Motives for physical activity participation among lebanese adults aged 18 to 50 years: a cross-sectional study / Motivos para participação de atividade física em libanes adultos de 18 a 50 anos: um estudo transversal

ABSTRACT Background: Sports participation motivations can be intrinsic, extrinsic, or even amotivational. Few studies on adult participation in PA have been found in the Lebanese context. This study aims to: a) investigate significant differences in sports participation motivation across gender, age, occupation, and time of practice, and b) investigate sports participation motives that discriminated the best between those variables. Material and methods: The Arabic version of the Sport Motivation Scale was collected electronically from 531 volunteers practicing regular PA for the last six months. Gender, occupation, marital status, and time of practice were all analyzed using Mann-Whitney U test and the Kruskal Wallis Test with 0.05 as level of significance. Results: Internal motivation subscales (particularly the intention to accomplish) were the most influential motives for both genders. A significant difference across gender was reported in the extrinsic motivation and amotivation subscales. Furthermore, age, occupation, marital status, and time of practice show significant differences in motivation factors either dependent or regardless of gender distribution (p<0.05). Conclusion: no significant differences in the intrinsic motivation for sports participation between genders. Other factors, on the other hand, had a substantial impact. Research contribution: these findings are intended to contribute to a better understanding of differences in motivation for participating in PA and to aid in its promotion among Lebanese adults

RESUMO Contexto: As motivações para a participação desportiva podem ser intrínsecas, extrínsecas ou mesmo amotivacionais. Poucos estudos sobre a participação de adultos em AF foram encontrados no contexto libanês. Este estudo tem como objetivos: a) investigar diferenças significativas na motivação para a prática desportiva em função do género, idade, profissão e tempo de prática, e b) investigar os motivos da prática desportiva que melhor discriminaram entre essas variáveis. Material e métodos: A versão árabe da Sport Motivation Scale foi coletada eletronicamente de 531 voluntários praticantes regulares de AF nos últimos seis meses. Gênero, ocupação, estado civil e tempo de atuação foram analisados por meio do teste U de Mann-Whitney e do teste de Kruskal Wallis com nível de significância de 0,05. Resultados: As subescalas de motivação interna (particularmente a intenção de realizar) foram os motivos mais influentes para ambos os sexos. Uma diferença significativa entre os gêneros foi relatada nas subescalas de motivação extrínseca e amotivação. Além disso, idade, ocupação, estado civil e tempo de prática mostram diferenças significativas nos fatores de motivação dependentes ou independentes da distribuição por gênero (p<0,05). Conclusão: não houve diferenças significativas na motivação intrínseca para a prática desportiva entre os sexos. Outros fatores, por outro lado, tiveram um impacto substancial. Contribuição da pesquisa: esses achados pretendem contribuir para uma melhor compreensão das diferenças na motivação para participar da AF e auxiliar na sua promoção entre adultos libaneses.

Sírios e libaneses no oeste paulista - décadas de 1880 a 1950 / Syrian and Lebanese in Western São Paulo / Sirios y libaneses en el oeste de San Pablo

O artigo busca explorar os condicionantes e características distintivas da inserção socioeconômica de sírios e libaneses no interior paulista, entre as décadas de 1880 e 1950. Do início difícil como mascates, portadores de uma cultura distante, os sírios e libaneses lograram se firmar como comerciantes, aproveitando as oportunidades que suas redes (de parentes e conterrâneos) e a economia cafeeira em expansão ofereciam, estabelecendo-se sobretudo nos ramos de roupas, tecidos e armarinhos de secos e molhados e de gado e cereais. Tomando como fonte principal uma série de obras - acadêmicas e memorialísticas -, nas quais o imigrante sírio e libanês é retratado no interior, o artigo indica ainda as principais regiões do oeste paulista nas quais o grupo se concentrou, discute trajetórias que ilustram algumas das possibilidades de mobilidade, a formação de lideranças, o modo como as práticas religiosas se transformaram e a mobilidade acentuada - como doutores e políticos - conquistada por estratos da primeira geração nascida no Brasil.

