10. Policy on Reasonable Accommodations for Medical Students with Disabilities in Common Achievement Tests / 医学教育

The Common Achievement Tests for medical students consists of Computer Based Testing (CBT) conducted before clinical training, and Objective Structured Clinical Examination (OSCE) conducted before and after clinical training. Since the publicization of the Common Achievement Tests for medical students before clinical training in 2023, the Committee for Reasonable Accommodation has been established within the Common Achievement Tests Organization (CATO), where reasonable accommodations for each exam are being considered. Reasonable accommodations begin with an assessment based on requests from candidates and proceed through constructive dialogue between candidates and universities. Additionally, recordings of practical training sessions are provided to facilitate objective assessments, enabling the provision of reasonable accommodations tailored to candidates’ participation in clinical training and internships, thereby ensuring smooth examination processes.

School-based intervention for anxiety using group cognitive behavior therapy in Pakistan: a feasibility randomized controlled trial

Abstract Background Anxiety and mood disorders are the main cause of illness in people under the age of 25, accounting for 45% of the global disease burden, whereas 4.6% of teenagers aged 15 to 19 are predicted to experience anxiety. Pakistan country, with a population of 200 million, has the worst mental health indicators and fewer than 500 psychiatrists. Despite the existence of various treatments for anxiety, this goes unrecognized and untreated. Due to a lack of awareness, evaluation, prevention, and interventional programs related to being implemented among adolescents in Pakistan, there is a rise in mental health issues in the earlier years of life. It calls for a critical need for indigenous, evidence-based interventions. The present study aimed to evaluate the feasibility of cognitive behavioral therapy (CBT)-based interventions to reduce anxiety symptoms among school children in Pakistan. Methods This study was a pre-post design, two-arm, single-blinded, feasibility, randomized controlled trial. Thirtyfour participants (experimental group, n = 17; control group, n = 17) were recruited from four semi-government schools in Rawalpindi with a mean age of 15 (M = 15, SD = 0.73). Two instruments Beck Anxiety Inventory for Youth (BAI-Y II) and BASC-3 Behavioural and Emotional Screening System Student (BESS-SF) were used to assess the severity of symptoms. Participants in the intervention arm received eight-group therapy CBT sessions. A two-way factorial analysis was used to examine the efficacy of CBT in reducing symptom severity. Results This study's findings showed that in comparison to the wait-list control group, CBT successfully improved anxiety symptoms among school children while enhancing their social skills. Conclusion This study will help improve the treatment for anxiety in Pakistan by prioritizing school-based intervention and group-based CBT intervention. Trial registration The trial has been registered at the American Economic Association's registry for randomized controlled trials. RCT ID: AEARCTR-00095 51. Registered 2022-07-04.

"Congelei com medo de me contaminar": tratando um caso de TEPT crônico com imobilidade tônica em uma fisioterapeuta da linha de frente na pandemia de COVID-19 / "I froze for fear of contaminating myself": treating a case of chronic PTSD with tonic immobility in a physiotherapist frontline during COVID-19 pandemic

RESUMO Objetivo: Neste estudo relatamos o caso de uma profissional de saúde com vivência de imobilidade tônica (IT) e posterior desenvolvimento de transtorno de estresse pós-traumático (TEPT) crônico em decorrência de trauma laboral por conta da COVID-19 que recebeu tratamento remoto com terapia cognitivo-comportamental focada no trauma (TCC-FT). Métodos: Relato de caso de uma paciente acompanhada por seis meses após o recebimento de TCC-FT remota. Resultados: Paciente do sexo feminino, de 36 anos, fisioterapeuta, que desenvolveu TEPT crônico e experienciou IT por medo da contaminação por coronavírus. As escalas psicométricas demonstraram que a TCC-FT reduziu consideravelmente os sintomas de TEPT e depressão e aumentou o apoio social e a resiliência. De acordo com o relato, o tratamento melhorou a concentração e a motivação, e reduziu o sentimento de culpa, a irritabilidade, a insegurança e o desconforto em lidar com outras pessoas. Conclusão: Este artigo demonstra que traumas decorrentes da COVID-19 podem ser capazes de desencadear IT e exemplifica um favorável desempenho da TCC-FT na melhoria global da saúde mental dos pacientes com TEPT crônico com vivência de IT.

ABSTRACT Objective: In this study, we report the case of a health professional with experience of tonic immobility (TI) and subsequent development of post-traumatic stress disorder (PTSD) as a result of occupational trauma due to COVID-19 who received remote treatment with Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Methods: A case report of a patient followed for six months after receiving remote TF-CBT. Results: A 36-year-old female patient, the physiotherapist who developed chronic PTSD and experienced TI for fear of coronavirus contamination. Psychometric scales demonstrated that TF-CBT considerably reduced PTSD and depression symptoms and increased social support and resilience. According to the report, the treatment improved concentration and motivation, and reduced feelings of guilt, irritability, insecurity, and discomfort in dealing with other people. Conclusion: This article demonstrates that trauma resulting from COVID-19 can trigger TI and exemplifies a favorable performance of TF-CBT in the global improvement of the mental health of patients with chronic PTSD who experience TI.

