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Structural brain changes associated with antipsychotic treatment in schizophrenia as revealed by voxel-based morphometric MRI: an activation likelihood estimation meta-analysis
No full textAbstract
Background
The results of multiple studies on the association between antipsychotic use and structural brain changes in schizophrenia have been assessed only in qualitative literature reviews to date. We aimed to perform a meta-analysis of voxel-based morphometry (VBM) studies on this association to quantitatively synthesize the findings of these studies.
Methods
A systematic computerized literature search was carried out through MEDLINE/PubMed, EMBASE, ISI Web of Science, SCOPUS and PsycINFO databases aiming to identify all VBM studies addressing this question and meeting predetermined inclusion criteria. All studies reporting coordinates representing foci of structural brain changes associated with antipsychotic use were meta-analyzed by using the activation likelihood estimation technique, currently the most sophisticated and best-validated tool for voxel-wise meta-analysis of neuroimaging studies.
Results
Ten studies (five cross-sectional and five longitudinal) met the inclusion criteria and comprised a total of 548 individuals (298 patients on antipsychotic drugs and 250 controls). Depending on the methodologies of the selected studies, the control groups included healthy subjects, drug-free patients, or the same patients evaluated repeatedly in longitudinal comparisons (i.e., serving as their own controls). A total of 102 foci associated with structural alterations were retrieved. The meta-analysis revealed seven clusters of areas with consistent structural brain changes in patients on antipsychotics compared to controls. The seven clusters included four areas of relative volumetric decrease in the left lateral temporal cortex [Brodmann area (BA) 20], left inferior frontal gyrus (BA 44), superior frontal gyrus extending to the left middle frontal gyrus (BA 6), and right rectal gyrus (BA 11), and three areas of relative volumetric increase in the left dorsal anterior cingulate cortex (BA 24), left ventral anterior cingulate cortex (BA 24) and right putamen.
Conclusions
Our results identify the specific brain regions where possible associations between antipsychotic drug usage and structural brain changes in schizophrenia patients are more consistently reported. Additional longitudinal VBM studies including larger and more homogeneous samples of schizophrenia patients may be needed to further disentangle such alterations from those possibly linked to the intrinsic pathological progressive process in schizophrenia
Educational intervention regarding diet and physical activity for pregnant women: changes in knowledge and practices among health professionals
No full textAbstract\ud
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Background\ud
The knowledge and practices of health professionals have a recognized role in behaviors related to the health of their patients. During pregnancy, this influence can be even stronger because there is frequent contact between women and doctors/nurses at periodic antenatal visits. When trained, supported and motivated, these professionals can act as health promoters. This study aimed to evaluate the effect of a focused educational intervention on improving the knowledge and practices of health professionals concerning diet and physical activity during pregnancy.\ud
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Methods\ud
A controlled, non-randomized study was performed to assess the effects of an educational intervention on the knowledge and practices of nurses and doctors who provide primary care to pregnant women. The intervention group, doctors and nurses (n = 22) from the family health units in a medium-sized city of São Paulo State, Brazil, received 16 h of training comprising an introductory course and three workshops, whereas the control group, doctors and nurses (n = 20) from traditional basic health units in Botucatu, did not. The professionals’ knowledge was assessed at two time points, 1 month prior to and 1 year after the beginning of the intervention, using an ad hoc self-report questionnaire. The increases in the knowledge scores for walking and healthy eating of the intervention and control groups were calculated and compared using Student’s t-test. To analyze the professionals’ practice, women in the second trimester of pregnancy were asked whether they received guidance on healthy eating and leisure-time walking; 140 of these women were cared for by professionals in the intervention group, and 141 were cared for by professionals in the control group. The percentage of pregnant women in each group that received guidance was compared using the chi-square test and the Prevalence Ratio (PR), and the corresponding 95 % confidence intervals (CI) were calculated.\ud
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Results\ud
The intervention improved the professionals’ knowledge regarding leisure-time walking (92 % increase in the score, p < 0.001). The women who were cared for by the intervention group were more likely to receive guidance regarding leisure-time walking (PR = 2.65; 95 % CI = 1.82-3.83) and healthy eating (PR = 1.76; 95 % CI = 1.34-2.31) when compared to the control group.\ud
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Conclusion\ud
It is possible to improve the knowledge and practices of health professionals through the proposed intervention aimed at primary health care teams providing antenatal care.Funding\ud
The São Paulo Research Foundation (Fundação de Amparo à Pesquisa do\ud
Estado de São Paulo; Fapesp) funded this study
Erratum to: Fertility rates among very young adolescent women: temporal and spatial trends in Brazil
No full textImpact of the Bolsa Família program on food availability of low-income Brazilian families: a quasi experimental study
No full textAbstract\ud
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Background\ud
The Bolsa Família Program was created in Brazil in 2003, by the joint of different social programs aimed at poor or very poor families with focus on income transfer to promote immediate poverty relief, conditionalities and complementary programs. Given the contributions of conditional cash transfer programs to poverty alleviation and their potential effects on nutrition and health, the objective of this study was to assess the impact of the Bolsa Família Program on food purchases of low-income households in Brazil.\ud
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Methods\ud
Representative data from the Household Budget Survey conducted in 2008–2009 were studied, with probabilistic sample of 55,970 households. 11,282 households were eligible for this study and 48.5 % were beneficiaries of the BFP. Food availability indicators were compared among paired blocks of households (n = 100), beneficiaries or non-beneficiaries of the Bolsa Família Program, with monthly per capita income up to R$ 210.00. Blocks of households were created based on the propensity score of each household to have beneficiaries and were homogeneous regarding potential confounding variables. The food availability indicators were weekly per capita expenditure and daily energy consumption, both calculated considering all food items and four food groups based on the extent and purpose of the industrial food processing. The comparisons between the beneficiaries and non-beneficiaries blocks of households were conducted through paired ‘t’ tests.\ud
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Results\ud
Compared to non-beneficiaries, the beneficiaries households had 6 % higher food expenditure (p = 0.015) and 9.4 % higher total energy availability (p = 0.010). It was found a 7.3 % higher expenditure on in natura or minimally processed foods and 10.4 % higher expenditure on culinary ingredients among the Bolsa Família Program families. No statistically significant differences were found regarding the expenditure and the availability of processed and ultra-processed food and drink products. In the in natura or minimally processed foods group, the expenditure and the availability of meat, tubers and vegetables were higher among the Bolsa Família Program beneficiaries.\ud
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Conclusion\ud
The Bolsa Família Program impact on food availability among low-income families was higher food expenditure, higher availability of fresh foods and culinary ingredients, including those foods that increase diet’s quality and diversity.To FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo for the doctoral scholarship (Process 2010/17080-9)
Non-neoplastic bulky mediastinal mass presentation in an adolescent patient: a case report
No full textAbstract
Introduction
Mediastinal masses in pediatric patients are very heterogeneous in origin and etiology. In the first decade of life, 70% of the mediastinal masses are benign whereas malignant tumors are more frequent in the second decade of life. Among the mediastinal masses, lymph nodes are the most common involved structures and could be enlarged due to a lymphoma, leukemia, metastatic disease, or due to infectious diseases as sarcoidosis, tuberculosis and others.
Case presentation
We report a case of a 13-year-old Caucasian girl who came to the emergency room with a history of intermittent fever, weight loss and night sweating for at least 1 month. A radiologic image work-up presented an anterior and posterior mediastinal mass. The 18F-fluorodeoxyglucose positron emission tomography presented a high maximum standard uptake value, which directed our decision for mediastinal biopsy for diagnostic elucidation. Histologic examination described the mass as granulomatous tuberculosis. The patient was treated with anti-tuberculosis therapy and developed a full clinical recovery.