The article seeks to explore the conditions and distinctive characteristics of the socioeconomic insertion of Syrians and Lebanese in the interior of São Paulo between the 1880s and 1950s. From the difficult beginning as peddlers with a distant culture, Syrians and Lebanese managed to establish themselves as merchants, seizing the opportunities that their networks (of relatives and of countrymen) and the expanding coffee economy offered, establishing themselves mainly in the sectors of clothing, linen and fabrics, cattle and cereals. Taking as main source a series of works in which the Syrian and Lebanese immigrants are portrayed in the interior, the article also indicates the main regions of west of São Paulo where the group mainly concentrated, and discusses trajectories which illustrate some of the possibilities of mobility, formation of leadership, the way religious practices have been transformed and the marked mobility - as doctors and politicians - achieved by strata of the first generation born in Brazil.

El artículo busca explorar los condicionantes y las características distintivas de la inserción socioeconómica de sirios y libaneses en el interior paulista entre la década del ochenta del siglo XIX y la del cincuenta del siglo XX. Del inicio difícil como vendedores ambulantes, portadores de una cultura distante, los sirios y libaneses lograron establecerse como comerciantes, aprovechando las oportunidades que sus redes;de parientes y de compatriotas; y que la economía cafetalera en expansión ofrecía se establecieron sobre todo en las ramas de ropa y tejidos, de mercería, y de ganado y cereales. Tomando como fuente principal una serie de obras en las que el inmigrante sirio y libanés es retratado en el interior, el artículo indica además las principales regiones del oeste paulista en las que el grupo se concentró, discute trayectorias que ilustran algunas de las posibilidades de movilidad, la formación de los líderes, el modo en que las prácticas religiosas se transformaron y la movilidad acentuada;como doctores y como políticos; conquistada por estratos de la primera generación nacida en Brasil.

Estrutura conceptual do envelhecimento em diferentes etnias / Estructuras conceptuales del envejecimiento en diferentes etnias / Conceptual structure of aging in different ethnicities

Resumo OBJETIVO Elaborar uma estrutura conceptual que explique como idosos de diferentes culturas vivenciam o envelhecimento, formulam conceitos e atribuem valores ao processo de envelhecer. MÉTODO Pesquisa de abordagem qualitativa, realizada com 33 idosos, em município da tríplice fronteira. Os dados foram coletados no período entre fevereiro e agosto de 2011, utilizando como estratégia teórico-metodológica o Interacionismo Simbólico e a Grounded Theory. RESULTADOS Identificou-se o tema central "Tendo que envelhecer: as práticas socioculturais direcionando o envelhecimento em diferentes etnias", constituído por subprocessos que caracterizam os conceitos estruturais do estudo: A velhice concebida por multifatores (físicos, biopsíquicos e socioculturais); Vivenciando o envelhecer no processo de adaptação cultural; Vivenciando o envelhecer como a continuidade da vida; Redefinindo os papeis sociais e; A cultura influenciando hábitos e costumes no cuidado à saúde. CONCLUSÕES A experiência de envelhecer revelou-se um processo singular a cada indivíduo e os valores atribuídos ao mesmo são influenciáveis pela cultura.

Resumen OBJETIVO Elaborar una estructura conceptual que explique cómo ancianos de diferentes culturas sienten el envejecimiento, formulan conceptos y atribuyen valores en el proceso de envejecer. MÉTODO Investigación de abordaje cualitativa, realizada con 33 ancianos, en un municipio de la triple frontera. Se recolectaron los datos desde febrero hasta agosto del 2011, utilizando como estrategia teórica-metodológica el Interaccionismo Simbólico y el Grounded Theory. RESULTADO La temática central identificada fue: "Teniendo que envejecer: las prácticas socioculturales direccionando el envejecimiento en diferentes etnias", constituido por subprocesos que caracterizan los conceptos estructurales del estudio: La vejez concebida como multifactorial (físicos, biopsíquicos y socioculturales); Vivenciando el envejecimiento en el proceso de adaptación cultural; Vivenciando el envejecimiento como continuación de la vida; Redefiniendo los papeles sociales; y La cultura influenciando hábitos y costumbres en el cuidado a la salud. CONCLUSIÓN La experiencia de envejecer se mostró como un proceso singular de cada individuo y los valores atribuidos al mismo son influenciados por cada cultura.

