Does physical activity and inflammation mediate the job stress-headache relationship? A sequential mediation analysis in the ELSA-Brasil study.

BACKGROUND: Evidence indicates that physical activity reduces stress and promote a myriad of health-enhancing effects through anti-inflammatory mechanisms. However, it is unknown whether these mechanisms interfere in the association between psychosocial job stress and headache disorders. OBJECTIVE: To test whether physical activity and its interplay with the systemic inflammation biomarkers high-sensitivity C-reactive protein (hs-CRP) and acute phase glycoproteins (GlycA) would mediate the associations between job stress and headache disorders. METHODS: We cross-sectionally evaluated the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) regarding job stress (higher demand and lower control and support subscales), migraine and tension-type headache (ICHD-2 criteria), self-reported leisure-time physical activity, and plasma hs-CRP and GlycA levels. Conditional process analyses with a sequential mediation approach were employed to compute path coefficients and 95 % confidence intervals (CI) around the indirect effects of physical activity and biomarkers on the job stress-headache relationship. Separate models were adjusted for sex, age, and depression and anxiety. Further adjustments added BMI smoking status, and socioeconomic factors. RESULTS: In total, 7,644 people were included in the study. The 1-year prevalence of migraine and tension-type headache were 13.1 % and 49.4 %, respectively. In models adjusted for sex, age, anxiety, and depression, the association between job stress (lower job control) and migraine was mediated by physical activity [effect = -0.039 (95 %CI: -0.074, -0.010)] but not hs-CRP or GlycA. TTH was associated with higher job control and lower job demand, which was mediated by the inverse associations between physical activity and GlycA [Job Control: effect = 0.0005 (95 %CI: 0.0001, 0.0010); Job Demand: effect = 0.0003 (95 %CI: 0.0001, 0.0007]. Only the mediating effect of physical activity in the job stress-migraine link remained after further adjustments including socioeconomic factors, BMI, smoking, and the exclusion of major chronic diseases. CONCLUSION: In the ELSA-Brasil study, physical activity reversed the link between job stress and migraine independently of systemic inflammation, while the LTPA-mediated downregulation of GlycA was associated with lower job stress-related TTH.

Three Decades of Research on the Development of Ibogaine Treatment of Substance Use Disorders: A Scientometric Analysis.

Ibogaine is a natural psychoactive drug that has been investigated for its potential role in the treatment of substance use disorders since the mid-1960s. To evaluate the interest in ibogaine's use as a therapeutic agent, we performed a scientometric analysis covering the last three decades (1993-2002, 2003-2012, and 2013-2022). A complementary analysis was performed to select and describe published clinical trials and meta-analyses. A total of 1523 references were found. Linear growth of publications in the first and third decades were identified, and the average number of publications from 1993 to 2002 was lower than that in the other two decades. Researchers from five continents were identified. Globally, academic research centers in the United States and Canada were the most productive. Cocaine, tobacco, morphine, and alcohol prevailed as major keywords in the first two decades and opioids and psychedelics were included in the third decade. A few key authors were the most co-referenced. One preclinical meta-analysis and no meta-analysis in humans were found. Research trends for ibogaine are widespread, growing, and consonant with current attentiveness in drug abuse. Our findings support the pressing need for rigorous clinical research on ibogaine to evaluate its efficacy and safety.

VALIDITY OF THE BRAZILIAN-PORTUGUESE VERSION OF MOOREHEAD-ARDELT QUALITY OF LIFE QUESTIONNAIRE II AMONG PATIENTS WITH SEVERE OBESITY.

BACKGROUND: Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. AIMS: This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity. METHODS: We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m²) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-Åsberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. RESULTS: The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. CONCLUSIONS: The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.

Validity of the brazilian-portuguese version of moorehead-ardelt quality of life questionnaire ii among patients with severe obesity / Validade da versão em português-brasileiro do questionário moorehead-ardelt quality of life-ii em pacientes com obesidade grave

ABSTRACT BACKGROUND: Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. AIMS: This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity. METHODS: We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m²) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-Åsberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. RESULTS: The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. CONCLUSIONS: The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.

