Efficacy of electroconvulsive therapy augmentation for partial response to clozapine: a pilot randomized ECT – sham controlled trial

Abstract Background Thirty percent of schizophrenia patients are treatment-resistant. Objective This is a single-blinded sham-controlled trial to assess the efficacy of electroconvulsive therapy (ECT) as augmentation strategy in patients with clozapine-resistant schizophrenia. Methods Twenty three subjects were randomly assigned to 12 sessions of ECT (N = 13) or placebo (Sham ECT) (N = 10). The primary outcome was improvement on psychotic symptoms as measured by the mean reduction of the PANSS positive subscale. The assessments were performed by blind raters. Results At baseline both groups were similar, except for negative and total symptoms of the PANSS, which were higher in the Sham group. At the endpoint both groups had a significant decrease from basal score. In the ECT group the PANSS total score decreased 8.78%, from 81.23 to 74.75 (p = 0.042), while the positive subscale had a mean reduction of 19% (19.31 to 16.17, p = 0.006). In the Sham group, the mean reduction of PANSS total score was 15.27% (96.80 to 87.43; p = 0.036), and the PANSS positive subscale decreased 27.81% (22.90 to 19.14, p = 0.008). The CGI score in ECT group decreased 23.0% (5.23 to 4.17; p = 0.001) and decreased 24.31% in the Sham ECT group (5.80 to 4.86; p = 0.004). Discussion In this pilot study, we found no difference between the groups.

Co-occurrence of communication disorder and psychiatric disorders in maltreated children and adolescents: relationship with global functioning

Objective: To study the co-occurrence of psychiatric disorders (PD) and communication disorders (CD) and their relationship with global functioning in maltreated children and adolescents. Methods: The sample comprised 143 maltreated children and adolescents (55.8% male). All underwent clinical communication and psychiatric evaluations, as well as global functioning assessment using the Children’s Global Assessment Scale (C-GAS). Results: Four groups emerged from evaluation: Group 1 (n=7, 4.9%) did not exhibit any disorders; Group 2 (n=26, 18.2%) exhibited PD; Group 3 (n=34, 23.8%) exhibited CD; and Group 4 (n=76, 53.1%) exhibited both PD and CD on evaluation. Significant differences in global functioning scores were found between G1 and G2, G1 and G4, G2 and G4, and G3 and G4, with the highest C-GAS scores found in G1 and the lowest in G4. Conclusion: Rates of PD and CD are high in this maltreated population. The presence of PD has a major impact on C-GAS score, and the simultaneous presence of CD increases the already impaired function of PD. Demonstration of the additive effects of PD and CD on youth functioning suggests that professionals should be alert to the presence of both disorders to better act preventively and therapeutically in a high-risk population.

Hypertension prevalence among indigenous populations in Brazil: a systematic review with meta-analysis / Prevalencia de hipertensión arterial en indígenas de Brasil: una revisión sistemática con meta-análisis / Prevalência de hipertensão arterial em indígenas do Brasil: uma revisão sistemática com meta-análise

Abstract OBJECTIVE Evaluating the evidence of hypertension prevalence among indigenous populations in Brazil through a systematic review and meta-analysis. METHODS A search was performed by two reviewers, with no restriction of date or language in the databases of PubMed, LILACS, SciELO, Virtual Health Library and Capes Journal Portal. Also, a meta-regression model was designed in which the last collection year of each study was used as a moderating variable. RESULTS 23 articles were included in the review. No hypertension was found in indigenous populations in 10 studies, and its prevalence was increasing and varied, reaching levels of up to 29.7%. Combined hypertension prevalence in Indigenous from the period of 1970 to 2014 was 6.2% (95% CI, 3.1% - 10.3%). In the regression, the value of the odds ratio was 1.12 (95% CI, 1.07 - 1.18; p <0.0001), indicating a 12% increase every year in the probability of an indigenous person presenting hypertension. CONCLUSION There has been a constant increase in prevalence despite the absence of hypertension in about half of the studies, probably due to changes in cultural, economic and lifestyle habits, resulting from indigenous interaction with non-indigenous society.

