Mery Natali Silva Abreu

Factors associated with low quality of life in schizophrenia

Interest in quality of life in mental health care has been stimulated by the deinstitutionalization of psychiatric patients as well as a parallel interest in understanding the scope of their daily lives. This study aims to investigate the socio-demographic and clinical variables related to low quality of life, using a cross-sectional design to evaluate quality of life by means of the QLS-BR scale. We interviewed a sample of 123 outpatients from a reference mental health center in Divinópolis, Minas Gerais State, Brazil, clinically diagnosed with schizophrenia. Univariate and multivariate logistic regression analyses were carried out. The results showed that low quality of life is associated with one or more of the following: male gender, single marital status, low income plus low schooling, use of three or more prescribed psychoactive drugs, psychomotor agitation during the interview, and current follow-up care. The study identifies plausible indicators for the attention and care needed to improve psychiatric patient treatment.

Circulating levels of GDNF in bipolar disorder

Neurotrophic factors regulate the survival and growth of neurons, and influence synaptic efficiency and plasticity. Several studies suggest the existence of a relationship between changes in neurotrophic levels and bipolar disorder (BD). The glial cell-line derived neurotrophic factor (GDNF) influences monoaminergic neurons and glial cells, but its role in BD patients is controversial. In order to elucidate it we evaluated plasma levels of GDNF in a sample of 70 BD patients (35 in mania and 35 in euthymia) and compared with 50 healthy controls matched for age, gender and educational levels. GDNF plasma levels were measured by enzyme-linked immunosorbent assay (ELISA). Patients were assessed by a Mini-International Neuropsychiatric Interview (MINI-plus), Young Mania and Hamilton Depression Rating Scales. Plasma GDNF levels were significantly increased in BD patients in euthymia compared with BD patients in mania and healthy controls (p<0.05). GDNF plasma levels were correlated with age (ρ=0.30, p<0.05) and negatively correlated with manic symptoms in BD patients (ρ=-0.54, p<0.05). Our results provide evidence that peripheral levels of GDNF are related with different mood states in BD, reinforcing the involvement of neurotrophic factors in its physiopathology.

Ordinal logistic regression models: application in quality of life studies

Quality of life has been increasingly emphasized in public health research in recent years. Typically, the results of quality of life are measured by means of ordinal scales. In these situations, specific statistical methods are necessary because procedures such as either dichotomization or misinformation on the distribution of the outcome variable may complicate the inferential process. Ordinal logistic regression models are appropriate in many of these situations. This article presents a review of the proportional odds model, partial proportional odds model, continuation ratio model, and stereotype model. The fit, statistical inference, and comparisons between models are illustrated with data from a study on quality of life in 273 patients with schizophrenia. All tested models showed good fit, but the proportional odds or partial proportional odds models proved to be the best choice due to the nature of the data and ease of interpretation of the results. Ordinal logistic models perform differently depending on categorization of outcome, adequacy in relation to assumptions, goodness-of-fit, and parsimony.

Regressão logística ordinal em estudos epidemiológicos

Ordinal logistic regression models have been developed for analysis of epidemiological studies. However, the adequacy of such models for adjustment has so far received little attention. In this article, we reviewed the most important ordinal regression models and common approaches used to verify goodness-of-fit, using R or Stata programs. We performed formal and graphical analyses to compare ordinal models using data sets on health conditions from the National Health and Nutrition Examination Survey (NHANES II).Os modelos de regressao logistica ordinal vem sendo aplicados com sucesso na analise de estudos epidemiologicos. Entretanto, a verificacao da adequacao de cada modelo tem recebido atencao limitada. O artigo apresenta uma breve analise dos principais modelos de regressao logistica ordinal e as estrategias para ajuste s, as tecnicas de verificacao de qualidade do ajuste, bem como os comandos para execucao nos softwares R e Stata. A metodologia e ilustrada com aplicacao dos dados do Second National Health and Nutrition Examination Survey (NHANES II), o conhecido levantamento de saude e nutricao.

