Prevalência de doenças da tireóide em idosos: resultados do São Paulo Ageing & Health Study

This study aimed to estimate prevalence of thyroid disorders in the São Paulo Ageing & Health Study, an epidemiological study addressing several health-adverse outcomes among elderly people living in a poor area of São Paulo, Brazil. All participants answered a questionnaire and had a blood sample collected to assess levels of tireotropic hormone and free-thyroxine. Among 1,373 people (60.8% women), prevalence rates (95% confidence interval) for thyroid dysfunction (%) were: overt hyperthyroidism, 0.7% (0.2-1.1)[women: 0.8% (0.2-1.5); men: 0.4% (0.01-0.9)]; overt hypothyroidism, 5.7% (4.5-6.9) [women: 5.9% (4.3-7.5); men: 5.4% (3.5-7.3)]; subclinical hyperthyroidism, 2.4% (1.6-3.2) [women: 2.8% (1.6-3.9); men: 1.9% (0.7-3.0)]; and subclinical hypothyroidism, 6.5% (5.2-7.8) [women: 6.7% (5.0-8.4); men: 6.1% (4.1-8.2)]. There was no difference in prevalence rates according to gender, but almost 40% of women were diagnosed and under treatment compared to 9% of men. The burden of thyroid disorders in this sample is high and most participants were not aware of them.O objetivo da pesquisa foi avaliar a prevalência de doenças da tireóide no São Paulo Ageing & Health Study, estudo epidemiológico focado em desfechos de saúde adversos em amostra de idosos moradores de São Paulo, Brasil. Todos os participantes responderam a questionário e colheram sangue para dosagem de hormônio tireotrópico e tiroxina-livre. Entre os 1.373 participantes (60,8% mulheres), a prevalência (intervalo de 95% de confiança) de hipertireoidismo clínico foi de 0,7% (0.2-1,1) [mulheres: 0,8% (0,2-1,5); homens: 0,4% (0,01-0,9)]; hipotireoidismo clínico, 5,7% (4,5-6,9) [mulheres: 5,9% (4,3-7,5); homens: 5,4% (3,5-7,3)]; hipertireoidismo subclínico, 2,4% (1,6-3,2) [mulheres: 2,8% (1,6-3,9); homens: 1,9% (0,7-3,0)]; e hipotireoidismo subclínico, 6,5% (5,2-7,8) [mulheres: 6,7% (5,0-8,4); homens: 6,1% (4,1-8,2)]. Não houve diferença na prevalência de doenças da tireóide por sexo. Quarenta por cento das mulheres tinham diagnóstico e estavam tratando, comparadas a 9% dos homens. A prevalência de disfunção tireoidiana foi elevada e a maioria dos participantes desconhecia o diagnóstico.(FAPESP) São Paulo Research Foundatio

Explaining how a psychosocial intervention (PROACTIVE) based on behavioural activation improved outcomes of depression in older adults living in deprived regions of Brazil:The mediating roles of reduced loneliness and stepped care

BackgroundThe PROACTIVE trial was a task-shared, stepped and collaborative care, psychosocial intervention based on psychoeducation and behavioural activation in 715 participants (60–94 years; mean (SD) 68·6 (6.9) years; 74·1 % female), that was highly effective at improving recovery from depression among older adults in Brazil. Here we investigate mediators of the intervention's effectiveness.MethodsCausal mediation analysis using interventional indirect effects, simultaneously decomposed the total effect of PROACTIVE on recovery from depression (PHQ-9 < 10) into multiple indirect effects including: dose of intervention (numbers of sessions and activities completed); social support (Luben Social Network Scale); perceived loneliness (UCLA questionnaire); and additional sessions offered to participants who did not respond during the initial phase of the stepped care intervention.ResultsOf the intervention's total effect (difference in probability of recovery from depression between the intervention and control arms 0·216 [bias-corrected 95 % CI: 0·149, 0·291]): 13 % was mediated through reduced loneliness (0·028 [0·013, 0·046]); and 25 % through attending additional sessions for participants who did not initially respond to the intervention (0·055 [0·007, 0·102]).LimitationsDue to limitations in our sample size our study may lack power to detect some nuances such as interactions between different mediators.ConclusionsOur findings emphasise the importance of a home-based intervention to improve depression outcomes where participants are encouraged to self-select activities to mitigate against loneliness. Importantly, our findings suggest that the intervention's stepped-care component offering additional sessions to participants who did not experience an early response shows promise in ensuring a sustained recovery from depression

