Online group therapies for anxiety, obsessive-compulsive, and trauma-related disorders: a systematic review.

Background: This systematic review examined the existing literature to determine the evidence supporting the efficacy of online group treatments for anxiety-, obsessive-compulsive- and trauma-related disorders (AOTDs). Methods: A systematic review using the PUBMED, PsycInfo, Web of Science, and ClinicalTrials databases with no language, date, or study design filters was performed. The inclusion criteria comprised studies that examined individuals who had received a formal diagnosis of AOTDs, were aged 18 years or older, and had baseline and endpoint assessments of symptom severity using formal tools. Results: Five studies on social anxiety disorder (SAD), four on post-traumatic stress disorder (PTSD) and one on tic disorders (TDs) were found. The studies were open-label (n = 2) and randomized controlled trials (RCTs) (n = 8), with five of the RCTs being non-inferiority trials. Most studies were conducted in the US and investigated psychological CBT based interventions via internet-based therapies (IBT: n = 4), video teleconferencing (VTC: n = 5) or a combination of both (n = 1). In SAD, IBT studies associated with a clinician assisted web-based forum (here termed "forum-enhanced" studies) were superior to waiting lists and not inferior to similar versions that were also "forum enhanced" but self-guided, "telephone enhanced" by a contact with a non-specialist, and "email enhanced" by a contact with a clinician individually. Studies involving VTC have shown comparable effectiveness to in-person interventions across some online group CBT based treatments for PTSD. Two open trials also demonstrated symptoms reductions of social anxiety and tics through VTC. Conclusion: There is evidence supporting the effectiveness of online group treatments for SAD and PTSD. Further studies from different research groups may be needed to replicate the use of these and other forms of online treatments in individuals with SAD, PTSD, and other clinical populations, such as OCD, panic disorder, agoraphobia and specific phobias. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023408491.

Long-term airway evolution after orthognathic surgery: Systematic Review.

Orthognathic surgery is a procedure that consists of correcting the abnormalities of the maxilla, mandible or both. Maxillary movements have a direct effect on the upper airways. For this reason, in the preoperative period, bone movements should be carefully analyzed and planned to avoid causing any damages to the airways. The goal of this study was to discuss the long-term evolution of the airways after orthognathic surgery. In order to do that, a search was performed through the databases PubMed, Virtual Health Library (VHL) and Scopus, using the acronym PICO strategy and a guiding question to conduct the search. Through the keywords and boolean operators "and" and "or" we found 930 articles. After reading the titles, abstracts and application of inclusion and exclusion criteria, we had 21 articles that were studied in their integrity. At the end of the selection, only 8 studies were included in the review. The postoperative evaluations from the selected studies showed that the airways suffered variations, independently of the patient's facial pattern. In addition, the airways tend to return to initial volumes, but none of the included studies obtained a complete return to the initial airways, even 6 years after surgery. Therefore, more studies with controlled methodologies should be conducted in order to have a better understanding of the airways and their changes.

Avaliação do conhecimento dos estudantes de odontologia sobre a hipnose terapêutica / Evaluation of the knowledge of dentistry students about therapeutic hypnosis

