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1.
J Med Internet Res ; 21(11): e11346, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31714246

RESUMO

BACKGROUND: There is a considerable shortfall in specialized health care professionals worldwide to deliver health services, and this shortfall is especially pronounced in low-middle-income countries. This has led to the implementation of task-shifted interventions, in which specific tasks are moved away from highly qualified health workers to health workers with less training. The World Health Organization (WHO) has published recommendations for such interventions, but guidelines for software and systems supporting such interventions are not included. OBJECTIVE: The objective of this study was to formulate a number of software requirements for computer systems supporting task-shifted interventions. As the treatment of mental health problems is generally considered to be a task for highly trained health care professionals, it poses interesting case studies for task-shifted interventions. Therefore, we illustrated the use of the identified software requirements in a mobile system created for a task-shifted depression intervention to be provided to older adults in deprived areas of São Paulo, Brazil. METHODS: Using a set of recommendations based on the WHO's guidance documentation for task-shifted interventions, we identified 9 software requirements that aim to support health workers in management and supervision, training, good relationship with other health workers, and community embeddedness of the intervention. These 9 software requirements were used to implement a system for the provision of a psychosocial depression intervention with mobile Android interfaces to structure interventions and collect data, and Web interfaces for supervision and support of the health care workers delivering the intervention. The system was tested in a 2-arm pilot study with 33 patients and 11 health workers. In all, 8 of these 11 health workers participated in a usability study subsequent to the pilot. RESULTS: The qualitative and quantitative feedback obtained with the System Usability Scale suggest that the system was deemed to have a usability of between OK and Good. Nevertheless, some participants' responses indicated that they felt they needed technical assistance to use the system. This was reinforced by answers obtained with perceived usefulness and ease of use questionnaires, which indicated some users felt that they had issues around correct use of the system and perceived ability to become skillful at using the system. CONCLUSIONS: Overall, these high-level requirements adequately captured the functionality required to enable the health workers to provide the intervention successfully. Nevertheless, the analysis of results indicated that some improvements were required for the system to be useable in a task-shifted intervention. The most important of these were better access to a training environment, access for supervisors to metadata such as duration of sessions or exercises to identify issues, and a more robust and human-error-proof approach to the availability of patient data on the mobile devices used during the intervention.

3.
BMC Public Health ; 19(1): 1152, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438903

RESUMO

BACKGROUND: Depression is a common and recurrent condition among older adults and is associated with poor quality of life and increased health care utilization and costs. The purpose of this pilot study was to assess the feasibility of delivering a psychosocial intervention targeting depression, and to develop the procedures to conduct a cluster randomized controlled trial among older adults registered with primary care clinics in poor neighbourhoods of São Paulo, Brazil. METHODS: We conducted a pilot study of a two-arm cluster, non-randomized controlled trial. Two primary care clinics adhering to the Family Health Strategy were allocated to either the intervention or the control arm. In the control arm, patients received enhanced usual care consisting of staff training for improved recognition and management of depression. In the intervention arm, alongside the enhanced usual care, patients received a 17-week psychosocial intervention delivered by health workers assisted with an application installed in a tablet. RESULTS: We randomly selected 579 of 2020 older adults registered in the intervention clinic to participate in the study. Among these individuals, 353 were assessed for depression and 40 (11.0%) scored at least 10 on the PHQ-9 and were therefore invited to participate. The consent rate was 33/40 (82%) with a resulting yield of 33/579 (5.7%). In the control arm, we randomly selected 320 older adults among 1482 registered in the clinic, 223 were assessed for depression and 28 (12.6%) scored 10 or above on the PHQ-9. The consent rate was 25/28 (89%), with a resulting yield of 25/320 (7.8%). Of the 33 who consented in the intervention arm, 19 (59.4%) completed all sessions. The mean PHQ-9 at follow-up (approximately 30 weeks after inclusion) were 12.3 (SD = 3.7) and 3.8 (SD = 3.9) in the control and intervention arms, respectively. Follow-up rates were 92 and 94% in control and intervention arms, respectively. CONCLUSIONS: Identification and engagement of clinics, randomization, recruitment of individuals, measures, and baseline and follow-up assessments all proved to be feasible in primary care clinics in São Paulo, Brazil. Results support the development of a definitive cluster randomized controlled trial. TRIAL REGISTRATION: This study was retrospectively registered with Registro Brasileiro de Ensaios Clínicos (ReBEC), number RBR-5nf6wd . Registered 06 August 2018.


