Migraine preventive treatment failure: A cross-sectional study in a tertiary center in Brazil / Falha no tratamento preventivo da enxaqueca: um estudo transversal em um centro terciário no Brasil

BACKGROUND: In Brazil, there is a scarcity of evidence on migraine burden in patients who have experienced previous preventive treatment failure (PPTF). OBJECTIVE: To evaluate the associations between ≥ 3 PPTF and clinical, psychiatric, and medical history data. METHODS: In a retrospective, cross-sectional study, the medical records of migraine patients who first visited a tertiary specialized clinic were examined. We selected adults of both sexes aged ≥ 18 who attended their first appointment between March and July 2017. Ordinal logistic regression models estimated the associations between number of PPTF (no previous treatment, 1 PPTF, 2, and ≥ 3 PPTF) and chronic migraine, the number of diagnosis exams performed, abortive drugs classes used, and non-pharmacological treatments tried (all categorized as none, 1- 3, and ≥ 4), and severe depression (PHQ-9 ≥ 15) and anxiety (GAD-7 ≥ 15), adjusted for sex, age, and years with disease. RESULTS: Data from 440 patients (72.1 % female) with a mean (SD) age of 37.3 (13.0) years were analyzed. The frequency of no previous treatment was 37.7 % (166/440), while 31.8 % (140/440) showed ≥ 3 PPTF. In patients with ≥ 3 PPTF, 35.7 % (50/140) had episodic, and 64.3 % (90/140) had chronic migraine. Compared to no previous treatment, patients with ≥ 3 PPTF showed higher odds (95 % confidence interval) for chronic migraine [2.10 (1.47, 2.98)], ≥ 4 diagnosis exams [6.59 (3.38, 12.84)], ≥ 4 abortive drug classes [16.03 (9.53, 26.94)], ≥ 4 non-pharmacological treatments [5.91 (3.07,11.35)], and severe depression [1.75 (1.07, 2.88)] and anxiety [1.73 (1.05, 2.85)]. CONCLUSION: Patients first visiting a headache specialist had a high frequency of non-response treatment associated with higher migraine burden in terms of chronification, psychiatric comorbidity, acute medication and non-pharmacological treatment inefficacy, and unnecessary exams.

FUNDAMENTO: No Brasil, há escassez de evidências sobre a carga da enxaqueca em pacientes que apresentaram falha prévia no tratamento preventivo (FTPP). OBJETIVO: Avaliar as associações entre ≥ 3 PPTF e dados clínicos, psiquiátricos e de história médica. MÉTODOS: Em um estudo retrospectivo e transversal, foram examinados os prontuários de pacientes com enxaqueca que visitaram pela primeira vez uma clínica especializada terciária. Foram selecionados adultos de ambos os sexos com idade ≥ 18 anos que compareceram à primeira consulta entre março e julho de 2017. Modelos de regressão logística ordinal estimaram as associações entre número de PPTF (sem tratamento prévio, 1 PPTF, 2 e ≥ 3 PPTF) e enxaqueca crônica, o número de exames de diagnóstico realizados, classes de medicamentos abortivos utilizados e tratamentos não farmacológicos tentados (todos categorizados como nenhum, 1-3 e ≥ 4) e depressão grave (PHQ-9 ≥ 15) e ansiedade (GAD-7 ≥ 15), ajustado por sexo, idade e anos de doença. RESULTADOS: Foram analisados ​​dados de 440 pacientes (72,1% mulheres) com idade média (DP) de 37,3 (13,0) anos. A frequência de nenhum tratamento prévio foi de 37,7% (166/440), enquanto 31,8% (140/440) apresentaram ≥ 3 PPTF. Em doentes com ≥ 3 PPTF, 35,7% (50/140) tiveram enxaqueca episódica e 64,3% (90/140) tiveram enxaqueca crónica. Em comparação com nenhum tratamento anterior, pacientes com ≥ 3 PPTF apresentaram chances mais altas (intervalo de confiança de 95%) para enxaqueca crônica [2,10 (1,47, 2,98)], ≥ 4 exames de diagnóstico [6,59 (3,38, 12,84)], ≥ 4 classes de medicamentos abortivos [16,03 (9,53; 26,94)], ≥ 4 tratamentos não farmacológicos [5,91 (3,07;11,35)] e depressão grave [1,75 (1,07; 2,88)] e ansiedade [1,73 (1,05; 2,85)]. CONCLUSÃO: Os pacientes que consultaram pela primeira vez um especialista em dor de cabeça tiveram uma alta frequência de não resposta ao tratamento associada a maior carga de enxaqueca em termos de cronificação, comorbidade psiquiátrica, medicação aguda e ineficácia do tratamento não farmacológico e exames desnecessários.