Biomechanical Comparison of Internal Fixation by Traditional and Cortical Bone Trajectory Pedicle Screw / 医用生物力学

Objective To compare the effects of cortical bone trajectory ( CBT) and traditional trajectory ( TT)pedicle screw internal fixation on the range of motion (ROM) and rod system stress of normal and osteoporotic(OP) spines. Methods The L3-S1 finite element models of normal and OP spines were established. The screwrod system with two kinds of trajectory was used for internal fixation of the L4-5 segment, so as to simulate sixphysiological loads, namely, flexion, extension, left / right bending, left / right rotation. The effects of two internalfixation methods on ROMs and maximum equivalent stress of screws in normal and OP spines were compared.Results For both bone conditions, CBT and TT significantly reduced ROM of the fixed segment (L4-5) and theentire segment of lower lumbar spine ( L3-S1). However, the ROM decline of CBT group was slightly smaller than that of TT group, and their ROMs were similar under flexion and extension, but the ROM differences were significant under lateral bending and axial rotation. In addition, for both the normal and OP spine models, themaximum equivalent stress of screws in CBT group was significantly higher than that in TT group. Compared withTT group, the screw stress of CBT group in normal spine model under flexion and extension, lateral bending,axial rotation was increased by 27% , 268% and 58% , respectively. However, when CBT technique was used atthe same time, the OP spine model had a smaller screw stress distribution than the normal spine model.Conclusions Compared with TT technique, CBT technique can achieve higher screw stress under OP conditionand reduce screw stress concentration under normal bone condition. In addition, CBT slightly increases ROMs of each segment, which is conducive to recovery of spinal physiological function after surgery. Lateral bending and axial rotation can produce negative mechanical effects, and these two physiological loads should be avoided.

Cadaveric study of anatomical measurement of isthmus parameters of lumbar spine to guide cortical bone screw placement

SUMMARY OBJECTIVE: To reduce surgical exposure and improve accuracy, this study evaluated the anatomical distance parameter D (including D1, D2, and D3) of the lumbar isthmus for cortical bone screw insertion. METHODS: A total of 25 structurally complete lumbar dry specimens were used for lumbar anatomy measurements. The six cadaver specimens were divided into upper and lower parts on the plane of the T11-T12 vertebrae, and we use the lower parts. Therefore, six lumbar wet specimens and another four complete lumbar dry specimens were selected. The lumbar isthmus tangent point was considered a coordinate origin, and the insertion point was determined through translating the distance of D1 value to the midline of the vertebral body horizontally and then vertically moved toward inferior board of the transverse process with the distance of D3 value. RESULTS: In four dry and six wet intact lumbar specimens, cortical bone screws were placed according to the average value of the isthmus parameter D. A total of 100 trajectories were verified in specimens by X-ray and computed topography scan to evaluate the safety, accuracy, and feasibility of the surgical use of isthmus parameter D. Using this parameter, the rates of excellent screw placement were 95% (38/40) in four dry specimens and 88.7% (53/60) in six wet specimens. CONCLUSION: The isthmus parameter D is easier to use by the operator, which can improve surgical accuracy and reduce operation time. LEVEL OF EVIDENCE: Level IV, prospective study.

Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review / Preditores de resposta à terapia cognitivo-comportamental em pacientes com transtorno de estresse pós-traumático: uma revisão sistemática

OBJETIVO: O transtorno de estresse pós-traumático (TEPT) é um transtorno altamente prevalente e incapacitante. Mesmo quando tratado com uma intervenção de primeira linha, terapia cognitivo-comportamental (TCC), 45% dos pacientes continuam sofrendo desse transtorno. Portanto, conhecer os fatores que podem prever quem responderá à TCC seria de grande valor no tratamento desses pacientes. Por esse motivo, revisamos sistematicamente a literatura para identificar as variáveis que poderiam predizer a resposta à TCC em pacientes que sofrem de TEPT. MÉTODOS: Seguindo as diretrizes do PRISMA 2020, pesquisamos em banco de dados eletrônico como ISI Web of Science, Scopus, PsycINFO, MEDLINE e PTSDpubs até novembro de 2021. Dois autores conduziram independentemente a seleção do estudo e a extração de dados. Estudos que examinaram possíveis preditores de resposta à terapia, com amostra de adultos (18-65 anos) de ambos os sexos, com e sem comorbidades, foram considerados elegíveis. As características dos estudos foram sintetizadas em uma tabela. O risco de viés foi avaliado pela ferramenta de avaliação de qualidade de risco de viés da Cochrane. RESULTADOS: Vinte e oito estudos envolvendo 15 variáveis foram selecionados. Desses, oito mostraram baixo risco de viés, 19 mostraram algumas preocupações e um mostrou alto risco potencial de viés. A relação terapêutica foi a única variável considerada um preditor de boa resposta à terapia. Todas as outras variáveis apresentaram resultados conflitantes. CONCLUSÕES: A variável mais promissora, embora muito fraca cientificamente, é a relação terapêutica. Ensaios clínicos randomizados adicionais devem ser conduzidos para esclarecer o papel dessa variável como um preditor de resposta da TCC em pacientes com TEPT.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. METHODS: Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. RESULTS: Twenty- -eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. CONCLUSIONS: The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.

