Epidemiologia das síndromes parkinsonianas em idosos do sul do Brasil : estudo observacional de base populacional

INTRODUÇÃO: A doença de Parkinson (DP) apresenta distribuição universal, incluindo todos os grupos étnicos e socioeconômicos, como um distúrbio neurodegenerativo altamente prevalente. No entanto, existem vários desafios adicionais para as pessoas que vivem com DP em países em desenvolvimento, principalmente, aqueles com baixo nível socioeconômico. Há acesso limitado a cuidados neurológicos no Brasil devido a uma distribuição desigual de neurologistas e instalações neurológicas que é mais crítica nas regiões mais pobres do país. Além disso, as pessoas nessas comunidades vulneráveis estão mais expostas à poluição ambiental, incluindo pesticidas e metais usados na agricultura e mineração, respectivamente. Dados confiáveis sobre a prevalência e incidência da DP no Brasil são essenciais para entender a proporção desse acesso limitado aos cuidados de pacientes com DP, sua carga na região e o potencial papel dos fatores de risco ambientais e de estilo de vida na DP. Infelizmente, há poucos dados epidemiológicos sobre DP na América Latina, incluindo o Brasil, com evidente necessidade de mais informações em suas regiões notavelmente diferentes. OBJETIVO: avaliar a prevalência de casos de DP e outras síndromes parkinsonianas em uma amostra de base populacional na região sul do País. MÉTODOS: trata-se de um estudo de base populacional realizado no município de Veranópolis, Rio Grande do Sul, Brasil. Todas as pessoas com 60 anos ou mais (N = 3493 pessoas, de acordo com o censo do IBGE de 2010) foram rastreadas para sintomas parkinsonianos e suspeita de distúrbio comportamental do sono REM (RBD); os selecionados foram examinados por pelo menos um Neurologista especialista em Transtornos do Movimento para determinar o diagnóstico de DP ou transtornos relacionados. Todos os participantes selecionados foram submetidos a avaliações clínicas e entrevistados com o auxílio de um questionário abrangente sobre dados clínicos e sociodemográficos, sintomas prodrômicos, bem como exposições ambientais e de estilo de vida, incluindo uso ocupacional e não ocupacional de pesticidas e metais pesados. A prevalência de DP e distúrbios relacionados foi estimada de acordo com a idade, sexo e zona de moradia. Uma análise exploratória foi realizada para determinar a associação de DP e cada variável investigada. RESULTADOS: Foram triados 3470 idosos na etapa inicial do estudo, 1471 foram triados positivamente para suspeita de parkinsonismo e/ou RBD. Foram avaliados 701 pelos neurologistas para confirmação diagnóstica. Esta tese está apresentada com três artigos. Artigo 1: “Epidemiology of Parkinson’s disease in low- to upper middle-income countries: a systematic review and meta-analysis”. Nesta revisão sistemática o objetivo foi determinar a prevalência da DP em países de baixa a média renda. Observamos que a 6 prevalência da DP diferiu entre as regiões do mundo e variou de 49 por 100.000 (África Subsaariana) a 1.081 por 100.000 (América Latina e Caribe). Houve uma prevalência crescente de DP com o avanço da idade. A prevalência entre homens e mulheres foi semelhante. Encontramos um aumento na prevalência da DP em populações com maior PIB per capita em 5 anos e maior expectativa de vida. Artigo 2: “Prevalence and incidence of Parkinson's disease and other forms of parkinsonism in a cohort of elderly individuals in Southern Brazil: protocol for a population-based study”. Neste artigo, foi apresentado o protocolo utilizado para a realização deste estudo em detalhes, incluindo o protocolo para o estudo paralelo de incidência da DP que será estimada a partir do seguimento em cinco anos dos participantes prodrômicos. Artigo 3: “Prevalence of Parkinsonism and Parkinson's disease in the elderly population in Southern Brazil: A community-based study”. Neste artigo, a prevalência estimada de parkinsonismo foi de 3,8% (IC 95%, 3,19 – 4,50), sem diferenças entre os sexos em todas as idades, e a prevalência de DP foi de 1,64% (IC 95%, 1,25 – 2,12). A prevalência geral de DP foi maior em homens (2,17%, 95%IC: 1,49 – 3,06) do que em mulheres (1,25%, 95%IC: 0,81 – 1,84; p = 0,047). A análise de subgrupo mostrou diferença significativa entre os sexos apenas na faixa etária de 70-74 (p = 0,017) e 75-79 (p = 0,016) anos. Não houve diferenças significativas nas taxas de prevalência de DP entre áreas urbanas e rurais. CONCLUSÃO: Em países de baixa renda ou em desenvolvimento, a prevalência de DP foi maior do que o esperado, superando as estimativas fornecidas pelo Global Burden of Disease (GBD) para países com baixo índice sociodemográfico. Foi demonstrado que há uma menor prevalência de DP identificada na faixa etária acima de 70 anos, quando examinando dados de regiões desenvolvidas globalmente. Avaliando uma cidade no sul do Brasil (Veranópolis, RS), as estimativas de prevalência de DP e parkinsonismo são inferiores às prevalências encontradas em estudo realizado na população de uma cidade da região Sudeste do Brasil (Bambuí, MG) e parecem ser comparáveis às prevalências encontradas em populações de países desenvolvidos. Considerando que Veranópolis possui um alto índice de desenvolvimento humano (IDH), consideramos que esse seja um