Sugarcane Genotypes with Contrasting Biological Nitrogen Fixation Efficiencies Differentially Modulate Nitrogen Metabolism, Auxin Signaling, and Microorganism Perception Pathways.

Sugarcane is an economically important crop that is used for the production of fuel ethanol. Diazotrophic bacteria have been isolated from sugarcane tissues, without causing visible plant anatomical changes or disease symptoms. These bacteria can be beneficial to the plant by promoting root growth and an increase in plant yield. Different rates of Biological Nitrogen Fixation (BNF) were observed in different genotypes. The aim of this work was to conduct a comprehensive molecular and physiological analysis of two model genotypes for contrasting BNF efficiency in order to unravel plant genes that are differentially regulated during a natural association with diazotrophic bacteria. A next-generation sequencing of RNA samples from the genotypes SP70-1143 (high-BNF) and Chunee (low-BNF) was performed. A differential transcriptome analysis showed that several pathways were differentially regulated among the two BNF-contrasting genotypes, including nitrogen metabolism, hormone regulation and bacteria recognition. Physiological analyses, such as nitrogenase and GS activity quantification, bacterial colonization, auxin response and root architecture evaluation, supported the transcriptome expression analyses. The differences observed between the genotypes may explain, at least in part, the differences in BNF contributions. Some of the identified genes might be involved in key regulatory processes for a beneficial association and could be further used as tools for obtaining more efficient BNF genotypes.

Endometriosis Surgery during the First Wave of the COVID-19 Pandemic: A Brazilian Single Institution Experience.

Introduction. Early in the 2020 Coronavirus pandemic stay-at-home guidelines, there were public health orders that elective surgeries be deferred to prioritize hospital beds for critically ill COVID-19 patients. Besides, several reasons led to the postponement of consultations, diagnostic tests, and elective therapeutic procedures. As a result, some women with endometriosis faced chronification of their pain and decreased prospects for pregnancy. The aim of this study was to describe individual responses to minimally invasive complete excision of endometriosis through 40 days of follow-up of women whose endometriosis was considered severe enough to proceed with surgery during the fourth, fifth, and sixth months of constraints imposed by the pandemic. Preventive strategies and safety measures employed to protect patients and staff from acquiring or transmitting Coronavirus infection are presented. Case Presentation. This case series report enrolled 11 consecutive Brazilian women (ages 22 to 47 y) who underwent minimally invasive surgical treatment of endometriosis between June 26 and August 17, 2020. Cases of endometriosis requiring more urgent surgery were promptly identified and considered individually. The strict safety measures were well accepted by patients. No women developed any flu-like or COVID-19-related symptoms (cough, dyspnea, fever, or anosmia) in the 40 days of postoperative follow-up. One of the most praised measures reported by patients was the routine testing of the patient, the person who would accompany her in the hospital, and all medical staff and employees. Discussion. It is feasible to safely perform elective endometriosis surgery in selected cases during a pandemic.

Catastrophization is related to the patient and not to the severity of migraine.

