Structured physical exercise for bipolar depression: an open-label, proof-of concept study.

BACKGROUND: Physical exercise (PE) is a recommended lifestyle intervention for different mental disorders and has shown specific positive therapeutic effects in unipolar depressive disorder. Considering the similar symptomatology of the depressive phase in patients with bipolar disorder (BD) and unipolar depressive disorder, it is reasonable to suggest that PE may also be beneficial for bipolar depression. However, there is an absence of studies evaluating the antidepressant effect of a structured PE intervention in BD. METHODS: This is an open-label, single-arm study trial. Fifteen patients with a diagnosis of BD Type I or Type II, presenting a depressive episode were included in the study. After physical and functional evaluation, patients participated in supervised training sessions with aerobics followed by strength exercises, three times per week, for 12 weeks (36 training sessions). Depressive and manic symptoms were assessed at baseline and 2, 4, 8, and 12 weeks. Additionally, quality of Life and functioning were assessed at baseline and 4, 8, and 12 weeks). Finally, we tested cardiorespiratory fitness, muscle strength and body composition at baseline and week-12. RESULTS: The mean (± SD) Montgomery Asberg Depression Rating Scale (MADRS) score at baseline was 23.6 ± 8.3 points and after 12 weeks of PE the mean score was 10.2 ± 4.8 points. Nine patients (82%) presented an antidepressant response defined as a reduction of more than 50% of depressive symptoms at week 12 with five of those patients (45%) presenting criteria for full remission. A large and significant Cohen's D Effect Size (pre-post) was verified for MADRS reduction [1.98 (95% Confidence interval = 0.88 to 3.08)]. We did not detect a significant change in manic symptoms, functioning, and quality of life during the 12-week follow-up. At week-12, all patients increased their muscular strength (one repetition maximal test - 1RM) and reduced the percentage of body fat (spectral bioelectrical impedance analysis). CONCLUSIONS: This study, using rigorous criteria and a structured intervention, provides valid pilot data, showing the feasibility of a structured PE intervention for the treatment of depressive symptoms in BD, and suggesting a potential adjunctive antidepressant effect. Moreover, PE showed a positive impact on muscle strength and body composition. This should be further verified by randomized controlled studies.

Parental age and the risk of bipolar disorder in the offspring: A systematic review and meta-analysis.

OBJECTIVES: Whether parental age, i.e., paternal or maternal, at childbirth is associated with the risk of bipolar disorder (BD) in offspring remains unclear. We conducted a meta-analysis of observational studies to address this gap. METHODS: PubMed, PsycINFO, Embase, and Web of Science were searched up to June 2021. Studies investigating the associations between parental age at childbirth (exposure) and the risk of BD in offspring (outcome) were eligible for inclusion in our study. Paternal and maternal age were examined separately. Odds ratio (OR) was used as the effect size index. Data were pooled through random-effects meta-analyses. RESULTS: Seven studies involving 3,183,539 participants and 23,253 individuals with BD were included in our meta-analyses. Meta-analyses indicated an increased risk of BD in the offspring of the older paternal age groups (35-44 years old [k = 5; OR = 1.09; 95% CI 1.05, 1.14; p < 0.0001] and ≥45 years old [k = 5; OR = 1.44; 95% CI 1.19, 1.14; p = 0.0001]) in comparison with the reference category (25-34 years old). Meta-analysis also indicated an increased risk of BD in the offspring of the older maternal age group (≥40 years old [k = 3; OR = 1.20; 95% CI 1.10, 1.31; p < 0.0001]) in comparison with the reference category (20-29 years old). CONCLUSIONS: Advanced paternal and maternal age were both associated with an increased risk of BD in offspring. Further studies are needed to investigate the mechanisms behind this association.

Men's position in family care on situations of chronic illness. / Lugares do homem no cuidado familiar no adoecimento crônico.

OBJECTIVE: To understand the care by men in situations of chronic illness of one or more of his children, based on the dimensions of care. METHOD: It was based on a comprehensive approach and on the (re)view of the database of the matrix research to which the study is linked, with emphasis on three experiences of illness, in which the men effectively participated in the family care: two children with sickle cell anemia; son with adrenoleukodystrophy and son with concomitant diseases (cancer and kidney disease). RESULTS: The analysis diagram of each family demonstrated different ways of caring, explaining the relationship between the dimensions of care by men: social; affective/relational and physical/circulation, as well as the reverberations between these dimensions in the care. CONCLUSION: This understanding is important for health professionals to consider and respect the personalities, dignity and particularities of each family. It also gave visibility to care that has been significantly provided by man, thus supporting him in this process.

