Stressful Events During Last Year, Violence and Anxiety and Depression: A Moderated Mediation Model by Sex.

The literature suggests that being subject to a stressful life and victimization may negatively affect mental health, and that women and men seem to differ in these variables. Nevertheless, neither the mediating role of victimization experiences in the relationship between stress and mental health, nor the moderated role of sex have been explored. A sample of 826 adults, aged from 18 to 77 years old, completed a set of self-reported questionnaires (69.4% women). Results revealed significant mediation effects of psychological violence on the relationship between stress, depression and anxiety. Participants who reported more stressful life events in the previous year, also reported higher psychological abuse, which in turn predicted higher depression and anxiety. Furthermore, the moderating effects of sex were found to be statistically significant. Results suggest that interventions should be tailored to individual needs in order to prevent secondary victimization derived from biased beliefs related to stress, violence and gender in professional practice.

A composite indicator to measure sustainable water use in Portugal: A compromise programming approach.

Clean water is an important resource for maintaining human life, economic activities, and ecosystems' survival. Nevertheless, its irregular distribution and occasional scarcity lead to the need to promote its sustainable use. To assess the current situation and the dynamics of sustainable water use, it is crucial to identify the main factors affecting it and to propose monitoring indicators. This paper develops an approach based on compromise programming to analyse water use sustainability at the municipal level, with a methodology that comprise a framework designed in five steps: 1 - indicators' choice; 2 - indicators's weights; 3 - definition of sustainability rankings with the application of a compromise programming approach; 4- application of a GIS analysis; 5 - identification of the main factors affecting sustainable water use. As a first result, the consensus weights of the chosen indicators were defined, indicating that the most important internal factors affecting sustainable water use are safe water, the percentage of housing served by water supply and water distributed by inhabitant. Then sustainability rankings at the municipality level were defined considering these factors. Finally, it was possible to conclude that tourism activity, income level, and young age population have a significant negative effect on sustainable water use, and municipal revenue has a positive effect. Irrigated farming shows a non-significant negative effect on sustainable water use. Population density, elderly population and education level did not show the expected effects on sustainable water use.

Why Are Men More Likely to Endorse Myths About Child Sexual Abuse Than Women? Evidence From Disposition and Situation-Based Approaches.

Research on attitudes toward Child Sexual Abuse (CSA) consistently shows that men are more likely to endorse myths about CSA events, victims and perpetrators, compared to women. Here we present two studies that examine why these gender differences occur. Study one (N = 439) followed a dispositional approach to test the mediating role of empathy, social dominance orientation (SDO) and propensity for moral disengagement in the association between gender and the endorsement of CSA myths. Male participants showed higher levels of SDO and propensity for moral disengagement, and lower empathy, which in turn were associated with greater CSA myths acceptance. Study two (N = 360) followed a situational approach to test these processes using a specific case of CSA. Male participants showed higher levels of SDO and lower empathy, which in turn were associated with lower scores of perceived assault seriousness, victim credibility, perpetrator culpability, and greater victim culpability. Overall, the results suggest that men and women may appraise CSA differently, which can be partly explained by differences in SDO, propensity to morally disengage, and empathy. Furthermore, different cognitive mechanisms may be activated with regard to general appraisals of CSA compared to specific cases of CSA.

Victimization Experiences and Well-Being in Adulthood: A Systematic Review and Meta-Analysis.

Scientific research has explored the impact of violence during adulthood on psychopathology. Fewer efforts have been made from a positive theoretical framework, and no systematic evidence has been provided. This manuscript describes a literature review and meta-analysis on the relationship between victimization experiences and well-being in adulthood. A literature review was performed, and 27 studies met the inclusion criteria for the systematic review 16 for the meta-analysis. The meta-analysis yielded a medium and significant overall effect size (r = -0.309, p < .001), which indicated that greater victimization experiences partly explain lower well-being outcomes. A set of theoretical and methodological issues are discussed, specifically considering the conceptualization of victimization and well-being as well as the studies design, sample characteristics, measures, and data analysis. Derived from this integrative discussion, some recommendations are also provided for future research.

Child Sexual Abuse Myth Scale: Validity and Reliability Evidence in the Portuguese Context.

Child sexual abuse myths legitimize abusive behaviors, involving high levels of victim blame and low levels of offender liability. The present study aims to: (i) adapt a measure of endorsement of child sexual abuse myths to the Portuguese context (i.e., Child Sexual Abuse Myth Scale - CSAMS); and (ii) provide validity and reliability evidence for this measure. A total of 423 adults (66.2% female) filled out a sociodemographic questionnaire, the Ambivalent Sexism Inventory, and the CSAMS. The CSAMS validity and reliability results supported the original structure, which comprises three dimensions: Blame Diffusion (e.g., 'Adolescent girls who wear very revealing clothing are asking to be sexually abused'), Restrictive Stereotypes (e.g., 'Most children are sexually abused by strangers or by men who are not well known to the child'), and Denial of Abusiveness (e.g., 'Older children, who have a better understanding of sexual matters, have a responsibility to actively resist sexual advances by adults'). Configural and metric invariance by sex were held, and criterion validity was observed through significant associations between myths, sexism and sex. This study provided evidence in support of the validity and reliability of the Portuguese version of the Child Sexual Abuse Myth Scale.

Treatment of iron deficiency anemia with liposomal iron in inflammatory bowel disease: efficacy and impact on quality of life.

Background Anemia is a clinical condition frequently seen in patients with inflammatory bowel disease, which is responsible for a significant loss of quality of life. Objective To assess the efficacy and safety of using oral liposomal iron to treat iron deficiency anemia in inflammatory bowel disease patients, as well as assess the impact of this treatment on psychometric scores. Methods Patients with inactive/mildly active inflammatory bowel disease were screened for anemia in this interventional pilot study conducted from November 2016 to March 2018. Patients with mild anemia were treated with oral liposomal iron for 8 weeks. Main outcome measure The primary endpoint of the study was the response to liposomal oral iron therapy. Treatment response was defined as patients who achieved a hemoglobin increase of ≥ 1 g/dL and/or hemoglobin normalization by the 8th week of treatment. Results Out of 200 screened patients, 40 (20%) had anemia. Of the 21 patients who completed treatment, 13 (62%) responded to oral liposomal iron replacement therapy (mean increases of hemoglobin from 11.4 to 12.6 g/dL). The transferrin saturation index increased by an average of 10.2 (p = 0.006) and the quality of life by 26.3 (p < 0.0001). There was also a mean reduction of 9.2 in the perception of fatigue (p < 0.0001). Conclusion Treatment with oral liposomal iron is effective in improving mild iron deficiency anemia and quality of life, as well as in decreasing fatigue in patients with inactive or mildly active inflammatory bowel disease.

Implications of detection of foramen ovale patent after cryptogenic ischemic stroke.

BACKGROUND: Therapeutic uncertainty is inherent in decisions in patients with patent foramen ovale (PFO) and cryptogenic stroke. We aimed to determine clinical implications of PFO identification in transesophageal echocardiography (TEE) after a cryptogenic ischemic stroke. METHODS: Consecutive TEE done between 2011 and 2015 in patients with previous cryptogenic stroke was evaluated. Clinical implications of PFO identification (closure and/or medical therapy) were retrieved from the medical records and discharge summaries. Adverse events related to therapy, stroke recurrence and death were analyzed during follow-up. RESULTS: Three-hundred one patients (mean age 59 ± 11 years; 61% male) underwent a TEE, of which 77 (26%) patients had a diagnosis of PFO. Patients with PFO were younger (56 ± 13 versus 60 ± 14, p = 0.03). Of those with PFO, 23 (30%) underwent percutaneous closure of PFO and these patients had more frequently complex or large PFO (p < 0.001 and p = 0.004, respectively). The remaining 54 (70%) were treated with medical therapy: 30 (39%) with antiplatelet therapy and 24 (31%) with oral anticoagulation. During follow-up (44 ± 17 months), only two patients had another stroke (both referred for PFO closure, while they were waiting for the procedure) and two patients, on whom PFO closure was not performed, died (not for cardiovascular causes). CONCLUSION: PFO's (size and complexity) and patients' characteristics influenced clinical decision when PFO was detected on TEE. The risk for recurrent stroke was not increased in patients who did not undergo PFO closure; although two patients waiting for PFO closure had recurrent stroke, demonstrating its importance.

Vitimização múltipla femina: histórias de vida, depressão ecoping / Female multiple victimization: life stories, depression and coping STRATEGIES

Estudos da área de Psicologia indicam a existência de uma correlação entre vitimização múltipla e maior complexidade na sintomatologia. Contudo, há mulheres expostas à adversidade cumulativa que não desenvolvem problemas de ajustamento psicológico. Este estudo procurou identificar as estratégias de copingpelas quais as mulheres, com e sem sintomatologia depressiva, lidam com a vitimização múltipla que sofreram ao longo da vida. Para tal, recorreu-se a um roteiro de entrevistas semiestruturadas, o qual foi administrado a 30 mulheres com perguntas sobre as suas histórias de vida. Os conteúdos das entrevistas posteriormente foram alvo de uma análise temática, cujos resultados revelam a presença de um copingdiversificado, heterogêneo e espontâneo, que se caracteriza por ser essencialmente de tipo ativo (e.g., resolução de problemas, autoconfiança, procura de apoiosocial). As mulheres com e sem sintomatologia depressiva reportam, sobretudo, estratégias de copingfocado no problema face à vitimização. Os resultados reforçam a necessidade de, nos processos de apoio, se identificar e potenciar tais mecanismos de copingativados pelas vítimas de forma a promover o seu ajustamento psicológico.(AU)

Research suggests the existence of a relationship between multiple victimization and greater symptomatology complexity. However, some women exposed to cumulative adversity do not develop psychological adjustment issues. With that in mind, this study aimed to identify women’s coping strategies to deal with lifetime multiple victimization. For such a purpose, thirty semi-structured interviews were conducted with women, focusing on their life stories. The content of the interviews was subjected to thematic analysis. Results revealed that these women used diverse and spontaneous coping strategies. In addition, these coping strategies are heterogeneous and can be labeled as active (e.g., problem solving, self-confidence, search for social support). Moreover, women with and without depressive symptoms mostly report problem-focused coping strategies in face of victimization. In conclusion, results reinforce the need, regarding support processes, to identify and promote coping mechanisms spontaneously activated by the victims in order to favor their psychological adjustment(AU)

La investigación documenta la existencia de una relación entre la victimización múltiple y mayor complejidad en la sintomatología. Sin embargo, hay mujeres expuestas a adversidad acumulada que no desarrollan problemas de ajuste psicológico. Este estudio trata de identificar las estrategias de copingde las mujeres ante la victimización múltiple sufrida durante toda la vida. Las 30 entrevistas semiestructuradas acerca de sus historias de vida fueron sometidas a un análisis temático. Los resultados patentizan la presencia de un copingdiverso, heterogéneo y espontáneo, que se caracteriza por ser activo (por ejemplo, la resolución de problemas, la autoconfianza, la búsqueda de apoyo social). Las mujeres con y sin síntomas depresivos expresan estrategias de copingcentralizadas en la resolución de problemas ante la victimización. Los resultados refuerzan la necesidad de, en los procesos de apoyo, se identificar y desarrollar esas estrategias activadas autónomamente por las víctimas con el fin de favorecer su adaptación psicológica(AU)

Vitimização múltipla feminina: histórias de vida, depressão ecoping / Female multiple victimization: life stories, depression and coping strategies / Victimización múltiple femenino: historias de la vida, depressión, estrategias de coping

Estudos da área de Psicologia indicam a existência de uma correlação entre vitimização múltipla e maior complexidade na sintomatologia. Contudo, há mulheres expostas à adversidade cumulativa que não desenvolvem problemas de ajustamento psicológico. Este estudo procurou identificar as estratégias de copingpelas quais as mulheres, com e sem sintomatologia depressiva, lidam com a vitimização múltipla que sofreram ao longo da vida. Para tal, recorreu-se a um roteiro de entrevistas semiestruturadas, o qual foi administrado a 30 mulheres com perguntas sobre as suas histórias de vida. Os conteúdos das entrevistas posteriormente foram alvo de uma análise temática, cujos resultados revelam a presença de um copingdiversificado, heterogêneo e espontâneo, que se caracteriza por ser essencialmente de tipo ativo (e.g., resolução de problemas, autoconfiança, procura de apoiosocial). As mulheres com e sem sintomatologia depressiva reportam, sobretudo, estratégias de copingfocado no problema face à vitimização. Os resultados reforçam a necessidade de, nos processos de apoio, se identificar e potenciar tais mecanismos de copingativados pelas vítimas de forma a promover o seu ajustamento psicológico.