BACKGROUND: Catastrophization is a psychological aspect of pain that alters its perception and expression. OBJECTIVE: To investigate the feature of catastrophization in migraine. METHODS: An online survey of individuals suffering from migraine attacks at least twice a month, for at least one year was carried out. Confidentiality was assured and participants gave details of their headache (including a visual analogue pain scale) and answered the Hospital Anxiety and Depression Scale and the Catastrophization Scale questionnaires. RESULTS: The survey included 242 individuals with migraine attacks at least twice a month. The median scores observed in this group of individuals were 7 for pain, 11 for anxiety, 7 for depression, and 2 for catastrophization. Catastrophization had no correlation with the duration (p=0.78) or intensity (p=0.79) of the migraine. There was no correlation between catastrophization and headache frequency (p=0.91) or the monthly amount of headache medication taken (p=0.85). High scores for catastrophization (≥3.0) were identified in one third of the participants. These high scores were not associated with age, headache duration, pain severity, frequency of attacks, or traits of depression or anxiety. There was a moderate association between both depression and anxiety traits with catastrophization. CONCLUSIONS: Catastrophization seems to be a trait of the individual and appears to be unrelated to the characteristics of the migraine.

Catastrophization is related to the patient and not to the severity of migraine / Catastrofização se relaciona ao paciente e não à gravidade da enxaqueca

ABSTRACT Background: Catastrophization is a psychological aspect of pain that alters its perception and expression. Objective: To investigate the feature of catastrophization in migraine. Methods: An online survey of individuals suffering from migraine attacks at least twice a month, for at least one year was carried out. Confidentiality was assured and participants gave details of their headache (including a visual analogue pain scale) and answered the Hospital Anxiety and Depression Scale and the Catastrophization Scale questionnaires. Results: The survey included 242 individuals with migraine attacks at least twice a month. The median scores observed in this group of individuals were 7 for pain, 11 for anxiety, 7 for depression, and 2 for catastrophization. Catastrophization had no correlation with the duration (p=0.78) or intensity (p=0.79) of the migraine. There was no correlation between catastrophization and headache frequency (p=0.91) or the monthly amount of headache medication taken (p=0.85). High scores for catastrophization (≥3.0) were identified in one third of the participants. These high scores were not associated with age, headache duration, pain severity, frequency of attacks, or traits of depression or anxiety. There was a moderate association between both depression and anxiety traits with catastrophization. Conclusions: Catastrophization seems to be a trait of the individual and appears to be unrelated to the characteristics of the migraine.

RESUMO Antecedentes: A catastrofização é um aspecto psicológico da dor, alterando sua percepção e expressão. Objetivos: Investigar o fenômeno da catastrofização na enxaqueca. Métodos: Pesquisa online com indivíduos que sofrem de crises de enxaqueca pelo menos duas vezes por mês, por pelo menos um ano. O sigilo foi assegurado. O participante dava detalhes de sua dor de cabeça (incluindo escala de dor analógica visual) e respondeu à Escala de Ansiedade e Depressão Hospitalar e à Escala de Catastrofização. Resultados: A pesquisa identificou 242 indivíduos com ataques de enxaqueca pelo menos duas vezes por mês. Os escores medianos observados neste grupo de indivíduos foram 7 para dor, 11 para ansiedade, 7 para depressão e 2 para catastrofização. Catastrofização não teve correlação com a duração (p=0,78) ou intensidade (p=0,79) da dor na crise de enxaqueca. Não houve correlação entre catastrofização e frequência de crises (p=0,91) ou quantidade mensal de medicação usada para tratar a cefaleia (p=0,85). Foram identificados escores elevados para catastrofização (≥3,0) em um terço dos participantes. Esses escores elevados não foram associados à idade, duração da dor de cabeça, gravidade da dor, frequência de ataques e traços de depressão ou de ansiedade. Houve moderada associação entre casos com concomitante depressão e ansiedade e catastrofização. Conclusões: A catastrofização parece ser um traço do indivíduo e parece não estar relacionada às características da enxaqueca.

Clinical Profile and Sex Differences in Brazilian Children and Adolescents Receiving Psychiatric Services in the Emergency Department.