Consumo de frutas e hortaliças por idosos de baixa renda na cidade de São Paulo

OBJECTIVE: To estimate the socioeconomic and sociodemographic factors associated with the daily intake of five servings of fruit and vegetables by elderly individuals living in low income areas, identifying the main fruits and vegetables which compose the diet of this population. METHODS: This is a cross-sectional population-based study with 2,066 low income elderly individuals (>;60 years) living in the city of São Paulo, Southeastern Brazil, in 2003-2005. To assess the fruit and vegetable intake a Food Frequency Questionnaire was administered. The answers were transformed into daily intake and compared with the recommendations of the World Health Organization (five or more servings per day). The relationship between recommended fruit and vegetable intake and socioeconomic variables was analyzed using logistic regression models. RESULTS: Of the participants, 60.5% were women and 39.5% were men. Approximately one third of the elders (n=723; 35.0%) did not consume any kind of fruit or vegetable on a daily basis and 19.8% reported a daily intake of five or more servings of fruits and vegetables. This intake was positively associated with income and years of schooling. CONCLUSIONS: The fruit and vegetable intake of low income elderly individuals in the city of São Paulo was insufficient according to the recommendations of the World Health Organization and is associated with unfavorable socioeconomic conditions.OBJETIVO: Estimar los factores socioeconómicos y sociodemográficos asociados al consumo diário de cinco porciones de frutas y hortalizas por ancianos residentes en áreas de baja renta, identificando las principales frutas y hortalizas que componen la dieta de esta población. MÉTODOS: Estudio transversal de base poblacional con 2.066 ancianos (>;60 años) de baja renta residentes en la ciudad de São Paulo, Sureste de Brasil, en 2003-2005. Para la evaluación del consumo de frutas y hortalizas fue aplicado cuestionario de frecuencia alimentaria. Las respuestas fueron transformadas en consumo diário y comparadas con las recomendaciones de la Organización Mundial de la Salud (consumo de cinco o más porciones diárias). La relación entre consumo recomendado de frutas y hortalizas y variables socioeconómicas fue evaluada mediante modelos de regresión logística. RESULTADOS: De los participantes, 60,5% eran mujeres y 39,5% hombres. Cerca de un tercio de los ancianos (n=723; 35,0%) no consumia diariamente ningún tipo de fruta u hortaliza y 19,8% relataron consumo diário de cinco o más porciones de frutas y hortalizas. Este consumo estuvo positivamente asociado con la renta y la escolaridad. CONCLUSIONES: El consumo de frutas y hortalizas de ancianos de baja renta del município de São Paulo se mostró insuficiente con relación a las recomendaciones de la Organización Mundial de la Salud y está asociado a condiciones socioeconómicas desfavorables.OBJETIVO: Estimar os fatores socioeconômicos e sociodemográficos associados ao consumo diário de cinco porções de frutas e hortaliças por idosos residentes em áreas de baixa renda, identificando as principais frutas e hortaliças que compõem a dieta desta população. MÉTODOS: Estudo transversal de base populacional com 2.066 idosos (>;60 anos) de baixa renda residentes na cidade de São Paulo, SP, em 2003-2005. Para a avaliação do consumo de frutas e hortaliças foi aplicado questionário de freqüência alimentar. As respostas foram transformadas em consumo diário e comparadas às recomendações da Organização Mundial da Saúde (consumo de cinco ou mais porções diárias). A relação entre consumo recomendado de frutas e hortaliças e variáveis socioeconômicas foi avaliada mediante modelos de regressão logística. RESULTADOS: Dos participantes, 60,5% eram mulheres e 39,5% homens. Cerca de um terço dos idosos (n=723; 35,0%) não consumia diariamente nenhum tipo de fruta ou hortaliça e 19,8% relataram consumo diário de cinco ou mais porções de frutas e hortaliças. Este consumo esteve positivamente associado à renda e à escolaridade. CONCLUSÕES: O consumo de frutas e hortaliças de idosos de baixa renda do município de São Paulo mostrou-se insuficiente em relação às recomendações da Organização Mundial da Saúde e está associado a condições socioeconômicas desfavoráveis

Effect of a task-shared, collaborative care psychosocial intervention to improve depressive symptomatology among older adults in socioeconomically deprived areas of Brazil (PROACTIVE):cluster randomised controlled trial

