Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Objectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

ABSTRACT. Cognitive functions have been the subject of studies evaluating the pathophysiological mechanism of speech control. Objective: To compare the groups of patients with and without speech disorders with cognitive assessment, demographic, and clinical data (disease duration, functionality, and motor symptoms). Methods: Retrospective, cross-sectional study. Patients were evaluated using the Addenbrooke's Cognitive Examination III and neuropsychological tests. The following speech subsystems were analyzed: articulation, phonation, resonance, and prosody, through auditory-perceptual evaluation (based on the Protocol for the Evaluation of Acquired Speech Disorders in Individuals with Parkinson's Disease — PADAF Protocol tests), observing aspects of speech programming and execution. The patients were distributed into three subgroups (normal cognition, mild cognitive impairment, and dementia). After speech evaluation, they were divided into two subgroups (with and without speech disorders). Results: A total of 150 patients participated in this study, 104 men and 46 women, 63.58 (8.81) years of age, 11.03 (4.00) years of schooling, 6.61 (4.69) years of disease progression, and with the highest proportion of individuals in stage I–II of the Hoehn & Yarh (H&Y) scale (86, or 57.33%). Statistically significant differences were observed between subgroups with and without speech alteration. Worse performance was verified in the Trail Making Test (TMT) TMT-Δ and a tendency of difference in the TMT-B of the subgroup with speech disorders, in addition to worse severity of motor symptoms (H&Y) and cognitive complaints. Conclusion: Individuals with speech disorders brought more frequent cognitive complaints and impairment below expected in tests assessing executive functions. Future studies, with stratification by type of speech disorder, are necessary to contribute to and validate these results.

RESUMO. As funções cognitivas têm sido alvo de estudos que avaliam o mecanismo patofisiológico do controle da fala. Objetivo: Comparar subgrupos de pacientes com e sem alterações de fala quanto à avaliação cognitiva, dados demográficos e clínicos (tempo de evolução da doença, funcionalidade e gravidade dos sintomas motores). Métodos: Estudo retrospectivo, de corte transversal. Os pacientes foram avaliados pelo Exame Cognitivo de Addenbrooke III e testes neuropsicológicos. Foram analisados os seguintes subsistemas da fala: articulação, fonação, ressonância e prosódia, por meio de avaliação perceptivo-auditiva (baseada em testes do Protocolo de Avaliação dos Distúrbios Adquiridos de Fala em Indivíduos com Doença de Parkinson — PADAF), sendo observados aspectos da programação e execução da fala. Os pacientes foram distribuídos em três subgrupos (cognição normal, comprometimento cognitivo leve e demência). Após a avaliação da fala, foram divididos em dois subgrupos (com desordens da fala e sem desordens da fala). Resultados: Participaram deste estudo 150 pacientes, 104 homens e 46 mulheres, com 63,58 (8,81) anos de idade, 11,03 (4,00) anos de escolaridade e 6,61 (4,69) anos de evolução da doença, e maior proporção de indivíduos no estágio I–II da Escala de Hoehn & Yarh — H&Y (86, ou 57,33%). Foram observadas diferenças estatisticamente significantes entre os subgrupos com e sem alteração da fala. Houve pior desempenho no Trail Making Test (TMT) TMT-Δ e tendência de diferença no TMT-B no subgrupo com desordens da fala, além de pior gravidade dos sintomas motores (H&Y) e queixa cognitiva. Conclusão: Os indivíduos com desordens da fala trouxeram queixas cognitivas com maior frequência e prejuízo abaixo do esperado nos testes que avaliam as funções executivas. Estudos futuros, com estratificação por tipo de distúrbio da fala, são necessários para a contribuição e validação destes resultados.

Abstract Understanding the spatial pattern of a particular geographic phenomenon such as deforestation is a key issue to establish monitoring programs to prevent the depletion of natural resources. Thus, the goal of this study was to assess the spatial pattern of deforested areas in the Pardo and Jequitinhonha River basins using Ripley’s K function. First, we mapped all deforested areas in these basins using Landsat multispectral imagery from 2007 to 2015. Then, we used the Ripley’s K function to test for spatial interactions between deforestation events. Our results showed that deforestations predominantly occur in a clustering spatial pattern in these basins. Spatial statistical analyses as Ripley’s K function may provide a baseline for deforestation monitoring, as well as allowing us to understand the spatial pattern of deforestation in different natural ecosystems, especially in countries like Brazil, where the territorial dimension presents a great difficulty for the effectiveness of deforestation monitoring.

