RESUMO
O objetivo do presente estudo foi identificar a concordância entre agravos bucais autorreferidos durante e após a COVID-19 e condições clínicas de pacientes do município de Palhoça-SC. Materiais e Método: Estudo exploratório, transversal de base quantitativa descritiva com 30 participantes que possuíram testagem positiva para COVID-19 no município de Palhoça-SC. Cada paciente participou de uma avaliação clínica, identificando os agravos bucais, nessa mesma oportunidade, foram registrados dados sociodemográficos e condições bucais autorreferidas. Todas as análises foram conduzidas pelo Software Stata® versão 13. Análises descritivas, inferenciais pelo teste de Qui-quadrado de Pearson (α=5%). Concordância entre presença dos agravos bucais autorreferidos e presença do agravo avaliado clinicamente, pelo coeficiente Kappa e classificadas como: fraca 0 a 0,20; razoável 0,41 a 0,60; boa 0,61 a 0,80; muito boa 0,81 a 0,92; e excelente 0,93 a 1,00. Resultados: A maioria da amostra foram de mulheres (70%), com idade entre 36-59 anos (56,6%) e de baixa renda (70%). Houve concordância boa entre presença de cárie e relato de dor (Kappa=0,70), e para o diagnóstico clínico de sangramento gengival e autopercepção ruim/péssima a classificação também foi boa (Kappa=0,72). Todavia, a concordância entre o relato de sintomas de boca seca e baixo fluxo salivar foi considerada razoável (Kappa=0,57), assim como, para a presença de bolsa periodontal e o relato de autopercepção ruim/péssima (Kappa=0,41). Conclusão: A autopercepção das condições de saúde bucal durante a pandemia foi concordante com determinadas condições clínicas que necessitam de atendimento odontológico, corrobando com as preocupações sobre o agravamento das condições bucais durante a pandemia.(AU)
Aim: To identify the concordance between self-reported oral health problems during and after COVID-19 and clinical conditions of patients in the city of Palhoça-SC. Materials and Method: Exploratory, cross-sectional study with a descriptive quantitative base, formatted by 30 patients who tested positive for COVID-19 in the municipality of Palhoça-SC. Each patient participated in a clinical evaluation, identifying oral health problems. At the same time, sociodemographic data and self-reported oral conditions were recorded. All analyzes were performed using the Stata® Software, version 13. Descriptive and inferential analyzes were performed using Pearson's chi-square test (α=5%). Agreement between the presence of self-reported oral health problems and the presence of the clinically evaluated disease, by the Kappa coefficient and classified as: weak 0 to 0.20; take 0.21 to 0.40; reasonable 0.41 to 0.60; good 0.61 to 0.80; very good 0.81 to 0.92; and excellent 0.93 to 1.00. Results: Most of the sample were women (70%), aged between 36-59 years (56.6%) and low-income (70%). There was good agreement between the presence of caries and reported pain (Kappa=0.70), and for the clinical diagnosis of gingival bleeding and bad/very poor self-perception, the classification was also good (Kappa=0.72). However, the agreement between the report of symptoms of dry mouth and low salivary flow was considered reasonable (Kappa=0.57), as well as the presence of periodontal pockets and the report of poor/terrible self-perception (Kappa=0.41). Conclusion: The self-perception of oral health conditions during the pandemic was consistent with certain clinical conditions that require dental care, corroborating concerns about the worsening of oral conditions during the pandemic.(AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Autorrelato , COVID-19/epidemiologia , Doenças da Boca/epidemiologia , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Saúde Bucal , Estudos Transversais , Autoavaliação Diagnóstica , Doenças da Boca/diagnósticoRESUMO