RESUMO RACIONAL: Pacientes com obesidade apresentam múltiplas condições psiquiátricas comórbidas e experienciam prejuízos na qualidade de vida relacionada à saúde. Ferramentas confiáveis e válidas que avaliam a qualidade de vida relacionada à saúde são essenciais para a prática clínica. OBJETIVOS: Este estudo teve como objetivo investigar a confiabilidade e validade do Moorehead-Ardelt Quality of Life-II de seis itens entre pacientes com obesidade grave. MÉTODOS: Foram avaliados 387 pacientes (idade média de 43 anos, 78,8% mulheres, índice de massa corporal (IMC) médio de 46,5 kg/m², na lista de espera de um centro cirurgia bariátrica. Assistentes de pesquisa treinados aplicaram simultaneamente o Moorehead-Ardelt Quality of Life-II, a Escala de Depressão de Montgomery-Åsberg e a Avaliação Global do Funcionamento para avaliar, respectivamente, a qualidade de vida relacionada à saúde, os sintomas depressivos comórbidos e o nível funcional do paciente. RESULTADOS: A consistência interna do Moorehead-Ardelt Quality of Life-II foi considerada aceitável. A pontuação total do Moorehead-Ardelt Quality of Life-II foi correlacionada com a gravidade dos sintomas depressivos e nível funcional. Quanto maior o IMC, menor a qualidade de vida relacionada à saúde. O Moorehead-Ardelt Quality of Life-II apresentou uma estrutura unidimensional. CONCLUSÕES: O questionário Moorehead-Ardelt Quality of Life-II unidimensional é confiável e válido na avaliação da qualidade de vida relacionada à saúde em pacientes brasileiros com obesidade grave. O questionário permite avaliar rapidamente a qualidade de vida relacionada à saúde dos pacientes em diferentes contextos, considerando depressão e nível funcional.

Cardiovascular risk factors and major depressive disorder: a cross-sectional study in São Paulo, Brazil

ABSTRACT BACKGROUND: Cardiovascular risk factors can mediate the association between depression and cardiovascular diseases. OBJECTIVE: To evaluate cardiovascular risk factors in adult individuals with and without histories of major depression in the metropolitan region of São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study in São Paulo (SP), Brazil. METHODS: This study evaluated 423 individuals without any lifetime diagnosis of major depression and 203 individuals with a previous diagnosis of major depression (n = 626). The participants underwent a psychiatric evaluation using a structured clinical interview (SCID-1), an anthropometric evaluation and a clinical evaluation that included blood pressure measurement and assessment of fasting blood glucose, lipid profile and physical activity levels. RESULTS: Individuals with histories of major depression were more likely to be female (P < 0.0001). Individuals with lifetime diagnoses of major depression were more likely to be current smokers (odds ratio, OR 1.61; 95% confidence interval, CI 1.01-2.59) and to have diabetes (OR 1.79; 95% CI 1.01-3.21); and less likely to be obese (OR 0.58; 95% CI 0.35-0.94). CONCLUSION: Individuals with major depression had higher odds of presenting tobacco smoking and diabetes, and lower odds of being obese. Healthcare professionals need to be aware of this, so as to increase the rates of diagnosis and treatment in this population.

Cardiovascular risk factors and major depressive disorder: a cross-sectional study in São Paulo, Brazil.

BACKGROUND: Cardiovascular risk factors can mediate the association between depression and cardiovascular diseases. OBJECTIVE: To evaluate cardiovascular risk factors in adult individuals with and without histories of major depression in the metropolitan region of São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study in São Paulo (SP), Brazil. METHODS: This study evaluated 423 individuals without any lifetime diagnosis of major depression and 203 individuals with a previous diagnosis of major depression (n = 626). The participants underwent a psychiatric evaluation using a structured clinical interview (SCID-1), an anthropometric evaluation and a clinical evaluation that included blood pressure measurement and assessment of fasting blood glucose, lipid profile and physical activity levels. RESULTS: Individuals with histories of major depression were more likely to be female (P < 0.0001). Individuals with lifetime diagnoses of major depression were more likely to be current smokers (odds ratio, OR 1.61; 95% confidence interval, CI 1.01-2.59) and to have diabetes (OR 1.79; 95% CI 1.01-3.21); and less likely to be obese (OR 0.58; 95% CI 0.35-0.94). CONCLUSION: Individuals with major depression had higher odds of presenting tobacco smoking and diabetes, and lower odds of being obese. Healthcare professionals need to be aware of this, so as to increase the rates of diagnosis and treatment in this population.