A hipnose é conceituada como um estado modificado da consciência, mais próximo da vigília do que do sono. Configura-se como um ótimo método terapêutico auxiliar com diversos benefícios na odontologia, visto que é possível tratar o paciente no consultório empregando essa técnica junto ao tratamento em diversas especialidades odontológicas, além de que permite a dispensa do uso de medicamentos algumas vezes. Deste modo, o objetivo desse trabalho foi avaliar o conhecimento dos estudantes de odontologia sobre a hipnose terapêutica em tratamentos odontológicos. Tratou-se de um estudo exploratório descritivo de abordagem quantitativa realizado com alunos devidamente matriculados no 1º, 5º e 10º períodos dos cursos de Odontologia do Centro Universitário de João Pessoa - UNIPÊ, no Curso de Odontologia da Universidade Federal da Paraíba - UFPB, e no Curso de Odontologia da Faculdade Integrada de Patos - FIP. A amostra da pesquisa foi igual ao universo, sendo constituída de 257 estudantes. A coleta de dados foi realizada na Universidade Federal da Paraíba, UNIPÊ e na FIP sendo utilizado um questionário contendo questões objetivas relacionadas ao conhecimento sobre hipnose e sua aplicação. Com isso, constatou-se que os estudantes eram em sua maioria do gênero feminino (70%) com idade entre 18 e 21 anos (45,1%), não possuíam graduação (76%), não tinham conhecimento sobre as técnicas de hipnose (59%) e nem conheciam a resolução das Práticas Integrativas e Complementares (CFO nº82/2008). No entanto, a maioria dos entrevistados acreditava na técnica (75%), apresentavam vontade de fazer um curso sobre hipnose (77%) e acreditavam que o odontólogo possuía capacidade para realizar tal técnica (67%). Quando perguntados sobre as aplicações da hipnose na clínica odontológica houve o predomínio do controle de medo, trauma, ansiedade e tensão (17,9%). Em relação aos principais traumas no consultório observou-se que a maioria não tinha traumas (43,7%), seguido de barulho do motorzinho (12,1%). Concluiu-se que o fato de uma grande parcela dos estudantes de odontologia não possuir conhecimento acerca da hipnose, pode refletir na necessidade de inserção do conteúdo de Práticas Integrativas e Complementares nos cursos de graduação nessas instituições, além de que existem poucos estudos na literatura com essa temática ressaltando a importância do presente estudo... (AU)

Hypnosis is conceptualized as a modified state of consciousness, closer to waking than to sleep. It is configured as a great auxiliary therapeutic method with several benefits in dentistry, since it is possible to treat the patient in the office using this technique along with treatment in various dental specialties, in addition to allowing the dispensation of the use of medications sometimes. Thus, the objective of this work was to evaluate the knowledge of dentistry students about therapeutic hypnosis in dental treatments. It was an exploratory descriptive study with a quantitative approach carried out with students duly enrolled in the 1st, 5th and 10th periods of Dentistry courses at Centro Universitário de João Pessoa - UNIPÊ, in the Dentistry Course at Universidade Federal da Paraíba - UFPB, and in the Dentistry Course at Faculdade Integrada de Patos - FIP. The research sample was the same as the universe, consisting of 257 students. Data collection was carried out at the Federal University of Paraíba, UNIPÊ and at FIP, using a questionnaire containing objective questions related to knowledge about hypnosis and its application. Thus, it was found that the students were mostly female (70%) aged between 18 and 21 years old (45.1%), had no graduation (76%), had no knowledge about hypnosis techniques (59%) and did not even know the resolution of Integrative and Complementary Practices (CFO nº82 / 2008). However, most of the interviewees believed in the technique (75%), they wanted to take a course on hypnosis (77%) and believed that the dentist had the capacity to perform this technique (67%). When asked about the applications of hypnosis in the dental clinic, there was a predominance of fear, trauma, anxiety and tension control (17.9%). Regarding the main traumas in the office, it was observed that the majority had no traumas (43.7%), followed by the noise of the small engine (12.1%). It was concluded that the fact that a large portion of dentistry students do not have knowledge about hypnosis, may reflect the need to insert the content of Integrative and Complementary Practices in undergraduate courses in these institutions, in addition to the fact that few studies were literature with this theme emphasizing the importance of the present study... (AU)

Caregivers' resilience in mild and moderate Alzheimer's disease.

Objectives: To investigate the resilience of caregivers of people with mild and moderate Alzheimer's disease (PwAD) and the related sociodemographic and clinical characteristics.Methods: Cross-sectional assessment of dyads of PwAD and family caregivers (N = 106). Caregivers were assessed for resilience, depression, anxiety, hopelessness, quality of life, burden and cognition. PwAD were assessed for severity of dementia, cognition, neuropsychiatric symptoms, functionality, quality of life and awareness of disease.Results: Most of the caregivers (51.1%) reported emotional problems (symptoms of anxiety, stress and depression). In both mild (p < 0.05) and moderate (p < 0.05) PwAD groups, resilience was inversely related to self-reported emotional problems. There was not a significant difference between caregivers of mild and moderate PwAD resilience (p < 0.05). Upon analyzing the factors related to resilience, we found some differences between the groups of caregivers of mild and moderate PwAD. Neuropsychiatric symptoms of PwAD (p < 0.05) and caregiver's depressive symptoms (p < 0.05) were related to resilience of caregivers of mild PwAD. In the moderate group, caregivers' higher levels of quality of life (p < 0.05) and co-residing with PwAD (p < 0.05) were related to resilience.Conclusion: Caregivers' resilience is driven by different factors according to disease severity. The findings suggest that resilience allows caregivers to manage and respond positively to stressful demands of care.

