Discriminações e preconceitos: temas que precisam de muito debate na formação dos profissionais de saúde / Discrimination and prejudice: topics that require extensive debate in the training of healthcare professionals

Conteúdos curriculares relativos às Ciências Humanas e Sociais têm muita importância no desenvolvimento de habilidades que vão construir competências relacionadas ao comportamento dos egressos. O curso de Odontologia da Univates aborda, desde o início da formação temáticas relacionadas a discriminação e ao preconceito de forma integrada no seu currículo. O trabalho apresenta relatos de experiências de quatro estudantes durante os estágios com o objetivo de identificar, reconhecer e discutir questões relacionadas ao preconceito e discriminação no desenvolvimento do estágio extramuros, apresentando os desafios e dificuldades encontradas nesse processo. Através de relatos subjetivos podemos perceber os diferentes itinerários de formação que os estudantes percorrem, além da ampliação das oportunidades de contato com essas temáticas. Nos relatos são descritas atividades de aprendizagem realizadas durante o curso e que são retomadas no enfrentamento das situações vivenciadas nos estágios. Dramatizações, leitura de materiais, desafios propostos no CBL (Challenge Based Learning), produções de resumoseparticipações em congressos vão sendo elencadas como referências importantes no atendimento de populações específicas como indígenas, imigrantes, pessoas com pele preta e que fazem uso de tornozeleiras eletrônicas, além de contatos com pessoas transexuaise portadores de necessidades especiais. Essas experiências, muitas vezes, são possíveis pela presença dos estudantes nas redes de saúde. O estágio extramuros amplia as experiências de atendimento aos estudantes, contribuindo para uma formação mais generalista e humanista. O contato dos estudantes com diferentes realidades é benéfico para o desenvolvimento de novas perspectivas a partir dos conteúdos trabalhados de forma teórica e, quando integrados, podem contribuir para uma formação mais cidadã (AU).

Curriculum subjects related to Human and Social Sciences are important to the development of skills that will build the abilities related to the behavior of graduates. From the beginning of training, the Univates Dentistry course addresses themes related to discrimination and prejudice in an integrated way in its curriculum. This academic project features reports of four students during their internships, aiming to identify, recognize and discuss issues related to prejudice and discrimination in the development of the internship, presenting the challenges encountered in this process. Through subjective reports it is possible to understand the different paths that graduation students go through, and the expansion of opportunities to get in touch with these themes. In the reports, the students describe many learning activities applied during the course that later were used in situations experienced in the internships. Acting, relevant paper reading, challenges proposed in the CBL (Challenge Based Learning), production of overviews and reports and participation in conferences are some of the important references in the care of specific populations such as indigenous people, immigrants, people with black skin, convicted people with electronic anklets, transsexuals and individuals with special needs. These experiences are often only possible due to the presence of students in the public health and care systems. The internship expands the student service experiences, contributing for a more humanized and real graduation. The contact of students with different realities is beneficial for the development of new perspectives from the content learned theoretically and, when combined, can build up to a more humanized graduation (AU).

Abnormal Cerebellar Volume in Patients with Remitted Major Depression with Persistent Cognitive Deficits.

Cerebellar involvement in major depressive disorder (MDD) has been demonstrated by a growing number of studies, but it is unknown whether cognitive functioning in depressed individuals is related to cerebellar gray matter volume (GMV) abnormalities. Impaired attention and executive dysfunction are characteristic cognitive deficits in MDD, and critically, they often persist despite remission of mood symptoms. In this study, we investigated cerebellar GMV in patients with remitted MDD (rMDD) that showed persistent cognitive impairment. We applied cerebellum-optimized voxel-based morphometry in 37 patients with rMDD and with cognitive deficits, in 12 patients with rMDD and without cognitive deficits, and in 36 healthy controls (HC). Compared with HC, rMDD patients with cognitive deficits had lower GMV in left area VIIA, crus II, and in vermal area VIIB. In patients with rMDD, regression analyses demonstrated significant associations between GMV reductions in both regions and impaired attention and executive dysfunction. Compared with HC, patients without cognitive deficits showed increased GMV in bilateral area VIIIB. This study supports cerebellar contributions to the cognitive dimension of MDD. The data also point towards cerebellar area VII as a potential target for non-invasive brain stimulation to treat cognitive deficits related to MDD.

Cognitive remediation therapy modulates intrinsic neural activity in patients with major depression.