OBJECTIVE: We present a survey of sex differences and socio-demographic and clinical variables in children and adolescents receiving a psychiatric consultation service in an emergency department (ED). METHODS: This observational, retrospective, and cross-sectional study included all records of patients (age, <18 years) who received psychiatric services in an ED in a 4-year period (January 2010 to December 2013). RESULTS: Two hundred fifty-nine records of children and adolescents were located. The mean age of the participants was 14.19 years, and most subjects were female (59.5%) and had private health insurance (83.7%). Most participants (87.4%) were accompanied by their parents. The main complaints were suicide attempts (21.8%) and psychomotor agitation/aggressiveness (21.8%). Unipolar depression (37.8%) and adjustment, reactive, and anxiety disorders (13.7%) were the most prevalent diagnoses. Most patients received an indication of psychiatric hospitalization (51.7%). Females had more suicide attempts than males (28.3% vs 12.4%) and less psychomotor agitation/aggressiveness than males (15.5% vs 31.4%). Females also exhibited more unipolar depression (47.6% vs 23.5%), fewer psychotic disorders (4.2% vs 16.3%), and substance use/misuse (1.4% vs 13.3%) than males. Males needed more psychiatric medication during evaluation (37.9% vs 19.2%). CONCLUSIONS: This survey of the profile of pediatric patients evaluated by a psychiatric service in an ED in Brazil was the first of its kind. The large percentage of patients referred for hospitalization highlights the importance of specialized psychiatry care for this age group in this facility, which is a common entry point for mental health care.

Prevalence and correlates of generalized anxiety disorder among elderly people in primary health care / Prevalência e correlatos do transtorno de ansiedade generalizada em idosos atendidos em atenção primária

OBJECTIVE: To examine the prevalence of generalized anxiety disorder (GAD) and its associations with sociodemographic and health factors. METHODS: A cross-sectional study with a population-based sample of 578 individuals aged 60 years or older from the Family Health Strategy (FHS) program of Porto Alegre, RS, Brazil. Home visit screening and general data collection were made by trained Community Health Workers (CHWs). Diagnoses of psychiatric disorders were made by board-certified psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus) in the Hospital São Lucas of the Pontifical University of Rio Grande do Sul (PUCRS). RESULTS: GAD was found in 9% of the sample (n = 52; CI 95% = 6.9-11.6). The main results of the multivariate analysis show associations between GAD and retirement (PR: 0.43, CI: 0.25-0.76), history of falls (PR: 2.52, CI: 1.42-4.49), cohabitation with four or more people (PR: 1.80, CI: 1.04-3.13), having more than one hospitalization in the last year (PR: 2.53, CI: 1.17-5.48) and self-perception of health as regular (PR: 2.75, CI: 1.02-7.47). Retirement in the elderly shows 2.32x less risk of GAD, although confounding factors may have overestimated this finding and underestimated the association with female gender (PR: 1.61, CI: 0.83-3.10). CONCLUSIONS: We estimate a high prevalence of GAD in this population. Associations were found between GAD and health self-perceived as regular, cohabitation with four or more people, history of falls and more than one hospitalization in the last year. These epidemiological data from the Family Health Strategy are important to develop further strategies for this age group that could improve the health care practice.

OBJETIVO: Examinar a prevalência do transtorno de ansiedade generalizada (TAG) em idosos e suas associações com fatores sociodemográficos e de saúde. MÉTODOS: Estudo transversal, composto por uma amostra de base populacional de 578 indivíduos com 60 anos ou mais, participantes do programa Estratégia Saúde da Família (ESF) de Porto Alegre, RS, Brasil. Agentes de saúde treinados realizaram coleta de dados dos indivíduos durante as visitas domiciliares. A avaliação diagnóstica psiquiátrica foi realizada por psiquiatras, no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), por meio da aplicação do Mini International Neuropsychiatric Interview plus (MINIplus). RESULTADOS: O TAG foi encontrado em 9% (n = 52; IC 95% = 6,9-11,6) da amostra. Os principais resultados da análise multivariada evidenciaram associações entre TAG e aposentadoria (RP: 0,43; IC: 0,25-0,76), história de quedas (RP: 2,52; IC: 1,42-4,49), coabitação com quatro ou mais pessoas (RP: 1,80; IC: 1,04-3,13), ter mais de uma hospitalização no último ano (RP: 2,53, IC: 1,17-5,48) e autopercepção de saúde avaliada como regular (RP: 2,75, IC: 1,02-7,47). Idosos aposentados apresentaram risco 2,32 menor de TAG, embora fatores confundidores possam ter superestimado esse achado e subestimado a associação com gênero feminino (RP: 1,61; IC: 0,83-3,10). CONCLUSÕES: Estimou-se uma alta prevalência de TAG nessa população de idosos. Foram encontradas associações de TAG com autopercepção de saúde regular, coabitação com quatro ou mais pessoas, mais de uma hospitalização no último ano e história de quedas. Esses dados oriundos da Estratégia Saúde da Família são importantes para o desenvolvimento de estratégias adicionais que possam melhorar a prática de assistência à saúde na população idosa.