Research suggests the existence of a relationship between multiple victimization and greater symptomatology complexity. However, some women exposed to cumulative adversity do not develop psychological adjustment issues. With that in mind, this study aimed to identify women’s coping strategies to deal with lifetime multiple victimization. For such a purpose, thirty semi-structured interviews were conducted with women, focusing on their life stories. The content of the interviews was subjected to thematic analysis. Results revealed that these women used diverse and spontaneous coping strategies. In addition, these coping strategies are heterogeneous and can be labeled as active (e.g., problem solving, self-confidence, search for social support). Moreover, women with and without depressive symptoms mostly report problem-focused coping strategies in face of victimization. In conclusion, results reinforce the need, regarding support processes, to identify and promote coping mechanisms spontaneously activated by the victims in order to favor their psychological adjustment.

La investigación documenta la existencia de una relación entre la victimización múltiple y mayor complejidad en la sintomatología. Sin embargo, hay mujeres expuestas a adversidad acumulada que no desarrollan problemas de ajuste psicológico. Este estudio trata de identificar las estrategias de copingde las mujeres ante la victimización múltiple sufrida durante toda la vida. Las 30 entrevistas semiestructuradas acerca de sus historias de vida fueron sometidas a un análisis temático. Los resultados patentizan la presencia de un copingdiverso, heterogéneo y espontáneo, que se caracteriza por ser activo (por ejemplo, la resolución de problemas, la autoconfianza, la búsqueda de apoyo social). Las mujeres con y sin síntomas depresivos expresan estrategias de copingcentralizadas en la resolución de problemas ante la victimización. Los resultados refuerzan la necesidad de, en los procesos de apoyo, se identificar y desarrollar esas estrategias activadas autónomamente por las víctimas con el fin de favorecer su adaptación psicológica.

Anemia in inflammatory bowel disease outpatients: prevalence, risk factors, and etiology.

UNLABELLED: Anemia is common in inflammatory bowel disease (IBD). However, epidemiological studies of nonwestern IBD populations are limited and may be confounded by demographic, socioeconomic, and disease-related influences. This study evaluated the prevalence, risk factors, and etiology of anemia in Brazilian outpatients with IBD. METHODS: In this cross-sectional study, 100 Crohn's disease (CD) patients and 100 ulcerative colitis (UC) subjects were assessed. Anemia workup included complete blood count, ferritin, transferrin saturation, serum levels of folic acid and vitamin B12, and C-reactive protein (CRP) concentration. RESULTS: The overall prevalence of anemia in IBD was 21%. There was no significant difference in the prevalence of anemia between CD subjects (24%) and UC (18%). Moderate disease activity (OR: 3.48, 95% CI, 1.95-9.64, P = 0.002) and elevated CRP levels (OR: 1.8, 95% CI, 1.04-3.11, P = 0.02) were independently associated with anemia. The most common etiologies of anemia found in both groups were iron deficiency anemia (IDA; 10% on CD and 6% on UC) followed by the anemia of chronic disease (ACD; 6% for both groups). CONCLUSIONS: In Brazilian IBD outpatients, anemia is highly concurrent condition. Disease moderate activity as well as increased CRP was strongly associated with comorbid anemia. IDA and/or ACD were the most common etiologies.

Metastização uterina de carcinoma mamário - Relato de caso / Uterine metastasis of breast carcinoma - Case report

A doença metastática que envolve o útero é rara. Geralmente os ovários são o órgão envolvido e o tumor primário é habitualmente da mama ou do trato gastrointestinal.Caso clínico: Os autores apresentam um caso de metastização uterina de carcinoma mamário. A doente tinha antecedentes de mastectomia bilateral por carcinoma invasivo NOS havia mais de 30 anos. A avaliação histológica do produto de biópsia histeroscópica, complementada com imuno-histoquímica, confirmou a origem do tumor primário como mamário e de variante lobular. A doente recusou outros procedimentos invasivos, mas concordou com seguimento clínico e ecográfico. Conclusão: Geralmente a doença metastática da mama para o trato genital feminino deve-se majoritariamente a carcinoma lobular invasivo. Apresentamos um caso de metastização uterina de carcinoma lobular invasivo, mais de 30 anos após o tumor primário, o qual foi classificado como carcinoma invasivo NOS e confirmado em revisão de lâminas. É de salientara importância de uma correta informação clínica ao patologista do antecedente oncológico, de forma a poder ser feito um correto diagnóstico diferencial.