BACKGROUND: Cognitive impairment is a core feature of major depressive disorder (MDD). Cognitive remediation may improve cognition in MDD, yet so far, the underlying neural mechanisms are unclear. This study investigated changes in intrinsic neural activity in MDD after a cognitive remediation trial. METHODS: In a longitudinal design, 20 patients with MDD and pronounced cognitive deficits and 18 healthy controls (HC) were examined using resting-state functional magnetic resonance imaging. MDD patients received structured cognitive remediation therapy (CRT) over 5 weeks. The whole-brain fractional amplitude of low-frequency fluctuations was computed before the first and after the last training session. Univariate methods were used to address regionally-specific effects, and a multivariate data analysis strategy was employed to investigate functional network strength (FNS). RESULTS: MDD patients significantly improved in cognitive function after CRT. Baseline comparisons revealed increased right caudate activity and reduced activity in the left frontal cortex, parietal lobule, insula, and precuneus in MDD compared to HC. In patients, reduced FNS was found in a bilateral prefrontal system at baseline (p < 0.05, uncorrected). In MDD, intrinsic neural activity increased in right inferior frontal gyrus after CRT (p < 0.05, small volume corrected). Left inferior parietal lobule, left insula, left precuneus, and right caudate activity showed associations with cognitive improvement (p < 0.05, uncorrected). Prefrontal network strength increased in patients after CRT, but this increase was not associated with improved cognitive performance. CONCLUSIONS: Our findings support the role of intrinsic neural activity of the prefrontal cortex as a possible mediator of cognitive improvement following CRT in MDD.

Aberrant cortical neurodevelopment in major depressive disorder.

BACKGROUND: There is strong neuroimaging evidence that cortical alterations represent a core pathophysiological feature of major depressive disorder (MDD). Differential contributions of cortical features of neurodevelopmental origin, which may distinctly contribute to MDD vulnerability, disease-onset, or symptom expression, are unclear at present. METHODS: We investigated distinct markers of cortical neurodevelopment, i.e. local cortical gyrification (LGI) and thickness (CT) in patients with MDD (n = 38) and healthy controls (HC, n = 22) using 3 T structural magnetic resonance imaging data and surface-based data analysis techniques. CT and LGI were computed using the Computational Anatomy Toolbox (CAT12). Analyses were performed for the entire cortical surface followed by a complementary regions-of-interest approach. RESULTS: MDD patients showed significantly greater LGI in frontal, cingulate, parietal, temporal, and occipital regions compared to HC (FDR-corrected at p < 0.05 using threshold-free cluster enhancement). No significant differences of CT were found. In the MDD-group, correlations were found between duration of illness in years and number of depressive episodes and LGI of frontal, temporal, and parietal regions (p < 0.05). LIMITATIONS: Main limitations are the relatively modest sample size and a cross-sectional study design. We did not control for early environmental factors potentially influencing neurodevelopment, such as childhood trauma. We report associations uncorrected for multiple comparisons. CONCLUSIONS: The data suggest different local trajectories of cortical change in MDD. In addition, our data support the notion that aberrant cortical development may serve as a vulnerability marker of MDD, as well as a potential predictor of disease course.

Cognitive Impairment Along the Course of Depression: Non-Pharmacological Treatment Options.

Major Depressive Disorder (MDD) is one of the most common psychiatric disorders, with a large global impact on both the individual and the society. In this narrative review, we summarize neurocognitive deficits during acute and (partially) remitted states of depression. Furthermore, we outline the potential negative effect of cognitive impairment (CI) on functional recovery, and discuss the role of several variables in the development of CI for MDD patients. Though there is cumulating evidence regarding persistent CI in unipolar depression, research on treatment options specific for this patient group is still scarce. Hence the central aim of our review is to present non-pharmacological interventions, which are thought to reduce CI in affected MDD patients. We discuss cognitive remediation therapy (CRT), physical exercise, yoga, mindfulness-based therapy, and modern neuromodulation approaches like neurostimulation and neurofeedback training. In conclusion, we propose future directions for research on CI in depression. Looking further ahead, we suggest creative interventional designs that include a direct comparison of different non-pharmacological treatment approaches on neurocognition and functional outcome of MDD. Furthermore, additive and synergistic effects of CRT with other treatment approaches should be examined and compared to create multimodal and even personalized intervention programs.

Two-week test-retest stability of the cold pressor task procedure at two different temperatures as a measure of pain threshold and tolerance.

BACKGROUND: The cold pressor task (CPT) was originally developed as a clinically indicative cardiovascular test, and quantifies vascular response and pulse excitability when a subject's hand is immersed into ice water. Since the test procedure results in a gradually increasing cold pain, the CPT has been widely used as a nociceptive stimulus in experimental studies on adults and children. AIM: To evaluate the test-retest stability of response patterns using the CPT as a measure of pain threshold and pain tolerance. MATERIALS AND METHODS: In the present study, sixty-one undergraduate students received painful stimulation using the CPT either at 4°C or 6°C. Measurements of pain threshold, pain tolerance and pain intensity ratings using the short form of the McGill pain questionnaire (SF-MPQ), were derived. The assessment was repeated twice over an interval of 2 weeks. Test-Retest stability was assessed within a three-layered approach, using ANOVAs, interclass correlation coefficients and standard error of the mean. A Bland-Altman analysis was also performed. Possible predictors of pain threshold and pain tolerance were assessed using random effect panel regression models. RESULTS: No significant differences emerged as a function of temperature (4°C or 6°C) on pain threshold, pain tolerance, and pain ratings. Environmental variables (room temperature and humidity) show no impact on measures of pain threshold and pain tolerance. CONCLUSION: Consistent with previous findings, regression analysis reveals that age is significantly associated with pain tolerance. The CPT procedure shows excellent 2 week test-retest stability to assess pain threshold and pain tolerance within a student population.