CBT based comprehensive psychotherapy in an elderly female with resistant chronic depression.

Background: The population of the elderly has been on the rise in recent years and this demographic trend is likely to continue. Depression tends to be common in the elderly. Further it is possible that cognitive abilities start deteriorating as a result of depression and even more so due to several changes that are already occurring. This may impact an individual’s cognition, functionality, and autonomy, may progress from a subclinical level to a pathological level if not intervened early. Medications work to reduce symptom severity but sometimes patients become resistant to it and other interventions have to be used. CBT techniques have been found to be effective to treat depression and further efficacy of reminiscence therapy for older adults with mild to moderate depression has been established. Method: The present study was undertaken with the objective of establishing the efficacy of a comprehensive psychotherapy program for an elderly woman, aged 66 years, who presented with a diagnosis of chronic depression, along with chronic pain and sub clinical cognitive limitations. Techniques of CBT, reminiscence therapy and cognitive training was carried out for 8 weekly sessions. Results: The outcome of the intervention showed improvements in overall functioning along with generalization of the training, thereby implicating the effectiveness of the intervention. Conclusion: Thus, it is important to promote active aging, fostering healthy mental functioning and training the cognitive capabilities, to avoid pathological aging or reducing its impact

Effectiveness of Counseling Based on Functional Analytic Psychotherapy with Enhanced Cognitive Therapy on the Sexual Quality of Life of Married Adolescent Women / Eficácia do aconselhamento baseado em psicoterapia analítica funcional - Com abordagem de terapia cognitiva aprimorada (FECT) na qualidade de vida sexual de mulheres adolescentes casadas

Abstract Objective Early marriage has many deleterious effects on the health of girls, such as sexual dissatisfaction, an inevitable result of the lack of sufficient knowledge about sexual issues at the time of the marriage. The goal of the present study was to determine the effectiveness of counseling based on functional analytic psychotherapy with enhanced cognitive therapy (FECT) on the sexual quality of life of married adolescent women. Methods This clinical trial was conducted between July and October 2019 on 150 married adolescent women who met the inclusion criteria. In the intervention group, FECTwas conducted in sixteen 90-minute sessions twice a week. The Sexual Quality of Life-Female (SQOL-F) questionnaire was used. When the study ended, the control group was given the choice of receiving the same intervention as the intervention group. Results The paired t-test showed a significant difference between the mean score of sexual quality of life before (52.33±23.09) and after (88.08±10.51) counseling in the intervention group (p<0.0001). According to the analysis of covariance, there was a significant difference between the score on sexual quality after counseling between the intervention (88.08±10.51) and control (60.32±23.73) groups (p<0.0001). There was also a significant difference between the mean score on the four dimensions of sexual quality of life in the intervention group (p<0.0001). Conclusion The results showed that counseling based on FECT improved the sexual quality of life in all dimensions in married adolescent women.

Resumo Objetivo O casamento precoce tem muitos efeitos deletérios sobre a saúde das meninas, como a insatisfação sexual, resultado inevitável da falta de conhecimento suficiente sobre questões sexuais no momento do casamento. O objetivo do presente estudo foi determinar a eficácia do aconselhamento baseado em psicoterapia analítica funcional com terapia cognitiva aprimorada (FECT) na qualidade de vida sexual de mulheres adolescentes casadas. Métodos Este ensaio clínico foi realizado entre julho e outubro de 2019 em 150 mulheres adolescentes casadas que preencheram os critérios de inclusão. No grupo de intervenção, FECT foi realizado em dezesseis sessões de 90 minutos duas vezes por semana. Foi utilizado o questionário Sexual Quality of Life-Female (SQOL-F). Quando o estudo terminou o grupo de controle teve a opção de receber a mesma intervenção do grupo de intervenção. Resultados O teste t pareado mostrou diferença significativa entre o escore médio da qualidade de vida sexual antes (52,33±23,09) e após (88,08±10,51) o aconselhamento no grupo intervenção (p<0,0001). De acordo com a análise de covariância houve diferença significativa entre o escore de qualidade sexual após aconselhamento entre os grupos intervenção (88,08±10,51) e controle (60,32±23,73) (p<0,0001). Também houve diferença significativa entre a pontuação média nas quatro dimensões da qualidade de vida sexual no grupo de intervenção (p<0,0001). Conclusão Os resultados mostraram que o aconselhamento baseado no FECT melhorou a qualidade de vida sexual em todas as dimensões em mulheres adolescentes casadas.

