Obesity-related knowledge and body mass index: a national survey in Portugal.

PURPOSE: Obesity-related knowledge predicts weight control but previous studies only comprise individuals with excessive weight and assess very specific aspects of knowledge. This study aims to evaluate several domains of obesity-related knowledge according to the body mass index (BMI) in a representative sample of Portuguese-speaking dwellers in mainland Portugal. METHODS: A sample of 1624 participants aged 16-79 years was analyzed. Eighteen questions comprising eight obesity domains were asked: prevalence, physical activity, number of calories, adiposity location, causes, diagnosis, treatment and consequences; each one was dichotomized into correct/incorrect knowledge. RESULTS: The majority of Portuguese-speaking dwellers recognized the benefits of physical activity, the risks of abdominal obesity and most consequences of excessive weight, independently of their BMI. However, knowledge gaps were identified regarding prevalence, calories and BMI diagnosis. BMI influenced specific obesity-related knowledge: participants with a normal BMI knew the BMI formula more often, identified 22 as normal BMI more frequently and had the highest proportion of correct knowledge regarding the number of calories an adult should eat; obese individuals identified natural products as not being good treatments for obesity more often. After adjusting for age, sex and educational level, obese individuals identified natural products and supplements as not being good obesity treatments more often. CONCLUSIONS: Obesity-related knowledge gaps (prevalence, calories, and diagnosis) were identified among Portuguese adults. Moreover, correct knowledge does not necessarily translate into a healthier BMI. Besides the dissemination of accurate information, public health interventions should focus on the transfer of knowledge to behaviors that will guarantee better weight management. EVIDENCE-BASED MEDICINE RANKINGS: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Is there a role for salvage radiotherapy in locally advanced breast cancer refractory to neoadjuvant chemotherapy?

INTRODUCTION: Locally advanced breast cancer (LABC) is a major problem, especially in developing countries. The standard treatment for LABC is neoadjuvant chemotherapy, with or without anti-Her2 therapy, followed by surgery, radiotherapy, and adjuvant systemic treatment if appropriate. However, there are few data in the literature addressing alternatives when neoadjuvant chemotherapy fails to reduce the tumour for surgery. MATERIALS AND METHODS: We conducted a retrospective study including all patients who had non-metastatic LABC treated with neoadjuvant chemotherapy and who were not eligible for surgical resection; these patients were submitted to salvage radiotherapy (RTX) between January 2000 and December 2012 at the Brazilian National Cancer Institute. RESULTS: Fifty-seven patients were included, with a median age of 51 (23-72) years. The most frequent clinical stages were IIIA and IIIB, corresponding to 19.3% and 70.2%, respectively; mean tumour size was 8.74 (3-18) cm, and 44 patients (77.2%) had nodal involvement. Chemotherapeutic regimens containing anthracyclines were prescribed to 98.2% of the patients. Fifteen patients (26.3%) received taxanes and anthracyclines. Radiation dose was 50 Gy divided into 25 fractions; 43 patients (75.4%) had their tumours downsized by RTX and underwent mastectomy. Overall survival (OS) was 38 (23-52) months. Patients who were submitted to surgery had an OS of 49 (28-70) months and those who were not eligible for mastectomy after radiotherapy had an OS of 18 (9-27) months. CONCLUSION: This retrospective study confirms that RTX is an effective treatment to downsize LABC tumours with low or no response to chemotherapy, thereby enabling surgical resection which may improve overall patient outcome.

Treatment response in type 2 diabetes patients with major depression.

AIMS: Major depression is more prevalent in patients with type 2 diabetes mellitus (T2DM) than in general population. Comparing psychotherapeutic and pharmacological treatment responses could help to inform the choice between available treatment options. METHOD: Thirty-four patients with T2DM and major depression detected by using the Hospital Anxiety-Depression Scale (HADS), the Montgomery-Äsberg Depression Rating Scale (MADRS) and a structured interview (Mini-International Neuropsychiatric Interview) were randomized to undergo Interpersonal Psychotherapy (IPT) or treatment with sertraline in a 3-month acute intervention course in addition to a 3-month continuation format. Provided that the initial MADRS score was not reduced ≥25% at week 6, these early non-responding patients continued treatment in a sequential add-on combined format. Psychological adjustment to diabetes, attachment style, diabetes self-efficacy, quality of life and HbA1c were also evaluated along intervention. RESULTS: Out of 22 early-responding patients (11 for each treatment type), 16 had clinically significant improvements (<50% initial MADRS score) at endpoint with 11 reaching remission (MADRS scores ≤8), and with no significant differences between IPT and sertraline. Within sequential add-on treatment, out of eight patients, only three of them achieved a clinically significant improvement and only one reached remission. CONCLUSIONS: These preliminary results suggested that IPT may be an option to treat major depression in T2DM against medical care with sertraline. Early non-responding patients likely need alternative or longer treatment interventions. Limitations of this study relate to small sample and absence of a control group, which was difficult to implement due to ethical restrictions. KEY PRACTITIONER MESSAGE: Findings suggest that Interpersonal Psychotherapy is a useful tool to treat major depression in type 2 diabetes patients. A significant number of type 2 diabetes patients with major depression do not achieve depression remission irrespective of the type of treatment. Further clinical research should focus on addictive effects of psychotherapy and psychopharmacology in the treatment of depressed patients with chronic somatic diseases.