Qualidade de vida e dimensão ocupacional na esquizofrenia: uma comparação por sexo

Schizophrenia has been associated with low quality of life in patients, and the impact can vary by gender. Knowing gender differences may help implement specific interventions. This study focuses on quality of life in male and female outpatients with schizophrenia, particularly examining the occupational domain. A cross-sectional study using the Quality of Life Scale (QLS-BR) was carried out. Comparisons of scores by gender used uni- and multivariate analyses by means of a classification tree through the CHAID algorithm and ordinal logistic regression. Women showed higher quality of life scores (p 5 years) was another significant factor for lower scores. Women had better quality of life scores than men, suggesting that they have more occupational activities due to their greater participation in domestic and social activities.

A cytokine study of adult patients with obsessive-compulsive disorder

OBJECTIVES We aimed to determine the plasma levels of cytokines in patients with obsessive-compulsive disorder (OCD) as compared with healthy controls and to investigate whether there is any association between their concentrations and OCD clinical and therapeutic features. METHODS Forty patients with OCD and 40 healthy controls had their plasmas assessed for a range of cytokines (tumor necrosis factor-α, or TNF-α), chemokines (CCL2, CCL3, CCL11, CCL24, CXCL8, CXCL9, CXCL10), and other mediators (TNF soluble receptors sTNFR1 and sTNFR2 and interleukin-1 receptor antagonist) by enzyme-linked immunosorbent assay. Patients with OCD were further examined with the Mini-International Neuropsychiatric Interview, the Obsessive-Compulsive Inventory-Revised, and the Beck Depression Inventory. RESULTS Compared with healthy controls, patients with OCD exhibited significantly increased plasma levels of CCL3, CXCL8, sTNFR1, and sTNFR2. Among patients with OCD, there was a positive correlation between relative antidepressant dose and sTNFr2 levels. Furthermore, although the levels of sTNFR1 correlated positively with the severity of washing symptoms, CCL24 levels correlated negatively with the severity of hoarding. CONCLUSIONS The levels of certain immune markers are increased in adult patients with OCD and seem to vary according to predominant symptoms dimensions. Other studies are required to establish whether our findings truly reflect immunologic dysfunction in OCD or are the result of other hidden confounding factors.

Adverse socioeconomic conditions and oocyst-related factors are associated with congenital toxoplasmosis in a population-based study in Minas Gerais, Brazil.

Objective Congenital toxoplasmosis is a public health problem in Brazil. This study aimed to determine risk factors associated with congenital toxoplasmosis in Minas Gerais which is the second largest Brazilian State based on number of inhabitants, and its territorial extension is larger than that of France. Methods: Population-based case-control study to assess the association between congenital toxoplasmosis and maternal exposure to infection risk factors. The study included mothers/children participating in the Minas Gerais Newborn Screening Program. The cases consisted of 175 mothers of infected children, and the controls consisted of 278 mothers of children without suspected infection. The associations were assessed through binomial logistic regression with p≤0.05. Results The variables associated with lower probability of toxoplasmosis were: older mother age (OR = 0.89; CI95% = 0.85–0.93), higher level of education (OR = 0.85; CI95% = 0.78–0.92), access to potable water (OR = 0.21; CI95% = 0.08–0.51), and home with flush toilet (OR = 0.18; CI95% = 0.04–078). The variables associated with higher probability of infection were: cats in the neighborhood (OR = 2.27; CI95% = 1.27–4.06), owning or visiting homes with domestic cats (OR = 1.90; CI95% = 1.09–3.31), handling the soil (OR = 2.29; CI95% = 1.32–3.96), and eating fresh meat not previously frozen (OR = 3.97; CI95% = 2.17–7.25). After stratification according region of residence (rural or urban/peri-urban), home with flush toilet and consumption of treated water were protective against the disease only in the rural stratum. Conclusions In Minas Gerais, congenital toxoplasmosis has been associated with poor socioeconomic conditions. Considering maternal exposure to sources of Toxoplasma gondii, the predominating risk factors were those related to the ingestion of oocysts. It is expected that these results will contribute to development of a program for prevention of congenital toxoplasmosis adapted to the reality of the population of Minas Gerais. The differences between populations living in rural and urban areas regarding the main risk factors for toxoplasmosis point to the need of considering regional specificities in planning strategies to control congenital toxoplasmosis.