Effects of direct high sodium exposure at endothelial cell migration.

The present study aimed to test the hypothesis that high sodium affects the migratory phenotype of endothelial cells (EC) and investigates mechanisms involved independently of hemodynamic factors. Cell migration was evaluated by Wound-Healing at conditions: High Sodium (HS; 160 mM) and Control (CT; 140 mM). O2- production was evaluated by DHE. NADPH oxidase activity was determined by chemiluminescence assay. Expression of adhesion molecules was analyzed by RT-PCR. Shear Stress was performed using a rhythmic shake. Nitric oxide production was measured by Griess reaction. HS-induced impairment in EC migration while both Candesartan and DPI prevented it. HS increased NADPH oxidase activity, which was blocked by Candesartan. Also, HS increased O2- production that was inhibited by Candesartan. HS decreased adhesion molecules expression via ROS (Integrin Alpha 5, Integrin Beta 1, Integrin Beta 3, VE-Cadherin and PECAM) and via AT1R (PECAM). The nitric oxide production induced by shear stress was decreased after EC exposure to HS while both Candesartan and DPI prevented it. Conclusion: This study demonstrated that HS reduced EC migration by AT1R and ROS derived from NADPH Oxidase and mitochondria. The HS reduction in adhesion molecules expression modulated by ROS and AT1R may help to explain the impairment in migration capacity. Also, HS affected EC functionality by reducing their nitric oxide production in response to shear stress.

Predisposition to Burnout Syndrome in prison officers / Predisposição à Síndrome de Burnout em agentes de segurança penitenciária

The aim of this study was to verify the predisposition of Penitentiary Security Agents (PSA) to develop Burnout Syndrome(BS). This study was carried out in 2017 at the Judge Flósculo da Nóbrega Prison in the city of João Pessoa/PB, using across-sectional approach, with a non-probabilistic sample, including 47 PSAs. The applied questionnaire was elaboratedand adapted by Chafic Jbeili, inspired by the Maslach Burnout Inventory (MBI), which measures the BS level. Data wereanalyzed using descriptive and inferential statistics. The Fisher exact test was applied, considering p0.05). The data indicate a high predisposition to BS development. This study does not diagnose BS, butallows for the early identification of the problem, supporting programmed actions for the well-being of the PSA, aiming at improving the quality of life of these workers

O estudo teve como objetivo verificar a predisposição dos Agentes de Segurança penitenciárias (ASP) em desenvolverSíndrome de Burnout (SB). O estudo foi realizado em 2017 no Presídio Desembargador Flósculo da Nóbrega na cidadede João Pessoa/PB, através de uma abordagem transversal, com amostra não probabilística, incluindo 47 ASP. Oquestionário aplicado foi elaborado e adaptado por Chafic Jbeili, inspirado no Maslach Burnout Inventory (MBI), quepermite a mensuração do nível da SB. Os dados foram analisados por meio de estatística descritiva e inferencial. Testeestatístico Exato de Fisher foi aplicado, considerando p0,05). Os dados indicam alta predisposição ao desenvolvimento da SB. O estudo não faz diagnósticoda SB, porém permite a identificação precoce do problema, favorecendo para que ações para o bem-estar do ASP sejamprogramadas, visando a melhora da qualidade de vida dos trabalhadores

Análise das lesões dentais nos laudos periciais produzidos pelo núcleo de medicina e odontologia legal da Paraíba, Brasil / Analysis of dental injuries from expert reports produced by Nucleus for Legal Medicine and Dentistry, Paraíba State, Brazil

