Karen Amaral Tavares Pinheiro

Prevalência e fatores associados ao sobrepeso e à obesidade em adolescentes

OBJETIVO: Determinar a prevalencia e os fatores associados ao sobrepeso e a obesidade em adolescentes de zona urbana. METODOS: Estudo transversal de base populacional, realizado no municipio de Pelotas, Rio Grande do Sul, de 2001 a 2002. Adolescentes entre 15 e 18 anos de idade foram medidos, pesados e responderam a questionario auto-aplicavel. De 90 setores sorteados, foram visitados 86 domicilios em cada setor, totalizando 960 adolescentes. A prevalencia de sobrepeso e obesidade foi definida a partir do indice de massa corporal, mediante a utilizacao dos pontos de corte, ajustados a idade e ao sexo. Realizou-se analise multivariada com regressao de Poisson, considerando um modelo hierarquico das variaveis associadas ao sobrepeso e a obesidade. RESULTADOS: A prevalencia de sobrepeso e de obesidade foi 20,9% e 5%, respectivamente. A relacao entre a obesidade e idade e escolaridade do adolescente foi inversa. Verificou-se associacao de sobrepeso e obesidade com o relato de obesidade dos pais (p=0,03) e maturacao sexual do adolescente (p=0,01). Os habitos de fazer dieta e omitir refeicoes foram associados a obesidade, com riscos de 3,98 (IC 95%: 1,83-8,67) e 2,54 (IC 95%: 1,22-5,29), respectivamente. CONCLUSOES: A prevalencia de sobrepeso e obesidade na regiao sao preocupantes a despeito do comportamento dos adolescentes para prevenir a obesidade. E necessaria a implantacao de campanhas mais eficazes, direcionadas a orientar melhor os adolescentes.

Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil

Objective:  To describe the prevalence of paternal postpartum depression (PPD) as well as its association with maternal PPD.

Common mental disorders in adolescents: a population based cross-sectional study

OBJECTIVE To assess the prevalence and the factors associated with common mental disorders among adolescents in Pelotas, a southern Brazilian city. METHOD A population based cross-sectional study was carried out in the urban area of Pelotas. Multi-stage sampling was used to obtain a sample of adolescents aged between 15 and 18 years. Adolescents were interviewed using a self-report confidential questionnaire. The presence of common mental disorders was assessed using the Self-Reporting Questionnaire 20 (SRQ-20). Multivariate analysis was carried out using the Poisson regression with a robust adjustment of variance and control for design effect. RESULTS Nine hundred and sixty adolescents were interviewed. The prevalence of common mental disorders was 28.8%. Adolescents aged 17 years showed prevalence of 1.37 (95% CI 1.06-1.78) times greater than the 15 year olds. Adolescents whose mothers had between 5 and 8 years of schooling had a prevalence 1.42 (95% CI 1.01-1.51) times greater than those whose mothers had more than 8 years of schooling. Smoking and sedentary behavior were also associated with an increased prevalence of common mental disorders. Those who were dissatisfied with their body image showed a prevalence of 1.47 (95% CI 1.07-2.02). CONCLUSIONS Maternal schooling, tobacco smoking, sedentary behavior and body image dissatisfaction were factors associated with the presence of common mental disorders.

Suicidal behavior in pregnant teenagers in southern Brazil: Social, obstetric and psychiatric correlates