Bipolar disorder and tobacco smoking: Categorical and dimensional clinical correlates in subjects from the Brazilian bipolar research network.

BACKGROUND: People with bipolar disorder (BD) have high rates of smoking. However, the scientific literature examining the association between clinical outcomes in BD and tobacco smoking is still limited and there are conflicting results. The objective of the current study was to comprehensively investigate associations between BD and tobacco smoking in a large Brazilian sample. METHODS: This study evaluated 336 outpatients from the Brazilian Bipolar Research Network, which is a collaboration between three large academic centers in Brazil. MAIN FINDINGS: Regarding the categorical analysis (i.e. current smokers versus non-smokers), tobacco smokers showed: 1) a higher percentage of individuals identifying as Non-Caucasians; 2) a longer duration of illness; 3) a longer duration of untreated illness; 4) more severe manic symptoms; 4) a stronger family history of mood disorder; and 6) a higher current prevalence of alcohol/substance use disorder. The dimensional analysis in smokers (i.e. number of cigarettes per day versus clinical variables) found a positive correlation between number of cigarettes per day and a) age, b) age at onset of BD, c) duration of illness, and d) current diagnosis of panic disorder. CONCLUSION: This study found important clinical correlates of tobacco smoking in BD subjects. We observed that the variables associated with current smoker status (categorical approach) are not necessarily correlated with number of cigarettes per day (dimensional approach). Duration of illness appears to be a particularly relevant clinical variable in the association between BD and tobacco smoking.

Lugares do homem no cuidado familiar no adoecimento crônico / Lugares del hombre en el cuidado familiar en el proceso de enfermedad crónica / Men's position in family care on situations of chronic illness

RESUMO Objetivo Compreender o cuidado pelo homem na situação crônica de adoecimento de um ou mais de seus filhos, a partir do "lugar" em que tal cuidado acontece. Método Pautou-se pela abordagem compreensiva, a partir da (re) vista ao banco de dados de pesquisa matricial à qual o estudo se vincula, com relevo a três experiências de adoecimento selecionadas, em que o homem se posiciona de forma efetiva no cuidado familiar: dois filhos com anemia falciforme; filho com adrenoleucodistrofia e filho com agravos concomitantes (câncer e doença renal). Resultados O diagrama analisador de cada família possibilitou compreender as diferentes formas de cuidar, explicitando a relação que se estabelece entre os diversos lugares do cuidado pelo homem: social; afetivo/relacional e físico/de circulação, bem como as reverberações entre esses lugares no cuidado como um todo. Conclusão Tal compreensão se mostra importante para que os profissionais de saúde considerem e respeitem a pessoalidade, a dignidade e a singularidade de cada família, conferindo também visibilidade ao cuidado moldado significativamente pelo homem, amparando-o, então, nesse processo.

RESUMEN Objetivo Comprender el cuidado por el hombre en la situación crónica de enfermedad de uno o más de sus hijos desde el "lugar" en que ocurre dicho cuidado. Método Se pautó por el abordaje comprensivo, a partir de la (re)vista al banco de datos de investigación matricial a la que el estudio se vincula, con relieve para tres experiencias de proceso de enfermedad seleccionadas, en que el hombre se posiciona de modo efectivo en el cuidado familiar: dos hijos con anemia falciforme; hijo con adrenoleucodistrofia e hijo con agravamientos concomitantes (cáncer y enfermedad renal). Resultados El diagrama analizador de cada familia posibilitó comprender las distintas formas de cuidar, explicitando la relación que se establece entre los diferentes lugares del cuidado por el hombre: social; afectivo/relacional y físico/de circulación, así como las reverberaciones entre esos lugares en el cuidado como un todo. Conclusión Dicha comprensión se muestra importante para que los profesionales sanitarios consideren y respeten la personalidad, la dignidad y la singularidad de cada familia, otorgando también visibilidad al cuidado forjado significativamente por el hombre, amparándolo, de ese modo, en dicho proceso.

