued smoking and exhibited high nicotine dependence. Smoking was associated with brown skin (p = 0.020), single-parent household (p = 0.006), a fair family relationship (p = 0.003), and drug users in the family (p = 0.04). A significantly higher prevalence ratio was detected for boys (p = 0.038), higher family income (p> 0.001), living with one family member (p> 0.001), and a fair family relationship (p> 0.001). CONCLUSIONS: We identified factors associated with smoking initiation, revealing the importance of supporting health education strategies to change this reality.

The efficacy of long-term psychodynamic psychotherapy, fluoxetine and their combination in the outpatient treatment of depression.

OBJECTIVE: There are few randomized controlled trials examining the efficacy of long-term psychodynamic psychotherapy (LTPP) in depression treatment. LTPP was compared with fluoxetine treatment and their combination; METHODS: 272 depressed patients (aged 26-34, 72% with a first episode of depression) were randomized to receive LTPP (one session/week), fluoxetine treatment (20-60 mg/day) or their combination for 24 months. Beck Depression Inventory (BDI) was the outcome measure. The psychotherapy was not manualized and the treatment took place under real-life conditions in an outpatient psychiatric clinic. RESULTS: Intention-to-treat analyses indicated that all the treatments were associated with significant reductions in the BDI scores (mean reduction of 18.88 BDI points). Furthermore, LTPP and combination therapy were more effective in reducing BDI scores than fluoxetine alone (22.08 and 22.04 vs. 12.53 BDI points). CONCLUSIONS: LTPP, pharmacological treatment with fluoxetine and their combination are effective in reducing symptoms of patients with moderate depression. LTPP and combined treatment were more effective compared to fluoxetine alone. These findings have implications for patients with depression who may benefit from long-term psychotherapy or combined treatment, or for depressed patients who do not wish to take medications such as fluoxetine.

Increase in brain-derived neurotrophic factor expression in early crack cocaine withdrawal.

Recent reports suggest that brain-derived neurotrophic factor (BDNF) could be a biomarker for relapse, drug craving and withdrawal severity. In particular, elevated BDNF levels among former cocaine users have been associated with higher rates of relapse in 90 d. However, no data are available on BDNF levels at baseline and during crack cocaine withdrawal. This study evaluated BDNF among crack cocaine users during inpatient treatment, before and after withdrawal, vs. healthy controls. Clinical correlates with changes in BDNF levels were also assessed. Serum BDNF was evaluated in 49 male crack users on the first and last days of hospitalization and in 97 healthy controls. Serum BDNF was assayed using a sandwich ELISA kit. BDNF levels were significantly lower upon admission when compared to controls, even after adjustment for age, length of inpatient treatment, number of crack rocks used in the last 30 d, years of crack use and interaction between the latter two variables. At discharge, BDNF levels between patients and controls were similar. Number of crack rocks used in the last 30 d and years of crack use were inversely correlated with the outcome. Our findings show that BDNF levels increase during early crack cocaine withdrawal, at an inverse correlation with number of crack rocks used in the last 30 d and years of crack use.

Association between anger expression and attempted suicide at a general emergency hospital in the south of Brazil.

INTRODUCTION: Suicide is one of the leading causes of death in the world. For every person who commits suicide, twenty or more have attempted to take their own lives. The emotional state of anger is often associated with suicidal behavior. However, this association needs to be further clarified. OBJECTIVES: This study sought to investigate the profiles of traits and expressions of anger in inpatients admitted to a general emergency hospital after surviving a suicide attempt. METHODS: In this case-control study, a sample of 28 suicide survivors was matched for sex, age, and educational level with 56 controls. The State-Trait Anger Expression Inventory-2 was used to measure anger traits and expression. RESULTS: Suicide survivors scored higher for anger traits and expression and lower for anger control than the control group. They also had lower levels of state anger and willingness to express anger verbally than the control group. CONCLUSIONS: Patients who attempted suicide and had high scores for anger expression (in and out) are inclined to have extreme difficulty in interpersonal relationships and rigidity towards change and are at higher risk of developing psychopathologies.

Association of physical activity levels and the prevalence of COVID-19-associated hospitalization.

