Carla Guariglia

Performance of a Brazilian population on the test of functional health literacy in adults

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.

Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil

The importance of investigating the etiology for dementia lies in the possibility of treating potentially reversible dementias. The aims of this retrospective study are to determine the prevalence of potentially reversible dementias among 454 outpatients seen at the Cognitive and Behavioral Neurology Unit, Hospital das Clínicas, São Paulo University School of Medicine-Brazil, between the years of 1991 and 2001, and observe their evolution in follow-up. Among the initial 454 patients, 275 fulfilled the DSM-IV criteria for dementia. Alzheimers disease was the most frequent diagnosis (164 cases; 59.6%). Twenty-two cases (8.0%) of potentially reversible dementia were observed, the most frequent diagnoses being neurosyphilis (nine cases) and hydrocephalus (six cases). Full recovery was observed in two patients and partial recovery in 10 patients. Two cases were not treated and eight cases were lost on follow-up. The prevalence found in the present study falls within the range reported in previous studies (0-30%).

Topographical disorientation in Alzheimer's disease

UNLABELLED Topographical disorientation (TD) has not been as extensively studied as other frequent manifestations of Alzheimers disease (AD). OBJECTIVE To verify the occurrence of TD and to identify the neuropsychological dysfunctions associated with TD in AD. METHOD Thirty patients with probable AD, their caregivers and 30 subjects without dementia (controls) were interviewed with a questionnaire and evaluated with tests related to topographical orientation. RESULTS AD patients, even those with mild dementia, differ from controls in the questionnaire on topographical orientation and in most neuropsychological tests except for tests of spatial working memory, point localization, three dimension and nonsense figure copy. When the performances in the neuropsychological tests of patients with mild or moderate dementia were compared, only landmark recognition and route description were more impaired in moderate dementia. CONCLUSION TD occurs even in mild dementia of AD, a finding apparently not explained by the impairments of more elementary spatial functions.

Influence of age, gender and educational level on performance in the Brief Cognitive Battery-Edu

The Brief Cognitive Battery-Edu (BCB-Edu) contains nine tests, seven of which are related to the memory of drawings, and has good accuracy in the diagnosis of cognitive impairment. Objectives To evaluate the influence of age, gender and educational level on the performance in tests related to memory of drawings of the BCB-Edu in healthy subjects. Methods Participants were adult volunteers; exclusion criteria were illiteracy, neurologic or psychiatric disorders, visual or hearing impairment, untreated chronic clinical conditions, alcoholism, use of drugs, and for those aged 65 or over, an informant report of cognitive or functional impairment. We evaluated 325 individuals (207 women), with a mean age of 47.1 (±16.8) years, ranging from 19 to 81, and a mean of 9.8 (±5.0) schooling-years. Univariate analyses, correlations and logistic regression were employed (α=0.05). Results There were significant negative correlations between age and the scores in four of the seven tests. However, schooling-years were positively correlated to the scores, where schooling-years decreased with age in this sample (rho= -0.323; p<0.001). Logistic regression confirmed that gender influenced the learning of drawings, where women performed better, while age influenced incidental memory, immediate memory, learning and delayed recall of the drawings, and schooling-years influenced visual identification, immediate memory, learning, delayed recall and recognition of the drawings. Conclusion Gender, age and education influence the performance on the memory of drawings of the BCB-Edu, although the extent of these influences differs according to the nature of the test.

Spatial working memory in Alzheimer's disease A study using the Corsi block-tapping test

The Corsi block-tapping test was developed as a non-verbal task to measure spatial memory. In this test, cubes are tapped by the examiner in novel sequences of increasing length after which participants are required to reproduce each sequence immediately. Objectives To evaluate spatial working memory in Alzheimer’s disease (AD) patients. Methods 30 elderly control subjects (21 women, 9 men) and 30 patients with probable Alzheimer’s disease (15 women and 15 men), with 8 or more years of schooling, were evaluated with the Mini-Mental State Examination (MMSE), digit span and Corsi block-tapping test. Proportions were compared using Chi-Square, and continuous variables with the Mann-Whitney tests. Results AD patients were older than controls (p=0.014), but there were no differences regarding gender or educational level between these groups. The performance on the Corsi block-tapping test differed between AD and control individuals (p=0.010), and between patients with moderate dementia and controls (p=0.032), but not between control individuals and patients with mild dementia (p=0.090). Conclusions In the present study, AD patients with moderate dementia showed impairment in spatial working memory while those with mild dementia did not. This finding may be due to the relatively small sample size, but it is also possible that spatial memory may be normal in the initial (limbic) phase of AD.

Native Valve Endocarditis due to Enterococcus hirae Presenting as a Neurological Deficit

Enterococcus hirae is a rare isolate in clinical specimens. We describe a case of native aortic valve endocarditis in a 56-year-old man. This is the third reported case of endocarditis due to this organism, the first without recurrence of endocarditis and the first presenting as a neurological deficit.

Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.

A successful case of anti-NMDAR encephalitis without tumor treated with a prolonged regimen of plasmapheresis

Anti-NMDA receptor encephalitis is a severe but treatable autoimmune disease of the CNS. However, the use of immunotherapy and long-term outcomes have yet to be defined for this disease. We describe a case of an 18-year-old male diagnosed with anti-NMDAR encephalitis not associated with tumor, which did not respond to initial treatment with immunoglobulin, followed by corticosteroids, cyclophosphamide and evolved with significant clinical improvement after a prolonged course of plasmapheresis. Although it is not possible to affirm the good outcome was due solely to the prolonged plasmapheresis regimen, recently published data shows that improvement may take weeks or months to occur. This case discloses another therapeutic possibility for patients with refractory disease who fail to respond to recommended first-line and second-line therapy.

Desempeño de una población brasilera en la prueba de alfabetización funcional para adultos en el área de salud

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.