BACKGROUND: Post-traumatic stress disorder (PTSD) is a debilitating condition, which generates an extensive burden. We aimed to investigate in a huge metropolitan area, the prevalence of traumatic experiences, the development of PTSD, and its predictors. METHODS: Traumatic experiences and PTSD were assessed in 5037 adult individuals of the general population. Cross-tabulations method assessed the prevalence of traumatic events and PTSD. Logistic regression models investigated predictors of lifetime and 12-month odds of PTSD and the conditional probability of developing PTSD for specific traumas. RESULTS: Lifetime and 12-month diagnoses of PTSD were found in 3.2% and 1.6% of the sample. 'Witnessing anyone being injured or killed, or unexpectedly seeing a dead body' (35,7%) and 'being mugged or threatened with a weapon' (34.0%) were the two most reported traumas. The commonest events before PTSD onset were 'sudden unexpected death of a loved one' (34.0%), 'interpersonal violence' (31.0%), and 'threats to the physical integrity of others' (25.0%). Experiences related to "interpersonal violence" presented the highest conditional probability for PTSD (range 2.2-21.2%). Being 'sexually assaulted or molested' (21.2% total; 22.3% women; 0.0% men) and being 'raped' (18.8% total; 18.4% women; 20.1% men) were the two experiences with the highest odds for PTSD. While being female was a predictor of less exposure to any event (OR = 0.69), females were more prone to develop lifetime PTSD after exposure to an event (OR = 2.38). CONCLUSION: Traumatic events are frequent in the general population and a small group of traumatic events accounts for most cases of subsequent PTSD.
Assuntos
Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Brasil/epidemiologiaRESUMO
INTRODUCTION: The potential benefits attributable to late reperfusion fall under the "open artery hypothesis", in which the stunned peri-infarction zone after revascularization restores blood supply, improving its contractility. A study showed that late coronary recanalization after myocardial infarction (MI), irrespective of the viability status, improved left ventricular ejection fraction (LVEF) and myocardial contractility mainly in the segments adjacent and distant to the infarction. Purpose: To evaluate whether late recanalization in patients with STEMI without viability by Cardiovascular Magnetic Resonance (CMR) can reduce the reverse remodeling. Viable cases will be kept in the registry. METHODS: This is a prospective randomized controlled trial, with at least 6 months follow-up. Patients with STEMI not reperfused between 24 hours and 28 days with IRA with lesion greater than 50% with segmental dysfunction and absence of viability on CMR are eligible for inclusion. Patients with previous MI, cardiomyopathy or clinical instability are excluded. Participants randomly assigned (1:1) to PCI and Optimal Medical Treatment (OMT) or only OMT. Expected outcome is the change on reverse remodeling of the end systolic volume at 6 months likewise the improvement in segmental contractility at 6 months. The sample size of 35 patients in each group provides 80% power with a two-sided significance level of 0.05. Descriptive statistics and statistical inferential methods are employed to measure changes between the groups. The trial has local ethical review board approval. RESULTS: 28 patients have been already enrolled. CONCLUSION: This trial will provide insights into the potential benefits of opening the IRA in segments without viability, improving contractility of surrounding myocardium.
Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Volume Sistólico , Espectroscopia de Ressonância Magnética , CardiomiopatiasRESUMO
A large number of stroke survivors suffer from a significant decrease in upper extremity (UE) function, requiring rehabilitation therapy to boost recovery of UE motion. Assessing the efficacy of treatment strategies is a challenging problem in this context, and is typically accomplished by observing the performance of patients during their execution of daily activities. A more detailed assessment of UE impairment can be undertaken with a clinical bedside test, the UE Fugl-Meyer Assessment, but it fails to examine compensatory movements of functioning body segments that are used to bypass impairment. In this work, we use a graph learning method to build a visualization tool tailored to support the analysis of stroke patients. Called NE-Motion, or Network Environment for Motion Capture Data Analysis, the proposed analytic tool handles a set of time series captured by motion sensors worn by patients so as to enable visual analytic resources to identify abnormalities in movement patterns. Developed in close collaboration with domain experts, NE-Motion is capable of uncovering important phenomena, such as compensation while revealing differences between stroke patients and healthy individuals. The effectiveness of NE-Motion is shown in two case studies designed to analyze particular patients and to compare groups of subjects.
