Binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery.

PURPOSE: The aim of the present study was to determine possible associations between binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery. METHODS: A cross-sectional study was conducted with 254 obese patients recruited from the general surgery service for bariatric procedures at the hospital affiliated with the Federal University of Pernambuco, Brazil. Evaluations were performed using the Binge Eating Scale (BES), Beck Depression Inventory, Beck Scale for Suicidal Ideation (BSSI) and a questionnaire addressing sociodemographic characteristics. RESULTS: Most patients were women (82%), 48% had a moderate binge eating disorder, 42% a severe binge eating disorder, 32% had symptoms suggestive of mild, moderate or severe depression and 6% had suicidal ideation. Severe binge eating was positively associated with depressive symptoms (p < 0.001) and suicidal ideation (p < 0.05). Cases of severe binge eating were more frequent in young adults, but not necessarily associated with symptoms of depression or suicidal ideation in this portion of the sample. CONCLUSIONS: The present findings underscore the need for psychological and psychiatric follow-up of obese candidates for bariatric surgery using appropriate assessment scales to guide therapeutic approaches. LEVEL III: Evidence obtained from cross-sectional study.

Transtornos alimentares e insatisfação corporal nas práticas relacionadas ao bullying em adolescentes / Eating disorders and body dissatisfaction in practices related to bullying in adolescents / Trastornos de la conducta alimentaria e insatisfacción corporal en prácticas relacionadas con el acoso escolar en adolescentes

Objetivos: Identificar a associação dos transtornos alimentares e insatisfação corporal na prática do bullying em adolescentes. Métodos: Estudo transversal, em uma população de 144 adolescentes, entre 14 a 19 anos de uma escola pública. Foram utilizados os instrumentos Eating Attitudes Test - EAT-26; Bulimic Investigatory Test of Edinburgh ­ BITE; Body Shape Questionay - BSQ e questionário sobre Bullying, em suas versões para adolescentes. Resultados: Foi visto que cerca de 1,4% dos adolescentes apresentaram compulsão alimentar; 23,6% sintomas sugestivos para TA; 16% insatisfação corporal; 49,3% foram classificados como vítimas e/ou vítima/agressor; 29,8% foram classificados com agressor e/ou vítima/agressor. Segundo o EAT- 26 e BSQ, não houve uma correlação positiva entre bullying (vítima e/ou agressor) os sintomas sugestivos para TA (p>0,136) e a insatisfação corporal (p>0,896), respectivamente. Os adolescentes que sofreram vitimização do bullying apresentaram uma correlação positiva com sintomas de bulimia nervosa (BN) (p<0,039) e com a gravidade de sintomas (p<0,006), de acordo com escala BITE. Conclusão: Houve correlação entre o bullying e sintomas sugestivos para TA, principalmente a BN. De modo que se faz necessário o desenvolvimento de ações para redução do bullying e prevenção dos TA nos adolescentes, os resultados obtidos servem como uma alerta para a saúde pública.

Objectives: To identify an association of eating disorders and body dissatisfaction in adolescents' bullying in adolescents. Methods: A cross-sectional study was carried out in a population of 144 adolescents aged 14 to 19 years of a public school. The Food Attitude Test - EAT-26 instruments were used; Edinburgh Bulimia Research Test - BITE; Body Shape Questionay - BSQ and Bullying Quiz, in their teenage versions. Results: It was seen that it is 1.4% of adolescents binge eating; 23.6% suggestive symptoms for BP; 16% body dissatisfaction; 49.3% were classified as victims and / or victims / aggressors; 29.8% were classified as aggressor and / or victim / aggressor. According to the EAT-26 and BSQ, there was no positive alternative between bullying (victim and / or aggressor) the suggestive symptoms for AT (p> 0.136) and body dissatisfaction (p> 0.96), respectively. Adolescents who suffered from bullying had an average of bulimia nervosa (BN) symptoms (p <0.039) and a severity of symptoms (p<0.006), according to the BITE scale. Conclusion: There was a correlation between bullying and symptoms suggestive of AT, mainly BN. Thus, it is necessary to develop actions to reduce the intimidation and avoidance of AT in adolescents, the results are considered as an alert to public health.