BACKGROUND Suicidal behavior and its correlates remain relatively understudied in pregnant teenagers. METHODS A cross-sectional study with a consecutive sample of pregnant teenagers recipient of prenatal medical assistance by the national public health system in the urban area of Pelotas, southern Brazil. Sample size was estimated in 871 participants. Suicidal behavior and psychiatric disorders were assessed with the Mini International Neuropsychiatric Interview; the Abuse Assessment Screen was used to identify physical or sexual abuse; social support was assessed with the Medical Outcomes Survey Social Support Scale; a self-report questionnaire was used to collect socio-demographic, obstetric and other psychosocial data. RESULTS Forty three (4.94%) teenagers refused to participate, resulting in 828 participants. Prevalence of suicidal behavior was 13.3%; lifetime suicide attempts were referred by 7.4%, with 1.3% reporting attempting suicide within the last month. After adjustment, we found significant associations of suicidal behavior with the 18-19 years old subgroup, low education, prior abortion, previous major depression, and physical abuse within the last 12 months. Pregnant teenagers with high social support showed prevalence ratios (PR) 67% lower (PR: 0.33; 95%CI: 0.19-0.56) than those with low social support. Furthermore, a wide range of psychiatric disorders, most notably major depressive disorder (PR: 2.75; 95%CI: 1.34-5.63) and panic disorder (PR: 6.36; 95%CI: 1.61-25.10), remained associated with suicidal behavior after adjustment. LIMITATIONS The cross-sectional design precludes causal inferences. CONCLUSIONS We found that suicidal behavior is a relatively common feature in pregnant teenagers, frequently associated with psychiatric disorders.

Risk of suicide and mixed episode in men in the postpartum period

OBJECTIVES To assess suicide risk in men with mood disorders at the postpartum period. METHODS We conduct a longitudinal study with 650 men whose child has born from April 2007 to May 2008 at maternity hospital. The first assessment was in the antenatal period and the second within 30 to 60days postpartum. Suicide risk, anxiety disorders, hypomanic, manic and mixed episodes were assessed by the Mini International Neuropsychiatric Interview (MINI). RESULTS The prevalence of suicide risk in fathers in postpartum was of 4.8%. Fathers with postpartum depression were 20.97 (CI: 5.74; 76.53) more likely to present suicide risk and those with mixed episodes showed a chance of 46.50 (CI: 10.52; 205.53) times higher than those who did not suffer from any mood disorder. CONCLUSION Mixed episodes are common in fathers at postpartum, posing a higher suicide risk than depressive and manic/hypomanic episodes. Therefore, in order to reduce the suicide risk, clinicians should address and treat adequately mixed affective states in this specific population.

Association of a serotonin transporter gene polymorphism (5-HTTLPR) and stressful life events with postpartum depressive symptoms: a population-based study

Abstract We conducted a cross-sectional study nested within a cohort study with 276 postpartum women to evaluate the role of a serotonin transporter gene polymorphism (5-HTTLPR) and the stressful life events (SLE) on the risk of postpartum depression (PPD) symptoms in a community sample. Participants were assessed between 45 and 90 days after delivery with the Edinburgh Postnatal Depression Scale (EPDS) and the Mini International Neuropsychiatric Interview (MINI). Data regarding socio-demographic variables, alcohol consumption, tobacco smoking and SLE occurring during pregnancy, were also collected. In the adjusted analysis, the women carrying the long (L) allele (LL) who experienced SLE showed higher prevalence ratios (PR) for PPD symptoms (EPDS ≥13) than those with two copies of the short (S) allele (SL) (PR = 9.91; 95% confidence interval: 1.70–57.87). In contrast, a trend of association was found between prior history of major depressive disorder (MDD) and the S allele carrier status (p = 0.07). No association was found between the formal diagnosis of current MDD and the 5-HTTLPR genotypes. In line with previous reports, we find in this sample that the L allele carrier status was associated with a heighten risk of depressive symptoms in postpartum when SLE were experienced during pregnancy.

Cocaine Addiction and Family Dysfunction: A Case-Control Study in Southern Brazil

Family-related factors play a crucial role in the onset, development, and maintenance of drug misuse and addiction. To investigate the hypothesis that families with a cocaine addicted son display more dysfunction than control families, we applied the Personal Authority in the Family System and the Self-Report Measure of Family Functioning to 67 case triads (child–father–mother) in which the son was an inpatient with a primary diagnosis of cocaine abuse or dependence and to 67 matched control triads from the community (Pelotas, Brazil) in 2000. Case children, mothers, and fathers were significantly more likely to present nuclear family triangulation than their matched control subjects. In addition, case triads had a significantly greater chance of perceiving family functioning as enmeshment. These results suggest both structural and functional differences in these families. We argue for the need of interventions in the family as a whole and for further research in this area.

