Social connections and risk of incident mild cognitive impairment, dementia, and mortality in 13 longitudinal cohort studies of ageing.

INTRODUCTION: Previous meta-analyses have linked social connections and mild cognitive impairment, dementia, and mortality. However, these used aggregate data from North America and Europe and examined a limited number of social connection markers. METHODS: We used individual participant data (N = 39271, Mage  = 70.67 (40-102), 58.86% female, Meducation  = 8.43 years, Mfollow-up  = 3.22 years) from 13 longitudinal ageing studies. A two-stage meta-analysis of Cox regression models examined the association between social connection markers with our primary outcomes. RESULTS: We found associations between good social connections structure and quality and lower risk of incident mild cognitive impairment (MCI); between social structure and function and lower risk of incident dementia and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality. DISCUSSION: Different aspects of social connections - structure, function, and quality - are associated with benefits for healthy aging internationally. HIGHLIGHTS: Social connection structure (being married/in a relationship, weekly community group engagement, weekly family/friend interactions) and quality (never lonely) were associated with lower risk of incident MCI. Social connection structure (monthly/weekly friend/family interactions) and function (having a confidante) were associated with lower risk of incident dementia. Social connection structure (living with others, yearly/monthly/weekly community group engagement) and function (having a confidante) were associated with lower risk of mortality. Evidence from 13 longitudinal cohort studies of ageing indicates that social connections are important targets for reducing risk of incident MCI, incident dementia, and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality.

Dose-response relationship between late-life physical activity and incident dementia: A pooled analysis of 10 cohort studies of memory in an international consortium.

INTRODUCTION: Though consistent evidence suggests that physical activity may delay dementia onset, the duration and amount of activity required remains unclear. METHODS: We harmonized longitudinal data of 11,988 participants from 10 cohorts in eight countries to examine the dose-response relationship between late-life physical activity and incident dementia among older adults. RESULTS: Using no physical activity as a reference, dementia risk decreased with duration of physical activity up to 3.1 to 6.0 hours/week (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.67 to 1.15 for 0.1 to 3.0 hours/week; HR 0.68, 95% CI 0.52 to 0.89 for 3.1 to 6.0 hours/week), but plateaued with higher duration. For the amount of physical activity, a similar pattern of dose-response curve was observed, with an inflection point of 9.1 to 18.0 metabolic equivalent value (MET)-hours/week (HR 0.92, 95% CI 0.70 to 1.22 for 0.1 to 9.0 MET-hours/week; HR 0.70, 95% CI 0.53 to 0.93 for 9.1 to 18.0 MET-hours/week). DISCUSSION: This cross-national analysis suggests that performing 3.1 to 6.0 hours of physical activity and expending 9.1 to 18.0/MET-hours of energy per week may reduce dementia risk.

Associations between social connections and cognition: a global collaborative individual participant data meta-analysis.