Objetivos: Identificar una asociación de los trastornos alimentarios y la insatisfacción corporal en el acoso escolar en adolescentes. Métodos: Se realizó un estudio transversal en una población de 144 adolescentes de 14 a 19 años de una escuela pública. Fueron utilizados los instrumentos Food Attitude Test - EAT-26; Edinburgh Bulimia Research Test - BITE; Body Shape Questionay - BSQ y Bullying Quiz, en sus versiones para adolescentes. Resultados: Se observó que es 1,4% de los adolescentes atracones; 23,6% síntomas sugestivos para BP; 16% insatisfacción corporal; 49,3% fueron clasificados como víctimas y / o víctimas / agresores; 29,8% fueron clasificados como agresor y / o víctima / agresor. De acuerdo con el EAT-26 y BSQ, no hubo alternativa positiva entre la intimidación (víctima y / o agresor) los síntomas sugestivos de TA (p> 0,136) y la insatisfacción corporal (p> 0,96), respectivamente. Los adolescentes que sufrieron bullying presentaron una media de síntomas de bulimia nerviosa (BN) (p <0,039) y una gravedad de síntomas (p <0,006), según la escala BITE. Conclusiones: Se observó una correlación entre el acoso escolar y síntomas sugestivos de TA, principalmente BN. Por lo tanto, es necesario desarrollar acciones para reducir la intimidación y la evitación de TA en adolescentes, los resultados se consideran como una alerta a la salud pública.

Teaching and practice in Homeopathy via pharmacobotany and pathophysiology

Semiology, Clinical Pathophysiology, Phytotherapy and Homeopathy were taught through active methodology by the Moodle platform (HL) also using apps for monitoring injuries through SAPB site, building rationality for the external topic use of homeopathic and herbal medicines.At the 7th Infirmary of General Hospital Santa Casa de Misericordia in Rio de Janeiro, the clinical medical team of the Benoit Mure Nucleus of Assistance Teaching and Research,made a medicinal plant gardenwith the agricultural/environmental educator, and communityethnicalleaders. Undergraduate students from UNIFASE/FMP Academic League of Physiology and Pathophysiology plantedCalendula Officinalis seedlings, destined to research in pharmacobotany and to be in touch with pharmacotechnical prepares. Aims: To follow-up the study since from seedling of Calendula Officinalistill to prepare of HUD. Methodology: To prepare medicinal garden: plant seedlings of Calendula offin accordance with good agricultural techniques. At first: Three seeds in ten pots, made in triplicate (N = 90), to obtain explants of quality analyzed whose evaluation was about plant development (explants percentual: weight, size, viability, morphology). To visit pharmacy-school to learn how to preparematrix extracts and High Ultra-Diluted Solutions (HUD) of Calendula off 6DH. Results and Discussion: The stages of teaching semiology and practice in pharmacobotany, besides cultive plant have been completed.Viability was impaired because of lack of irrigation during 4 months (50%). Weight, sizewere minor than usual but with no statistical significance (p>0.05). Morphology was maintained. Unfortunately, the visit to pharmacy-school couldn't be performed at this period. Conclusion: Through hybrid learning and face-to-face activities completely realized, students had qualitative perception of the relevance about morphology and quality of plant development, chemistry plant production, aiming for resolutive actions based upon pathophysiology of chronic diseases. Because of pandemic, it was described just a preliminary experience. After returning to normal activities the experiment will be repeated.

Risk of eating disorders, changes in salivary cortisol concentrations and nutritional status of adolescents.

PURPOSE: The imposition of the thin body as an ideal of beauty and the changes that occur in adolescence lead to a constant concern with adolescents' body weight, putting them at risk for eating disorders. Thus, the study sought to investigate associations between eating disorders and salivary cortisol concentrations, nutritional status and depressive symptoms in female adolescents with bulimia. METHODS: A cross-sectional study was carried out with 1435 adolescents aged 10-19 years. The Bulimic Investigatory Test of Edinburgh (BITE) and Body Shape Questionnaire (BSQ) questionnaires were used. A follow-up study was conducted from a random selection of female adolescents diagnosed with Bulimia Development and Well-Being Assessment-(DAWBA) to assess associations with salivary cortisol concentrations and nutritional status. RESULTS: The prevalence of body dissatisfaction among adolescents with symptoms of bulimia was 37%. There was a significant difference between salivary cortisol and bulimia (Risk Group = 0.33 ± 0.20 µg/100 ml, Diagnostic Group = 0.44 ± 0.21 µg/100 ml p = 0.040), and correlation positive between the risk of bulimia with symptoms of depression (0.355 p = 0.002) and with Body Mass Index (0.259 p = 0.028). High concentrations of salivary cortisol in bulimic adolescents may be associated with hyperactivity of the hypothalamic-pituitary-adrenal axis and depressive symptoms. CONCLUSIONS: Nutritional status indicators cannot be used alone for the diagnosis of bulimia, since cortisol levels seem to be a reliable parameter in the identification of bulimia, provided they are used with other diagnostic criteria. LEVEL III: Evidence obtained from cross-sectional study.

The presence of migraine symptoms was associated with a higher likelihood to present eating disorders symptoms among teenage students.

OBJECTIVE: To investigate the association between migraine and signs and symptoms of eating disorders among teenagers. And as secondary objectives: to investigate the prevalence of eating disorders signs and symptoms and to identify the prevalence of migraine among teenagers. METHODS: Cross-sectional study was carried out in public schools which included adolescents aged 11-18 years, of both sexes. For eating disorders evaluation two self-reported questionnaires were used: Eating Attitudes Test-26 (EAT-26) and The Bulimic Investigatory Test of Edinburg (BITE). The presence and characterization of headache were verified following the International Classification of Headache Disorders (ICHD-II). RESULTS: 607 adolescents (388 females) with mean age of 13.9 years (95% CI: 13.7; 14) were included. The eating disorders symptoms based on EAT-26 (p = 0.041) and the bulimia nervosa symptoms (p = 0.014) evaluation were more prevalent among teenagers with migraine compared with non-migraine. Also, in multivariate analysis, the adjusted odds ratio (OR) to present bulimia nervosa symptoms is 1.85 times higher among females than males. And, the adjusted OR to present bulimia nervosa symptoms among teenagers with migraine is 1.51 times (OR) higher than among non-migraine. CONCLUSIONS: The presence of migraine symptoms were associated with a higher likelihood to present eating disorders symptoms among teenagers, especially in females, that was associated with a 1.85-fold increase in the risk to present bulimia nervosa symptoms. LEVEL OF EVIDENCE: III, Evidence obtained from cross-sectional study.

Electromyographic Patterns and the Identification of Subtypes of Awake Bruxism.

The future of awake bruxism assessment will incorporate physiological data, possibly electromyography (EMG) of the temporal muscles. But up to now, temporal muscle contraction patterns in awake bruxism have not been characterized to demonstrate clinical utility. The present study aimed to perform surface EMG evaluations of people assessed for awake bruxism to identify possible different subtypes. A 2-year active search for people with awake bruxism in three regions of the country resulted in a total of 303 participants (223 women, 38 ± 13 years, mean and SD). Their inclusion was confirmed through non-instrumental approaches for awake bruxism: self-reported questionnaire and clinical exam, performed by three experienced and calibrated dentists (Kappa = 0.75). Also, 77 age- and sex-matched healthy controls were recruited (49 women, 36 ± 14 years). Temporalis surface EMG was performed with a portable device (Myobox; NeuroUp, Brazil). EMG signals were sent to a computer via Bluetooth 4.0 at a sampling rate of 1,000 Hz. Digital signal processing was performed using the commercial neuroUP software, transformed in RMS and then normalized for peak detection (EMG peaks/min), in a 10 min session. Cluster analysis revealed three distinct subtypes of awake bruxism: phasic, tonic, and intermediate. Individuals with a predominance of EMG peaks/min were classified as the "phasic" subtype (16.8%). Those with the highest EMG rest power were classified as the "tonic" subtype (32.3%). There was also an "intermediate" subtype (50.8%), when both variables remained low. Characterization of awake bruxism physiology is important for future establishment of instrumental assessment protocols and treatment strategies.

Association between eating disorders, suicide and depressive symptoms in undergraduate students of health-related courses.

OBJECTIVE: To identify symptoms of eating disorders and potential associations with risk of suicide and depressive symptoms in undergraduate students of health-related courses. METHODS: A cross-sectional study involving 271 students. The following instruments were used to identify symptoms of eating disorders: Eating Attitudes Test-26 and Bulimic Investigatory Test of Edinburgh. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to screen for depressive symptoms and risk of suicide, respectively. Participants answered a questionnaire aimed to collect biodemographic data for economic classification of the sample. RESULTS: Symptoms of eating disorders and bulimia nervosa were detected in 7.4% and 29.1% of students, respectively. Approximately 17.3% of students had symptoms of major depression, and 13.6% were at risk of suicide to some extent; risk of suicide was thought to be low in 7.4%, moderate in 0.7% and high in 5.5% of students in this subset. The risk of eating disorder development was correlated with the risk of suicide (p<0.001). CONCLUSION: Undergraduate students at risk of developing eating disorders, or with symptoms suggestive of depression, are more prone to commit suicide.

