Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 2(6)2015 - 8 Articles


1 - Cognitive Behavioral Therapy: state of the art, a review

Ana Claudia C. de Ornelas Maia; Luís Moacir Nascimento Pereira; Antonio Egidio Nardi; Adriana Cardoso

MEDICALEXPRESS 2015;2(6):M150601

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Protocols in Cognitive-Behavioral Therapy applied for individual or group for the treatment of anxiety and mood disorders has been found to be effective. Case conceptualization is relevant and essential in Cognitive-Behavioral Therapy because it describes and explains patient presentations in ways that inform interventions. Yet the evidence base challenges the claimed benefits of case conceptualization. A systematic review of the literature has been conducted based on data from ISI Web of Knowledge and PubMed. Articles relating to Cognitive-Behavioral Therapy Protocols in both individual and group therapy procedures were selected. We reviewed 366 articles; we discarded 141, which were not in English, 86, which were reviews and 93 because of inadequate titles. After reading the abstracts a further 18 articles were excluded, leaving 28 to be fully evaluated. Finally, 19 were selected for the final review. These articles that describe Cognitive-Behavioral Therapy treatment for panic disorder, which were effective when patients were also treated by a psychiatrist. Depressive symptoms were only mildly reduced with cognitive therapy in patients seeking the acquisition of coping skills requiring deliberate efforts and reflective thought. Actually, changes in despair thoughts and behaviors require less rumination of negative interpretation of depressive patients. Finally, the Unified Protocol is an efficient procedure for group treatment in cases of generalized anxiety and mood disorders.

Keywords: Protocols, Cognitive-Behavioral Therapy, conceptualization.

2 - Chronic effects of aerobic exercise on panic disorder: a systematic review of randomized and non-randomized trials

Eduardo Lattari; Flávia Paes; Ana Machado; Nuno Barbosa Ferreira Rocha; Antônio Egidio Nardi; Sérgio Machado

MEDICALEXPRESS 2015;2(6):M150602

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BACKGROUND: In general, most studies have supported an association between the acute effects of exercise and a reduced state anxiety, but failed to completely explain the relationship between the chronic effect of exercise and anxiety traits.
OBJECTIVE: The aim of this study was to systematically review the literature regarding the chronic effect of exercise on symptoms associated with panic disorder.
METHODS: The studies were retrieved from a MEDLINE/PubMed, ISI Web of Knowledge and SciELO. We adopted PICOS's strategy recommended to determine the eligibility criteria. The survey was conducted using an advanced search in the ISI Web of Science and MEDLINE / PubMed with MeSH terms and Entry Terms for the keywords "Panic Disorder" basis and "Exercise". Boolean operators "AND" and "OR" were used separately or in combination. Two independent researchers performed the selection of studies; in case of disagreement they sought a consensus on the selection.
RESULTS: A total of 265 articles were identified: 199 articles from PubMed/Medline, 63 articles from ISI Web of Science and 3 articles by manual searches. Thus, 31 articles were analyzed by the eligibility criteria and the exclusion criteria, a total of five studies included in the systematic review.
CONCLUSION: The regular practice of aerobic exercise seems to be an appropriate intervention to promote improvements in the severity of anxiety symptoms in PD patients.

Keywords: Chronic effects, Aerobic exercise, Panic disorder.


3 - A spatial coherence-based vision-free brain-computer interface using auditory selective attention

Leonardo Bonato Felix; Aluizio d'Affonsêca Netto; Fernando de Souza Ranaudo; Antonio Mauricio Ferreira Leite Miranda de Sá