BACKGROUND: Poor social connections (eg, small networks, infrequent interactions, and loneliness) are modifiable risk factors for cognitive decline. Existing meta-analyses are limited by reporting aggregate responses, a focus on global cognition, and combining social measures into single constructs. We aimed to investigate the association between social connection markers and the rate of annual change in cognition (ie, global and domain-specific), as well as sex differences, using an individual participant data meta-analysis. METHODS: We harmonised data from 13 longitudinal cohort studies of ageing in North America, South America, Europe, Africa, Asia, and Australia. Studies were eligible for inclusion if they had baseline data for social connection markers and at least two waves of cognitive scores. Follow-up periods ranged from 0 years to 15 years across cohorts. We included participants with cognitive data for at least two waves and social connection data for at least one wave. We then identified and excluded people with dementia at baseline. Primary outcomes were annual rates of change in global cognition and cognitive domain scores over time until final follow-up within each cohort study analysed by use of an individual participant data meta-analysis. Linear mixed models within cohorts used baseline social connection markers as predictors of the primary outcomes. Effects were pooled in two stages using random-effects meta-analyses. We assessed the primary outcomes in the main (partially adjusted) and fully adjusted models. Partially adjusted models controlled for age, sex, and education; fully adjusted models additionally controlled for diabetes, hypertension, smoking, cardiovascular risk, and depression. FINDINGS: Of the 40 006 participants in the 13 cohort studies, we excluded 1392 people with dementia at baseline. 38 614 individual participants were included in our analyses. For the main models, being in a relationship or married predicted slower global cognitive decline (b=0·010, 95% CI 0·000-0·019) than did being single or never married; living with others predicted slower global cognitive (b=0·007, 0·002-0·012), memory (b=0·017, 0·006-0·028), and language (b=0·008, 0·000-0·015) decline than did living alone; and weekly interactions with family and friends (b=0·016, 0·006-0·026) and weekly community group engagement (b=0·030, 0·007-0·052) predicted slower memory decline than did no interactions and no engagement. Never feeling lonely predicted slower global cognitive (b=0·047, 95% CI 0·018-0·075) and executive function (b=0·047, 0·017-0·077) decline than did often feeling lonely. Degree of social support, having a confidante, and relationship satisfaction did not predict cognitive decline across global cognition or cognitive domains. Heterogeneity was low (I2=0·00-15·11%) for all but two of the significant findings (association between slower memory decline and living with others [I2=58·33%] and community group engagement, I2=37·54-72·19%), suggesting robust results across studies. INTERPRETATION: Good social connections (ie, living with others, weekly community group engagement, interacting weekly with family and friends, and never feeling lonely) are associated with slower cognitive decline. FUNDING: EU Joint Programme-Neurodegenerative Disease Research grant, funded by the National Health and Medical Research Council Australia, and the US National Institute on Aging of the US National Institutes of Health.

O Significado de Saúde e Doença para o Aluno de Medicina ao longo da Graduação: Estudo Exploratório entre Alunos da Unifesp-EPM / The Meaning of Health and Illness for Medical Students during the Undergraduate Course

RESUMO No início da graduação, a compreensão sobre saúde e doença do aluno depende de seus conhecimentos e experiências prévias, bem como do grau de contato com a prática médica e a realidade que envolve esse tema. Neste estudo, pretende-se compreender qual é a visão de saúde e doença que permeia a mente dos futuros médicos e traçar que relações são estabelecidas entre a noção de saúde e doença com as experiências pessoais e profissionais do aluno ao longo da graduação. Foi realizado um estudo qualitativo, utilizando-se um questionário psicossocial e entrevista semiestruturada com alunos do primeiro, terceiro e sexto ano de um mesmo ano letivo da Universidade Federal de São Paulo (Unifesp-EPM). O material foi submetido à análise de conteúdo. As experiências e características pessoais de cada participante, assim como as experiências curriculares e extracurriculares e o currículo oculto influenciam tanto a visão que possuem de saúde e doença quanto a escolha profissional. Nota-se certo esfriamento na relação médico-paciente e uma postura de maior desconfiança em relação aos pacientes ao longo da graduação. Os alunos têm o conhecimento de uma visão mais global e humana dos pacientes, mas não conseguem colocá-la em prática. Observa-se que essa problemática está vinculada ao fato de terem dificuldade de entrar em contato com os aspectos emocionais despertados na relação médico-paciente.

ABSTRACT Medical students’ views on health and illness in the early stages of their degree course depend on their knowledge and past experiences as well as the amount of contact with medical practice and the reality surrounding this issue. The aim of this study was to understand the view of health and illness in the minds of future doctors and to delineate the relationships established between the notion of health and illness, the school curriculum, personal experiences, and the social and professional students’ trajectory throughout the course. A qualitative study was conducted, with a psychosocial questionnaire and semi-structured interviews used on students in the first, third, and sixth year at the Federal University of São Paulo (Unifesp-EPM) in 2008. The material was subjected to content analysis, identifying the experiences and personal characteristics of each participant, as well their curricular and extracurricular experiences, and determining how the hidden curriculum influences both their views on health and illness as well as their career choice. A certain coldness may be noted in the doctor-patient relationship, as well as a greater distrust of patients. Graduating students demonstrated a need to protect feelings aroused by their experiences of the medical course. It is clear that students are aware of a more global and human view of their patients, however, it seems that they know this merely cognitively and are emotionally unable to put it into practice. This issue may be linked to the fact that they experience difficulties dealing with the emotional aspects of the doctor-patient relationship.

Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis.

BACKGROUND: The association between depression, anxiety, and polycystic ovary syndrome (PCOS) is still unclear. Therefore, a systematic review and meta-analysis was conducted to assess the rates of comorbid psychiatric disorders among women with PCOS compared to women without it. METHODS: PubMed/MEDLINE, Embase, PsycINFO, and Web of Science databases were searched from inception to November 27, 2015. Studies were eligible for inclusion if they were original reports in which the rates of mood (bipolar disorder, dysthymia, or major depressive disorder), obsessive-compulsive spectrum disorders, trauma- and stressor-related disorders, anxiety disorders or psychotic disorders, somatic symptom and related disorders, or eating disorders had been investigated among women with an established diagnosis of PCOS and compared with women without PCOS. Psychiatric diagnosis should have been established by means of a structured diagnostic interview or through a validated screening tool. Data were extracted and pooled using random effects models. RESULTS: Six studies were included in the meta-analysis; of these, five reported the rates of anxiety and six provided data on the rates of depression. The rate of subjects with anxiety symptoms was higher in patients with PCOS compared to women without PCOS (odds ratio (OR) =2.76; 95% confidence interval (CI) 1.26 to 6.02; Log OR =1.013; P=0.011). The rate of subjects with depressive symptoms was higher in patients with PCOS compared to women without PCOS (OR =3.51; 95% CI 1.97 to 6.24; Log OR =1.255; P<0.001). CONCLUSION: Anxiety and depression symptoms are more prevalent in patients with PCOS.

Stressful life events and acute kidney injury in intensive and semi-intensive care unities.

INTRODUCTION: Several studies point out that pathophysiological changes related to stress may influence renal function and are associated with disease onset and evolution. However, we have not found any studies about the influence of stress on renal function and acute kidney injury. OBJECTIVE: To evaluate the association between stressful life events and acute kidney injury diagnosis, specifying the most stressful classes of events for these patients in the past 12 months. METHODS: Case-control study. The study was carried out at Hospital São Paulo, in Universidade Federal de São Paulo and at Hospital dos Servidores do Estado de São Paulo, in Brazil. Patients with acute kidney injury and no chronic disease, admitted to the intensive or semi-intensive care units were included. Controls included patients in the same intensive care units with other acute diseases, except for the acute kidney injury, and also with no chronic disease. Out of the 579 patients initially identified, 475 answered to the Social Readjustment Rating Scale (SRRS) questionnaire and 398 were paired by age and gender (199 cases and 199 controls). RESULTS: The rate of stressful life events was statistically similar between cases and controls. The logistic regression analysis to detect associated effects of the independent variables to the stressful events showed that: increasing age and economic classes A and B in one of the hospitals (Hospital São Paulo - UNIFESP) increased the chance of a stressful life event (SLE). CONCLUSIONS: This study did not show association between the Acute Kidney Injury Group with a higher frequency of stressful life events, but that old age, higher income, and type of clinical center were associated.

Eventos vitais estressores e lesão renal aguda em centros de terapia semi-intensiva e intensiva / Stressful life events and acute kidney injury in intensive and semi-intensive care unities