Association between eating disorders, suicide and depressive symptoms in undergraduate students of health-related courses / Associação entre transtornos alimentares, suicídio e sintomas depressivos em universitários de cursos de saúde

ABSTRACT Objective: To identify symptoms of eating disorders and potential associations with risk of suicide and depressive symptoms in undergraduate students of health-related courses. Methods: A cross-sectional study involving 271 students. The following instruments were used to identify symptoms of eating disorders: Eating Attitudes Test-26 and Bulimic Investigatory Test of Edinburgh. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to screen for depressive symptoms and risk of suicide, respectively. Participants answered a questionnaire aimed to collect biodemographic data for economic classification of the sample. Results: Symptoms of eating disorders and bulimia nervosa were detected in 7.4% and 29.1% of students, respectively. Approximately 17.3% of students had symptoms of major depression, and 13.6% were at risk of suicide to some extent; risk of suicide was thought to be low in 7.4%, moderate in 0.7% and high in 5.5% of students in this subset. The risk of eating disorder development was correlated with the risk of suicide (p<0.001). Conclusion: Undergraduate students at risk of developing eating disorders, or with symptoms suggestive of depression, are more prone to commit suicide.

RESUMO Objetivo: Identificar sintomas de transtornos alimentares e possíveis associações com o risco de suicídio e sintomas depressivos em universitários de cursos de saúde. Métodos: Neste estudo de corte transversal, foram avaliados 271 estudantes. Foram utilizados os instrumentos Teste de Atitudes Alimentares e Bulimic Investigatory Test of Edinburgh, para identificação de sintomas de transtornos alimentares. Para o rastreamento de sintomas depressivos, foi usado o questionário de autoavaliação da Escala de Hamilton − Depressão, e o Mini International Neuropsychiatric Interview, para identificação do risco de suicídio. Todos os participantes responderam um questionário contendo informações sociodemográficas, para classificação econômica da amostra. Resultados: A frequência para sintomas de transtornos alimentares foi de 7,4% e de 29,1% para sintomas de bulimia nervosa. Cerca de 17,3% foram sintomáticos para depressão maior, e 13,6% tinham algum grau de risco de suicídio; destes, 7,4% foram considerados com risco de suicídio leve, 0,7% com risco moderado e 5,5% com risco alto de suicídio. Houve correlação entre risco para transtornos alimentares e risco de suicídio (p<0,001). Conclusão: Universitários com risco para os transtornos alimentares, bem como os que possuem sintomatologia sugestiva para depressão têm maior probabilidade de desenvolver o risco de suicídio.

Accuracy and Psychometric Properties of the Brazilian Version of the Montreal Cognitive Assessment as a Brief Screening Tool for Mild Cognitive Impairment and Alzheimer's Disease in the Initial Stages in the Elderly.

OBJECTIVE: To evaluate the applicability and the psychometric properties of Montreal Cognitive Assessment Brazilian Version (MoCA-BR) in the elderly, as well as comparing its accuracy as a tracking test for mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) with the accuracy of Mini-Mental State Examination (MMSE). METHOD: A transversal study was performed in 4 reference medical centers that care for the elderly. In all, 229 elderly participated in the study. To select the sample, the clinical history of the elderly, Pfeffer Functional Activities Questionnaire, and neuropsychological battery, apart from MMSE and MoCA-BR cognitive tests, were selected. The elderly were classified into control, MCI, and mild AD groups. RESULTS: There was a significant statistical difference between the MoCA-BR scores of the elderly and the control group, MCI, and mild AD (p < 0.001). The Cronbach alpha for MoCA-BR was 0.77, indicating a good internal consistency. The test-retest reliability was elevated, with intraclass correlation coefficient (ICC) 0.91. The inter-examiner reliability was excellent (ICC 0.96). The area under curve of the receiver operating characteristics curve was 0.95, when evaluating the ability of MoCA-BR to discriminate between the elderly with cognitive impairment and cognitively healthy elderly. CONCLUSIONS: The results of the study show that the Brazilian version of MoCA is a reliable cognitive tracking tool and is accurate for the detection of MCI and early stage AD, with good applicability on the elderly with education equal to or more than 4 years and adequate to discriminate between cognitively healthy elderly, and those with MCI and mild, proving to be superior to MMSE in tracking MCI and similar to this test when tracking mild AD.