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Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Movimento , Recuperação de Função Fisiológica , Extremidade SuperiorRESUMO
OBJECTIVE: Most countries fail to treat individuals with psychopathologies. Investigating treatment barriers and reasons for dropout are key elements to overcoming this scenario. METHODS: A representative sample of 2,942 urban-dwelling adults was interviewed face-to-face within a cross-sectional, stratified, multistage probability survey of the general population. Psychiatric diagnosis, severity level, use of services, reasons for not seeking treatment, and treatment dropout were investigated. RESULTS: Only 23% of individuals with a psychopathology of any severity level in the last 12 months received treatment. Low perceived need for treatment (56%) was the most common reason for not seeking treatment. The most visited settings were psychiatric, other mental health care, and general medical care. Among those with a perceived need for treatment (44%), psychological barriers were the most common reason for not seeking it. Treatment dropout was more prevalent among those who visited a general medical care setting. Among individuals still in treatment, human services and psychiatric care were the most common types. Female sex was associated with structural barriers (OR = 2.1). Disorder severity was negatively associated with need barriers (OR = 0.4), and positively associated with structural barriers (OR = 2.5) and psychological barriers (OR = 2.5). CONCLUSION: Despite the need for treatment and better services, psychological barriers were the major reason for not seeking treatment. Apart from providing more specialists, investing in awareness, de-stigmatization, and information is the ultimate strategy for improving psychiatric care.
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Transtornos Mentais , Serviços de Saúde Mental , Adulto , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
BACKGROUND: Childhood adversities (ECA) are deleterious experiences that can occur during individuals' development, which has been associated with several negative health outcomes. AIM: Analyze the effect of ECA on the onset of DSM-IV disorders throughout life. METHOD: The Composite International Diagnostic Interview (CIDI) was used in a stratified, multistage area probability sample of 5037 individuals aged 18 or more to assess the presence of childhood adversities, 20 psychiatric disorders and their ages of onset. Discrete-time survival models were performed to estimate the odds of disorder onset. Data are from the São Paulo Megacity Mental Health Survey, the Brazilian branch of the World Mental Health Survey Initiative. FINDINGS: 53.6% of the sample experienced at least one ECA, and parental death (16.1%) and physical abuse (16%) were the most reported occurrences. Parental mental illness (OR = 1.99 to 2.27) and family violence (OR = 1.55 to 1.99) were the adversities most consistently associated with psychopathology across all age groups, while economic adversities (OR = 2.71 to 3.30) and parent criminality (OR = 1.72 to 1.77) were associated with psychopathology in individuals whose onset of disorder occurred from age 13 years on. Parental mental disorders and economic adversities were the strongest and most consistent predictors of all four classes of psychopathologies examined in multivariate models controlled for the clustering of adversities. Physical abuse was associated with externalizing disorders, while sexual abuse with internalizing disorders. INTERPRETATION: Childhood adversities were consistently associated with mental disorders. Economic adversities and parent mental disorders were predictive of psychopathology even if controlled for type (additive) and type and number of adversities (interactive models). Parental mental disorder and family violence were the main predictors of psychopathology onset across all age groups. Parental mental disorder was the only adversity that predicted all classes of disorders investigated.