Abstract OBJECTIVE To develop a conceptual framework that explains how elderly people from different cultures experience aging, formulate concepts and assign values to the process of aging. METHOD Qualitative research conducted with 33 elderly people in a municipality of the triple border. The data were collected between February and August of 2011, using Symbolic Interactionism and the Grounded Theory as the theoretical and methodological strategy. RESULTS The central theme identified was: "Having to age: sociocultural practices guiding aging in different ethnicities", which was made up of sub processes that characterize the study's structural concepts: aging conceived as multifactorial (physical, biopsychic and sociocultural); Experiencing aging in the process of cultural adaptation; Experiencing aging as the continuation of life; Redefining social roles; and The culture influencing habits and customs in healthcare. CONCLUSION The experience of aging proved to be a unique process for each individual and the values assigned to it are influenced by one's own culture.

Surveillance Study of Acute Gastroenteritis Etiologies in Hospitalized Children in South Lebanon (SAGE study) / 대한소아소화기영양학회지

PURPOSE: Acute gastroenteritis (AGE) is a major cause of morbidity and remains a major cause of hospitalization. Following the Syrian refugee crisis and insufficient clean water in the region, this study reviews the etiological and epidemiological data in Lebanon. METHODS: We prospectively analyzed demographic, clinical and routine laboratory data of 198 children from the age of 1 month to 10 years old who were admitted with the diagnosis of AGE to a private tertiary care hospital located in the district of Nabatieh in south Lebanon. RESULTS: Males had a higher incidence of AGE (57.1%). Pathogens were detected in 57.6% (n=114) of admitted patients, among them single pathogens were found in 51.0% (n=101) of cases that consisted of: Entamoeba histolytica 26.3% (n=52), rotavirus 18.7% (n=37), adenovirus 6.1% (n=12) and mixed co-pathogens found in 6.6% (n=13). Breast-fed children were significantly less prone to rotavirus (p=0.041). Moreover, children who had received the rotavirus vaccine were significantly less prone to rotavirus (p=0.032). CONCLUSION: Our findings highlight the high prevalence of E. histolytica infection as the major cause of pediatric gastroenteritis in hospitalized children, during the summer period likely reflecting the insanitary water supplies and lack of hygiene. Moreover the 42.4% of unidentified causative pathogens should prompt us to widen our diagnostic laboratory arsenal by adopting new diagnostic technologies.

Do trauma individual ao trauma coletivo. Os Xiitas do sul do Líbano e os bombardeios israelenses 2006 / From individual trauma to collective trauma. The Shi'ites of southern Lebanon and the Israeli bombing 2006 / Del trauma individual al trauma colectivo. Los chiitas del sur del Líbano y el bombardeo israelí 2006

O artigo é uma síntese das pesquisas de campo realizadas com a comunidade xiita do sul do Líbano em 2008. Procurou-se averiguar a conexão e superposição do trauma individual ao trauma coletivo na luta de resistência à invasão das forças israelenses a suas terras. O grupo étno-confessional participa depois de décadas de uma conjuntura nacional de enfrentamentos mortíferos entre suas comunidades. De outro lado da fronteira, há Israel, o inimigo que depois de submeter sua região por vinte anos, volta a atacá-los em 2006. Foram registradas vinte entrevistas com indivíduos de ambos os sexos, cujas questões abertas objetivaram suas histórias de vida. A análise de conteúdo do material permitiu sua separação em três grupos. Os depoimentos de seus representantes coloca em relevo o grau de afetação provocado pelos eventos. Averiguamos as disposições psíquicas desses sujeitos que vivem constantemente situações de stress e de eventos traumáticos. Observamos o papel da identificação grupal à mensagem de seus mitos fundadores e como fator de reforço egoico no enfrentamento a esse real catastrófico.

This article is a synthesis of field studies carried out in the Shiite community in South Lebanon in 2008. The aim of this study was to investigate the connection and superposition of the individual trauma over the collective trauma in the struggle and resistance against the invasion of Israeli forces in their lands. This ethnic confessional group has for decades been involved in a series of nationwide deadly struggles within their communities. On the other side of the border lies Israel, the enemy that after subjugating their region for twenty years, attacked them again in 2006. We then studied the psychological conditions of these subjects that constantly undergo traumatic and stressful situations. We observed how this group identifies with the message of their forefathers and myths and how it strengthens their egos on facing this catastrophic reality.