Este estudo tem como objetivo estudar as lesões dentais nos laudos de lesão corporal do Núcleo de Medicina e Odontologia Legal do Instituto de Polícia Científica na cidade de João Pessoa-PB. Trata-se de uma pesquisa documental e descritiva com abordagem quantitativa que utilizou dados secundários da Instituição responsável pelos laudos traumatológicos de vítimas com lesões dentais. A amostra foi composta por 185 laudos nos anos de 2012 a 2014. Os resultados revelaram maior frequência do sexo masculino e a faixa etária entre 18 e 27 anos. A violência em acidentes terrestres foi o agente etiológico mais frequente (47%). A maioria das vítimas teve perdas de incisivos (84,3%). A avaliação do dano de acordo com o Art.129 do Código Penal Brasileiro mostrou que 44,9% dos casos analisados foram considerados com debilidade permanente, apenas 0,5% dos casos tinham incapacidade para as ocupações habituais por mais de 30 dias e 40,5% causaram deformidade às vítimas periciadas. Conclui-se que nos laudos de lesões dentais do NUMOL ­ PB existem distorções entre o que foi encontrado no exame físico e nas respostas aos quesitos, o que pode remeter à uma formação técnica deficitária ou falta de calibração entre os peritos que avaliam as lesões dentais.

This study aimed to assess dental injuries described in bodily injury reports of the Nucleus for Legal Medicine and Dentistry (NUMOL) of the Institute of Scientific Police in João Pessoa, PB, Brazil. It was a documentary and descriptive study using a quantitative approach of secondary data from the institute responsible for the reports of victims with dental injuries. The sample consisted of 185 reports from 2012 to 2014. The results revealed a higher prevalence of male and young individuals. Land accidents were the most frequent etiological agent of the injuries (47%). The majority of the victims lost incisor (84.3%). According to Brazilian Penal Code, Article 129, the measure of damages indicated that 44.9% of the victims had permanent impairment; and only 0.5% of them became unable to perform usual tasks for more than 30 days. In addition, 40.5% of the injuries caused deformities to the victims. It is concluded that the reports of dental injuries filed in NUMOL, PB, should be performed exclusively by experts in the field, as data distortions were observed.

The Relationship Between Social Cognition and Awareness in Alzheimer Disease.

A large body of evidence highlights the social cognitive impairment in neurodegenerative diseases such Alzheimer disease (AD). This study investigated the relationship among social and emotional functioning (SEF), awareness of disease, and other clinical aspects in people with AD (PwAD). A consecutive series of 50 people with mild to moderate AD and their 50 family caregivers were assessed. There was a significant difference between self-rated SEF and informant-rated SEF. In 56% of PwAD, self-rated SEF is lower than informant-rated SEF. People with AD mostly presented with mildly impaired awareness of the disease (56%), 20% had moderately impaired awareness of the disease, and 6% were unaware of the disease. The multivariate linear regression showed that informant-rated SEF was related to the social functioning, and relationships, domains of awareness of disease, and the PwAD informant-rated quality of life. The relationship between SEF and awareness of social functioning and relationship domain shows that they are comprised of judgments related to perceptions about oneself, values, and beliefs qualitatively different from awareness of memory or functionality, which can be directly observed.

Odontopediatras e técnicas aversivas no controle do comportamento infantil

Avaliar o perfil dos odontopediatras e o uso das técnicas aversivas para o controle do comportamento no cotidiano clínico. Sujeitos e método: foi realizado um estudo transversal, censitário, realizado com 33 odontopediatras atuantes na cidade de João Pessoa, regularmente inscritos no Conselho Regional de Odontologia da Paraíba. Os dados foram coletados por meio de questionário, objetivando avaliar: dados sociodemográficos; seleção e indicação das técnicas aversivas; ansiedade do odontopediatra e o consentimento e aceitação das técnicas aversivas pelas crianças/responsáveis. A análise dos dados foi realizada por estatística descritiva. Resultados: os odontopediatras foram representados principalmente pelo sexo feminino (93,9%), graduados há mais de 10 anos (84,8%) e com especialização (45,5%). Entre os profissionais, 84,8% utilizavam as técnicas aversivas, destes, 75,0% utilizavam as técnicas em pelo menos dois a cada 10 pacientes. No entanto, apenas 66,6% consideraram a abordagem do assunto suficiente durante a pós/graduação. A técnica aversiva mais escolhida pelos profissionais foi a contenção de braços, pernas e cabeça sem dispositivos específicos (53,6%), a principal indica- ção foi para crianças birrentas e agressivas (39,3%) e os profissionais relataram baixa ansiedade para execução das técnicas (46,4%). A maioria dos odontopediatras (60,7%) não solicitava a assinatura do termo de consentimento. Além disso, 92,9% afirmaram que a estabilização protetora não era rejeitada pelos pais, como também, 92,9% não consideraram que a estabilização protetora prejudicasse a aceitação do tratamento odontológico posterior da família do paciente. Conclusão: foi comum os odontopediatras utilizarem as técnicas aversivas para o controle comportamental, porém poucos solicitavam a autorização pelo termo de consentimento.

