Bayesian Networks for Prescreening in Depression: Algorithm Development and Validation.

BACKGROUND: Identifying individuals with depressive symptomatology (DS) promptly and effectively is of paramount importance for providing timely treatment. Machine learning models have shown promise in this area; however, studies often fall short in demonstrating the practical benefits of using these models and fail to provide tangible real-world applications. OBJECTIVE: This study aims to establish a novel methodology for identifying individuals likely to exhibit DS, identify the most influential features in a more explainable way via probabilistic measures, and propose tools that can be used in real-world applications. METHODS: The study used 3 data sets: PROACTIVE, the Brazilian National Health Survey (Pesquisa Nacional de Saúde [PNS]) 2013, and PNS 2019, comprising sociodemographic and health-related features. A Bayesian network was used for feature selection. Selected features were then used to train machine learning models to predict DS, operationalized as a score of ≥10 on the 9-item Patient Health Questionnaire. The study also analyzed the impact of varying sensitivity rates on the reduction of screening interviews compared to a random approach. RESULTS: The methodology allows the users to make an informed trade-off among sensitivity, specificity, and a reduction in the number of interviews. At the thresholds of 0.444, 0.412, and 0.472, determined by maximizing the Youden index, the models achieved sensitivities of 0.717, 0.741, and 0.718, and specificities of 0.644, 0.737, and 0.766 for PROACTIVE, PNS 2013, and PNS 2019, respectively. The area under the receiver operating characteristic curve was 0.736, 0.801, and 0.809 for these 3 data sets, respectively. For the PROACTIVE data set, the most influential features identified were postural balance, shortness of breath, and how old people feel they are. In the PNS 2013 data set, the features were the ability to do usual activities, chest pain, sleep problems, and chronic back problems. The PNS 2019 data set shared 3 of the most influential features with the PNS 2013 data set. However, the difference was the replacement of chronic back problems with verbal abuse. It is important to note that the features contained in the PNS data sets differ from those found in the PROACTIVE data set. An empirical analysis demonstrated that using the proposed model led to a potential reduction in screening interviews of up to 52% while maintaining a sensitivity of 0.80. CONCLUSIONS: This study developed a novel methodology for identifying individuals with DS, demonstrating the utility of using Bayesian networks to identify the most significant features. Moreover, this approach has the potential to substantially reduce the number of screening interviews while maintaining high sensitivity, thereby facilitating improved early identification and intervention strategies for individuals experiencing DS.

Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth / Uso do WhatsApp por idosos depressivos em áreas socioeconomicamente carentes de Guarulhos, São Paulo, Brasil: desafios e possibilidades para a telessaúde / Uso de WhatsApp por ancianos deprimidos en áreas desfavorecidas socioeconómicamente en Guarulhos, São Paulo, Brasil: retos y posibilidades de la telesalud

This study aimed to investigate the relationship between sociodemographic characteristics, depressive symptomatology, mobile phone ownership, and different uses of WhatsApp among older adults enrolled in primary care clinics in Guarulhos, São Paulo State, Brazil. This is a secondary data analysis, using data collected in the screening of participants to be included in the PROACTIVE cluster randomized trial. Individuals aged ≥ 60 years, registered in primary care clinics in Guarulhos, were assessed for sociodemographic characteristics, depressive symptoms according to the PHQ-9, mobile phone ownership, and use of WhatsApp. We performed multiple logistic regression models to investigate characteristics of the potential users of digital interventions. Of 3,356 older adults screened for depression, 45.7% said they use WhatsApp to receive/send messages. In the subsample that presented depressive symptomatology (n = 1,020), 41.9% stated using WhatsApp. Younger older adults and those with better socioeconomic status used more WhatsApp and were more likely to own a mobile phone. Participants with higher levels of symptoms of depression were less likely to use WhatsApp. Gender, age, schooling level, income, and depressive symptomatology are variables associated with the possession of a cell phone and with the use of WhatsApp by the older adults of the sample. These findings can help to implement digital health programs better suited to disadvantaged populations in Brazil and other low- and middle-income countries through mental telehealth interventions using WhatsApp and mobile health services to the older people.

Este estudo teve como objetivo investigar a relação entre características sociodemográficas, sintomatologia depressiva, posse de telefone celular e diferentes usos do WhatsApp entre idosos cadastrados em unidades básicas de saúde de Guarulhos, São Paulo, Brasil. Trata-se de uma análise de dados secundários com informações coletadas na triagem dos participantes a serem incluídos neste estudo randomizado em cluster PROATIVO. Indivíduos com 60 anos ou mais, cadastrados em unidades básicas de saúde de Guarulhos, foram avaliados quanto a características sociodemográficas, sintomas depressivos, de acordo com o PHQ-9, posse de telefone celular e uso do WhatsApp. Foram utilizados modelos de regressão logística múltipla para investigar as características dos potenciais usuários de intervenções digitais. Dos 3.356 idosos depressivos, 45,7% usavam o WhatsApp para receber/enviar mensagens. Na subamostra que apresentou sintomatologia depressiva (n = 1.020), 41,9% disseram usar o WhatsApp. Adultos mais jovens e com melhor status socioeconômico usavam mais o WhatsApp e eram mais propensos a possuir um telefone celular. Participantes com níveis mais altos de sintomas de depressão eram menos propensos a utilizar o WhatsApp. Sexo, idade, escolaridade, renda e sintomatologia depressiva são variáveis associadas à posse de telefone celular e ao uso do WhatsApp pelos idosos da população estudada. Esses achados podem ajudar a implementar programas de saúde digital mais adequados para populações desfavorecidas no Brasil e em outros países de baixa e média renda, principalmente intervenções de telessaúde mental que utilizem o WhatsApp e serviços móveis de saúde para idosos.