Assuntos
Depressão/prevenção & controle , Áreas de Pobreza , Psicoterapia , Idoso , Brasil , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Atenção Primária à Saúde , Resultado do Tratamento
4.
Neuroimage Clin ; 18: 932-942, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29876278

RESUMO

Background: White matter (WM) structural changes, particularly affecting the corpus callosum (CC), seem to be critically implicated in psychosis. Whether such abnormalities are progressive or static is still a matter of debate in schizophrenia research. Aberrant maturation processes might also influence the longitudinal trajectory of age-related CC changes in schizophrenia patients. We investigated whether patients with first-episode schizophrenia-related psychoses (FESZ) would present longitudinal CC and whole WM volume changes over the 5 years after disease onset. Method: Thirty-two FESZ patients and 34 controls recruited using a population-based design completed a 5-year assessment protocol, including structural MRI scanning at baseline and follow-up. The linear effects of disease duration, clinical outcome and antipsychotic (AP) use over time on WM and CC volumes were studied using both voxelwise and volume-based morphometry analyses. We also examined maturation/aging abnormalities through cross-sectional analyses of age-related trajectories of total WM and CC volume changes. Results: No interaction between diagnosis and time was observed, and clinical outcome did not influence CC volumes in patients. On the other hand, FESZ patients continuously exposed to AP medication showed volume increase over time in posterior CC. Curve-estimation analyses revealed a different aging pattern in FESZ patients versus controls: while patients displayed a linear decline of total WM and anterior CC volumes with age, a non-linear trajectory of total WM and relative preservation of CC volumes were observed in controls. Conclusions: Continuous AP exposure can influence CC morphology during the first years after schizophrenia onset. Schizophrenia is associated with an abnormal pattern of total WM and anterior CC aging during non-elderly adulthood, and this adds complexity to the discussion on the static or progressive nature of structural abnormalities in psychosis.


Assuntos
Antipsicóticos/uso terapêutico , Corpo Caloso/efeitos dos fármacos , Corpo Caloso/patologia , Esquizofrenia/tratamento farmacológico , Esquizofrenia/patologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/métodos , Masculino , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/patologia , Esquizofrenia/diagnóstico
5.
Clinics (Sao Paulo) ; 72(8): 474-480, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28954006

RESUMO

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


Assuntos
Doenças Assintomáticas/epidemiologia , Infarto Encefálico/complicações , Infarto Encefálico/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Fatores Etários , Idoso , Análise de Variância , Infarto Encefálico/fisiopatologia , Brasil/epidemiologia , Disfunção Cognitiva/fisiopatologia , Feminino , Humanos , Testes de Inteligência , Imagem por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Prevalência , Escalas de Graduação Psiquiátrica , Valores de Referência , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos
6.
Clinics ; 72(8): 474-480, Aug. 2017. tab
Artigo em Inglês | LILACS | ID: biblio-890719

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Idoso , Infarto Encefálico/complicações , Infarto Encefálico/epidemiologia , Doenças Assintomáticas/epidemiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/epidemiologia , Escalas de Graduação Psiquiátrica , Valores de Referência , Fatores Socioeconômicos , Brasil/epidemiologia , Imagem por Ressonância Magnética , Prevalência , Fatores de Risco , Análise de Variância , Fatores Etários , Medição de Risco , Infarto Encefálico/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Testes de Inteligência , Testes Neuropsicológicos
7.
PLoS Med ; 14(3): e1002261, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28323832

