Mobile solutions in depression: Enhancing communication with patients using an SMS-based intervention

Mobile solutions, namely the ones based on the Short Message Service (SMS), can play an important role in enhancing communication with patients with depression, between consultations, allowing the delivery of supportive messages or reminders. This paper presents an overview on this topic and describes a 4-stage study aiming to better understand the mHealth scenario in depression, specifically regarding the use of messaging services. The four stages comprised: (i) a diagnosis of perspectives and practices; (ii) a 6-weeks SMS intervention plan; (iii) a prototype of a digital application to support patients' follow-up and interaction; (iv) and a survey with physicians on digital experience and predisposition to use the prototype. Results underline the potential of the use of messaging systems and digital solutions to improve communication with patients with depression and point the benefits of blended-interventions (combining personal contact and SMSs, as an adjunct/complement to regular treatment). Further researched is needed, particular regarding the adjustment of these solutions to specific target groups

Silent Burdens in Disease: Fatigue and Depression in SLE

At a time when health is being recognized as more than just avoiding death, age and comorbidity are becoming increasingly important aspects of chronic disease. Systemic Lupus Erythematous (SLE) is probably one of the best paradigms of modern chronic disease, sitting at the crossroads of numerous somatic health problems, immune activation, depression, pain, and fatigue. One hundred forty-eight female participants were enrolled in the present study: 50 diagnosed with SLE, 45 with major depressive disorder (MDD), and 53 age-matched controls. Statistically significant lower scores in quality-of-life dimensions related to physical impairment were found in SLE. Patients with MDD presented significant levels of pain, reduced physical summary component (PSC), and general health scores different from healthy controls. Fatigue was reported in 90% of women with SLE and 77.8% of the MDD patients in contrast with 39.6% in the control group. Significant correlations were seen among fatigue severity, age, and educational level in SLE. From our own previous work and more recent work on the association of immune activation and depression, unexplained fatigue in SLE may signify an early sign of immune activation flare-up. The search for cytokine markers should perhaps be extended to fatigue in SLE

Validation of the Portuguese version of impulsive-premeditated aggression scale in an inmate population

Aggression is one of the core symptoms of antisocial personality disorder (ASPD) with therapeutic and prognostic relevance. ASPD is highly prevalent among inmates, being responsible for adverse events and elevated direct and indirect economic costs for the criminal justice system. The Impulsive/Premeditated Aggression Scale (IPAS) is a self-report instrument that characterizes aggression as either predominately impulsive or premeditated. This study aims to determine the validity and reliability of the IPAS in a sample of Portuguese inmates. A total of 240 inmates were included in the study. A principal component factor analysis was performed so as to obtain the construct validity of the IPAS impulsive aggression (IA) and premeditated aggression (PM) subscales; internal consistency was determined by Cronbach's alpha coefficient; convergent and divergent validity of the subscales were determined analyzing correlations with the Barratt Impulsiveness scale, 11th version (BIS-11), and the Psychopathic Checklist Revised (PCL-R). The rotated matrix with two factors accounted for 49.9% of total variance. IA subscale had 11 items and PM subscale had 10 items. The IA and PM subscales had a good Cronbach's alpha values of 0.89 and 0.88, respectively. The IA subscale is correlated with BIS-11 attentional, motor, and non-planning impulsiveness dimensions (p < 0.05). The PM subscale is correlated with BIS-11 attentional, motor impulsiveness dimensions (p < 0.05). The PM subscale is correlated with PCL-R interpersonal, lifestyle, and antisocial dimensions (p < 0.05). The IA subscale is not correlated with PCL-R. The Portuguese translated version of IPAS has adequate psychometric properties, allowing the measurement of impulsive and premeditated dimensions of aggression

Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors

Depression and anxiety cause severe loss of quality of life for patients with systemic lupus erythematosus. The causes and factors that contribute to these psychological manifestations in lupus are difficult to disentangle. This study compared clinical, psychological, and demographic factors between lupus patients, depressed patients, and rheumatoid arthritis patients to discover lupus-specific contributors to depression. Lupus-specific manifestations of depression were also investigated. Physiological, clinical, and psychosocial data were collected from 77 patients. ELISA was used to measure cytokine levels. Univariate and Multivariate analyses were used to compare the patient populations and identify correlations between key physical and psychological indicators. The prevalence of depression in the SLE cohort was 6 times greater than the healthy control subjects. Pain, IL-6, and Pittsburgh Sleep Quality index values were all significantly higher in SLE patients compared with the healthy control group (P < .001, P = .038, and P = .005, respectively). Anxiety levels were significantly higher in SLE patients compared to healthy and RA control patients (P = .020 and .011, respectively). Serum IL-10 concentrations, relationship assessment scale, and fatigue severity scale values were found to be correlated with depression among the SLE patients (P = .036, P = .007, and P = .001, respectively). Relationship assessment and fatigue severity scale scores were found to be the best indicators of depression for the SLE patients (P = .042 and .028, respectively). Fatigue Severity, relationship satisfaction, and IL-10 concentrations are indicators of depression in lupus patients. Despite also suffering from the pain and disability that accompanies chronic autoimmune disease, the rheumatoid arthritis patients had less anxiety and better relationship scores.The authors thank the Portugal Fulbright Commission for funding Dr. Pool

Influence of Biological Therapeutics, Cytokines, and Disease Activity on Depression in Rheumatoid Arthritis

Purpose: Rheumatoid arthritis (RA) is an often debilitating autoinflammatory disease. Patients with rheumatoid arthritis are often troubled by co-occurring depression or other psychological manifestations. RA patients have a variety of treatment options available, including biologicals that inhibit cytokines or immune cells. If these cytokines influence the psychological symptoms, then the use of cytokine inhibitors should modulate these symptoms.Methods: A cohort of 209 individuals was recruited. This group included 82 RA patients, 22 healthy subjects, 32 depressed control subjects, and 73 subjects with systemic lupus erythematosus. Of the RA patients, 51% were on a biological therapeutic. ELISA was used to measure cytokine levels. A variety of psychological assessments were used to evaluate depression, anxiety, sleep, fatigue, and relationship status. Clinical values were obtained from medical records.Results: IL-10 concentration was associated with depressive symptoms in the RA patients, healthy controls, and the lupus patients. In the patients with primary depression, depressive symptoms were associated with IL-6 and TNF-alpha. In RA patients, Tocilizumab use was associated with decreased depressive symptoms. 14 RA patients who were not using biologicals began using them by a one-month follow-up. In these patients, there was no significant change to any value except for fatigue.Conclusions: A variety of both biological and social factors influences depressive symptoms in RA. IL-10 and IL-6 are likely to be involved, since IL-10 concentration was associated with depression and Tocilizumab decreased depressive symptoms in the RA patients. The roles of these cytokines are different in RA and lupus, as high IL-10 in RA is associated with increased depressive symptoms, but high IL-10 in the lupus patients is associated with decreased depression. IL-6 was also associated with depressive symptoms in the patients with primary depression. These results strongly indicate that disease activity, including cytokine levels, has a strong impact on depressive symptoms.This study was supported by Portugal Fulbright Commission (Dr. Brian D. Poole)

Proposal for a collaborative LCA data management methodological aproach for creating "nodes" in the brazilian national inventory database (SICV) Brasil.

Global Guidance proposes mechanisms for LCA studies and data management for improving interoperability, data exchange, accessibility and credibility of LCA databases. The PBACV (CONMETRO, 2010) has among its objectives to implement in Brazil a system capable of organizing, storing and disseminating information of LCIs. The Brazilian government responded to this demand through IBICT, which developed the SICV Brazil. For a LCI database to succeed, it is necessary to have primary data provided by the productive sector. The availability of data contributes to the growth of the country while benefiting the primary data providers, as society is increasingly attentive to the transparency and environmental awareness of companies. The management of LCA data is not a concern of national LCI databases alone. Other institutions also need to manage their LCA data independently of proprietary software, ensuring autonomy and sustainability for their operations. Keeping data on someone?s own infrastructure favors autonomy, but multiplies infrastructure investment and impairs interoperability. This research proposes a procedure for shared management of LCA data through the creation nodes, an instance of SICV Brazil for storing LCI data from private and public institutions. This procedure for shared management promoted the Brazilian National Inventory Database (SICV Brazil) and offered advanced information resources to institutions, such as Embrapa, without additional infrastructure and facilitating interoperability with other institutions. Authors believe that the creation of other instances of the SICV could contribute to the advance of LCA in Brazil

An approach to simulate autonomous vehicles in urban traffic scenarios

The most common cause of traffic accidents is arguably the driver error due to lack of attention. And it is very unlikely this is going to change soon thanks to increasingly cell-phone usage, in-car entertainment systems, and naturally the more frequent traffic jams in highly populated areas. Autonomous vehicles, such as driverless cars, are a promising approach to decrease traffic accidents, as well as congestions. To test this approach, simulations are a safer, more efficient, and cheaper way than live testing. This paper presents an approach to implement a simulator to test such vehicles. It includes a study of the state of the art in driverless car simulation and discusses on the specific objectives that this particular simulator aims to achieve in order to aid testing the interactions of multiple driverless cars in urban networks

Prevalence of hepatitis A in the capitals of the States of North, Southeast and South regions of Brazil: decrease in prevalence and some consequences

Hepatitis A virus (HAV) infection has been considered one of the leading causes of acute hepatitis. The aim of the present study was to estimate the prevalence of HAV among children and adolescents in a population-based study in the capitals of the States of the North, Southeast and South of Brazil and identify predictive factors for the infection. A multi-stage sampling was used to select subjects aged between 5-9 and 10-19 years. Individual and household levels aside from the level of variables in the areas were collected. The outcome was the total IgG antibodies to HAV levels detected using a commercial Enzyme Immuno Assay (EIA). The associations between HAV and the independent variables were assessed using the odds ratio. A multilevel analysis was performed by GLLAMM using the Stata software. The prevalence of HAV infection in the 5-9 and 10-19 age groups was 28.7% and 67.5%, respectively for the North, 20.6% and 37.7%, for the Southeast and 18.9% and 34.5% for the South Region. The prevalence of HAV increased according to age in all sites. Variables related to education at the individual level (North and South), family and area level (South and Southeast) and family income level (Southeast and South) were independently associated with HAV infection. This emphasizes the need for individualized strategies to prevent the infection