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Longevidade , Transtornos Mentais , Adolescente , Brasil , Humanos , Acontecimentos que Mudam a Vida , Transtornos Mentais/epidemiologia , Fatores de RiscoRESUMO
Objetivo: analisar o perfil sociodemográfico e clínico de indivíduos com Diabetes Mellitus em Teresina, Piauí. Método: estudo observacional e retrospectivo, realizado a partir de dados secundários do Sistema HiperDia, de 2003 a 2012, extraídos em maio de 2020. Os dados foram analisados por meio de estatística descritiva. Resultados: foram analisados 1.486 casos novos de Diabetes Mellitus, com maior frequência do tipo 2, em mulheres, entre 40 e 59 anos. Predominaram indivíduos com o tipo 1 que não fumavam, não eram sedentários e não apresentavam sobrepeso. Quanto ao tipo 2, a maioria era sedentária, não fumante e não estava com sobrepeso. Entre as complicações, a doença renal foi mais prevalente, no tipo 1, e o Acidente Vascular Cerebral, no tipo 2. Conclusão: o conhecimento da situação epidemiológica do Diabetes Mellitus aponta a necessidade do desenvolvimento de ações para prevenção de fatores de risco evitáveis e de complicações.(AU)
Objective: to analyze the sociodemographic and clinical profile of individuals with Diabetes Mellitus in Teresina, Piauí. Method: observational and retrospective study, carried out using secondary data from the HiperDia System, from 2003 to 2012, extracted in May 2020. The data were analyzed using descriptive statistics. Results: 1,486 new cases of Diabetes Mellitus were analyzed, with a predominance of type 2, in females and aged between 40 and 59 years. Among individuals with type 1, those who did not smoke, were not sedentary and were not overweight predominated. As for type 2, most were sedentary, non-smokers and were not overweight. Among the complications, kidney disease was more prevalent, in type 1, and stroke, in type 2. Conclusion: knowledge of the epidemiological situation of Diabetes Mellitus points out the need to develop actions to prevent preventable risk factors and complications.(AU)
Objetivo: analizar el perfil sociodemográfico y clínico de individuos con Diabetes Mellitus en Teresina, Piauí. Método: estudio observacional y retrospectivo, realizado con datos secundarios del Sistema HiperDia, de 2003 a 2012, extraídos en mayo de 2020. Los datos se analizaron mediante estadística descriptiva. Resultados: se analizaron 1.486 nuevos casos de Diabetes, con predominio del tipo 2, en el sexo femenino y entre los 40 y 59 años. Entre los individuos con tipo 1, predominaron los que no fumaban, no eran sedentarios y no tenían sobrepeso. En cuanto al tipo 2, la mayoría eran sedentarios, no fumadores y no tenían sobrepeso. Entre las complicaciones, la enfermedad renal fue más prevalente, en el tipo 1, y el ictus, en el tipo 2. Conclusión: el conocimiento de la situación epidemiológica de la Diabetes Mellitus señala la necesidad de desarrollar acciones para prevenir factores de riesgo prevenibles y complicaciones.(AU)
Assuntos
Perfil de Saúde , Epidemiologia , Diabetes MellitusRESUMO
Chronic diseases are often comorbid and present a weighty burden for communities in the 21st century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual- and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional São Paulo Megacity Mental Health Survey, a stratified multistage area probability sampling investigation. Trained interviewers assessed mental morbidities and asked about physical conditions for 1,571 community-dwelling women and 1,142 men, aged between 18 and 64 years. Principal component analysis depicted patterns of physical-mental multimorbidity, by sex. Following, the patterns of multimorbidity were subjected to multilevel regression analysis, taking into account individual- and area-level variables. Three patterns of clustering were found for women: 'irritable mood and headache', 'chronic diseases and pain', and 'substance use disorders'. Among men, the patterns were: 'chronic pain and respiratory disease', 'psychiatric disorders', and 'chronic diseases'. Multilevel analyses showed associations between multimorbidity patterns and both individual- and area-level determinants. Our findings call for a reformulation of health-care systems worldwide, especially in low-resource countries. Replacing the single-disease framework by multi-disease patterns in health-care settings can improve the ability of general practitioners in the health-care of person-centred needs.