dos principais fatores que possam explicar esse achado. Outra explicação é o lapso temporal de quase 20 anos que separam os dois estudos.INTRODUCTION: Parkinson's disease (PD) has a universal distribution, including all ethnic and socioeconomic groups, as a highly prevalent neurodegenerative disorder. However, there are several additional challenges for people living with PD in developing countries, particularly those with low socioeconomic status. There is limited access to neurological care in Brazil due to an uneven distribution of neurologists and neurological facilities that is most critical in the country's poorest regions. Furthermore, people in these vulnerable communities are more exposed to environmental pollution, including pesticides and metals used in agriculture and mining, respectively. Reliable data on the prevalence and incidence of PD in Brazil are essential to understand the proportion of this limited access to care for PD patients, its burden in the region, and the potential role of environmental and lifestyle risk factors in PD. Unfortunately, there is little epidemiological data on PD in Latin America, including Brazil, with an obvious need for more information on their remarkably different regions. OBJECTIVE: to assess the prevalence of PD cases and other parkinsonian syndromes in a population-based sample in the southern region of the country. METHODS: this is a population-based study carried out in the city of Veranópolis, Rio Grande do Sul, Brazil. All people aged 60 years or older (N = 3493 people, according to the 2010 IBGE census) were screened for parkinsonian symptoms and suspected REM sleep behavior disorder (RBD); those selected were examined by at least one Neurologist specializing in Movement Disorders to determine the diagnosis of PD or related disorders. All selected participants underwent clinical assessments and were interviewed using a comprehensive questionnaire on clinical and sociodemographic data, prodromal symptoms, as well as environmental and lifestyle exposures, including occupational and non-occupational use of pesticides and heavy metals. The prevalence of PD and related disorders was estimated according to age, sex and area of residence. An exploratory analysis was performed to determine the association of PD and each investigated variable. RESULTS: 3470 elderly were screened in the initial stage of the study, 1471 were screened positively for suspected parkinsonism and/or RBD. 701 were evaluated by neurologists for diagnostic confirmation. This thesis is presented with three articles. Article 1: “Epidemiology of Parkinson’s disease in low- to upper middle-income countries: a systematic review and meta-analysis”. In this systematic review, the objective was to determine the prevalence of PD in low- and middleincome countries. We observed that the prevalence of PD differed between regions of the world and ranged from 49 per 100,000 (Sub-Saharan Africa) to 1,081 per 100,000 (Latin America and the Caribbean). There was an increasing prevalence of PD with advancing age. Prevalence among men and women was similar. We found an increase in the prevalence of PD in populations with higher 5-year GDP per capita and longer life expectancy. Article 2: “Prevalence and incidence of Parkinson's disease and other forms of parkinsonism in a cohort of elderly individuals in Southern Brazil: protocol for a population-based study”. In this article, the protocol used to carry out this study is presented in detail, including the protocol for the parallel study of the incidence of PD that will be estimated from the five-year follow-up of the prodromal participants. Article 3: “Prevalence of Parkinsonism and Parkinson's disease in the elderly population in Southern Brazil: A community-based study”. In this article, the estimated prevalence of parkinsonism was 3.8% (95% CI, 3.19 – 4.50), without differences between genders at all ages, and the prevalence of PD was 1.64% (CI 95%, 1.25 – 2.12). The overall prevalence of PD was higher in men (2.17%, 95%CI: 1.49 – 3.06) than in women (1.25%, 95%CI: 0.81 – 1.84; p = 0.047). Subgroup analysis showed a significant difference between genders only in the age group 70-74 (p = 0.017) and 75-79 (p = 0.016) years. There were no significant differences in PD prevalence rates between urban and rural areas. CONCLUSION: In low-income or developing countries, the prevalence of PD was higher than expected, exceeding the estimates provided by the Global Burden of Disease (GBD) for countries with a low sociodemographic index. It has been demonstrated that there is a lower prevalence of PD identified in the age group above 70 years when examining data from developed regions globally. Evaluating a city in the south of Brazil (Veranópolis, RS), the prevalence estimates of PD and parkinsonism are lower than the prevalence found in a study carried out in the population of a city in the Southeast region of Brazil (Bambuí, MG) and seem to be comparable to the prevalence found in populations of developed countries. Considering that Veranópolis has a high human development index (HDI), we believe that this is one of the main factors that can explain this finding. Another explanation is the time lapse of almost 20 years that separates the two studies