RESUMO

BACKGROUND: The prevalence of dementia varies around the world, potentially contributed to by international differences in rates of age-related cognitive decline. Our primary goal was to investigate how rates of age-related decline in cognitive test performance varied among international cohort studies of cognitive aging. We also determined the extent to which sex, educational attainment, and apolipoprotein E ε4 allele (APOE*4) carrier status were associated with decline. METHODS AND FINDINGS: We harmonized longitudinal data for 14 cohorts from 12 countries (Australia, Brazil, France, Greece, Hong Kong, Italy, Japan, Singapore, Spain, South Korea, United Kingdom, United States), for a total of 42,170 individuals aged 54-105 y (42% male), including 3.3% with dementia at baseline. The studies began between 1989 and 2011, with all but three ongoing, and each had 2-16 assessment waves (median = 3) and a follow-up duration of 2-15 y. We analyzed standardized Mini-Mental State Examination (MMSE) and memory, processing speed, language, and executive functioning test scores using linear mixed models, adjusted for sex and education, and meta-analytic techniques. Performance on all cognitive measures declined with age, with the most rapid rate of change pooled across cohorts a moderate -0.26 standard deviations per decade (SD/decade) (95% confidence interval [CI] [-0.35, -0.16], p < 0.001) for processing speed. Rates of decline accelerated slightly with age, with executive functioning showing the largest additional rate of decline with every further decade of age (-0.07 SD/decade, 95% CI [-0.10, -0.03], p = 0.002). There was a considerable degree of heterogeneity in the associations across cohorts, including a slightly faster decline (p = 0.021) on the MMSE for Asians (-0.20 SD/decade, 95% CI [-0.28, -0.12], p < 0.001) than for whites (-0.09 SD/decade, 95% CI [-0.16, -0.02], p = 0.009). Males declined on the MMSE at a slightly slower rate than females (difference = 0.023 SD/decade, 95% CI [0.011, 0.035], p < 0.001), and every additional year of education was associated with a rate of decline slightly slower for the MMSE (0.004 SD/decade less, 95% CI [0.002, 0.006], p = 0.001), but slightly faster for language (-0.007 SD/decade more, 95% CI [-0.011, -0.003], p = 0.001). APOE*4 carriers declined slightly more rapidly than non-carriers on most cognitive measures, with processing speed showing the greatest difference (-0.08 SD/decade, 95% CI [-0.15, -0.01], p = 0.019). The same overall pattern of results was found when analyses were repeated with baseline dementia cases excluded. We used only one test to represent cognitive domains, and though a prototypical one, we nevertheless urge caution in generalizing the results to domains rather than viewing them as test-specific associations. This study lacked cohorts from Africa, India, and mainland China. CONCLUSIONS: Cognitive performance declined with age, and more rapidly with increasing age, across samples from diverse ethnocultural groups and geographical regions. Associations varied across cohorts, suggesting that different rates of cognitive decline might contribute to the global variation in dementia prevalence. However, the many similarities and consistent associations with education and APOE genotype indicate a need to explore how international differences in associations with other risk factors such as genetics, cardiovascular health, and lifestyle are involved. Future studies should attempt to use multiple tests for each cognitive domain and feature populations from ethnocultural groups and geographical regions for which we lacked data.


Assuntos
Apolipoproteínas E/genética , Disfunção Cognitiva/epidemiologia , Escolaridade , Genótipo , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etiologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais
8.
Front Psychol ; 8: 57, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28184203

RESUMO

Cardiovascular risk (CVR) factors may be associated with poor cognitive functioning in elderlies and impairments in brain structure. Using MRI and voxel-based morphometry (VBM), we assessed regional white matter (WM) volumes in a population-based sample of individuals aged 65-75 years (n = 156), subdivided in three CVR subgroups using the Framingham Risk Score. Cognition was assessed using the Short Cognitive Performance Test. In high-risk subjects, we detected significantly reduced WM volume in the right juxtacortical dorsolateral prefrontal region compared to both low and intermediate CVR subgroups. Findings remained significant after accounting for the presence of the APOEε4 allele. Inhibitory control performance was negatively related to right prefrontal WM volume, proportionally to the degree of CVR. Significantly reduced deep parietal WM was also detected bilaterally in the high CVR subgroup. This is the first large study documenting the topography of CVR-related WM brain volume deficits. The significant association regarding poor response inhibition indicates that prefrontal WM deficits related to CVR are clinically meaningful, since inhibitory control is known to rely on prefrontal integrity.

9.
PLoS One ; 11(6): e0157719, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27352293

RESUMO

This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants read a vignette describing a 70-year-old individual (Mary or John) with a depressive disorder and answered questions measuring stigma. The prevalence of the three stigma domains was between 30.2 and 37.6% among older participants from São Paulo and between 27.6 and 35.4% among older participants from Manaus. Older adults from both cities reported similar prevalence of perceived stigma. Key factors associated with stigmatizing beliefs among older participants were reporting depressive symptoms, having physical limitations, and identifying the case of the vignette as a case of mental disorder. Among health professionals, the prevalence of the three stigma domains was between 19.8 and 34.8% in São Paulo and 30.2 and 44.6% in Manaus. The key factor associated with stigma among primary health care professionals was city, with consistently higher risk in Manaus than in São Paulo. Findings confirm that public stigma against older adults in Brazil is common. It is important to educate the public and primary health care providers in Brazil on stigma related to mental illness in order to reduce barriers to adequate mental health treatment.