Conclusions
The present case report demonstrates that a bulky mediastinal lymphadenopathy detected on 18F-fluorodeoxyglucose positron emission tomography is not always a malignant lesion, and in countries where tuberculosis is endemic, this etiology should not be forgotten during clinical investigations. There is a need for more accurate cut-off values for this technology; meanwhile, the further investigation of patients with bulky mediastinal masses with procedures such as the open biopsy is indispensable
Correlation between microstructure and corrosion behavior of two Al-Fe-Si alloys
No full textIn this work, the corrosion behavior of the AA4006 alloy made by the twin roll\ud
caster process was evaluated using electrochemical impedance spectroscopy\ud
(EIS), anodic potentiodynamic polarization curves, and scanning electron\ud
microscopy (SEM). This alloy belongs to the Al–Fe–Si system and is present with\ud
higher amounts of Fe and Si than AA1050 aluminum. Electrochemical tests\ud
were performed in a sulfate solution with or without chloride ions, and two\ud
different areas of the AA4006 alloy were tested: at the surface and at the center\ud
of the sheet (half thickness). The results obtained were compared to the\ud
commercially pure AA1050 aluminum. Electrochemical tests carried out using\ud
the solution without chloride ions presented similar results; however, the\ud
addition of chloride ions resulted in localized corrosion in all samples. It was\ud
possible to compare the corrosion behavior of the studied materials analyzing\ud
these electrochemical data and the micrographs obtained by scanning eléctron\ud
microscopyIPENCNPEMCAPE
Geographical distribution of Amblyomma cajennense (sensu lato) ticks (Parasitiformes: Ixodidae) in Brazil, with description of the nymph of A. cajennense (sensu stricto)
No full textAbstract\ud
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Background\ud
Until recently, Amblyomma cajennense (Fabricius, 1787) was considered to represent a single tick species in the New World. Recent studies have split this taxon into six species. While the A. cajennense species complex or A. cajennense (sensu lato) (s.l.) is currently represented by two species in Brazil, A. cajennense (sensu stricto) (s.s.) and Amblyomma sculptum Berlese, 1888, their geographical distribution is poorly known.\ud
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Methods\ud
The distribution of the A. cajennense (s.l.) in Brazil was determined by morphological examination of all lots of A. cajennense (s.l.) in two large tick collections of Brazil, and by collecting new material during three field expeditions in the possible transition areas between the distribution ranges of A. cajennense (s.s.) and A. sculptum. Phylogenetic analysis inferred from the ITS2 rRNA gene was used to validate morphological results. Morphological description of the nymphal stage of A. cajennense (s.s.) is provided based on laboratory-reared specimens.\ud
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Results\ud
From the tick collections, a total 12,512 adult ticks were examined and identified as 312 A. cajennense (s.s.), 6,252 A. sculptum and 5,948 A. cajennense (s.l.). A total of 1,746 ticks from 77 localities were collected during field expeditions, and were identified as 249 A. cajennense (s.s.), 443 A. sculptum, and 1,054 A. cajennense (s.l.) [these A. cajennense (s.l.) ticks were considered to be males of either A. cajennense (s.s.) or A. sculptum]. At least 23 localities contained the presence of both A. cajennense (s.s.) and A. sculptum in sympatry. DNA sequences of the ITS2 gene of 50 ticks from 30 localities confirmed the results of the morphological analyses. The nymph of A. cajennense (s.s.) is morphologically very similar to A. sculptum.\ud
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Conclusion\ud
Our results confirmed that A. cajennense (s.l.) is currently represented in Brazil by only two species, A. cajennense (s.s.) and A. sculptum. While these species have distinct distribution areas in the country, they are found in sympatry in some transition areas. The current distribution of A. cajennense (s.l.) has important implications to public health, since in Brazil A. sculptum is the most important vector of the bacterium Rickettsia rickettsii, the etiological agent of Brazilian spotted fever.Thanks to Gustavo Fernochi for his technical support in editing photographs.\ud
This work was supported by Conselho Nacional de Desenvolvimento\ud
Científico e Tecnológico (CNPq, Project 141945/2010-9, Fundação de Amparo\ud
à Pesquisa do Estado de São Paulo (FAPESP, Project 2014/14464-1), and\ud
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/\ud
PROEX 2327/2015), Brazil
Adherence to and acceptability of home fortification with vitamins and minerals in children aged 6 to 23 months: a systematic review
No full textAbstract\ud
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Background\ud