MEDICALEXPRESS 2015;2(6):M150603

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INTRODUCTION: The development of Brain Computer Interfaces based on Auditory Selective Attention allows patients unable to voluntarily control eye movement to interact with the interface, because such systems are independent of vision. An alternative technique suitable for Brain Computer Interface applications is Spatial Coherence, an objective method to detect the side where a subject is focusing attention. This method takes into consideration the Coherence Function and the topographic distribution of responses between EEG electrodes. In this work, we further study the Information Transfer Rate and the effects of overlapping windows in the calculations. The idea behind the overlapping is to decrease the duration of the test in order to augment the Information Transfer Rate.
METHOD: EEG signals were collected from fourteen adult men aged between 19 and 28 years. Amplitude-modulated tones were used for stimulation, with 32 and 38 Hz modulation and 500 and 2000 Hz carrier frequencies, on the left and right ears, respectively. Spatial coherence was used in an online Brain Computer Interface system using auditory steady-state responses modulated by Auditory Selective Attention.
RESULTS: The obtained hit rates and the Information Transfer Rate may be considered appropriate, with a maximum value of 82% and 1.89 bits/min. The better detector regarding sensitivity versus specificity can be obtained by using a 50% overlap between consecutive data windows.
CONCLUSION: We conclude that the Spatial Coherence successfully detected the focus of attention, and it seemed useful as a classifier of the attention condition for vision-free Brain Computer Interface.

Keywords: Brain-Computer Interface; EEG; Spatial Coherence; Auditory selective attention.

4 - Excessively crying infants are more common among children of parents with restless legs syndrome

José Carlos Pereira Jr; Márcia Pradella Hallinan; José Hugo de Lins Pessoa

MEDICALEXPRESS 2015;2(6):M150604

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OBJECTIVE: We have frequently observed that infants presenting with excessive crying and fussing, or colic at night have parents with Restless Legs Syndrome. Our objective was to determine if these infants are more likely to have parents with Restless Legs Syndrome (Willis-Ekbom Disease).
METHODS: We interviewed 67 families with infants and children, in search of a history of excessive crying and fussing during their first four months of life. Their parents were investigated for Restless Legs Syndrome.
RESULTS: Among the 134 interviewed parents, 39 (29%) had Restless Legs Syndrome. Among the 96 children, 37 (38%) presented excessive crying and fussing. Of these, 28 (76%) had at least one parent with Restless Legs Syndrome. Among the 59 children without excessive crying and fussing only 14 (24%) had at least one parent with Restless Legs Syndrome. The association between events (children of parents with vs. without Restless Legs Syndrome) was measured by the phi coefficient (0.510), indicating a more than trivial association. The estimated association was 75.7 vs. 27.7, Odds Ratio = 10 at 95% confidence interval, 3.82-26.15).
CONCLUSION: Children with excessive crying and fussing were more likely to have at least one parent with Restless Legs Syndrome. The present evidence is insufficient to conclude that infantile excessive crying and fussing is equivalent to a a probable diagnosis of parental Restless Legs Syndrome. However, they provide information as well as the necessary motivation to undertake more extensive studies of infants with excessive crying and fussing.

Keywords: Restless legs syndrome; Childhood restless legs syndrome; Colic; Infant.

5 - Anthropometric indicators and their adequacy in older adults from two towns in distinct Brazilian regions

Aline Rodrigues Barbosa; Moane Marchesan; Alexsander Vieira Guimarães; Vivian Francielle França; Maria de Fátima Nunes Marucci; Raildo da Silva Coqueiro; Marcos Henrique Fernandes

MEDICALEXPRESS 2015;2(6):M150605

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OBJECTIVE: To compare anthropometric indicators and their adequacy among older adults from two towns of distinct Brazilian regions.
METHODS: A cross-sectional, population, and household-based epidemiological study. A total of 793 persons (age > 60) from the Southern and Northeastern regions of Brazil were evaluated, according to age groups (60-69, 70-79, and > 80 years) and sex. Data for body mass, height, body mass index, triceps skinfold thickness, arm muscle circumference, arm, waist and calf circumferences are presented. The prevalence of adequate anthropometric indicators was also compared for body mass index, arm circumference arm muscle circumference, triceps skinfold thickness, calf circumference and waist circumference.
RESULTS: Subjects from the Southern region (n = 477) showed significantly greater mean values for all anthropometric variables vs. subjects from the Northeastern region (n = 316). Underweight (BMI < 22.0 kg/m2) was prevalent in the Northeast, overweight (BMI > 27.0 kg/m2) in the South. Older adults from the Northeast presented a higher proportion of adequate weight circumference. Other measured anthropometric indicators revealed a greater proportion of older adults with nutritional adequacy in the Southern region.
CONCLUSION: This study provides information that can be used for anthropometric assessment of older adults in towns within the same context. Older adults of the two regions show vulnerable nutritional status, deficiency in the northeastern and excess in the southern region.