Assuntos
Depressão/psicologia , Estigma Social , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atitude , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes/psicologia , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/ética
10.
PLoS One ; 11(3): e0150046, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26930353

RESUMO

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


Assuntos
Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Atenção Primária à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Centros Comunitários de Saúde Mental , Estudos Transversais , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Apoio Social , Fatores Socioeconômicos , Estresse Psicológico/psicologia , Adulto Jovem
11.
Arch Phys Med Rehabil ; 97(6): 947-52, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26827830

RESUMO

OBJECTIVE: To assess different aspects of sexual function in men with spinal cord injury (SCI) using the Male Sexual Quotient (MSQ), a newly developed tool to assess sexual function and satisfaction. DESIGN: Cross-sectional study. SETTING: Tertiary rehabilitation center. PARTICIPANTS: Patients (N=295) older than 18 years (mean age ± SD, 40.7±14.5y) with SCI for more than 1 year (median time since SCI, 3.6y; range, 1.6-7.0y) were assessed from February to August 2012. Patients completed the MSQ questionnaire and the Sexual Health Inventory for Men (SHIM). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Performance in various domains of sexual function was evaluated using the MSQ and SHIM questionnaires. RESULTS: Erectile function, ejaculation, and orgasm were the most severely affected domains. The median MSQ score was 40 (range, 8-66), and the median SHIM score was 5 (range, 0-16). The diagnostic properties of the 2 instruments were similar in the discrimination of sexually active subjects. The area under the receiver operating characteristic curve was .950 (95% confidence interval [CI], .923-.979) for the MSQ and .942 (95% CI, .915-.968) for the SHIM. There was a strong correlation between the 2 instruments (r=.826; 95% CI, .802-.878). CONCLUSIONS: Different domains of sexual function are severely impaired in men with SCI, although their sexual interest remains high. The MSQ and SHIM scores strongly correlate, but the MSQ provides a more comprehensive assessment of sexual dysfunction in male patients with SCI.


Assuntos
Avaliação da Deficiência , Modalidades de Fisioterapia/normas , Disfunções Sexuais Fisiológicas/etiologia , Traumatismos da Medula Espinal/complicações , Adolescente , Adulto , Idoso , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Adulto Jovem
12.
J Bone Miner Res ; 31(6): 1146-57, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26814375

RESUMO

Previous studies have shown a relationship between osteoporosis and increased mortality risk. However, none of these studies performed a concomitant evaluation of the parathyroid hormone (PTH)-calcium-vitamin D axis and bone mass to accurately determine the contribution of each of these parameters to survival in older subjects. Thus, we sought to investigate the association between bone parameters and mortality in a longitudinal, prospective, population-based cohort of 839 elderly subjects. Clinical data (including history of fractures and cardiovascular events) were assessed using a specific questionnaire. Laboratory exams, including serum 25OHD and PTH, were also performed. Bone mineral density (BMD) at the lumbar spine and hip were evaluated using DXA. All analyses were performed at baseline (2005 to 2007). Mortality was recorded during follow-up. Multivariate Cox proportional regression was used to compute hazard ratios for all-cause and cardiovascular mortality. Over a mean 4.06 ± 1.07 years, there were 132 (15.7%) deaths. These individuals were compared to 707 subjects who were alive at the end of the coverage period for mortality data collection. In a multivariate Cox proportional hazards model, age (HR 1.32; 95% CI, 1.13 to 1.55; p = 0.001, for each 5-year increase), male gender (HR 1.90; 95% CI, 1.30 to 2.79; p = 0.001), recurrent falls (more than two in the previous year; HR 1.65; 95% CI, 1.06 to 2.56; p = 0.026), diabetes mellitus (HR 2.17; 95% CI, 1.46 to 3.21; p < 0.001), low physical activity score (HR 1.78; 95% CI, 1.14 to 2.79; p = 0.011), prior cardiovascular event (HR 1.76; 95% CI, 1.18 to 2.63; p = 0.006), total hip BMD (HR 1.41; 95% CI, 1.15 to 1.72; p = 0.001, per each 1 SD decrease), and intact PTH (iPTH) (HR 1.06; 95% CI, 1.04 to 1.08; p < 0.001, per each 10 pg/mL increase) were independently associated with all-cause mortality. The subjects in the highest quartile of PTH (>49 pg/mL) were at a higher risk of cardiovascular death (HR 3.09; 95% CI, 1.36 to 6.99; p = 0.007) compared with the subjects in the lowest quartile (<26 pg/mL). Low BMD and higher PTH were significantly associated with mortality in community-dwelling older adults. These findings support the notion that careful screening of these bone parameters might lead to better management of older patients and improve outcomes in this population. © 2016 American Society for Bone and Mineral Research.