Este estudio tuvo como objetivo determinar la relación entre las características sociodemográficas, los síntomas depresivos, la tenencia de teléfono celular y los diferentes usos de WhatsApp entre los ancianos inscritos en unidades básicas de salud en Guarulhos, São Paulo, Brasil. Este es un análisis de datos secundarios, que recopiló la información del triaje de los participantes a ser incluidos en este estudio aleatorio en un clúster PROACTIVO. Se evaluaron las características sociodemográficas, los síntomas depresivos según el PHQ-9, la tenencia de celular y el uso de WhatsApp de los participantes de 60 años o más, registrados en unidades básicas de salud de Guarulhos. Se utilizaron los modelos de regresión logística múltiple para identificar las características de los potenciales usuarios de las intervenciones digitales. De los 3.356 ancianos deprimidos, el 45,7% utilizaba WhatsApp para recibir/enviar mensajes. En la submuestra que presentó síntomas depresivos (n = 1.020), el 41,9% dijo usar WhatsApp. Los adultos más jóvenes con mejor nivel socioeconómico usaban más WhatsApp y tenían más probabilidades de tener un teléfono celular. Los participantes con niveles más altos de síntomas de depresión tenían menos probabilidades de usar WhatsApp. El sexo, la edad, la educación, la renta y los síntomas depresivos fueron las variables asociadas a la tenencia de celular y al uso de WhatsApp por parte de los ancianos de la población estudiada. Estos hallazgos pueden ayudar a implementar programas de salud digital que sean más adecuados para las poblaciones desfavorecidas en Brasil y en otros países de bajos y medianos ingresos, en particular las intervenciones de telesalud mental que utilizan WhatsApp y servicios de salud móviles para ancianos.

Differences in total brain volume between sexes in a cognitively unimpaired elderly population

OBJECTIVES: Although a large number of studies have shown brain volumetric differences between men and women, only a few investigations have analyzed brain tissue volumes in representative samples of the general elderly population. We investigated differences in gray matter (GM) volumes, white matter (WM) volumes, and intracranial volumes (ICVs) between the sexes in individuals older than 66 years using structural magnetic resonance imaging (MRI). METHODS: Using FreeSurfer version 5.3, we obtained the ICVs and GM and WM volumes from the MRI datasets of 84 men and 92 women. To correct for interindividual variations in ICV, GM and WM volumes were adjusted with a method using the residuals of a least-square-derived linear regression between raw volumes and ICVs. We then performed an analysis of covariance comparing men and women, including age and years of schooling as confounding factors. RESULTS: Women had a lower socioeconomic status overall and fewer years of schooling than men. The comparison of unadjusted brain volumes showed larger GM and WM volumes in men. After the ICV correction, the adjusted volumes of GM and WM were larger in women. CONCLUSION: After the ICV correction and taking into account differences in socioeconomic status and years of schooling, our results confirm previous findings of proportionally larger GM in women, as well as larger WM volumes. These results in an elderly population indicate that brain volumetric differences between sexes persist throughout the aging process. Additional studies combining MRI and other biomarkers to identify the hormonal and molecular bases influencing such differences are warranted.

High frequency of silent brain infarcts associated with cognitive deficits in an economically disadvantaged population

OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.

Prevalence of Depression and Depression Care for Populations Registered in Primary Care in Two Remote Cities in the Brazilian Amazon.

BACKGROUND: The prevalence of depression has been widely studied in high-income countries and in large cities of low-income countries; however, little is known about the prevalence and treatment gap of depression in remote areas of the Amazonian region in Brazil. OBJECTIVES: The objectives of this study are to estimate the prevalence of depression in adults registered with the Family Health Strategy in two remote cities in the Brazilian Amazon and to investigate the proportion of individuals with depression that received mental health care. METHODS: This is a cross-sectional study of an adult population registered with primary care clinics in the cities of Coari and Tefé, State of Amazon, Brazil. Depression was defined as a score of ≥10 on the Patient Health Questionnaire-9. Depression care was evaluated by asking participants with depression if they received antidepressants and/or had been seen by a health professional at a community mental health center in the three months prior to the interview. Poisson regression was used to examine the unadjusted and adjusted associations between depression and exposure variables. RESULTS: The overall prevalence of depression was 19.1% (95% CI: 17.2-21.1), with 22.2% (95% CI: 19.3-25.0) among women and 16.0% (95% CI: 13.4-18.5) among men. The prevalence of depression in Coari and Tefé were 18.3% (CI 95% 15.7-21.0) and 19.9% (95% CI:17.2-22.7), respectively. Being a woman, lacking social support, increasing exposure to stressful life events and having a higher number medical comorbidities were consistently associated with depression. Lower educational attainment and income, tobacco use, and risky alcohol use were also associated with depression in the unadjusted analyses. Only 11.5% of those with depression were receiving antidepressants and/or visited the mental health care facility during the three months prior to the interview. CONCLUSION: Approximately one in five adults in our sample had depression. A high proportion of participants presented indicators of social disadvantage and other risk factors previously associated with depression worldwide. There was a large treatment gap for depression in the Amazonian region, which demonstrates the need for innovative models of depression care in primary care settings in Brazil.

Prevalência de transtornos mentais comuns e contexto social: análise multinível do São Paulo Ageing & Health Study (SPAH) / Prevalence of common mental disorders and the relationship to the social context: multilevel analysis of the São Paulo Ageing & Health Study (SPAH) / Prevalencia de trastornos mentales comunes y contexto social: análisis multinivel del São Paulo Ageing & Health Study (SPAH)

O contexto social pode ter papel importante na etiologia dos transtornos mentais e na sua prevalência. O objetivo do presente estudo foi investigar fatores de risco que contribuem para a prevalência de transtornos mentais comuns (TMC), considerando distintos níveis contextuais: indivíduo, domicílio e setor censitário. Para isso, utilizou-se uma amostra de base populacional de 2.366 indivíduos participantes do São Paulo Ageing & Health Study. A presença de TMC foi identificada pelo instrumento SRQ-20. Sexo, idade, escolaridade e ocupação foram características individuais associadas à prevalência de TMC. Modelos de regressão logística multinível mostraram que parte da variância na prevalência de TMC foi associada ao nível do domicílio, com associações entre aglomeração, renda familiar e prevalência de TMC, mesmo após controle para características individuais. Esses resultados sugerem que características do ambiente onde as pessoas vivem contribuem para sua saúde mental.

Social context can play a important role in the etiology and prevalence of mental disorders. The aim of the present study was to investigate risk factors for common mental disorders (CMD), considering different contextual levels: individual, household, and census tract. The study used a population-based sample of 2,366 respondents from the São Paulo Ageing & Health Study. Presence of CMD was identified by the SRQ-20. Sex, age, education, and occupation were individual characteristics associated with prevalence of CMD. Multilevel logistic regression models showed that part of the variance in prevalence of CMD was associated with the household level, showing associations between crowding, family income, and CMD, even after controlling for individual characteristics. These results suggest that characteristics of the environment where people live can influence their mental health status.

El contexto social puede tener un importante papel en la etiología de los trastornos mentales y en su prevalencia. El objetivo del presente estudio fue investigar factores de riesgo que contribuyen a la prevalencia de trastornos mentales comunes (TMC), considerando distintos niveles contextuales: individuo, domicilio y área de censo. Para ello se utilizó una muestra de base poblacional con 2.366 individuos, participantes del São Paulo Ageing & Health Study. La presencia de TMC fue identificada por el instrumento SRQ-20. Sexo, edad, escolaridad y ocupación fueron las características individuales asociadas a la prevalencia de TMC. Los modelos de regresión logística multinivel mostraron que una parte de la variancia en la prevalencia de TMC se asoció al nivel de domicilio, con asociaciones entre aglomeración, renta de la familia y prevalencia de TMC, incluso después del control para características individuales. Estos resultados sugieren que las características del ambiente donde viven las personas contribuyen a su salud mental.

Education and WHO recommendations for fruit and vegetable intake are associated with better cognitive function in a disadvantaged Brazilian elderly population: a population-based cross-sectional study.

Brazil has one of the fastest aging populations in the world and the incidence of cognitive impairment in the elderly is expected to increase exponentially. We examined the association between cognitive impairment and fruit and vegetable intake and associated factors in a low-income elderly population. A cross-sectional population-based study was carried out with 1849 individuals aged 65 or over living in São Paulo, Brazil. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Fruit and vegetable intake was assessed with a Food Frequency Questionnaire (FFQ) and categorized into quartiles of intake and into total daily fruit and vegetable intake using the cut-off points for the WHO recommendations (<400 grams/day or ≥ 400 grams/day). The association between cognitive impairment and each quartile of intake, and WHO recommendation levels, was evaluated in two separate multivariate logistic models. The WHO recommendations for daily intakes ≥ 400 grams/day were significantly associated with 47% decreased prevalence of cognitive impairment. An effect modification was found in both models between cognitive impairment and "years of education and physical activity" and "years of education and blood levels of HDL" So that, having 1 or more years of education and being physically active or having 1 or more years of education and levels higher than 50 mg/dl of HDL-cholesterol strongly decreased the prevalence of cognitive impairment. In this socially deprived population with very low levels of education and physical activity and fruit and vegetable intake, those who attained WHO recommendations, had 1 year or more of education and were physically active had a significantly lower prevalence of cognitive impairment. A more comprehensive understanding of the social determinants of mental health is needed to develop effective public policies in developing countries.

Serum phosphate and hip bone mineral density as additional factors for high vascular calcification scores in a community-dwelling: the São Paulo Ageing & Health Study (SPAH).

OBJECTIVE: To analyze the association between abdominal aortic calcification scores (AACS) and bone metabolism parameters in a well-characterized general population of older adults. BACKGROUND: Several studies suggest a link between bone mineral metabolism disorders and vascular calcification; although only few of them analyze bone mineral density(BMD), laboratory bone markers and cardiovascular parameters at the same time and none were done in a miscegenated population. METHODS: This cross-sectional study included 815 subjects ≥ 65 years old. The risk factors for osteoporosis and cardiovascular disease as well as a wide array of demographic and lifestyle characteristics were collected using a standardized questionnaire. BMD was measured by DXA. Kauppila's method was used to quantify the AAC score (AACS) by spine X-rays. Laboratory analyses were also performed. RESULTS: AAC was observed in 63.2% of subjects with a median AACS of 2 (IQR: 0-7). AACS were categorized in quartiles and the highest quartile of AACS (>7) were compared with the three lower quartiles of AACS (≤ 7). Logistic regression analysis was performed using parameters with statistical significance in the univariate analysis. The best logistic regression model revealed that AACS>7 was negatively associated with femoral neck BMD and positively associated with phosphorus, adjusted by age, current smoking, LDL, and arterial hypertension in the elderly community-dwelling population. CONCLUSIONS: We identified that higher serum phosphate levels and lower hip BMD are independent bone variables that are associated with elevated vascular calcification scores, supporting the search for effective prevention and treatment strategies that may simultaneously reduce these modifiable risk factors in older subjects.

Fibrilação atrial e demência: resultados do São Paulo ageing & health study / Atrial fibrillation and dementia: results from the Sao Paulo ageing & health study

FUNDAMENTO: A fibrilação atrial é um fator de risco controverso para demência. OBJETIVO: O objetivo deste estudo é avaliar a associação entre fibrilação atrial e demência em participantes do São Paulo Ageing & Health. MÉTODOS: O São Paulo Ageing & Health é um estudo transversal, de base populacional, de idosos residentes em um uma região de baixa renda da cidade de São Paulo, Brasil. Diagnóstico de demência foi realizado de acordo com o protocolo do grupo 10/66, com base em critérios do Manual de Diagnóstico e Estatística das Perturbações Mentais (DSM-IV). O diagnóstico de fibrilação atrial foi feito por eletrocardiograma de 12 derivações, avaliado por dois cardiologistas. Dados demográficos e de fatores de risco cardiovasculares também foram obtidos. RESULTADOS: A demência foi diagnosticada em 66 (4,3%) e fibrilação atrial em 36 (2,4%) de 1.524 participantes com um eletrocardiograma válido. A razão de chances bruta para demência em participantes com fibrilação atrial foi 2,8 (intervalo de confiança [IC] 95%: 1,0-8,1; p = 0,06) em comparação com indivíduos sem fibrilação atrial. Relação positiva foi encontrada em mulheres (RC 4,2; IC 95%: 1,2-15,1; p = 0,03). Após ajuste para idade, no entanto, essa associação tornou-se não significativa (RC 2,2, IC 95%: 0,6-8,9; p = 0,26). CONCLUSÃO: Não houve associação independente entre a fibrilação atrial e demência nessa amostra. A prevalência da fibrilação atrial pode ser baixa nesta população em virtude da mortalidade cardiovascular prematura.

BACKGROUND: Atrial fibrillation (AF) is a controversial risk factor for dementia. OBJECTIVE: The objective of this study was to assess the association between AF and dementia in the "Sao Paulo Ageing & Health" (SPAH) study participants. METHODS: SPAH is a cross-sectional, population-based study of elderly people living in a deprived neighborhood in Sao Paulo, Brazil. Dementia diagnosis was performed according to the 10/66 study group protocol based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Diagnosis of AF was made using a 12-lead electrocardiogram (ECG) recording, which was assessed by two cardiologists. Data on demographics and cardiovascular risk factors were also obtained. RESULTS: Dementia was diagnosed in 66 (4.3%) and AF in 36 (2.4%) of 1,524 participants with a valid ECG. The crude odds ratio (OR) for dementia in participants with AF was 2.8 (95% confidence interval [CI]: 1.0-8.1; p=0.06) compared with individuals without AF. When analyzing data according to sex, a positive relationship was found in women (OR 4.2; 95% CI: 1.24-15.1; p=0.03). After age-adjustment, however, this association was no longer significant (OR 2.2; 95% CI: 0.6-8.9; p=0.26). CONCLUSION: There was no independent association between AF and dementia in this sample. The prevalence of AF may be low in this population owing to premature cardiovascular death.

BDNF gene polymorphism, cognition and symptom severity in a Brazilian population-based sample of first-episode psychosis subjects / Polimorfismo do gene do BDNF, cognição e gravidade dos sintomas em uma amostra de base populacional brasileira de indivíduos apresentando o primeiro episódio psicótico

OBJECTIVE: To investigate the influence of brain-derived neurotrophic factor (BDNF) gene variations on cognitive performance and clinical symptomatology in first-episode psychosis (FEP). METHODS: We performed BDNF val66met variant genotyping, cognitive testing (verbal fluency and digit spans) and assessments of symptom severity (as assessed with the PANSS) in a population-based sample of FEP patients (77 with schizophreniform psychosis and 53 with affective psychoses) and 191 neighboring healthy controls. RESULTS: There was no difference in the proportion of Met allele carriers between FEP patients and controls, and no significant influence of BDNF genotype on cognitive test scores in either of the psychosis groups. A decreased severity of negative symptoms was found in FEP subjects that carried a Met allele, and this finding reached significance for the subgroup with affective psychoses (p < 0.01, ANOVA). CONCLUSIONS: These results suggest that, in FEP, the BDNF gene Val66Met polymorphism does not exert a pervasive influence on cognitive functioning but may modulate the severity of negative symptoms.