OBJECTIVES: We compared physical activity levels before the outbreak and quarantine measures with COVID-19-associated hospitalization prevalence in surviving patients infected with SARS-CoV-2. Additionally, we investigated the association of physical activity levels with symptoms of the disease, length of hospital stay, and mechanical ventilation. DESIGN: Observational, cross-sectional. METHODS: Between June 2020 and August 2020, we invited Brazilian survivors and fully recovered patients infected with SARS-CoV-2 to respond to an online questionnaire. We shared the electronic link to the questionnaire on the internet. We collected data about clinical outcomes (symptoms, medications, hospitalization, and length of hospital stay) and cofactors, such as age, sex, ethnicity, preexisting diseases, socioeconomic and educational, and physical activity levels using the International Physical Activity Questionnaire (IPAQ short version). RESULTS: Out of 938 patients, 91 (9.7%) were hospitalized due to COVID-19. In a univariate analysis, sex, age, and BMI were all associated with hospitalizations due to COVID-19. Men had a higher prevalence of hospitalization (66.6%, p = 0.013). Patients older than 65 years, obese, and with preexisting disease had a higher prevalence of COVID-19-related hospitalizations. In a multivariate regression model, performance of at least 150 min/wk (moderate) and/or 75 min/wk (vigorous) physical activity was associated with a lower prevalence of hospitalizations after adjustment for age, sex, BMI, and preexisting diseases (PR = 0.657; p = 0.046). CONCLUSIONS: Sufficient physical activity levels were associated with a lower prevalence of COVID-19-related hospitalizations. Performing at least 150 min a week of moderate-intensity, or 75 min a week of vigorous-intensity physical activity was associated with 34.3% reduction in prevalence.

Brief antibullying intervention for adolescents in public schools.

OBJECTIVES: To assess the results of a brief antibullying intervention for adolescents in public schools. METHOD: This was a controlled experimental study whose subjects were 1,043 students in 5th through 9th grades from public schools in Porto Alegre/State of Rio Grande do Sul, conducted between April and November 2015. Adolescents and school teachers randomly assigned to the intervention group participated in two meetings focused on educative aspects of bullying. Outcome was assessed using the Bullying Questionnaire - victim and perpetrator version. Generalized Estimating Equations was used to evaluate the effect of the intervention. RESULTS: Average age of subjects was 12.5 (SD=1.62) years. A total of 613 (58.7%) adolescents participated in interventions. They were compared to 430 (41.3%) participants in the control group. The study did not observe any significant difference in bullying scores after the intervention. CONCLUSIONS: This study indicates the usefulness of clarifying precisely what bullying is in schools as part of an initial approach to an educative strategy on this topic.

The association between traumatic experiences and suicide attempt in patients treated at the Hospital de Pronto Socorro in Porto Alegre, Brazil.

OBJECTIVE: To analyze associations between attempted suicide and childhood trauma. METHODS: A seven month comparative case-control study (28 subjects - patients with suicide attempt; 56 controls - patients without suicide attempt). The following instruments were used: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), and Medical Outcomes Study (MOS). RESULTS: The group with suicide attempt had significantly higher scores for some variables: emotional abuse (p < 0.001), physical abuse (p < 0.001), emotional neglect (p < 0.001), and physical neglect (p < 0.001). CONCLUSIONS: The results suggest that variables related to previous trauma may influence future suicide attempts. The adoption of preventive and therapeutic actions related to mistreatments during child development is a crucial factor in reduction of suicide risk.

Translation and cultural adaptation of the DSM-5 Personality Inventory - Brief Form (PID-5-BF).

INTRODUCTION: The Personality Inventory for the DSM-5 - Brief Form (PID-5-BF) - is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. OBJECTIVES: To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. METHODS: The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. RESULTS: The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. CONCLUSION: The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.

Maternal Weight Variation in Different Intrauterine Environments: An Important Role of Hypertension.

