Spanish-Speaking Therapists Increasingly Switch to Telepsychology During COVID-19: Networked Virtual Reality May Be Next.

Background: Social distancing restrictions imposed due to the Novel Coronavirus 2019 (COVID-19) pandemic resulted in a rapid shift in the delivery of psychological interventions from in-person to telehealth. Much of the research on this transition has been conducted with English-speaking mental health providers, leaving a gap in understanding related to how this shift has impacted Spanish-speaking treatment providers. Methods: Fifty non-U.S. Spanish-speaking therapists completed a survey related to their use of telecommunication modalities; client population characteristics; professional, ethical, and legal/regulatory issues; and telehealth training and practice. Participants completed the survey at one time point and retrospectively described their use of telehealth both pre-pandemic and during the pandemic. Results: Most of the 50 Spanish-speaking therapists surveyed reported using telepsychology 58% before COVID-19 versus 84% during the COVID-19 pandemic (χ2 = 5.76, p < 0.05). Compared with pre-pandemic, the number of hours therapists spent using telepsychology per week increased significantly for early adopter therapists (those who began using telehealth before the pandemic began) (Z = -3.18, p = 0.001) and also for late adopter therapists who only began using telehealth during the pandemic (Z = -3.74, p < 0.001). Many therapists reported equity issues. Most participants also reported ethical and regulatory concerns regarding security/confidentiality or Health Insurance Porability and Accountability Act. Conclusions: The rapid adoption of technology to deliver therapy during COVID-19 has spurred growing pains for Spanish-speaking therapists and their underserved clients, and more research is needed to better understand and improve the therapists' adoption of these technologies with diverse patient populations.

Global adult tobacco survey data as a tool to monitor the WHO framework convention on tobacco control (WHO FCTC) implementation: the Brazilian case

The Global Adult Tobacco Survey (GATS) was conducted in Brazil to provide data on tobacco use in order to monitor the WHO FCTC implementation in the country. It was carried out in 2008 using an international standardized methodology. The instrument included questions about tobacco use prevalence, cessation, secondhand smoke, knowledge, attitudes, media and advertising. Weighted analysis was used to obtain estimates. A total of 39,425 interviews were conducted. The prevalence of current tobacco use was 17.5%, (22.0%, men; 13.3%, women). The majority of users were smokers (17.2%) and their percentage was higher in rural areas (20.4%) than in urban areas (16.6%). About 20% of individuals reported having been exposed to tobacco smoke in public places. Over 70% of respondents said they had noticed anti-smoking information in several media and around 65% of smokers said they had considered quitting because of warning labels. About 30% of respondents had noticed cigarette advertising at selling points and 96% recognized tobacco use as a risk factor for serious diseases. Data in this report can be used as baseline for evaluation of new tobacco control approaches in Brazil, vis-…-vis WHO FCTC demand reduction measures (AU)

Incidence, aetiology and neurodisability associated with severe microcephaly: a national surveillance study.

OBJECTIVE: To determine the incidence, causes and neurodevelopmental impact of severe microcephaly (head circumference <-3SD) up to age 2 years. DESIGN: Binational active paediatric surveillance study undertaken in 2017-2018 to identify and characterise new diagnoses of severe microcephaly. SETTING: UK and Ireland. PARTICIPANTS: Infants aged under 12 months at diagnosis. INTERVENTIONS: Observational study. MAIN OUTCOME MEASURES: Incidence, aetiology and neurodevelopmental outcomes at age 2 years. RESULTS: Fifty-nine infants met the case definition, of whom 30 (51%) were girls; 24 (41%) were born preterm (<37 weeks' gestation); and 34 (58%) were of 'white' ethnicity. Eight (14%) children died before 12 months of age. Incidence of severe microcephaly was 5.5 per 100 000 infants (95% CI 4.0 to 7.3). Higher relative risk (RR) was associated with preterm birth (RR 7.7, 95% CI 3.8 to 15.1) and British Asian ethnicity (RR 3.6, 95% CI 1.6 to 7.8). Microcephaly was mainly due to genetic causes (59%), brain ischaemia/hypoxia (10%) and congenital infection (8%), and 19% remained undetermined. Each child was referred on average to eight specialists, and 75% had abnormal brain imaging. By 2 years of age, 55 children experienced neurodevelopmental abnormalities, including feeding problems (68%), motor delay (66%), visual impairment (37%), hearing loss (24%) and epilepsy (41%). CONCLUSIONS: Although severe microcephaly is uncommon, it is associated with high mortality, complex multimorbidity and neurodisability, thus representing a significant ongoing burden for families and healthcare services. Potentially preventable causes include preterm birth, hypoxic/ischaemic brain injury and congenital infections. Clinical guidelines are essential to standardise aetiological investigation and optimise multidisciplinary management.