ABSTRACT Objective To understand the care by men in situations of chronic illness of one or more of his children, based on the dimensions of care. Method It was based on a comprehensive approach and on the (re)view of the database of the matrix research to which the study is linked, with emphasis on three experiences of illness, in which the men effectively participated in the family care: two children with sickle cell anemia; son with adrenoleukodystrophy and son with concomitant diseases (cancer and kidney disease). Results The analysis diagram of each family demonstrated different ways of caring, explaining the relationship between the dimensions of care by men: social; affective/relational and physical/circulation, as well as the reverberations between these dimensions in the care. Conclusion This understanding is important for health professionals to consider and respect the personalities, dignity and particularities of each family. It also gave visibility to care that has been significantly provided by man, thus supporting him in this process.

Adolescer e adoecer na perspectiva de jovem e família / To be an adolescent and sicken in the youth's and family's perspective / Ser un adolescente enfermo en la perspectiva del joven y de la familia

RESUMO Objetivo: Este estudo busca enfatizar a vivência do adolescer concomitante ao adoecer através de linha de ado ecimento e desenvolvimento de jovem que, na adolescência, experienciou a instauração de condição crónica por agravos concomitantes -doença renal e câncer. Método: Pesquisa de abordagem compreensiva, modelado como estudo de situação, através da História de Vida, operacionalizada por Entrevista em Profundidade e ob servação de campo; sendo sujeitos do estudo um jovem adoecido e alguns membros de sua família. Resultados: O desenho de linhas imbricadas do adoecimento e do adolescer possibilitou compreender as diferentes fases da condição crónica por agravos concomitantes e suas significativas repercussões para a vida do jovem. Dessa imbricação entre o adolescer e o adoecer, emergiram diversos enfrentamentos mediante as modificações físico-biológicas, comportamentais e sociais vivenciadas, configurando essa experiência única e complexa. Conclusão: Tal compreensão se mostra importante aos profissionais de saúde, de modo que busquem atender as necessida des do ser humano em desenvolvimento como um todo, não apenas as manifestações da doença.

ABSTRACT Objective: This study seeks to highlight the experience of being an adolescent and concomitantly suffer a chronic condition. The study focuses on a teenager who experienced the establishment of a chronic condition due to concomitant aggravations -kidney disease and cancer during adolescence. Methodology: A comprehensive study modeled as a situational analysis of Life History was performed by means of in-depth interviews and field observations. The test subjects were a teenager suffering from a chronic disease and some of his family members. Results: By intertwining the realities of suffering a chronic condition and going through adolescence, we were able to understand the different stages of said chronic condition due to concomitant aggravations and its significant impact on the life of the teenager. Several conflicts emerged from this overlap of adolescence and disease due to physical, biological, behavioral, and social changes; which make such experience complex and unique. Conclusion: This understanding proves important to health professionals allowing them to holistically meet the needs of a developing human being and not only pay attention to the manifestations of the disease.

RESUMEN Objetivo: En este estudio se pretende dar a conocer la experiencia de ser un adolescente concomitante de caer enfermo a través de la línea de enfermedad y desarrollo del joven, que en la adolescencia ha experimentado el establecimiento de una condición crónica con enfermedades concomitantes: dolencia renal y cáncer. Método: Investigación con enfoque integral modelado como estudio de situación mediante la Historia de Vida, realizada por la Entrevista en Profundidad y observación de campo; el sujeto de estudio fue un joven enfermo y algunos miembros de su familia. Resultados: El diseño de líneas entrelazadas de la enfermedad y del adolescente ha per mitido entender las diferentes etapas de la condición crónica resultante de las enfermedades concomitantes y su impacto significativo en la vida de los jóvenes. De este entrelazamiento entre el adolescente y la enfermedad surgieron varios enfrentamientos por los cambios físicos y biológicos, ajuste conductual y social, vividos en esta experiencia compleja y única. Conclusión: Tal entendimiento es importante para los profesionales de la salud, permitiéndoles satisfacer las necesidades del ser humano en desarrollo en su conjunto, y no sólo las manifesta ciones de la enfermedad.

Serum BDNF levels in unaffected first-degree relatives of patients with bipolar disorder

Objective: Unaffected relatives of bipolar disorder (BD) patients have been investigated for the identification of endophenotypes in an attempt to further elucidate the pathophysiology of the disease. Brain-derived neurotrophic factor (BDNF) is considered to be implicated in the pathophysiology of BD, but its role as an endophenotype has been poorly studied. We investigated abnormal serum BDNF levels in BD patients, in their unaffected relatives, and in healthy controls. Methods: BDNF levels were obtained from 25 DSM-IV bipolar I disorder patients, 23 unaffected relatives, and 27 healthy controls. All BD patients were in remission. The unaffected subjects were first-degree relatives of the proband who had no lifetime DSM-IV diagnosis of axis I disorder. BDNF serum levels were determined by sandwich ELISA using monoclonal BDNF-specific antibodies. Results: There were no statistical differences in BDNF levels among BD patients, relatives, and healthy controls. Conclusion: Serum BDNF levels may not indicate high genetic risk for BD, possibly acting as state markers rather than trait markers of the disease.