A Estratégia Saúde da Família como indicador para o enfrentamento da COVID-19 em Santa Catarina, Brasil / The Family Health Strategy as an indicator for coping with COVID-19 in Santa Catarina, Brazil

Objetivo: analisar relação entre a cobertura pela Estratégia de Saúde da Família e a disponibilidade de respiradores com a taxa de contágio e mortalidade da COVID-19 no Estado de Santa Catarina, Brasil. Materiais e métodos: trata-se de um estudo ecológico, que utiliza modelos computacionais de análise geoespacial sobre o avanço do COVID-19 nos 295 municípios de Santa Catarina. Resultados: o Estado apresentou casos em todos os municípios, e uma taxa de infecção por Covid-19 de 1,63%. No modelo de regressão realizado, a cobertura pela Estratégia de Saúde da Família apresentou correlação com a mortalidade e a taxa de infecção pela Covid-19. A quantidade de respiradores apresentou correlação com a mortalidade. Conclusão: em Santa Catarina a Estratégia de Saúde da Família e a compra de novos respiradores, apresentam-se como aliados no enfrentamento à COVID 19..Au

Objective: to relate the coverage by the FHS and the availability of respirators with the transmission and mortality rate of COVID-19 in the state of Santa Catarina, Brazil. Materials and methods: this is an ecological study, which uses computational models of geospatial analysis on the progress of COVID-19 to the 295 cities in Santa Catarina. The correlation between the FHS coverage and the number of respirators grouped in the mesoregions was calculated with the COVID-19 transmission and mortality rates. Results: the state had low infection rates of 0.07% and mortality of 1.72%, when compared to Brazil. There was an increase in cases in smaller municipalities, indicating the interiorization of the pandemic. There was no correlation between FHS coverage with infection and mortality. However, respirators are associated with lower mortality. Conclusion: regional disparity was found in the presence of respirators in the state's micro-regions, suggesting an imbalance in the quality of care for critically ill patients during the pandemic..Au

Dimensions of Anger Reactions (DAR-5): a useful screening tool for anger in the general population.

BACKGROUND: Dimensions of Anger Reactions (DAR-5) is a brief 5-item instrument to assess experience of anger. We aimed to verify the DAR-5 as a screening instrument in the community. METHODS: A sample of 368 apparently healthy adults who attended an outpatient ambulatory facility self-reported on the DAR-5 scale, the Spielberger's State-Trait Anger Expression Inventory (STAXI), the Beck Anxiety Inventory (BAI), and the Patient Health Questionnaire (PHQ-9). Indicators of reliability and validity were calculated to demonstrate the performance of the DAR-5. RESULTS: According to the DAR-5, around half the respondents found themselves becoming angry with people or situations and reported persistent duration of anger. Antagonism towards others was the least frequently experienced anger (8.4%). The DAR-5 was found to be reliable and stable, showing a significant correlation with the BAI and PHQ-9 for both sexes. In confirmatory factor analysis, a one-dimensional structure of anger experience was demonstrated through salient fit statistics. A cut-off > 8 was the best threshold against STAXI for discriminating cases of anger, irrespective of sex. CONCLUSIONS: The shortness of the DAR-5, along with its cost-effective applicability, qualifies this measuring tool as a useful instrument for inclusion in the routine assessment of anger reactions in the general population.Key pointsThis is the first time the validity of DAR-5 has been demonstrated in a developing country.The Portuguese version of DAR-5 has appropriate sensitivity and high specificity.The DAR-5 demonstrated to be a reliable and stable instrument, irrespective of sex.

Benzodiazepine use in Sao Paulo, Brazil

OBJECTIVES: To report the prevalence and factors associated with the use of benzodiazepines in the general population and those with a mental health condition in the metropolitan area of São Paulo, Brazil. METHODS: 5,037 individuals from the Sao Paulo Megacity Mental Health Survey data were interviewed using the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. Additionally, participants were asked if they had taken any medication in the previous 12 months for the treatment of any mental health condition. RESULTS: The prevalence of benzodiazepine use ranged from 3.6% in the general population to 7.8% among subjects with a mental health condition. Benzodiazepine use was more prevalent in subjects that had been diagnosed with a mood disorder as opposed to an anxiety disorder (14.7% vs. 8.1%, respectively). Subjects that had been diagnosed with a panic disorder (33.7%) or bipolar I/II (23.3%) reported the highest use. Individuals aged ≥50 years (11.1%), those with two or more disorders (11.2%), those with moderate or severe disorders (10%), and those that used psychiatric services (29.8%) also reported higher use. CONCLUSION: These findings give an overview of the use of benzodiazepines in the general population, which will be useful in the public health domain. Benzodiazepine use was higher in those with a mental health condition, with people that had a mood disorder being the most vulnerable. Furthermore, females and the elderly had high benzodiazepine use, so careful management in these groups is required.

