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Berger W.,Federal University of Rio de Janeiro | Berger W.,University of California at San Francisco | Coutinho E.S.F.,Escola Nacional de Saude Publica ENSP FIOCRUZ | Figueira I.,Federal University of Rio de Janeiro | And 6 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2012

Purpose: We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies. Methods: A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate metaregression models were fitted to identify variables related to the prevalences heterogeneity. Results: A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers. Conclusions: Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities. © Springer-Verlag 2011. Source


Lima A.A.,Federal University of Rio de Janeiro | Fiszman A.,Federal University of Rio de Janeiro | Marques-Portella C.,Federal University of Rio de Janeiro | Mendlowicz M.V.,Federal University of Fluminense | And 7 more authors.
Journal of Psychiatric Research | Year: 2010

Tonic immobility is the last defense reaction to entrapment by a predator. In humans, peritraumatic tonic immobility was correlated with PTSD severity and poor response to treatment. This study compared the role of peritraumatic dissociation, panic physical symptoms and tonic immobility as predictors of response to standard pharmacotherapy for PTSD. Thirty-six PTSD patients underwent a naturalistic pharmacological treatment. The Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C) and the Clinical Global Impressions Severity of Illness item scores (CGI-S) were employed at baseline and endpoint to examine treatment outcome. Peritraumatic reactions were assessed using the Physical Reactions Subscale, the Peritraumatic Dissociative Experiences Questionnaire and four motor questions of the Tonic Immobility Scale. After controlling for confounders, tonic immobility was the best predictor of a poor response to treatment, either considering the PCL-C or the CGI-S scores. Tonic immobility seems to have a greater negative impact on PTSD prognosis than peritraumatic panic or dissociation. Additional translational and clinical research may inform about particular mechanisms underlying tonic immobility and open new avenues for prevention and treatment of PTSD. © 2009 Elsevier Ltd. All rights reserved. Source


Rodrigues H.,Federal University of Rio de Janeiro | Figueira I.,Federal University of Rio de Janeiro | Lopes A.,Federal University of Rio de Janeiro | Goncalves R.,Federal University of Rio de Janeiro | And 3 more authors.
PLoS ONE | Year: 2014

The treatment of anxiety is on the edge of a new era of combinations of pharmacologic and psychosocial interventions. A new wave of translational research has focused on the use of pharmacological agents as psychotherapy adjuvants using neurobiological insights into the mechanism of the action of certain psychological treatments such as exposure therapy. Recently, d-cycloserine (DCS) an antibiotic used to treat tuberculosis has been applied to enhance exposure-based treatment for anxiety and has proved to be a promising, but as yet unproven intervention. The present study aimed to evaluate the efficacy of DCS in the enhancement of exposure therapy in anxiety disorders. A systematic review/metaanalysis was conducted. Electronic searches were conducted in the databases ISI-Web of Science, Pubmed and PsycINFO. We included only randomized, double-blind, placebo-controlled trials with humans, focusing on the role of DCS in enhancing the action of exposure therapy for anxiety disorders. We identified 328 references, 13 studies were included in our final sample: 4 on obsessive-compulsive disorder, 2 on panic disorder, 2 on social anxiety disorder, 2 on posttraumatic stress disorder, one on acrophobia, and 2 on snake phobia. The results of the present meta-analysis show that DCS enhances exposure therapy in the treatment of anxiety disorders (Cohen d = -0.34; CI: -0.54 to -0.14), facilitating the specific process of extinction of fear. DCS seems to be effective when administered at a time close to the exposure therapy, at low doses and a limited number of times. DCS emerges as a potential new therapeutic approach for patients with refractory anxiety disorders that are unresponsive to the conventional treatments available. When administered correctly, DCS is a promising strategy for augmentation of CBT and could reduce health care costs, drop-out rates and bring faster relief to patients. © 2014 Rodrigues et al. Source


Costa M.F.,Federal University of Fluminense | Mendlowicz M.V.,Federal University of Fluminense | Mendlowicz M.V.,Federal University of Rio de Janeiro | Vasconcelos A.G.G.,Escola Nacional de Saude Publica ENSP FIOCRUZ | And 4 more authors.
Journal of Anxiety Disorders | Year: 2011

The DSM-IV-TR postulates that PTSD symptoms are organized into 3 clusters. This assumption has been challenged by growing number of factor analytical studies, which tend to favor 4-factor, first-order models. Our objective was to investigate whether the clusters of PTSD symptoms identified in North American and European studies could be replicated in a Brazilian sample composed of 805 primary care patients living in hillside slums. Volunteers were asked to fill out the Brazilian version of the Posttraumatic Stress Disorder Checklist-Civilian Version and a confirmatory factor analysis of this scale was conducted with the software LISREL 8.80. Seven models were tested and a 4-factor, first-order solution including an emotional numbing cluster was found to provide the best fit. Although PTSD has been characterized by some critics as a Western culture-specific disorder lacking universal validity, our results seem to uphold the cross-cultural validity of the 4-factor, first-order model. © 2011 Elsevier Ltd. Source


De Moura J.F.,PPG em Saude Publica e Meio Ambiente | Hacon S.D.S.,Escola Nacional de Saude Publica ENSP FIOCRUZ | Vega C.M.,Pontifical Catholic University of Rio de Janeiro | Hauser-Davis R.A.,Pontifical Catholic University of Rio de Janeiro | And 2 more authors.
Bulletin of Environmental Contamination and Toxicology | Year: 2012

Total mercury (Hg) was determined in muscle tissue of 20 Guiana dolphins stranded along the coast of Rio de Janeiro state, Brazil, with a mean of 1.07 μg/g wet weight. Mercury concentrations were positively related to body length, possibly related to the capacity of the dolphins to bioaccumulate this element throughout life. The Hg concentrations were not significantly different between males and females, although females (1.08 μg/g) showed slightly higher levels than males (1.04 μg/g). Concentrations were low when compared to results of studies carried out with small cetaceans in the Northern Hemisphere, and with previous studies in the Southeastern Brazil. © 2011 Springer Science+Business Media, LLC. Source

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