INTRODUÇÃO: Diversos estudos evidenciam que as alterações fisiopatológicas, quando associadas ao estresse, podem influenciar a fisiologia renal e estão associadas ao aparecimento de doenças. Entretanto, não foi encontrado nenhum estudo que tivesse realizado investigação associando estresse e lesão renal aguda. OBJETIVO: Avaliar a associação entre os eventos vitais estressores e o diagnóstico de lesão renal aguda, especificando as classes de eventos mais estressores para esses pacientes, nos últimos 12 meses. MÉTODOS: Estudo caso-controle. Foi realizado no Hospital São Paulo da Universidade Federal de São Paulo e no Hospital dos Servidores do Estado de São Paulo. Foram incluídos pacientes com lesão renal aguda, sem doenças crônicas, assistidos em Centros de Terapia Intensiva ou semi-intensivas. Os Controles incluíram pacientes assistidos nos mesmos Centros de Terapia Intensiva, com outras doenças agudas, exceto lesão renal aguda e, também, sem doenças crônicas. Dos 579 pacientes inicialmente identificados, 475 responderam ao instrumento Social Readjustment Rating Scale (SRRS) e 398 pacientes foram pareados por idade e sexo (199 casos/199 controles). RESULTADOS: Constatou-se que a frequência dos eventos vitais estressores nos casos apresentava equivalência estatística aos controles. A regressão logística para examinar os efeitos combinados das variáveis independentes associados aos eventos estressantes evidenciou que: o aumento da idade e as classes econômicas AB intensificam a chance da presença do evento estressante em cerca de duas vezes; as classes socioeconômicas AB do Hospital São Paulo elevam a chance de evento estressante. CONCLUSÕES: O presente estudo não evidenciou que o grupo com lesão renal aguda estivesse associado à maior frequência de eventos estressores, mas idade e renda elevadas e, ainda, o tipo de centro clínico estão associados.

INTRODUCTION: Several studies point out that pathophysiological changes related to stress may influence renal function and are associated with disease onset and evolution. However, we have not found any studies about the influence of stress on renal function and acute kidney injury. OBJECTIVE: To evaluate the association between stressful life events and acute kidney injury diagnosis, specifying the most stressful classes of events for these patients in the past 12 months. METHODS: Case-control study. The study was carried out at Hospital São Paulo, in Universidade Federal de São Paulo and at Hospital dos Servidores do Estado de São Paulo, in Brazil. Patients with acute kidney injury and no chronic disease, admitted to the intensive or semi-intensive care units were included. Controls included patients in the same intensive care units with other acute diseases, except for the acute kidney injury, and also with no chronic disease. Out of the 579 patients initially identified, 475 answered to the Social Readjustment Rating Scale (SRRS) questionnaire and 398 were paired by age and gender (199 cases and 199 controls). RESULTS: The rate of stressful life events was statistically similar between cases and controls. The logistic regression analysis to detect associated effects of the independent variables to the stressful events showed that: increasing age and economic classes A and B in one of the hospitals (Hospital São Paulo - UNIFESP) increased the chance of a stressful life event (SLE). CONCLUSIONS: This study did not show association between the Acute Kidney Injury Group with a higher frequency of stressful life events, but that old age, higher income, and type of clinical center were associated.

Public stigma and schizophrenia in São Paulo city.

OBJECTIVE: To assess public stigma in relation to people with schizophrenia and possible factors associated with this phenomenon. METHOD: A cross-sectional study was conducted with a probabilistic sample of 500 individuals who live in the city of São Paulo, Brazil, and are aged between 18 and 65 years. A structured questionnaire was used, and it was applied in person. Questionnaire began with the presentation of a vignette describing an individual with schizophrenia (according to DSM-IV and ICD-10 criteria). This was followed by questions that assessed perceived negative reactions and discrimination, perceived dangerousness and emotional reactions in relation to the case presented in the vignette. RESULTS: People with schizophrenia were perceived as potentially dangerous by 74.2% of interviewees. In addition, 59.0% of the sample perceived them as capable of arousing negative reactions, and 57.2% as capable of arousing discrimination in society. However, emotional reactions reported by the interviewees themselves were mainly pro-social in nature. The most important factors associated with these responses were: attribution of "biological" causes and perceived dangerousness. CONCLUSION: This study indicated that beliefs related to public stigma towards people with schizophrenia are commonly held in São Paulo city. An important focus for future studies is to investigate the scope and impact of public stigma on the everyday experiences of people with schizophrenia in the Brazilian context.