Optimal Cutoff Scores for Dementia and Mild Cognitive Impairment in the Brazilian Version of the Montreal Cognitive Assessment among the Elderly.

OBJECTIVE: To propose cutoff scores for the Brazilian version of the Montreal Cognitive Assessment (MoCA-BR) stratified by education in order to detect mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) in the elderly. METHOD: A transversal study in health centers was performed on 159 elderly people with 4-12 years of education and 70 of their peers with over 12 years of schooling. The MoCA-BR cutoff scores for screening cognitive impairment were determined based on an ROC curve analysis. RESULTS: The ROC curve analysis indicated that cutoff scores under 20 were good for screening elderly people with cognitive impairment with more than 12 years of education, and scores under 21 were good for screening those with 4-12 years of education. CONCLUSIONS: MoCA-BR scores under 21 points (after adding 1 point to the elderly with ≤12 years of education) indicate a need to continue the diagnostic investigation with regular follow-ups.

Prevalence of TMD and level of chronic pain in a group of Brazilian adolescents.

AIMS: To determine the prevalence of temporomandibular disorders and associated factors in an adolescent sample from Recife, Brazil. MATERIALS AND METHODS: A cross-sectional study was conducted with 1342 adolescents aged 10-17 years. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used by calibrated examiners to evaluate the presence and levels of chronic pain. To evaluate the socioeconomic conditions, the subjects answered the Brazilian Economic Classification Criteria (CCEB) questionnaire. Data were analyzed by means of binary logistic regression in SPSS. RESULTS: The results showed that 33.2% of the subjects had TMD irrespective of age (p = 0.153) or economic class (p = 0.653). Statistically significant associations were found between TMD and female gender (p = 0.017), headache/migraine in the past six months (p<0.001), chronic pain (p<0.001) and chronic pain level (p<0.001). In the final model, logistic regression showed that the level of chronic pain and the headache/migraine in the past six months were related to the presence of TMD. CONCLUSIONS: The prevalence of TMD was considered high (33.2%) and adolescents with chronic pain and headache in the past six months were more likely to have TMD. CLINICAL RELEVANCE: The data contribute to the understanding of TMD among adolescents and to the development of preventive measures and polices to identify the dysfunction promptly.

Differences in cortisol concentrations in adolescents with eating disorders: a systematic review / Diferenças nas concentrações de cortisol em adolescentes com transtornos alimentares: uma análise sistemática

Abstract Objective: To perform a systematic review of the literature for scientific evidence of possible differences in cortisol concentrations in adolescents with eating disorders. Source of data: Electronic searches were conducting in the PubMed, Scientific Electronic Library Online, Virtual Health Library, and Science Direct databases for articles published between 2007 and 2017 using the keywords, cortisol, hydrocortisone; eating disorders, bulimia, bulimia nervosa, anorexia, anorexia nervosa; adolescence, adolescent, adolescents. Synthesis of data: A total of 192 articles were found. After the analysis of the eligibility criteria using the PRISMA method, 19 articles were selected for the present review. Most studies were conducted in Europe. Adolescents diagnosed with anorexia nervosa were evaluated in all studies, except one, when other eating disorders were investigated. Blood was the means used for the determination of cortisol. In ten studies, cortisol levels were higher in the group with anorexia than the control group and a reduction in cortisol levels occurred in the adolescents after being submitted to nutritional recovery. Conclusions: Patients with eating disorders may have several clinical consequences, such as changes in body fat distribution, changes in bone mineral density, worsening of neurocognitive ability, and endocrine changes (e.g., hypercortisolemia), which in turn can lead to hyperglycemia, insulin resistance, hypertension, and increased risk of infections. The findings demonstrate that adolescents with eating disorders, especially anorexia nervosa, have increased cortisol levels, which are reduced after the treatment period. Further studies on differences in cortisol concentrations in adolescents with other eating disorders are needed, using different methods.

