Síntomas depresivos y trastorno motor en pacientes con enfermedad de Parkinson

Introduction. Complex relations between brain and psychopathology have attracted the interest of researchers, aiming to clarify the neurobiological mechanisms of depression in Parkinson's disease, obviously in addiction to mental features. Aims. The association of motor impairment and decline of personal autonomy with severity of depressive symptoms was the hypothesis of the present study. Aiming to check this hypothesis, the objective of this study consisted in investigating relationships between the severity of depressive symptoms and motor characteristics of Parkinson's disease. Patients and methods. Thirty patients (53 to 80 year-old) with medical diagnosis of idiopathic Parkinson's disease in initial clinic stages were studied. The Unified Parkinson's Disease Rating Scale, Hoehn-Yahr Scale, and Schwab & England Scale were used to assess the clinic signs and symptoms. The depressive symptoms were identified by complete anamnesis, examination of mental condition, and the Hamilton Rating Scale for Depression and the Anxiety and Depression Scale. Statistical analysis was performed by Pearson's correlation and multiple regression analysis. Results. A significant correlation of severity of depression symptoms with disease stage (p < 0.02), with motor signs (p < 0.008), and with functional performance (p < 0.007) was found. Conclusion. There was significant association between motor impairment and severity of depressive symptoms, and between depression and early disease onset or prolonged duration of Parkinson's disease. © 2007, Revista de Neurología.

Drug dependence, mental impairment and education

This study aimed to evaluate the mental conditions of cocaine-dependent individuals and school commitment/attachment. We evaluated 50 patients referred to the psychiatry emergency room due to mental disorders from chemical dependence. After clinical diagnosis, clinical interview, Hospital Anxiety and Depression Scale, Hamilton Scale for Depression and Brief Psychiatric Rating Scale were applied. The Spearman and Mann-Whitney nonparametric tests, as well as the t-Student test were utilized for statistical analysis.. The accepted significance value was 0.05. All subjects had used cocaine or crack and other substances. Only 13 (26%) did not drop out of school (group 1). Regarding the other 37 (74%), irregular class attendance , successive failures and definitive school drop out rates (group 2) were verified. These subjects presented an early substance use when compared with those which did not drop out of school (p=0.0001). Patients with an early substance use presented higher school dropout rates than those with a later initiation to substance use. Psychopathological phenomena were frequent in both groups.

Avaliação de sintomas neuropsiquiátricos na demência: Para melhorar a precisão

The issue of this article concerned the discussion about tools frequently used tools for assessing neuropsychiatric symptoms of patients with dementia, particularly Alzheimer's disease. The aims were to discuss the main tools for evaluating behavioral disturbances, and particularly the accuracy of the Neuropsychiatric Inventory - Clinician Rating Scale (NPI-C). The clinical approach to and diagnosis of neuropsychiatric syndromes in dementia require suitable accuracy. Advances in the recognition and early accurate diagnosis of psychopathological symptoms help guide appropriate pharmacological and non-pharmacological interventions. In addition, recommended standardized and validated measurements contribute to both scientific research and clinical practice. Emotional distress, caregiver burden, and cognitive impairment often experienced by elderly caregivers, may affect the quality of caregiver reports. The clinician rating approach helps attenuate these misinterpretations. In this scenario, the NPI-C is a promising and versatile tool for assessing neuropsychiatric syndromes in dementia, offering good accuracy and high reliability, mainly based on the diagnostic impression of the clinician. This tool can provide both strategies: a comprehensive assessment of neuropsychiatric symptoms in dementia or the investigation of specific psychopathological syndromes such as agitation, depression, anxiety, apathy, sleep disorders, and aberrant motor disorders, among others.

Validation of the brazilian version of the apathy inventory

Background Apathy is a frequent neuropsychiatric condition in neurodegenerative disorders, depression, and often in mild cognitive impairment. The Apathy Inventory (AI) is a reliable instrument for improving the accuracy of the apathy diagnosis. The aim was to establish the validity of the Apathy Inventory for the Brazilian community. Methods We established the concurrent validity, internal consistency, inter-rater reliability, and the sensitivity and specificity of AI for the Brazilian community in a cohort of 175 individuals with Alzheimer's disease, Parkinson's disease, depression, mild cognitive impairment, and healthy controls. The three dimensions of the AI (emotional blunting, lack of initiative, and lack of interest) were compared with the Apathy domain of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C) in an independent scheme. Results The analyses demonstrated high correlation coefficients in AI's individual dimensions and in AI-total score (F = 0.965). Concerning the NPI-C/Apathy domain, intra-class correlation coefficients were also high (F = 0.977). Concurrent validity was high according to both raters on AI dimensions × NPI-C/Apathy domain and regarding total score (rater 1: rho = 0.956 vs. rater 2: rho = 0.970). The internal consistency of the AI was also high concerning the AI's individual dimensions and total score (rater 1: 0.945 vs. rater 2: 0.958). Conclusion We observed high internal consistency, high concurrent validity, and inter-rater reliability of the Apathy Inventory. In addition, we found that its sensitivity and specificity were high. We suggest that the Brazilian version of the Apathy Inventory would be an appropriate instrument to identify the apathy syndrome in Brazilian patients. © 2012 John Wiley & Sons, Ltd.