Translation and Brazilian adaptation of the Relationship Scales Questionnaire (RSQ).

OBJECTIVES: To describe the process of translating and adapting the Relationship Scales Questionnaire (RSQ) from English into Brazilian Portuguese and to present the results of its test-retest reliability using the version developed for interview application. METHODOLOGY: The process was based on the guidelines of the International Society for Pharmaeconomics and Outcomes Research (ISPOR), which propose 10 steps for the translation and cross-cultural adaptation of self-administered instruments. The original authors of the RSQ have agreed to the translation. The interview version was applied to a sample of 43 healthy elders (≥60 years old) enrolled in a primary health care program in the city of Porto Alegre, state of Rio Grande do Sul, southern Brazil, and then reapplied. The scores of the two applications were compared using the paired sample t-test. RESULTS: Only 6 of the 30 items required the adaptation of words or expressions to maintain its conceptual and semantic equivalence. The self-administered form of the RSQ posed difficulties for elders due to visual deficiencies and lower education level, both common in this age group, demonstrating a need for the development of a version of the RSQ in a structured interview format. Only the measure for secure attachment presented significant differences after the application of the retest, indicating reliability of the version being proposed. CONCLUSION: Translation of the RSQ is the first step towards the validation of an attachment evaluation instrument for use in the elderly population in Brazil, allowing for future studies on this topic.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance.

INTRODUCTION: User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. METHODS: This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. RESULTS: We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. CONCLUSION: Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.

Relationship between childhood maltreatment and geriatric depression: the mediator effect of personality traits.

BACKGROUND: Childhood maltreatment is an important factor associated with adverse mental health outcomes including geriatric depression and the "big five" personality characteristics. The objective of this study was to evaluate a model where personality characteristics mediate the relationship between childhood maltreatment and geriatric depression. METHOD: In this cross-sectional study, elderly subjects from socioeconomically disadvantaged neighborhoods of Porto Alegre, Brazil (n = 260) completed the Childhood Trauma Questionnaire (CTQ), NEO-Five Factor Inventory (NEO-FFI), and Mini International Neuropsychiatric Interview 5.0 (MINI plus). We used structural equation modeling (SEM) to evaluate the mediation hypothesis. RESULTS: The five personality factors (neuroticism, extraversion, agreeableness, openness, and conscientiousness) were related to childhood maltreatment and depression. Mediation analysis revealed that neuroticism and extraversion are complete mediators, agreeableness and conscientiousness are partial mediators, and openness is not a mediator. CONCLUSIONS: These findings support the hypothesis in which childhood maltreatment is associated with geriatric depression and mediated by personality factors. These results suggest that reducing the maladaptive personality trait in elderly people who suffered childhood maltreatment could prevent geriatric depression.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance / Satisfação com o cuidado em uma unidade de internação psiquiátrica brasileira: diferenças nas percepções dos pacientes segundo tipo de plano de saúde

Abstract Introduction User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. Methods This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. Results We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. Conclusion Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.