Resumo Objetivo: Realizar uma análise sistemática da literatura em busca de evidências científicas de possíveis diferenças nas concentrações de cortisol em adolescentes com transtornos alimentares. Fonte de dados: Pesquisas eletrônicas foram realizadas nas bases de dados do Pubmed, da Scientific Electronic Library Online, da Biblioteca Virtual da Saúde e do Science Direct em busca de artigos publicados entre 2007 e 2017 que utilizaram as palavras-chave: cortisol, hidrocortisona, transtornos alimentares, bulimia, bulimia nervosa, anorexia, anorexia nervosa, adolescência, adolescente e adolescentes. Síntese dos dados: Foram encontrados 192 artigos. Após a análise dos critérios de elegibilidade utilizando o método PRISMA, 19 artigos foram selecionados para esta análise. A maioria dos estudos foi realizada na Europa. Os adolescentes diagnosticados com anorexia nervosa foram avaliados em todos os estudos, com exceção de um, em que outros transtornos alimentares foram investigados. A coleta de sangue foi o meio utilizado para a determinação do cortisol. Em dez estudos, os níveis de cortisol estavam mais elevados no grupo com anorexia do que no grupo de controle e ocorreu uma redução nos níveis de cortisol nos adolescentes após serem submetidos a uma recuperação nutricional. Conclusões: Os pacientes com transtornos alimentares podem apresentar diversas consequências clínicas, como alterações na distribuição de gordura corporal, alterações na densidade mineral óssea, piora da capacidade neurocognitiva e alterações endócrinas, como a hipercortisolemia que, por sua vez, pode levar à hiperglicemia, resistência à insulina, hipertensão e ao aumento do risco de infecções. Os achados demonstraram que os adolescentes com transtornos alimentares, principalmente a anorexia nervosa, apresentaram níveis mais elevados de cortisol, que são reduzidos após o período de tratamento. São necessários estudos adicionais sobre as diferenças nas concentrações de cortisol em adolescentes com outros transtornos alimentares, utilizando meios diferentes.

Differences in cortisol concentrations in adolescents with eating disorders: a systematic review.

OBJECTIVE: To perform a systematic review of the literature for scientific evidence of possible differences in cortisol concentrations in adolescents with eating disorders. SOURCE OF DATA: Electronic searches were conducting in the PubMed, Scientific Electronic Library Online, Virtual Health Library, and Science Direct databases for articles published between 2007 and 2017 using the keywords, cortisol, hydrocortisone; eating disorders, bulimia, bulimia nervosa, anorexia, anorexia nervosa; adolescence, adolescent, adolescents. SYNTHESIS OF DATA: A total of 192 articles were found. After the analysis of the eligibility criteria using the PRISMA method, 19 articles were selected for the present review. Most studies were conducted in Europe. Adolescents diagnosed with anorexia nervosa were evaluated in all studies, except one, when other eating disorders were investigated. Blood was the means used for the determination of cortisol. In ten studies, cortisol levels were higher in the group with anorexia than the control group and a reduction in cortisol levels occurred in the adolescents after being submitted to nutritional recovery. CONCLUSIONS: Patients with eating disorders may have several clinical consequences, such as changes in body fat distribution, changes in bone mineral density, worsening of neurocognitive ability, and endocrine changes (e.g., hypercortisolemia), which in turn can lead to hyperglycemia, insulin resistance, hypertension, and increased risk of infections. The findings demonstrate that adolescents with eating disorders, especially anorexia nervosa, have increased cortisol levels, which are reduced after the treatment period. Further studies on differences in cortisol concentrations in adolescents with other eating disorders are needed, using different methods.

Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer's Disease (AD) in the elderly?

ABSTRACTObjective:To compare the accuracy of Mini-Mental State Examination (MMSE) and of the Montreal Cognitive Assessment (MoCA) in tracking mild cognitive impairment (MCI) and Alzheimer's Disease (AD). METHOD: A Systematic review of the PubMed, Bireme, Science Direct, Cochrane Library, and PsycInfo databases was conducted. Using inclusion and exclusion criteria and staring with 1,629 articles, 34 articles were selected. The quality of the selected research was evaluated through the Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2). RESULT: More than 80% of the articles showed MoCA to be superior to MMSE in discriminating between individuals with mild cognitive impairment and no cognitive impairment. The area under the curve varied from 0.71 to 0.99 for MoCA, and 0.43 to 0.94 for MMSE, when evaluating the ability to discriminate MCI in the cognitively healthy elderly individuals, and 0.87 to 0.99 and 0.67 to 0.99, respectively, when evaluating the detection of AD. The AUC mean value for MoCA was significantly larger compared to the MMSE in discriminating MCI from control [0.883 (CI 95% 0.855-0.912) vs MMSE 0.780 (CI 95% 0.740-0.820) p < 0.001]. CONCLUSION: The screening tool MoCA is superior to MMSE in the identification of MCI, and both tests were found to be accurate in the detection of AD.