El presente artículo es una síntesis de las investigaciones de campo realizadas con la comunidad chiita del sur del Líbano en 2008. El objetivo fue investigar la conexión y la superposición del trauma individual al trauma colectivo durante la lucha de resistencia a la invasión de las fuerzas israelíes a sus tierras. Este grupo étnico-confesional participa, después de décadas, de una coyuntura nacional de enfrentamientos mortales entre sus comunidades. Del otro lado de la frontera está Israel, el enemigo que después de haber ocupado la región por veinte años, vuelve a atacarlos en 2006. Se realizaron veinte entrevistas a través de preguntas abiertas a individuos de ambos sexos, con la finalidad de estudiar sus historias de vida. El análisis de contenido del material permitió separarlo en tres grupos. Los testimonios de sus representantes colocan en evidencia el grado en que estos acontecimientos los afectaron. Se investigó las estructuraciones psíquicas de estos individuos que viven constantemente situaciones de estrés y hechos traumáticos. Fue observado, igualmente, el papel de la identificación del grupo en relación al mensaje de sus mitos fundadores y de qué forma estos actúan como factor de refuerzo del ego en el enfrentamiento a esa realidad catastrófica.

Cuidado filial e o relacionamento com o idoso em famílias de diferentes nacionalidades / Cuidado filial y la relación con el anciano en familias con diferentes nacionalidades / Filial care and the relationship with the elderly in families of different nationalities

RESUMO Objetivo: identificar de que forma ocorrem o cuidado filial e o relacionamento com o idoso em famílias de diferentes nacionalidades. Método: estudo qualitativo, realizado em município da tríplice fronteira do Paraná com 33 idosos de cinco nacionalidades e que adotou como estratégia teórico-metodológica o Interacionismo Simbólico e a Grounded Theory. Resultados: entre os libaneses, a religião muçulmana direciona a conduta dos filhos em obediência e respeito aos pais; entre os franceses, destacam-se relações familiares distantes e o cuidado asilar. Para os paraguaios, a relação familiar é estreita; os chineses têm o cuidado filial como obrigação tácita; e os brasileiros costumam acolher e cuidar dos pais na velhice. Conclusão: houve predomínio do cuidado familial, mas as tradições de cada sociedade direcionam as ações desse cuidado, sendo necessário, para a prática assistencial, que os profissionais da saúde reconheçam o contexto no qual os idosos estão inseridos.

RESUMEN Objetivo: identificar de qué forma ocurren el cuidado filial y la relación con el anciano en familias de diferentes nacionalidades. Método: estudio cualitativo, realizado en un municipio de la triple frontera del Paraná con 33 ancianos de cinco nacionalidades y que adoptó como estrategia teórico metodológica el Interaccionismo Simbólico y la Grounded Theory. Resultados: entre los libaneses, la religión musulmana direcciona la conducta de los hijos en obediencia y respeto a los padres; entre los franceses, se destacan relaciones familiares distantes y hogar de ancianos. Para los paraguayos, la relación es estrecha; los chinos consideran al cuidado filial como una obligación tácita; y los brasileños acostumbran a amparar y cuidar a los padres en la vejez. Conclusión: hubo un predominio del cuidado familiar, aunque las tradiciones de cada sociedad direccionan las acciones de dicho cuidado, siendo necesario, para la práctica asistencial, que los profesionales de la salud reconozcan el contexto en el cual los ancianos están insertos.

ABSTRACT Objective: identify how filial care and the relationship with the elderly occur in families of different nationalities. Method: qualitative study carried out in a town on the triple frontier of Paraná, comprising 33 elderly people of five different nationalities, adopting the Symbolic Interactionism and the Grounded Theory as theoretical-methodological strategy. Results: among Lebanese people, the Muslim religion teaches children to obey and respect parents; among French, distant family relationships and institutions for the elderly stand out. Paraguayans hold close family relationships; Chinese people consider filial care as a tacit obligation; Brazilians, in turn, tend to embrace and take care of their parents in old age. Conclusion: family care prevailed, but the traditions of each society lead the actions of that care, demanding health professionals' capacity of recognizing in which context the elderly is inserted.