Public stigma and schizophrenia in São Paulo city / Estigma público e esquizofrenia na cidade de São Paulo

OBJECTIVE: To assess public stigma in relation to people with schizophrenia and possible factors associated with this phenomenon. METHOD: A cross-sectional study was conducted with a probabilistic sample of 500 individuals who live in the city of São Paulo, Brazil, and are aged between 18 and 65 years. A structured questionnaire was used, and it was applied in person. Questionnaire began with the presentation of a vignette describing an individual with schizophrenia (according to DSM-IV and ICD-10 criteria). This was followed by questions that assessed perceived negative reactions and discrimination, perceived dangerousness and emotional reactions in relation to the case presented in the vignette. RESULTS: People with schizophrenia were perceived as potentially dangerous by 74.2 percent of interviewees. In addition, 59.0 percent of the sample perceived them as capable of arousing negative reactions, and 57.2 percent as capable of arousing discrimination in society. However, emotional reactions reported by the interviewees themselves were mainly pro-social in nature. The most important factors associated with these responses were: attribution of "biological" causes and perceived dangerousness. CONCLUSION: This study indicated that beliefs related to public stigma towards people with schizophrenia are commonly held in São Paulo city. An important focus for future studies is to investigate the scope and impact of public stigma on the everyday experiences of people with schizophrenia in the Brazilian context.

OBJETIVO: Avaliar o estigma público em relação a pessoas com esquizofrenia e possíveis fatores associados a este fenômeno. MÉTODO: Foi realizado inquérito domiciliar com uma amostra probabilística de 500 indivíduos residentes na cidade de São Paulo, com idade entre 18 e 65 anos. Utilizou-se um questionário estruturado que se iniciava com a apresentação de uma vinheta descrevendo um indivíduo com esquizofrenia (segundo o DSM-IV e a CID 10), seguido de um questionário estruturado com questões sobre a percepção de reações negativas e discriminação, a percepção do risco de violência e as reações emocionais em relação ao caso apresentado na vinheta. RESULTADOS: Pessoas com esquizofrenia foram percebidas como potencialmente perigosas por 74,2 por cento dos entrevistados. Além disso, 59,0 por cento da amostra acreditam que estas pessoas podem gerar reações negativas, enquanto 57,2 por cento acreditam que podem provocar discriminação na sociedade. No entanto, reações emocionais relatadas pelos próprios entrevistados foram principalmente de natureza positiva. Os fatores mais importantes associados a estas respostas foram atribuição de causas "biológicas" e percepção de risco de violência. CONCLUSÃO: Este estudo indica que crenças relacionadas ao estigma público em relação a pessoas com esquizofrenia são encontradas com frequência entre a população da cidade de São Paulo. Um importante foco para futuros estudos é investigar o impacto do estigma público nas experiências diárias de pessoas com esquizofrenia no contexto brasileiro.

Association among physical, psychiatric and socioeconomic conditions and WHOQOL-Bref scores.

The aim of this study is to investigate the impact of psychiatric morbidity, depression, cognitive deficit, number of self-reported illnesses and socio-demographic variables on the WHOQOL-Bref domain scores. WHOQOL-Bref domain scores are substantially affected by psychiatric morbidity and income. Depression, the number of self-reported illnesses and the female gender also explain the variability of other domains to a lesser extent.

Association among physical, psychiatric and socioeconomic conditions and WHOQOL-Bref scores / Associação dos fatores físicos, psiquiátricos e socioeconômicos e os escores do WHOQOL-Bref

The aim of this study is to investigate the impact of psychiatric morbidity, depression, cognitive deficit, number of self-reported illnesses and socio-demographic variables on the WHOQOL-Bref domain scores. WHOQOL-Bref domain scores are substantially affected by psychiatric morbidity and income. Depression, the number of self-reported illnesses and the female gender also explain the variability of other domains to a lesser extent.

O objetivo deste estudo é o de investigar o impacto da morbidade psiquiátrica, depressão, comprometimento cognitivo, número de doenças autorreferidas e variáveis sociodemográficas nos escores do WHOQOL-Bref. Os escores dos domínios do WHOQOL-Bref estão associados à morbidade psiquiátrica e renda. A depressão, o número de doenças autorreferidas e o sexo feminino também explicam a variabilidade nos outros domínios, porém em menor grau.