Facial emotion recognition in euthymic patients with bipolar disorder and their unaffected first-degree relatives.

BACKGROUND: Facial emotion recognition (FER) is an important task associated with social cognition because facial expression is a significant source of non-verbal information that guides interpersonal relationships. Increasing evidence suggests that bipolar disorder (BD) patients present deficits in FER and these deficits may be present in individuals at high genetic risk for BD. The aim of this study was to evaluate the occurrence of FER deficits in euthymic BD patients, their first-degree relatives, and healthy controls (HC) and to consider if these deficits might be regarded as an endophenotype candidate for BD. METHODS: We studied 23 patients with DSM-IV BD type I, 22 first-degree relatives of these patients, and 27 HC. We used the Penn Emotion Recognition Tests to evaluate tasks of FER, emotion discrimination, and emotional acuity. Patients were recruited from outpatient facilities at the Institute of Psychiatry of the University of Sao Paulo Medical School, or from the community through media advertisements, had to be euthymic, with age above 18years old and a diagnosis of DSM-IV BD type I. RESULTS: Euthymic BD patients presented significantly fewer correct responses for fear, and significantly increased time to response to recognize happy faces when compared with HC, but not when compared with first-degree relatives. First-degree relatives did not significantly differ from HC on any of the emotion recognition tasks. CONCLUSION: Our results suggest that deficits in FER are present in euthymic patients, but not in subjects at high genetic risk for BD. Thus, we have not found evidence to consider FER as an endophenotype candidate for BD.

Association between duration of untreated bipolar disorder and clinical outcome: data from a Brazilian sample

Objective: Bipolar disorder (BD) is often left untreated for long periods, and this delay in treatment correlates with unfavorable prognosis. The present study sought to assess the magnitude of duration of untreated bipolar disorder (DUB) in Brazil. We hypothesized that DUB would be longer in Brazil than in developed countries, and would be associated with poor clinical outcomes. Methods: One hundred and fifty-two psychiatric outpatients were evaluated for BD diagnosis, demographics, DUB, and clinical outcomes. Results: The mean age and mean DUB were, respectively, 38.9±10.8 and 10.4±9.8 years. An extended DUB was associated with early onset of BD (p < 0.001), depression as first mood episode (p = 0.04), and presence of BD in a first-degree relative (p = 0.012). Additionally, a longer DUB was associated with poorer clinical outcomes, such as elevated rates of rapid cycling (p = 0.004) and anxiety disorders (p = 0.016), as well as lower levels of current full remission (p = 0.021). Conclusion: As DUB may be a modifiable variable, better medical education regarding mental health, more structured medical services, and population-wide psychoeducation might reduce the time between onset and proper management of BD, thus improving outcome.

Serum BDNF levels in unaffected first-degree relatives of patients with bipolar disorder.

OBJECTIVE: Unaffected relatives of bipolar disorder (BD) patients have been investigated for the identification of endophenotypes in an attempt to further elucidate the pathophysiology of the disease. Brain-derived neurotrophic factor (BDNF) is considered to be implicated in the pathophysiology of BD, but its role as an endophenotype has been poorly studied. We investigated abnormal serum BDNF levels in BD patients, in their unaffected relatives, and in healthy controls. METHODS: BDNF levels were obtained from 25 DSM-IV bipolar I disorder patients, 23 unaffected relatives, and 27 healthy controls. All BD patients were in remission. The unaffected subjects were first-degree relatives of the proband who had no lifetime DSM-IV diagnosis of axis I disorder. BDNF serum levels were determined by sandwich ELISA using monoclonal BDNF-specific antibodies. RESULTS: There were no statistical differences in BDNF levels among BD patients, relatives, and healthy controls. CONCLUSION: Serum BDNF levels may not indicate high genetic risk for BD, possibly acting as state markers rather than trait markers of the disease.

Association between duration of untreated bipolar disorder and clinical outcome: data from a Brazilian sample.