Tabagismo entre adolescentes e adultos jovens de Belo Horizonte, Minas Gerais, Brasil: influência do entorno familiar e grupo social

The study aimed to estimate smoking prevalence in Belo Horizonte, Minas Gerais State, Brazil, and related risk factors among adolescents. We used data from the household survey conducted by the Brazilian National Cancer Institute (2002-2003). The following variables were analyzed: demographic data; physical activity; smoking; and alcohol consumption. The study included information on 630 adolescents (15-24 years of age) living in Belo Horizonte. Multivariate logistic regression analyses were carried out, with hierarchical entry of variables into the model and the generalized estimating equation (GEE) method. Overall smoking prevalence was 11.7%. The following factors were associated with smoking: alcohol consumption (OR = 20.6), older age (OR = 1.2), paternal smoking (OR = 4.0), sibling smoker (OR = 2.5), and best friend smoker (OR = 5.2). Smoking prevalence among adolescents was high, increasing with age and alcohol consumption.

Ordinal logistic regression in epidemiological studies

Ordinal logistic regression models have been developed for analysis of epidemiological studies. However, the adequacy of such models for adjustment has so far received little attention. In this article, we reviewed the most important ordinal regression models and common approaches used to verify goodness-of-fit, using R or Stata programs. We performed formal and graphical analyses to compare ordinal models using data sets on health conditions from the National Health and Nutrition Examination Survey (NHANES II).Os modelos de regressao logistica ordinal vem sendo aplicados com sucesso na analise de estudos epidemiologicos. Entretanto, a verificacao da adequacao de cada modelo tem recebido atencao limitada. O artigo apresenta uma breve analise dos principais modelos de regressao logistica ordinal e as estrategias para ajuste s, as tecnicas de verificacao de qualidade do ajuste, bem como os comandos para execucao nos softwares R e Stata. A metodologia e ilustrada com aplicacao dos dados do Second National Health and Nutrition Examination Survey (NHANES II), o conhecido levantamento de saude e nutricao.

Health-related quality of life in patients with Chagas disease.

INTRODUCTION Chagas disease (ChD) is a chronic illness related to significant morbidity and mortality that can affect the quality of life (QoL) of infected patients. However, there are few studies regarding QoL in ChD. The objectives of this study are to construct a health-related QoL (HRQoL) profile of ChD patients and compare this with a non-ChD (NChD) group to identify factors associated with the worst HRQoL scores in ChD patients. METHODS HRQoL was investigated in 125 patients with ChD and 21 NChD individuals using the Medical Outcomes Study 36-item Short-Form (SF-36) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). Patients were submitted to a standard protocol that included clinical examination, ECG, Holter monitoring, Doppler echocardiogram and autonomic function tests. RESULTS HRQoL scores were significantly worse among the ChD group compared to the NChD group in the SF-36 domains of physical functioning and role-emotional and in the MLWHFQ scale. For the ChD group, univariate analysis showed that HRQoL score quartiles were associated with level of education, sex, marital status, use of medication, functional classification and cardiovascular and gastrointestinal symptoms. In the multivariate analysis, female sex, fewer years of education, single status, worst functional classification, presence of cardiovascular and gastrointestinal symptoms, associated illnesses, Doppler echocardiographic abnormalities and ventricular arrhythmia detected during Holter monitoring were predictors of lower HRQoL scores. CONCLUSIONS ChD patients showed worse HRQoL scores compared to NChD. For the ChD group, sociodemographic and clinical variables were associated with worst scores.