Resumo Fundamento Alguns pacientes com COVID-19 apresentam injúria miocárdica. Objetivo Detectar a injúria miocárdica em pacientes criticamente doentes, e comparar o envolvimento cardíaco entre crianças com síndrome respiratória aguda grave (SARS) e crianças com síndrome inflamatória multissistêmica (MIS-C). Métodos Todas as crianças acometidas da COVID-19 admitidas em uma unidade de terapia intensiva de referência foram cadastradas de forma prospectiva e fizeram uma ecografia transtorácica bidimensional (ETT-2D) e um teste de troponina I cardíaca (cTnI) nas primeiras 72 horas. Para a análise estatística, um p <0,05 bilateral foi considerado significativo. Resultados 33 pacientes foram incluídos, dos quais 51,5% apresentaram cTnI elevada e/ou ETT-2D anormal e 36,4% precisaram de suporte cardiovascular, que foi mais frequente em pacientes com cTnI elevada e anormalidades em ETT-2D do que em pacientes com exames normais (83,3% e 33,3%, respectivamente; p 0,006, 95% IC = 0,15-0,73). Os achados de ETT-2D mais comuns foram efusão pericárdica (15,2%) e regurgitação tricúspide/mitral (15,2%). Sinais de envolvimento cardíaco foram mais comuns na MIS-C que na SARS. Pacientes com MIS-C também apresentaram um índice mais alto de necessidade de suporte cardiovascular (66,7% X 25%, p 0,03, 95% IC = -0,7 a -0,04) e um índice mais frequente de cTnI elevada (77,8% X 20,8%; p 0,002, 95% IC = 0,19 a 0,79). Os valores preditivos negativos de cTnI para detecção de anormalidades de ETT-2D foram 100% para pacientes com MIS-C, e 73,7% para pacientes com SARS. Conclusão Sinais de injúria cardíaca foram comuns, especialmente em pacientes com MIS-C. As anormalidades na ETT-2D foram sutis. A realização de um teste de cTnI na admissão pode ajudar os prestadores de assistência de saúde a discriminar os pacientes com uma necessidade mais urgente de uma ETT-2D.

Abstract Background Some patients with COVID-19 present myocardial injury. Objective To detect myocardial injury in critically ill paediatric patients, and to compare cardiac involvement between children with severe acute respiratory syndrome (SARS) and children with multisystemic inflammatory syndrome (MIS-C). Methods All COVID-19 children admitted to a referral intensive care unit were prospectively enrolled and had a two-dimensional echocardiogram (2D-TTE) and a cardiac troponin I (cTnI) assay within the first 72 hours. For statistical analysis, two-sided p < 0.05 was considered significant. Results Thirty-three patients were included, of which 51.5% presented elevated cTnI and/or abnormal 2D-TTE and 36.4% needed cardiovascular support, which was more frequent in patients with both raised cTnI and 2D-TTE abnormalities than in patients with normal exams (83.3% and 33.3%, respectively; p 0.006, 95% CI = 0.15-0.73). The most common 2D-TTE findings were pericardial effusion (15.2%) and mitral/tricuspid regurgitation (15.2%). Signs of cardiac involvement were more common in MIS-C than in SARS. MIS-C patients also presented a higher rate of the need for cardiovascular support (66.7% vs 25%, p 0.03, 95% CI = -0.7 to -0.04) and a more frequent rate of raised cTnI (77.8% vs 20.8%; p 0.002, 95% CI = 0.19 to 0.79). The negative predictive values of cTnI for the detection of 2D-TTE abnormalities were 100% for MIS-C patients and 73.7% for SARS patients. Conclusion signs of cardiac injury were common, mainly in MIS-C patients. 2D-TTE abnormalities were subtle. To perform a cTnI assay upon admission might help providers to discriminate those patients with a more urgent need for a 2D-TTE.