Consumo de formulações emagrecedoras e risco de transtornos alimentares em universitários de cursos de saúde / Consumption of dietary substances and their association with risk of eating disorders in college students

RESUMO Objetivo Avaliar o consumo de formulações emagrecedoras e sua possível associação com o risco de transtornos alimentares (TAs) em universitários de cursos de saúde de diversos níveis socioeconômicos. Métodos Estudo epidemiológico transversal, realizado com 276 universitários matriculados em quatro cursos da área da saúde. Para a obtenção dos dados, utilizaram-se três instrumentos autoaplicáveis: o Eating Attitudes Test (EAT-26), o Bulimic Investigatory Test of Edinburgh (BITE) e, para investigar o consumo de formulações emagrecedoras, um questionário elaborado pela própria equipe de pesquisa. Para análise dos dados, aplicou-se o teste qui-quadrado, adotando-se o nível de significância de 5%. Resultados Vinte e um universitários apresentaram risco de TA pela escala EAT-26, correspondente a 7,6% dos pesquisados. A frequência do uso de formulações emagrecedoras foi de 7,2%. Houve associação significativa (p < 0,001) entre o uso de formulações emagrecedoras e a presença de risco para TA (33,3%), com percentual muito elevado quando comparado ao percentual de entrevistados sem risco de TA que estavam em uso de medicamentos (5,1%). Conclusões O consumo de formulações emagrecedoras esteve associado tanto à presença de risco para TA, nas escalas EAT-26 e BITE, quanto aos níveis socioeconômicos, principalmente para a classe de renda C.

ABSTRACT Objective to evaluate the consumption of weight loss formulations and their possible association with risk of eating disorders (ED) in university students of health courses of different socioeconomic levels. Methods A cross-sectional epidemiological study was carried out with 276 university students enrolled in four health courses. To obtain the data, three self-applied instruments were used: the Eating Attitudes Test (EAT-26), the Bulimic Investigatory Test of Edinburgh (BITE) and to investigate the consumption of weight-loss formulations a questionnaire prepared by the research team was used. For the data analysis, the chi-square test was applied, adopting the level of significance of 5%. Results Twenty-one university students presented a risk of ED by the EAT-26 scale, corresponding to 7.6% of the respondents. The frequency of use of weight loss formulations was 7.2%. There was a significant association (p < 0.001) between the use of weight loss formulations and the presence of risk for ED (33.3%), with a very high percentage when compared to the percentage of non-ED respondents who were using medication (5.1%). Conclusions The consumption of dietary formulations was associated with both the presence of risk for ED, on the EAT-26 and BITE scales, and on socioeconomic levels, especially for income class C.

Influence of Age and Education on the Performance of Elderly in the Brazilian Version of the Montreal Cognitive Assessment Battery.

AIMS: To provide normative data for the Brazilian version of the Montreal Cognitive Assessment (MoCA-BR) and to measure the effect of sociodemographic variables on the cognitive performance of cognitively healthy elderly people. METHODS: A sample of 110 cognitively healthy individuals, aged over 65 years, with at least 4 years of schooling were recruited from 3 health care centers for the elderly in Recife, Brazil. The cognitive performance was assessed using MoCA-BR. RESULTS: The average score of these elderly people in the MoCA-BR was 23.2 ± 2.7. Their schooling correlated positively with the cognitive performance, with a Spearman's coefficient of 0.33 (p < 0.001). There was a statistically significant negative correlation between age and the cognitive performance (Spearman's rho = -0.19). The multiple linear regression model with the highest adjusted coefficient of determination was the one that included schooling and age (adjusted R2 = 0.127). CONCLUSIONS: The cognitive performance of healthy elderly was evaluated and was strongly influenced by schooling and, to a lower degree, by age.

Relação entre comportamento suicida e transtornos alimentares: uma revisão sistematizada / Relación entre comportamiento suicida y trastornos alimentarios: una revisiónsistematizada / Relationship between suicidal behavior and eating disorders: a systematic review

Objective: this paper offers a systematic review of the literature on eating disorders and the relationship with suicidal behavior. Methods: Searches were performed in the Medline, Lilacs, Adolec and Pubmed databases for articles published between 2003 and 2014. Results: Anorexia nervosa was the most often cited eating disorder in the articles selected. In cases of bulimia nervosa, suicide attempts and self-aggression were more frequent among those who use multiple compensation behaviors. Behavior disorders, emotional disorders and chemical dependency were described as risk factors in all publications. Conclusion: Despite the small number of studies performing an in-depth investigation into the relationship between eating disorder and suicidal behavior, the concomitant presence of these conditions places the health of patients at greater risk.