Itinerário de um pesquisador-interveniente posto à prova em seus próprios desafios de identidade: uma intervenção num estabelecimento escolar no Líbano / Itinerary of a researcher-stakeholder tested in his own identity challenges: an intervation in a Lebanese school / Trayectoria de un investigador-interviniente puesto a prueba en sus propios retos de identidad: intervención en una escuela en Líbano

Neste artigo, apoiando-se em certos elementos de uma intervenção realizada, ao longo de três anos (2012-2015) em um estabelecimento escolar libanês, o autor deseja analisar, em retrospectiva, seu posicionamento de pesquisador-interveniente ligado à evolução de suas questões de identidade, tanto no aspeto intrapsíquico quanto no profissional. Primeiramente, o autor apresentará algumas características do cenário escolar libanês.

Based on certain elements of a three-year (2012-2015) intervention at a Lebanese school, in this study the author wishes to analyze in retrospect his researcher-stakeholder position linked to the evolution of his identity issues, both in the intrapsychic and professional aspects. The author will present at first some characteristics of the Lebanese school scene.

Con base en determinados aspectos de una intervención llevada a cabo en una escuela en Líbano durante tres años, 2012 a 2015, en este texto el autor pretende analizar retrospectivamente su postura como investigador-interviniente desde la evolución de sus cuestionamientos sobre identidad, tanto en el ámbito intrapsíquico cuanto en el ámbito profesional. En primer lugar, el autor presentará algunas características del escenario escolar libanés.

Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS) guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03), and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02). Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy.

Development and evaluation of continuing education course in renal nutrition

BACKGROUND/OBJECTIVE: Competent renal dietitians are crucial for better patient compliance and clinical outcomes, specifically in critical settings. The aim of this study was to develop and evaluate an evidence-based course in renal dietetics for dietitians working in health care systems where dietetic specialization is absent. SUBJECTS/METHODS: Fifteen licensed dietitians working with hemodialysis patients in Lebanon were randomly recruited to participate in the course. The latter was developed by the study's primary investigator, according to evidence-based practice guidelines, and focused on all aspects of renal nutrition. Total course duration was 28 hours spread over a 2 month period. Dietitians' knowledge in renal nutrition was tested pre- and post-training through a 23-item questionnaire; the total score was expressed in percentage (< 60% score indicated insufficient knowledge). Paired-samples t test was used for statistical analysis. RESULTS: Overall knowledge of the dietitians significantly improved post-training and reached satisfactory levels (pre: 38.75 +/- 17.20%, post: 62.08 +/- 21.85%). Sub-analysis of the change in the knowledge showed significant and satisfactory improvement only in 3 topics: 1) correct body weight use in calculations, 2) energy estimation method and 3) phosphorus management. Knowledge in the fluid management significantly improved but did not achieve a satisfactory level. CONCLUSION: The course significantly improved dietitians' knowledge in renal nutrition. If adopted as part of the continuing education of dietitians in countries that lack dietetic specializations, it may serve the first step towards improving health care practice.

Validation of the Arabic version of the SCOFF questionnaire for the screening of eating disorders

The high prevalence of eating disorders in Arab countries indicates a need for an Arabic language screening tool. This study aimed to validate an Arabic version [A-SCOFF] of the British SCOFF questionnaire, a brief tool for the screening of eating disorders in primary health care. After translation and back-translation the A-SCOFF was given to 123 female patients [mean age 32 [SD 8.8] years] visiting primary health-care centres in Beirut. Each patient was evaluated by an eating disorders specialist blinded to A-SCOFF results. The validated Arabic version of the Mini International Neuropsychiatric Interview and the DSM-IV criteria for eating disorders were used as diagnostic references. The best diagnostic threshold for the A-SCOFF was found to be at 2 positive answers with a sensitivity of 80.0%, a specificity of 72.7% and an area under the curve of 80.0%. The A-SCOFF questionnaire is accurate and reliable for the early detection of eating disorders in this high-risk population

Nutritional education for management of osteodystrophy (NEMO) trial: Design and patient characteristics, Lebanon