Quality of life in mild dementia: patterns of change in self and caregiver ratings over time

Objectives: To determine changes over time in self and caregiver ratings of quality of life (QoL) in people with dementia (PwD) and to identify factors associated with changes in QoL ratings. Methods: In this longitudinal study, 69 people with mild Alzheimer’s disease and their caregivers were assessed at baseline and after 1 year. We examined the association of QoL ratings with the following variables at the two time points: awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms, and caregiver burden. Multivariate regression analyses were conducted to examine the contribution of co-factors. Results: At baseline, PwD self-ratings of QoL were associated with caregiver ratings of PwD QoL (p = 0.001). Caregiver ratings were associated with PwD mood (p = 0.001) and self-rated QoL (p = 0.001). After 1 year, caregiver ratings of PwD QoL changed significantly (p = 0.049, d = -0.27), whereas PwD self-ratings did not (p = 0.89, d = 0.09). PwD awareness of disease changed significantly (p = 0.001) at 1 year, having declined in 25.4% and improved in 12.3% of participants. PwD QoL self-ratings were associated with caregiver ratings (p = 0.001). Caregiver ratings of PwD QoL after 1 year were associated with PwD mood (p = 0.029), self-reported QoL (p = 0.001), and awareness of disease (p = 0.033). Conclusions: The association between self and caregiver ratings of PwD QoL was maintained over 1 year. The primary factors accounting for the change in caregiver ratings were PwD mood and awareness of disease. QoL and cognitive impairment seem to be relatively independent in mild dementia.

Quality of life in mild dementia: patterns of change in self and caregiver ratings over time.

OBJECTIVES:: To determine changes over time in self and caregiver ratings of quality of life (QoL) in people with dementia (PwD) and to identify factors associated with changes in QoL ratings. METHODS:: In this longitudinal study, 69 people with mild Alzheimer's disease and their caregivers were assessed at baseline and after 1 year. We examined the association of QoL ratings with the following variables at the two time points: awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms, and caregiver burden. Multivariate regression analyses were conducted to examine the contribution of co-factors. RESULTS:: At baseline, PwD self-ratings of QoL were associated with caregiver ratings of PwD QoL (p = 0.001). Caregiver ratings were associated with PwD mood (p = 0.001) and self-rated QoL (p = 0.001). After 1 year, caregiver ratings of PwD QoL changed significantly (p = 0.049, d = -0.27), whereas PwD self-ratings did not (p = 0.89, d = 0.09). PwD awareness of disease changed significantly (p = 0.001) at 1 year, having declined in 25.4% and improved in 12.3% of participants. PwD QoL self-ratings were associated with caregiver ratings (p = 0.001). Caregiver ratings of PwD QoL after 1 year were associated with PwD mood (p = 0.029), self-reported QoL (p = 0.001), and awareness of disease (p = 0.033). CONCLUSIONS:: The association between self and caregiver ratings of PwD QoL was maintained over 1 year. The primary factors accounting for the change in caregiver ratings were PwD mood and awareness of disease. QoL and cognitive impairment seem to be relatively independent in mild dementia.

Impacto da saúde bucal na qualidade de vida de escolares do município de pequeno porte da paraíba / Impact of oral health in life quality of school children in a small municipality of Paraíba

Introdução: Doenças bucais são comuns na infância e causam um impacto negativo na qualidade de vida das crianças. Objetivo: Avaliar a relação do impacto da qualidade de vida e necessidade de tratamento odontológico de crianças na faixa etária de 8 a 10 anos em escolas municipais de ensino de Mari (PB). Material e método: Oitenta e seis escolares participaram da pesquisa que consistiu na aplicação do Child Perceptions Questionnaire (CPQ8-10) e exame bucal utilizando o índice INTO realizado por um único examinador calibrado (kappa interexaminador=0,83 e intraexaminador=0,54). Foi realizada estatística descritiva e inferencial (Qui quadrado e Exato de Fisher) com nível de significância de 5%, através do programa Statistical Package for the Social Sciences. Resultados: A maioria das crianças possuía 8 anos (38,4%, n=33), eram do sexo feminino (58,1%, n=50), sendo equitativamente distribuídas em escolas da zona urbana e rural. A maioria das crianças tinha necessidade de tratamento dentário (73,3%). O domínio mais frequente do CPQ foi alto e médio impacto na qualidade de vida das crianças foram os sintomas bucais (68,6%). Houve associação significativa entre os aspectos relacionados ao bem estar-social e a necessidade de tratamento cirúrgico restaurador, onde 72,7% dos pesquisados apresentavam elevada necessidade de tratamento restaurador e alto ou médio impacto em sua qualidade de vida (p<0,05). Houve associação estatisticamente significativa entre o impacto de qualidade de vida da criança e a necessidade de tratamento cirúrgico-restaurador (p<0,05). Conclusão: Pôde-se concluir que o impacto de qualidade de vida e a necessidade de tratamento estão associados nos escolares pesquisados.(AU)

Introduction: Oral Diseases are common in childhood and have a negative impact on quality of life of children. Objective: To evaluate the relationship of the impact of quality of life and need for dental treatment of children aged 8 to 10 years in municipal schools of education in Mari (PB). Methods: Eighty-six students participated in the survey which consisted of the application of the Child Perceptions Questionnaire (CPQ8-10) and oral examination using the INTO index performed by a single calibrated examiner (kappa = 0.83 inter and intra-rater = 0.54). Descriptive and inferential statistics (square and Fisher exact Thursday) with 5% significance level was performed using the Statistical Package for Social Sciences program. Results: Most of the children had 8 years (38.4%, n = 33) were female (58.1%, n = 50), and evenly distributed in schools in urban and rural areas. Most children had need of dental treatment (73.3%). The most common domain CPQ was high and medium impact on the quality of life of children were the oral symptoms (68.6%). A significant association between the aspects related to welfare and social and the need for surgical treatment restorer, where 72.7% of respondents had a high need for restorative treatment and high or medium impact on their quality of life (p <0.05). There was a statistically significant association between the child's quality of life impact and the need for surgical-restorative treatment (p <0.05). Conclusion: It was concluded that the impact of quality of life and the need for treatment are associated in schoolchildren.(AU)

Cross-cultural adaptation of the Social and Emotional Questionnaire on Dementia for the Brazilian population.

CONTEXT AND OBJECTIVE: Impairments in social and emotional functioning may affect the communication skills and interpersonal relationships of people with dementia and their caregivers. This study had the aim of presenting the steps involved in the cross-cultural adaptation of the Social and Emotional Questionnaire (SEQ) for the Brazilian population. DESIGN AND SETTING: Cross-cultural adaptation study, conducted at the Center for Alzheimer's Disease and Related Disorders in a public university. METHODS: The process adopted in this study required six consecutive steps: initial translation, translation synthesis, back translation, committee of judges, pretesting of final version and submission to the original author. RESULTS: In general, the items had semantic, idiomatic, conceptual and experiential equivalence. During the first pretest, people with dementia and their caregivers had difficulties in understanding some items relating to social skills, which were interpreted ambiguously. New changes were made to allow better adjustment to the target population and, following this, a new pretest was performed. This pre-test showed that the changes were relevant and gave rise to the final version of the instrument. There was no correlation between education level and performance in the questionnaire, among people with dementia (P = 0.951). CONCLUSION: The Brazilian Portuguese version of the Social and Emotional Questionnaire was well understood and, despite the cultural and linguistic differences, the constructs of the original version were maintained.

Facial expression recognition in Alzheimer's disease: a longitudinal study.

Facial recognition is one of the most important aspects of social cognition. In this study, we investigate the patterns of change and the factors involved in the ability to recognize emotion in mild Alzheimer's disease (AD). Through a longitudinal design, we assessed 30 people with AD. We used an experimental task that includes matching expressions with picture stimuli, labelling emotions and emotionally recognizing a stimulus situation. We observed a significant difference in the situational recognition task (p ≤ 0.05) between baseline and the second evaluation. The linear regression showed that cognition is a predictor of emotion recognition impairment (p ≤ 0.05). The ability to perceive emotions from facial expressions was impaired, particularly when the emotions presented were relatively subtle. Cognition is recruited to comprehend emotional situations in cases of mild dementia.