OBJETIVO: Investigar a influência da variação do gene do fator neurotrófico derivado do cérebro (BDNF) no desempenho cognitivo e na sintomatologia clínica durante o primeiro episódio psicótico (PEP). MÉTODOS: Foram realizados a genotipificação das variantes Val66met do BDNF, o teste cognitivo (fluência verbal e repetição de dígitos) e as avaliações da gravidade dos sintomas (conforme avaliado pela Positive and Negative Syndrome Scale [PANSS]) em uma amostra de pacientes com PEP de base populacional (77 com psicose esquizofreniforme e 53 com psicose afetiva) e 191 vizinhos controle saudáveis. RESULTADOS: Não houve diferença na proporção de portadores do alelo Met entre pacientes com PEP e o grupo controle. Não houve influência significativa do genótipo do BDNF sobre a pontuação de cada um dos grupos psicóticos. Foi encontrada uma diminuição da gravidade dos sintomas negativos em sujeitos com PEP portadores do alelo Met, e essa descoberta mostrou-se significativa para o subgrupo com psicose afetiva (p < 0,01, ANOVA). CONCLUSÕES: Os resultados sugerem que, no PEP, o polimorfismo Val66Met do gene do BDNF não exerce uma influência importante sobre o funcionamento cognitivo, mas pode modular a gravidade dos sintomas negativos.

Prevalence of hepatitis B virus infection and carriage after nineteen years of vaccination program in the Western Brazilian Amazon.

INTRODUCTION: Reductions in the prevalence of hepatitis B virus (HBV) infection and carriage, decreases in liver cancer incidence, and changes in patterns of liver dysfunctions are described after hepatitis B vaccination. METHODS: We conducted a population-based seroprevalence study aimed at estimating the HBV prevalence and risk of infection in the rural area of Lábrea following nineteen years of HBV vaccination. RESULTS: Half of the subjects showed total anti-HBc of 52.1% (95% CI 49.6-54.7). The HBsAg prevalence was 6.2% (95% CI 5.1-7.6). Multivariate analysis showed an inverse association between HBV infection and vaccination (OR 0.62; 95% CI 0.44-0.87). HBsAg remained independently associated with past hepatitis (OR 2.44; 95% CI 1.52-3.89) and inversely to vaccination (OR 0.43; 95% CI 0.27-0.69). The prevalence of HBeAg among HBsAg-positive individuals was 20.4% (95% CI 12.8-30.1), with the positive subjects having a median age of 11 years (1-46) p=0.0003. CONCLUSIONS: We demonstrate that HBV infection is still an important public health issue and that HBV vaccination could have had better impact on HBV epidemiology. If we extrapolate these findings to other rural areas in the Brazilian Amazon, we can predict that the sources of chronic infected patients remain a challenge. Future studies are needed regarding clinical aspects, molecular epidemiology, surveillance of acute cases, and risk groups.

Cardiovascular risk factors in patients with first-episode psychosis in São Paulo, Brazil.

OBJECTIVE: The objective was to evaluate the cardiovascular profile of first-episode psychosis patients in São Paulo, Brazil, an issue that has not been sufficiently explored in low-/middle-income countries. METHOD: A cross-sectional study was performed 1 to 3 years after an initial, larger survey that assessed first-episode psychosis in São Paulo. We evaluated cardiovascular risk factors and lifestyle habits using standard clinical examination and laboratory evaluation. RESULTS: Of 151 contacted patients, 82 agreed to participate (mean age=35 years; 54% female). The following diagnoses were found: 20.7% were obese, 29.3% had hypertension, 39.0% had dyslipidemia, 19.5% had metabolic syndrome, and 1.2% had a >20% 10-year risk of coronary heart disease based on Framingham score. Also, 72% were sedentary, 25.6% were current smokers, and 7.3% reported a heavy alcohol intake. CONCLUSION: Compared to other samples, ours presented a distinct profile of higher rates of hypertension and diabetes (possibly due to dietary habits) and lower rates of smoking and alcohol intake (possibly due to higher dependence on social support). Indirect comparison vs. healthy, age-matched Brazilians revealed that our sample had higher frequencies of hypertension, diabetes and metabolic syndrome. Therefore, we confirmed a high cardiovascular risk in first-episode psychosis in Brazil. Transcultural studies are needed to investigate to which extent lifestyle contributes to such increased risk.

Prevalence of hepatitis B virus infection and carriage after nineteen years of vaccination program in the Western Brazilian Amazon / Prevalência da infecção e de portadores do vírus da hepatite B, após 19 anos do programa de vacinação na Amazônia ocidental Brasileira

INTRODUCTION: Reductions in the prevalence of hepatitis B virus (HBV) infection and carriage, decreases in liver cancer incidence, and changes in patterns of liver dysfunctions are described after hepatitis B vaccination. METHODS: We conducted a population-based seroprevalence study aimed at estimating the HBV prevalence and risk of infection in the rural area of Lábrea following nineteen years of HBV vaccination. RESULTS: Half of the subjects showed total anti-HBc of 52.1 percent (95 percent CI 49.6-54.7). The HBsAg prevalence was 6.2 percent (95 percent CI 5.1-7.6). Multivariate analysis showed an inverse association between HBV infection and vaccination (OR 0.62; 95 percent CI 0.44-0.87). HBsAg remained independently associated with past hepatitis (OR 2.44; 95 percent CI 1.52-3.89) and inversely to vaccination (OR 0.43; 95 percent CI 0.27-0.69). The prevalence of HBeAg among HBsAg-positive individuals was 20.4 percent (95 percent CI 12.8-30.1), with the positive subjects having a median age of 11 years (1-46) p=0.0003. CONCLUSIONS: We demonstrate that HBV infection is still an important public health issue and that HBV vaccination could have had better impact on HBV epidemiology. If we extrapolate these findings to other rural areas in the Brazilian Amazon, we can predict that the sources of chronic infected patients remain a challenge. Future studies are needed regarding clinical aspects, molecular epidemiology, surveillance of acute cases, and risk groups.