Qualidade de vida em mulheres no climatério atendidas na atenção básica de Promissão-SP

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Qualidade de vida em mulheres no climatério atendidas na Atenção Primária

The experience of menopause is increasingly present, and demand strategies to improve the quality of life of women during this period. This research aimed to evaluate the quality of life for women in the climacteric phase, with or without the use of hormone replacement therapy (HRT). This is a longitudinal epidemiological study of a sample of 99 women per group. It was evaluated the sociodemographic, clinical and behavioral characteristics. It was used the Menopause Rating Scale (MRS) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). For data analysis, it was used the Student t test, chi-square and Tukey. HRT users had an average age of 50.76 ± 3.63 years, and nonusers of 48.95 ± 6,27anos (p = 0.01). It was identified a higher frequency of moderate climacteric symptoms of mild intensity. The social aspects evidenced scores below 50 for the two groups. There were differences between groups with respect to the components of the SF-36 and MRS to general health, functional capacity, lower capacity, depression, insomnia and vasomotor phenomena.

Exercício físico, marcadores inflamatórios e genótipo da APOE em idosos com comprometimento cognitivo leve e idosos cognitivamente preservados

Pós-graduação em Ciências da Motricidade - IBRC

Constraining the absolute neutrino mass scale and Majorana CP violating phases by future 0νββ decay experiments

Assuming that neutrinos are Majorana particles, in a three-generation framework, current and future neutrino oscillation experiments can determine six out of the nine parameters which fully describe the structure of the neutrino mass matrix. We try to clarify the interplay among the remaining parameters, the absolute neutrino mass scale and two CP violating Majorana phases, and how they can be accessed by future neutrinoless double beta (0vυββ) decay experiments, for the normal as well as for the inverted order of the neutrino mass spectrum. Assuming the oscillation parameters to be in the range presently allowed by atmospheric, solar, reactor, and accelerator neutrino experiments, we quantitatively estimate the bounds on m 0, the lightest neutrino mass, that can be inferred if the next generation 0υββ decay experiments can probe the effective Majorana mass (m ee) down to ∼1 meV. In this context we conclude that in the case that neutrinos are Majorana particles, (a) if m 0≳300 meV, i.e., within the range directly attainable by future laboratory experiments as well as astrophysical observations, then m ee≳30 meV must be observed, (b) if m 0 ≤ 300 meV, results from future 0υββ decay experiments combined with stringent bounds on the neutrino oscillation parameters, especially the solar ones, will place much stronger limits on the allowed values of m 0 than these direct experiments. For instance, if a positive signal is observed around m ee = 10 meV, we estimate 3≲m 0/meV≲65 at 95% C.L.; on the other hand, if no signal is observed down to m ee = 10 meV, then m 0≲55 meV at 95% C.L.

Influence of door handles design in effort perception: accessibility and usability

The application of ergonomics in product design is essential to its accessibility and usability. The development of manual devices should be based on ergonomic principles. Effort perception analysis is an essential approach to understand the physical and subjective aspects of the interface. The objective of the present study was to analyze the effort perception during a simulated task with different door handles by Portuguese subjects of both genders and different ages. This transversal study agreed with ethical aspects. 180 subjects of both genders pertaining to three age groups have participated. Five door handles with different shapes were evaluated. A subjective numeric rating scale of 5 levels was used to evaluate the effort. For statistical analysis it was applied the Friedman non-parametric test. The results have showed no significant differences of effort perception in door handles "A" and "B"; "A" and "D"; and "D" and "C". Door handle "E" presented the lowest values of all. In general, there's an inverse relationship between the results of biomechanical studies and the effort perception of the same task activity. This shows that door handles design influence directly these two variables and can interfere in the accessibility and usability of these kinds of products.