The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review.

Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.

Using Immersive Virtual Reality Distraction to Reduce Fear and Anxiety before Surgery.

Presurgical anxiety is very common and is often treated with sedatives. Minimizing or avoiding sedation reduces the risk of sedation-related adverse events. Reducing sedation can increase early cognitive recovery and reduce time to discharge after surgery. The current case study is the first to explore the use of interactive eye-tracked VR as a nonpharmacologic anxiolytic customized for physically immobilized presurgery patients. Method: A 44-year-old female patient presenting for gallbladder surgery participated. Using a within-subject repeated measures design (treatment order randomized), the participant received no VR during one portion of her preoperative wait and interactive eye-tracked virtual reality during an equivalent portion of time in the presurgery room. After each condition (no VR vs. VR), the participant provided subjective 0-10 ratings and state-trait short form Y anxiety measures of the amount of anxiety and fear she experienced during that condition. Results: As predicted, compared to treatment as usual (no VR), the patient reported having 67% lower presurgical anxiety during VR. She also experienced "strong fear" (8 out of 10) during no VR vs. "no fear" (0 out of 10) during VR. She reported a strong sense of presence during VR and zero nausea. She liked VR, she had fun during VR, and she recommended VR to future patients during pre-op. Interactive VR distraction with eye tracking was an effective nonpharmacologic technique for reducing anticipatory fear and anxiety prior to surgery. The results add to existing evidence that supports the use of VR in perioperative settings. VR technology has recently become affordable and more user friendly, increasing the potential for widespread dissemination into medical practice. Although case studies are scientifically inconclusive by nature, they help identify new directions for future larger, carefully controlled studies. VR sedation is a promising non-drug fear and anxiety management technique meriting further investigation.

Chemical composition and biological activities of the essential oil from Eugenia stipitata McVaugh leaves.

In the present study, the volatile components and cytotoxic, antibacterial, antioxidant, and antiprotozoal activities of the essential oil obtained from the leaves of Eugenia stipitata McVaugh (Myrtaceae) grown in the Brazilian Northeast region (Araripe) were investigated. The essential oil was obtained by hydrodistillation. The leaves of E. stipitata provided an oil yield of 0.13 ± 0.01% (w/w). The volatile compounds in the essential oil of E. stipitata were analysed using gas chromatography, and the volatile chemical composition was mainly composed of ß-eudesmol (15.28%), γ-eudesmol (10.85%), elemol (10.21%) and caryophyllene oxide (6.65%). The essential oil of E. stipitata was highly selective against Leishmania braziliensis and L. infantum promastigotes. The essential oil exhibited good antibacterial activity. E. stipitata essential oil showed low free-radical scavenging activity. Our results suggest that the E. stipitata essential oil is a relevant source of the primary compounds required for the development of antibacterial and antiprotozoal drugs.

Anti-Trichomonas vaginalis activity of essential oils extracted from Caatinga Myrtaceae species and chemical composition of Eugenia pohliana DC.

The current trichomoniasis treatment is restrict to 5-nitroimidazole drugs and the emergence of resistant isolates points the need for new therapeutical alternatives. In this study the anti-Trichomonas vaginalis activity of essential oils obtained from Myrtaceae occurring in Caatinga, a plant family with potential antiparasitic activity, was showed. The essential oils varied in their capacity to kill ATCC and fresh clinical T. vaginalis isolates, which was associated with heterogeneity and different patterns of endosymbiosis. Essential oils caused moderate to strong cytotoxicity against mammalian cells, but essential oil of Eugenia pohliana (EOEp) exhibited promising selectivity index towards vaginal epithelial cells. A checkerboard assay revealed a synergistic effect when EOEp and metronidazole were associated, indicating different mechanisms of action. The GC/MS analysis demonstrated the volatile composition of EOEp, with δ-cadinene as majoritary component. This molecule seems to contribute to the trichomonacidal effect and shows potential for the prospection of new antiparasitic compounds.