INTRODUÇÃO: Reduções nas taxas de prevalência de infecção pelo vírus da hepatite B (VHB) e de portadores, incidência de câncer de fígado e mudança nos padrões de doenças hepáticas são descritos, depois da introdução da vacinação contra hepatite B. MÉTODOS: Foi conduzido um estudo de soro prevalência de base populacional, com o objetivo de estimar a prevalência do VHB e fatores de risco de infecção na área rural de Lábrea, depois de 19 anos de introdução da vacinação contra hepatite B. RESULTADOS: Metade dos indivíduos investigados mostrou reatividade ao anti-HBc total, 52,1 por cento (IC 95 por cento 49,6-54,7). A prevalência do HBsAg foi 6,2 por cento (IC 95 por cento 5,1-7,6). Análises multivariadas mostrou associação inversa da infecção pelo VHB e vacinação (OR 0,62; IC 95 por cento 0<44-0,87). A presença do HBsAg permaneceu independentemente associada com o passado de hepatite (OR 2,44; IC 95 por cento 1,52-3,89) e inversamente associado a história de vacinação (OR 0,43; IC 95 por cento 0,27-0,69). A prevalência do HBeAg, entre os HBsAg positivos foi 20,4 por cento (IC95 por cento 12,8-30,1), tendo em média os indivíduos positivos 11 anos de idade (1-46) p=0,0003. CONCLUSÕES: Foi demonstrado que o VHB é ainda um importante problema de saúde publica, e que a vacinação contra o VHB poderia ter tido um impacto maior na epidemiologia do VHB na região. Se esses achados forem extrapolados para outras regiões rurais da Amazônia brasileira, podemos predizer que a fonte de pacientes crônicos é ainda um desafio a ser vencido. Estudos futuros devem focar os aspectos clínicos, a epidemiologia molecular, vigilância de casos agudos e grupos de risco.

Tamanho ao nascer e problemas de saúde mental aos 11 anos em uma coorte brasileira de nascimentos / Size at birth and mental health problems at 11 years of age in a Brazilian birth cohort

The aim of this study was to evaluate the association between size at birth and mental health problems at 11 years of age in the 1993 Pelotas (Brazil) Birth Cohort Study. Newborns were weighed and measured, and anthropometric indices were calculated. At 11 years of age, mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Prevalence of mental health problems was 32 percent (95 percentCI: 31-33). After adjusting for potential confounders, newborns with weight and body mass index (BMI) for age z-scores < -2 SD were at 27 percent (95 percentCI: 7-49) and 29 percent (95 percentCI: 10-51) greater risk, respectively, of developing mental health problems at age 11 years than those born with normal scores. Newborns with BMI and head circumference for age z-scores > +2 SD were at 34 percent (95 percentCI: 6-71) and 19 percent (95 percentCI: 1-40) greater risk, respectively, of developing mental health problems than those with normal scores. The results suggest that early factors that are reflected as size measurements at birth can cause mental health problems later in life.

O objetivo foi avaliar a associação entre tamanho ao nascer e problemas de saúde mental aos 11 anos na Coorte de Nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 1993. Foram pesados e medidos ao nascer 4.358 recém-nascidos. Avaliou-se problemas de saúde mental com o questionário de capacidades e dificuldades (Strengths and Difficulties Questionnaire - SDQ). A prevalência de problemas de saúde mental foi de 32 por cento (IC95 por cento: 31-33). Na análise ajustada, os 291 (6,7 por cento) recém-nascidos com escorez de peso/idade e os 268 (6,2 por cento) com índice de massa corporal (IMC)/idade < -2 DP tiveram, respectivamente, 27 por cento (IC95 por cento: 7-49) e 29 por cento (IC95 por cento: 10-51) maior risco de apresentar problemas de saúde mental aos 11 anos quando comparados com aqueles com escore normal. Os 102 (2,43 por cento) recém-nascidos com escorez de IMC e os 279 (6,4 por cento) com perímetro cefálico/idade > +2 DP tiveram, respectivamente, 34 por cento (IC95 por cento: 6-71) e 19 por cento (IC95 por cento: 1-40) maior risco de apresentar esses problemas se comparados com aqueles com escore normal. Os resultados sugerem que fatores ocorridos na gestação e refletidos nas medidas de tamanho ao nascer podem ocasionar problemas de saúde mental em etapas tardias.

Osteoporotic fractures in the Brazilian community-dwelling elderly: prevalence and risk factors.

The risk of osteoporotic fractures is known to vary among populations. There are no studies analyzing concomitantly clinical, densitometric, and lab risk factors in miscigenated community-dwelling population of Brazil. A total of 1007 elderly subjects (600 women and 407 men) from São Paulo, were evaluated using a questionnaire that included risk factors for osteoporotic fractures. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the hip and lumbar spine. Laboratory blood tests were also obtained. The prevalence of osteoporotic fractures was 13.2% (133 subjects), and the main fracture sites were distal forearm (6.0%), humerus (2.3%), femur (1.3%), and ribs (1.1%). Women had a higher prevalence (17.5%; 95% confidence interval [CI]: 14.6-20.6) than men (6.9%; 95% CI: 4.4-9.3) (p<0.001). After adjusting for significant variables, logistic regression revealed that female gender (odds ratio [OR]=2.7; 95% CI; 1.6-4.5; p<0.001), current smoking (OR=1.9; 95% CI: 1.2-3.3; p=0.013), and the femoral neck T-score (OR=0.7; 95% CI: 0.5-0.9; p=0.001) remain significant risk factors for osteoporotic fractures in the community-dwelling elderly. Our findings identified that female gender, current smoking, and low hip BMD are independent risk factors for osteoporotic fractures.