Assuntos
Doença Crônica/epidemiologia , Nível de Saúde , Transtornos Mentais/epidemiologia , Multimorbidade , Adolescente , Adulto , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Atenção à Saúde , Países em Desenvolvimento , Feminino , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Análise Multinível/métodos , Doenças do Sistema Nervoso/epidemiologia , Análise de Componente Principal/métodos , Doenças Respiratórias/epidemiologia , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
Objective: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. Methods: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. Results: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. Conclusion: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Família/psicologia , Relações Interpessoais , Acontecimentos que Mudam a Vida , Fatores Socioeconômicos , Violência/psicologia , Violência/estatística & dados numéricos , Brasil , Análise por Conglomerados , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Fatores Sexuais , Estudos Transversais , Análise Fatorial , Entrevista PsicológicaRESUMO
BACKGROUND: Psychiatric disorders tend to distribute unevenly in women and men with severe obesity. The current research aimed to identify homogeneous clusters of concurrent psychiatric disorders among patients seeking bariatric surgery, by gender. METHODS: We recruited a consecutive sample of 393 candidates with obesity (311 women and 82 men) in a university-based bariatric center. Trained clinicians assessed psychiatric disorders through the Structured Clinical Interview for DSM-IV (SCID). Latent class analysis categorized pre-surgical patients into uniform clusters of co-occurring psychiatric disorders. RESULTS: For both genders, the 3-class psychopathological clustering was the best-fitting solution. Among women, the latent classes were: (1) "oligosymptomatic", wherein 42% of patients showed low probability of psychiatric disorders; (2) "bipolar with comorbidities", in 33%; and (3) "anxiety/depression", in 25%. Among men, (1) "bipolar with comorbidities" was found in 47% of patients; (2) "oligosymptomatic", in 40%; and (3) "anxiety/depression", in 13%. For both genders, the probability of presenting eating disorders was higher in both "bipolar" and "anxiety/depression" classes. Substance use disorders was prominent among "bipolar" men. In comparison with "oligosymptomatic" class, the likelihood of higher BMI was observed among "bipolar" men and poorer work attainment among men with "anxiety/depression". LIMITATION: Participants was cross-sectionally drawn from a single bariatric center. CONCLUSIONS: Pre-surgical men and women with severe obesity were distributed in three comorbidity profiles and revealed analogous psychopathological patterns. The class of "bipolar disorders" most likely presented comorbidity with eating and substance use disorder. This natural clustering of psychiatric disorders among bariatric patients suggests gender-related therapeutic approaches and surgical outcomes.
Assuntos
Cirurgia Bariátrica/psicologia , Obesidade Mórbida/psicologia , Fatores Sexuais , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Transtorno Bipolar/psicologia , Análise por Conglomerados , Comorbidade , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
OBJECTIVE: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. METHODS: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. RESULTS: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. CONCLUSION: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.
Assuntos
Família/psicologia , Relações Interpessoais , Acontecimentos que Mudam a Vida , Adolescente , Adulto , Brasil , Criança , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/estatística & dados numéricos , Análise por Conglomerados , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Violência/psicologia , Violência/estatística & dados numéricos , Adulto JovemRESUMO
INTRODUCTION: Most studies on the epidemiology of personality disorders (PDs) have been conducted in high-income countries and may not represent what happens in most part of the world. In the last decades, population growth has been concentrated in low- and middle-income countries, with rapid urbanization, increasing inequalities and escalation of violence. Our aim is to estimate the prevalence of PDs in the Sao Paulo Metropolitan Area, one of the largest megacities of the world. We examined sociodemographic correlates, the influence of urban stressors, the comorbidity with other mental disorders, functional impairment and treatment. METHODS: A representative household sample of 2,942 adults was interviewed using the WHO-Composite International Diagnostic Interview and the International Personality Disorder Examination-Screening Questionnaire. Diagnoses were multiply imputed, and analyses used multivariable regression. RESULTS AND DISCUSSION: Prevalence estimates were 4.3% (Cluster A), 2.7% (Cluster B), 4.6% (Cluster C) and 6.8% (any PD). Cumulative exposure to violence was associated with all PDs except Cluster A, although urbanicity, migration and neighborhood social deprivation were not significant predictors. Comorbidity was the rule, and all clusters were associated with other mental disorders. Lack of treatment is a reality in Greater Sao Paulo, and this is especially true for PDs. With the exception of Cluster C, non-comorbid PDs remained largely untreated in spite of functional impairment independent of other mental disorders. CONCLUSION: Personality disorders are prevalent, clinically significant and undertreated, and public health strategies must address the unmet needs of these subjects. Our results may reflect what happens in other developing world megacities, and future studies are expected in other low- and middle-income countries.
