Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Peru

OBJECTIVE There is a need, in the absence of formal services, to design interventions aimed at improving the lives of people with dementia and their families. This study tested the effectiveness of the 10/66 caregiver intervention among people with dementia and their caregivers in Lima, Peru. METHOD Design/participants: a randomized controlled trial was performed involving 58 caregivers of people with dementia that received the intervention in the beginning of the trial (n = 29) or six months later (n = 29). The intervention consisted of three modules: 1) assessment (one session); 2) basic education about dementia (two sessions); and 3) training regarding specific problem behaviors (two sessions). Main outcome measures: Caregivers and patients with dementia were assessed at baseline and after six months. For caregivers, the measures included strain (Zarit Burden Interview), psychological distress (SRQ-20), and quality of life (WHOQOL-BREF). Dementia patients completed scales assessing behavioral and psychological symptoms (NPI-Q) and quality of life (DEMQOL). RESULTS Caregivers in the intervention group reported significantly decreased strain measures six months after the intervention compared to controls. No group differences were found in respect to the caregivers' psychological distress and to quality of life in both caregivers and patients. CONCLUSION The 10/66 intervention seems to be as effective as similar interventions used in more developed countries

Dementia in low-income and middle-income countries: Different realities mandate tailored solutions

CNPq (a Brazilian public agency)Univ Fed Sao Paulo, Dept Psychobiol, Sao Paulo, BrazilChristian Med Coll & Hosp, Dept Psychiat, Vellore, Tamil Nadu, IndiaUniv Fed Sao Paulo, Dept Psychobiol, Sao Paulo, BrazilCNPq: 311031/2016-1Web of Scienc

Métodos: epidemiológicos para pesquisa com usuários de drogas: revisão de métodos para estudo da prevalência e morbidade

Epidemiological studies of drug misusers have until recently relied on two main forms of sampling: probability and convenience. The former has been used when the aim was simply to estimate the prevalence of the condition and the latter when in depth studies of the characteristics, profiles and behaviour of drug users were required, but each method has its limitations. Probability samples become impracticable when the prevalence of the condition is very low, less than 0.5% for example, or when the condition being studied is a clandestine activity such as illicit drug use. When stratified random samples are used, it may be difficult to obtain a truly representative sample, depending on the quality of the information used to develop the stratification strategy. The main limitation of studies using convenience samples is that the results cannot be generalised to the whole population of drug users due to selection bias and a lack of information concerning the sampling frame. New methods have been developed which aim to overcome some of these difficulties, for example, social network analysis, snowball sampling, capture-recapture techniques, privileged access interviewer method and contact tracing. All these methods have been applied to the study of drug misuse. The various methods are described and examples of their use given, drawn from both the Brazilian and international drug misuse literature.São descritos e discutidos os vários métodos de amostragem, de probabilidade e conveniência para estudos epidemiológicos sobre usuários de drogas, e apresentados exemplos de seu uso, com base na literatura brasileira e internacional. Os estudos epidemiológicos sobre usuários de drogas, realizados até recentemente, têm utilizado duas formas principais de amostragem: a de probabilidade e a de conveniência. A primeira tem sido utilizada quando o objetivo é apenas estimar a prevalência da condição sendo pesquisada e a segunda (conveniência) quando as características, perfis e comportamentos de usuários de drogas são os focos do trabalho. Ambos os métodos têm suas limitações, amostras probabilísticas ficam cada vez mais impraticáveis quando a prevalência de determinada condição é muito baixa, menor do que 0,5% por exemplo, ou quando a condição sendo estudada é uma atividade clandestina, como o uso de drogas ilícitas. Por outro lado, os resultados de amostras de conveniência são limitados porque não podem ser generalizados para a população total de usuários de droga, devido ao viés de seleção e a falta de informações a respeito do sampling frame. Novos métodos têm sido desenvolvidos para superar essas dificuldades, por exemplo, análise da rede social, técnica de amostragem bola-de-neve (snowball sampling), técnica de captura e recaptura, método utilizando um entrevistador com acesso privilegiado à população-alvo (PAI - Privileged Access Interviewer Method) e técnica de investigação epidemiológica chamada de contact tracing.Universidade Federal de São Paulo (UNIFESP)UNIFESP, EPM, São Paulo, BrazilSciEL

Psychometric properties of EURO-D, a geriatric depression scale: a cross-cultural validation study