OBJECTIVE: Different intrauterine environments may influence the maternal prepregnancy body weight (BW) variation up to 6 months postpartum. The objective of the present study was to verify the association of sociodemographic, obstetric, nutritional, and behavioral factors with weight variation in women divided into four groups: hypertensive (HM), diabetic (DM), smokers (SM), and control mothers (CM). METHODS: It was a convenience sample of 124 postpartum women recruited from 3 public hospitals in the city of Porto Alegre, state of Rio Grande do Sul, Brazil, between 2011 and 2016. Multiple linear regressions and generalized estimating equations (GEE) were conducted to identify the factors associated with maternal weight variation. For all GEE, the maternal weight measurements were adjusted for maternal height, parity, educational level, and the type of delivery, and 3 weight measurements (prepregnancy, preceding delivery, and 15 days postpartum) were fixed. RESULTS: A hierarchical model closely associated the maternal diagnosis of hypertension and a prepregnancy body mass index (BMI) classified as overweight with maternal weight gain measured up to the 6th month postpartum (the difference between the maternal weight at 6 months postpartum and the prepregnancy weight). These results showed that the BW of the HM group and of overweight women increased ∼ 5.2 kg 6 months postpartum, compared with the other groups. Additionally, women classified as overweight had a greater BW variation of 3.150 kg. CONCLUSION: This evidence supports the need for specific nutritional guidelines for gestational hypertensive disorders, as well as great public attention for overweight women in the fertile age.

OBJETIVO: Diferentes ambientes intrauterinos podem influenciar a variação de peso corporal pré-gestacional materno até 6 meses pós-parto. O objetivo do presente estudo foi verificar a associação de fatores sociodemográficos, obstétricos, nutricionais e comportamentais com a variação de peso em mulheres divididas em quatro grupos: hipertensas (HM), diabéticas (DM), tabagistas (SM) e controles (CM). MéTODOS: Amostra de conveniência de 124 puérperas recrutadas em 3 hospitais públicos da cidade de Porto Alegre, Rio Grande do Sul, Brasil, entre 2011 e 2016. Regressões lineares múltiplas e modelos de equações de estimativas generalizadas (GEE) foram realizados para identificar os fatores associados à variação do peso materno. Para todas as GEE, as medidas de peso materno foram ajustadas para a estatura materna, paridade, escolaridade e tipo de parto, e três medidas de peso (pré-gravidez, anterior ao parto e 15 dias pós-parto) foram fixadas. RESULTADOS: Um modelo hierárquico associou o diagnóstico materno de hipertensão e o índice de massa corporal (IMC) pré-gestacional de sobrepeso com ganho de peso materno medido até o 6° mês pós-parto (diferença entre o peso materno aos 6 meses pós-parto e o peso pré-gestacional). Estes resultados mostraram que o grupo HM e mulheres com sobrepeso aumentaram o peso corporal em ∼ 5,2 kg 6 meses pós-parto, em comparação com os demais grupos. Além disso, as mulheres classificadas com sobrepeso tiveram uma variação maior de peso corporal, de 3,150 kg. CONCLUSãO: Evidenciou-se a necessidade de diretrizes nutricionais específicas para distúrbios hipertensivos gestacionais, bem como de maior atenção dos serviços de saúde públicos para mulheres com excesso de peso em idade fértil.

Evaluation of BDNF levels in patients hospitalized for physical trauma at an emergency hospital in Porto Alegre, southern Brazil.

OBJECTIVE: To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma. METHODS: Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years. RESULTS: We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (Umorning = 1107, pmorning = 0.575; Uafternoon = 7175, pafternoon = 0.028). CONCLUSIONS: The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.

Leptin levels and its correlation with crack-cocaine use severity: A preliminary study.

BACKGROUND: Crack-cocaine is an important public health problem in Brazil and worldwide. It is a potent form of cocaine which results in rapid and damaging stimulating effects on the central nervous system through inhibition of the dopamine transporter. Some studies have suggested that both food and drugs - including crack, can act on the same brain reward mechanisms, altering the dopamine pathways that modulate behavioral responses. Our hypothesis was that leptin, a well-known peptide that modulates energy metabolism and appetite, can be used as a biomarker for drug use. METHODS: Anthropometric data, drug use profiles, and leptin serum levels were evaluated in a cross-sectional study of 40 crack-cocaine users. RESULTS: Leptin showed an inverse correlation with the severity of crack use, and this correlation remained when corrected by body mass index (BMI) and body composition by bioimpedance (BIA). The majority of subjects were eutrophic or overweight/obese considering BMI and BIA, and these variables were not significantly associated with the severity of crack use, but positively correlated with leptin levels. CONCLUSIONS: Our preliminary findings suggest that leptin could be involved in drug use severity, perhaps through pathways similar to those whereby it modulates food intake. Considering the anthropometric parameters, these findings provide additional evidence that low weight is not predominant in crack users.

Metacognitive interventions in text production and working memory in students with ADHD.

This study compared the effects of two metacognitive interventions on writing, working memory (WM), and behavioral symptoms of students with attention-deficit/hyperactivity disorder (ADHD). The disorder was clinically diagnosed by a multidisciplinary team according to DSM-IV criteria. The first approach consisted of a combined intervention in text production and WM while the second focused only on WM. Participants were 47 students from the fifth to ninth grades of two public elementary schools in Porto Alegre (Brazil), randomized to one of the two interventions groups. Writing and WM were assessed before, immediately after, and 3 months after the interventions. The results suggest that both interventions contributed to improving behavior and school performance, whereas only the combined intervention increased the overall quality of narrative text, organization of paragraphs, and denouement.

The influence of perception of care and maternal protection on breastfeeding practices on the infants' third month of life / Influência da percepção do cuidado e da proteção materna sobre as práticas de aleitamento materno em lactentes no terceiro mês de vida

Abstract Objectives: to evaluate the influence of perception of care and maternal protection on breastfeeding practices on the infants' third month of life. Methods: longitudinal study with mother-infant pairs distributed in five groupsof gestational clinical conditions. The recruitment occurred in the period 2011 to 2016 at three hospitals in the public health systems in Porto Alegre, Brazil. The Parental Bonding Instrument and the Edinburgh Postpartum Depression Scale were assessed. Exclusive and prolonged breastfeeding were analyzed by questionnaires. Data were analyzed by one-way ANOVA with Tukey's post-hoc test, Kruskal-Wallis with Dunn's post-hoc test, or Pearson's chi-squared test. The significance was set at 5%. Results: 209 mother-infant pairs were investigated. Among those who did not practice breastfeeding, a lower perception of care, a higher perception of maternal protection, and a higher score of postpartum depression were observed (p=0.022, p=0.038, and p<0.001, respectively), when compared to peers who practiced. The control group had a significantly higher perception of care when compared to thediabetes mellitus group (p=0.006), and the perception of maternal protection and postpartum depression had no differences between the intrauterine groups (p>0.05). Conclusions: the perception of care and maternalprotection and the postpartum depressive symptomatology influenced breastfeeding at three months. It is possible to assume a transgenerational effect on breastfeeding, suggesting the existence of a complex model related to mental health in a sample of women who had different backgrounds of gestational clinical conditions

Resumo Objetivos: avaliar a influência da percepção do cuidado e da proteção materna sobre as práticas de aleitamento materno em lactentes no terceiro mês de vida. Métodos: estudo longitudinal, com pares mães-lactentes distribuídos em cinco grupos de diferentes condições clínicas gestacionais. O recrutamento ocorreu no período de 2011 a 2016 em três hospitais da rede pública de saúde de Porto Alegre, Brasil. Foram utilizados o Parental Bonding Instrument e o Edinburgh Postpartun Depression Scale. O aleitamento materno exclusivo e continuado foi analisado por questionários. Na análise de dados foram utilizados os testes de ANOVA com post-hoc de Tukey, Kruskal-Wallis com post-hoc de Dunn e Qui-quadrado. Resultados: foram investigados 209 pares mães-lactentes. Entre aqueles que não praticaram o aleitamento materno foi observadouma menor percepção de cuidado materno, uma maior percepção de proteção materna e ummaior escore de depressão pós-parto (p=0,022, p=0,038 e p<0,001, respectivamente) quandocomparados aos pares mães-lactentes que praticaram. O grupo controle teve significativamente maior percepção do cuidado materno quando comparado ao grupo com diabetes mellitus (p=0,006) enquanto a percepção de proteção materna e a depressão pós-parto não apresentaram diferenças entre os cinco grupos intrauterinos (p>0,05). Conclusões: a percepção de cuidado e proteção materna e asintomatologia depressiva pós-parto influenciaram o aleitamento materno aos três meses. É possível assumir um efeito transgeracional no aleitamento materno, sugerindo a existência de um modelo complexo relacionado à saúde mental numa amostra de mulheres que tinham diferentes antecedentes de condições clínicas gestacionais.

Yoga and breathing technique training in patients with heart failure and preserved ejection fraction: study protocol for a randomized clinical trial.