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Transtornos da Personalidade/epidemiologia , Brasil/epidemiologia , Cidades/epidemiologia , Comorbidade , Exposição à Violência , Migração Humana , Humanos , Entrevista Psicológica , Análise Multivariada , Transtornos da Personalidade/terapia , Pobreza , Prevalência , Escalas de Graduação Psiquiátrica , Análise de Regressão , Inquéritos e Questionários , População UrbanaRESUMO
The current study investigates the patterns of disease persistence and comorbidity of psychiatric disorders among patients with class III obesity in pre-operative period. For 393 treatment-seeking patients with severe obesity recruited from a bariatric center, we ascertained their psychiatric diagnosis through Structured Clinical Interview for DSM-IV (SCID-I). Following, the frequency, persistence and comorbidity pattern of psychiatric disorders in this sample were determined. Current psychiatric disorders were observed in over half of patients during preoperative period, being anxiety disorders the most frequent diagnosis. For lifetime disorders, mood disorders were the most frequent diagnosis. Most of the sample presented 2 or more concurrent lifetime psychiatric disorders. While mood and eating disorders were frequent conditions, anxiety disorders were the most persistent conditions (the highest one month-to-lifetime prevalence ratio) and were significantly correlated with bipolar, depressive and eating disorders. Psychiatric disorders are frequent and enduring conditions among patients looking for bariatric surgery. Comorbid anxiety, mood, and eating disorders are remarkable features in treatment-seeking patients with obesity. Prognostic implications of preoperative psychiatric disorders on surgery outcome should be demonstrated prospectively in intervention studies.
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Transtornos de Ansiedade/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos do Humor/epidemiologia , Obesidade Mórbida/psicologia , Adulto , Cirurgia Bariátrica/psicologia , Brasil/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Período Pré-Operatório , PrevalênciaRESUMO
BACKGROUND: Childhood adversities have been associated with a number of medical and psychiatric outcomes. However, the reported effects that specific childhood adversities have on suicidality vary across studies. METHOD: This was a cross-sectional, stratified, multistage area probability investigation of a general population in Brazil, designated the São Paulo Megacity Mental Health Survey. The World Mental Health Composite International Diagnostic Interview was applied in 5037 individuals ≥ 18 years of age, in order to assess 12 different adversities occurring during childhood and/or adolescence, as well as to look for associations between those adversities and subsequent suicidality in different age strata. RESULTS: Over half of the respondents reported at least one childhood adversity. Only physical abuse was consistently associated with suicide attempts in all subsequent life stages (OR = 2.1). Among adults 20-29 years of age, the likelihood of a suicide attempt was correlated with parental divorce, whereas suicidal ideation was associated with prior sexual abuse. Among adults over 30 years of age, physical illness and economic adversity emerged as relevant childhood adversities associated with suicide attempts, whereas sexual abuse, family violence, and economic adversity were associated with suicidal ideation. CONCLUSION: Childhood adversities, especially physical abuse, are likely associated with unfavorable consequences in subsequent years. For suicidality across a lifespan, the role of different childhood adversities must be examined independently.
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Cidades/estatística & dados numéricos , Acontecimentos que Mudam a Vida , Vigilância da População , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Maus-Tratos Infantis , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
Suicide tends to occur in families, and parental psychopathology has been linked to offspring suicidal behaviors. This study explores the influence of parental mental disorders across the lifespan. Data are from the Sao Paulo Megacity Mental Health Survey, a cross-sectional household study with a representative sample of the adult population living in the Sao Paulo Metropolitan Area, Brazil (N=2,942). Survival models examined bivariate and multivariate associations between a range of parental disorders and offspring suicidality. After controlling for comorbidity, number of mental disorders and offspring psychopathology, we found that parental psychopathology influences suicidal behaviors throughout most part of the life cycle, from childhood until young adult years. Generalized anxiety disorder (GAD) and antisocial personality were associated with offspring suicidal ideation (OR 1.8 and 1.9, respectively), panic and GAD predicted suicidal attempts (OR 2.3 and 2.7, respectively), and panic was related to the transition from ideation to attempts (OR 2.7). Although noticed in many different stages of the lifespan, this influence is most evident during adolescence. In this period, depression and antisocial personality increased the odds of suicidal ideation (OR 5.1 and 3.2, respectively), and depression, panic disorder, GAD and substance abuse predicted suicidal attempts (OR varying from 1.7 to 3.8). In short, parental disorders characterized by impulsive-aggression and anxiety-agitation were the main predictors of offspring suicidality across the lifespan. This clinically relevant intergenerational transmission of suicide risk was independent of offspring mental disorders, and this underscores the need for a family approach to psychopathology.