BACKGROUND: There is an urgent need to reduce the burden of depression among older adults in low-income and middle-income countries (LMICs). We aimed to evaluate the efficacy of a task-shared, collaborative care psychosocial intervention for improving recovery from depression in older adults in Brazil. METHODS: PROACTIVE was a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial conducted in Guarulhos, Brazil. Primary care clinics (clusters) were stratified by educational level and randomly allocated (1:1) to either enhanced usual care alone (control group) or to enhanced usual care plus the psychosocial intervention (intervention group), which involved a 17-week psychosocial programme based on psychoeducation and behavioural activation approaches. Individuals approached for the initial screening assessment were selected randomly from a list of individuals provided by the Health Secretariat of Guarulhos. Face-to-face baseline assessments were conducted among adults aged 60 years or older registered with one of the primary care clinics and identified with clinically significant depressive symptomatology (9-item Patient Health Questionnaire [PHQ-9] score ≥10). Community health workers delivered the programme through home sessions, supported by a dedicated tablet application. Masking of clinic staff and community health workers who delivered the intervention was not feasible; however, research assistants conducting recruitment and follow-up assessments were masked to trial allocation. The primary outcome was recovery from depression (PHQ-9 score <10) at 8-month follow-up. All primary analyses were performed by intention to treat with imputed data. Adaptations to the protocol were made due to the COVID-19 pandemic; recruitment and intervention home sessions were stopped, and follow-up assessments were conducted by telephone. This trial is registered with the ISRCTN registry, ISRCTN57805470. FINDINGS: We identified 24 primary care clinics in Guarulhos that were willing to participate, of which 20 were randomly allocated to either the control group (ten [50%] clusters) or to the intervention group (ten [50%] clusters). The four remaining eligible clusters were kept as reserves. Between May 23, 2019, and Feb 21, 2020, 8146 individuals were assessed for eligibility, of whom 715 (8·8%) participants were recruited: 355 (49·7%) in the control group and 360 (50·3%) in the intervention group. 284 (80·0%) participants in the control group and 253 (70·3%) in the intervention group completed follow-up at 8 months. At 8-month follow-up, 158 (62·5%) participants in the intervention group showed recovery from depression (PHQ-9 score <10) compared with 125 (44·0%) in the control group (adjusted odds ratio 2·16 [95% CI 1·47–3·18]; p<0·0001). These findings were maintained in the complete case analysis. No adverse events related to the intervention were observed. INTERPRETATION: Although the COVID-19 pandemic altered delivery of the intervention, the low-intensity psychosocial intervention delivered mainly by non-mental health professionals was highly efficacious in improving recovery from depression in older adults in Brazil. Our results support a low-resource intervention that could be useful to reduce the treatment gap for depression among older people in other LMICs. FUNDING: São Paulo Research Foundation and Joint Global Health Trials (UK Department for International Development, Medical Research Council, and the Wellcome Trust)

Neuroanatomical pattern classification in a population-based sample of first-episode schizophrenia

AbstractRecent neuroanatomical pattern classification studies have attempted to individually classify cases with psychotic disorders using morphometric MRI data in an automated fashion. However, this approach has not been tested in population-based samples, in which variable patterns of comorbidity and disease course are typically found. We aimed to evaluate the diagnostic accuracy (DA) of the above technique to discriminate between incident cases of first-episode schizophrenia identified in a circumscribed geographical region over a limited period of time, in comparison with next-door healthy controls. Sixty-two cases of first-episode schizophrenia or schizophreniform disorder and 62 age, gender and educationally-matched controls underwent 1.5T MRI scanning at baseline, and were naturalistically followed-up over 1year. T1-weighted images were used to train a high-dimensional multivariate classifier, and to generate both spatial maps of the discriminative morphological patterns between groups and ROC curves. The spatial map discriminating first-episode schizophrenia patients from healthy controls revealed a complex pattern of regional volumetric abnormalities in the former group, affecting fronto-temporal-occipital gray and white matter regions bilaterally, including the inferior fronto-occipital fasciculus, as well as the third and lateral ventricles. However, an overall modest DA (73.4%) was observed for the individual discrimination between first-episode schizophrenia patients and controls, and the classifier failed to predict 1-year prognosis (remitting versus non-remitting course) of first-episode schizophrenia (DA=58.3%). In conclusion, using a “real world” sample recruited with epidemiological methods, the application of a neuroanatomical pattern classifier afforded only modest DA to classify first-episode schizophrenia subjects and next-door healthy controls, and poor discriminative power to predict the 1-year prognosis of first-episode schizophrenia

Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil

Depressive and subthreshold depressive symptomatology are common but often neglected in older adults. / Objective: This study aimed to assess rates of depressive and subthreshold depressive symptomatology, and the characteristics associated, among older adults living in a socioeconomically deprived area of Brazil. / Methods: This study is part of the PROACTIVE cluster randomised controlled trial. 3356 adults aged 60+ years and registered in 20 primary health clinics were screened for depressive symptomatology with the Patient Health Questionnaire-9 (PHQ-9). Depressive status was classified according to the total PHQ-9 score and the presence of core depressive symptoms (depressed mood and anhedonia) as follows: no depressive symptomatology (PHQ-9 score 0–4, or 5–9 but with no core depressive symptom); subthreshold depressive symptomatology (PHQ-9 score 5–9 and at least one core depressive symptom); and depressive symptomatology (PHQ-9 score ≥ 10). Sociodemographic information and self-reported chronic conditions were collected. Relative risk ratios and 95% CIs were obtained using a multinomial regression model. / Results: Depressive and subthreshold depressive symptomatology were present in 30% and 14% of the screened sample. Depressive symptomatology was associated with female gender, low socioeconomic conditions and presence of chronic conditions, whereas subthreshold depressive symptomatology was only associated with female gender and having hypertension. / Conclusions: Depressive and subthreshold depressive symptomatology is highly prevalent in this population registered with primary care clinics. Strategies managed by primary care non-mental health specialists can be a first step for improving this alarming and neglected situation among older adults

High frequency of silent brain infarcts associated with cognitive deficits in an economically disadvantaged population

OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (