RESUMO
RESUMO Este estudo teve como objetivo conhecer as práticas em saúde sexual e reprodutiva de mulheres da etnia Xukuru do Ororubá. Trata-se de uma pesquisa descritiva exploratória, com abordagem qualitativa, que se utiliza da Teoria Transcultural do Cuidado. Foram entrevistadas 18 mulheres indígenas, na Aldeia de Cimbres, terra Xukuru, localizada na Serra do Ororubá, município de Pesqueira (PE). Foram codificadas quatro categorias analíticas, que contemplaram as categorias nativas/êmicas identificadas nos dados coletados: 1) Mulheres da etnia Xukuru do Ororubá e o lugar que ocupam; 2) Políticas de saúde e seu impacto na vida das mulheres indígenas; 3) Práticas em saúde sexual e reprodutiva; 4) Enfermagem: promoção à saúde e empoderamento. Frequentemente, ressalta-se a importância do feminino dentro dos povos indígenas, contudo, a relação entre homens e mulheres desagua em uma relação de poder desfavorável para as mulheres. O povo Xukuru do Ororubá encontra-se em uma situação sanitária e de saúde semelhante à população geral do Agreste e do Sertão pernambucano. As mulheres Xukuru do Ororubá fazem uso simultâneo e regular da biomedicina e da medicina indígena, contudo, sem uma real articulação. Urge o redirecionamento das práticas em saúde da mulher através da dinâmica da sensibilidade cultural.
ABSTRACT The aim of the current study is to get to know the sexual and reproduction health practices of women belonging to the Xukuru of Ororubá ethnic group. It followed a descriptive exploratory design, of qualitative approach, based on the Transcultural Care Theory. Eighteen indigenous women, from the Cimbres village, located in Xukuru of Ororubá territory, Pesqueira County (PE), were interviewed. Four analytical categories were coded, which included the native/emic categories identified in the data collected: 1) Women belonging to the Xukuru of Ororubá ethnic group and the place they occupy; 2) Health policies and their impact on indigenous women's lives; 3) Practices in sexual and reproductive health; 4) Nursing: health promotion and empowerment. The importance of the female character inside indigenous populations is often highlighted, however, the different behavioral patterns and roles attributed to men and women still lies on power relations unfavorable to women. The Xukuru of Ororubá face sanitary and health conditions similar to that faced by the general population living in the Agreste and Hinterland regions of Pernambuco State. Xukuru of Ororubá women make regular and simultaneous use of biomedicine and indigenous medicine, however, without real articulation. There is an urgent need to redirect women-health practices in order to perform nursing practices based on a transcultural approach.
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The relationship between structural changes in grey matter and treatment response in patients with late-life depression remains an intriguing area of research. This magnetic resonance imaging (MRI) study compares the baseline grey matter volume of elderly people with and without major depression (according to the DSM-IV-TR criteria) and assesses its association with antidepressant treatment response. Brain MRI scans were processed using statistical parametric mapping and voxel-based morphometry. The sample consisted of 30 patients with depression and 22 healthy controls. We found a significant volumetric reduction in the orbitofrontal cortex bilaterally in patients in comparison with controls. According to their remission status after antidepressant treatment, patients were classified as remitted or not remitted. Compared with controls, remitted patients showed a volumetric reduction in the orbitofrontal cortex bilaterally and in another cluster in the right middle temporal pole. Non-remitted patients showed an even greater volumetric reduction in the orbitofrontal cortex bilaterally compared with controls. To investigate predictive factors of remission after antidepressant treatment, we used a logistic regression. Both baseline Mini Mental State Examination score and baseline left superior lateral orbitofrontal cortex volume (standardized to the total grey matter volume) were associated with remission status. Our findings support the use of regional brain atrophy as a potential biomarker for depression. In addition, baseline cognitive impairment and regional grey matter abnormalities predict antidepressant response in patients with late-life depression.
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Encéfalo/patologia , Transtorno Depressivo Maior/patologia , Idade de Início , Idoso , Antidepressivos/uso terapêutico , Biomarcadores/análise , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Mapeamento Encefálico , Estudos de Casos e Controles , Estudos Transversais , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: Neuroimaging has been widely used in studies to investigate depression in the elderly because it is a noninvasive technique, and it allows the detection of structural and functional brain alterations. Fractional anisotropy (FA) and mean diffusivity (MD) are neuroimaging indexes of the microstructural integrity of white matter, which are measured using diffusion tensor imaging (DTI). The aim of this study was to investigate differences in FA or MD in the entire brain without a previously determined region of interest (ROI) between depressed and non-depressed elderly patients. METHOD: Brain magnetic resonance imaging scans were obtained from 47 depressed elderly patients, diagnosed according to DSM-IV criteria, and 36 healthy elderly patients as controls. Voxelwise statistical analysis of FA data was performed using tract-based spatial statistics (TBSS). RESULTS: After controlling for age, no significant differences among FA and MD parameters were observed in the depressed elderly patients. No significant correlations were found between cognitive performance and FA or MD parameters. CONCLUSION: There were no significant differences among FA or MD values between mildly or moderately depressed and non-depressed elderly patients when the brain was analyzed without a previously determined ROI.
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Transtorno Depressivo Maior/patologia , Imagem de Tensor de Difusão/métodos , Idoso , Envelhecimento , Encéfalo/patologia , Encéfalo/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Imagem de Tensor de Difusão/instrumentação , Feminino , Avaliação Geriátrica , Humanos , Masculino , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To compare the volume of the hippocampus and parahippocampal gyrus in elderly individuals with and without depressive disorders, and to determine whether the volumes of these regions correlate with scores on memory tests. METHOD: Clinical and demographic differences, as well as differences in regional gray matter volumes, were assessed in 48 elderly patients with depressive disorders and 31 control subjects. Brain (structural MRI) scans were processed using statistical parametric mapping and voxel-based morphometry. Cognitive tests were administered to subjects in both groups. RESULTS: There were no between-group gray matter volume differences in the hippocampus or parahippocampal gyrus. In the elderly depressed group only, the volume of the left parahippocampal gyrus correlated with scores on the delayed naming portion of the visual-verbal learning test. There were also significant direct correlations in depressed subjects between the volumes of the left hippocampus, right and left parahippocampal gyrus and immediate recall scores on verbal episodic memory tests and visual learning tests. In the control group, there were direct correlations only between overall cognitive performance (as assessed with the MMSE) and the volume of right hippocampus, and between the total score on the visual-verbal learning test and the volume of the right and left parahippocampal gyrus. CONCLUSIONS: These findings highlight different patterns of relationship between cognitive performance and volumes of medial temporal structures in depressed individuals and healthy elderly subjects. The direct correlation between delayed visual-verbal memory recall scores with left parahippocampal volumes specifically in elderly depressed individuals provides support to the view that depression in elderly populations may be a risk factor for dementia.
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Depressão/complicações , Transtornos da Memória/etiologia , Transtornos da Memória/patologia , Lobo Temporal/fisiopatologia , Idoso , Análise de Variância , Feminino , Lateralidade Funcional/fisiologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estimulação Luminosa , Tempo de Reação , Estatística como Assunto , Lobo Temporal/patologia , Aprendizagem Verbal/fisiologia , Percepção Visual/fisiologiaRESUMO
This is a study on burden of caregivers of patients with Alzheimer's disease attended at a Reference Center for Cognitive Disorders. OBJECTIVE: To evaluate the profile and burden on caregivers of patients with Alzheimer's disease attended at a Reference Center for Cognitive Disorders. METHODS: We collected demographic information and data on the relationship with the patient from caregivers, and measured burden with the Zarit scale. The patients were evaluated with the following scales: the Cambridge Cognitive Test (CAMCOG); Mini Mental State Examination, the Neuropsychiatric Inventory for neuropsychiatry symptoms, and Functional Activities Questionnaire - FAQ for functional impairment. RESULTS: Of the 31 caregivers, 77.4% were female, predominantly, and daughters, having a mean age of 58.6 years, educational level of 8.1 years, 70% of caregivers co-resided with the patient and 71% did not work. The mean time as a caregiver was 3 years. Twenty-seven percent of the caregivers presented mild to severe burden. The variables presenting significant association with caregiver burden were scores on the NPI and CAMCOG. CONCLUSION: The social demographic characteristics of the sample were similar to those of studies performed in other countries. The average time as a caregiver and the frequency of caregivers with mild to intense burden were lower than those reported in international studies. Neuropsychiatric symptoms and severity of cognitive decline were the main factors associated to burden in this sample of mostly mild to moderate demented AD patients. Further studies are necessary to verify whether the burden is indeed less intense in our milieu.
Trata-se de um estudo sobre a sobrecarga do cuidador dos pacientes com doença de Alzheimer atendidos em Centro de Referência em Distúrbios Cognitivos. OBJETIVO: Avaliar o perfil e a sobrecarga do cuidador dos pacientes com doença de Alzheimer atendidos em Centro de Referência em Distúrbios Cognitivos. MÉTODO: Foram obtidos dados demográficos do cuidador e sobrecarga de acordo com a Escala de Sobrecarga de Zarit. Os pacientes foram avaliados com os seguintes testes e escalas: Teste Cognitivo Cambridge (CAMCOG); Mini-Exame do Estado Mental; Inventário Neuropsiquiátrico (NPI), para a presença de sintomas neuropsiquiátricos; e o Questionário de Atividades Funcionais (QAF), de Pfeffer, para o comprometimento funcional. RESULTADOS: Os 31 cuidadores eram predominantemente do sexo feminino, filhas, idade média 58,6 anos, escolaridade média de 8,1 anos; 70% dos cuidadores moravam com o paciente; 71% não trabalhavam. O tempo médio como cuidador foi de 3 anos. Vinte e sete por cento dos cuidadores apresentavam sobrecarga de intensidade leve a intensa. As variáveis que apresentaram associação significativa com a sobrecarga do cuidador foram os escores do NPI e do CAMCOG. CONCLUSÃO: As características sociodemográficas dos cuidadores foram semelhantes às de estudos feitos em outros países. Entretanto, sobrecarga foi menos freqüente do que em estudos internacionais. A intensidade dos transtornos neuropsiquiátricos e a gravidade do declínio cognitivo foram os principais fatores associados à sobrecarga nesta amostra constituída principalmente por pacientes com DA, com demência leve a moderada. Mais estudos são necessários para verificar se a sobrecarga do cuidador é menos intensa em nosso meio.