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Objective. Juvenile-onset fibromyalgia (JFM) is a paradigmatic chronic pain condition for which the underlying neurobiological substrates are poorly understood. This study examined, for the first time, data-driven resting-state functional connectivity (rsFC) alterations in 37 female adolescents with JFM compared with 43 healthy female adolescents and identified associations with bodily pain. Methods. Whole-brain voxel-wise rsFC alterations were assessed using the intrinsic connectivity contrast, a measure of node centrality at each voxel, and seed-based analyses for interpretability. We studied the relationship between rsFC alterations in somatosensory systems and the location and extension of bodily pain. Results. Adolescents with JFM had voxel-wise rsFC reductions in the paracentral lobule (PCL)/primary somatosensory cortex (S1) (T = 4.89, family-wise error corrected p-value (pFWE) < 0.001) and left midcingulate cortex (T = 4.67, pFWE = 0.043). Post hoc analyses revealed reduced rsFC spanning major cortical sensory hubs (T > 4.4, pFWE < 0.030). Cortico-cortical rsFC reductions within PCL/S1 in JFM occurred in locations innervated by bodily areas where the pain was most frequent (F = 3.15; positive false discovery rate = 0.029) and predicted widespread pain (T > 4.4, pFWE < 0.045). Conversely, adolescents with JFM had increases in PCL/S1–thalamus (T = 4.75, pFWE = 0.046) and PCL/S1–anterior insula rsFC (T = 5.13, pFWE = 0.039). Conclusion. Reduced cortico-cortical sensory integration involving PCL/S1 and spanning the sensory systems may underly critical pain sensory features in youth with JFM. Reduced sensory integration is paralleled by augmented cross-talk between sensory and affective/salience-processing regions, potentially indicating a shift toward more affectively colored sensory experiences to the detriment of specific sensory discrimination. [ABSTRACT FROM AUTHOR]

New graduate nurses often lack professional confidence to voice safety concerns. An evidence review was conducted to determine how participating in a mentorship program impacts the development of assertive communication during the first year of practice. Evidence indicates that providing a supportive environment, with physical and emotional access to mentors, should be used to increase new graduate nurses' self-perceived ability and willingness to voice safety concerns. [ABSTRACT FROM AUTHOR]

Abstract. Psychological therapies, such as cognitive behavioral therapy, are widely used multifaceted approaches that have been shown to improve pain-related functioning. A small but growing number of studies have used brain imaging to support the use of psychological therapies for pain. Although these studies have led to an increased understanding of how therapies may engage neural systems, there are multiple technical and conceptual challenges to consider. Based on the current literature, several components of effective psychological therapies for pain may be supported by changes in neural circuitry, which are most consistently represented by diminished activation and/or reduced hyperconnectivity in brain regions related to pain processing, emotion, and cognitive control. Findings may vary based on methodological approaches used and may also differ depending on targets of treatment. To provide a nuanced understanding of the current literature, specific targets and components of effective treatments for which a neural basis has been investigated are reviewed. These treatment components include catastrophic thinking about pain, increasing self-efficacy, mindfulness, anxiety symptom reduction, and exposure-based approaches. In general, such strategies have the potential to normalize regional hyperactivations and reduce hyperconnectivity in brain regions associated with nociceptive processing, cognition, and emotion, although additional research is needed. By determining if there are indeed distinct brain mechanisms engaged by different components of psychological therapy and evidence for specific changes in neural function after these interventions, future therapies may be more optimally tailored for individuals afflicted with chronic pain.

Este trabalho objetiva compreender as contribuições da Didática Crítica para a formação de professores. Para tanto, a partir de revisão bibliográfica, aborda o que é Didática e qual sua função na formação de professores, no âmbito teórico-prático, para o processo de ensino-aprendizagem. Trata-se de um objeto de estudo atrelado a questões não meramente técnicas, mas de cunho político-pedagógico da educação, imbricado em relações sociais. Como resultado dos impactos das transformações sociais e educacionais, ao longo do contexto histórico, a Didática em distintas teorias pedagógicas também se altera. Considerando sua não neutralidade, vincula-se a determinados objetivos, finalidades e concepções de educação. Logo, é orientada por determinados fundamentos teórico-metodológicos e pode estar em sintonia com processos de conservação ou de transformação social. Esse estudo evidencia a relevância da Didática Crítica enquanto componente indispensável na formação e prática pedagógica, que pode ser um instrumento de resistência e luta para o desenvolvimento da consciência político-pedagógica do professor comprometido com a transmissão e apropriação pelos estudantes de formas mais elaboradas de conhecimentos científicos, filosóficos e artístico-culturais, atrelada a dimensão histórica e aos determinantes da educação, pressupostos na Pedagogia Histórico-Crítica.

Abstract. Introduction:. Disabling chronic pain is a common experience for children and adolescents. However, the evidence base for chronic pain interventions for youth is extremely limited, which has hindered the development of evidence-based practice guidelines for most pediatric chronic pain conditions. Objectives:. To review and provide recommendations on clinical trial design and evaluation in children and adolescents with chronic pain. Methods:. In this article, we summarize key issues and provide recommendations for addressing them in clinical trials of chronic pain interventions in children and adolescents and their families. Results:. To stimulate high-quality trials of pediatric chronic pain management interventions, attention to key issues including sample characterization, trial design and treatment administration, outcome measurement, and the ethics of intervening with children and adolescents, as opposed to adults with chronic pain, is needed. Conclusion:. Future research to develop interventions to reduce or prevent childhood chronic pain is an important priority area, and requires special considerations in implementation and evaluation in clinical trials.

Adolescents with chronic pain often suffer significant impairment in physical, emotional, and social domains. Surprisingly little is known about executive functioning (EF) in youth with chronic pain or how EF deficits may contribute to functional impairment. Study participants included 60 adolescents between the ages of 12 and 17 years (M = 14.57). Thirty participants with chronic musculoskeletal pain and 30 age- and gender-matched healthy controls were recruited from a large Midwestern children’s hospital in the United States. Participants completed the Behavior Rating Inventory of Executive Functioning (BRIEF-2) as well as multiple measures of functional impairment across key domains: school, social, emotional (anxiety, depression), and physical. Adolescents with chronic musculoskeletal pain reported significantly greater EF impairment compared to healthy age- and gender-matched peers. Clinically elevated risk levels of impairment were reported across all aspects of EF, with many adolescents in the chronic pain group scoring above the clinical risk cut off for working memory (52%), inhibition (45%), and cognitive flexibility (38%). EF was also significantly related to functional impairment across all domains. Findings suggest that EF may have an impact across several critical domains of functioning for youth with chronic pain.