Resumo Objetivo Avaliar características sociodemográficas e obstétricas de mulheres com diabetes gestacional que mantêm hiperglicemia no período pós-parto (6–12 semanas pós-parto). Métodos Este é um estudo longitudinal de coorte com mulheres com diagnóstico de diabetes gestacional e/ou macrossomia fetal entre 1° de março de 2016 a 1° de março de 2017. As mulheres coletaram glicemia de jejum, teste de tolerância a glicose e hemoglobina glicada entre 6 a 12 semanas pós-parto. Os dados foram coletados de prontuários médicos e durante entrevista na primeira consulta de revisão pós-parto. Uma análise estatística foi realizada através do cálculo de frequências, porcentagens, teste do qui-quadrado, teste exato de Fisher, teste de Mann-Whitney e regressão multivariada de Poisson. A significância estatística adotada foi de 5%. Resultados Cento e vinte e duas mulheres foram incluídas. A maioria delas tinha menos de 35 anos de idade (70,5%), eram brancas, multíparas, e não tinham história de diabetes gestacional. Treze por cento das participantes desenvolveu hiperglicemia persistente. A análise univariada mostrou que os fatores relacionados com a persistência de hiperglicemia no período pós-natal foram: idade materna acima de 35 anos, sobrepeso, obesidade grau 1 e ganho de peso abaixo de 5 quilos. A análisemultivariada incluiu o diagnóstico no primeiro trimestre como fator de risco para hiperglicemia persistente. Conclusão Mulheres acima de 35 anos, obesidade, sobrepeso e diagnóstico de diabetes gestacional no primeiro trimestre estão relacionados com hiperglicemia persistente no período pós-parto.

Abstract Objective To evaluate the obstetric and sociodemographic characteristics of gestational diabetic women who maintained hyperglycemia in the postpartum period (6-12 weeks postpartum). Methods This is a longitudinal cohort study with women who have had gestational diabetes and/or macrosomic children between March 1st, 2016 and March 1st, 2017. Between 6 and 12 weeks after birth, women who had gestational diabetes collected fasting glycemia, glucose tolerance test, and glycated hemoglobin results. The data were collected from medical records and during an interview in the first postpartum consultation. A statistical analysis was performed using frequency, percentage, Chi- Squared test, Fisher exact test, Mann-Whitney test, and multivariate Poisson regression. The significance level adopted for the statistical tests was 5%. Results One hundred and twenty-two women were included. Most of the women were younger than 35 years old (70.5%), white, multiparous, and with no history of gestational diabetes. Thirteen percent of the participants developed persistent hyperglycemia. A univariate analysis showed that maternal age above 35 years, being overweight, having grade 1 obesity and weight gain under 5 kg was related to the persistence of hyperglycemia in the postpartum period. Conclusion Maternal age above 35 years, obesity and overweight, and the diagnosis of gestational diabetes in the first trimester of pregnancy are associated with hyperglycemia during the postpartum period.

The voltammetry is an important analytical technique and also useful for pKa determination. It is a usual procedure of this technique to employ inert electrolyte concentration 100 times higher than redox compound concentration further a pH buffer. However, the ionic strength changes with the solution pH. In this work, we study the consequences of this procedure by using a model system, aniline. A differential pulse voltammetry was used with a glass carbon electrode in 4.0 x 10-3 mol L-1 aniline, 0.04 mol L-1 Britton-Robinson Buffer, NaNO3 as inert electrolyte and pH from 2.0 up to 7.0. The first oxidation peak (0.67V ca.) was used. The pKa determination was performed by using intersection lines at Epeak versus pH. This method was also theoretically discussed for both the oxidant or reducing compound with Brönsted acid-base behavior. For the cited procedure, the ionic strength changed from 0.418 to 0.528 mol L-1, and the experimental pKa (5.691) was far from theoretical one (4.722), still a good fit of lines to experimental data. Using the correct procedure, the experimental pKa (4.938) was near the theoretical one. Therefore, we have proved the need for a more careful adjust of ionic strength in this application.

Abstract This study aimed to investigate if the inclusion of different spices in bovine burger affects bacterial growth, lipid oxidation and sensorial characteristics of the products. Four hamburger formulations were prepared: control (without additives), saffron (1%), ginger (1%) and urucum (1%). The products were analyzed for total bacterial count (TBC) on days 0, 7 and 15 (storage at 4 °C) and 0, 15 and 60 (storage at -30 °C) and, for rancidity, on days 0, 30 and 60 (storage at -30 °C). The acceptance of the sensory attributes and the purchase intent were evaluated using hedonic scales. All burgers formulated with spices and kept at 4 °C had lower TBC than the control formulation, whereas for those stored at -30 °C, the same occurred only with the ginger-made ones. Lower lipid oxidation was found for the formulations containing the spices. Control and ginger formulations led the acceptance of the tasters for the attributes appearance and color, besides that, aroused greater interest in the purchase intention trial. It was concluded that the addition of spices reduced TBC and delayed the lipid oxidation of hamburgers, and that the products elaborated with ginger had the highest sensory acceptance and purchase intention indexes.

