An Internet-Based Guided Self-Help Intervention for Panic Symptoms: Randomized Controlled Trial.

Background: Internet-based guided self-help is efficacious for panic disorder, but it is not known whether such treatment is effective for milder panic symptoms as well. Objective: To evaluate the effectiveness of Don't Panic Online, an Internet-based self-help course for mild panic symptoms, which is based on cognitive behavioral principles and includes guidance by email. Methods: A pragmatic randomized controlled trial was conducted. Participants (N=126) were recruited from the general population and randomized to either the intervention group or to a waiting-list control group. Inclusion criteria were a Panic Disorder Severity Scale-Self Report (PDSS-SR) score between 5-15 and no suicide risk. Panic symptom severity was the primary outcome measure; secondary outcome measures were anxiety and depressive symptom severity. Measurements were conducted online and took place at baseline and 12 weeks after baseline (T1). At baseline, diagnoses were obtained by telephone interviews. Results: Analyses of covariance (intention-to-treat) showed no significant differences in panic symptom reduction between groups. Completers-only analyses revealed a moderate effect size in favor of the intervention group (Cohen's d=0.73, P=.01). Only 27% of the intervention group finished lesson 4 or more (out of 6). Nonresponse at T1 was high for the total sample (42.1%). Diagnostic interviews showed that many participants suffered from comorbid depression and anxiety disorders. Conclusions: The Internet-based guided self-help course appears to be ineffective for individuals with panic symptoms. However, intervention completers did derive clinical benefits from the intervention

Millipede taxonomy after 250 years: classification and taxonomic practices in a mega-diverse yet understudied arthropod group.

BACKGROUND: The arthropod class Diplopoda is a mega-diverse group comprising >12,000 described millipede species. The history of taxonomic research within the group is tumultuous and, consequently, has yielded a questionable higher-level classification. Few higher-taxa are defined using synapomorphies, and the practice of single taxon descriptions lacking a revisionary framework has produced many monotypic taxa. Additionally, taxonomic and geographic biases render global species diversity estimations unreliable. We test whether the ordinal taxa of the Diplopoda are consistent with regards to underlying taxonomic diversity, attempt to provide estimates for global species diversity, and examine millipede taxonomic effort at a global geographic scale. METHODOLOGY/PRINCIPAL FINDINGS: A taxonomic distinctness metric was employed to assess uniformity of millipede ordinal taxa. We found that ordinal-level taxa are not uniform and are likely overinflated with higher-taxa when compared to related groups. Several methods of estimating global species richness were employed (Bayesian, variation in taxonomic productivity, extrapolation from nearly fully described taxa). Two of the three methods provided estimates ranging from 13,413-16,760 species. Variations in geographic diversity show biases to North America and Europe and a paucity of works on tropical taxa. CONCLUSIONS/SIGNIFICANCE: Before taxa can be used in an extensible way, they must be definable with respect to the diversity they contain and the diagnostic characters used to delineate them. The higher classification for millipedes is shown to be problematic from a number of perspectives. Namely, the ordinal taxa are not uniform in their underlying diversity, and millipedes appear to have a disproportionate number of higher-taxa. Species diversity estimates are unreliable due to inconsistent taxonomic effort at temporal, geographic, and phylogenetic scales. Lack of knowledge concerning many millipede groups compounds these issues. Diplopods are likely not unique in this regard as these issues may persist in many other diverse yet poorly studied groups

Comparing Pedagogical Innovations

Innovation seems to be a constant – and necessary – theme in education. A common underlying rationale is that changes in education of all levels and types prepare citizens for life in the knowledge society. The contexts include intensifying globalisation, progressively shorter half-lives of knowledge, and economic competitiveness which requires increased collaboration and different ways of working (Hershock et al. 2007; Scardamalia & Bereiter 2010). As the creation and dissemination of knowledge are perceived to be of paramount importance, education requires new goals and processes. This view is applicable both in economically advanced countries (e.g. European Round Table of Industrialists 1997; OECD 2004) and in less developed countries (e.g. UNESCO 2003; Kozma 2008)

Tratamento do transtorno de pânico com terapia psicodramática de grupo Treatment for panic disorder with psychodramatic group therapy