Metastatic disease involving the uterus is rare. Typically it is the ovaries that are involved and the primary tumor is usually the breast or the gastrointestinal tract. Case report: We describe a case of metastatic breast carcinoma involving the uterus in a patient who had had a bilateral mastectomy due to invasive carcinoma NOS more than thirty years ago. Histological assessment of the hysteroscopy biopsy specimen including immunohistochemistry staining confirmed the breast carcinoma as the primary lesion, however it was classified as lobular carcinoma. The patient refused surgery or other invasive procedures, having complied nevertheless to follow up with clinical and ultrasound evaluation. Conclusion: Metastatic breast disease to the feminine genital tract is more frequently due to lobular invasive carcinoma. We present a case of uterine metastization of invasive lobular carcinoma more than thirty years since the primary tumor, which was classified as invasive carcinoma NOS and confirmed by histological revision. It is of great importance to give the pathologist the correct information about the patient, namely of any oncologic background, so differential diagnosis can be made.

Relação adiponectina/leptina como método para avaliação da sensibilidade insulínica / Adiponectin/leptin ratio as an evaluation method to insulin sensitivity

Nos últimos anos, ocorreram mudanças na compreensão da fisiopatologia de doenças que cursam com inflamação subclínica, entre elas a obesidade e o diabetes mellitus tipo 2, condições que têm como substrato comum a resistência insulínica. A avaliação da sensibilidade à insulina (SI) é realizada por métodos indiretos como o cálculo do índice HOMA-IR que apresenta boa correlação com o clamp euglicêmico hiperinsulinêmico, considerado padrão ouro. Recentemente, a relação entre adiponectina/leptina (A/L), citocinas envolvidas na fisiopatologia da síndrome metabólica, tem sido proposta como método para avaliação da SI. Revisamos estudos sobre a relação A/L para avaliação da SI e os dados mostraram que, comparada ao HOMA-IR, a relação A/L constitui um marcador confiável de SI em pacientes com diabetes mellitus tipo 2 e em não diabéticos. Estes achados permitem sugerir a relação A/L como método de avaliação da SI, mas necessitam de confirmação em estudos com maior número de indivíduos.

The knowledge of the pathophysiology of inflammatory diseases coursing with insulin resistance such as obesity and type 2 diabetes has changed. The assessment of insulin sensitivity (IS) is carried out through indirect methods such as the HOMA-IR which shows a good correlation with the euglycemic hyperinsulinemic clamp, the gold standard for IS. Recently, the ratio between adiponectin/leptin (A/L), cytokines involved in the pathophysiology of the metabolic syndrome, has been proposed as an alternative method for the assessment of the IS. In this paper the authors reviewed studies that examined the A/L ratio as a tool to estimate IS and the data showed that compared to HOMA-IR, the A/L ratio is a reliable marker for IS in obese patients with and without type 2 diabetes. These findings suggest that the ratio A/L could be used as an evaluation method to estimate IS but should be confirmed in studies with high number of individuals.

[Beliefs and attitudes of professionals about marital violence: studies with health professionals, policemen and teachers]. / Crenças e atitudes dos profissionais face à violência conjugal: estudos com profissionais de saúde, polícias e profesores.

This article presents a set of three research projects that aimed to characterize the beliefs about marital violence of the professionals most directly implied in the response and prevention of this problem. A research questionnaire that evaluates beliefs about marital violence was administered to a sample of 226 health professionals, 85 law enforcement agents and 280 teachers. On the global results show a tendency to moderate disagreement with beliefs that legitimize this form of abuse. Some myths, however, persist in these samples, namely those related to the privacy of the problem, its rarity and attribution to external causes. Male and older subjects show, in general, higher levels of violence legitimization.

