Impacto da doença de Parkinson na qualidade de vida de indivíduos nas fases leve e moderada

Orientador : Prof. Dr. Hélio Ghizoni TeiveCo-orientador : Profª. Drª. Marise Bueno ZontaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna. Defesa : Curitiba, 21/11/2014Inclui referências : f. 84-97Resumo: Introdução: A Doença de Parkinson (DP) é uma afecção crônico-degenerativa do sistema nervoso central, de evolução lenta e progressiva, caracterizada por sinais e sintomas motores como tremor de repouso, bradicinesia, alterações da postura, do equilíbrio e da marcha. Além dos sintomas motores outros como depressão, ansiedade, estigma afetam de modo significativo a qualidade de vida (QV) destes indivíduos. Objetivos: Avaliar o impacto da Doença de Parkinson na qualidade de vida de indivíduos nas fases leve e moderada, descrever e comparar os sinais e sintomas presentes nestas fases e verificar quais fatores estão mais relacionados ao declínio clínico/funcional e da QV desses indivíduos. Casuística: Foram comparados dois grupos de indivíduos com DP de ambos os sexos, 50 classificados como de evolução leve (GEL) e 50 moderada (GEM), provenientes da Associação Paranaense dos Portadores de Parkinsonismo (APPP). Métodos: O Protocolo de avaliação constou de dados de história clínica coletados no prontuário, de dados obtidos através de entrevista e preenchimento de questionário e de dados clínico/funcionais obtidos através da aplicação da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS), domínios Atividades de Vida Diária (AVD's) e Exame Motor, e do Questionário de Qualidade de Vida na Doença de Parkinson (PDQ-39). A evolução da doença foi classificada pela Escala de Hoehn e Yahr (HY). Resultados: Os grupos foram homogêneos no que se refere ao gênero, idade (60 - 80 anos), raça, estado civil e escolaridade. A media do tempo de evolução no GEL foi 3,4 anos (±2,2) e no GEM 8,1 (±4,7). O GEM apresentou maior comprometimento nas AVDs (UPDRS) com significância limítrofe (p = 0,05), sendo a piora observada especialmente no aumento da salivação (p <0,004) na necessidade de assistência para higiene (p=0,02) e na frequência do "freezing" (p=0,042). O GEM apresentou escores indicativos de maior comprometimento em treze dos 14 domínios do Exame Motor (UPDRS), com diferença significativa considerando a presença do tremor de repouso (p=0,035), do "bater dos dedos" (p=0,001) e da bradicinesia (p=0,031). A QV nos indivíduos do GEM foi significativamente mais comprometida nos itens mobilidade (p=0,013), Estigma (p=0,043) e cognição (p=0,002), e apresentou valores de significância limítrofe considerando AVDs (p=0,05). O desconforto corporal (p=0,04) foi um fator de piora da QV nos indivíduos do GEM. Não foi observada relação entre o gênero e dados clínicos/funcionais e de QV entre os indivíduos do GEL. No GEM a piora na QV entre os homens esteve relacionada à falta de suporte de amigos e familiares (p=0,01). Entre os casados a piora da QV esteve relacionada ao Estigma (p=0,02) (GEM) e à falta de suporte de amigos e familiares nos dois grupos (p<0,001). Não foi observada relação entre idade e dados clínicos/funcionais e de QV entre os indivíduos do GEL. No GEM observou-se que a maior idade esteve relacionada à maior dependência nas AVDs (p=0,02) e ao maior comprometimento na cognição (concentração e memória) (p=0,01). O maior tempo de evolução da doença esteve relacionado à pior QV nos domínios AVDs (GEL) (p=0,03) e Bem Estar Emocional (GEM) (p=0,01). Conclusão: Nesta amostra, o aumento da salivação, a necessidade de ajuda para higiene, a maior frequência do freezing, a bradicinesia e a maior intensidade do tremor de repouso e bater dos dedos foram marcadores de piora clínica/funcional na fase moderada da DP. O impacto da evolução da DP na QV esteve relacionado ao estigma, cognição e ao comprometimento para mobilidade e AVDs. Nesta amostra os Indivíduos com DP do gênero masculino, os casados, aqueles com maior tempo de evolução da doença e com maior idade apresentaram maior comprometimento na QV. PALAVRAS - CHAVE: Doença de Parkinson, Qualidade de Vida, Questionário de Qualidade de vida na Doença de Parkinson, Escala Unificada de Avaliação da Doença de Parkinson.Abstract: Introduction: Parkinson's Disease (PD) is a chronic degenerative affection of the central nervous system with slow and progressive evolutionary dynamics, characterized by motor signs and symptoms such as resting tremor, bradykinesia and changes in posture, balance and gait. In addition to motor symptoms, other symptoms such as depression, anxiety and stigma significantly affect these individuals' quality of life (QOL). Objectives: Assess the Parkinson's Disease impact on the QoL of individuals in mild and moderate stages, describe and compare