INTRODUÇÃO/OBJETIVOS: Há poucos trabalhos publicados sobre psicoterapia grupal para pacientes com transtorno de pânico (TP); além disso, esses estudos geralmente são restritos a abordagens cognitivo-comportamentais. O objetivo deste trabalho é relatar uma experiência de atendimento psicoterápico psicodramático grupal para portadores de TP, iniciada em 1996 na Faculdade de Medicina de Botucatu/Unesp, e discutir aspectos psicodinâmicos desse transtorno. MÉTODOS: Atende-se uma média de oito a dez pacientes em sessões mensais de duas horas de duração, nas quais se utilizam técnicas psicodramáticas. O uso associado de psicofármacos é a regra. A temática é aberta, centrando-se tanto em aspectos próprios do TP (sintomas mais comuns; peregrinação em serviços médicos até o diagnóstico; preocupações hipocondríacas; limitações e dependência; reações dos familiares; estratégias de exposição e enfrentamento; efeitos e reações dos medicamentos) quanto em problemas individuais específicos. RESULTADOS: A abordagem psicodramática favorece a identificação e a elaboração de aspectos psicodinâmicos. Entre estes, destacaram-se os sentimentos de desamparo e seus desdobramentos: insegurança; fragilidade e medo; raiva e culpa; sentimentos de desamor e rejeição; vergonha e inferioridade; isolamento e dificuldade de pedir ajuda; dificuldade de identificar e de expressar sentimentos - manifestados somaticamente -; e dificuldade de assumir o papel de "cuidador" e outras responsabilidades. CONCLUSÕES: Aspectos valiosos para o tratamento do TP, como apoio mútuo, companheirismo, confiança, modelo e estímulo, são favorecidos pelo contexto grupal homogêneo. O compartilhar de experiências e sofrimentos comuns propiciou rápida coesão e suporte grupal, melhora da capacidade de expressar sentimentos e da auto-estima e o aprimoramento de papéis sociais. Além da melhora dos sintomas, possibilitou-se a melhor compreensão e elaboração destes, que passam a ser integrados significativamente no contexto existencial.<br>INTRODUCTION: There are few published articles on group psychotherapy for patients with panic disorder (PD) and usually they are restricted to the cognitive-behavioral approach. OBJECTIVE: To describe an experience of group psychodramatic therapy for PD patients, started in 1996 at Botucatu Medical School - UNESP, and discuss psychodynamic aspects of the panic disorder. METHODS: Two-hour monthly psychodramatic sessions, with an average of 8 to10 patients were carried out. The patients were usually receiving concomitantly psychopharmacological treatment. The subjects to be discussed were freely chosen, ranging from issues directly related to PD (most common symptoms, hurdles to get to a diagnosis, hypochondriac concerns, limitations and dependency, family reactions, strategies of exposure and coping, and effects of drug treatment) to individual conflicts and problems. RESULTS: The psychodramatic approach favors the identification and elaboration of psychodynamic aspects. The most common feelings observed were helplessness and other related ones, such as: insecurity; vulnerability and fear; anger and guilt; isolation and difficulty in identifying and expressing emotions (which manifested physically); and difficulty in assuming the role of caretaker and other responsibilities. CONCLUSIONS: Valuable aspects for the treatment of PD, such as mutual support, partnership, confidence, modeling and encouragement, are favored in a group setting, where sharing experiences and sufferings helped to improve the participants' self-esteem, their ability to express emotions and to play different social roles. Besides the clinical improvement, the symptoms could be better understood and elaborated, and meaningfully integrated into their life context

Living and health conditions of elderly people over 80

Objective: This article proposes to describe demographic data and health conditions of elderly people at age 80 or more.Method: Quantitative-descriptive study of 95 elderlies from five units of the Family Health Strategy in the period from September to December 2013, using script with general data of the living conditions and health, including validated scales in geriatrics and gerontology.Results: The average age was 85.4 years. There was a predominance of women. Most were widowers with family income, more frequently between 2 or 3 minimum wages and economic participation is for means of sharing responsibility. They present dependency for many of Daily Living Instrumental Activities and, on average, reported 2.2 diseases. Fear of falling, decreased vision and hearing as well as pain in different body regions are reported.Conclusion: It appears that they have more intense needs than the elderly in general, requiring new ways of organizing their health care.Objetivo: Se propone a describir las condiciones de vida y la salud de las personas mayores de 80 años o más.Método: Estudio cuantitativo-descriptivo realizado con 95 personas de cinco unidades de la Estrategia Salud de la Familia, mediante un guión con los datos generales de las condiciones de vida y de salud, incluyendo escalas validadas en geriatría y gerontología.Resultados: La edad promedio fue de 85,4 años. Las mujeres predominaron en la mayoría de los viudos, el ingreso familiar más común es de 2-3 salarios mínimos. La dependencia actual de muchas de las actividades instrumentales de la vida diaria, en promedio 2.2 enfermedades reportadas y medicamentos utilizados 4.3 / ancianos. Mencionan el miedo de caerse, disminución de la visión, y dolor en diferentes regiones del cuerpo.Conclusión: Parece que tienen necesidades más intensas de las personas mayores en general, lo que requiere la preparación de la sociedad para cumplir con la misma eficacia.Objetivo: Propõe-se a descrever dados sociodemográficos e as condições de saúde de idosos com 80 anos ou mais.Método: Estudo quantitativo-descritivo realizado com 95 idosos de cinco unidades da Estratégia Saúde da Família, no período de setembro a dezembro de 2013, utilizando roteiro com dados gerais das condições de vida e de saúde, incluindo escalas validadas em geriatria e gerontologia.Resultados: A média de idade foi de 85,4 anos. Houve predomínio de mulheres. A maioria viúvos com renda familiar, mais frequente, de 2 a 3 salários mínimos, e a participação econômica é a de dividir responsabilidade. Apresentam dependência para muitas das Atividades Instrumentais de Vida Diária e, em média, referiram 2,2 doenças. Referem medo de cair, diminuição da visão e da audição, além de dor em diferentes regiões do corpo.Conclusão: Depreende-se que eles apresentam necessidades mais intensas dos que os idosos em geral, demandando novas formas de organizar seu cuidado em saúde