An Exploratory Study on the Effectiveness of Virtual Reality Analgesia for Children and Adolescents with Kidney Diseases Undergoing Venipuncture.

The current study evaluated the effectiveness of VR analgesia among pediatric and adolescent patients with kidney disease undergoing venipuncture. Patients at an Italian Children's hospital (N = 82, age range 7-17 years) undergoing venipuncture were randomly assigned to a No VR group (non-medical conversation) vs. a Yes VR group (VR analgesia). After the procedure, patients gave 0-10 Verbal Numeric Pain Scale ratings. Compared with patients in the No VR Group, patients in the Yes VR group reported significantly lower "Pain intensity"(No VR mean = 2.74, SD = 2.76 vs. Yes VR mean = 1.56, SD = 1.83) and the VR group also rated "Pain unpleasantness" significantly lower than the No VR group (No VR mean = 2.41, SD = 0.94 vs. Yes VR mean = 1.17, SD = 1.80). Patients distracted with VR also reported having significantly more fun during the venipuncture procedure. No side effects emerged. In addition to reducing pain intensity, VR has the potential to make venipuncture a more fun and less unpleasant experience for children with CKD, as measured in the present study for the first time. Finally, in exploratory analyses, children aged 7-11 in the VR group reported 55% lower worst pain than control subjects in the same age range, whereas children aged 12 to 17 in the VR group only reported 35% lower worst pain than control subjects. Additional research and development using more immersive VR is recommended.

Leishmanicidal and trypanocidal potential of the essential oil of Psidium myrsinites DC.

Neglected tropical diseases (NTDs) are a group of pathologies caused by infectious agents or parasites, including the protozoa Leishmania sp. and Trypanosoma cruzi, which cause leishmaniasis and Chagas disease, respectively. The complications of the treatment regimen indicate the urgent need to search for new strategies and therapeutic agents. Among these is the essential oil of Psidium myrsinites DC. The essential oil of the leaves (PMEO) was evaluated in vitro, and cytotoxic activity was analysed against promastigotes of Leishmania braziliensis and Leishmania infantum and epimastigotes of Trypanosoma cruzi, as well as mammalian cells. The results showed that the PMEO had relevant activity against L. braziliensis, low cytotoxicity and a high selectivity index SI = 6.6. These results suggest that PMEO has antiparasitic potential against L. braziliensis, making this species is a possible alternative therapeutic source, given its effectiveness in the in vitro tests performed, opening the possibility of new biological studies in vivo.

Therapists Make the Switch to Telepsychology to Safely Continue Treating Their Patients During the COVID-19 Pandemic. Virtual Reality Telepsychology May Be Next.

Before COVID-19, most therapists had concerns about telepsychology, and only treated patients in person. During the COVID-19 lockdown, patients still needed therapy, but in-person therapy sessions became unsafe. The current study measured how many therapists are using online therapy before vs. during COVID-19, how much training they have received, and their knowledge about legal restrictions on using telepsychology. A sample of 768 U.S.A. mental health professionals completed a 29-item online survey. Results show that before COVID-19, most therapists only saw their patients in person (e.g., at the therapists office), but during the COVID-19 pandemic, nearly all therapists used a wide range of telecommunication technologies to communicate with their quarantined patients, including texting, telephones, video conferences, and even virtual reality. According to within-subject related samples comparisons, 39% of survey respondents used telepsychology before COVID-19, vs. 98% during COVID-19 (χ2 = 450.02, p< 0.001). Therapists reported high treatment effectiveness using telepsychology (7.45 on 0-10 scale). However, overall, on a 0-10 scale, therapists reported a significant increase in feeling burned out during the COVID-19 pandemic, Mean = 3.93 (SD = 1.93) before vs. 6.22 (SD = 2.27) during the pandemic (Z = -18.57, p < 0.001). Although the APA ethics guidelines encourage therapists to use telepsychology with their patients during the crisis, gaps in respondents' knowledge identify a need for increased specialized training and education. Although the current study showed that virtual reality is rarely used by the therapists surveyed, virtual reality is a promising new telepsychology technology. Billions of dollars are currently being invested in mass producing immersive virtual reality systems. In the future, as networked immersive Virtual Reality becomes more widely available, therapists and patients in physically different locations will be able to "meet" in a shared computer-generated world designed for therapy sessions, potentially including group sessions. Telepsychology and virtual reality have the potential to be increasingly valuable tools to help therapists mitigate the consequences of COVID-19. Research, development and training is recommended.