Validity studies of quality of life instruments for eating disorders: systematic review of the literature.

To conduct a systematic review of studies that evaluated quality of life (QOL) among individuals with eating disorders, to analyze the characteristics of specific QOL instruments for eating disorders. Bibliographic searches were conducted in 6 databases and manual searches in 2 journals, covering the period from January 1975 to June 2008. The search strategies provided a total of 29,537 references. Out of the 41 studies that met the inclusion criteria for this review, 5 reported on the validation process for 4 specific instruments for eating disorders. Among the 4 specific QOL instruments for eating disorders, 3 presented adequate development procedures and psychometric properties. However, further research is needed to prove the validity and applicability of these instruments. Additional validation studies are needed, especially in relation to patients who deny that they have a disorder.

Tobacco use among the elderly: a systematic review and meta-analysis / Uso de tabaco entre idosos: revisão sistemática e meta-análise

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13 percent in both genders (22 percent male and 8 percent female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.

O objetivo deste estudo foi combinar os resultados de pesquisas identificadas sobre a prevalência do tabagismo em idosos, para estimar sua prevalência mundial e possíveis fatores relacionados a este tipo de comportamento entre eles. A revisão da literatura incluiu busca nas bases de dados eletrônicas como MEDLINE, LILACS e Biological Abstracts, busca manual em jornais especializados e nas referências citadas. A prevalência global combinada foi estimada usando-se o modelo de efeitos randômicos. O número total de idosos incluídos em todos os levantamentos foi 140.058, com dados disponíveis em todos os continentes. A prevalência de tabagismo foi de 13 por cento em ambos os sexos (22 por cento homens e 8 por cento mulheres). As taxas de prevalência foram heterogêneas e estiveram associadas com a definição de tabagismo, aplicação do questionário e com a economia de cada país. A maior taxa de prevalência foi encontrada entre idosos do sexo masculino que vivem em países de renda mais alta.

Prevalence and characteristics of outpatient psychotherapy use: a systematic review.

Psychotherapy is an efficacious and long used type of care. However, information available in specialized literature shows that this area has been little studied. The objective of this study is to determine the prevalence of use of outpatient psychotherapy by adult population, their related factors, and funding sources through systematic review, including qualitative and quantitative analyses of original articles with cross-sectional design and population-based sampling. Between January 1970 and December 2007, 3 databases were searched. A total of 2240 articles were identified, and 6 studies fulfilled the inclusion criteria. These studies investigated the prevalence of use of outpatient psychotherapy either in the moment or for 12 months or throughout life. Some of them investigated sociodemographic and health characteristics of users, costs, and treatment-funding sources. Studies' restricted number and different characteristics did not enable a meta-analysis. Six studies on the prevalence of use of outpatient psychotherapy were identified, thus revealing lack of data on this issue.

[Quality of life and eating disorders: a systematic review]. / Qualidade de vida e transtornos alimentares: uma revisão sistemática.

This article provides a systematic review of articles on quality of life (QoL) among individuals with eating disorders. A literature search was conducted using six databases. Manual searches were also performed in two specialized journals, covering the period from January 1975 to June 2008. The search strategies identified a total of 29,537 articles. Forty-one studies met the inclusion criteria, and 36 were analyzed in the present review. Patients with eating disorders showed reduced QoL as compared to normal controls and individuals with other psychiatric disorders. The mental health component of QoL showed greater impairment than the physical component. Patients with binge eating disorders showed reduced physical and psychological QoL. We identified few studies on QoL in bulimia nervosa-only patients. QoL assessment of anorexia nervosa patients showed a modest impact on the physical domain. However, this finding should be interpreted with caution, since it may be due to an artifact in the disorder's psychopathology rather than better health status per se.

Public stigma and schizophrenia in São Paulo city.