Background: Many of the assessment tools used to study depression among older people are adaptations of instruments developed in other cultural setting. There is a need to validate those instruments in low and middle income countries (LMIC).Methods: A one-phase cross-sectional survey of people aged [greater than or equal to] 65 years from LMIC. EURO-D was checked for psychometric properties. Calibration with clinical diagnosis was made using ICD-10. Optimal cutpoint was determined. Concurrent validity was assessed measuring correlations with WHODAS 2.0.Results: 17,852 interviews were completed in 13 sites from nine countries. EURO-D constituted a hierarchical scale in most sites. the most commonly endorsed symptom in Latin American sites was depression; in China was sleep disturbance and tearfulness; in India, irritability and fatigue and in Nigeria loss of enjoyment. Two factor structure (affective and motivation) were demonstrated. Measurement invariance was demonstrated among Latin American and Indian sites being less evident in China and Nigeria. At the 4/5 cutpoint, sensitivity for ICD-10 depressive episode was 86% or higher in all sites and specificity exceeded 84% in all Latin America and Chinese sites. Concurrent validity was supported, at least for Latin American and Indian sites.Conclusions: There is evidence for the cross-cultural validity of the EURO-D scale at Latin American and Indian settings and its potential applicability in comparative epidemiological studies.Wellcome Trust (UK)WHOUS Alzheimer's AssociationFONACIT-VenezuelaPuerto Rico State LegislatureInst Memory Depress & Dis Risk, Lima 12, PeruKings Coll London, Ctr Global Mental Hlth, Hlth Serv & Populat Res Dept, Inst Psychiat Psychol & Neurosci, London WC2R 2LS, EnglandPeruvian Univ, Lima, PeruUniversidade Federal de São Paulo, UNIFESP, São Paulo, BrazilMed Univ Havana, Havana, CubaUniversidade Federal de São Paulo, UNIFESP, São Paulo, BrazilWellcome Trust (UK): GR066133US Alzheimer's Association: IIRG-04-1286Web of Scienc

Nonprescribed use of tranquilizers and use of other drugs among Brazilian students

Objectives: To describe patterns of nonprescribed use of tranquilizers by students aged 10 to 18 years and assess the sociodemographic characteristics of these adolescents and their use of other substances. Methods: A randomized and stratified sample of 47,979 students from state and private schools of the 27 Brazilian state capitals completed a self-report questionnaire. Poisson regression was used to estimate the associations between tranquilizer use and sociodemographic factors, as well as the use of other psychotropic substances. Results: The lifetime prevalence of nonprescribed use of tranquilizers was 3.9%. Use was most common among girls, wealthier adolescents, and those from private schools. An association was found between use of tranquilizers and lifetime use of alcohol (prevalence ratio [PR] = 3.15; 95% confidence intervals [95%CI] 2.58-3.85), tobacco (PR = 2.61; 95%CI 2.31-2.95), illicit drugs (PR = 3.70; 95%CI 3.19-4.29), and other prescription drugs (PR = 7.03; 95%CI 6.18-7.99). As the number of substances adolescents reported having used increased, so did the nonprescribed use of tranquilizers. Conclusions: Nonprescribed use of tranquilizers by adolescents might indicate the use of other substances, including high-risk combinations such as tranquilizers and alcohol. The risks of this association should be addressed during the early stages of drug prevention programs.Universidade Federal de São Paulo (UNIFESP) Department of PsychobiologyUNIFESP, Department of PsychobiologySciEL

Estimating the number of people living with dementia at different stages of the condition in India: a Delphi process

Introduction: Numerous studies have previously estimated the dementia prevalence in India. However, as these estimates use different methodologies and sampling strategies, generating definitive prevalence estimates can be difficult. Methods: A Delphi process involving eight clinical and academic experts provided prevalence estimates of dementia within India, split by sex and age. The experts were also asked to estimate the number of people potentially living at different stages of the condition. A priori criteria were used to ascertain the point in which consensus was achieved. Results: Our consensus estimates generated a dementia prevalence of 2.8% (95% CI = 1.9 to 3.6) for those aged 60 years and above in India. Consensus was achieved across age and sex prevalence estimates, with the exception of one (females aged 60-64). Our experts estimated that 42.9% of people living with dementia in India had a mild severity. Conclusions: The findings indicate that there could be approximately 3.9 million people living with dementia in India, of which 1.7 million could be living with dementia of mild severity. Such estimates can better help researchers and policy makers to estimate the true cost and impact of dementia in India and can inform resource allocation decisions

Em pacientes com doença de Parkinson, a depressão aumenta de acordo com o aumento da gravidade do comprometimento cognitivo

Objective : To test the hypothesis that severity of cognitive impairment modifies the association between depression and Parkinson’s disease (PD). Method : One-phase population-based door-to-door surveys. This is a secondary analysis of 1,451 people aged 65 years and older with cognitive impairment living in defined catchment areas. Depression was estimated according to ICD-10, self-reported PD, disability according to WHODAS-II and cognitive status according to the CSI-D. Results : The mean age of the sample was 79.3 years old and most (69%) were women. Of the total sample, 16.1% had depression and it was significantly higher among participants with PD. There was an increase on the ORs of the association between depression and PD with decreased scores in the cognitive test (Adjusted OR from 0.98 to 8.04). Conclusion : The association between depression and PD increases with the severity of the cognitive impairment.Objetivo : Testar a hipótese que a gravidade do prejuízo cognitivo modifica a associação entre depressão e doença de Parkinson (DP). Método : Estudo populacional através da análise secundária de 1.451 pessoas com idade maior ou igual a 65 anos com prejuízo cognitivo que residiam em áreas de abrangência definidas. A depressão foi estimada de acordo com a CID-10, auto-relato de DP, incapacidade conforme a WHODAS-II e nível cognitvo de acordo com a CSI-D. Resultado : A média de idade foi 79,3 anos, predominaram as mulheres (69%). Do total de indivíduos, 16,1% tinham depressão, significantemente maior entre os participantes com DP. Houve aumento gradativo na OR relativa à associação entre depressão e DP com a diminuição do escore no teste cognitivo (OR ajustado variou de 0,98 a 8,04). Conclusão : A associação entre depressão e DP parece aumentar com a gravidade do prejuízo cognitivo.Universidade de São Paulo Departamento de Neurociências e Ciências do ComportamentoUniversidade Federal de São Paulo (UNIFESP) Laboratório Interdisciplinar de Neurociências Clínicas Departamento de PsiquiatriaHospital Israelita Albert Einstein Instituto Israelita de Ensino e PesquisaNational Institute of Neurology and Neurosurgery of MéxicoUniversidade Federal de São Paulo (UNIFESP) Departamento de PsicobiologiaUNIFESP, Laboratório Interdisciplinar de Neurociências Clínicas Depto. de PsiquiatriaUNIFESP, Depto. de PsicobiologiaSciEL

Implementação em Portugal de um estudo de prevalência da demência e da depressão geriátrica: a metodologia do 10/66 Dementia Research Group

ResumoIntroduçãoA demência e a depressão têm um impacto social muito significativo. Em Portugal, escasseiam dados epidemiológicos em pessoas idosas na comunidade. Em países em desenvolvimento, o 10/66 Dementia Research Group (DRG) conduziu múltiplos estudos sobre a prevalência e a incidência destes quadros. Os protocolos de avaliação 10/66‐DRG foram validados extensivamente nesses países, havendo vantagens potenciais na aplicação em regiões europeias com populações idosas de baixa escolaridade. Neste estudo, fundamentamos e descrevemos a implementação em Portugal da metodologia 10/66‐DRG para estudo da prevalência da demência e da depressão geriátrica.Materiais e métodosO trabalho de campo desenrola‐se numa fase única, em áreas geográficas definidas, sendo avaliados detalhadamente e de forma sistemática todos os residentes de 65 anos ou mais. A informação é recolhida dos participantes e de informadores próximos (www.alz.co.uk/1066/).ResultadosSelecionámos e mapeámos uma área urbana (em Fernão Ferro) e outra rural (em Mora), definindo amostras finais de 702 e 779 pessoas, respetivamente. Os instrumentos de avaliação foram cuidadosamente traduzidos e adaptados ao contexto português. Teve lugar um treino rigoroso dos entrevistadores, assegurando a fiabilidade de cotação interobservadores.Discussão e conclusãoA aplicação dos protocolos 10/66‐DRG permitirá obter dados robustos de prevalência de demência e de depressão, com amostras comunitárias de pessoas idosas em Portugal. Dada a validade internacional da metodologia utilizada, estes resultados serão comparáveis com os de outros centros 10/66, à escala mundial.AbstractIntroductionDementia and depression have a huge social impact. In Portugal, epidemiological data is scarce regarding community dwelling elderly people with these conditions. In developing countries, the 10/66 Dementia Research Group‐DRG has conducted multiple studies on the corresponding prevalence and incidence. The 10/66‐DRG protocols for population‐based studies were extensively validated in those countries, and there is a rationale to apply them in low literacy elderly populations in Europe. We describe the implementation of the protocols related to the prevalence study (on dementia and geriatric depression) in Portuguese settings.Materials and methodsThis is a one‐phase survey, in which all people 65+ years living in defined catchment areas are comprehensively evaluated. Information is collected directly from participants and from a related informant (www.alz.co.uk/1066/).ResultsWe selected and mapped an urban area (in Fernão Ferro) and a rural one (in Mora). The final samples were n=702 and n=779 respectively. Questionnaires were carefully translated and culturally adapted. Rigorous training procedures took place to ensure inter‐rater reliability.Discussion and conclusionsThe implementation of the 10/66‐DRG protocols will lead to robust data on the prevalence of dementia and depression in community samples of elderly people in Portugal. Given the international validity of our methodology, these results will be comparable with those from other 10/66 centres around the world