Facial expression recognition in Alzheimer’s disease: a longitudinal study / Reconhecimento da expressão facial na doença de Alzheimer: um estudo longitudinal

Facial recognition is one of the most important aspects of social cognition. In this study, we investigate the patterns of change and the factors involved in the ability to recognize emotion in mild Alzheimer’s disease (AD). Through a longitudinal design, we assessed 30 people with AD. We used an experimental task that includes matching expressions with picture stimuli, labelling emotions and emotionally recognizing a stimulus situation. We observed a significant difference in the situational recognition task (p ≤ 0.05) between baseline and the second evaluation. The linear regression showed that cognition is a predictor of emotion recognition impairment (p ≤ 0.05). The ability to perceive emotions from facial expressions was impaired, particularly when the emotions presented were relatively subtle. Cognition is recruited to comprehend emotional situations in cases of mild dementia.

O reconhecimento da expressão facial é um dos aspectos mais importantes relacionados à cognição social. Foram investigados os padrões de mudança e os fatores envolvidos na habilidade de reconhecer emoções na doença de Alzheimer (DA) leve. Em um estudo longitudinal foram avaliadas 30 pessoas com DA. Para a avaliação da capacidade de reconhecimento facial na DA foi utilizada uma tarefa experimental que inclui a combinação de expressões com uma figura estímulo, rotulação da emoção e reconhecimento emocional de uma situação estímulo. Foi encontrada diferença significativa entre os momentos 1 e 2 na tarefa de reconhecimento situacional (p ≤ 0.05). A regressão linear mostrou que a cognição (p ≤ 0.05) é o fator preditor para o prejuízo do reconhecimento emocional, o que sugere um recrutamento da cognição para a compreensão de situações emocionais mais complexas. Houve comprometimento na percepção de emoções em expressões faciais, particularmente, quando as emoções eram sutis.

Resilience of caregivers of people with dementia: a systematic review of biological and psychosocial determinants.

INTRODUCTION: Although caregivers of people with dementia may face difficulties, some positive feelings of caregiving may be associated with resilience. OBJECTIVE: This study systematically reviewed the definitions, methodological approaches and determinant models associated with resilience among caregivers of people with dementia. METHODS: Search for articles published between 2003 and 2014 in ISI, PubMed/MEDLINE, SciELO and Lilacs using the search terms resilience, caregivers and dementia. RESULTS AND CONCLUSIONS: Resilience has been defined as positive adaptation to face adversity, flexibility, psychological well-being, strength, healthy life, burden, social network and satisfaction with social support. No consensus was found about the definition of resilience associated with dementia. We classified the determinant variables into biological, psychological and social models. Higher levels of resilience were associated with lower depression rates and greater physical health. Other biological factors associated with higher levels of resilience were older age, African-American ethnicity and female sex. Lower burden, stress, neuroticism and perceived control were the main psychological factors associated with resilience. Social support was a moderating factor of resilience, and different types of support seemed to relieve the physical and mental overload caused by stress.

Resilience of caregivers of people with dementia: a systematic review of biological and psychosocial determinants / Resiliência de cuidadores de pessoas com demência: revisão sistemática de determinantes biológicos e psicossociais

Introduction: Although caregivers of people with dementia may face difficulties, some positive feelings of caregiving may be associated with resilience. Objective: This study systematically reviewed the definitions, methodological approaches and determinant models associated with resilience among caregivers of people with dementia. Methods: Search for articles published between 2003 and 2014 in ISI, PubMed/MEDLINE, SciELO and Lilacs using the search terms resilience, caregivers and dementia. Results and conclusions: Resilience has been defined as positive adaptation to face adversity, flexibility, psychological well-being, strength, healthy life, burden, social network and satisfaction with social support. No consensus was found about the definition of resilience associated with dementia. We classified the determinant variables into biological, psychological and social models. Higher levels of resilience were associated with lower depression rates and greater physical health. Other biological factors associated with higher levels of resilience were older age, African-American ethnicity and female sex. Lower burden, stress, neuroticism and perceived control were the main psychological factors associated with resilience. Social support was a moderating factor of resilience, and different types of support seemed to relieve the physical and mental overload caused by stress. .