Understanding Matters of the Mind in Obesity

@#Obesity is a growing global concern, and Singapore is not spared from the global epidemic. Apart from the increased risk for many serious diseases and health conditions, obese individuals are vulnerable to many psychological comorbidities. Obesity management through lifestyle changes can be limited by various barriers, increasing the challenge of implementation and leaving some clinicians feeling frustrated and stressed. The paper examines the barriers identified in the literature, discusses the use of cognitive behavioural concepts and techniques to facilitate the lifestyle change process and explores the use of motivation and readiness to change to guide the clinician’s strategies.

Alterações do córtex cingulado anterior como um preditor de resposta à terapia cognitivo-comportamental / Alterations of anterior cingulate cortex as predictors of response to cognitive-behavioral therapy

RESUMO Objetivo A terapia cognitivo-comportamental (TCC) tem eficácia bem-documentada na literatura científica para transtornos relacionados aos sintomas da ansiedade. No entanto, há uma parcela de pacientes que não responde ao tratamento psicoterápico. Por isso, os estudos sobre as alterações no córtex cingulado anterior (CCA) como preditoras neurais do tratamento têm contribuído para encontrar respostas sobre as diferenças nas respostas ao tratamento. O objetivo do presente estudo é descrever, por meio de revisão sistemática, os estudos encontrados até o ano de 2018 sobre o papel do CCA na predição de resposta à terapia. Métodos Foram realizadas buscas nas bases PsycInfo, Web of Science e PubMed com termos referentes ao tema "córtex cingulado anterior", "terapia cognitivo-comportamental" e "predição de respostas", incluindo estudos com neuroimagem estrutural e funcional. Resultados As buscas apresentaram 14 artigos sobre "transtorno de estresse pós-traumático (TEPT)", "transtorno obsessivo-compulsivo (TOC)" e "transtorno de ansiedade social (TAS)". Os estudos com neuroimagem estrutural apresentaram resultados promissores. A maior espessura do CCA foi preditora de melhor resposta ao tratamento para TEPT e TOC. Os resultados de neuroimagem funcional foram promissores para maior ativação como preditora de melhor resposta para TAS. Por outro lado, os resultados para TEPT apontaram que a menor ativação pode ser preditora de melhores respostas. Conclusão As alterações nos estudos de neuroimagem sugerem que o CCA tenha um papel de predição de resposta ao tratamento com TCC. Estudos posteriores com amostras maiores podem contribuir para a ampliação da eficácia nos tratamentos de tais transtornos.

ABSTRACT Objective The efficacy of cognitive-behavioral therapy (CBT) on the treatment of anxiety-related disorders has been well documented. However, a number of patients do not respond to psychotherapeutic treatment. Therefore, changes in the anterior cingulate cortex (ACC) as a neural predictor of treatment response have contributed to understanding the differences in treatment outcome. The aim of this study is to describe, through a systematic review, studies published until 2018 that investigate the role of the anterior cingulate cortex on the prediction of response to therapy. Methods Searches have been conducted in the PsycInfo, Web of Science and PubMed databases for articles related to the terms "anterior cingulate cortex", "cognitive-behavioral therapy" and "prediction of response", including studies with structural and functional neuroimaging. Results We selected 14 articles on "post-traumatic stress disorder (PTSD)", "obsessive-compulsive disorder (OCD)" and "social anxiety disorder (SAD)". Overall, Structural neuroimaging studies functional neuroimaging results were promising. A greater thickness on the ACC was associated with a better response to treatment for PTSD and OCD. Greater activation of the ACC was positively associated with a greater response to treatment for patients with SAD. On the other hand, for those with PTSD, lower activation may be a better predictor of improvement. Conclusion The structural and functional alterations observed in neuroimage studies suggest that the ACC has a role in predicting treatment response to CBT. Future studies with larger samples may contribute to the improvement of treatment efficacy in such disorders.

Avaliação da qualidade do leite de cabra em uma mini usina do Cariri paraibano através da contagem de células somáticas e contagem bacteriana total / Evaluation of quality of goat milk in a mini parairan Cariri usina through somatic cell count and total bacterial count

A qualidade do leite é definida por diversos fatores entre eles a sanidade da glândula mamária e a higienização dos equipamentos processadores de leite. O objetivo desse estudo foi avaliar a qualidade do leite através da determinação dos componentes do leite e da contagem de células somáticas e contagem bacteriana total. Foram avaliadas 27 amostras de leite de cabra cru em uma mini usina do Cariri paraibano. De acordo com os resultados encontrados verifica-se que os valores médios de lactose e a CBT encontram se fora dos padrões estabelecidos, já a CCS apresentam índices altos de acordo com os limites fisiológicos considerados normais para a espécie. Esses resultados demonstram falhas no manejo e a necessidade de implementação de melhorias contínuas.

