Derivation and Validation of a Phenoconversion-Related Pattern in Idiopathic Rapid Eye Movement Behavior Disorder.

BACKGROUND: Idiopathic rapid eye movement sleep behavior disorder (iRBD) represents the prodromal stage of α-synucleinopathies. Reliable biomarkers are needed to predict phenoconversion. OBJECTIVE: The aim was to derive and validate a brain glucose metabolism pattern related to phenoconversion in iRBD (iRBDconvRP) using spatial covariance analysis (Scaled Subprofile Model and Principal Component Analysis [SSM-PCA]). METHODS: Seventy-six consecutive iRBD patients (70 ± 6 years, 15 women) were enrolled in two centers and prospectively evaluated to assess phenoconversion (30 converters, 73 ± 6 years, 14 Parkinson's disease and 16 dementia with Lewy bodies, follow-up time: 21 ± 14 months; 46 nonconverters, 69 ± 6 years, follow-up time: 33 ± 19 months). All patients underwent [18 F]FDG-PET (18 F-fluorodeoxyglucose positron emitting tomography) to investigate brain glucose metabolism at baseline. SSM-PCA was applied to obtain the iRBDconvRP; nonconverter patients were considered as the reference group. Survival analysis and Cox regression were applied to explore prediction power. RESULTS: First, we derived and validated two distinct center-specific iRBDconvRP that were comparable and significantly able to predict phenoconversion. Then, SSM-PCA was applied to the whole set, identifying the iRBDconvRP. The iRBDconvRP included positive voxel weights in cerebellum; brainstem; anterior cingulate cortex; lentiform nucleus; and middle, mesial temporal, and postcentral areas. Negative voxel weights were found in posterior cingulate, precuneus, middle frontal gyrus, and parietal areas. Receiver operating characteristic analysis showed an area under the curve of 0.85 (sensitivity: 87%, specificity: 72%), discriminating converters from nonconverters. The iRBDconvRP significantly predicted phenoconversion (hazard ratio: 7.42, 95% confidence interval: 2.6-21.4). CONCLUSIONS: We derived and validated an iRBDconvRP to efficiently discriminate converter from nonconverter iRBD patients. [18 F]FDG-PET pattern analysis has potential as a phenoconversion biomarker in iRBD patients. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Nascendo, encantando e cuidando: uma etnografia do processo de nascimento nos Pankarau de Pernambuco / Birthing, enchanting and caring an etnography about the birthing process in the Pankararu of Pernambuco

Este trabalho pretende compreender como se dá o Processo de Nascimento entre a população indígena Pankararu de Pernambuco, tratando principalmente dos cuidados e itinerários a ele associados, a partir da experiência de algumas mulheres indígenas. Para isso, será feito o exercício de olhar primeiramente o contexto e cultura indígena locais, considerando suas relações com os encantados e a sociedade envolvente, principalmente com os sistemas oficiais de saúde disponibilizados pelo Estado. No contexto Pankararu, o nascimento envolve tanto os conhecimentos e práticas biomédicas e indígenas, como a utilização de remédios do mato, passar pelo atendimento pré-natal, a realização do parto domiciliar ou hospitalar, além do batizado em casa. Para esta pesquisa foi utilizado o método etnográfico por meio da observação participante e de entrevistas semiestruturadas que viabilizaram apreender alguns dos saberes locais dessa população, relacionados ao parto e nascimento. O principal resultado desta investigação foi a revelação de como tem sido a assistência e experiência dessas mulheres com relação à sua saúde reprodutiva, considerando a demanda de contracepção, a ocorrência de partos em casa e nos hospitais, o trabalho das parteiras indígenas e o resguardo para controle da dona-do-corpo.

This work tries to understand the Process of Birth in the Pankararu indigenous population, in Pernambuco, focussing primarily on its associated cares and itineraries, based on the experience of some indigenous woman. To achieve this, an exercise of looking at the local indigenous context and culture will be conducted, considering the relations with the encantados and the absorbing society, mainly with the official health systems made available by the State. In the Pankararu context, birth involves both biomedical and indigenous knowledges and practices, the use of remédios do mato (medicinal herbs), frequenting prenatal care, giving birth at the hospital or at home and a home baptism. For this research, the ethnographic method was used, through participant observation and semi structured interviews that made it feasible to grasp some of the local knowledge of this population about labour and birth. The primary result of this investigation was the revelation of how the assistance has been received by these women and their experience regarding their reproductive health, taking into account the demand for contraception, the occurrence of home and hospital deliveries, indigenous midwives and the resguardo (postpartum restrictions period) for dona-do-corpos control.