As contingências do trabalho bancário: um estudo sobre os mecanismos de mediação e defesa do sofrimento / Social skills training: evaluation of an interpersonal professional development program for undergraduates of exact sciences courses

O setor bancário sofre mudanças importantes desde a reestruturação produtiva na década de90, implicando redução significativa no contingente de trabalhadores e transformações na or-ganização do trabalho. Estas contingências impactam na saúde mental do bancário, sendo re-levante investigar os mecanismos de mediação e defesa do sofrimento utilizados pelostrabalhadores diante deste contexto. Esta pesquisa descritiva, de abordagem qualitativa, foirealizada por meio de entrevistas com bancários de instituição privada de atuação nacional,submetidas à análise de conteúdo. A investigação identificou os efeitos da organização dotrabalho, onde as premissas da gestão geram importante individualização do trabalho, pois obancário é tensionado pela pressão da meta e pela necessidade de reconhecimento. Há mobi-lização subjetiva no sentido de tentar mediar o sofrimento decorrente da dinâmica do traba-lho, como evidenciado na superficialidade afetiva e no isolamento que busca dar conta dademanda de atribuições imposta, o que se reflete na condição de atendimento aos clientes.Dentre as estratégias de mediação presentes nas experiências dos participantes estão a coo-peração, a inteligência prática e a transgressão; como mecanismos de defesa, foram identifi-cados o cinismo viril, a insensibilidade afetiva, o isolamento e o adoecimento psíquico(AU)

Decrease of bone formation in adult women with fragility fractures.

OBJECTIVES: To compare bone mineral density (BMD) and some markers of bone metabolism in women with fragility fractures and in normal age-matched subjects. METHODS: A 100 women with at least one vertebral deformity > 25%, and 219 age-, BMI- and parity-matched healthy women, were recruited for the study. In all the patients fractures were symptomatic and occurred at least 1 year before densitometric measurement. Forearm bone mineral density (BMD) as well as biochemical assessment of some markers of bone turnover were measured in all the subjects. RESULTS: BMD was significantly lower in the fracture than in the control group (0.326 +/- 0.073 vs. 0.379 +/- 0.079; P < 0.001). Fractured women showed alkaline phosphatase (ALP) and osteocalcin (OC) serum levels significantly lower than controls, while no differences were found in fasting urinary calcium and hydroxyproline excretion. Women without fractures showed a significant correlation between ALP and both age and years since menopause (YSM). Such a correlation is lacking in the fracture group. CONCLUSIONS: Women with vertebral deformities likely due to a fracture had a forearm BMD and markers of bone formation lower than normal. Whether low bone density is due to a low peak of bone mass or to an increased postmenopausal bone loss sustained by an uncoupling between the two bone remodelling processes is still unclear.

Different rates of forearm bone loss in healthy women with early or late menopause.

The aim of this study was to evaluate whether healthy women with early or late menopause have different rates of age- and menopause-related bone loss, and whether premature menopause really represents a risk factor for osteopenia. Healthy women aged from 27 to 84 years (n = 2204), with no history of fractures, were divided into two groups according to their age at menopause (AAM): group A with AAM < or = 43, and group B with AAM > or = 50 years. Bone mineral density (BMD) was measured in the distal non-dominant forearm by single-photon absorptiometry. Group B had a significantly lower average BMD than group A (group A, 0.430 +/- 0.074 g/cm2; group B, 0.419 +/- 0.081; p = 0.003); however, the average age of group A was significantly lower, and weight and height were significantly higher. When women older than 50 years of age were divided into five age-matched subgroups, BMD was significantly lower in women with AAM < or = 43 years up to 60 years; after that age this difference disappeared and, in the oldest subgroups, BMD was significantly lower in group B than in group A. Independent variables such as age, AAM and body mass index (BMI) explain about 30% of the variation of BMD, using a multiple linear regression analysis. In both groups age and BMI weighted more than AAM in determining BMD. When BMD was plotted versus either chronological age or years since menopause, women with late menopause showed a significantly faster bone loss than those with early menopause.(ABSTRACT TRUNCATED AT 250 WORDS)

Ketoconazole treatment in Cushing's syndrome: experience in 34 patients.

OBJECTIVE: Ketoconazole treatment of Cushing's syndrome has been reported in single cases and a few small groups of 5-8 patients. We report our experience in 34 patients. DESIGN: Clinical study, with pretreatment and post-treatment evaluations. PATIENTS: Out of 67 patients with Cushing's syndrome admitted during the last 6 years, 34 (28 females/six males; age range 14-67 years) received ketoconazole as a palliative treatment due to severe clinical conditions or management of the disease while awaiting results of definitive therapy. MEASUREMENTS: Urinary cortisol, plasma cortisol and ACTH, and routine chemistry were measured every week for 4 weeks, and then once a month. RESULTS: Comparing the last values (mean +/- SEM) during treatment with baseline, urinary cortisol decreased from 1296 +/- 176 to 270 +/- 69 nmol/d (n = 34; P less than 0.001); plasma cortisol decreased from 672 +/- 31 to 549 +/- 35 nmol/l (n = 34; P less than 0.001). For patients with pituitary-dependent Cushing's syndrome, urinary cortisol decreased from 1073 +/- 126 to 200 +/- 21 nmol/d (n = 28; P less than 0.001) while plasma ACTH changed from 12.5 +/- 1.3 to 11.3 +/- 0.8 pmol/l (n = 26; not significant). Twelve patients were treated for more than 6 months, and those with pituitary-dependent disease all received pituitary radiation therapy, except the two who eventually escaped pharmacological control. One additional patient with adrenal carcinoma and one with ectopic ACTH syndrome showed lack of control of urinary cortisol levels. Ketoconazole was withdrawn within the first week in two patients for allergic reaction and acute liver toxicity. Other side-effects included: asymptomatic liver function abnormalities in three patients; gastrointestinal symptoms in four; worsening of gynaecomastia in one. Rapid clinical improvement was observed together with the normalization of urinary cortisol levels, with regression of symptoms such as diabetes mellitus, hypertension, hypokalaemia, and restoration of well being. CONCLUSIONS: These data confirm that ketoconazole is valuable in the management of hypercortisolism, provided that patients are closely watched to exclude those who may develop liver toxicity and to prevent the occurrence of adrenal insufficiency.

[X-ray bone densitometry. Study of in vitro and in vivo reproducibility]. / Densitometria ossea a raggi X. Studi di riproducibilità in vitro ed in vivo.

We studied the reproducibility in vitro and in vivo of a new bone densitometer (HOLOGIC QDR-1000, software version 4.03) which uses an x-ray source at two different levels of energy. Short and long term coefficient of variation (c.v.) in vitro is less than 0.5%. In vivo c.v. is less than 1% in normal body weight subjects and less than 3% in obese subjects. The ingestion of 500 mg of calcium element did not modify bone mineral density (BMD), while 1000 mg determined an increase of BMD equal to 2.6% and 1.5% in the two subjects examined. The increase of water thickness on a three femoral heads phantom caused a progressive reduction of bone mineral content (BMC) and BMD until 12.1% less than basal value and an increase of c.v. from 0.1% to 1%. The addition of oil to water at different percentages determined a slight increase of both BMC and BMD, till 3.5% with 66% of oil in water, if compared with the values obtained with water alone. The reduction of soft tissue around the bone determined a progressive decrease of BMD reaching 3.4% less than basal value when the reduction was 30%.

Severe hyperthyroidism due to metastatic papillary thyroid carcinoma with favorable outcome.

A case of extremely severe hyperthyroidism due to bone metastasis of papillary thyroid cancer is described. Hyperthyroidism began in this patient soon after the discovery of pelvic metastasis and worsened after total thyroidectomy and after the first dose of radioiodine. The administration of methimazole, prednisone and multiple, fractioned and small doses of radioiodine cured the hyperthyroidism and stabilized the neoplastic growth. Hyperthyroidism lasted for at least six months and hypothyroidism appeared only after seven months. Thus, the fractionation of the doses of radioiodine together with antithyroid drugs appears to be an effective treatment in patients with hyperthyroidism due to metastatic thyroid cancer.

[Treatment of male hypogonadotropic hypogonadism]. / La terapia dell'ipogonadismo ipogonadotropo maschile.

Males affected by hypogonadotropic hypogonadism can be treated with androgen replacement therapy, if they do not wish fertility. In order to limit or avoid androgen toxicity on the liver, it is possible to use testosterone undecanoate (which is absorbed in the gut by lymphatic system) at the dose of 160-240 mg/die or testosterone esters administered intramuscolarly at the dose of 250 mg/month. Estradiol and DHT derived from testosterone catabolism can be in excess therefore they can be provoke toxic phenomena, even if slight, such as gynecomastia or prostatic diseases. If patients wish fertility, they must be treated with gonadotropins or pulsatile LHRH. Therapeutic effects are very different depending on the different origin of the hypogonadism. In postpubertal onset hypogonadotropic hypogonadism, the response is constant and rapid; sperm count normalization can be reached within 6 months with the only hCG. Prepubertal onset hypogonadotropic hypogonadal men need hu-FSH too and longer treatment (18-24 months); sperm count normalization can be reached in less than half case. Nevertheless fertility can be reached even in oligozoospermic stage. Negative prognostic factors are: pan-hypopituitarism, cryptorchidism, how old are the patients at the beginning of the treatment and small testis volume. It is not yet clear if pulsatile LHRH therapy is profitable in terms of therapeutic results.

Serum levels of calcitonin in Cushing's syndrome.

Serum levels of calcitonin (CT) were studied in 21 patients with Cushing's syndrome (CS), 18 females and 3 males aging from 16 to 59 years, and in 70 age and sex matched normal subjects. Patients with CS showed CT values significantly lower than those found in controls (9.9 +/- 5.0 pg/ml vs. 15.9 +/- 6.3 pg/ml, mean +/- SD; p less than 0.01), while no difference was observed in total serum calcium and phosphate and calcium corrected for albumin. No correlation between CT and serum calcium and phosphate, serum cortisol and urinary free cortisol was found. It is possible that low CT levels are involved in the pathogenesis of bone loss observed in CS.

Ultrastructure of cortisol-secreting adrenal adenomata.

Two adrenocortical adenomata causing Cushing's syndrome were examined by electron microscopy. Adenomatous cells were arranged in islets and contained ovoid nuclei with a prominent nucleoli. Mitochondria were polymorphic and displayed tubular and lamelliform cristae. Some cells were apparently devoid of lipid droplets and possessed an exceedingly well developed SER, the tubules of which were intermingled with small stacks of ribosome-studded cisternae, while other parenchymal cells contained large clumps of lipid droplets and scanty SER tubules. A conspicuous Golgi apparatus and many dense bodies of probable lysosomal nature were also observed. These findings suggest that the adenomata are derived from the zona fasciculata and that lipid-laden and lipid-free cells are, respectively, resting and actively secreting elements.

Calcitonin serum levels in different pituitary diseases. A preliminary report.

The calcitonin (CT) concentration has been determined in the serum of 17 patients with different pituitary diseases. More or less elevated levels were found in 7 of them. No definite correlation has been observed between the immunoreactive CT and the different pituitary hormones.