OBJECTIVE: To assess public stigma in relation to people with schizophrenia and possible factors associated with this phenomenon. METHOD: A cross-sectional study was conducted with a probabilistic sample of 500 individuals who live in the city of São Paulo, Brazil, and are aged between 18 and 65 years. A structured questionnaire was used, and it was applied in person. Questionnaire began with the presentation of a vignette describing an individual with schizophrenia (according to DSM-IV and ICD-10 criteria). This was followed by questions that assessed perceived negative reactions and discrimination, perceived dangerousness and emotional reactions in relation to the case presented in the vignette. RESULTS: People with schizophrenia were perceived as potentially dangerous by 74.2% of interviewees. In addition, 59.0% of the sample perceived them as capable of arousing negative reactions, and 57.2%, as capable of arousing discrimination in society. However, emotional reactions reported by the interviewees themselves were mainly pro-social in nature. The most important factors associated with these responses were: attribution of 'biological' causes and perceived dangerousness. CONCLUSION: This study indicated that beliefs related to public stigma towards people with schizophrenia are commonly held in São Paulo city. An important focus for future studies is to investigate the scope and impact of public stigma on the everyday experiences of people with schizophrenia in the Brazilian context.

Qualidade de vida e transtornos alimentares: uma revisão sistemática / Quality of life and eating disorders: a systematic review

O objetivo foi fazer uma revisão sistemática dos estudos que avaliam qualidade de vida em pessoas com transtornos alimentares. Foram realizadas buscas bibliográficas em seis bases de dados e buscas manuais em duas revistas, abrangendo o período de janeiro de 1975 até junho de 2008. As estratégias de busca forneceram um total de 29.537 referências. Quarenta e um estudos preencheram os critérios de inclusão desta revisão e 36 foram analisados no presente trabalho. De modo geral, os estudos revelam prejuízos na qualidade de vida de pacientes com transtornos alimentares quando comparados a grupos normais ou outras patologias psiquiátricas. O aspecto mental da qualidade de vida mostra-se mais prejudicado. A avaliação da qualidade de vida em sujeitos com transtorno da compulsão alimentar periódica revela prejuízos nos aspectos físico e mental da qualidade de vida. Há pouca evidência e discussão para indivíduos com bulimia nervosa isoladamente. Em sujeitos com anorexia nervosa, a avaliação requer cautela, já que o aparente menor impacto físico pode ser reflexo da psicopatologia específica deste transtorno e não do funcionamento saudável.

This article provides a systematic review of articles on quality of life (QoL) among individuals with eating disorders. A literature search was conducted using six databases. Manual searches were also performed in two specialized journals, covering the period from January 1975 to June 2008. The search strategies identified a total of 29,537 articles. Forty-one studies met the inclusion criteria, and 36 were analyzed in the present review. Patients with eating disorders showed reduced QoL as compared to normal controls and individuals with other psychiatric disorders. The mental health component of QoL showed greater impairment than the physical component. Patients with binge eating disorders showed reduced physical and psychological QoL. We identified few studies on QoL in bulimia nervosa-only patients. QoL assessment of anorexia nervosa patients showed a modest impact on the physical domain. However, this finding should be interpreted with caution, since it may be due to an artifact in the disorder's psychopathology rather than better health status per se.

Public stigma: the community's tolerance of Alzheimer disease.

OBJECTIVES: To investigate public stigma relating to Alzheimer disease (AD) and variables correlated with this outcome. DESIGN: Cross-sectional study. SETTING: City of São Paulo, Brazil. PARTICIPANTS: A representative sample of 500 individuals aged 18-65 years, living within the community. MEASUREMENTS: Subjects were interviewed to assess three dimensions of stigma (stereotypes, prejudice, and discrimination). Stigma was considered present in this study when all three domains were simultaneously fulfilled. RESULTS: The 41.6% of the participants expressed stereotypes; 43.4% prejudice; and 35.5% discrimination. Among the whole sample, 14.8% endorsed the stigma definition criterion adopted for this study. Those with fewer years of education were 2.32 times as likely to stigmatize persons carrying AD. Stigma was unaffected by other sociodemographic variables, experience of mental illness, emotional reactions, or general information about AD. CONCLUSIONS: Dimensions of stigma were highly prevalent in relation to AD. Interventions are needed to reduce the negative effects of stigma.

Tobacco use among the elderly: a systematic review and meta-analysis.

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.