BACKGROUND: Current therapies for heart failure (HF) are followed by strategies to improve quality of life and exercise tolerance, besides reducing morbidity and mortality. Some HF patients present changes in the musculoskeletal system and inspiratory muscle weakness, which may be restored by inspiratory muscle training, thus increasing respiratory muscle strength and endurance, maximal oxygen uptake (VO2), functional capacity, respiratory responses to exercise, and quality of life. Yoga therapies have been shown to improve quality of life, inflammatory markers, and peak VO2 mostly in HF patients with a reduced ejection fraction. However, the effect of different yoga breathing techniques in patients showing HF with a preserved ejection fraction (HFpEF) remain to be assessed. METHODS/DESIGN: A PROBE (prospective randomized open blinded end-point) parallel-group trial will be conducted at two specialized HF clinics. Adult patients previously diagnosed with HFpEF will be included. After signing informed consent and performing a pre-test intervention, patients will be randomized into three groups and provided with either (1) active yoga breathing techniques; (2) passive yoga breathing techniques (pranayama); or and (3) control (standard pharmacological treatment). Follow-up will last 8 weeks (16 sessions). The post-intervention tests will be performed at the end of the intervention period for analysis of outcomes. Interventions will occur continuously according to patients' enrollment. The main outcome is respiratory muscular resistance. A total of 33 enrolled patients are expected. The present protocol followed the SPIRIT guidelines and fulfilled the SPIRIT checklist. DISCUSSION: This trial is probably the first to assess the effects of a non-pharmacological intervention, namely yoga and specific breathing techniques, to improve cardiorespiratory function, autonomic system, and quality of life in patients with HFpEF. TRIAL REGISTRATION: REBEC Identifier: RBR-64mbnx (August 19, 2012). Clinical Trials Register: NCT03028168 . Registered on 16 January 2017).

Diagnóstico Psicodinâmico Operacionalizado (OPD-2) em pacientes com comportamento suicida prévio / Operationalized Psychodynamic Diagnosis (OPD-2) in patients with previous suicidal behavior

OBJETIVO: avaliar o funcionamento psicodinâmico de pacientes pós-tentativa de suicídio através do Diagnóstico Psicodinâmico Operacionalizado (OPD-2) e de outros instrumentos complementares. MÉTODOS: estudo de caso utilizando métodos mistos de análise (quali-quantitativa). Os pacientes foram avaliados em follow up 3 anos após a primeira entrevista (que ocorreu logo após a tentativa de suicídio), e dois deles concordaram em participar do follow up. RESULTADOS: observou-se nível moderado de funcionamento global nos pacientes. Os conflitos psíquicos com maior prevalência foram o de 'autoestima' e 'necessidade de ser cuidado' versus 'autossuficiência'. Em suas relações, mostraram-se dependentes, impulsivos e exigentes, o que ocasiona sensação constante de abandono. Nessa perspectiva, o medo de ser abandonado faz com que se distanciem e se isolem. Os fatores protetivos de tendências suicidas foram a qualidade da rede de apoio (MOS), a maior interação social, a maior estabilidade do self, o nível de defesas maduras e o tratamento em saúde mental posterior à alta hospitalar. CONCLUSÃO: o OPD-2 demonstrou-se um instrumento apropriado para uma ampla compreensão psicológica de pessoas que tiveram tentativas de suicídio.(AU)

OBJECTIVE: to evaluate the psychodynamic functioning of patients after suicide attempts through the Operationalization Psychodynamic Diagnosis (OPD-2) and other complementary instruments. METHODS: case study using mixed methods of analysis (quali-quantitative). Patients were evaluated in follow up 3 years after the first interview (which occurred shortly after the suicide attempt), and two of them has agreed in participating of the follow up. RESULTS: a moderate level of overall functioning was observed in the patients. The most prevalent psychic conflicts were 'self-esteem' and 'need to be cared for' versus 'self-sufficiency'. In their relationships, they have shown up to be dependent, impulsive and demanding, which causes a constant feeling of abandonment. In this perspective, the fear of being abandoned causes them to distance themselves and be isolated. The protective factors of suicidal tendencies were the quality of the support network (MOS), the greater social interaction, the greater stability of the self, the level of mature defenses and the mental health treatment after hospital discharge. CONCLUSION: OPD-2 proved to be an appropriate instrument for a broad psychological comprehension of people who had suicide attempts.(AU)