Validação do questionário do comportamento planeado na diabetes: atividade física

Este estudo tem como objetivo validar o “Questionário do Comportamento Planeado na Diabetes – Atividade Física”, em pacientes Portugueses com diabetes tipo 2 (DM2). Este questionário avalia variáveis relacionadas com a atividade física baseadas na Teoria do Comportamento Planeado: intenções, atitudes, normas subjetivas, controlo comportamental percebido, planeamento da ação e planeamento do coping. Os instrumentos usados foram: Escala Revista de Autocuidados com a Diabetes (Versão de Investigação de Pereira, Costa, & Castro, 2008) e Escala de Confiança no Médico (Versão Portuguesa de Pereira, Pedras, & Machado, 2013). No estudo participaram 120 pessoas com diagnóstico de diabetes (39,2% mulheres e 60,8% homens) diagnosticados com DM2, cuja média de idades foi 59,7 anos. A análise fatorial exploratória encontrou uma estrutura com cinco fatores que explicam 76,15% da variância. Os alphas de Cronbach obtidos foram satisfatórios. O instrumento apresenta validades de construto e discriminante adequadas.Fundação para a Ciência e a Tecnologia (FCT

Influência das varáveis familiares nos auto-cuidados em diabéticos tipo 2

Fundação para a Ciência e Tecnologia (FCT

Spousal support and satisfaction with healthcare services as moderators between psychological morbidity and adherence to diet in Type 2 Diabetes patients

Objectives: This study analyzed the moderating role of partners’ support and satisfaction with healthcare services in the relationship between psychological morbidity and adherence to diet in patients with type 2 diabetes (T2DM). Methods: Participants were 387 recently diagnosed T2DM patients that answered the following instruments: Revised Summary of Diabetes Self- Care Activities Measure, Hospital Anxiety and Depression Scales, Multidimensional Diabetes Questionnaire and Patient Satisfaction Questionnaire. Results: Partners’ positive and negative support moderated the relationship between psychological morbidity and adherence to diet. Satisfaction with healthcare services also moderated the relationship between psychological morbidity and adherence to diet. Conclusions: Intervention programs to promote adherence to diet in patients with type 2 diabetes should focus on partners’ support and patient satisfaction with healthcare services.This study is part of a research project PTDC/SAU-ESA/67581/2006 supported by the Foundation for Science and Technology of Portugal (FCT)