Resumen OBJETIVO Evaluar las evidencias acerca de la prevalencia de hipertensión arterial en indígenas brasileños por medio de una revisión sistemática y la realización de metanaálisis. MÉTODO Se llevó a cabo la búsqueda por dos revisores, sin restricción de fecha e idioma en las bases de datos PubMed, LILACS, SciELO, Biblioteca Virtual en Salud y Portal de Periódicos de Capes. También se hizo un modelo de metarregresión en que el último año de recolección de cada estudio fue utilizado como variable moderadora. RESULTADOS Fueron incluidos 23 artículos en la revisión. Hubo ausencia de hipertensión en los indígenas en 10 estudios y las prevalencias fueron crecientes y variadas, alcanzando niveles de hasta el 29,7%. La prevalencia combinada de hipertensión en los indígenas en el período de 1970 a 2014 fue del 6,2% (IC95%, 3,1% - 10,3%). En la regresión, el valor de la razón de probabilidades fue de 1,12 (IC95%, 1,07 - 1,18; p < 0,0001), indicando un incremento del 12% cada año en la probabilidad de que un indígena presente hipertensión arterial. CONCLUSIÓN Hubo aumento creciente en la prevalencia, pese a la ausencia de hipertensión, en cerca de la mitad de los estudios, probablemente consecuente de cambios de hábitos culturales, económicos y de estilo de vida, resultantes de la interacción del indio con la sociedad no indígena.

Resumo OBJETIVO Avaliar as evidências sobre a prevalência de hipertensão arterial em indígenas brasileiros por meio de uma revisão sistemática e realização de meta-análise. MÉTODO Realizou-se busca por dois revisores, sem restrição de data e idioma nas bases de dados PubMed, LILACS, SciELO, Biblioteca Virtual em Saúde e Portal de Periódicos da Capes. Também foi feito um modelo de meta-regressão em que o último ano de coleta de cada estudo foi utilizado como variável moderadora. RESULTADOS Foram incluídos 23 artigos na revisão. Houve ausência de hipertensão nos indígenas em 10 estudos e as prevalências foram crescentes e variadas, atingindo níveis de até 29,7%. A prevalência combinada de hipertensão nos indígenas no período de 1970 a 2014 foi de 6,2% (IC95%, 3,1% - 10,3%). Na regressão, o valor da razão de chances foi de 1,12 (IC95%, 1,07 - 1,18; p < 0,0001), indicando aumento de 12% a cada ano, na chance de um indígena apresentar hipertensão arterial. CONCLUSÃO Houve aumento crescente na prevalência, apesar da ausência de hipertensão, em cerca da metade dos estudos, provavelmente decorrente de mudanças de hábitos culturais, econômicos e de estilo de vida, resultantes da interação do índio com a sociedade não indígena.

Self-care in heart failure patients / Autocuidado de pacientes com insuficiência cardíaca / Autocuidado de los pacientes con insuficiencia cardíaca

AbstractObjective: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients.Method: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care). Association tests were applied, considering a descriptive level of 0.05.Results: the mean age of participants was 57.7 (SD =11.3) years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0) years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3), selfcare management: 50.0 (SD = 20.3) and self-care confidence: 52.6 (SD=22.7)) and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%), self-care management (14.7%) and self-care confidence (19%). Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001), longer time of experience with the disease (p=0.05) and joint monitoring by physician and nurse (p=0.007).Conclusion: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement.

ResumoObjetivo:descrever o comportamento de autocuidado e seus fatores associados em amostra de pacientes brasileiros com insuficiência cardíaca.Método:estudo transversal descritivo, com amostra não probabilística de 116 pacientes ambulatoriais em tratamento para a insuficiência cardíaca. O autocuidado foi avaliado pela Self-Care of Heart Failure Index v 6.2, (escores ≥70 pontos=autocuidado adequado). Aplicados testes de associação, adotando-se um nível descritivo de 0,05.Resultados:a idade média dos participantes era de 57,7 (desvio-padrão=11,3) anos; 54,3% homens; escolaridade média de 5,5 (desvio-padrão=4,0) anos de estudo e 74,1% em classe funcional II-III. As médias dos escores nas subescalas da Self-Care of Heart Failure Index v 6.2, indicaram autocuidado inadequado (manutenção do autocuidado: 53,2 (desviopadrão=14,3), manejo do autocuidado: 50,0 (desvio-padrão=20,3) e confiança do autocuidado: 52,6 (desvio-padrão=22,7)), assim como foram baixas as frequências de participantes com autocuidado adequado (manutenção do autocuidado (6,9%), manejo do autocuidado (14,7%) e confiança do autocuidado (19%). Escores mais elevados do Self-Care of Heart Failure Index, v.6, foram associados com: fração de ejeção ventricular esquerda menor (p=0,001), maior tempo de experiência com a doença (p=0,05) e acompanhamento conjunto do profissional médico e enfermeiro (p=0,007).Conclusão:são necessários investimentos para melhorar o comportamento de autocuidado e a enfermagem pode ter papel relevante nessa melhora.