BARIATRIC SURGERY AND BINGE EATING DISORDER: SHOULD SURGEONS CARE ABOUT IT? A LITERATURE REVIEW OF PREVALENCE AND ASSESSMENT TOOLS.

BACKGROUND: Eating pathologies among bariatric surgery candidates are common and associated with adverse surgical outcomes, including weight regain and low quality of life. However, their assessment is made difficult by the great variety and inconsistent use of standardized measures. OBJECTIVE: The purpose of this review was to synthesize current knowledge on the prevalence of binge eating disorder (BED) in presurgical patients and to make a critical appraisal of assessment tools for BED. METHODS: A search was conducted on PubMed, Scopus, and Web of Science databases from January 1994 to March 2017. Data were extracted, tabulated and summarized using a narrative approach. RESULTS: A total of 21 observational studies were reviewed for data extraction and analysis. Prevalence of BED in bariatric populations ranged from 2% to 53%. Considerable variation in patient characteristics and in BED assessment measures was evident among the studies. In addition, several methodological weaknesses were recognized in most of the studies. Ten different psychometric instruments were used to assess BED. Clinical interviews were used in only 12 studies, though this is the preferred tool to diagnose BED. CONCLUSION: Study heterogeneity accounted for the variability of the results from different centers and methodological flaws such as insufficient sample size and selection bias impaired the evidence on the magnitude of BED in surgical settings. For the sake of comparability and generalizability of the findings in future studies, researchers must recruit representative samples of treatment-seeking candidates for bariatric surgery and systematically apply standard instruments for the assessment of BED.

Cirurgia bariátrica e transtorno de compulsão alimentar: os cirurgiões devem se preocupar com isso? Uma revisão da literatura sobre a prevalência e os métodos de diagnóstico / Bariatric surgery and binge eating disorder: should surgeons care about it? a literature review of prevalence and assessment tools

ABSTRACT BACKGROUND: Eating pathologies among bariatric surgery candidates are common and associated with adverse surgical outcomes, including weight regain and low quality of life. However, their assessment is made difficult by the great variety and inconsistent use of standardized measures. OBJECTIVE: The purpose of this review was to synthesize current knowledge on the prevalence of binge eating disorder (BED) in presurgical patients and to make a critical appraisal of assessment tools for BED. METHODS: A search was conducted on PubMed, Scopus, and Web of Science databases from January 1994 to March 2017. Data were extracted, tabulated and summarized using a narrative approach. RESULTS: A total of 21 observational studies were reviewed for data extraction and analysis. Prevalence of BED in bariatric populations ranged from 2% to 53%. Considerable variation in patient characteristics and in BED assessment measures was evident among the studies. In addition, several methodological weaknesses were recognized in most of the studies. Ten different psychometric instruments were used to assess BED. Clinical interviews were used in only 12 studies, though this is the preferred tool to diagnose BED. CONCLUSION: Study heterogeneity accounted for the variability of the results from different centers and methodological flaws such as insufficient sample size and selection bias impaired the evidence on the magnitude of BED in surgical settings. For the sake of comparability and generalizability of the findings in future studies, researchers must recruit representative samples of treatment-seeking candidates for bariatric surgery and systematically apply standard instruments for the assessment of BED.