Introdução: Apesar das dificuldades enfrentadas por cuidadores de pessoas com demência, sentimentos positivos quanto aos cuidados podem estar relacionados à resiliência. Objetivo: Revisamos sistematicamente a literatura sobre a conceituação, abordagens metodológicas e modelos determinantes relacionados à resiliência dos cuidadores de pessoas com demência. Métodos: Foi realizada uma busca por artigos publicados entre 2003 e 2014 nas bases de dados ISI, PubMed/MEDLINE, SciELO e Lilacs, usando os descritores resilience [resiliência], caregivers [cuidadores] e dementia [demência]. Resultados e conclusões: A resiliência foi definida como adaptação positiva para enfrentar adversidades, flexibilidade, bem-estar psicológico, força, vida saudável, sobrecarga, rede social e satisfação com o apoio social recebido. Não se encontrou consenso sobre o conceito de resiliência em relação à demência. As variáveis determinantes foram classificadas em modelos biológicos, psicológicos e sociais. Níveis mais altos de resiliência foram relacionados com taxas mais baixas de depressão e melhor saúde física. Os outros aspectos biológicos relacionados a níveis mais altos de resiliência foram idade avançada, etnia de origem africana e sexo feminino. Menos sobrecarga, estresse, neuroticismo e percepção de controle foram os principais aspectos psicológicos relacionados à resiliência. O apoio social foi um fator moderador da resiliência, pois uma variedade de tipos de apoio parece aliviar a sobrecarga física e mental causada pelo estresse. .

Awareness of disease is different for cognitive and functional aspects in mild Alzheimer's disease: a one-year observation study.

Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating Scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03-1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70-0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.

Spouse-caregivers' quality of life in Alzheimer's disease.

BACKGROUND: The relationship between sexuality and quality of life (QoL) of spouse-caregivers remains unclear. We designed this study to evaluate the relationship between sexual satisfaction and spouse-caregivers' QoL, and to determine the influence of the clinical characteristics of people with dementia (PWD) on spouse-caregivers' self-reported QoL. METHODS: Using a cross-sectional design, 54 PWD and their spouse-caregivers completed the QoL in Alzheimer's Disease scale (QoL-AD), questionnaire on sexual experience and satisfaction (QSES), Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), Pfeffer functional activities questionnaire (FAQ), the Cornell scale for depression in dementia (CSDD) and Zarit burden interview (ZBI). Univariate and multivariate regression analyses were conducted to identify the factors that influenced the spouse-caregivers' QoL ratings. RESULTS: We did not find a significant difference in QoL between male and female spouse-caregivers (p = 0.71). We also found that 13% of males and 48.1% of females demonstrated moderate to severe sexual dissatisfaction. However, we did not find a significant correlation between spouse-caregivers' QoL and sexual satisfaction (p = 0.41). The linear regression indicated that impaired awareness and lower QoL of PWD were significantly related to spouse-caregivers' QoL (p = 0.000). CONCLUSIONS: The spouse-caregivers' QoL is influenced by awareness of disease and PWD QoL. Our study would be helpful for the development of adequate psycho-educational approaches to increase spouse-caregivers' QoL, considering the specificities of the couples' relationship.

Caregivers' quality of life in mild and moderate dementia.

OBJECTIVE: To investigate quality of life (QoL) of caregivers of mild and moderate dementia and the aspects related to QoL. METHOD: Cross-sectional assessment of dyads of people with dementia (PwD) and family caregivers (n=88). RESULTS: Burden (p<0.05) and depressive symptoms (p<0.001) were related to caregivers' QoL in both stages of dementia. In mild dementia, caregivers' depressive symptoms (p<0.001) and PwD neuropsychiatric symptoms (p<0.001) were related to burden. PwD aberrant motor activity (p<0.001) and anxiety (p<0.001), and caregiver-reported QoL domains of friends (p<0.001) and mood (p<0.05) were related to depressive symptoms. In moderate dementia, self-reported QoL (p<0.01) and anxiety (p<0.01), and PwD anxiety (p<0.01) were related to burden. Caregivers' anxiety (p<0.001) and self-reported QoL (p<0.001) were related to depressive symptoms. CONCLUSION: Burden and depressive symptoms were related to QoL of caregivers of mild and moderate dementia. However, they are driven by different factors according to dementia severity.