Attachment to parents, romantic relationships, lifestyle, physical and mental health in university students

Pretendeu-se conhecer a relação entre apego aos pais, características das relações românticas, sintomatologia física, estilo de vida e morbilidade psicológica em 250 estudantes universitários, entre os 17 e 29 anos, que responderam a instrumentos de auto relato. Concluiu-se que o apego aos pais nos jovens adultos se relaciona com a sintomatologia física, a morbilidade psicológica e características das relações amorosas. O envolvimento numa relação romântica refl ecte-se na saúde, estando associado ao estilo de vida saudável e menos sintomas físicos. Exploraram-se os preditores da sintomatologia física e estilo de vida, e analisou-se a infl uência do sexo, tipo de família e nível socioeconómico nas variáveis em estudo. Assim, podem retirar-se implicações para o desenvolvimento de intervenções com jovens e pais.This study focused on the understanding of the relationship among attachment to parents, characteristics of romantic relationships, physical symptoms, lifestyle and psychological morbidity in 250 university students, aged between 17 and 29 years (M=20.88; SD=2.03), who answered self-report questionnaires. We concluded that attachment to parents for young adults is related to physical symptoms, psychological morbidity and characteristics of romantic relationships. Being in a romantic relationship has effects on health, since it is related to a healthier lifestyle and less physical symptoms. We explored the predictors of physical symptoms and lifestyle, and analyzed the influence of sex, type of family and socioeconomic status on the variables studied. As a result, implications can be drawn to develop interventions with youngsters and parents

Depression, anxiety and stress in adult children caregivers of oncological patients

Te aim of this study is to describe levels of depression, anxiety, and stress in adult ofspring of cancer patients; and to analyze gen der diferences in psychological morbidity, as well as the association between psychological morbidity and traumatic symptomatology. Tis study is correlational with a sample of 214 adult ofspring who completed the Depression, Anxiety and Stress Scales (DASS-21) and the Impact of Event Scale-Revised (IES-R). Te results revealed that 6-60% of the participants showed ‘normal’ or ‘mild’ levels of stress, anxiety, or depression; 15-26% ‘moderate’ levels; and 4-12% ‘severe’ or ‘extremely severe’ levels. Women had higher levels of anxiety and stress than men. Positive correlations were found between the DASS 21 and the IES-R. In conclusion, some adult ofspring caregivers re veal severe levels of psychological morbidity. Te results show a need for psychological intervention in this population, particularly in the female gender.Tis study was conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds, and co-fnanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653)

Self-reported adherence to foot care in type 2 diabetes patients: do illness representations and distress matter?

Aim: This study examined the differences and the predictive role of clinical variables, illness representations, anxiety, and depression symptoms, on self-reported foot care adherence, in patients recently diagnosed with type 2 diabetes mellitus (T2DM) and assessed no longer than a year after the diagnosis (T1) and four months later (T2). Background: The high rate of diabetes worldwide is one of the major public health challenges. Foot care is the behavior least performed by patients although regular foot care could prevent complications such as diabetic foot and amputation. Psychosocial processes such as illness representations and distress symptoms may contribute to explain adherence to foot self-care behaviors. Methods: This is a longitudinal study with two assessment moments. The sample included 271 patients, who answered the Revised Summary of Diabetes Self-Care Activities, Brief-Illness Perception Questionnaire, and Hospital Anxiety and Depression Scale. Findings: Patients reported better foot care adherence at T2. Having a higher duration of T2DM and the perception of more consequences of diabetes were associated with better self-reported foot care adherence, at T1. At T2, the predictors were lower levels of HbA1c, better self-reported foot care adherence at T1, higher comprehension about T2DM, as well as fewer depressive symptoms. Interventions to promote adherence to foot care should have in consideration these variables. The results of the present study may help health professionals in designing interventions that early detect depressive symptoms and address illness beliefs, in order to promote foot self-care behaviors reducing the incidence of future complications.This study is the part of a research project PTDC/SAUESA/67581/2006 supported by the Foundation for Science and Technology of Portugal (FCT)

The mediator and/or moderator role of complexity of knowledge about healthy eating and self-regulated behavior on the relation between family’s income and children’s obesity

Childhood obesity rates have been increasing over the years and is considered one of the most serious public health problems of the century. Low socioeconomic status has been associated with a higher body mass index. However, the pathways underlying this complex relationship are poorly understood. This study aimed to evaluate the possible mediation and/or moderation effects of complexity of knowledge about healthy eating, and self-regulation processes towards healthy eating, in the association between family’s income and weight of elementary school age children. The results showed that complexity of knowledge does not mediate the relationship between socioeconomic status and weight. Still, whenever the levels of complexity of knowledge and self-regulation are high, there is a moderation effect of complexity of knowledge on the relationship between family’s income and weight, conditioned by self-regulation scores. These promising findings support the idea that knowledge about healthy eating in isolation could be insufficient for practicing a healthy diet and underline the relevance of combining transmission of knowledge with training in specific competences (e.g., self-regulation strategies). Considering that complexity of knowledge about healthy eating and self-regulation strategies are interrelated and can be both improved, future preventive interventions could consider incorporating both in their design to mitigate childhood obesity.This study was conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through the national funds (PIDDAC). Additionally, this study was supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds (PTDC/PSI-GER/28302/2017), and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-028302). This study was also supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education, through the national funds, within the scope of the Transitory Disposition of the Decree No. 57/2016, of 29th of August, amendedbyLawNo. 57/2017of19July. Lastly, BP was supported by a research scholarship and CS was supported by a Post-Doctoral research grant both awarded by the project “In-person and Online Healthy Eating Promotion through Self-regulation: Assessing the Efficacy of a Narrative-based Intervention” (POCI-01-0145-FEDER-028302)

Sintomas depressivos e distúrbios motores axiais em indivíduos com doença de Parkinson : um estudo transversal