The Application of Cognitive Behavioral Therapy into An Institutional-Based Therapeutic Rehabilitation Program for Out-of-Wedlock Adolescent / Jurnal Sains Kesihatan Malaysia

@#Cognitive Behavioral Therapy (CBT) is a critical rehabilitation component for teens who involved in sexual offences. CBT restructures their reasoning capacity to control their anti-social behaviour. An in-depth qualitative study was conducted in one of the state's institutions for girls to investigate the practice of CBT. Ten pregnant out of wedlock teens who were participate in the therapeutic rehabilitation programme were interviewed thoroughly about the practice of CBT. The study found that the practice of CBT in the programme focused only on the religious activities, tend to focus on the vocational programme, the absence of knowledge enhancement programme, no therapy expert to conduct the CBT procedure, and the absence of any set of protocol treatment for therapy. The findings then encourages the study to recommend few interventions that can enhance the implementation of the CBT practice for teens who involved with sex offence.

Biomechanical Evaluation of Upper-Middle Thoracic Vertebrae Fixed by Cortical Bone Trajectory Screws: A Finite Element Simulation Study / 医用生物力学

Objective To compare biomechanical properties of cortical bone trajectory (CBT) screw and traditional trajectory screw for fixing upper-middle thoracic spine. Methods The tomography images were obtained by CT scanning of normal T7 and T8 segments, and the three-dimensional (3D) model of T7-8 was reconstructed by Mimics software. The finite element model of upper-middle thoracic spine was established by optimizing FreeForm model and pre-processing function of ANSYS software. On this basis, the CBT screw and pedicle screw fixation models after discectomy were established, and 5 N·m flexion, extension, lateral bending and rotation loads were applied to the two model groups, respectively. The displacement and peak stress of vertebrae and implants under different working conditions were compared and analyzed. Results Under different loading conditions, the maximum displacement of CBT screw group was lower than that of pedicle screw group, and the range of motion of CBT screw group was lower than that of pedicle screw group. The stress level of both models was close, and the stress of CBT screw group was slightly lower than that of pedicle screw group. Under the load of flexion, extension and rotation, the maximum vertebral stress of pedicle screw group decreased by 31%, 17% and 18% compared with that of CBT screw group, and under lateral bending load, the vertebral stress of CBT screw group was 20% lower than that of pedicle screw group. Under the load of flexion and rotation, the maximum stress of pedicle screw group decreased by 2% and 11%; however, the maximum stress of CBT screw group was 11% and 1% lower than that of pedicle screw group. Conclusions The stability of CBT screw was better than that of pedicle screw, and the overall stress distribution was similar to that of pedicle screw. However, the vertebral stress distribution of CBT group was slightly inferior. The research findings provide a theoretical basis for the clinical application of cortical screw fixation after the failure in pedicle screw fixation for the upper-middle thoracic vertebrae.

Parâmetros de qualidade do leite bovino em propriedades de agricultura familiar / Quality parameters of bovine milk from family farms

Propriedades da agricultura familiar tem contribuído para aumentar a produção leiteira, e podem ser considerados importantes para cadeia produtiva do leite. A higiene no processo produtivo deve ser o foco principal para garantir maior produção e qualidade do leite. Monitorou-se a qualidade do leite de vacas, em propriedades da agricultura familiar, no município de Bofete/SP, antes e após a adoção de medidas de controle. Avaliaram-se 21 propriedades, selecionadas por conveniência. Após período inicial de 13 coletas para monitoramento de CCS e CBT, os proprietários dos dois grupos (G1 e G2) receberam orientações técnicas sobre mastite e qualidade do leite, em atividade de dia de campo. Os proprietários do G1 além dessas atividades receberam intervenção no manejo utilizado, com visita técnica, e orientações individuais quanto à maneira adequada de ordenha e obtenção higiênica do leite. Posteriormente foram realizadas novas coletas quinzenais (n=12) como anteriormente, de amostras de leite de conjunto, de cada propriedade dos dois grupos, bem como do tanque comunitário. Foram consideradas variáveis climáticas como precipitação, temperatura e umidade relativa do ar. Observou-se uma variação dos resultados de cada coleta tanto para CCS/mL de leite quanto para CBT/mL de leite, nos dois períodos. Quanto a CCS no G1 houve uma diminuição significativa (P < 0,02), enquanto que para CBT houve um ligeiro aumento, bem menor, quando comparado ao valor mediano que foi de 381x103 UFC/mL de leite no G2. Os resultados medianos de CCS/mL de leite e de CBT/mL de leite do tanque comunitário foram mais elevados nas duas fases (períodos), entretanto muito superior para CBT. A análise das variáveis climáticas evidenciou aumento das medianas nos três parâmetros avaliados. A correlação entre essas variáveis e qualidade do leite, não mostrou diferenças para o Log10 da CCS e CBT. Pode-se concluir pela higiene precária no manejo de ordenha.(AU)