Chemical composition, antioxidant and antiprotozoal activity of Eugenia gracillima Kiaersk. leaves essential oil.

This work evaluated the volatile composition, antioxidant and antiprotozoal activities of the essential oil obtained from leaves of Eugenia gracillima Kiaersk. (EGEO) grown in Brazilian Northeast area (Araripe, Brazil). The volatile compounds of EGEO were analyzed by GC and GC-MS and its chemical composition is mainly composed of sesquiterpene hydrocarbons (91.22%), oxygenated sesquiterpenes (7.45%) and monoterpene (1.01%). The most abundant volatile constituents of the EGEO were germacrene D (16.10%), γ-muurolene (15.60%), bicyclogermacrene (8.53%), germacrene B (7.43%), and Δ-elemene (6.06%). The oil showed weak to moderate antioxidant activity. EGEO was highly selective to Leishmania braziliensis and Leishmania infantum promastigotes with selective indexes of 73.66 and 71.41, respectively. EGEO did not inhibit Trypanosoma cruzi. These data suggest that the E. gracillima essential oil is a relevant source of lead compounds for development of anti-Leishmania drugs.

Chronic myeloid leukemia-from the Philadelphia chromosome to specific target drugs: A literature review.

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm and was the first neoplastic disease associated with a well-defined genotypic anomaly - the presence of the Philadelphia chromosome. The advances in cytogenetic and molecular assays are of great importance to the diagnosis, prognosis, treatment, and monitoring of CML. The discovery of the breakpoint cluster region (BCR)-Abelson murine leukemia (ABL) 1 fusion oncogene has revolutionized the treatment of CML patients by allowing the development of targeted drugs that inhibit the tyrosine kinase activity of the BCR-ABL oncoprotein. Tyrosine kinase inhibitors (known as TKIs) are the standard therapy for CML and greatly increase the survival rates, despite adverse effects and the odds of residual disease after discontinuation of treatment. As therapeutic alternatives, the subsequent TKIs lead to faster and deeper molecular remissions; however, with the emergence of resistance to these drugs, immunotherapy appears as an alternative, which may have a cure potential in these patients. Against this background, this article aims at providing an overview on CML clinical management and a summary on the main targeted drugs available in that context.

Helicobacter pylori infection: Beyond gastric manifestations.

Helicobacter pylori (H. pylori) is a bacterium that infects more than a half of world's population. Although it is mainly related to the development of gastroduodenal diseases, several studies have shown that such infection may also influence the development and severity of various extragastric diseases. According to the current evidence, whereas this bacterium is a risk factor for some of these manifestations, it might play a protective role in other pathological conditions. In that context, when considered the gastrointestinal tract, H. pylori positivity have been related to Inflammatory Bowel Disease, Gastroesophageal Reflux Disease, Non-Alcoholic Fatty Liver Disease, Hepatic Carcinoma, Cholelithiasis, and Cholecystitis. Moreover, lower serum levels of iron and vitamin B12 have been found in patients with H. pylori infection, leading to the emergence of anemias in a portion of them. With regards to neurological manifestations, a growing number of studies have associated that bacterium with multiple sclerosis, Alzheimer's disease, Parkinson's disease, and Guillain-Barré syndrome. Interestingly, the risk of developing cardiovascular disorders, such as atherosclerosis, is also influenced by the infection. Besides that, the H. pylori-associated inflammation may also lead to increased insulin resistance, leading to a higher risk of diabetes mellitus among infected individuals. Finally, the occurrence of dermatological and ophthalmic disorders have also been related to that microorganism. In this sense, this minireview aims to gather the main studies associating H. pylori infection with extragastric conditions, and also to explore the main mechanisms that may explain the role of H. pylori in those diseases.

Is There an Ideal Rest Interval Between Races During Vaquejada in Which It Would Be Possible to Associate Best Performance and Welfare?