Overweight and obesity in Portugal: national prevalence in 2003-2005.

Obesity is an endemic health problem in most developed countries, requiring serious public health attention. The first Portuguese nationwide representative survey about obesity (with objective anthropometric measurement) was undertaken from 1995 to 1998. This paper presents data coming from the second and most recent nationwide representative study of obesity, with objective measurement of weight, height, waist and hip circumferences. Data were collected between January 2003 and January 2005. The survey collected objective body mass index (BMI) values of 8116 participants aged 18-64. Main findings were: 2.4% of the sample had low weight (BMI < 18.5), 39.4% were overweight (BMI between 25.0 and 29.9), and 14.2% obese (BMI > or = 30). Waist circumference measurement showed that 45.6% of the sample suffers increased cardiovascular health risks associated with high waist circumference. The overall overweight/obesity prevalence increased from 49.6% (in 1995-1998) to 53.6% (in 2003-2005). These data suggest that although obesity was identified as a public health problem one decade ago, action to reduce it does not seem to have been very effective to date. Well-defined public health intervention must be targeted to specific population groups where higher levels of obesity prevalence were found: low socioeconomic level groups and low-education level groups.

Prevalence of obesity in Portugal.

Obesity is a serious health problem in developed countries. Knowledge of reliable and nationwide representative data is a must for any public health action. The dimension of this problem in Portugal was first assessed in 1995-1998. A similar populational survey using objective anthropometric measures is now being conducted (field work started in January 2003). A total of 6411 subjects aged 18-64 years old have already been measured and their respective body mass indexes (BMIs) calculated. Results from 2003 to 2005 show 38.6% is overweight and 13.8% has obesity. The total of overweight and obesity is 52.4%. In 1995-1998 survey, overweight was 35.2% and obesity was 14.4%. The total was 49.6%. These results suggest an increase of the overweight/obesity (altogether) prevalence in the last 10 years. Actual results show that more than half of the adult sample has excessive weight and 2.4% of the sample has low BMI. Finally, 45.6% of the sample suffers increased health risks because of high waist circumference (> or =80 cm for women; > or =94 cm for men). These results highlight the fact that, although obesity was identified as a public health problem one decade ago, action to reduce it does not seem to have been very effective to date.

[Cognitive effects of therapy with topiramate in patients with refractory partial epilepsy]. / Efectos cognitivos del tratamiento con topiramato en pacientes con epilepsia parcial refractaria.

INTRODUCTION: Multiple studies have demonstrated that antiepileptic drug therapy may have consequences on cognitive function. Topiramate (TPM) is a new antiepileptic drug characterized by several mechanisms of action, which has proved to be clinically effective in the reduction of the quantity of crisis in epileptic patients. Clinical studies frequently report subjective cognitive complains, inconsistently sustained. The main objective of this study was to assess neuropsychological effects attributable to the addition of TPM to the current antiepileptic therapy, in patients with refractory partial epilepsy. PATIENTS AND METHODS: 44 patients were assessed through a cognitive battery applied before beginning of therapy with TPM and 6 months after the dosage had been stabilized. Tests had been chosen to assess verbal and non verbal memory, executive functions, language, visuomotor processing and psychomotor functions. The cognitive study was conducted in parallel with clinical trials TOPMAT-EPAJ-111 and TOP-POR1. RESULTS: The statistical analysis of results didn t show changes in motor tests, in sustained attention and in logical and visual memory. Deterioration of semantic verbal fluency, verbal learning, work memory and visuomotor skills was observed. Considering the effects of the dosage of topiramate and the total quantity of antiepileptic drugs, major commitment was observed in patients taking more than 400 mg/day. CONCLUSIONS: Like other antiepileptic drugs, topiramate, used in polytherapy in patients with refractory epilepsy, may have consequences on cognitive functions. These changes may be related with the potentiating action of this drug at the level of neurotransmission system of gamma amino butyric acid (GABA), substance that has inhibitory properties in the fore regions of the brain.

[Epidemiology of anorexia nervosa. Prevalence of anorexia nervosa in female adolescents from the districts of Lisboa and Setubal]. / Epidemiologia da anorexia nervosa. Prevalência da anorexia nervosa em adolescentes do sexo feminino nos distritos de Lisboa e Setúbal.

UNLABELLED: Prevalence studies of anorexia nervosa (AN) have shown differences depending of the country and method applied. The partial syndrome is being emphasized. There has been no epidemiological study done on AN in the Portuguese population of continental Portugal. Our objectives were: 1) to study the prevalence of AN in Portuguese populations; 2) to study the presence of partial syndrome and of body image disturbance; 3) to calculate the number of girls dieting; 4) to correlate with other variables. A population of 2,398 girls ranging 10 to 21 years old, from 30 State secondary schools in the Lisbon and Setubal districts were studied. A questionnaire was answered with questions allowing assessment of all DSM IIIR criteria for AN. RESULTS: Prevalence of AN--0.37%, partial syndrome--12.6%, body image disturbance without weight loss--7%, wish to decrease weight in normal or low weight girls--38%, overweight--15.3%, the peak of age for AN was 15 years, the most prevalent socio-economic class for AN was 2 (scale 1 (higher) to 5). School performance was worse with AN and the age menarche was sooner.

Influence of learning to read and write on the morphology of the corpus callosum.

Variations in the individual anatomy of the corpus callosum have been reported in several conditions. There seem to be genetic influencing factors, but it is impossible to rule out some environmental ones. This study focuses on the question of the environmental factors, using formal learning to read and write as the main difference in the groups to be compared. Based on magnetic resonance imaging sagital images, the contour of the corpus callosum (CC) of 41 carefully selected women (18 illiterate and 23 literate) was digitized. The comparison between the two groups showed a small difference in the region of the CC where parietal fibres are thought to cross. This region is thinner in illiterate subjects. As illiteracy in this group is the result of social constraints, and the two groups that were compared are well matched for other cultural and pragmatic aspects than literacy, the results are interpreted as showing the possible influence of formal learning to read and write, on the biological development of the brain.

[Health behaviors in Portugal. Epidemiological studies]. / Comportamentos na saúde em Portugal. Alguns estudos epidemiológicos.

It is necessary to evaluate habitudes and behaviours in health in Portugal. The purpose of this review is to analyse some portuguese epidemiological studies. CINDI-Portugal, ERICA-Portugal and the National Health Inquiry were national studies regarding multiple health data. Nutritional attitudes and practices have been evaluated since 1940. The National Food Study and the Study of Prevalence of Obesity in Portugal studied Portuguese nutritional attitudes. There are studies of the prevalence of eating disorders i school populations. Some research about the association between food and disease is reported. The Portuguese Food Balance is reviewed. Some methodological problems are pointed out and the results discussed. The results of Portuguese studies suggest that our country is in danger of errors in the course of consumption attitudes.

[Characterization of leukocytes, lymphocytes and lymphocyte subsets in eating disorders]. / Caractérisation des leucocytes, lymphocytes et populations lymphocytaires dans les maladies du comportement alimentaire.

Mental anorexia patients have severe denutrition and high cortisol levels. Nervous bulimia presents a particular psychic profile. The aim of this study was to evaluate lymphocyte population in eating disorders in order to understand the effect of these disturbances on immune system. We have found that patients with mental anorexia or bulimia present a significant decrease of leucocytes, lymphocytes, CD2 and CD4. Patients with post-anorexia bulimia have no significant variants. There is no difference between mental anorexia and nervous bulimia. There is a tendential variation between mental anorexia and controls in relation to CD45Ra. Considering the similar patterns of immune disturbance in anorexia and bulimia it looks like a dominance of neuroimmune network over malnutrition. Naive cells are particularly sensitive to malnutrition.

[Obesity and dyslipidemia. Nature of an association]. / Obesidade e dislipidemia. Natureza de uma associação.

Obesity is commonly associated with hyperlipidemia on the basis of clinical and epidemiological studies, but the mechanisms of that relationship are not well understood. To evaluate the contribution of obesity to fasting levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG), we retrospectively analyzed data of 209 patients (175 women and 34 men) attending our outpatient clinic to lose weight. Hyperlipidemia, namely hypertriglyceridemia and low levels of HDL-C, was more frequent in more advanced grades of obesity. Fifty per cent of men with moderate obesity were found to have hypertriglyceridemia and 41.6% showed low levels of HDL-C. However, the relationship between obesity and hyperlipidemia is confounded by age and is not significant when body mass index (BMI) is correct for age. After this correction, we only found a significant correlation (r = 0.93, p = 0.01) between BMI and hypertriglyceridemia in female patients. We conclude that hyperlipidemia and obesity are associate but their relationship is weak and influenced by age. Also important in this relationship seems to be the distribution of body fat.