Family operated dairies have contributed to increase milk production and can be considered important in the milk production chain. Hygiene in the productive process must be the major focus to assure greater milk quality and production. The quality of milk from cows in family farms in the city of Bofete/SP was monitored before and after the establishment of control measures. Twenty-one dairy family farms, selected for convenience, were evaluated. After the initial period of 13 collections for SCC and TBC monitoring, farmers of the two groups (G1 and G2) received technical guidance about mastitis and milk quality during a day of field activity. G1 farmers, besides these activities, received intervention in the adopted management by means of technical visit and individual guidance as to adequate milking manner and hygienic milk production. Then, new fortnight collections (n=12) were performed, as previously, of a set of milk samples from each farm and both groups, as well as from the community tank. Climate variables were considered, such as rainfall, temperature and relative humidity. There was a variation in the results of each collection for both SCC/mL milk and TBC/mL milk in the two periods. As to SCC in G1, there was a statistically significant decrease (P < 0.02), while for TBC there was a slight increase, rather lower compared to the median value, which was 381x103 CFU/mL milk in G2. The median results of SCC/mL milk and TBC/mL milk from the community tank were greater in the two stages (periods), but much superior for TBC. Analysis of the climate variables evidenced an increase in the medians for all three evaluated parameters. The correlation between these variables and milk quality did not show differences for Log10 of SCC and TBC. It can be concluded that the milking management hygiene was precarious.(AU)

Simultaneous Determination of Twelve Kinds of Residual Solvents in A New Drug CBT108 By Headspace Gas Chromatography / 分析化学

A simple and sensitive method for simultaneous determination of 12 kinds of residual solvents in a new drug CBT108 was established and validated by headspace gas chromatographic technology. The rationality,accuracy and feasibility of the analytical method were verified. Under the optimized conditions, simultaneous separation and determination of 12 kinds of residual solvents, including methanol, ethanol, ether, acetone, acetonitrile, dichloromethane, n-hexane, ethyl acetate, tetrahydrofuran, heptane, toluene and carbon tetrachloride was carried out by using a DB624 capillary column(30 m×0.53 mm×3.0 μm) for separation, a flame ionization detector for detection and internal standard method for quantitation. Good linearity was obtained for 12 solvents with the correlation coefficients(R2) of more than 0.997. The limits of quantitation and detection were defined at S/N=3 and S/N=10,respectively. LOQ and LOD for 12 solvents were given as 0.024 μg/mL and 0.0072 μg/mL for methanol,0.1 μg/mL and 0.012 μg/mL for ethanol, 0.01 μg/mL and 0.005 μg/mL for ether, 0.1 μg/mL and 0.008 μg/mL for acetone, 1.025 μg/mL and 0.0615 μg/mL for acetonitrile, 0. 09 μg/mL and 0. 06 μg/mL for dichloromethane, 0. 09 μg/mL and 0.06 μg/mL for n-hexane, 0. 25 μg/mL and 0. 008 μg/mL for ethyl acetate, 0. 108 μg/mL and 0.014 μg/mL for tetrahydrofuran,0.16 μg/mL and 0.0004 μg/mL for carbon tetrachloride,0.0075 μg/mL and 0.005 μg/mL for heptane, and 0.0445 μg/mL and 0.0014 μg/mL for toluene. The adding standards recoveries for 12 residual solvents at three spiked levels were in the range of 90.96%-108.67%,with relative standard deviations of 0.1%-5.7%. This simple,high accuracy and good repeatability method is feasible for rapidly determination of 12 residual solvents in drug candidate CBT108. Meanwhile, this simple method provides a consulted value for detection of residual solvents in other medicines.

Efficacy of cognitive behavioral therapy in children and adolescents with insomnia: a systematic review and meta-analysis

Insomnia is highly prevalent in children and adolescents. However, the efficacy of cognitive behavioral therapy for insomnia (CBT-i) in children and adolescents remains controversial. Therefore, this systematic review and meta-analysis aimed to assess the efficacy of CBT-i in children and adolescents. We conducted a search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO to select primary studies evaluating CBT-i in children and adolescents that were primarily diagnosed through standardized diagnostic criteria. The primary outcomes of the meta-analysis included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%). Six randomized controlled trials and four open-label trials met all inclusion criteria. A total of 464 participants (ranging from 5-19 years of age) were included. Based on the results from sleep logs, a significant pooled effect size was observed for SOL and SE%. However, no significant pooled effect size was found for WASO or TST. Results from actigraphy were consistent with the sleep logs. A significant pooled effect size was observed for SOL and SE%, and no significant pooled effect size was found for WASO or TST. CBT-i might be effective in the treatment of children and adolescents with insomnia.