Vaquejada is an important Brazilian equine discipline. Understanding physiological adaptations of these athletes is crucial to improve properly performance, guaranteeing welfare. The objective of this study was to evaluate the influence of three vaquejada simulation tests (VST) on physiological parameters of horses and standardize a possible rest interval between races. Ten clinically healthy Quarter horses, 8.9 ± 4.3 year-old and 441.3 ± 25.0 kg, executed three VST, 5 days apart from each other. Vaquejada simulation tests consisted of two horses, a puller, and a helper, running with a bull on a soft sand track in which they must put the bull down. On M1, they ran three times with a 5-min rest between races; on M2, with a 10-min rest; and M3, with a 15-min rest. Clinical evaluation and blood sampling were made in all VST, before (T0), immediately after first run (T1), second run (T2), third run (T3) and at 30 minutes (T4), and 4 hours (T5) of recovery. Variables were statistically analyzed with a bifactorial comparison (P < .05). Exercise increased heart rate (HR), respiratory rate, body temperature (BT), lactate, triglycerides, packed cell volume, RBC, and hemoglobin concentration, with higher values in pull horses due to a more intense exercise. With 15-min of rest interval, helper horses showed lower values of glucose, aspartate aminotransferase, creatine kinase, BT, and higher values of triglycerides, also working at the same speed and distance with a lower HRmax and HRmed. Pull and helper horses had shown modifications of biomarkers. Furthermore, 15-min rest interval between races improved performance of helper horses as they used properly energy sources and cardiovascular function, respecting precepts of welfare.

Pathogenesis and clinical management of Helicobacter pylori gastric infection.

Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects approximately 4.4 billion individuals worldwide. However, its prevalence varies among different geographic areas, and is influenced by several factors. The infection can be acquired by means of oral-oral or fecal-oral transmission, and the pathogen possesses various mechanisms that improve its capacity of mobility, adherence and manipulation of the gastric microenvironment, making possible the colonization of an organ with a highly acidic lumen. In addition, H. pylori presents a large variety of virulence factors that improve its pathogenicity, of which we highlight cytotoxin associated antigen A, vacuolating cytotoxin, duodenal ulcer promoting gene A protein, outer inflammatory protein and gamma-glutamyl transpeptidase. The host immune system, mainly by means of a Th1-polarized response, also plays a crucial role in the infection course. Although most H. pylori-positive individuals remain asymptomatic, the infection predisposes the development of various clinical conditions as peptic ulcers, gastric adenocarcinomas and mucosa-associated lymphoid tissue lymphomas. Invasive and non-invasive diagnostic methods, each of them with their related advantages and limitations, have been applied in H. pylori detection. Moreover, bacterial resistance to antimicrobial therapy is a major challenge in the treatment of this infection, and new therapy alternatives are being tested to improve H. pylori eradication. Last but not least, the development of effective vaccines against H. pylori infection have been the aim of several research studies.

[Interobserver reliability of the International Classification of Primary Care]. / Confiabilidade interobservador da Classificação Internacional de Cuidados Primários.

OBJECTIVE: The International Classification of Primary Care was developed as an attempt to overcome the limitations of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, when used for primary health care. The aim of the study was to evaluate the interobserver reliability of the International Classification for Primary Care when coding reasons for health-related interruption of daily activities. METHODS: Data analyzed pertained to 801 subjects from Phase 2 of the Pró-Saúde Study, involving the employees of a Rio de Janeiro university who reported having been prevented from carrying out any of their usual activities (work, study, or leisure) for health-related reasons in the two weeks prior to data collection. Health problems reported in response to an open question were separately coded by two classifiers. Interobserver reliability with respect to number of health problems was calculated by weighted kappa; for the remaining analyses (chapters and full codes), crude kappa coefficients were used. RESULTS: A total of 1,641 health problems were coded by the first classifier, and 1,629 by the second. Interobserver reliability with respect to the number of health problems coded was substantial (weighted kappa=0.94; 95% CI: 0.93;0.94). Chapter and full codes showed substantial (kappa=0.89; 95% CI: 0.88;0.90) and moderate (0.76; 95% CI: 0.76;0.78) reliability, respectively. CONCLUSIONS: The results suggest that the International Classification of Primary Care is adequate for the coding of health-related reasons for interruption of daily activities.

The Use of Virtual Reality Facilitates Dialectical Behavior Therapy® "Observing Sounds and Visuals" Mindfulness Skills Training Exercises for a Latino Patient with Severe Burns: A Case Study.