Background: Depression is an important nonmotor symptom of Parkinson's disease (PD) and has been associated with the motor symptoms in these individuals. Objectives: To determine whether there are relationships between depressive symptoms and abnormalities in axial postural alignment and axial motor deficits, especially postural instability, and trunk rigidity in PD. Methods: In this cross-sectional study, 65 individuals were evaluated using the Beck Depression Inventory-II (BDI-II) for the analysis of depressive symptoms and underwent a postural assessment of head, trunk, and hip sagittal alignment through computerized photogrammetry. The MDS-UPDRS was used to assess clinical aspects of PD, the Trunk Mobility Scale was used to assess axial rigidity, and the MiniBESTest to assess balance. To determine the relationship between depressive symptoms and postural alignment, multiple linear regression analysis was performed. Results: The participants with depressive symptoms had more severe motor deficits as well as greater trunk rigidity and worse postural instability (p < 0.05). When the postural angles were compared between men and women using Student's t-test, it was found that men had greater flexion angles of the head (p = 0.003) and trunk (p = 0.017). Using multiple linear regression analysis corrected for the age and sex of the participants, we verified that the anterior trunk inclination was significantly larger in the PD population with depressive symptoms (R2 = 0.453, β = 0.116, and p = 0.045). Conclusion: PD individuals with depressive symptoms have more severe flexed trunk posture, mainly in older men. Additionally, more severe depressive symptoms are associated with worsening postural instability, trunk rigidity and motor deficits in this population.Antecedentes: A depressão é um sintoma não motor importante da doença de Parkinson (DP) e tem sido associada aos sintomas motores nesses indivíduos. Objetivos: Determinar se existem relações entre sintomas depressivos e anormalidades no alinhamento postural axial e déficits motores axiais, especialmente instabilidade postural e rigidez de tronco na DP. Métodos: Neste estudo transversal, 65 indivíduos foram avaliados pelo BDI-II para análise de sintomas depressivos e submetidos à avaliação postural do alinhamento sagital de cabeça, tronco e quadril por meio de fotogrametria computadorizada. A MDS-UPDRS avaliou os aspectos clínicos, TMS avaliou rigidez axial e o MiniBESTest equilíbrio. Para determinar a relação entre sintomas depressivos e alinhamento postural, realizou-se uma análise de regressão linear múltipla. Resultados: Os participantes com sintomas depressivos apresentaram déficits motores mais graves, bem como maior rigidez de tronco e pior instabilidade postural (p < 0,05). Quando comparados os ângulos posturais entre homens e mulheres pelo teste t de Student, verificou-se que os homens apresentaram maiores graus de flexão da cabeça (p = 0,003) e do tronco (p = 0,017). Por meio da análise de regressão linear múltipla corrigida para a idade e sexo dos participantes, verificamos que a inclinação anterior do tronco foi significativamente maior nos indivíduos com DP com sintomas depressivos do que sem sintomas depressivos (R2 = 0,453, β = 0,116 e p = 0,045) Conclusão: Indivíduos com DP com sintomas depressivos apresentam postura de tronco flexionado mais severa, principalmente em homens mais idosos. Além disso, os sintomas depressivos mais graves pioram significativamente a instabilidade postural, a rigidez do tronco e os déficits motores nessa população

O papel da Psilocibina no tratamento de depressão resistente / The role of Psilocybin in the treatment of resistant depression

Introdução: A depressão é um transtorno psiquiátrico caracterizado por episódios agudos ou recorrentes de humor deprimido e perda de interesse ou prazer, levando a prejuízos funcionais ao paciente. A psilocibina é uma droga psicodélica com propriedades alucinógenas e serotoninérgicas derivada de cogumelos do gênero Psilocybe. Estudos recentes demonstram potenciais efeitos terapêuticos dessa substância em pacientes com depressão refratária. Metodologia: Realizou-se uma revisão sistemática, com busca ativa de artigos, na biblioteca Pubmed. A estratégia de busca para a biblioteca utilizou a pesquisa com os descritores: “psilocibina”, “depressão”, “tratamento” e seus correspondentes na língua inglesa. Foram filtradas publicações em todos os períodos. Dentre os 88 estudos inicialmente filtrados, foram selecionadas 8 publicações que mais se adequaram à temática e que apresentavam maior relevância. Foram excluídos estudos com metodologias contestáveis e estudos diferentes de Ensaios Clínicos; Revisões Sistemáticas; Meta-Análises e Testes Controlados Randomizados, além dos trabalhos publicados em revista com Qualis inferior à B3. Discussão: A psilocibina é um agonista do receptor de serotonina e um psicodélico clássico encontrado em alguns cogumelos. O efeito psicodélico dessa droga é mediado especificamente pelo agonista do receptor de serotonina (5-HT2A), com algum efeito em receptores (5-HT1A e 5-HT2C), sem efeitos diretos em receptores dopaminérgicos. Esse fármaco atua no córtex pré-frontal medial, reduzindo seu fluxo sanguíneo e normalizando sua hiperatividade. Este mecanismo altera a atividade cerebral indutora do humor depressivo. Desta maneira, a substância caracteriza uma nova farmacocinética entre os antidepressivos, visto que os inibidores seletivos da recaptação de serotonina não são agonistas diretos do receptor 5-HT2A. Conclusão: A psilocibina tem potencial terapêutico promissor no campo do tratamento para depressão resistente. Contudo, destaca-se a necessidade de pesquisas com maiores amostras de voluntários, principalmente no que diz à sua aplicabilidade, assim como determinar uma dose mais eficaz