A comparative study of the effectiveness of group-based cognitive behavioral therapy and dialectical behavioral therapy in reducing depressive symptoms in Iranian women substance abusers

Various therapeutic approaches have been used to improve depressive symptoms in substance abusers. In a quasi-experimental study with a pretest-posttest design and experimental and control groups, we examined and compared the effectiveness of two group-based treatment strategies­cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)­in reducing depressive symptoms among Iranian women substance abusers. The statistical population included all female addict patients who referred to addiction treatment centers of Birjand city in 2015. A sample of 30 subjects were selected through the available sampling method and randomly assigned into experimental (CBT and DBT) and control groups (each group, 10 patients). The data collection instrument was the Beck Depression Inventory (BDI) questionnaire. The patients in the experimental groups were given skills in eight sessions of 90 min. The data were analyzed by the SPSS-19 software by using mean, standard deviation, and percentages at the descriptive level and analysis of covariance (ANCOVA) test at the inferential level. The comparison of the mean depression score before intervention in all the groups showed no significant difference. However, after intervention, the findings showed that both CBT and DBT interventions could reduce the mean scores of depression in women substance abusers, 17.5 ± 3.0 vs 29.3 ± 4.1 (F[1,17] = 51.91, p value < 0.01) and 14.7 ± 1.8 vs 29.3 ± 4.1 (F[1,17] = 106.62, p value < 0.01), respectively, for CBT and DBT. Post-treatment effect sizes were large and did not differ statistically for CBT (ηp2, 0.75) and DBT (ηp2, 0.86). Therefore, this study highlights the importance of CBT and DBT skills training to substance abusers and provides initial evidence of their effectiveness.(AU)

Eclectic approach to anxiety disorders among rural children / Abordagem eclética a transtornos de ansiedade em crianças de zona rural

Abstract Introduction Anxiety disorders in primary school-aged children negatively affect their mental health and psychological development. Available non-medical treatments for these conditions are time-consuming and expensive. In this context, eclectic therapy is a therapeutic approach that incorporates some therapeutic techniques and philosophies to create the ideal treatment. In this study, eclectic therapy consisted of art therapy and cognitive-behavioral therapy designed for children suffering from high level of anxiety in their middle childhood years. The therapy also included group guidance sessions for their mothers. The effectiveness of this intervention was examined in the study. Methods 61 students aged 9-12 years with high levels of anxiety participated in the study. Intervention A (n = 20) consisted of 9-hour eclectic therapy for children with 3-hour group guidance sessions for their mothers. Intervention B (n = 20) consisted of 9-hour eclectic therapy for children. There was also a control group (n = 21). Results Teacher ratings of children's mental health difficulties and self-report ratings of anxiety disorders indicated a significant difference from pretest to posttest, revealing a large effect size between the two interventions. Higher levels of pretest scores significantly predicted higher posttest scores for all domains of anxiety and mental health difficulties. Furthermore, age, gender, mothers working a 15-hour day, mother's educational level, parental divorce rates, parental death, and family monthly income predicted therapy outcomes. Conclusion Results provide support for the effectiveness of eclectic art and CBT to improve children's mental health and reduce anxiety through changing thoughts, beliefs, emotions, and behaviors that may cause fear and anxiety.

Resumo Introdução Transtornos de ansiedade em escolares afetam sua saúde mental e seu desenvolvimento psicológico. Tratamentos alternativos disponíveis consomem tempo e são dispendiosos. Nesse contexto, a terapia eclética é uma abordagem terapêutica que incorpora algumas técnicas e filosofias terapêuticas para criar o tratamento ideal. Neste estudo, terapia eclética consistiu de terapia artística e terapia cognitivo-comportamental (TCC) planejada para escolares com altos níveis de ansiedade. A terapia também incluiu sessões de orientação em grupo para as mães. A eficácia da intervenção foi examinada. Métodos 61 escolares com idade de 9-12 anos e altos níveis de ansiedade participaram do estudo. A intervenção A (n = 20) consistiu de 9 horas de terapia eclética para crianças com sessões de 3 horas de orientação em grupo para as mães. A intervenção B (n = 20) consistiu de 9 horas de terapia eclética para crianças. Houve também um grupo controle (n = 21). Resultados Escores atribuídos pelos professores às dificuldades de saúde mental das crianças e escores de ansiedade autoaplicados indicaram diferenças significativas entre resultados pré-teste e pós-teste, revelando grande tamanho de efeito entre as duas intervenções. Escores pré-teste maiores foram preditores significativos de escores pós-teste mais altos para todos os domínios de ansiedade e dificuldades de saúde mental. Idade, gênero, mães trabalhando 15 horas/dia, nível educacional da mãe, índice de divórcio, morte de um dos pais e renda familiar mensal foram preditores de desfechos da terapia. Conclusão Os resultados sugerem a eficácia de arte eclética e TCC para melhorar a saúde mental de crianças e reduzir a ansiedade através de mudança em pensamentos, crenças, emoções e comportamentos que possam causar medo e ansiedade.