Assuntos
Transtornos Mentais/psicologia , Relações Pais-Filho , Pais/psicologia , Suicídio , Brasil , HumanosRESUMO
The adenoviral conjunctivitis is one of the biggest causes of conjunctival infection in the world. Conjunctivitis causes relatively nonspecific symptoms, as hyperaemia and chemosis. Even after biomicroscopy, complex laboratory tests, such as viral culture, are necessary to identify the pathogen or its etiology. To contribute to the better understanding of the pathobiology of the adenoviral conjunctivitis, the tear fluids of patients with unilateral acute adenovirus conjunctivitis (UAAC), normal donors (control) and patients with allergic conjunctivitis were analyzed. Tear samples were collected with Schirmer strips from control, allergic conjunctivitis and UAAC patients, diagnosed by clinical signs. UAAC tears were tested positive in viral cultures. After the elution, HA was quantified using an ELISA-like fluorometric assay and the protein profile was determined by SDS-PAGE. A profound increase in the HA tear content in UAAC patients was found when compared to control and ALC. This HA increase in UAAC tears remarkably was not observed in tears from contralateral eyes without clinical signs, nor in allergic conjunctivitis. In addition a distinct profile of UAAC tear proteins was observed in patients with UAAC. The quantification of HA in the tear fluid is a rapid, sensitive and specific test. This molecule might be a biomarker candidate for acute conjunctivitis.
Assuntos
Infecções por Adenovirus Humanos/diagnóstico , Conjuntivite Viral/diagnóstico , Proteínas do Olho/análise , Ácido Hialurônico/análise , Lágrimas/química , Doença Aguda , Infecções por Adenovirus Humanos/fisiopatologia , Adulto , Biomarcadores/análise , Estudos de Casos e Controles , Criança , Conjuntivite Viral/fisiopatologia , Conjuntivite Viral/virologia , Eletroforese em Gel de Poliacrilamida , Feminino , Humanos , Masculino , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Obesity and psychiatric disorders are burdensome health problems commonly observed in general population and clinical samples. However, non-standardized assessment and small size of the sample might hamper conclusions of the investigations. The objective of this study is to replicate previous findings on frequency of psychiatric disorders and associated factors among obese patients seeking bariatric surgery, assessed through standardized interview. MATERIAL AND METHOD: The sample was comprised of 393 treatment-seeking obese patients (79.1% women; mean age 43.0 years, mean BMI 47.8 kg/m(2)) recruited from a university-based bariatric center. Trained clinicians ascertained the psychiatric diagnosis of the participants through structured clinical interview for DSM-IV Axis I diagnosis (SCID-I). RESULTS: The current rate of any psychiatric disorders was 57.8% (58.5% men vs. 57.6% women). The current anxiety disorders were the most frequent diagnosis (46.3%) among those participants with current disorder. Age and educational level were associated with the likelihood of presenting current psychiatric disorders. The lifetime rate of any psychiatric disorders was 80.9% (81.7 men vs. 80.7% women). Lifetime affective disorders were the most frequent diagnosis (total 64.9%; bipolar disorders 35.6% and depressive disorders 29.3%). About half of the sample presented 3 or more concurrent disorders among those respondents presenting any lifetime psychiatric disorders. CONCLUSIONS: Psychiatric disorders are frequent conditions among obese patients before bariatric surgery. Systematic assessment of patients in the pre-surgical phase is recommended. Prognostic implications of psychiatric disorders on surgery outcome should be demonstrated in follow-up study.