Reação de cultivares de algodoeiro a Ramularia areola

Dentre as doenças causadoras de manchas foliares em algodoeiro, a mancha de ramulária (Ramularia areola Atk) tem se tornado importante em virtude das condições climáticas favoráveis para o desenvolvimento do patógeno, aliadas ao uso de cultivares suscetíveis, plantio consecutivo e extenso. Neste trabalho avaliaram-se os cultivares Delta Opal, Acala 90, Makina, Delta Penta e Sure Grow 821 quanto à resistência a R. areola, em condições de campo na FCAV-UNESP, no ano de 2006. A severidade da doença, que ocorreu por infecção natural das plantas pelo fungo, foi avaliada semanalmente em trinta plantas devidamente marcadas, utilizando-se uma escala descritiva de notas: 1 = 0%, 2 = até 5%, 3 = de 5,1 a 25%, 4 = de 25,1 a 50% e 5 = acima de 50% de área foliar com sintomas. Foram elaboradas curvas de progresso da doença para os cinco cultivares e o modelo monomolecular foi o que melhor se ajustou aos dados, em comparação com o logístico, o exponencial e o modelo de Gompertz. A análise dos dados indicou que houve diferença significativa entre os genótipos, sendo que Delta Opal, Makina e Sure Grow 821 mostraram-se mais suscetíveis e Delta Penta e Acala 90 mais resistentes ao fungo.

Training on synthetic ethylene-vinyl acetate bench model allows novice medical students to acquire suture skills

PURPOSE: To assess the acquisition of suture skills by training on ethylene-vinyl acetate bench model in novice medical students.METHODS: Sixteen medical students without previous surgery experience (novices) were randomly divided into two groups. During one hour group A trained sutures on ethylene-vinyl acetate (EVA) bench model with feedback of instructors, while group B (control) received a faculty-directed training based on books and instructional videos. All students underwent a both pre-and post-tests to perform two-and three-dimensional sutures on ox tongue. All recorded performances were evaluated by two blinded evaluators, using the Global Rating Scale.RESULTS: Although both groups have had a better performance (p<0.05) in the post-test when compared with the pre-test, the analysis of post-test showed that group A (EVA) had a better performance (p<0.05) when compared with group B (control).CONCLUSION: The ethylene vinyl acetate bench model allowed the novice students to acquire suture skills faster when compared to the traditional model of teaching.

Does bench model fidelity interfere in the acquisition of suture skills by novice medical students?

OBJETIVO: Embora vários modelos de bancada inanimados tenham sido descritos para o treinamento de habilidades de sutura, até o momento, não existe um método ideal para esse ensino e aprendizagem durante a formação médica. O objetivo foi avaliar se a fidelidade dos modelos de bancada interfere na aquisição de habilidades de sutura em estudantes de medicina iniciantes na prática cirúrgica. MÉTODOS: 36 estudantes de medicina sem exposição prévia a habilidades cirúrgicas foram randomizados em três grupos (n = 12): treinamento de suturas baseado em materiais didáticos (controle); treinamento de suturas em modelo de baixa-fidelidade (modelo de bancada de etileno vinil acetato); ou treinamento de suturas em modelo de alta-fidelidade (modelo de bancada de pele de pata de porco). Foram aplicados pré e pós-testes (realização de pontos simples e pontos subdérmicos invertidos em língua de boi). Três ferramentas (Global Rating Scale com avaliação cega, tamanho do efeito e autopercepção da confiança baseada em uma escala de Likert) foram utilizadas para mensurar todas as performances de sutura. RESULTADOS: A análise após o treinamento demonstrou que os estudantes que treinaram nos modelos tiveram um melhor (p < 0.0000) desempenho na avaliação pela Global Rating Scale, quando comparados com o controle, independente da fidelidade do modelo. A magnitude do efeito (treinamento) foi considerada grande (> 0.80) em todas as mensurações. Após o treinamento os alunos sentiram-se mais confiantes (p < 0.0000) para executarem os dois tipos de suturas. CONCLUSÃO: A aquisição de habilidades de suturas no modelo de baixa fidelidade foi semelhante à prática no modelo de alta fidelidade, sendo que a melhora no desempenho dos participantes que treinaram nesses dois modelos foi superior à aprendizagem baseada em materiais didáticos.

Associação entre classe econômica e estresse na ocorrência da disfunção temporomandibular

Objetivou-se neste estudo verificar a associação da classe econômica e do estresse com a ocorrência de disfunção temporomandibular (DTM). A população deste estudo constituiu-se de uma amostra estatisticamente significativa de 354 indivíduos de ambos os sexos, pertencentes a diferentes classes econômicas da zona urbana do município de Piacatu, São Paulo, Brasil. Para isso, utilizou-se o Critério de Classificação Econômica Brasil (CCEB) para a estratificação econômica da população. Retirou-se uma amostra de cada estrato, na qual aplicou-se o Questionário de Fonseca para verificar o grau de DTM, e a Escala de Reajustamento Social (SRRS) para verificar o grau de estresse. Os dados coletados foram tabulados por meio do programa Epi Info 2000, versão 3.2, e analisados estatisticamente por meio do Teste Qui-Quadrado, com nível de significância de 5%. Os chefes das famílias foram assim distribuídos: 4 famílias pertencentes à Classe A2, 14 à Classe B1, 25 à Classe B2, 112 à Classe C, 174 à Classe D e 25 à Classe E. Após a análise estatística não foi observada associação significativa entre classe econômica e disfunção temporomandibular (DTM); entretanto, a mesma ocorreu entre estresse e DTM (p<0,01). A classe econômica não influencia na ocorrência de DTM, mas existe associação direta entre estresse e disfunção temporomandibular.

