Children affected by mental disorders are largely unrecognised and untreated across the world. Community resources, including the school system and teachers, are important elements in actions directed to promoting child mental health and preventing and treating mental disorders, especially in low- and middle-income countries. We developed a web-based program to educate primary school teachers on mental disorders in childhood and conducted a cluster-randomised controlled trial to test the effectiveness of the web-based program intervention in comparison with the same program based on text and video materials only and to a waiting-list control group. All nine schools of a single city in the state of São Paulo, Brazil, were randomised to the three groups, and teachers completed the educational programs during 3 weeks. Data were analysed according to complete cases and intention-to-treat approaches. In terms of gains of knowledge about mental disorders, the web-based program intervention was superior to the intervention with text and video materials, and to the waiting-list control group. In terms of beliefs and attitudes about mental disorders, the web-based program intervention group presented less stigmatised concepts than the text and video group and more non-stigmatised concepts than the waiting-list group. No differences were detected in terms of teachers' attitudes. This study demonstrated initial data on the effectiveness of a web-based program in educating schoolteachers on child mental disorders. Future studies are necessary to replicate and extend the findings.

Background: A quantitative study was undertaken for the first time on the normal liver of male and female 2-year-old brown trout, Salmo trutta.Methods: Liver was fixed by controlled perfusion. Organ-level morphometry provided weight and volume. A two-stage stereological approach was performed at light and electron microscopy levels. Systematic sampling and point-counting morphometry were used for estimating the relative volumes of the structural compartments. Total absolute volumes of these components were obtained by multiplying each volume density by the volume of its reference space.Results: Liver volume was 3,423.6 mm 3 for males and 3,657.4 mm 3 for females. Parenchyma accounted for 95% of hepatic volume. Veins and bile ducts occupied, respectively, 76% and 17% of the stroma, whereas arteries, connective tissue, and melanomacrophages together composed only 6%. Hepatocytes occupied 88% of the parenchyma. Nonhepatocytic cells (endothelium, biliary epithelial cells, Ito cells, and macrophages) composed 4% of the parenchyma, the capillary lumen 6%, and other spaces (Disse space, canaliculi, and lumina of preductules and ductules) composed 2%. Significant sexual differences were found: (1) Females showed a greater parenchymal volume density (0.85% vs. 0.35%) and absolute volume (29.5 mm 2 vs. 11.7 mm 3 ) of Ito cells; (2) macrophages of females also presented a greater parenchymal volume density (0.94% vs. 0.46%), but not absolute volume.Conclusions: The need to analyze both relative and absolute stereological data was stressed. Similarities and differences were detected between brown trout and other species (fishes and mammals); the findings suggest that, despite architectural differences, some quantitative parameters of liver microanatomy were retained during phylogeny. Factors mediating sexual differences in Ito cells and macrophages were discussed and the need for further studies was highlighted. Anat.

The Family Health Strategy (FHS) started out as the Family Health Program (FHP

Notice of Retraction and Replacement. Lopes et al. Gamma ventral capsulotomy for obsessivecompulsive disorder: a randomized clinical trial.

E-learning was highly appreciated as a learning tool, especially by students with the least frequency of Internet use. Nonetheless, it worked better for those previously familiar with e-courses. The AAMPC e-course provided effective knowledge transmission and retention. Complementary strategies to reduce misconceptions about alcohol-related problems must be developed for the training of primary care staff.

Our aim was to investigate the impact of comorbid body dysmorphic disorder (BDD) on the response to sequential pharmacological trials in adult obsessive-compulsive disorder (OCD) patients. The sequential trial initially involved fluoxetine monotherapy followed by one of three randomized, add-on strategies: placebo, clomipramine or quetiapine. We included 138 patients in the initial phase of fluoxetine, up to 80 mg or the maximum tolerated dosage, for 12 weeks. We invited 70 non-responders to participate in the add-on trial; as 54 accepted, we allocated 18 to each treatment group and followed them for an additional 12 weeks. To evaluate the combined effects of sex, age, age at onset, initial severity, type of augmentation and BDD on the response to sequential treatments, we constructed a model using generalized estimating equations (GEE). Of the 39 patients who completed the study (OCD-BDD, n = 13; OCD-non-BDD, n = 26), the OCD-BDD patients were less likely to be classified as responders than the OCD-non-BDD patients (Pearson Chi-Square = 4.4; p = 0.036). In the GEE model, BDD was not significantly associated with a worse response to sequential treatments (z-robust = 1.77; p = 0.07). The predictive potential of BDD regarding sequential treatment strategies for OCD did not survive when the analyses were controlled for other clinical characteristics.

Children affected by mental disorders are largely unrecognized and untreated across the world. The educational system is closely related to the childhood mental health field and actions that occur in the context of education may be critical to improve the care of those affected by mental illness. We developed a web-based program (web-based interactive educational group, WBIE) to educate and assist primary school teachers in the recognition and management of children with mental disorders. Additionally, we conducted a cluster-randomized controlled trial to test the effectiveness of the WBIE intervention in comparison to the same program based on text and video materials only (text and video-based educational group, TVBE) and to no training (waiting list control, WL). The nine schools of a community in São Paulo, Brazil, were randomized to the three groups, and teachers completed the educational programs during three weeks. Regarding knowledge, the WBIE group was superior to the TVBE group in 2 out of 9 outcomes and the WBIE group was superior to the WL group in 5 out of 9 outcomes. The TVBE was superior to the WL in 2 out of 9 outcomes. Regarding beliefs and attitudes, the WBIE group presented less stigmatized concepts than the TVBE group and more non-stigmatized concepts than the WL group, which presented less stigmatized concepts than the TVBE. There was no effect of the intervention over attitudes to mental health. This randomized controlled trial demonstrated the effectiveness of a web-based program to educate school teachers in the identification and management of children with mental disorders.

In controlled clinical trials, each of several prognostic factors should be balanced across the trial arms. Traditional restricted randomization may be proved inadequate especially with small sample sizes. In psychiatric disorders such as obsessive compulsive disorder (OCD), small trials prevail. Therefore, procedures to minimize the chance of imbalance between treatment arms are advisable. This paper describes a minimization procedure specifically designed for a clinical trial that evaluates treatment efficacy for OCD patients. Aitchison's compositional distance was used to calculate vectors for each possibility of allocation in a covariate adaptive method. Two different procedures were designed to allocate patients in small blocks or sequentially one-by-one. Partial results of this allocation procedure as well as simulated ones are shown. In the clinical trial for which this procedure was developed, the balancing between treatment arms was achieved successfully. Simulations of results considering different arrival order of patients showed that most of the patients are allocated in a different treatment arm if arrival order is modified. Results show that a random factor is maintained with the random arrival order of patients. This specific procedure allows the use of a large number of prognostic factors for the allocation decision and was proved adequate for a psychiatric trial design.