signs and symptoms present in these stages and investigate which factors are more often related to the decline of these individuals' QOL. Casuistry: Two groups with PD of both genders were compared: 50 individuals were classified as mild disease (MID) and 50 as moderate disease (MOD), from the Associação Paranaense dos Portadores de Parkinsonismo - APPP (Paraná Association of Persons with Parkinsonism). Methods: Evaluation Protocol consisted of clinical history data collected from medical records, data obtained through interviews and questionnaire, and data obtained by applying the Unified Parkinson's Disease Rating Scale (UPDRS), Daily Living Activities (DLA) and Motor Examination domains, and the Parkinson's Disease Quality of Life Questionnaire (PDQ-39). Disease evolution was classified as per the Hoehn and Yahr Scale (HY). Results: Groups were homogeneous as to gender, age (60 - 80 years), race, marital status and education level. Average MID time was 3.4 years (±2.2) and average MOD time was 8.1 years (±4.7). The MOD presented greater impairment in DLAs (UPDRS) with borderline significance (p=0.05), and worsening was observed especially as to salivation (p<0.004), need for assistance with hygiene (p=0.02) and freezing frequency (p=0.042). MOD scores indicated greater impairment in thirteen of the 14 Motor Examination domains (UPDRS), with a significant difference considering the presence of resting tremor (p=0.035), "pill rolling" (p=0.001) and bradykinesia (p=0.031). QOL in MOD individuals was significantly more impaired as to the following items: mobility (p=0.013), stigma (p=0.043) and cognition (p=0.002), and the values showed borderline significance considering DLAs (p=0.05). Body discomfort was also a QOL aggravating factor in the MOD individuals (p=0.04). No relationship was found between genders with clinical/functional data and QOL considering MID; however, the worse QOL among man in MOD was related to lake of support from friends and family (p=0.01). Among married individuals the lake of support from friends and family was related to worse QOL in both groups (p<0.001) and Stigma (p=0.02) as well in the MOD. No relationship was found between age and clinical/functional data and QOL in MID, whereas in MOD higher age ranges were related to higher dependence in DLAs (p=0.02) and greater cognition impairment (focus and memory) (p=0.01). The longer time of disease progression was associated to worse QOL in the domains of DLAs (MID) (p=0.03) and Emotional Wellbeing (MOD) (p=0.01). Conclusion: In this sample, increased salivation, the need for help for Hygiene, the highest frequency of freezing, bradykinesia and the greater intensity of the resting tremor and "pill rolling" were clinical and functional worsening markers to the moderate stage of PD. The impact in QOL was related to Stigma, cognition and impairment in mobility and DLAs. In this sample older, male and married individuals and those with longer disease progression had greater impairment in QOL. Keywords: Parkinson's Disease, Quality of Life, Parkinson's Disease Quality of Life Questionnaire, Unified Parkinson's Disease Rating Scale

The role of uric acid in the insulin resistance in children and adolescents with obesity

Objective: To investigate the association between serum uric acid levels and insulin resistance in children and adolescents with obesity. Methods: Cross-sectional study with 245 children and adolescents (134 obese and 111 controls), aged 8-18 years. The anthropometric variables (weight, height and waist circumference), blood pressure and biochemical parameters were collected. The clinical characteristics of the groups were analyzed by t-test or chi-square test. To evaluate the association between uric acid levels and insulin resistance the Pearson's test and logistic regression were applied. Results: The prevalence of insulin resistance was 26.9%. The anthropometric variables, systolic and diastolic blood pressure and biochemical variables were significantly higher in the obese group (p<0.001), except for the high-density-lipoprotein cholesterol. There was a positive and significant correlation between anthropometric variables and uric acid with HOMA-IR in the obese and in the control groups, which was higher in the obese group and in the total sample. The logistic regression model that included age, gender and obesity, showed an odds ratio of uric acid as a variable associated with insulin resistance of 1.91 (95%CI 1.40-2.62; p<−0.001). Conclusions: The increase in serum uric acid showed a positive statistical correlation with insulin resistance and it is associated with and increased risk of insulin resistance in obese children and adolescents

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data