OBJETIVO: evaluar el funcionamiento psicodinámico de pacientes tras intentos de suicidio a través del Diagnóstico Psicodinámico Operacionalizado (OPD-2) y otros instrumentos complementarios. MÉTODOS: estudio de caso utilizando métodos mixtos de análisis (cuali-cuantitativo). Los pacientes fueron evaluados en el seguimiento 3 años después de la primera entrevista (que ocurrió poco después del intento de suicidio), y dos de ellos han aceptado participar del seguimiento. RESULTADOS: se observó un nivel moderado de funcionamiento general en los pacientes. Los conflictos psíquicos más prevalentes fueron la "autoestima" y la "necesidad de ser atendido" versus la "autosuficiencia". En sus relaciones se han mostrado dependientes, impulsivos y exigentes, lo que provoca un constante sentimiento de abandono. En esta perspectiva, el miedo al abandono hace que se distancien y se aíslen. Los factores protectores de las tendencias suicidas fueron la calidad de la red de apoyo (MOS), la mayor interacción social, la mayor estabilidad del yo, el nivel de defensas maduras y el tratamiento de salud mental tras el alta hospitalaria. CONCLUSIÓN: OPD-2 resultó ser un instrumento apropiado para una amplia comprensión psicológica de las personas que tuvieron intentos de suicidio.(AU)

Access and adherence to medication among people with diabetes in Brazil: evidences from PNAUM. / Acesso e adesão a medicamentos entre pessoas com diabetes no Brasil: evidências da PNAUM.

OBJECTIVE: To describe people with diabetes in Brazil and to compare their sociodemographic characteristics, access and self-reported adherence to diabetes prescribed drugs. METHODS: Data analysis from the National Survey on Access, Use and Promotion of the Rational Use of Medicines, a household survey, with sampling by clusters, according to sex and age domains and national and macro-regional representativeness. Adults (≥ 20 years old) who reported having diabetes constituted the sample. The weighted frequencies of the variables in the sample were analyzed and the Pearson χ2 test was applied to evaluate the statistical significance of the differences between the strata for the data of access, form of financing and adherence to the drugs, considering the level of significance of 5%. RESULTS: We found a higher proportion of women, people over 60 years and economy class C. Most participants reported having two or more comorbidities, in addition to diabetes, and taking five or more drugs. Regarding access, 97.8% say they have access to prescription drugs for diabetes and 70.7% say they get them totally free of charge. There was low adherence to anti-diabetic treatment, with significant macro-regional differences (p = 0,001), and greater vulnerability in the South and Northeast regions. CONCLUSION: Better access to diabetes medicines in the country has been demonstrated. However, to improve the efficiency of health public spending, it is necessary to achieve higher rates of adherence to treatment.

OBJETIVO: Descrever as pessoas com diabetes no Brasil e comparar suas características sociodemográficas, o acesso e a adesão autorreferida aos medicamentos prescritos. MÉTODOS: Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos, um inquérito domiciliar, com plano amostral por conglomerados, segundo domínios de sexo e idade e representatividade nacional e macrorregional. Os adultos (≥ 20 anos) que referiram ter diabetes constituíram a amostra. Analisaram-se as frequências ponderadas das variáveis na amostra e aplicou-se o teste do χ2 de Pearson para avaliar a significância estatística das diferenças entre os estratos para os dados de acesso, forma de financiamento e adesão aos medicamentos, considerando o nível de significância de 5%. RESULTADOS: Encontrou-se uma maior proporção de mulheres, de maiores de 60 anos e da classe econômica C. A maioria referiu ter duas ou mais comorbidades além do diabetes e tomar cinco ou mais medicamentos. Quanto ao acesso, 97,8% dizem ter acesso aos medicamentos prescritos para diabetes e 70,7%, que os obtêm de forma totalmente gratuita. Verificou-se baixa adesão ao tratamento farmacológico, com diferenças macrorregionais significativas (p = 0,001) e maior vulnerabilidade nas regiões sul e nordeste. CONCLUSÃO: Demonstrou-se melhor acesso aos medicamentos para diabetes no país. Entretanto, para melhorar a eficiência dos gastos públicos, ficou demonstrada a necessidade de melhorar a adesão ao tratamento medicamentoso.