Assuntos
Densidade Óssea , Mortalidade , Hormônio Paratireóideo/sangue , Acidentes por Quedas/mortalidade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Vitamina D/sangue
13.
Fam Pract ; 33(3): 233-7, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26219991

RESUMO

BACKGROUND: Depression, diabetes and hypertension are major contributors to the global burden of disease; however, the majority of research on depression and co-morbid conditions originates in high-income countries. OBJECTIVE: This study examines the depression identification rate and compares treatment rates of depression with those of diabetes and hypertension among elderly individuals served in primary care through the Family Health Program (FHP) in São Paulo, Brazil. METHOD: A total of 1558 São Paulo Ageing and Health Study participants (low-income adults ≥65 years old living in São Paulo) registered in the FHP were included for analysis. Chart review was performed for participants with an International Classification of Diseases, 10th edition (ICD-10) depression diagnosis (from survey interview) to verify if depression was recorded for these individuals. Depression, diabetes and hypertension treatment were assessed based on clinical assessments and medication checks. RESULTS: Seventy-three participants (4.8%) had ICD-10 depression, 344 (23.2%) had confirmed diabetes and 1207 (79.3%) had confirmed hypertension. The proportion of those identified with depression by medical chart review (n = 63 for individuals whose chart could be found) was 4.8% (n = 3). Nine individuals (12.3%) with ICD-10 depression were treated. Rates of diabetes and hypertension treatment were 72.4% and 77.4%, respectively. CONCLUSION: Levels of treatment of depression in older adults receiving care in the FHP is very low compared to treatment rates of diabetes and hypertension. Collaborative care effectiveness trials for the treatment of depression in the FHP are needed to improve the quality of depression care for this population.


Assuntos
Envelhecimento/psicologia , Depressão/epidemiologia , Depressão/terapia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Classificação Internacional de Doenças , Masculino , Pobreza , Atenção Primária à Saúde
14.
PLoS One ; 10(10): e0140945, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26474472

RESUMO

Inter-subject variability in age-related brain changes may relate to educational attainment, as suggested by cognitive reserve theories. This voxel-based morphometry study investigated the impact of very low educational level on the relationship between regional gray matter (rGM) volumes and age in healthy elders. Magnetic resonance imaging data were acquired in elders with low educational attainment (less than 4 years) (n = 122) and high educational level (n = 66), pulling together individuals examined using either of three MRI scanners/acquisition protocols. Voxelwise group comparisons showed no rGM differences (p<0.05, family-wise error corrected for multiple comparisons). When within-group voxelwise patterns of linear correlation were compared between high and low education groups, there was one cluster of greater rGM loss with aging in low versus high education elders in the left anterior cingulate cortex (p<0.05, FWE-corrected), as well as a trend in the left dorsomedial prefrontal cortex (p<0.10). These results provide preliminary indication that education might exert subtle protective effects against age-related brain changes in healthy subjects. The anterior cingulate cortex, critical to inhibitory control processes, may be particularly sensitive to such effects, possibly given its involvement in cognitive stimulating activities at school or later throughout life.