OBJECTIVE: Bipolar disorder (BD) is often left untreated for long periods, and this delay in treatment correlates with unfavorable prognosis. The present study sought to assess the magnitude of duration of untreated bipolar disorder (DUB) in Brazil. We hypothesized that DUB would be longer in Brazil than in developed countries, and would be associated with poor clinical outcomes. METHODS: One hundred and fifty-two psychiatric outpatients were evaluated for BD diagnosis, demographics, DUB, and clinical outcomes. RESULTS: The mean age and mean DUB were, respectively, 38.9±10.8 and 10.4±9.8 years. An extended DUB was associated with early onset of BD (p < 0.001), depression as first mood episode (p = 0.04), and presence of BD in a first-degree relative (p = 0.012). Additionally, a longer DUB was associated with poorer clinical outcomes, such as elevated rates of rapid cycling (p = 0.004) and anxiety disorders (p = 0.016), as well as lower levels of current full remission (p = 0.021). CONCLUSION: As DUB may be a modifiable variable, better medical education regarding mental health, more structured medical services, and population-wide psychoeducation might reduce the time between onset and proper management of BD, thus improving outcome.

GENOGRAM AND ECO-MAP AS TOOLS FOR UNDERSTANDING FAMILY CARE IN CHRONIC ILLNESS OF THE YOUNG / GENOGRAMA Y ECOMAPA COMO HERRAMIENTAS PARA COMPRENSIÓN DEL CUIDADO FAMILIAR EN LAS ENFERMEDADES CRÓNICAS DEL JOVEN / GENOGRAMA E ECOMAPA COMO FERRAMENTAS PARA COMPREENSÃO DO CUIDADO FAMILIAR NO ADOECIMENTO CRÔNICO DE JOVEM

ABSTRACT The aim of this study was to understand family organization in care nucleus and supporting networks for families of young patients who experienced childhood kidney disease and adolescent cancer. It is a situational study using the history of life by means of in-depth interviews and observation. A genogram and an eco-map were used as analytical tools for data organization and analysis. The genogram showed family composition and the relationships established among its members and the care nucleus, strengthening the continuing and prolonged care required by the youth. The eco-map contrasted the punctual and unlinked work of the supporting network with the implicated, affective, and continuing work from the base network participation in the illness experienced by the youth. These tools allow health professionals to know the family organization in care, and the resources and networks with which they count on for support through the experience of a chronic illness.

RESUMEN El objetivo de este estudio es comprender la organización familiar en núcleos de cuidado y las redes de sustentación y apoyo tejidas por familias de jóvenes que vivieron, en su infancia, enfermedad renal y, en la adolescencia, el cáncer. Estudio de Situación, utilizando la Historia de Vida, operada por la Entrevista en Profundidad y Observación. Para organización y análisis de los datos, empleamos las herramientas analíticas genograma y el ecomapa. El genograma mostró la composición familiar y las relaciones establecidas entre sus entes y los núcleos de cuidado, potencializando el cuidado continuado y prolongado exigido por el joven. El ecomapa contrastó la actuación puntual y desvinculada de la red de apoyo con la forma implicada, afectiva y continuada con que la red de sustentación participó de la experiencia de la enfermedad del joven. Tales herramientas permiten a los profesionales de la salud conocer la organización familiar para el cuidado, los recursos y redes con que cuenta para sustentarla y ampararla en la experiencia de enfermedades crónicas.

RESUMO Este estudo objetivou compreender a organização familiar em núcleos de cuidado e redes de sustentação e apoio tecidas por família de jovem que vivenciaram, na infância, doença renal e, na adolescência, o câncer. Estudo de situação, utilizando história de vida, operacionalizada por entrevista em profundidade e observação. Para organização e análise dos dados, empregou-se as ferramentas analíticas genograma e ecomapa. O genograma mostrou a composição familiar e as relações estabelecidas entre seus entes e os núcleos de cuidado, potencializando o cuidado continuado e prolongado exigido pelo jovem. O ecomapa contrastou a atuação pontual e desvinculada da rede de apoio com a forma implicada, afetiva e continuada com que a rede de sustentação participou da experiência de adoecimento do jovem. Tais ferramentas permitem aos profissionais da saúde conhecer a organização familiar para o cuidado, os recursos e redes com que conta para sustentá-la e ampará-la na experiência de adoecimento crônico.

Gray matter volumes in patients with bipolar disorder and their first-degree relatives.

