Openness and age influence cognitive progression: a longitudinal study.

BACKGROUND: Some psychological and personality characteristics of individuals seem to determine behavioral patterns that are associated with better health throughout life and, consequently, prevent the progression of early cognitive changes to dementia. OBJECTIVE: To identify which individuals have modified cognitive ratings after 24 months of follow-up and correlating with personality traits. METHODS: One hundred and two volunteers were evaluated clinically and for personality characteristics and neuropsychological testing. Of these, 25 subjects were classified as cognitively normal (CN), 25 as subjective cognitive decline (SCD), 28 as nonamnestic mild cognitive impairment (naMCI), and 24 as amnestic mild cognitive impairment (amMCI) at baseline. Follow-up occurred over 2 years from the initial assessment, and the cognitive categories of the participants were re-analyzed every 6 months to observe differences in their classification. RESULTS: Out of the 102 subjects, 65 remained at follow-up. The sample followed-up longitudinally was composed predominantly of women (65%), white (74%), with a mean age of 78 (±7.5) years old and 12 (±4.8) years of schooling. Throughout the process, 23% of CN, 15% of SDC, and 27% of naMCI individuals worsened cognitively. Amnestic with mild cognitive impairment volunteers remained stable or improved. Individuals with older age show more significant cognitive deterioration, and those with very low or high rates of the openness personality trait are associated with cognitive decline utilizing the Fisher exact test, probably because the open extremes influence choices, stress management, and behavioral maintenance. CONCLUSION: The factors most associated with cognitive change in this group of older adults were age and the intensity of the openness aspects of personality.

ANTECEDENTES: Algumas características psicológicas e de personalidade determinam padrões comportamentais que se associam a uma melhor saúde ao longo da vida e, consequentemente, impedem a progressão de alterações cognitivas para demência. OBJETIVO: Identificar quais indivíduos modificaram cognitivamente após 24 meses de acompanhamento e correlacionar com traços de personalidade. MéTODOS: 102 voluntários foram avaliados clinicamente por características de personalidade e testes neuropsicológicos. Destes, 25 indivíduos foram classificados como cognitivamente normais (CN), 25 como com declínio cognitivo subjetivo (DCS), 28 com comprometimento cognitivo leve não amnéstico (CCLNa) e 24 com comprometimento cognitivo leve amnéstico (CCLAm) no início do estudo. O acompanhamento ocorreu ao longo de 2 anos a partir da avaliação inicial, e as categorias cognitivas dos participantes foram reanalisadas a cada 6 meses para observar diferenças em sua classificação. RESULTADOS: Dos 102 indivíduos, 65 permaneceram em acompanhamento. A amostra acompanhada longitudinalmente foi composta predominantemente por mulheres (65%), brancas (74%), com média de idade de 78 (±7,5) anos e 12 (±4,8) anos de escolaridade. Ao longo do processo, 23% dos indivíduos CN, 15% dos DCS e 27% dos indivíduos CCLNa pioraram cognitivamente. Os voluntários CCLAm permaneceram estáveis ou melhoraram. Indivíduos com idade mais avançada apresentam deterioração cognitiva mais significativa, e aqueles com taxas muito baixas ou altas do traço de personalidade abertura estão associados ao declínio cognitivo utilizando o teste exato de Fisher. Provavelmente, a característica abertura influencia as escolhas, o gerenciamento do estresse e a manutenção do comportamento. CONCLUSãO: Os fatores mais associados à alteração cognitiva neste grupo de idosos foram a idade e a intensidade dos aspectos abertura da personalidade.

Translation, cross-cultural adaptation, and validity of the Brazilian version of the Cognitive Function Instrument.

Subjective cognitive decline (SCD) is defined as a self-perception of a progressive cognitive impairment, which is not detected objectively through neuropsychological tests. The Alzheimer's Disease Cooperative Study developed the Cognitive Function Instrument (CFI) to evaluate individuals with SCD. The CFI consists of two versions, namely, a self-report and a partner report. Objective: This study aimed to translate CFI into Brazilian Portuguese, perform a cross-cultural adaptation, and validate the Brazilian version. Methods: The translation and transcultural adaptation process consisted of six stages, and the preliminary version was answered by a sample of individuals recruited among the patients' caregivers from a cognitive neurology outpatient clinic. Finally, the final Brazilian version of the CFI was applied to a sample of nondemented older adults to validate the instrument, which was divided into with and without SCD, according to the answer "yes" for the question: "Do you feel like your memory is becoming worse?". Results: The final version of CFI showed a high level of acceptability as an assessment tool in nondemented older adults. Participants with SCD had higher scores in the CFI self-report compared with those without complaints. In the receiver operating characteristic curve analysis, the area under the curve of the CFI self-report was 0.865 (95% confidence interval 0.779-0.951), and the cutoff score of 2.0 was the one that best distinguished the SCD group from the control group, with a sensitivity of 73.3% and a specificity of 81.5%. Conclusions: CFI proved to be an instrument with good accuracy and easy applicability to identify older adults with SCD.

O declínio cognitivo subjetivo (DCS) é definido como uma autopercepção de um comprometimento cognitivo progressivo, não detectado objetivamente por meio de testes neuropsicológicos. O Alzheimer's Disease Cooperative Study desenvolveu o instrumento de função cognitiva (IFC) para avaliar indivíduos com DCS. O IFC existe em duas versões, uma do paciente e outra do acompanhante. Objetivo: O objetivo deste estudo foi traduzir para o português brasileiro, fazer uma adaptação transcultural e validar a versão brasileira do IFC. Métodos: O processo de tradução e adaptação transcultural consistiu em seis etapas, e a versão preliminar foi respondida por uma amostra de voluntários recrutados entre os cuidadores de pacientes de um ambulatório de Neurologia Cognitiva. Por fim, a versão brasileira final do IFC foi aplicada a idosos sem demência, que foram divididos naqueles com e sem DCS de acordo com a resposta "sim" à questão: "Você sente que a sua memória está piorando?". Resultados: A versão final do IFC mostrou alto nível de aceitabilidade como ferramenta de avaliação em idosos sem demência. Os participantes com DCS tiveram pontuações mais altas na versão do paciente em comparação com aqueles sem queixas. Nas análises da curva característica de operação do receptor (ROC), a área sobre a curva da versão do paciente foi de 0,865 (intervalo de confiança [IC95%] 0,779­0,951) e a pontuação de corte de 2,0 foi a que melhor distinguiu o grupo com DCS dos controles, com sensibilidade de 73,3% e especificidade de 81,5%. Conclusões: O IFC mostrou-se um instrumento de boa acurácia e de fácil aplicabilidade para identificar idosos com DCS.

COMVC-19: A Program to protect healthcare workers' mental health during the COVID-19 Pandemic. What we have learned.

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

"The Italian Study on Recovery 2" Phase 1: Psychometric Properties of the Recovery Assessment Scale (RAS), Italian Validation of the Recovery Assessment Scale.

BACKGROUND: The achievement of recovery is related to the notion of developing personal potential and restoring a legitimate social role, even against the backdrop of mental illness limitations. It is still difficult to fully understand this highly subjective and dynamic process. Therefore, in order to test the recovery process, specific tools, still only marginally used in our country, are needed. AIMS: The Italian Study on Recovery is the first study aimed at confirming the validity of the Italian version of the Recovery Assessment Scale (RAS), an instrument developed with the goal of detecting recovery among patients. METHOD: This multicentric research involved several Mental Health Services from various parts of Italy. The first phase of the study consisted in the administration of the Italian translation of RAS, previously used in a pilot study conducted in 2009. RAS was administered to 219 patients diagnosed with psychosis, whose mental disorder lasted for at least 5 years. RESULTS: Findings supported the good psychometric properties of the Italian version of RAS, demonstrating its capability of identifying patients matching the "in recovery" operational criteria. CONCLUSIONS: In consideration of the results highlighting the good psychometric properties of RAS, the present study may contribute to the diffusion of instruments to be included in Mental Health Service planning in the Italian context, in order to start a recovery-oriented transformation.

Openness and age influence cognitive progression: a longitudinal study / Abertura e idade influenciam a progressão de cognição: um estudo longitudinal

Abstract Background Some psychological and personality characteristics of individuals seem to determine behavioral patterns that are associated with better health throughout life and, consequently, prevent the progression of early cognitive changes to dementia. Objective To identify which individuals have modified cognitive ratings after 24 months of follow-up and correlating with personality traits. Methods One hundred and two volunteers were evaluated clinically and for personality characteristics and neuropsychological testing. Of these, 25 subjects were classified as cognitively normal (CN), 25 as subjective cognitive decline (SCD), 28 as nonamnestic mild cognitive impairment (naMCI), and 24 as amnestic mild cognitive impairment (amMCI) at baseline. Follow-up occurred over 2 years from the initial assessment, and the cognitive categories of the participants were re-analyzed every 6 months to observe differences in their classification. Results Out of the 102 subjects, 65 remained at follow-up. The sample followed-up longitudinally was composed predominantly of women (65%), white (74%), with a mean age of 78 (±7.5) years old and 12 (±4.8) years of schooling. Throughout the process, 23% of CN, 15% of SDC, and 27% of naMCI individuals worsened cognitively. Amnestic with mild cognitive impairment volunteers remained stable or improved. Individuals with older age show more significant cognitive deterioration, and those with very low or high rates of the openness personality trait are associated with cognitive decline utilizing the Fisher exact test, probably because the open extremes influence choices, stress management, and behavioral maintenance. Conclusion The factors most associated with cognitive change in this group of older adults were age and the intensity of the openness aspects of personality.

Resumo Antecedentes Algumas características psicológicas e de personalidade determinam padrões comportamentais que se associam a uma melhor saúde ao longo da vida e, consequentemente, impedem a progressão de alterações cognitivas para demência. Objetivo Identificar quais indivíduos modificaram cognitivamente após 24 meses de acompanhamento e correlacionar com traços de personalidade. Métodos 102 voluntários foram avaliados clinicamente por características de personalidade e testes neuropsicológicos. Destes, 25 indivíduos foram classificados como cognitivamente normais (CN), 25 como com declínio cognitivo subjetivo (DCS), 28 com comprometimento cognitivo leve não amnéstico (CCLNa) e 24 com comprometimento cognitivo leve amnéstico (CCLAm) no início do estudo. O acompanhamento ocorreu ao longo de 2 anos a partir da avaliação inicial, e as categorias cognitivas dos participantes foram reanalisadas a cada 6 meses para observar diferenças em sua classificação. Resultados Dos 102 indivíduos, 65 permaneceram em acompanhamento. A amostra acompanhada longitudinalmente foi composta predominantemente por mulheres (65%), brancas (74%), com média de idade de 78 (±7,5) anos e 12 (±4,8) anos de escolaridade. Ao longo do processo, 23% dos indivíduos CN, 15% dos DCS e 27% dos indivíduos CCLNa pioraram cognitivamente. Os voluntários CCLAm permaneceram estáveis ou melhoraram. Indivíduos com idade mais avançada apresentam deterioração cognitiva mais significativa, e aqueles com taxas muito baixas ou altas do traço de personalidade abertura estão associados ao declínio cognitivo utilizando o teste exato de Fisher. Provavelmente, a característica abertura influencia as escolhas, o gerenciamento do estresse e a manutenção do comportamento. Conclusão Os fatores mais associados à alteração cognitiva neste grupo de idosos foram a idade e a intensidade dos aspectos abertura da personalidade.

Superwellness Program: a cognitive-behavioral therapy-based group intervention to reduce weight gain in patients treated with antipsychotic drugs.

OBJECTIVE:: To assess the effectiveness of a cognitive-behavioral therapy-based intervention (Superwellness Program) on weight gain compared with a treatment-as-usual (TAU) approach in patients treated with antipsychotics, and to evaluate the relationship between body mass index (BMI) variation and clinical variables. METHOD:: Eighty-five patients treated with antipsychotics were allocated across two groups, experimental (n=59) and control (n=26). The Superwellness Program (experimental group) consisted of 32 twice-weekly 1-hour sessions, conducted by a psychologist and a nutritionist/nurse, concurrently with moderate food intake and moderate physical activity plans. Sociodemographic, clinical, and biological variables were collected at baseline, at the end of intervention (16 weeks), and after 6 months. RESULTS:: BMI change from baseline differed significantly between the experimental and control groups, with a larger decrease in the experimental group (F = 5.5, p = 0.021). Duration of illness moderated the effect of treatment on BMI (p = 0.026). No significant (p = 0.499) effect of intervention during the follow-up period was found. Interestingly, the intervention indirectly induced a significant (p = 0.024) reduction in metabolic risk by reducing BMI. CONCLUSION:: A cognitive-behavioral therapy-based intervention could be useful in reducing weight in a clinical population taking antipsychotics, with consequent benefit to physical and mental health.

[Health care in groups from the perspective of the elderly]. / Atenção à saúde em grupos sob a perspectiva dos idosos.

This study aimed to describe and analyze the activities in elderly groups at basic health care units. Suffering from chronic-degenerative diseases, the elderly need continuous and more frequent health care. This can be facilitated by group actions, privileging educational activities. We found great diversity in methods, responsible teams and group composition. As to the patients, this activity allows for a better understanding and acceptance of the illness, as well as for the recovery of social roles and the occupation of leisure time. For services, the groups permit increased bonding. However, this requires training and permanent education for professionals, with a view to a significant dialogue. The increasing tendency of these actions in Campinas/SP is accompanying the guidelines of the Family Health PAIDEIA project. The group is a possible and privileged space to apply the PAIDEIA method.

COMVC-19: A Program to protect healthcare workers' mental health during the COVID-19 Pandemic. What we have learned

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

Superwellness Program: a cognitive-behavioral therapy-based group intervention to reduce weight gain in patients treated with antipsychotic drugs

Objective: To assess the effectiveness of a cognitive-behavioral therapy-based intervention (Superwellness Program) on weight gain compared with a treatment-as-usual (TAU) approach in patients treated with antipsychotics, and to evaluate the relationship between body mass index (BMI) variation and clinical variables. Method: Eighty-five patients treated with antipsychotics were allocated across two groups, experimental (n=59) and control (n=26). The Superwellness Program (experimental group) consisted of 32 twice-weekly 1-hour sessions, conducted by a psychologist and a nutritionist/nurse, concurrently with moderate food intake and moderate physical activity plans. Sociodemographic, clinical, and biological variables were collected at baseline, at the end of intervention (16 weeks), and after 6 months. Results: BMI change from baseline differed significantly between the experimental and control groups, with a larger decrease in the experimental group (F = 5.5, p = 0.021). Duration of illness moderated the effect of treatment on BMI (p = 0.026). No significant (p = 0.499) effect of intervention during the follow-up period was found. Interestingly, the intervention indirectly induced a significant (p = 0.024) reduction in metabolic risk by reducing BMI. Conclusion: A cognitive-behavioral therapy-based intervention could be useful in reducing weight in a clinical population taking antipsychotics, with consequent benefit to physical and mental health.

Atenção à saúde em grupos sob a perspectiva dos idosos / Health care in groups from the perspective of the elderly

Este estudo objetivou descrever e analisar as atividades em grupos de idosos em unidades básicas de saúde. Portador de múltiplos transtornos, o idoso requer cuidados contínuos e freqüentes dos serviços de saúde, o que pode ser facilitado pelas ações em grupos, privilegiando a ação educativa. Observou-se grande diversidade de métodos, equipes responsáveis e composição dos grupos. Em relação aos idosos constatou-se que essa atividade permite a sua melhor compreensão e aceitação do adoecimento, bem como a retomada de papéis sociais e a ocupação do tempo livre. Para os serviços, os grupos possibilitam a ampliação do vínculo, requerendo, entretanto, a capacitação e educação permanente dos profissionais no sentido de possibilitar um diálogo significativo. A tendência de aumento dessas ações em Campinas-SP vem acompanhando as diretrizes do projeto PAIDÉIA de Saúde da Família, sendo o grupo um espaço possível e privilegiado de aplicação do "método da roda"

Idosos em cena: falas do adoecer / Senior citizens in the limelight: the discourses of illness

Tendo por preocupação a melhor qualidade e resolutividade na atenção à saúde dos idosos e sabendo serem eles portadores de um quadro de múltipla morbidade de difícil controle e prevenção, buscou-se conhecer este problema sob a perspectiva dos próprios sujeitos: seu entendimento acerca do processo de adoecimento e dos cuidados necessários. Por meio de estudo qualitativo, constatou-se que a percepção do adoecer entre os idosos fundamenta-se em seu contexto de vida e na referência da capacidade para o trabalho. Foram demonstrados o acesso a serviços de saúde e o conhecimento técnico das enfermidades, descritas pela presença de sinais e sintomas, e fatores causais e associados. Entretanto, enquanto experiências pessoais que incorporam vivências de cuidado, as narrativas necessitam ser compartilhadas, analisando-se suas mediações o que permitiria aos profissionais de saúde uma aproximação ao contexto do adoecer e do envelhecer, e ao processo de aceitação e, assim, a um cuidado integral e fundado na busca de autonomia.

Idosos e cuidadores fragilizados? / Fragile Elderly and Care-Takers?

Na atenção à saúde de idosos fragilizados faze-se necessária a presença do cuidador e da assistência domiciliar. Este trabalho descreve as percepções acerca das necessidades e dificuldades de um grupo de idosos e seus cuidadores no que concerne ao estado de interdependência, em especial aos aspectos emocionais que interferem na qualidade de vida. Foram realizadas entrevistas domiciliares de agosto a novembro de 2003 com 90 famílias sob atenção domiciliar oferecida por Unidades Básicas e de Saúde da Família de Campinas/SP. Os idosos, 41 homens e 49 mulheres, apresentavam, em média, 77 anos de idade; os homens em sua maioria eram casados e as mulheres viúvas; em grande porcentagem analfabetos e com baixa renda familiar; 28 com dependência leve e 62 moderada ou grave, apresentando dificuldades relativas a locomoção, realização de atividades e perda de autonomia; queixas de tristeza, preocupação e impotência, potencializadas pelo grau e amenizadas pelo tempo de dependência. Quanto aos cuidadores, a maioria era de filhas que referiram dificuldades relacionadas às atividades cotidianas próprias e no lidar com idosos, e como queixas: depressão, cansaço e preocupação, demonstrando ser o grau de dependência fator agravante, e o tempo protetor. Em estado de dependência acumulam-se dificuldades econômico-sociais, de acesso a serviços, físicas e emocionais, que fragilizam idosos e cuidadores. tais necessidades, em parte, vêm sendo supridas pela atenção domiciliar realizada pelas equipes de saúde da família e rede social de apoio, identificando-se, entretanto, a necessidade de maior atenção aos cuidadores.