Sustaining a burn injury increases an individual's risk of developing psychological problems such as generalized anxiety, negative emotions, depression, acute stress disorder, or post-traumatic stress disorder. Despite the growing use of Dialectical Behavioral Therapy® (DBT®) by clinical psychologists, to date, there are no published studies using standard DBT® or DBT® skills learning for severe burn patients. The current study explored the feasibility and clinical potential of using Immersive Virtual Reality (VR) enhanced DBT® mindfulness skills training to reduce negative emotions and increase positive emotions of a patient with severe burn injuries. The participant was a hospitalized (in house) 21-year-old Spanish speaking Latino male patient being treated for a large (>35% TBSA) severe flame burn injury. Methods: The patient looked into a pair of Oculus Rift DK2 virtual reality goggles to perceive the computer-generated virtual reality illusion of floating down a river, with rocks, boulders, trees, mountains, and clouds, while listening to DBT® mindfulness training audios during 4 VR sessions over a 1 month period. Study measures were administered before and after each VR session. Results: As predicted, the patient reported increased positive emotions and decreased negative emotions. The patient also accepted the VR mindfulness treatment technique. He reported the sessions helped him become more comfortable with his emotions and he wanted to keep using mindfulness after returning home. Conclusions: Dialectical Behavioral Therapy is an empirically validated treatment approach that has proved effective with non-burn patient populations for treating many of the psychological problems experienced by severe burn patients. The current case study explored for the first time, the use of immersive virtual reality enhanced DBT® mindfulness skills training with a burn patient. The patient reported reductions in negative emotions and increases in positive emotions, after VR DBT® mindfulness skills training. Immersive Virtual Reality is becoming widely available to mainstream consumers, and thus has the potential to make this treatment available to a much wider number of patient populations, including severe burn patients. Additional development, and controlled studies are needed.

The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study.

Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT®) is the most effective treatment for Borderline Personality Disorder, but demand for DBT® far exceeds existing clinical resources. Most patients with BPD never receive DBT®. Incorporating computer technology into the DBT® could help increase dissemination. Immersive Virtual Reality technology (VR) is becoming widely available to mainstream consumers. This case study explored the feasibility/clinical potential of using immersive virtual reality technology to enhance DBT® mindfulness skills training of a 32 year old female diagnosed with BPD. Prior to using VR, the patient experienced difficulty practicing DBT® mindfulness due to her emotional reactivity, and difficulty concentrating. To help the patient focus her attention, and to facilitate DBT® mindfulness skills learning, the patient looked into virtual reality goggles, and had the illusion of slowly "floating down" a 3D computer-generated river while listening to DBT® mindfulness training audios. Urges to commit suicide, urges to self harm, urges to quit therapy, urges to use substances, and negative emotions were all reduced after each VR mindfulness session and VR mindfulness was well accepted/liked by the patient. Although case studies are scientifically inconclusive by nature, results from this feasibility study were encouraging. Future controlled studies are needed to quantify whether VR-enhanced mindfulness training has long term benefits e.g., increasing patient acceptance and/or improving therapeutic outcome. Computerizing some of the DBT® skills treatment modules would reduce cost and increase dissemination.

Prevalência de casos de tricomoníase em laudos citopatológicos de um laboratório particular da cidade do Crato ­ Ceará / Prevalence of tricomoníase cases in citopatological reports of a particular laboratory of the city of Crato-Ceará

Objetivo: o presente artigo tem como objetivo avaliar a prevalência de mulheres infectadas pelo protozoário Trichomonas vaginalis (T. vaginalis) em um laboratório particular da cidade do Crato, Ceará. Metodologia: tratou-se de um estudo do tipo descritivo, retrospectivo com abordagem quantitativa. A coleta de dados foi realizada em um Laboratório particular de Análises Clínicas, localizado na cidade de Crato-CE, cujo grupo de estudo foi todas as mulheres, com idade entre 17 e 87 anos, que realizaram o exame de Papanicolau no período de 2014 a 2016. Resultados: foram quantificados os percentuais de amostras positivas para a tricomoníase e outras patologias correlatas obtendo-se como resultado que entre os anos de 2014 a 2016 foram realizados 28.910 exames citopatológicos, dos quais 2,22 % foram positivos para tricomoníase. Dentre os casos positivos 22,15% apresentaram co-infecção com outros microrganismos, sendo a Gardnerella vaginalis a principal bactéria encontrada, obtendo um total de 80,99% dos casos, Cândida sp com 11,97% dos casos, Leptothrix com 5,63% e Papilomavírus humano (HPV) com 1,41% dos casos. Observou-se que a faixa etária com maior incidência de tricomoníase é entre 26 a 45 anos, com um percentual de 65,21%, sendo possível notar a alta prevalência de tricomoníase na população feminina. Conclusão: os resultados foram apresentados a Secretaria de Saúde da cidade de Crato ­ Ceará com o intuito de alertar os profissionais de saúde com relação ao número de casos, incentivando a periodicidade do exame de Papanicolau e outros exames voltados ao diagnóstico dessa patologia, além de uma atenção especial ao tratamento das mulheres já infectadas .