Assuntos
Cirurgia Bariátrica/psicologia , Entrevista Psicológica , Transtornos Mentais/epidemiologia , Obesidade Mórbida/psicologia , Adulto , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , PrognósticoRESUMO
An ethanol extract and different partition fractions obtained from Lippia origanoides H.B.K. were assayed for light-mediated activity against strains of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). Identical assays were conducted with and without exposure to UV-A (400-315 nm) light to test for light enhanced activity. The ethanol extract and dichloromethane fraction showed light-mediated activity against the S. aureus strain, but not against the E. coli strain. The dichloromethane fraction was more active than the ethanol extract. Naringenin did not display light-mediated activity against the tested bacteria, indicating that the light-mediated antimicrobial activity of the dichloromethane fraction is not due to its major component. The results represent the first report of light-mediated antimicrobial activity of Lippia origanoides and show that its phytochemicals could be used as light-mediated antimicrobial agents.
Assuntos
Antibacterianos/química , Lippia/química , Fármacos Fotossensibilizantes/química , Extratos Vegetais/química , Raios Ultravioleta , Escherichia coli/efeitos dos fármacos , Escherichia coli/efeitos da radiação , Flavanonas/química , Cloreto de Metileno/química , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/efeitos da radiaçãoRESUMO
O objetivo do presente trabalho é diferenciar duas formas de pensar a feminilidade. A primeira, entendida a partir da economia libidinal de um homem e a segunda como uma forma própria de um sujeito se constituir sexuado. Neste trabalho, a feminilidade é pensada como uma posição do sujeito, e buscamos aproximar alguns dos principais conceitos que Freud e Lacan usam para pensar a feminilidade, nomeadamente, no caso de Freud, no que diz respeito à configuração particular da libido feminina entre a libido objetal e a libido narcísica e, no caso de Lacan, no que diz respeito à relação da mulher com o falo ser mediada por uma forma diferente de relação com o Outro.
The objective of this study is to distinguish between two ways of thinking about femininity by psychoanalysis. The first, understood from the point of view of the libidinal economy of a man, and the second as a definite way of a subject to constitute itself as a sexed being. In order to develop this idea of femininity as a subject position we tried to establish connections among some of the key concepts that Freud and Lacan used to think about this theme, specially, in the case of Freud, with regard to the particular configuration of female libido between object libido and narcissistic libido and, in the case of Lacan, with regard to woman's relationship to the phallus to be mediated by a different form of relationship with the Other.
El objetivo de este estudio consiste en distinguir entre dos formas de pensar la feminidad para el psicoanálisis. La primera, a partir de la economía libidinal de un hombre, y la segunda, en cuanto una forma propia de un sujeto de constituirse como sexual. El esfuerzo está en cómo tratar la idea de la feminidad como una posición de sujeto. Así, se trató establecer la conexión entre algunos de los conceptos clave que Freud y Lacan usan para dar cuenta del tema. Es decir, entre lo que Freud dice sobre la configuración particular de la libido femenina entre la libido objetal y la narcisista, y, lo que Lacan dice acerca de la relación de la mujer y del falo ser mediada por una forma de relación diferente con el Otro.
Le but de cette étude est de faire la distinction entre deux manières de penser la féminité. La premiere est conçue a partir de l'économie libidinale d'un homme et la seconde comme une forme propre d'un sujet se constituer en tant que sexué. Afin de développer cette idée de la féminité comme une position de sujet, nous avons essayé de rapprocher des concepts clés que Freud et Lacan utilisent pour rendre compte de la thématique, à savoir entre ce que dit Freud à propos de la configuration particulière de la libido féminine entre la libido d'objet et la libido narcissique et ce que dit Lacan sur la relation de la femme avec le phallus comme étant médié par un autre rapport à l'Autre.