This study aims to determine the effect of a trained dedicated dietitian on clinical outcomes among Lebanese hemodialysis (HD) patients: and thus demonstrate a viable developing country model. This paper describes the study protocol and baseline data. The study was a multicenter randomized controlled trial with parallel-group design involving 12 HD units: assigned to cluster A (n = 6) or B (n = 6). A total of 570 patients met the inclusion criteria. Patients in cluster A were randomly assigned as per dialysis shift to the following: Dedicated Dietitian (DD) (n = 133) and Existing Practice (EP) (n = 138) protocols. Cluster B patients (n = 299) received Trained Hospital Dietitian (THD) protocol. Dietitians of the DD and THD groups were trained by the research team on Kidney Disease Outcomes Quality Initiative nutrition guidelines. DD protocol included: individualized nutrition education for 2 hours/month/HD patient for 6 months focusing on renal osteodystrophy and using the Trans-theoretical theory for behavioral change. EP protocol included nutrition education given to patients by hospital dietitians who were blinded to the study. The THD protocol included nutrition education to patients given by hospital dietitian as per the training received but within hospital responsibilities, with no set educational protocol or tools. Baseline data revealed that 40% of patients were hyperphosphatemics (> 5.5 mg/dl) with low dietary adherence and knowledge of dietary P restriction in addition to inadequate daily protein intake (58.86%+/- 33.87% of needs) yet adequate dietary P intake (795.52 +/- 366.94 mg/day). Quality of life (QOL) ranged from 48-75% of full health. Baseline differences between the 3 groups revealed significant differences in serum P, malnutrition status, adherence to diet and P chelators and in 2 factors of the QOL: physical and social functioning. The data show room for improvement in the nutritional status of the patients. The NEMO trial may be able to demonstrate a better nutritional management of HD patients.

Prevalence and antibiotic susceptibility of Bacteroides fragilis group isolated from stool samples in North Lebanon

Fifty one strains of the Bacteroides fragilis group were isolated from 45 fecal samples. Classical phenotypic identification showed that 16 isolates were B. thetaiotaomicron, 12 B. uniformis, 9 B. eggerthii,7 B. vulgatus,3 B. caccae,2 Parabacteroides distasonis with 1 identified B. ovatus and 1 B. fragilis. The 51 strains were tested for susceptibility against 16 antimicrobial agents and the MICs for metronidazole were determined. The tests showed that imipenem, meropenem and chloram-phenicol were the most effective antibiotics (98%, 98% and 92.16% of susceptibility, respectively) followed by ticarcillin/clavulanic acid, piperacillin/tazobactam, rifampin (88.24% susceptibility), moxifloxacin 86.27% and tigecycline 84.31%. Ofloxacin and cefotaxime were the least effective antibiotics with 27.45% and 0% of activity respectively. Only six of the 51 isolated strains were resistant to metronidazole with MICs = 64 mg/L (1 strain) and > 256 mg/L (5 strains).

Computational Flow Dynamics of the Severe M1 Stenosis Before and After Stenting / 신경중재치료의학

PURPOSE: Computational flow dynamic (CFD) study has not been widely applied in intracranial artery stenosis due to requirement of high resolution in identifying the small intracranial artery. We described a process in CFD study applied to symptomatic severe intracranial (M1) stenosis before and after stenting. MATERIALS AND METHODS: Reconstructed 3D angiography in STL format was transferred to Magics (Materialise NV, Leuven, Belgium) for smoothing of vessel surface and trimming of branch vessels and to HyperMesh (Altair Engineering Inc., Auckland, New Zealand) for generating tetra volume mesh from triangular surface-meshed 3D angiogram. Computational analysis of blood flow in the blood vessels was performed using the commercial finite element software ADINA Ver 8.5 (ADINA R & D, Inc., Lebanon, MA). The distribution of wall shear stress (WSS), peak velocity and pressure in a patient was analyzed before and after intracranial stenting. RESULTS: Computer simulation of wall shear stress, flow velocity and wall pressure before and after stenting could be demonstrated three dimensionally by video mode according to flow vs. time dimension. Such flow model was well correlated with angiographic finding related to maximum degree of stenosis. Change of WSS, peak velocity and pressure at the severe stenosis was demonstrated before and after stenting. There was no WSS after stenting in case without residual stenosis. CONCLUSION: Our study revealed that CFD analysis before and after intracranial stenting was feasible despite of limited vessel wall dimension and could reveal change of WSS as well as flow velocity and wall pressure.

Crise social extrema, processos identificatórios e resistência psíquica os Druzos na guerra do Líbano / Extreme social crisis, identification processes and psychic resistance. The Druses in the Lebanses war

O trabalho se propõe analisar os impactos que uma crise social extrema pode ter sobre a construção identitária e nas condições psíquicas dos cidadãos. Procurou-se identificar quais foram os dinamismos psíquicos e sociais que tiveram relevância para enfrentar o perigo, ultrapassar a crise e, ao final dos combates, nas recomposições de suas vidas. O Líbano foi escolhido, por ter sido cenário de uma longa guerra inter-étnica, onde o povo Druzo esteve no centro das confrontações. Para conhecer esta realidade foram realizadas treze histórias de vida. A análise do material recolhido mostra o papel da memória coletiva e do discurso étnico como propiciadores da coesão grupal. A idealização e as crenças através de suas ideologias, serviram como garantia de sentido na mediação do vivido catastrófico.

This article discusses the impacts that na extreme social crisis on the construction of identify and the psychic conditions of the country’s citizens. The author seeks to identify approriate psychic and social dynamics that will help persons face danger, overcome the crisis and restructure their lives after the combats are over. We focused on Lebanon because it has beeen the scene of a long inter-ethnic war where the Druses were the center of the confrontations. In order to become acquainted with reality we collected and analyzed thirteen life-stories. The analysis of this material showed that the role of collective memory and ethnic discourse is to promote group cohesion. It also showed that idealization and beliefs based on its ideologies guaranteed a sense of mediation of the catastrophe they have gone through.

Development of adaptable and flexible treatment manuals for externalizing and internalizing disorders in children and adolescents / Desenvolvimento de manuais adaptáveis e flexíveis para transtornos de externalização e internalização em crianças e adolescentes

In this paper we describe the process used to develop treatment manuals for internalizing and externalizing disorders in children and adolescents. These manuals were developed to offer health care providers and others working in child mental health a flexible intervention that could be adapted to different countries and localities based on: 1) the amount of health care and school resources that are available; 2) the nature and severity of the types of problems children have; and 3) the preferences and cultural factors that are important within these communities. We also discuss the experiences and cultural issues faced by sites in Egypt, Lebanon, Israel, and Brazil who volunteered to implement the manualized treatment programs. The feedback received from these sites indicates that the manuals can be implemented to help children with internalizing and externalizing problems.

Neste artigo, descrevemos o processo utilizado para elaborar manuais de tratamento para transtornos de externalização e intrnalização em crianças e adolescentes. Esses manuais foram elaborados para oferecer uma intervenção flexível para provedores de atenção à saúde e demais profissionais que trabalham com a saúde mental da criança, podendo ser adaptados a diferentes países e localidades, com base: 1) no nível de atenção médica e de recursos educacionais disponíveis; 2) na natureza e na gravidade dos tipos de problemas que as crianças apresentam; e 3) nas preferências e fatores culturais que são importantes nessas comunidades. Discutimos, também, as experiências e os problemas culturais enfrentados pelas localidades no Egito, Líbano, Israel e Brasil que foram voluntárias em implementar os programas de tratamento especificados nos manuais. O retorno recebido dessas localidades indica que os manuais podem ser implementados para auxiliar as crianças com problemas de externalização e internalização.

Training of evidence-based assessment and intervention approaches in cross-cultural contexts: challenges and solutions / Treinamento de estratégias de intervenção e avaliação baseadas em evidências em contextos transculturais: desafios e soluções

Dissemination of evidence-based assessment and intervention approaches for child and adolescent with behavioral and/or emotional problems is now a priority in the field worldwide. However, developing staff competence in evidence-based assessment and intervention approaches in different countries is complicated by some environmental and economic constraints. In this paper a distance training/supervision model is discussed. We describe seven specific challenges encountered and solutions used for overcoming the obstacles in order to implement evidence-based assessment and intervention approaches in different sites in Brazil, Egypt, Israel, and Lebanon.

A disseminação de estratégias de intervenção e avaliação baseadas em evidências para crianças e adolescentes com problemas comportamentais e/ou emocionais é hoje uma prioridade mundial. No entanto, o desenvolvimento de equipes capacitadas para implementação de estratégias de intervenção e avaliação baseadas em evidências nos diferentes países é limitado por restrições ambientais e econômicas. Neste artigo, discute-se um modelo de treinamento/supervisão à distância. Em seguida, são descritos sete desafios específicos encontrados e as soluções utilizadas para superar os obstáculos para implementação de estratégias de intervenção e avaliação baseadas em evidências em diferentes localidades no Brasil, Egito, Israel e Líbano.