Resumo Introdução A avaliação da satisfação do usuário nos serviços de saúde mental é um importante indicador da qualidade do tratamento. O objetivo deste estudo foi avaliar a satisfação com o tratamento em uma amostra de pacientes internados com transtornos mentais e as associações entre os níveis de satisfação e variáveis clínicas/sociodemográficas. Métodos Este estudo exploratório investigou 227 pacientes psiquiátricos internados que responderam a Escala de Satisfação do Paciente com os Serviços de Saúde Mental (SATIS-BR) e a Escala de Percepção da Mudança (EMP). Os escores SATIS-BR foram analisados segundo associações com dados clínicos e sociodemográficos. Correlações de Pearson foram usadas para correlacionar escores SATIS com outras variáveis. Resultados Encontramos alto grau de satisfação com o atendimento na unidade de internação psiquiátrica avaliada. Em geral, os pacientes atribuíram satisfação máxima para a maioria dos itens. Os maiores escores de satisfação foram associados a pacientes em tratamento pelo Sistema Único de Saúde (SUS) e com menor escolaridade. A SATIS mostrou uma correlação positiva moderada com EMP. A pior dimensão avaliada foi associada às instalações físicas e conforto da enfermaria. Conclusão Pacientes com cobertura pelo SUS podem estar mais satisfeitos do que pacientes com planos privados de saúde quando tratados na mesma unidade. A avaliação da satisfação com o tratamento pode ser usada para reorganizar serviços em unidades de internação psiquiátrica.

Translation and Brazilian adaptation of the Relationship Scales Questionnaire (RSQ) / Tradução e adaptação brasileira do Relationship Scales Questionnaire (RSQ)

Abstract Objectives To describe the process of translating and adapting the Relationship Scales Questionnaire (RSQ) from English into Brazilian Portuguese and to present the results of its test-retest reliability using the version developed for interview application. Methodology The process was based on the guidelines of the International Society for Pharmaeconomics and Outcomes Research (ISPOR), which propose 10 steps for the translation and cross-cultural adaptation of self-administered instruments. The original authors of the RSQ have agreed to the translation. The interview version was applied to a sample of 43 healthy elders (≥60 years old) enrolled in a primary health care program in the city of Porto Alegre, state of Rio Grande do Sul, southern Brazil, and then reapplied. The scores of the two applications were compared using the paired sample t-test. Results Only 6 of the 30 items required the adaptation of words or expressions to maintain its conceptual and semantic equivalence. The self-administered form of the RSQ posed difficulties for elders due to visual deficiencies and lower education level, both common in this age group, demonstrating a need for the development of a version of the RSQ in a structured interview format. Only the measure for secure attachment presented significant differences after the application of the retest, indicating reliability of the version being proposed. Conclusion Translation of the RSQ is the first step towards the validation of an attachment evaluation instrument for use in the elderly population in Brazil, allowing for future studies on this topic.

Resumo Objetivos Descrever o processo de tradução e adaptação cultural do questionário Relationship Scales Questionnaire (RSQ) do inglês para o português do Brasil e apresentar os resultados de confiabilidade teste-reteste utilizando a versão desenvolvida para aplicação em entrevista. Metodologia O método utilizado teve como diretriz a proposta da International Society for Pharmaeconomics and Outcomes Research (ISPOR), de 10 passos para a tradução e adaptação transcultural de instrumentos autoaplicáveis. Os autores originais do RSQ concordaram com a tradução. A versão para entrevista dirigida foi aplicada em uma amostra de 43 idosos saudáveis (≥60 anos) cadastrados em um programa de atenção primária à saúde na cidade de Porto Alegre, RS, sendo então reaplicada. As pontuações das duas aplicações foram comparadas usando o teste t de Student para amostras pareadas. Resultados Apenas 6 dos 30 itens precisaram de adaptação cultural de palavras ou expressões para manter sua equivalência conceitual e semântica. O formato autoaplicável do RSQ mostrou-se pouco adequado entre idosos, devido à presença comum de déficits visuais e baixa escolaridade, demonstrando a necessidade do desenvolvimento de uma versão do RSQ em formato de entrevista dirigida. Apenas a medida de apego seguro apresentou diferença significativa após a aplicação do reteste, indicando a confiabilidade da versão proposta. Conclusão A tradução do RSQ é o primeiro passo para a validação de um instrumento de avaliação de apego para a população idosa no Brasil, permitindo futuros estudos sobre o tema.

