Situação de saúde mental de comunidades tradicionais: marcadores sociais em análise / Mental health status in traditional communities: Social markers under analysis / L'état de santé mentale dans les communautés traditionelles: les marqueurs sociaux à l'étude / Situación de la salud mental en comunidades tradicionales: marcadores sociales en análisis

Objetiva-se analisar a situação de saúde mental de 48 municípios nordestinos que registram a presença de comunidades quilombolas e de assentamentos de reforma agrária em seus territórios, considerando as condições de vida, a oferta de serviços de saúde e o perfil de morbimortalidade em saúde mental. São articulados aspectos de gênero, classe e raça para compreender a produção de iniquidades em saúde nesses territórios. Trata-se de um estudo descritivo, realizado a partir de análise quantitativa com dados secundários coletados de diferentes bases disponíveis em domínio público. Observa-se o entrecruzamento e a combinação de fatores que influenciam a situação de saúde mental de municípios com populações do campo e da floresta: a precariedade nas condições de vida e trabalho, retaguarda insuficiente de serviços de atenção psicossocial e desigualdades étnico-raciais e de gênero da morbimortalidade psiquiátrica.

This descriptive study sought to analyze the mental health status of 48 Northeastern municipalities in Brazil with quilombola communities and agrarian reform settlements in their territories, considering the living conditions, health service supply and the profile of morbidity and mortality in mental health. Gender, class and race aspects are articulated to understand the production of health inequities in these territories. By means of a quantitative analysis based on secondary data collected from different open databases, the research unveiled the intersection and combination of factors that influence the mental health status of municipalities with rural and forest populations: the precariousness of living and working conditions, insufficient support from psychosocial care services, and ethnic-racial and gender inequalities in psychiatric morbidity and mortality.

Cette recherche descriptive visait à analyser l'état de santé mentale dans 48 municipalités du Nord-Est brésilien ayant des communautés quilombolas et des établissements de réforme agraire sur leur territoire, en tenant compte des conditions de vie, de l'offre de services de santé et du profil de morbidité et de mortalité en matière de santé mentale. Les aspects de genre, de classe et de race sont articulés pour comprendre la production d'inégalités en matière de santé dans ces territoires. À partir d'une analyse quantitative basée sur des données secondaires recueillies dans différentes bases de données dans le domaine public, on dévoile l'intersection et la combinaison de facteurs qui influencent l'état de santé mentale dans les communes à population rurale et forestière : la précarité des conditions de vie et de travail, le soutien insuffisant des services de soins psychosociaux et les inégalités ethniques, raciales et de genre en matière de morbidité et de mortalité psychiatriques.

El objetivo de este artículo es analizar la situación de la salud mental en 48 municipios del Nordeste de Brasil que tienen comunidades quilombolas y asentamientos de reforma agraria en sus territorios, en cuanto a las condiciones de vida, la oferta de servicios de salud y el perfil de morbimortalidad en salud mental. Se articulan los aspectos de género, clase y raza para comprender la producción de las desigualdades sanitarias en estos territorios. Se trata de un estudio descriptivo, que aplicó el análisis cuantitativo a los datos secundarios recogidos de diferentes bases de datos disponibles en el dominio público. Se observan el entrecruzamiento y la combinación de factores que influyen en la situación de la salud mental en los municipios con poblaciones rurales y de la floresta: la precariedad en las condiciones laborales y de vida, el insuficiente apoyo de los servicios de atención psicosocial y las desigualdades étnico-raciales y de género en la morbimortalidad psiquiátrica.

Topographical Distribution of Lacunes and Cerebral Microbleeds in CADASIL Affected by Hypertension

BACKGROUND: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited small vessel disease caused by mutations in the Notch3 gene. Lacunes may reflect occlusive type microangiopathy. However, cerebral microbleeds (CMBs) may reflect bleeding-prone microangiopathy. In the present study, we aimed to determine whether hypertension influence the distribution and severity of lacunes and CMBs in patients with CADASIL. METHODS: The study population comprised 85 patients who underwent brain MRI, including T1-weighted image, susceptibility weighted image (SWI), and fluid attenuated inversion recovery (FLAIR) image. The patients were divided into two groups depending on the presence or absence of hypertension. In the first, demographic factors, and MRI findings were compared between CADASIL patients with and without hypertension. In the second, we undertook a region by region comparison of number of patients with lacunes or CMBs. RESULTS: The hypertensive group showed a higher incidence of CMBs in lobar area (p<0.001) and basal ganglia (p=0.014). CMBs tend to be observed more frequently in the thalamus (p=0.058), brainstem (p=0.057), and cerebellum (p=0.052) in the hypertensive group. However, hypertensive group demonstrated a higher incidence of lacunes just in lobar area (p=0.040). CONCLUSIONS: Our findings suggest that CMBs may be a more sensitive neuroimaging marker of hypertensive arteriopathy in patients with CADASIL.

Effects of Lacunar Infarctions on Cognitive Impairment in Patients with Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

BACKGROUND AND PURPOSE: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited microangiopathy caused by mutations in the Notch3 gene. Although previous studies have shown an association between lacunar infarction and cognitive impairment, the relationship between MRI parameters and cognition remains unclear. In this study we investigated the influence of MRI parameters on cognitive impairment in CADASIL. METHODS: We applied a prospective protocol to 40 patients. MRI analysis included the normalized volume of white-matter hyperintensities (nWMHs), number of lacunes, and number of cerebral microbleeds. Cognition was assessed with the aid of psychometric tests [Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-cognition (ADAS-cog), Trail-Making Test, and Stroop interference (Stroop IF)]. RESULTS: A multivariate regression analysis revealed that the total number of lacunes influenced the performance in the MMSE, ADAS-cog, and Stroop IF, while nWMHs had a strong univariate association with ADAS-cog and Stroop IF scores. However, this association disappeared in the multivariate analysis. CONCLUSIONS: These findings demonstrate that the number of lacunes is the main predictive factor of cognitive impairment in CADASIL.

Small Vessel Disease and Subcortical Vascular Dementia

Atherothromboembolism and intracranial small vessel disease are considered to be the main causes of cerebrovascular injury, which may lead to cognitive impairment and vascular dementia (VaD). VaD appears to be the second most common type of dementia with prevalence estimates of 10-15%. Cortical or multi-infarct dementia and subcortical vascular dementia (SVD) are suggested to be the two main forms of VaD. The main clinical features of SVD comprise decreased motor performance, early impairment of attention and executive function with slowing of information processing. SVD results from lacunar infarcts or multiple microinfarcts in the basal ganglia, thalamus, brainstem and white matter and are associated with more than 50% of the VaD cases. White matter changes including regions of incomplete infarction are usually widespread in VaD but their contribution to impairment of subcortical regions is unclear. While most of VaD occurs sporadically only a small proportion of cases bear clear familial traits. CADASIL is likely the most common form of hereditary VaD, which arises from subcortical arteriopathy. SVD needs unambiguous definition to impact on preventative and treatment strategies, and critical for selective recruitment to clinical trials.