Abstract The proteins recovered by ultrafiltration (UF) represent a co-product of fish industrialization and can be used as a protein ingredient in the fortification of food formulations. The objective of this study was to evaluate the quality of surimi fishburger elaborated with the proteins recovered by UF from the wastewater generated in the production of surimi. The water generated in the washing operations of trims of farmed tilapia (Oreochromis niloticus) were filtered in a 30 kDa polyethersulfone membrane. The recovered proteins were dehydrated in spray dryer and added at 5 and 10% into fishburgers made with tilapia surimi. The fishburgers were evaluated for proximal composition, cooking yield, sensory parameters and acceptability. The incorporation of proteins into the fishburgers improved the sensory aspects of the final product and provided greater acceptability while maintaining the same manufacturing yield. The addition of 10% of the recovered proteins increased the nutritional value of surimi fishburgers.

One new methodology for analysis of the antimicrobial oxolinic acid (OXA) based on adsorptive stripping voltammetry (AdSV) in carbon paste electrode (CPE) was developed and applied in untreated pond water sample. Cyclic voltammetry (CV) indicated that an irreversible anodic process occurs in KOH solution as supporting electrolyte. Quantification of the antimicrobial was carried out by differential pulse adsorptive stripping voltammetry (DPAdSV) at potential of deposition (ED) +1.05 V for 45 s to examine OXA adsorption on the surface of CPE. The limits of detection (LOD) and quantification (LOQ) of the method for OXA analysis were determined. The values of LOD were 0.0570 and 0.512 mg L-1 in absence of matrix and in the water sample, respectively, and the corresponding values of LOQ were 0.192 and 1.707 mg L-1, respectively. The apparent recovery percentage for different concentrations of OXA in natural waters ranged between 98.4 and 109%.

Resumo: O objetivo deste trabalho foi avaliar a utilização de interpoladores geoestatísticos e imagens de sensoriamento remoto, para a estratificação de povoamentos de Eucalyptus sp. em idade de corte. As estimativas da amostragem casual estratificada foram comparadas às estimativas da amostragem sistemática quanto à variável volume de madeira. A área de estudo correspondeu a um povoamento clonal de Eucalyptus sp. no Município de Lagoa Grande, MG. O inventário florestal foi realizado em 2011, em quatro situações de amostragem e diferentes números de parcelas. A estratificação da área foi feita por meio de krigagem da área basal (variável principal), da reflectância na banda TM5 (variável auxiliar) obtida em uma imagem Landsat 5 TM e com base na cokrigagem dessas variáveis. A área basal e a reflectância na banda TM5 apresentaram estrutura de dependência espacial. A estratificação reduziu o erro de amostragem em até 40%, em comparação ao erro da amostragem sistemática. As imagens de sensoriamento remoto e os interpoladores geoestatísticos krigagem e cokrigagem são eficientes na definição dos estratos em povoamentos de Eucalyptus sp., em decorrência da maior precisão dos estimadores da amostragem casual estratificada, que permitem estimativas volumétricas mais precisas do inventário florestal do que os da amostragem sistemática.

Abstract: The objective of this work was to evaluate the use of geostatistical interpolators and remote sensing images for the stratification of Eucalyptus sp. stands, at harvesting age. Estimates by stratified random sampling and systematic sampling were compared for the timber volume variable. The study area was a clonal plantation of Eucalyptus sp. in the municipality of Lagoa Grande, in the state of Minas Gerais, Brazil. The forest inventory was performed in 2011, considering four sampling situations and different plot numbers. The area stratification was carried out based on kriging of the basal area (target variable), on the reflectance values in the TM5 band (auxiliary variable) extracted from a Landsat 5 TM image, and on the cokriging of these variables. Basal area and reflectance in the TM5 band showed a spatial dependence structure. Stratification reduced the sampling error up to 40%, in comparison with that generated from systematic sampling. Remote sensing images and kriging and cokriging interpolators are efficient to define the strata in Eucalyptus sp. stands, as a consequence of the higher precision of the stratified random sampling estimators, which allow more precise volume estimates of the forest inventory than those of systematic sampling.