Clinical characteristics of 153 Brazilian patients with neuromyelitis optica spectrum disorder (NMOSD).

BACKGROUND: The 2015 criteria for diagnosing neuromyelitis optica spectrum disorder (NMOSD) have encouraged several groups across the world to report on their patients using these criteria. The disease typically manifests with severe relapses of optic neuritis, longitudinally extensive myelitis and/or brainstem syndromes, often leading to severe disability. Some patients are seropositive for antibodies against aquaporin-4 (AQP4), others are positive for anti-myelin oligodendrocyte glycoprotein (MOG), while a few are negative for both biomarkers. The disease is complex, and only now are specific therapeutic clinical trials being carried out. The present study adds to the literature through detailed clinical data from 153 medical records of Brazilian patients. METHODS: Retrospective assessment of medical records from nine specialized units in Brazil. RESULTS: NMOSD was more prevalent in females (4.1:1), who had significantly fewer relapses than males (p = 0.007) but presented similar levels of disability over time. African ancestry was associated with higher levels of disability throughout the disease course (p < 0.001), although the number of relapses was similar to that observed in white patients. Concomitant autoimmune diseases were relatively rare in this population (6.5%). Positivity for anti-AQP4 antibodies was identified in 62% of the patients tested, while 3% presented anti-MOG antibodies. Anti-AQP4 antibodies were not associated to worse disease course. The last medical record showed that six patients had died and 13 were wheelchair-bound. Seventy percent of the patients did not respond to first-line therapy (azathioprine and/or corticosteroids), and five patients continued to relapse even after four different courses of treatment. CONCLUSION: The present study adds to the reports from other countries presenting original data on Brazilian patients diagnosed with NMOSD according to the 2015 criteria.

There is no benefit in the use of postnatal intravenous immunoglobulin for the prevention of relapses of multiple sclerosis: findings from a systematic review and meta-analysis.

OBJECTIVE: Multiple sclerosis (MS) is a complex autoimmune and neurodegenerative disease of the central nervous system. Since MS affects mostly fertile women, pregnancy issues often arise in daily practice. The present study assessed the use of postpartum intravenous immunoglobulin (IVIG) in MS. METHODS: The authors individually searched for records using PubMed, Medline, EMBASE, Cochrane, SciELO, LILACS, and Google Scholar, using the terms "multiple sclerosis" OR "MS" AND "pregnancy" OR "gestation" OR "partum" OR "post-partum" OR "puerperium" AND "immunoglobulin". RESULTS: The initial search returned 321 papers. There were 11 eligible articles selected for the review. In total, 380 patients had received post-natal IVIG to reduce the number of postpartum relapses. The unadjusted number needed to treat was 6.3 for the quantitative and 5.8 for the qualitative analyses. CONCLUSION: The therapeutic effect of IVIG for prevention of postnatal relapses in MS could not clearly be established in this meta-analysis.

There is no benefit in the use of postnatal intravenous immunoglobulin for the prevention of relapses of multiple sclerosis: findings from a systematic review and meta-analysis / Não há benefício do uso de imunoglobulina endovenosa para prevenção de surtos na esclerose múltipla: achados de revisão sistemática e meta-análise

ABSTRACT Multiple sclerosis (MS) is a complex autoimmune and neurodegenerative disease of the central nervous system. Since MS affects mostly fertile women, pregnancy issues often arise in daily practice. The present study assessed the use of postpartum intravenous immunoglobulin (IVIG) in MS. Methods The authors individually searched for records using PubMed, Medline, EMBASE, Cochrane, SciELO, LILACS, and Google Scholar, using the terms "multiple sclerosis" OR "MS" AND "pregnancy" OR "gestation" OR "partum" OR "post-partum" OR "puerperium" AND "immunoglobulin". Results The initial search returned 321 papers. There were 11 eligible articles selected for the review. In total, 380 patients had received post-natal IVIG to reduce the number of postpartum relapses. The unadjusted number needed to treat was 6.3 for the quantitative and 5.8 for the qualitative analyses. Conclusion The therapeutic effect of IVIG for prevention of postnatal relapses in MS could not clearly be established in this meta-analysis.