ResumenObjetivo:describir el comportamiento de autocuidado y sus factores asociados en una muestra de pacientes brasileños con insuficiencia cardíaca.Método:estudio transversal descriptivo, con muestra no probabilística de 116 pacientes ambulatorios en tratamiento para la insuficiencia cardíaca. El autocuidado se evaluó por la Self-Care of Heart Failure Index, (puntuaciones ≥70 puntos=autocuidado adecuado). Se aplicaron pruebas de asociación, con un nivel descriptivo de 0,05.Resultados:la edad media de los participantes fue de 57,7 (desviación estándar=11,3) años; 54,3% hombres; escolaridad media de 5,5 (desviación estándar=4,0) años de estudio y 74,1% en clase funcional II-III. Las medias de las puntuaciones en las subscalas de la SelfCare of Heart Failure Index, indicaron autocuidado inadecuado (mantenimiento del autocuidado: 53,2 (desviación estándar=14,3), gestión del autocuidado: 50,0 (desviación estándar=20,3) y confianza del autocuidado: 52,6 (desviación estándar=22.7)) y bajas frecuencias de participantes con autocuidado adecuado (mantenimiento del autocuidado (6,9%), gestión del autocuidado (14,7%) y confianza del autocuidado (19%). Las puntuaciones más altas de la Self-Care of Heart Failure Index se asociaron con: fracción de eyección ventricular izquierda reducida (p=0,001), más larga experiencia con la enfermedad (p=0,05) y acompañamiento conjunto del profesional médico y enfermero (p=0,007).Conclusión:se necesitan inversiones para mejorar la conducta de autocuidado y la enfermería puede desempeñar un papel relevante en esta mejora.

Association study in Alzheimer’s disease of single nucleotide polymorphisms implicated with coffee consumption

There is evidence from animal and in vitro models of the protective effects of caffeine in Alzheimer’s disease. The suggested mechanisms through which caffeine may protect neurons against Alzheimer’s disease pathology include the facilitation of beta-amyloid clearance, upregulation of cholinergic transmission, and increased neuronal plasticity and survival. Epidemiological studies support that Alzheimer’s disease patients consume smaller amounts of coffee beverages throughout their lives as compared to age-matched cognitively healthy individuals. Objective: The aim of the present study was to determine whether the negative association between Alzheimer’s disease and coffee consumption may be influenced by a common genetic predisposition, given the fact that the pattern of coffee consumption is determined by both environmental and genetic factors. Method: We conducted an in silico search addressing the association between genetic polymorphisms related to coffee consumption and the diagnosis of Alzheimer’s disease. We further investigated the interactions between genes located in regions bearing these polymorphisms. Results: Our analysis revealed no evidence for a genetic association (nor interaction between related proteins) involving coffee consumption and Alzheimer’s disease. Discussion: The negative association between Alzheimer’s disease and coffee consumption suggested by epidemiological studies is most likely due to environmental factors that are not necessarily regulated by genetic background...

Auditory-perceptual analysis of voice in abused children and adolescents / Análise perceptivo-auditiva da voz de crianças e adolescentes vítimas de maus tratos

Introduction: Abused children and adolescents are exposed to factors that can trigger vocal changes. Objective: This study aimed to analyze the prevalence of vocal changes in abused children and adolescents, through auditory-perceptual analysis of voice and the study of the association between vocal changes, communication disorders, psychiatric disorders, and global functioning. Methods: This was an observational and transversal study of 136 children and adolescents (mean age 10.2 years, 78 male) who were assessed by a multidisciplinary team specializing in abused populations. Speech evaluation was performed (involving the aspects of oral and written communication, as well as auditory-perceptual analysis of voice, through the GRBASI scale). Psychiatric diagnosis was performed in accordance with the DSM-IV diagnostic criteria and by applying the K-SADS; global functioning was evaluated by means of the C-GAS scale. Results: The prevalence of vocal change was 67.6%; of the patients with vocal changes, 92.3% had other communication disorders. Voice changes were associated with a loss of seven points in global functioning, and there was no association between vocal changes and psychiatric diagnosis. Conclusion: The prevalence of vocal change was greater than that observed in the general population, with significant associations with communication disorders and global functioning. The results demonstrate that the situations these children experience can intensify the triggering of abusive vocal behaviors and consequently, of vocal changes. .