Serum homocysteine and physical exercise in patients with Parkinson's disease

Background: Hyperhomocysteinemia is a major risk factor for cerebral and peripheral vascular diseases, as well as cortical and hippocampal injury, including an increased risk of dementia and cognitive impairment. Elevated serum homocysteine (Hcy) concentrations are common in patients with Parkinson's disease (PD) who have been treated with levodopa; however, physical exercises can help reduce Hcy concentrations. The aim of the present study was to compare serum Hcy levels in patients with PD who partook in regular physical exercises, sedentary PD patients, and healthy controls.Methods: Sixty individuals were enrolled in the present study across three groups: (i) 17 patients who did not partake of any type of exercise; (ii) 24 PD patients who exercised regularly; and (iii) 19 healthy individuals who did not exercise regularly. All participants were evaluated by Hoehn and Yahr scale, the Unified Parkinson's Disease Rating Scale (UPDRS) and Schwab and England scale (measure daily functionality). The serum levels of Hcy were analyzed by blood samples collected of each participant. An analysis of variance and a Tukey's post hoc test were applied to compare and to verify differences between groups. Pearson's correlation and stepwise multiple regression analyses were used to consider the association between several variables.Results: Mean plasma Hcy concentrations in individuals who exercised regularly were similar to those in the healthy controls and significantly lower than those in the group that did not exercise at all (P = 0.000). In addition, patients who did not exercise were receiving significantly higher doses of levodopa than those patients who exercised regularly (P = 0.001). A positive relationship between levodopa dose and Hcy concentrations (R(2) = 0.27; P = 0.03) was observed in patients who did not exercise, but not in those patients who exercised regularly (R(2) = 0.023; P = 0.15).Conclusions: The results of the present study suggest that, even with regular levodopa therapy, Hcy concentrations in PD patients who exercise regularly are significantly lower than in patients who do not exercise and are similar Hcy concentrations in healthy controls.

Hospital-dia: para quem e para quê?

OBJETIVO: Estudar prospectivamente a população internada em um hospital-dia (HD) em relação a fatores que poderiam influenciar na melhora e na duração da internação. MÉTODOS: Foram entrevistados, para obtenção de dados sociodemográficos e avaliação da evolução, 34 pacientes internados no Hospital-Dia da Faculdade de Medicina de Botucatu, Unesp, durante um ano. O diagnóstico psiquiátrico foi avaliado pela CIDI (Composite International Diagnostic Interview), a sintomatologia psiquiátrica pela BPRS (Brief Psychiatric Rating Scale) e a incapacitação psicossocial pela DAS (Psychiatric Disability Assessment Schedule). Todos os pacientes foram acompanhados, e seus familiares, entrevistados. RESULTADOS: Predominaram mulheres (76%), jovens (61,8%), sem vínculo conjugal (71%), sem trabalho (82,4%), com diagnóstico de transtornos afetivos (44,1%) e com internações psiquiátricas prévias (44%). Apenas quatro (12%) pacientes apresentavam uma síndrome maior segundo BPRS. Houve considerável incapacitação psicossocial dos pacientes em alguns papéis sociais. Maior renda per capita foi um fator associado à melhor evolução. As internações duraram em média 74 dias. Pacientes com internações prévias tenderam a permanecer menos tempo no HD. CONCLUSÕES: Portadores de transtornos afetivos e quadros não-psicóticos geralmente não necessitam de internação por período integral em hospital psiquiátrico. Contudo, os pacientes deste estudo tiveram um elevado número de internações psiquiátricas prévias, provavelmente por necessitarem de um nível de atendimento além das possibilidades dos ambulatórios. Entretanto, pacientes com maior número de internações -- em tese mais graves -- tenderam a permanecer menos tempo no HD, o que suscita dúvidas quanto à sua adesão a serviços abertos, bem como aos possíveis fatores facilitadores dessa adesão. em um momento de crescimento expressivo no número de serviços de internação parcial no Brasil, como nos últimos anos, mais estudos são necessários a fim de esclarecer para quem e para quê são destinados esses serviços.