RESUMO Esclerose múltipla (EM) é uma complexa doença autoimune e neurodegenerativa do sistema nervoso central. Uma vez que EM afeta principalmente mulheres em idade fértil, assuntos relacionados à gravidez frequentemente surgem na prática diária. O presente estudo avaliou o uso pós-parto de imunoglobulina (IVIG) na EM. Métodos Os autores individualmente pesquisaram as bases de dados PubMed, Medline, EMBASE, Cochrane, SciELO, LILACS, e Google Scholar usando os termos "multiple sclerosis" OR "MS" AND "pregnancy" OR "gestation" OR "partum" OR "post-partum" OR "puerperium" AND "immunoglobulin". Resultados A pesquisa inicial retornou 321 artigos. Havia 11 artigos elegíveis para a revisão. No total, havia relato de 380 pacientes que receberam IVIG após a gravidez visando reduzir o número de surtos. O número necessário para tratar não ajustado foi 6,3 para análise quantitativa e 5,8 para análise qualitativa. Conclusão O efeito terapêutico da IVIG para prevenção dos surtos pós-parto na EM não pôde ser claramente estabelecida nesta meta-análise.

Influence of childhood abuse and neglect subtypes on late-life suicide risk beyond depression.

The association of childhood maltreatment and suicide has been extensively examined within the population. Depression figures as a main cause for the elevated suicide rate in advanced ages and is often related to childhood maltreatment. The purpose of the present study was to examine the relationship between childhood maltreatment subtypes and suicide risk, testing geriatric depression as a moderator. This is a cross-sectional study looking at a sample of 449 individuals 60 year s old or older from the Multidimensional Study of the Elderly of Porto Alegre Family Health Strategy, Brazil (EMI-SUS/POA). Childhood maltreatment (Childhood Trauma Questionnaire), geriatric depressive symptoms (Geriatric Depression Scale), and suicide risk (Mini International Neuropsychiatric Interview) were assessed. The subtypes of childhood abuse and neglect were significantly associated with suicide risk. In the multivariate analysis, controlling for age, gender, income, marital status, ethnicity, smoking, and geriatric depression symptoms, all trauma subtypes remained associated with suicide risk with the exception of physical neglect (EA = 3.65; PA = 3.16; SA = 5.1; EN = 2.43; PN = 1.76). The present study showed that childhood maltreatment subtypes predicted suicide risk, and geriatric depression does not directly mediate this relation.

Physical Activity Level and Risk of Falling in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis.

This systematic review examines the association between physical activity (PA) level and risk of falling in community-dwelling older adults. A search of PubMed, Embase, CINAHL, SPORTDiscus, and Web of Science was performed in January 2017. Four prospective cohort studies investigating the incidence of falls in a period of at least 12 months and its association with the level of PA in people aged 60 years and older were reviewed and pooled for meta-analysis. The pooled risk ratio (RR) for being a recurrent faller (2,420 participants) was 39% higher among those who were in the lowest PA level (RR = 1.39; 95% confidence interval [1.17, 1.65]; I2 = 0%, p = .43; p < .0001). The association between being a faller (7,927 participants) and PA level was inconclusive. This review identified that the benefit of general PA for preventing falls is associated with the adopted PA level.

Augusta Marie Déjerine-Klumpke: much more than just Déjerine's wife.

Augusta Marie Déjerine-Klumpke (1859-1927) was a formidable neurologist, neuroanatomist and researcher in France. One of the first women to be accepted for medical internship, externship and research in Paris, Augusta made her name studying and teaching anatomy, histology and dissection, attending clinical activities in neurology, obstetrics, pediatrics and neurologic trauma, performing necropsies, and writing scientific papers and book chapters. Her main research in neurology awarded her an eponym for the avulsion of the lowest root of the brachial plexus (Klumpke's palsy). Married to her professor, the remarkable Dr. Joseph Jules Déjerine, Augusta continued her career and became the first female president of the French Society of Neurology.