Introdução: Crianças e adolescentes vítimas de maus tratos estão expostas a fatores que podem desencadear alterações vocais. Objetivo: Analisar a prevalência de alteração vocal nesta população realizando análise perceptivo-auditiva da voz e estudar a associação entre alteração vocal, transtornos da comunicação, transtorno psiquiátrico e funcionamento global. Método: Estudo observacional e transversal. Participaram 136 sujeitos, com idade média de 10,2 anos, atendidos por equipe multidisciplinar especializada no tratamento ambulatorial de vítimas de maus tratos. Foi realizada avaliação fonoaudiologia (aspectos da comunicação orale escrita e análise perceptivo-auditiva da voz a qual foi feita por meio da escala GRBASI). O diagnóstico psiquiátrico foi dado de acordo com os critérios diagnósticos da CID-10 e aplicação do K-SADS; o funcionamento global foi avaliado por meio da escala C-GAS. Resultados: A prevalência de alteração vocal foi de 67,6%, dos pacientes com alteração vocal, 92,3% apresentaram outros transtornos da comunicação. A alteração vocal está associada a um prejuízo de sete pontos no funcionamento global e não apresentou associação com transtorno psiquiátrico. Conclusão: A prevalência de alterações vocais encontrada foi maior do que a observada na população geral, com associações significantes com transtornos da comunicação e funcionamento global. As situações que estas crianças vivem podem intensificar o desencadeamento de comportamentos vocais abusivos e consequentemente de alterações vocais. .

Religiousness and health-related quality of life of older adults / Religiosidade e qualidade de vida relacionada à saúde do idoso

OBJECTIVE To examine whether religiousness mediates the relationship between sociodemographic factors, multimorbidity and health-related quality of life of older adults. METHODS This population-based cross-sectional study is part of the Survey on Health, Well-Being, and Aging (SABE). The sample was composed by 911 older adults from Sao Paulo, SP, Southeastern Brazil. Structural equation modeling was performed to assess the mediator effect of religiousness on the relationship between selected variables and health-related quality of life of older adults, with models for men and women. The independent variables were: age, education, family functioning and multimorbidity. The outcome variable was health-related quality of life of older adults, measured by SF-12 (physical and mental components). The mediator variables were organizational, non-organizational and intrinsic religiousness. Cronbach's alpha values were: physical component = 0.85; mental component = 0.80; intrinsic religiousness = 0.89 and family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve) = 0.91. RESULTS Higher levels of organizational and intrinsic religiousness were associated with better physical and mental components. Higher education, better family functioning and fewer diseases contributed directly to improved performance in physical and mental components, regardless of religiousness. For women, organizational religiousness mediated the relationship between age and physical (β = 2.401, p < 0.01) and mental (β = 1.663, p < 0.01) components. For men, intrinsic religiousness mediated the relationship between education and mental component (β = 7.158, p < 0.01). CONCLUSIONS Organizational and intrinsic religiousness had a beneficial effect on the relationship between age, education and health-related quality of life of these older adults.

OBJETIVO : Analisar se a religiosidade exerce efeito mediador na relação entre fatores sociodemográficos, multimorbidade e qualidade de vida relacionada à saúde em idosos. MÉTODOS : Este estudo transversal, de base populacional, é parte do estudo Saúde, Bem-Estar e Envelhecimento (SABE). A amostra foi composta por 911 idosos da cidade de São Paulo, residentes na comunidade. A modelagem de equações estruturais foi realizada para verificar o efeito mediador da religiosidade na relação entre variáveis selecionadas e a qualidade de vida relacionada à saúde dos idosos, com modelos para homens e mulheres. As variáveis independentes foram: idade, escolaridade, funcionalidade familiar e multimorbidade. A variável de desfecho foi a qualidade de vida relacionada à saúde, medida pelo SF-12 (componentes físico e mental). As variáveis mediadoras foram a religiosidade organizacional, a não organizacional e a intrínseca. Os coeficientes alfa de Cronbach foram: componente físico = 0,85; componente mental = 0,80; religiosidade intrínseca = 0,89 e Apgar familiar = 0,91. RESULTADOS : Maiores níveis de religiosidade organizacional e intrínseca estiveram associados a melhor componente físico e mental para os idosos. Maior escolaridade, melhor funcionalidade familiar e menor número de doenças contribuíram diretamente para melhor desempenho nos componentes físico e mental, independente da religiosidade. Para as mulheres, a religiosidade organizacional mediou a relação entre a idade e os componentes físico (β = 2,401; p < 0,01) e mental (β = 1,663; p < 0,01). Para os homens, a religiosidade intrínseca mediou a relação entre a escolaridade e o componente mental (β = 7,158; p < 0,01). CONCLUSÕES : A religiosidade organizacional e intrínseca exercem efeito benéfico sobre a relação entre idade, escolaridade e a qualidade de vida relacionada à saúde desses idosos.