Investigating the role played by social support in the association between religiosity and mental health in low income older adults: results from the São Paulo Ageing & Health Study (SPAH) / Investigando o papel do suporte social na associação entre religiosidade e saúde mental em idosos de baixa renda: resultados do São Paulo Ageing & Health Study (SPAH)

OBJECTIVE: Religiosity has been associated with mental health, especially in the elderly. There is a shortage of studies on the factors that mediate this association, including social support. The aim of this study was to assess the association between the various dimensions of religiosity and the prevalence of common mental disorders among the elderly, and to verify whether social support can work as a mechanism that explains such mediation. METHOD: The sample consisted of an elderly population living in a low income region of the city of São Paulo (N = 1,980). Data on the socio-demographic profile of this population and on the prevalence of common mental disorders were collected, and indicators of religiosity and social support were identified. RESULTS: 90.7 percent of the sample considered themselves to be religious. In terms of denomination, 66.6 percent were Catholic. Forty-one per cent attended some kind of religious activity at least once or more times a week. The presence of common mental disorders was not associated with religious affiliation or subjective religiosity. The prevalence of common mental disorders in followers attending religious services was approximately half (OR between 0.43 and 0.55, p < 0.001) compared to those who never attend a religious service. Attending religious services was associated with higher levels of social support. The association between a higher attendance frequency and fewer common mental disorders did not change after the inclusion of relevant of social support variables. CONCLUSION: The study showed that subjects presented high levels of religiosity and that there is a strong association between religious attendance and the prevalence of common mental disorders, which could not be explained by social support.

OBJETIVO: A religiosidade tem sido associada à saúde física e mental com especial importância na população idosa. Existe uma carência de estudos abordando os mediadores desta associação, dentre eles o suporte social. O objetivo deste trabalho é analisar a associação entre dimensões de religiosidade e prevalência de transtornos mentais comuns entre idosos e testar o suporte social como mecanismo de mediação desta suposta associação. MÉTODO: A amostra foi constituída pela população idosa de uma região de baixa renda de São Paulo (N = 1.980). Foram coletados dados sociodemográficos, suporte social, indicadores de religiosidade e prevalência de transtorno mental comum. RESULTADOS: 90,7 por cento da amostra considerou-se religiosa (66,6 por cento Católica); 41,2 por cento frequentam uma ou mais vezes alguma atividade religiosa semanalmente. A presença de transtorno mental comum não foi associada com filiação religiosa ou considerar-se religioso. A prevalência de transtorno mental comum para os que frequentam serviço religioso foi aproximadamente a metade (OR entre 0,43 e 0,55, p < 0,001) daqueles que nunca frequentam. Maior frequência a serviços religiosos também se associou a maiores níveis de suporte social. A associação entre maior frequência e menos transtorno mental comum não sofreu alterações relevantes após inclusão das variáveis de suporte social. CONCLUSÃO: A amostra apresentou altos níveis de religiosidade, forte associação entre freqüência religiosa e menor prevalência de transtornos mentais comuns, que não foi explicada pelo suporte social.

Frequência de sintomas no último ano de vida de idosos de baixa renda em São Paulo: estudo transversal com cuidadores informais / Frequency of symptoms in the last year of life of underprivileged elders in São Paulo: a cross-sectional study with informal caregivers

O crescimento da população idosa brasileira fez aumentar a prevalência de doenças crônicas e o número de pessoas sofrendo de diversos sintomas ao final da vida. Este estudo objetivou entrevistar cuidadores de idosos falecidos, investigando a presença, intensidade e duração de sintomas no último ano, e se os mesmos foram tratados. Arrolaram-se idosos por inquérito domiciliar de base populacional em setores de baixa renda do Butantã, São Paulo. Eram elegíveis os idosos falecidos durante o período de dois anos de seguimento. Oitenta e um cuidadores foram entrevistados entre três e 16 meses pós-óbito e responderam um questionário sobre onze sintomas. Os sintomas mais referidos foram dor (78 por cento), fadiga (68 por cento), dispnéia (60 por cento), depressão e anorexia (58 por cento cada). Dor, dispnéia e fadiga foram os mais intensos. Dor, fadiga e depressão duraram 6 meses ou mais. Ficaram sem tratamento 79 por cento dos idosos com depressão, 77 por cento daqueles com incontinência urinária e 67 por cento daqueles com ansiedade. É necessário implementar conceitos e ações de cuidados paliativos para dar aos idosos mais dignidade e qualidade ao final da vida.

The Brazilian population of elders is growing, resulting in high prevalences of chronic diseases and people facing distressing symptoms in their last years. This study aimed at interviewing family caregivers of deceased elders to investigate the presence, severity and duration of common symptoms in the last year, as well as whether the symptoms were managed or not. Elders were enrolled in a population-based study in deprived areas of Butantã, São Paulo. After a two-year follow-up, any death was eligible for the study. Eighty-one caregivers were interviewed between three and sixteen months after elder's death and answered a questionnaire on eleven symptoms. The most commonly reported symptoms were pain (78%), fatigue (68%), dyspnea (60%), depression, and anorexia (58% each). Pain, dyspnea and fatigue were the most severe. Pain, fatigue and depression lasted 6 months or more. No treatment was received for depression (79%), urinary incontinence (77%) and anxiety (67%). The implementation of palliative care concepts and actions is mandatory to provide Brazilian elders with dignity and better quality at the end of life.