Objetivo: realizar uma revisão sistematizada da literatura acerca dos transtornos alimentares e sua relação com o comportamento suicida, analisando o conteúdo das publicações. Métodos: Foi Realizada uma busca sistematizada em bases de dados eletrônicas (Medline, Lilacs, Adolec e Pubmed), com foco em artigos publicados entre 2003 e 2014. Resultados: Dentre os estudos selecionados, a anorexia nervosa foi o distúrbio alimentar mais referido pelas publicações. No caso da bulimia nervosa, as taxas de tentativas de suicídio e/ou comportamentos auto agressivos são maiores entre indivíduos que utilizam uma compensação múltipla de comportamentos purgativos. Sobre os fatores de risco associados, evidenciou-se que os transtornos de comportamento, os transtornos emocionais e a dependência química apresentam-se descritos em todas as publicações. Conclusão: Ainda são escassos os trabalhos que investigam profundamente a relação entre transtornos alimentares e o comportamento suicida, porém é possível verificar que a presença concomitante pode comprometer ainda mais a saúde do paciente.

Objetivo: realizar una revisión sistematizada de la literatura sobre trastornos alimentarios y su relación con comportamiento suicida mediante el análisis del contenido de las publicaciones virtuales. Método: Realizar una búsqueda en bases de datos electrónicas (Medline, Liacs, Adolec y Pubmed), de artículos publicados del año 2003 al 2014. Resultados: En todos los estudios la anorexia nerviosa fue el disturbio alimentario más presente. Respecto de la bulimia nerviosa, las tasas de tentativas de suicidio y/o comportamientos autoagresivos son más elevadas entre individuos que recurren a varias formas de compensación mediante múltiples tipos de actitudes purgativas. Acerca de factores de riesgo asociados, los trastornos comportamentales, los emocionales y la dependencia química aparecen en todas las publicaciones. Conclusión: Todavía son escasos los trabajos que investigan en profundidad la relación entretrastornos alimentarios y comportamiento suicida. Se puede detectar empero que la presencia concomitante de ambas situaciones puede comprometer aun más la salud del paciente.

Cyclodextrins improving the physicochemical and pharmacological properties of antidepressant drugs: a patent review.

INTRODUCTION: Depression is a serious mood disorder and is one of the most common mental illnesses. Despite the availability of several classes of antidepressants, a substantial percentage of patients are unresponsive to these drugs, which have a slow onset of action in addition to producing undesirable side effects. Some scientific evidence suggests that cyclodextrins (CDs) can improve the physicochemical and pharmacological profile of antidepressant drugs (ADDs). The purpose of this paper is to disclose current data technology prospects involving antidepressant drugs and cyclodextrins. AREAS COVERED: We conducted a patent review to evaluate the antidepressive activity of the compounds complexed in CDs, and we analyzed whether these complexes improved their physicochemical properties and pharmacological action. The present review used 8 specialized patent databases for patent research, using the term 'cyclodextrin' combined with 'antidepressive agents' and its related terms. We found 608 patents. In the end, considering the inclusion criteria, 27 patents reporting the benefits of complexation of ADDs with CDs were included. EXPERT OPINION: The use of CDs can be considered an important tool for the optimization of physicochemical and pharmacological properties of ADDs, such as stability, solubility and bioavailability.

Prevalence of Suicide Risk Among Adolescents With Depressive Symptoms.

OBJECTIVE: To determine the prevalence of the risk of suicide among adolescents and to investigate associations between the risk of suicide and depressive symptoms. METHODS: A population-based cross-sectional study was conducted with 1,379 students aged 10-17 years enrolled in state-run public schools in northeastern Brazil in 2014. The following instruments were used to collect data: a socio-bio-demographic questionnaire; the Children's Depression Inventory (CDI) and the International Neuropsychiatric Interview (M.I.N.I. Brazilian version 5.0.0). Unidimensional and bidimensional tables were constructed for the data analysis, with absolute and relative frequencies. Odds ratios (OR) and respective intervals (95% confidence) were calculated and associated with the descriptive levels of Pearson's chi-square independence test. RESULTS: The prevalence of the risk of suicide was 29.7% in the population studied. Females aged between 14 and 17, those with siblings and those with depressive symptoms were at the greatest risk. CONCLUSION: The present findings revealed a very high risk of suicide and confirmed the significant that depressive symptoms are significantly associated with the risk of suicide among adolescents. Thus, it is necessary to develop suicide prevention programs for schools, with interdisciplinary primary healthcare actions.