Keywords: Ageing; Nutritional evaluation; Cross-sectional studies.

6 - Executive dysfunction and low academic attainment in adolescent substance abusers with a history of maltreatment

Paulo Jannuzzi Cunha; Paula Approbato de Oliveira; Mariana Cortezzi; Geraldo F. Busatto; Sandra Scivoletto

MEDICALEXPRESS 2015;2(6):M150606

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OBJECTIVE: Substance abuse and maltreatment are highly associated with Executive Cognitive Function impairments, but very little is known about how symptoms of a condition known as Dysexecutive Syndrome may impact on real-life activities, especially in adolescents. This study investigated the presence of Executive Cognitive Function deficits in maltreated substance-abusing adolescents relative to healthy control subjects and analyzed the association between executive performance and educational attainment.
METHOD: The sample consisted of 15 maltreated adolescent substance abusers and 15 non-maltreated healthy adolescents (controls). They were assessed by the Frontal Assessment Battery, composed of six subtests: Conceptualization, Mental flexibility, Motor programming, Sensitivity to interference, Inhibitory control, and Environmental autonomy.
RESULTS: Maltreated adolescents did not differ from controls in sociodemographic variables such as age, ethnicity, and handedness. However, they performed significantly and importantly below controls in almost all domains of Executive Cognitive Function, including abstract abilities, cognitive flexibility, motor planning, and sensitivity to interference. Maltreated adolescents also completed fewer years of formal education vs. controls. The Frontal Assessment Battery total score correlated with educational attainment throughout the sample (r = 0.511; p < 0.01).
CONCLUSION: Substance-abusing adolescents with a history of maltreatment performed more poorly vs. controls on a variety of measurements of executive functioning, and the results of the Frontal Assessment Battery were associated with educational attainment. Our results evidence a negative impact of dysexecutive symptoms on educational attainment in adolescents. Strategies focusing on neuropsychological rehabilitation may be relevant to help substance-abusing and maltreated adolescents to perform better at school and perhaps in life.

Keywords: Neuropsychology, Adolescents, Addiction, Educational attainment.

7 - Heat pack treatment does not attenuate repeated muscle damage in collegiate females

Eisuke Hiruma; Masako Uchida; Hiroshi Sasaki; Masakazu Umimura

MEDICALEXPRESS 2015;2(6):M150607

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OBJECTIVE: Unaccustomed exercise causes transient Delayed Onset Muscle Soreness (DOMS); creatine-kinase and DOMS are indirect markers of muscle damage. Heat pack treatment increases blood flow and relieves pain. We determined the effects of heat pack treatment on DOMS, Creatine-Kinase, pain and jumping following maximum calf-raise exercises.
METHODS: Exercise (3 days): calf-raise, 1 movement every 3 seconds until subjects could not maintain movement speed, Recovery: monitored for 7 days. Subjects: 14 female collegiate students (age: 20-22) with previous regular moderate exercise history, divided into heat pack treatment (n = 7; 40ºC, 20-min on both calf muscles immediately after exercise) vs. no treatment (n = 7). Measured parameters: number of daily movements, Creatine-Kinase, one-leg long jumping (JUMP) and perceived pain (PAIN). Maximum dorsiflexion, calf maximum circumference and isometric muscle strength were also measured, but showed no significant variation.
RESULTS: There were no differences between groups regarding the number of the calf-raise repetitions; Creatine-Kinase increased significantly from day 3 of the Exercise-period to day 5 of the recovery period and peaked on Recovery day 2 in both groups; it was higher in the treated-group vs. controls; PAIN significantly decreased immediately after the heat pack treatment; DOMS peaked in both groups on day 3 of the Exercise-period, and recovered by day 4 of the recovery period. JUMP values decreased significantly after the initial exercise and recovered to initial values by Day 4 of the recovery period.
CONCLUSION: Heat pack treatment for 20 minutes did not minimize DOMS following the maximum calf-raise exercise, but reduced immediate muscle soreness.

Keywords: Creatine kinase, Long jumping, Muscle soreness, Pain.


8 - Two years seen out: MedicalExpress going stronger than ever

Mauricio Rocha-e-Silva

MEDICALEXPRESS 2015;2(6):M150608