RESUMO CONTEXTO: Os transtornos alimentares entre os candidatos à cirurgia bariátrica são comuns e estão associados a resultados cirúrgicos adversos, incluindo recuperação de peso e baixa qualidade de vida. No entanto, sua avaliação é difícil pela grande variedade e uso inconsistente de métodos de avaliação padronizados. OBJETIVO: O objetivo desta revisão foi sintetizar o conhecimento atual sobre a prevalência do transtorno de compulsão alimentar (TCA) em pacientes pré-cirúrgicos e fazer uma avaliação crítica dos instrumentos de avaliação para TCA. MÉTODOS: A busca foi realizada nas bases de dados PubMed, Scopus e Web of Science de janeiro de 1994 a março de 2017. Os dados foram extraídos, tabulados e resumidos usando uma abordagem narrativa. RESULTADOS: Um total de 21 estudos observacionais foram revisados para extração e análise de dados. A prevalência de TCA nas populações bariátricas variou de 2% a 53%. Variações consideráveis nas características dos pacientes e nas medidas de avaliação do TCA foram evidentes entre os estudos. Além disso, várias fragilidades metodológicas na maioria dos estudos foram reconhecidas. Estudos utilizaram 10 diferentes instrumentos psicométricos para avaliar a TCA. Entrevistas clínicas foram utilizadas em 12 estudos, embora seja a ferramenta preferencial para diagnosticar o TCA. CONCLUSÃO: A heterogeneidade dos estudos foi responsável pela variabilidade dos resultados nos diferentes centros e falhas metodológicas, como tamanho insuficiente da amostra e viés de seleção, prejudicaram a estimativa da magnitude do TCA em cenários cirúrgicos. Para fins de comparabilidade e generalização dos achados em estudos futuros, os pesquisadores devem recrutar amostras representativas de candidatos à cirurgia bariátrica e fazer a aplicação sistemática de instrumentos padronizados para a avaliação do TCA.

Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence

The aim of this study was to review emerging evidence of novel treatments for anxiety disorders. We searched PubMed and EMBASE for evidence-based therapeutic alternatives for anxiety disorders in adults, covering the past five years. Eligible articles were systematic reviews (with or without meta-analysis), which evaluated treatment effectiveness of either nonbiological or biological interventions for anxiety disorders. Retrieved articles were summarized as an overview. We assessed methods, quality of evidence, and risk of bias of the articles. Nineteen systematic reviews provided information on almost 88 thousand participants, distributed across 811 clinical trials. Regarding the interventions, 11 reviews investigated psychological or nonbiological treatments; 5, pharmacological or biological; and 3, more than one type of active intervention. Computer-delivered psychological interventions were helpful for treating anxiety of low-to-moderate intensity, but the therapist-oriented approaches had greater results. Recommendations for regular exercise, mindfulness, yoga, and safety behaviors were applicable to anxiety. Transcranial magnetic stimulation, medication augmentation, and new pharmacological agents (vortioxetine) presented inconclusive benefits in patients with anxiety disorders who presented partial responses or refractoriness to standard treatment. New treatment options for anxiety disorders should only be provided to the community after a thorough examination of their efficacy.

Gender-related dimensions of childhood adversities in the general population

Objective: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. Methods: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. Results: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. Conclusion: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.

Gender-related patterns of psychiatric disorder clustering among bariatric surgery candidates: A latent class analysis.

BACKGROUND: Psychiatric disorders tend to distribute unevenly in women and men with severe obesity. The current research aimed to identify homogeneous clusters of concurrent psychiatric disorders among patients seeking bariatric surgery, by gender. METHODS: We recruited a consecutive sample of 393 candidates with obesity (311 women and 82 men) in a university-based bariatric center. Trained clinicians assessed psychiatric disorders through the Structured Clinical Interview for DSM-IV (SCID). Latent class analysis categorized pre-surgical patients into uniform clusters of co-occurring psychiatric disorders. RESULTS: For both genders, the 3-class psychopathological clustering was the best-fitting solution. Among women, the latent classes were: (1) "oligosymptomatic", wherein 42% of patients showed low probability of psychiatric disorders; (2) "bipolar with comorbidities", in 33%; and (3) "anxiety/depression", in 25%. Among men, (1) "bipolar with comorbidities" was found in 47% of patients; (2) "oligosymptomatic", in 40%; and (3) "anxiety/depression", in 13%. For both genders, the probability of presenting eating disorders was higher in both "bipolar" and "anxiety/depression" classes. Substance use disorders was prominent among "bipolar" men. In comparison with "oligosymptomatic" class, the likelihood of higher BMI was observed among "bipolar" men and poorer work attainment among men with "anxiety/depression". LIMITATION: Participants was cross-sectionally drawn from a single bariatric center. CONCLUSIONS: Pre-surgical men and women with severe obesity were distributed in three comorbidity profiles and revealed analogous psychopathological patterns. The class of "bipolar disorders" most likely presented comorbidity with eating and substance use disorder. This natural clustering of psychiatric disorders among bariatric patients suggests gender-related therapeutic approaches and surgical outcomes.