Atuação fisioterapêutica na qualidade de vida do paciente fibromiálgico / Physiotherapeutic actions in the quality of life of patients with fibromyalgia

Objetivos: Realizar uma revisão bibliográfica sobre fibromialgia e seus métodos de tratamento. Foram revisados os artigos publicados sobre o assunto nos bancos de dados PubMed e Sielo. Sintese dos Dados: A evolução dos pacientes quanto à melhora da qualidade de vida pode ser atribuída ao controle do quadro de dor e estados depressivos, possivelmente influenciados pela melho realização das atividades rotineiras, melhora da mobilidade, capacidade física e do sono, incluindo o acompanhamento de diversos profissionais de saúde. Conclusão: O paciente com fibromialgia necessita de um manejo interdisciplinar, contando com médicos, fisioterapeutas, preparadores físicos e psicólogos.

The effect of ring substitution on the O-neophyl rearrangement of 1,1-diarylalkoxyl radicals. A product and time-resolved kinetic study.

[reaction: see text] A product and time-resolved kinetic study of the effect of ring substitution on the reactivity of 1,1-diarylalkoxyl radicals has been carried out. The radicals undergo an O-neophyl shift to give the isomeric 1-aryl-1-aryloxyalkyl radicals from which the corresponding aromatic ketones are formed. The rearrangement rate constants are influenced by ring substitution, increasing in the presence of electron-withdrawing substituents and decreasing in the presence of electron-donating ones. From the results of product and kinetic studies, the following migratory aptitudes have been obtained: 4-trifluoromethylphenyl > phenyl approximately = 4-methylphenyl > 4-methoxyphenyl. Excellent Hammett-type correlations between the sigma+ substituent constants and both the visible absorption band maxima and the rearrangement rate constants have been obtained. The experimental results indicate that the rearrangement is governed by electronic effects in the starting 1,1-diarylalkoxyl radicals, whereas the stability of the rearranged carbon-centered radical plays a minor role, in line with a reactant-like transition state, strongly supporting the hypothesis that the O-neophyl rearrangement of 1,1-diarylalkoxyl radicals proceeds through a concerted mechanism.

Photolysis of 1-alkylcycloalkanols in the presence of (diacetoxyiodo)benzene and I2. Intramolecular selectivity in the beta-scission reactions of the intermediate 1-alkylcycloalkoxyl radicals.

The C-C beta-scission reactions of 1-alkylcycloalkoxyl radicals, generated photochemically by visible light irradiation of CH2Cl2 solutions containing the parent 1-alkylcycloalkanols, (diacetoxy)iodobenzene (DIB), and I2, have been investigated through the analysis of the reaction products. The 1-alkylcycloalkoxyl radicals undergo competition between ring opening and C-alkyl bond cleavage as a function of ring size and of the nature of the alkyl substituent. With the 1-propylcycloheptoxyl, 1-propylcyclooctoxyl,and 1-phenylcyclooctoxyl radicals, formation of products deriving from an intramolecular 1,5-hydrogen atom abstraction reaction from the cycloalkane ring has also been observed. The results are discussed in terms of release of ring strain associated to ring opening, stability of the alkyl radical formed by C-alkyl cleavage, and with cycloheptoxyl and cyclooctoxyl radicals, also in terms of the possibility of achieving a favorable geometry for intramolecular hydrogen atom abstraction.

Estudo comparativo entre a tonometria de näo contato com o tonômetro pulsair e a tonometria de aplanaçäo de Goldmann / Comparative study between non-contact tonometry with pulsair tonometer and Goldmann applanation tonometry

O estudo comparativo entre os tonômetros de aplanaçäo de Goldmann e o Pulsair realizado em 564 olhos de 295 pacientes repartidos em 3 grupos, mostrou grande variaçäo nas medidas individuais, mais acentuadas na faixa de Po de 30 a 50 mmHg (tonômetro de aplanaçäo de Goldmann tomado como padräo). Até 25 e 30 mmHg, o Pulsair deu valores mais elevados em relaçäo ao tonômetro de Goldmann. Acima de 30 mmHg do tonômetro de Goldmann, o Pulsair deu valores mais baixos. A anestesia tópica näo modificou significamente as tonometrias com o Pulsair (grupos I e II) em relaçäo à tonometria sem anestesia tópica (grupo III) com o mesmo tonômetro. O estudo estatístico com o test "t" para amostras pareadas mostrou grandes diferenças entre os dois instrumentos e a correlaçäo linear entre eles também näo foi adequada (r=0,74, 0,60 e 0,84 para os grupos I, II e III respectivamente)