Vitamin and mineral deficiencies affect more than two million people worldwide. In 2011, based on recent scientific evidence and the low effectiveness of current strategies, the World Health Organization recommended home fortification of foods with multiple micronutrients in powder (MNP) as a new strategy to prevent and control anaemia during childhood. This systematic review assessed adherence to and acceptability of home fortification with multiple micronutrients in powder (MNP) in complementary feeding.\ud
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Methods\ud
Adherence was assessed based on number or percentage of prescribed sachets that were consumed, and acceptability was assessed according to perceptions of caregivers and children about MNP.\ud
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Results\ud
In summary, the studies indicated that home fortification with MNP has good adherence, ranging from 50 % to over 90 % of the prescribed sachets and that MNP was well accepted by caregivers. Caregivers reported side effects in 3 % to 32 % of children taking MNP in many studies; diarrhoea, vomiting, and constipation were the most common.\ud
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Conclusions\ud
Home fortification with MNP has good adherence and acceptability in infants, with higher adherence in non-daily or flexible administration regimens. Characteristics of the target population and increased diarrhoea burden should be considered for planning public health programs with long term use of MNP. Acceptability of the MNP is satisfactory, when the use and perceived beneficial effects on children’s health are considered.SF Barros was supported by a scholarship for scientific initiation from the São\ud
Paulo State Research Foundation (FAPESP, No 2013/12968-0). MA Cardoso is\ud
supported by the Brazilian National Counsel of Technological and Scientific\ud
Development, CNPq (Grant nos. 308308/2013-1; 552747/2011-4).\ud
FAPESP and CNPq had no role in the design, analysis or writing of this articl
ClusMAM: fast and effective unsupervised clustering of large complex datasets using metric access methods
No full textAn efficient and effective clustering process is a core task of data mining analysis, and has become more important in the nowadays scenario of big data, where scalability is an issue. In this paper we present the ClusMAM method, which proposes a new strategy for clustering large complex datasets through metric access methods. ClusMAM aims at accelerating the process of relational partitional clustering by taking advantage of the inherent node separations of metric access methods. In comparison with other methods from the literature, ClusMAM is up to four orders of magnitude faster than the competitors maintaining clustering quality. Additionally, ClusMAM exploits the datasets to find compact and coherent clusters, suggesting the number of clusters k found in the data. The method was evaluated employing synthetic and real datasets, and the behavior of the method was consistent regarding the number of distance calculations and time required for the clustering process as well.FAPESPCAPESCNPqRESCUER Project (grants EU 614154 and CNPq/MCTI 490084/2013-3
Clinical profile and molecular characterization of Galactosemia in Brazil: identification of seven novel mutations
No full textAbstract
Background
Classical Galactosemia (CG) is an inborn error of galactose metabolism caused by the deficiency of the galactose-1-phosphate uridyltransferase enzyme. It is transmitted as an autosomal recessive disease and is typically characterized by neonatal galactose intolerance, with complications ranging from neonatal jaundice and liver failure to late complications, such as motor and reproductive dysfunctions. Galactosemia is also heterogeneous from a molecular standpoint, with hundreds of different mutations described in the GALT gene, some of them specific to certain populations, reflecting consequence of founder effect.
Methods
This study reviews the main clinical findings and depicts the spectrum of mutations identified in 19 patients with CG, six with Duarte Galactosemia and one with type 2 Galactosemia in Brazil. Some individuals were diagnosed through expanded newborn screening test, which is not available routinely to all newborns.
Results
The main classical Galactosemia mutations reported to date were identified in this study, as well as the Duarte variant and seven novel mutations - c.2 T > C (p.M1T), c.97C > A (p.R33S), c.217C > T (p.P73S), c.328 + 1G > A (IVS3 + 1G > A), c.377 + 4A > C (IVS4 + 4A > C), c.287_289delACA (p.N97del) and c.506A > C (p.Q169P). This was expected, given the high miscegenation of the Brazilian population.
Conclusions
This study expands the mutation spectrum in GALT gene and reinforces the importance of early diagnosis and introduction of dietary treatment, what is possible with the introduction of Galactosemia in neonatal screening programs