Bipolar disorder (BD) is highly heritable. First-degree relatives of BD patient have an increased risk to develop the disease. We investigated abnormalities in gray matter (GM) volumes in healthy first-degree relatives of BD patients to identify possible brain structural endophenotypes for the disorder. 3D T1-weighted magnetic resonance images were obtained from 25 DSM-IV BD type I patients, 23 unaffected relatives, and 27 healthy controls (HC). A voxel-based morphometry protocol was used to compare differences in GM volumes between groups. BD patients presented reduced GM volumes bilaterally in the thalamus compared with HC. Relatives presented no global or regional GM differences compared with HC. Our negative results do not support the role of GM volume abnormalities as endophenotypes for BD. Thalamic volume abnormalities may be associated the pathophysiology of the disease.

Participação da comunidade rural no cuidado de jovem adoecido crônico e sua família / Rural community participation in caregiving for a young person with chronic illness and his family / Participación de la comunidad rural en el cuidado al joven con enfermedad crónica y su familia

Objetivo: compreender a participação da comunidade rural na experiência do adoecimento crônico de jovem e família. Método: estudo de situação empregando a história de vida, conduzido por observação e entrevista em profundidade a jovem e família. A análise evidenciou as unidades de significado agrupadas no eixo de análise deste estudo. O projeto de pesquisa teve a aprovação do Comitê de Ética em Pesquisa, Protocolo 671/CEP-HUJM/09. Resultados: a mobilização da comunidade potencializou o cuidado em saúde, pois: a) suas ações foram pautadas na percepção/sensibilização quanto às necessidades do jovem e de sua família; b) não limitou sua atuação às necessidades de saúde; c) produziu respostas que, por vezes, superavam as expectativas da família; e d) forneceu subsídios diversificados que possibilitaram acesso às instituições de saúde e do judiciário. Conclusão: no contexto rural, onde persistem dificuldades de acesso e baixa qualidade na atenção em saúde, a comunidade rural atuou como mediadora sustentadora na experiência de adoecimento crônico de jovem e família.(AU)

Objective: understanding the participation of the rural community in the experience of chronic illness of the young person and his family. Method: study of situation applying the life history, conducted by observation and in-depth interview. The analysis showed the units of meaning which were grouped in the analysis axis of this study. The research project was approved by the Research Ethics Committee, Protocol 671/CEP-HUJM/09. Results: the community mobilization potentialized the health care, because: a) its actions were guided by the perception/awareness of the needs of the young person and his family; b) did not limit that actions to the health needs; c) produced responses which sometimes exceeded the family expectations; and d) provided various subsidies that enabled the access to health care institutions and the judiciary. Conclusion: in the rural context persists the difficulty to access the quality health care. The rural community acted as a sustainer mediator in the chronic illness experience of the young person and his family.(AU)

Objetivo: comprender la participación de la comunidad rural en la experiencia de la enfermedad crónica del joven y su familia. Método: un estudio de situación utilizando la historia de vida, impulsada por la observación y la entrevista en profundidad con el joven y su familia. El análisis mostró el significado de unidades agrupadas en el eje de análisis de este estudio. El proyecto de investigación fue aprobado por el Comité de Ética en la Investigación, Protocolo 671/CEP-HUJM/09. Resultados: la movilización comunitaria potenció la atención de la salud debido a que: a) sus acciones fueron guiadas por la percepción/conciencia de las necesidades del joven y su familia; b) no limitó sus actividades a las necesidades de salud; c) ha producido las respuestas que a veces superan las expectativas de la familia; d) proporcionan diversos subsidios que permitieron el acceso a las instituciones de salud y el poder judicial. Conclusión: en el contexto rural, donde sigue habiendo dificultades de acceso y la mala calidad en la atención de salud, la comunidad rural actuó como mediadora en el sostenimiento de la experiencia enfermedad crónica del joven y su familia.(AU)

Cuidado familiar na experiência do adoecimento crônico de um jovem / Family caregiving in chronic illness: a young person's experience / Cuidados familiares en la experiencia de enfermedad crónica de un joven

Objetivou-se compreender como se moldou o cuidado familiar na experiência de adoecimento crônico que perpassou a infância e a adolescênciade jovem acometido por doença renal e câncer. Estudo de abordagem compreensiva, moldado como análise situacional a partir da históriade vida. No trabalho de campo, empregou-se a entrevista em profundidade e observação para apreensão dos elementos ouvidos, vistos eexperienciados, registrados em diário de campo. A partir deste último, moldou-se o corpus de análise que, após leituras vertical e horizontal,evidenciou aspectos que permeiam as diferentes narrativas. Do corpus, desenhou-se o genograma do jovem e família. Conforme os afetamentosdo adoecimento crônico do jovem repercutiam na vida dos familiares, estes eram compelidos a cuidar dele, numa sinergia de atuações econstante movimento, oferecendo-lhe certa sustentação. Desenvolveram-se outras normalidades na vivência do adoecimento pelo jovem efamília e a cada nova condição imposta, novos meios de superação foram por eles desenvolvidos.