RESUMO Os transtornos da ansiedade e o transtorno obsessivo-compulsivo (TOC) e transtornos relacionados são altamente prevalentes e incapacitantes. Apesar disso, ainda existem lacunas a serem exploradas em relação ao tratamento desses transtornos. O medo é um sintoma central desses transtornos e sua aprendizagem é altamente dependente da atividade do fator neurotrófico derivado do cérebro (BDNF). Porém, será que a aprendizagem de medo mediada pelo BDNF deve ser considerada um alvo para o desenvolvimento de novos tratamentos para transtornos da ansiedade, TOC e transtornos relacionados? Revisamos as evidências que sugerem que a expressão de BDNF é necessária para a aquisição do medo condicionado, bem como para a evocação de sua extinção. Descrevemos os resultados relacionados a aprendizagem de medo, manipulação genética e epigenética da expressão de Bdnf em animais e variantes alélicas de BDNF em seres humanos. Posteriormente, discutimos como a manipulação dos níveis de BDNF representa um alvo em potencial para o tratamento, o que pode aumentar os benefícios das terapias que extinguem o medo previamente condicionado.

ABSTRACT Anxiety and obsessive-compulsive related disorders are highly prevalent and disabling disorders for which there are still treatment gaps to be explored. Fear is a core symptom of these disorders and its learning is highly dependent on the activity of the neurotrophin brain-derived neurotrophic factor (BDNF). Should BDNF-mediated fear learning be considered a target for the development of novel treatments for anxiety and obsessive-compulsive related disorders? We review the evidence that suggests that BDNF expression is necessary for the acquisition of conditioned fear, as well as for the recall of its extinction. We describe the findings related to fear learning and genetic/epigenetic manipulation of Bdnf expression in animals and BDNF allelic variants in humans. Later, we discuss how manipulation of BDNF levels represents a promising potential treatment target that may increase the benefits of therapies that extinguish previously conditioned fear.

OBJECTIVE: To compare the safety and efficacy of abdominal sacral colpopexy and sacrospinous ligament suspension with the use of vaginal mesh for apical prolapse. METHOD: This retrospective study was conducted from 2005 to 2012 and included 89 women with apical prolapse who underwent surgery. Assessments included pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) stage. Rates of objective cure and immediate/late complications were compared. RESULTS: In total, 41 of the 89 women underwent sacrospinous ligament suspension, and 48 of the women underwent abdominal sacral colpopexy. A total of 40.4% of the women had vault prolapse (p=0.9361). Most of them had no complications (93.2%) (p=0.9418). Approximately 30% of the women had late complications; local pain was the main symptom and was found only in women who underwent the abdominal procedure (25.6%) (p=0.001). Only the women who were submitted to the vaginal procedure had mesh exposure (18.4%). The objective success rate and the rate of anterior vaginal prolapse (p=0.2970) were similar for both techniques. CONCLUSION: Sacrospinous ligament suspension was as effective and had a similar objective success rate as abdominal sacral colpopexy for the treatment of apical prolapse. Sacrospinous ligament suspension performed with the use of vaginal mesh in the anterior compartment was effective in preventing anterior vaginal prolapse after surgery.

RESUMO OBJETIVO: A escala de Yale-Brown para avaliação do transtorno obsessivo-compulsivo é o instrumento mais utilizado para medir a gravidade desse transtorno. Descrevemos as deficiências dessa escala e propomos novos métodos de cálculo dos escores para avaliação de gravidade e resposta ao tratamento. MÉTODO: Os escores totais e subtotais da escala de Yale-Brown foram recuperados de um banco de dados de um estudo transversal com informações sobre 1.000 pacientes com transtorno obsessivo-compulsivos atendidos em sete centros especializados em saúde mental. Foram acrescentados os dados longitudinais de 155 pacientes participantes de um ensaio clínico de 12 semanas que avaliou a eficácia da fluoxetina ou da terapia cognitivo-comportamental como opções de tratamento de primeira linha. Todos os pacientes foram acompanhados por um médico que forneceu um parecer clínico de melhora. Nem os pacientes nem os médicos estavam conscientes das classificações propostas neste estudo. Novos métodos para avaliar os escores de gravidade foram comparados com o parecer clínico de melhora. RESULTADOS: Na escala obsessivo-compulsiva Yale-Brown, a soma de sub-escalas para compor a pontuação total não reflete com precisão a gravidade clínica. Além disso, a redução da pontuação com o tratamento, normalmente, não atinge o valor zero em qualquer das sub-escalas. Para superar esses problemas, sugerimos (a) o uso da pontuação máxima de qualquer das sub-escalas antes do tratamento; (b) o uso de um score mínimo de 4 em cada sub-escala ou um escore mínimo de 5 como o máximo de qualquer das sub-escalas como a meta para o pós-tratamento. Os novos métodos propostos tiveram melhor desempenho do que os tradicionais quanto a sensibilidade e especificidade contra o padrão ouro representado pelo parecer clínico de melhora. CONCLUSÃO: Os novos critérios propostos são coerentes com o parecer clínico de melhora e desempenham melhor do que a metodologia tradicional.