Adaptação transcultural e validação para o português da Escala de Atitudes em Relação ao Sabor da Health and Taste Attitude Scale (HTAS) / Cross-cultural adaptation and validation of the Health and Taste Attitude Scale (HTAS) in Portuguese

O objetivo do estudo foi apresentar a adaptação transcultural e validação da Escala de Atitudes em Relação ao Sabor da Health and Taste Attitude Scale para o Português. A metodologia contou com a tradução da escala; avaliação da equivalência conceitual, operacional e de item, por 14 experts e 51 universitárias; avaliação da equivalência semântica e mensuração, por 12 mulheres bilíngues por meio do teste t pareado, do coeficiente de correlação de Pearson e do coeficiente de correlação intraclasse; avaliação da consistência interna e confiabilidade teste-reteste por meio do Alpha de Cronbach e do Coeficiente de Correlação Intraclasse, respectivamente, após aplicação em 216 universitárias; avaliação da validade discriminante e concorrente, por meio do teste T e do Coeficiente de Correlação de Spearman, respectivamente; além de Análise Fatorial Confirmatória e Analise Fatorial Exploratória. A escala foi considerada adequada e de fácil compreensão pelos experts e universitárias e apresentou boa consistência interna e confiabilidade (µ 0,86; CCI 0,84). Os resultados apontam que a escala é válida e pode ser utilizada em estudos com mulheres, para entender melhor as atitudes em relação ao sabor.

The scope of this study was to show the cross-cultural adaptation and validation of the Health and Taste Attitude Scale in Portuguese. The methodology included translation of the scale; evaluation of conceptual, operational and item-based equivalence by 14 experts and 51 female undergraduates; semantic equivalence and measurement assessment by 12 bilingual women by the paired t-test, the Pearson correlation coefficient and the coefficient intraclass correlation; internal consistency and test-retest reliability by Cronbach's alpha and intraclass correlation coefficient, respectively, after application on 216 female undergraduates; assessment of discriminant and concurrent validity via the t-test and Spearman's correlation coefficient, respectively, in addition to Confirmatory Factor and Exploratory Factor Analysis. The scale was considered adequate and easily understood by the experts and university students and presented good internal consistency and reliability (µ 0.86, ICC 0.84). The results show that the scale is valid and can be used in studies with women to better understand attitudes related to taste.

Polydrug use among college students in Brazil: a nationwide survey

Objective: To estimate the frequency of polydrug use (alcohol and illicit drugs) among college students and its associations with gender and age group. Methods: A nationwide sample of 12,544 college students was asked to complete a questionnaire on their use of drugs according to three time parameters (lifetime, past 12 months, and last 30 days). The co-use of drugs was investigated as concurrent polydrug use (CPU) and simultaneous polydrug use (SPU), a subcategory of CPU that involves the use of drugs at the same time or in close temporal proximity. Results: Almost 26% of college students reported having engaged in CPU in the past 12 months. Among these students, 37% had engaged in SPU. In the past 30 days, 17% college students had engaged in CPU. Among these, 35% had engaged in SPU. Marijuana was the illicit drug mostly frequently used with alcohol (either as CPU or SPU), especially among males. Among females, the most commonly reported combination was alcohol and prescribed medications. Conclusions: A high proportion of Brazilian college students may be engaging in polydrug use. College administrators should keep themselves informed to be able to identify such use and to develop educational interventions to prevent such behavior. .

Single-nucleotide polymorphisms of GSK3B, GAB2 and SORL1 in late-onset Alzheimer's disease: interactions with the APOE genotype

In this study, we investigated the associations between single-nucleotide polymorphisms in GAB2 (rs2373115), GSK3B (rs6438552) and SORL1 (rs641120) and Alzheimer's disease (AD), both alone and in combination with the APOE*4 allele.