An examination of cross-cultural systems implementing evidence-based assessment and intervention approaches / Exame dos sistemas transculturais que implementam estratégias de intervenção e avaliação baseadas em evidências

Implementation of evidence-based assessment and intervention approaches for youth with behavioral and/or emotional problems is rising to recognition worldwide. Feasibility research is critical to examine what characteristics of systems allow for success or barriers to the implementation of evidence-based practices into real-world settings, especially when working cross-culturally. This paper briefly reviews the experience of 4 international sites to understand how the overall structure and specific site variables directed the implementation of the World Health Organization and the World Psychiatry Association project. Discussion includes a thematic summary of the successes and challenges experienced by the sites, and future directions of feasibility studies.

A implementação de estratégias de intervenção e avaliação baseadas em evidências para jovens com problemas comportamentais e/ou emocionais está assumindo reconhecimento internacional. Estudos de praticabilidade são críticos para examinar quais características dos sistemas permitem êxito ou se constituem em barreiras para a implementação de práticas baseadas em evidências em instituições do mundo real, especialmente quando trabalhando de forma transcultural. Este estudo revisa brevemente a experiência de quatro localidades internacionais para compreender como a estrutura geral e as variáveis específicas da localidade orientaram a implementação do projeto da Organização Mundial de Saúde e da Associação Mundial de Psiquiatria. A discussão inclui um resumo temático dos êxitos e desafios vivenciados pelas localidades e os caminhos futuros de estudos de praticabilidade.

The Lebanese mutation as an important cause of familial hypercholesterolemia in Brazil

Familial hypercholesterolemia (FH) is a common autosomal disorder that affects about one in 500 individuals in most Western populations and is caused by a defect in the low-density-lipoprotein receptor (LDLr) gene. In this report we determined the molecular basis of FH in 59 patients from 31 unrelated Brazilian families. All patients were screened for the Lebanese mutation, gross abnormalities of the LDLr gene, and the point mutation in the codon 3500 of the apolipoprotein B-100 gene. None of the 59 patients presented the apoB-3500 mutation, suggesting that familial defective ApoB-100 (FDB) is not a major cause of inherited hypercholesterolemia in Brazil. A novel 4-kb deletion in the LDLr gene, spanning from intron 12 to intron 14, was characterized in one family. Both 5' and 3' breakpoint regions were located within Alu repetitive sequences, which are probably involved in the crossing over that generated this rearrangement. The Lebanese mutation was detected in 9 of the 31 families, always associated with Arab ancestry. Two different LDLr gene haplotypes were demonstrated in association with the Lebanese mutation. Our results suggest the importance of the Lebanese mutation as a cause of FH in Brazil and by analogy the same feature may be expected in other countries with a large Arab population, such as North American and Western European countries.

A Nationwide Epidemiological Study of Mental Disorders in Korea (XIX): Suicide Ideation and Suicide Attempts / 신경정신의학

The nationwide epidemiological study of mental disorders including suicide ideation and suicide attempts in Korea using DIS-III Korean Version was conducted in the Capital City of Korea(Seoul) and 20 rural areas and compared to the other 8 countries. The results were as follows : 1) The lifetime prevalence of suicide ideation were 18.51% in New zealand, 15.62% in Munich, Germany, 14.20% in France, 11.25% in Canada, 11.18% in the USA, 9.5% in Puerto Rico, 5.28% in Taiwan and 2.09% in Lebanon, respectively 2) The lifetime prevalence of suicide ideation was higher in female than male Divorced and separated persons were at the highest risk and next were never married. Married persons were at the lowest risk. 3) The lifetime prevalence of suicide attempts were 5.93% in Puerto Rico, 4.95% in France, 4.43% in New Zealand, 3.82% in Canada, 3.44% in Munich Germany, 3.20% in Korea, 3.13% in the USA, 0.75% in Taiwan and 0.72% in Lebanon, respectively. 4) The lifetime prevalence of suicide attempts were highest in female and divorced or separated. Next were never married and lowest were married.