OBJECTIVE: The Yale-Brown Obsessive-Compulsive Scale is the most frequently used instrument to measure obsessive-compulsive symptom severity. We describe its shortcomings and propose new methods of evaluating current severity and treatment response. METHOD: The Yale-Brown Obsessive-Compulsive Scale total and subscale scores were pooled from one cross-sectional study database containing information on 1,000 obsessive-compulsive disorder patients from seven specialized mental health care centers. Additional longitudinal data were pooled for 155 patients who participated in a 12-week trial that evaluated the effectiveness of fluoxetine vs. cognitive-behavior therapy as first-line treatment options. All patients were followed by a clinician who provided a clinical opinion of improvement. Neither patients nor clinicians were aware of the classifications proposed in this study. New methods for using the severity scores were compared with the clinical opinion of improvement. RESULTS: In the Yale-Brown Obsessive-compulsive scale, the summing-up of subscale scores to compose a total score does not accurately reflect clinical severity. In addition, the reduction of scores with treatment does not usually reach score zero in either subscale. To overcome such problems, we suggest (a) use of the maximum score of any of the subscales; (b) use of a minimum score of 4 in each subscale or 5 for the maximum in any subscale as the goal after treatment. This method performed better than traditional ones regarding sensitivity and specificity against the gold standard represented by the clinical opinion of improvement. CONCLUSION: The new proposed response criteria are coherent with the clinical opinion of improvement and perform better than the traditional methodology.

O objetivo deste estudo foi analisar a evolução da área minerada no Quadrilátero Ferrífero (QF), Minas Gerais, e quantificar a área coberta com vegetação florestal nativa que foi suprimida por esta atividade durante os últimos 26 anos. Foram utilizadas imagens TM/Landsat 5 correspondente a área de estudo nos anos de 1985, 1989, 2000 e 2011. Para cada ano de análise, utilizando técnicas de interpretação visual de imagens, foram criados polígonos identificando e delimitando as áreas mineradas. Para a análise da supressão da vegetação florestal nativa pela mineração, as imagens de 1985 foram classificadas gerando um mapa temático de uso e cobertura do solo do QF. Em seguida, os polígonos de mineração identificados em cada ano de análise foram sobrepostos ao mapa da vegetação nativa possibilitando o cálculo da área de vegetação florestal nativa suprimida pela expansão da mineração. Entre os anos de 1985 a 2011, observou-se aumento de 213% na área minerada no QF. As áreas suprimidas de vegetação florestal nativa entre os anos de 1985 a 1989, 1989 a 2000 e 2000 a 2011 corresponderam respectivamente a 324,42 ha, 948,98 ha e 1989,68 ha, com uma perda total de vegetação nativa de 3.263,07 ha.

This study aimed at analyzing the evolution of the mined area in the Quadrilátero Ferrífero (QF) region, Minas Gerais state, Brazil, as well as to quantify the area covered by native forest that has been removed by mining activities during the last 26 years. TM/Landsat5 images from 1985, 1989, 2000 and 2011 were used. For each year of analysis, polygons of mined areas were detected and delimited using visual image interpretation techniques. For the analysis of the area covered by native forest suppressed by mining activities, a land cover and land use map of the QF region was provided, by using images from 1985. Native forest areas suppressed by mining expansion were calculated overlaying the thematic map and the mining polygons for each year of analysis. Taking into account the period from 1985 to 2011 there was an increase of 213% in the mined area. The areas of native forest removed throughout the years 1985-1989, 1989-2000 and 2000-2011 were respectively equal to 324.42 ha, 948.98 ha and 1,989.68 ha, with a total loss of 3,263.07 ha.