Legal standards of milk delivered for processing in Brazil / Adequação aos padrões legais de leite entregue para beneficiamento no Brasil

Thresholds for Somatic Cell Counts (SCC) and Total Bacterial Counts (TBC) in refrigerated raw milk have been stricter in Brazil since July 2014. We evaluated whether the composition of 11,051 milk samples delivered to processing plants in Paraná state, Brazil, by cooperative dairy farms, complies with government requirements and established changes. Milk quality was evaluated from June to August 2014, from dairy farms in three states. Data were obtained by infrared spectroscopy and flow cytometry. SCC was highest in June (p<0.05), when the highest number of samples and mean values was observed that did not comply with legal standards. No samples obtained in July complied with the requirements. The city in Mato Grosso do Sul state was the only one that met the legal requirements throughout the period studied. TBC did not vary (p>0.05) in the trimester, and none of the cities presented values below the maximum TBC allowed. Protein, fat and non-fat solids obtained complied with legal requirements. Total solids and lactose varied among the months (p<0.05), with highest values for total solids in June and for lactose in August. Milk samples did not comply with minimal requirements for SCC and TBC, and were not adjusted to more rigid quality standards.

Limites de contagem de células somáticas (CCS) e contagem bacteriana total (CBT) em leite cru refrigerado estão mais estritos no Brasil desde Julho de 2014. Foram avaliadas 11051 amostras de leite entregues para beneficiamento no Estado do Paraná, Brasil, por produtores de leite e cooperados e verificou-se se estas atendiam aos requisitos governamentais e às mudanças estabelecidas. A qualidade do leite foi avaliada de Junho a Agosto de 2014 em fazendas leiteiras de três estados. Os dados foram obtidos por espectroscopia em infravermelho e citometria de fluxo. CCS foi superior em Junho (p<0,05), quando foi observado maior número de amostras e valores médios que não estavam de acordo com os padrões legais. A cidade do Estado de Mato Grosso do Sul foi a única que cumpriu com os limites legais requeridos ao longo do período. CBT não apresentou variação (p>0,05) ao longo do trimestre, e nenhuma das cidades apresentou valores dentro do limite estabelecido para CBT. Proteína, gordura e sólidos não gordurosos estavam de acordo com os limites requeridos. Sólidos totais e lactose variaram ao longo dos meses (p<0,05), com valores elevados para sólidos totais em Junho e para lactose em Agosto. Amostras de leite não estavam de acordo com os requisitos mínimos de CCS e CBT, e não estão ajustadas aos padrões de qualidade mais rígidos.

Review of Cortical Bone Trajectory: Evidence of a New Technique

This article summarizes recent evidence on the cortical bone trajectory (CBT) obtained from published anatomical, biomechanical, and clinical studies. CBT was proposed by Santoni in 2009 as a new trajectory that can improve the fixation of pedicle screws in response to screw loosening in osteoporotic patients. Recently, research interest has been growing with increasing numbers of published series and frequent reports of new applications. We performed an online database search using the terms “cortical bone trajectory,”“pedicle screw,”“CBT spine,”“CBT fixation,”“MISS CBT,” and “traditional trajectory.” The search included the PubMed, Ovid MEDLINE, Cochrane, and Google Scholar databases, resulting in an analysis of 42 articles in total. These covered three aspects of CBT research: anatomical studies, biomechanical parameters, and clinical cases or series. Compared to the traditional trajectory, CBT improves pullout strength, provides greater stiffness in cephalocaudal and mediolateral loading, and shows superior resistance to flexion/extension; however, it is inferior in lateral bending and axial rotation. CBT seems to provide better immediate implant stability. In clinical studies, CBT has shown better perioperative results for blood loss, length of stay in hospital, and surgery time; similar or better clinical postoperative scores; and similar comorbidity, without any major fixation system complications due to instrumentation failure or screw misplacement. In addition, advantages such as less lateral exposure allow it to be used as a minimally invasive technique. However, most of the clinical studies were retrospective case series or case-control studies; prospective evidence on this technique is scarce, making a definitive comparison with the traditional trajectory difficult. Nevertheless, we can conclude that CBT is a safe technique that offers good clinical results with similar biomechanical and perioperative parameters to those of the traditional trajectory. In addition, new applications can improve its results and make it useful for additional pathologies.