Objective: the present article aims to evaluate the prevalence of women infected by the protozoan Trichomonas vaginalis (T. vaginalis) in a private laboratory in the city of Crato, Ceará. Methodology: this was a descriptive, retrospective study with a quantitative approach. The data collection was performed in a Private Laboratory of Clinical Analyzes, located in the city of Crato-CE, whose study group were all women aged between 17 and 87 years who underwent the papanicolau in the period from 2014 to 2016. Results: the percentages of positive samples for trichomoniasis and other related pathologies were quantified, resulting in 28.910 cytopathological exams between 2014 and 2016, of which 2.22% were positive for trichomoniasis. Among the positive cases, 22.15% presented co-infection with other microorganisms, Gardnerella vaginalis being the main bacterium found, obtaining a total of 80.99% of the cases, Candida sp. With 11.97% of the cases, Leptothrix with 5, 63% and human papillomavirus (HPV) with 1.41% of the cases. It was observed that the age group with the highest incidence of trichomoniasis is between 26 and 45 years old, with a percentage of 65.21%, being possible to note the high prevalence of trichomoniasis in the female population. In view of these results it is possible to note the high prevalence of trichomoniasis in the female population. Conclusion: the results were presented to the Health Department of the city of Crato-Ceará with the aim of alerting health professionals about the number of cases, encouraging the periodicity of the papanicolau and other tests aimed at the diagnosis of this pathology, besides paying special attention to the treatment of women already infected.

Perfil de consumo de outros produtos de tabaco fumado entre estudantes de trˆs cidades brasileiras: h motivo de preocupa‡Æo? / Smoking of non-cigarette tobacco products by students in three Brazilian cities: should we be worried?

O consumo de outros produtos de tabaco fumado vem crescendo no mundo pelo fato de serem socialmenteaceitos e pela cren‡a generalizada de causarem menos dano … sa£de do fumante, ajudados tamb‚m pela globaliza‡Æo das ind£strias do tabaco. Recentemente, no Brasil, os profissionais envolvidos com o controle do tabaco atentaram para a importƒncia de monitorar este consumo. Analisaram-se os dados provenientes doVigescola conduzido, em 2009, em trˆs cidades. As prevalˆnciasde uso de outros produtos de tabaco fumado nos £ltimos 30 dias entre os escolares de 13 a 15 anos foram elevadas em Campo Grande (18,3%; IC95%: 14,4%-22,9%) e SÆo Paulo (22,1%; IC95%: 19,0%-25,6%). Em Vit¢ria, a prevalˆncia encontrada nÆo foitÆo alta quanto …s demais (4,3%; IC95%: 3,1%-5,7%). NÆo houve diferen‡as estatisticamente significativaspor sexo. Entre os fumantes, o narguil‚ se destacou por seu alto consumo.  poss¡vel que a queda da prevalˆnciade fumantes de cigarro observada nos £ltimos anos no Brasil tenha favorecido o uso de outros produtos do tabaco como o narguil‚, sobretudo entre estudantes (AU)

Smoking of non-cigarette tobacco products is increasingworldwide because of their high socialacceptability, misperceptions about their purported harmlessness, and globalization of the tobaccoindustry. In Brazil, tobacco control experts have recently focused their attention on the importanceof monitoring the use of such products.We analyzed data from the Global Youth Tobacco Survey (2009) in three cities. Prevalence rates of non-cigarette tobacco smoking in the previous 30days among students 13 to 15 years of age were high in Campo Grande (18.3%; 95%CI: 14.4%-22.9%) and SÆo Paulo (22.1%; 95%CI: 19.0%- 25.6%), while Vit¢ria showed comparatively lowerprevalence (4.3%; 95%CI: 3.1%-5.7%). No statistical differences were observed in prevalence ratesaccording to gender. Water pipes were the most frequent form of non-cigarette tobacco smoking. The decline in cigarette smoking in Brazil in recentyears may have contributed to other forms of tobacco smoking, especially among students (AU)