This study aimed at understanding family caregiving for a young person with chronic illness since childhood. He had a kidney disease and cancer.The researchers used a comprehensive approach as situational analysis from his life history. During fieldwork, researchers carried out in-depthinterviews and direct observation aiming at apprehending elements they had heard, seen and experienced. These elements were then registered ina field diary. After vertical and horizontal reading, the corpus of analysis was identified and different aspects that permeated the narrative werehighlighted. A genogram of the individual and his family was built. The individual’s chronic condition changed family life: they were compelled tolook after him in a synergy of actions and constant motion that provided some support. New routines were created and other ways of overcomingthe new obstacles were developed.

El presente estudio tuvo como objetivo entender cómo se forma el cuidado familiar en la experiencia de enfermedad crónica de un joven con cáncery problemas renales desde la niñez y en la adolescencia. Se trata de una investigación comprensiva proyectada como análisis de la situación desdela historia de vida. Durante el trabajo de campo se utilizaron la entrevista en profundidad y la observación para obtener elementos oídos, vistosy vividos, registrados en el diario de campo. Luego, se fue formando el corpus de análisis que, después de su lectura vertical y horizontal, mostródiferentes aspectos que impregnaban la narración. Se elaboró el genograma del joven y de su familia. A medida que los daños de la enfermedadcrónica del joven repercutían en la vida de los familiares, éstos eran obligados a cuidarlo, en una sinergia de acciones y constante movimiento,brindándole una especie de apoyo. Hubo otras situaciones en la experiencia de enfermedad del joven y su familia y ante cada nueva condiciónimpuesta, ellos fueron buscando nuevos medios de superación.

Decisões judiciais referentes ao agravo câncer: análise dos argumentos do direito à saúde / Judicial decisions regarding cancer appeals: an analysis of arguments of the Law as applied to health / Sentencias judiciales referentes a la patología del cáncer: análisis de argumentos del derecho a la salud

As implicações do adoecimento por câncer exigem da pessoa adoecida e de sua família a busca por cuidados profissionais, que nem sempre são oferecidos de maneira resolutiva às suas necessidades, o que os leva a recorrer à instância jurídica para a efetivação do direito à saúde. Objetivou-se, nesse sentido, analisar contenda do direito à saúde entre os poderes do Estado e Magistrado em decisões judiciais envolvendo demandas em saúde de pessoas que vivenciam o agravo câncer. Estudo de abordagem qualitativa de caráter documental com análise de 34 decisões judiciais relativas ao período de maio/2008 a abril/2009, do TJMT. Das decisões analisadas, 88,2% foram por solicitação de medicamentos, 11,7% por suplementos nutricionais, 2,9% por transporte terrestre e 2,9% por neurocirurgia. No decorrer da análise, percebeu-se que os argumentos utilizados pelo Estado foram insuficientes mediante aqueles que o Magistrado apresentou ao reiterar o direito à vida, constitucionalmente garantido, sobrepondo-se aos interesses estatais

The implications of developing cancer demand that affected individuals and their families seek professional care, which are not always offered in a manner adequate to their needs. This leads them to appeal to court instances in order to guarantee their right to health. The goal of the present study is to analyze legal struggles in relation to the health of people with cancer. It is a qualitative documentary study analyzing 34 court rulings relative to the period of May 2008 to April 2009, made by the Mato Grosso Court of Justice (TJMT). Out of these, 88.2% were requests for medication, 11.7% for nutritional supplies, 2.9% for land transportation and 2.9% for neurosurgery. Throughout the analysis, we realized that the arguments used by the State were insufficient before those presented by the magistrate used to reaffirm the right to life as guaranteed by the constitution, which takes precedence over interests of the State

Las implicancias del padecimiento de cáncer exigen de la persona enferma y de su familia la búsqueda de cuidadosprofesionales, no siempre ofrecidos de modo resolutivo de sus necesidades, lo cual los lleva a recurrir a instancias jurídicas para efectivizar su derecho a la salud. Se objetivó analizar procesos del derecho a la salud entre los Poderes estatales y Magistrados en sentencias involucrando demandas de salud de personas afectadas por c áncer. Estudio de abordaje cualitativo, de carácter documental, analizando 34 sentencias jurídicas emitidas de mayo/2008 a abril/2009, del TJMT. De las sentencias analizadas, 88,2% correspondió a solicitud de medicamentos, 11,7% a suplementos nutricionales, 2,9% a transporte terrestre y 2,9% a neurocirugía. Durante el análisis, percibimos que los argumentos esgrimidos por el Estado fueron insuficientes frente a aquellos esgrimidos por el Magistrado al respaldar el derecho a la vida, constitucionalmente garantizado, superponiéndolo a los intereses estatales.

Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder.

OBJECTIVE: Bipolar disorder (BD) is associated with significant morbidity and mortality due to comorbid general medical conditions, particularly cardiovascular disease. This study is the first report of the Brazilian Research Network in Bipolar Disorder (BRN-BD) that aims to evaluate the prevalence and clinical correlates of cardiovascular risk factors among Brazilian patients with BD. METHODS: A cross-sectional study of 159 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROMAN) in São Paulo and the Bipolar Disorder Program (PROTAHBI) in Porto Alegre. Clinical, demographic, anthropometric, and metabolic variables were systematically assessed. RESULTS: High rates of smoking (27%), physical inactivity (64.9%), alcohol use disorders (20.8%), elevated fasting glucose (26.4%), diabetes (13.2%), hypertension (38.4%), hypertriglyceridemia (25.8%), low HDL-cholesterol (27.7%), general (38.4%) and abdominal obesity (59.1%) were found in the sample. Male patients were more likely to have alcohol use disorders, diabetes, and hypertriglyceridemia, whereas female patients showed higher prevalence of abdominal obesity. Variables such as medication use pattern, alcohol use disorder, and physical activity were associated with selected cardiovascular risk factors in the multivariable analysis. CONCLUSION: This report of the BRN-BD provides new data regarding prevalence rates and associated cardiovascular risk factors in Brazilian outpatients with BD. There is a need for increasing both awareness and recognition about metabolic and cardiovascular diseases in this patient population.

A sib-pair analysis of impulsivity in bipolar disorder type I.

OBJECTIVE: The aim of this study was to compare impulsivity among patients with bipolar disorder, their siblings, and healthy controls in order to examine whether impulsivity in bipolar disorder is related to genetic liability for the illness. METHODS: Using the Barratt Impulsiveness Scale, we assessed 204 subjects: 67 euthymic outpatients with bipolar disorder type I, 67 siblings without bipolar disorder, and 70 healthy controls. RESULTS: Impulsivity scores were higher among patients with bipolar disorder than among healthy controls. Siblings showed higher motor impulsivity scores than did healthy controls. CONCLUSIONS: Our results suggest that motor impulsivity may be a vulnerability marker for bipolar disorder. Our data may contribute to further improve preventive strategies in subjects at high risk for bipolar disorder.

Cardiovascular risk factors in outpatients with bipolar disorder: a report from the Brazilian Research Network in Bipolar Disorder

Objective: Bipolar disorder (BD) is associated with significant morbidity and mortality due to comorbid general medical conditions, particularly cardiovascular disease. This study is the first report of the Brazilian Research Network in Bipolar Disorder (BRN-BD) that aims to evaluate the prevalence and clinical correlates of cardiovascular risk factors among Brazilian patients with BD. Methods: A cross-sectional study of 159 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROMAN) in São Paulo and the Bipolar Disorder Program (PROTAHBI) in Porto Alegre. Clinical, demographic, anthropometric, and metabolic variables were systematically assessed. Results: High rates of smoking (27%), physical inactivity (64.9%), alcohol use disorders (20.8%), elevated fasting glucose (26.4%), diabetes (13.2%), hypertension (38.4%), hypertriglyceridemia (25.8%), low HDL-cholesterol (27.7%), general (38.4%) and abdominal obesity (59.1%) were found in the sample. Male patients were more likely to have alcohol use disorders, diabetes, and hypertriglyceridemia, whereas female patients showed higher prevalence of abdominal obesity. Variables such as medication use pattern, alcohol use disorder, and physical activity were associated with selected cardiovascular risk factors in the multivariable analysis. Conclusion: This report of the BRN-BD provides new data regarding prevalence rates and associated cardiovascular risk factors in Brazilian outpatients with BD. There is a need for increasing both awareness and recognition about metabolic and cardiovascular diseases in this patient population. .