Assuntos
Envelhecimento/fisiologia , Escolaridade , Substância Cinzenta/anatomia & histologia , Idoso , Cognição , Feminino , Substância Cinzenta/fisiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Tamanho do Órgão
15.
Neuroepidemiology ; 44(2): 85-90, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25765118

RESUMO

BACKGROUND: Epidemiological features of spinal cord injury (SCI) have been changing over the last decades. We evaluated the contemporary trends in the epidemiology of traumatic SCI patients from a rehabilitation center. METHODS: In a cross-sectional study, a consecutive series of 348 patients with traumatic SCI were evaluated. Variables were collected through an epidemiological form, which included gender, age at injury, duration and cause of SCI. We investigated SCI epidemiological trends over time including the association between gender and age at injury with SCI features such as etiology, injury severity and level. RESULTS: The mean age at SCI has increased from 26.0 ± 11.8 in patients with SCI before 2003 to 37.9 ± 15.7 in those with SCI after 2009 (p < 0.001). Gunshot wounds were the main cause of injury in patients with SCI before 2003, dropping from 40.6 to 16.9% after 2009 and being surpassed by road traffic injuries (38.6%) and falls (31.4%) after 2009 (p < 0.001). Gender, SCI severity and level have not changed significantly over the time. CONCLUSIONS: There was a major increase in the average age of patients as well as changes in the etiology of SCI over the past fifteen years, including a significant decrease in gunshot wounds and an increase in the frequency of road traffic injuries and falls. These changes and accompanying risk factors must be taken into consideration when planning measures to prevent SCI.


Assuntos
Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Front Aging Neurosci ; 6: 300, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25520654

RESUMO

Recent literature has presented evidence that cardiovascular risk factors (CVRF) play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer's disease (AD) and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies) in a sample of healthy elderly individuals. We aim to answer the following questions: is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images) enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: (i) we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease). (ii) When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. (iii) We found important gender differences, and the possible causes of that finding are discussed.

17.
Cad Saude Publica ; 30(9): 1875-83, 2014 Sep.
Artigo em Português | MEDLINE | ID: mdl-25317516

RESUMO

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


Assuntos
Transtornos Mentais/etiologia , Meio Social , Adulto , Idoso , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Fatores Socioeconômicos , População Urbana
18.
Cad. saúde pública ; 30(9): 1875-1883, 09/2014. tab
Artigo em Português | LILACS | ID: lil-725860

RESUMO

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


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


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


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Mentais/etiologia , Meio Social , Brasil/epidemiologia , Métodos Epidemiológicos , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Fatores Socioeconômicos , População Urbana
19.
PLoS One ; 9(4): e94042, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24736378

RESUMO

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


Assuntos
Cognição , Inquéritos sobre Dietas , Comportamento Alimentar , Frutas , Verduras , Populações Vulneráveis , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/prevenção & controle , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/prevenção & controle , Estudos Transversais , Feminino , Humanos , Masculino , Atividade Motora , Razão de Chances , Vigilância da População , Prevalência , Fatores de Risco
20.
Biomed Res Int ; 2014: 706157, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24575411

RESUMO

The presence of psychotic features in the course of a depressive disorder is known to increase the risk for bipolarity, but the early identification of such cases remains challenging in clinical practice. In the present study, we evaluated the diagnostic performance of a neuroanatomical pattern classification method in the discrimination between psychotic major depressive disorder (MDD), bipolar I disorder (BD-I), and healthy controls (HC) using a homogenous sample of patients at an early course of their illness. Twenty-three cases of first-episode psychotic mania (BD-I) and 19 individuals with a first episode of psychotic MDD whose diagnosis remained stable during 1 year of followup underwent 1.5 T MRI at baseline. A previously validated multivariate classifier based on support vector machine (SVM) was employed and measures of diagnostic performance were obtained for the discrimination between each diagnostic group and subsamples of age- and gender-matched controls recruited in the same neighborhood of the patients. Based on T1-weighted images only, the SVM-classifier afforded poor discrimination in all 3 pairwise comparisons: BD-I versus HC; MDD versus HC; and BD-I versus MDD. Thus, at the population level and using structural MRI only, we failed to achieve good discrimination between BD-I, psychotic MDD, and HC in this proof of concept study.


Assuntos
Transtorno Bipolar/patologia , Transtorno Depressivo Maior/patologia , Imagem por Ressonância Magnética/métodos , Adulto , Transtorno Bipolar/classificação , Transtorno Bipolar/diagnóstico por imagem , Transtorno Depressivo Maior/classificação , Transtorno Depressivo Maior/diagnóstico por imagem , Feminino , Humanos , Masculino , População , Radiografia
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