Brief psychoeducation for bipolar disorder: Impact on quality of life in young adults in a 6-month follow-up of a randomized controlled trial

There are scarce follow-up studies evaluating the role of psychoeducation in the treatment of bipolar disorder, especially in a young sample, with a recent diagnosis and that probably received a few previous interventions. This was a randomized clinical trial with young adults aged 18-29 years, who had been diagnosed with bipolar disorder through the Structured Clinical Interview for DSM (SCID). The evaluation of quality of life was carried out using the Medical Outcomes Survey 36-Item Short-Form Health Survey (MOS SF-36). All participants were randomized into two groups: combined intervention (psychoeducation plus medication) and treatment-as-usual (medication). The sample consisted of 61 patients divided in two groups (29 usual treatment; 32 combined intervention). The quality of life domains did not reveal statistically significant differences when comparing baseline, post-intervention and 6-month follow-up evaluations, which indicates that there is no difference between combined intervention and usual intervention regarding quality of life improvement. Both groups presented improvements in quality of life domains, except General Health and Bodily Pain, at post-intervention. Moreover, this improvement persisted at 6-month follow-up, except for the Role Physical Health domain, which remained reduced. Combined Psychoeducation plus pharmacological intervention is so effective in improving quality of life perception as it is pharmacological only intervention.

The influence of psychoeducation on regulating biological rhythm in a sample of patients with bipolar II disorder: a randomized clinical trial

Introduction Changes in biological rhythm are among the various characteristics of bipolar disorder, and have long been associated with the functional impairment of the disease. There are only a few viable options of psychosocial interventions that deal with this specific topic; one of them is psychoeducation, a model that, although it has been used by practitioners for some time, only recently have studies shown its efficacy in clinical practice. Aim To assess if patients undergoing psychosocial intervention in addition to a pharmacological treatment have better regulation of their biological rhythm than those only using medication. Method This study is a randomized clinical trial that compares a standard medication intervention to an intervention combined with drugs and psychoeducation. The evaluation of the biological rhythm was made using the Biological Rhythm Interview of Assessment in Neuropsychiatry, an 18-item scale divided in four areas (sleep, activity, social rhythm, and eating pattern). The combined intervention consisted of medication and a short-term psychoeducation model summarized in a protocol of six individual sessions of 1 hour each. Results The sample consisted of 61 patients with bipolar II disorder, but during the study, there were 14 losses to follow-up. Therefore, the final sample consisted of 45 individuals (26 for standard intervention and 19 for combined). The results showed that, in this sample and time period evaluated, the combined treatment of medication and psychoeducation had no statistically significant impact on the regulation of biological rhythm when compared to standard pharmacological treatment. Conclusion Although the changes in biological rhythm were not statistically significant during the time period evaluated in this study, it is noteworthy that the trajectory of the score showed a trend towards improvement, which may indicate a positive impact on treatment, though it may take a longer time than expected.

O impacto do baixo peso ao nascer relacionado à depressão gestacional para o financiamento federal da saúde pública: uma análise do Município de Pelotas, Rio Grande do Sul, Brasil

O baixo peso ao nascer esta relacionado com morbimortalidade e sequelas no desenvolvimento infantil, impactando nos custos dos sistemas de saude, por isso e importante avaliar fatores que o influenciam, estimando seu impacto no Sistema Unico de Saude (SUS). Este e um estudo prospectivo aninhado a uma coorte de gestantes que realizaram pre-natal e parto exclusivamente pelo SUS nos hospitais com UTI da cidade de Pelotas, Rio Grande do Sul, Brasil. Entre os resultados, concluiu-se que maes com episodios de depressao gestacional apresentam quase quatro vezes mais chances de ter um filho com baixo peso ao nascer (RP = 3,94; IC: 1,49-10,36). Valendo-se do calculo da fracao atribuivel na populacao, estima-se que, na populacao geral, 36,17% dos bebes com baixo peso ao nascer sao filhos de maes que tiveram episodio depressivo, estimando-se um custo que pode chegar a mais de R