Prevalence of thyroid disorders among older people: results from the São Paulo ageing & health study / Prevalência de doenças da tireóide em idosos: resultados do São Paulo ageing & health study

This study aimed to estimate prevalence of thyroid disorders in the São Paulo Ageing & Health Study, an epidemiological study addressing several health-adverse outcomes among elderly people living in a poor area of São Paulo, Brazil. All participants answered a questionnaire and had a blood sample collected to assess levels of tireotropic hormone and free-thyroxine. Among 1,373 people (60.8 percent women), prevalence rates (95 percent confidence interval) for thyroid dysfunction ( percent) were: overt hyperthyroidism, 0.7 percent (0.2-1.1)[women: 0.8 percent (0.2-1.5); men: 0.4 percent (0.01-0.9)]; overt hypothyroidism, 5.7 percent (4.5-6.9) [women: 5.9 percent (4.3-7.5); men: 5.4 percent (3.5-7.3)]; subclinical hyperthyroidism, 2.4 percent (1.6-3.2) [women: 2.8 percent (1.6-3.9); men: 1.9 percent (0.7-3.0)]; and subclinical hypothyroidism, 6.5 percent (5.2-7.8) [women: 6.7 percent (5.0-8.4); men: 6.1 percent (4.1-8.2)]. There was no difference in prevalence rates according to gender, but almost 40 percent of women were diagnosed and under treatment compared to 9 percent of men. The burden of thyroid disorders in this sample is high and most participants were not aware of them.

O objetivo da pesquisa foi avaliar a prevalência de doenças da tireóide no São Paulo Ageing & Health Study, estudo epidemiológico focado em desfechos de saúde adversos em amostra de idosos moradores de São Paulo, Brasil. Todos os participantes responderam a questionário e colheram sangue para dosagem de hormônio tireotrópico e tiroxina-livre. Entre os 1.373 participantes (60,8 por cento mulheres), a prevalência (intervalo de 95 por cento de confiança) de hipertireoidismo clínico foi de 0,7 por cento (0.2-1,1) [mulheres: 0,8 por cento (0,2-1,5); homens: 0,4 por cento (0,01-0,9)]; hipotireoidismo clínico, 5,7 por cento (4,5-6,9) [mulheres: 5,9 por cento (4,3-7,5); homens: 5,4 por cento (3,5-7,3)]; hipertireoidismo subclínico, 2,4 por cento (1,6-3,2) [mulheres: 2,8 por cento (1,6-3,9); homens: 1,9 por cento (0,7-3,0)]; e hipotireoidismo subclínico, 6,5 por cento (5,2-7,8) [mulheres: 6,7 por cento (5,0-8,4); homens: 6,1 por cento (4,1-8,2)]. Não houve diferença na prevalência de doenças da tireóide por sexo. Quarenta por cento das mulheres tinham diagnóstico e estavam tratando, comparadas a 9 por cento dos homens. A prevalência de disfunção tireoidiana foi elevada e a maioria dos participantes desconhecia o diagnóstico.

A practical approach to assess depression risk and to guide risk reduction strategies in later life.

BACKGROUND: Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies. METHODS: A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer. RESULTS: The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors. CONCLUSIONS: Our probabilistic matrix can be used to estimate depression risk and to guide the introduction of risk reduction strategies. Future studies should now aim to clarify whether interventions designed to mitigate the impact of risk factors can change the prevalence and incidence of depression in later life.

Cardiovascular risk factors associated with migraine among the elderly with a low income: the Sao Paulo Ageing & Health Study (SPAH).

BACKGROUND: To investigate the association between cardiovascular risk-factor profile and migraine in the elderly, we evaluated a population sample of ageing men and women (65 years or more) living in a low-income area in the city of São Paulo, Brazil. PATIENTS AND METHODS: We investigated migraine status and cardiovascular profile from a baseline of 1450 participants (65-102 years of age) of the São Paulo Ageing & Health Study (SPAH), a longitudinal population-based study with low-income elderly in Brazil. The following age and sex-adjusted cardiovascular risk factors were analyzed: blood pressure, pulse pressure, serum total and high-density lipoprotein cholesterol, body mass index, smoking, history of hypertension, diabetes and the 10-year risk of myocardial infarction or coronary heart disease death based on the Framingham Risk Score. RESULTS: The overall prevalence of migraine was 11.4%, and it was 3 times more frequent among women than men (15.3% vs 5.4%; P < 0.0001). Migraineurs were younger than non-migraineurs (mean age 70.6 years vs 72.1 years; P = 0.001, respectively). There was no statistically significant difference regarding the cardiovascular risk-factor profile after adjustment for age and sex among migraineurs and non-migraineurs. Only a decrease in the risk of hypertension among women (OR 0.58; 95% CI 0.38-0.90; P = 0.01) was also observed even after adjustment for age. CONCLUSIONS: Overall, we did not find a worse cardiovascular risk profile among elderly migraineurs. An inverse association between hypertension and migraine in women warrants further investigation.