Marcia Scazufca - Academia.edu (original) (raw)

Papers by Marcia Scazufca

Nature medicine, Mar 14, 2024

Scalable solutions to treat depression in older adults in low-resourced settings are urgently nee... more Scalable solutions to treat depression in older adults in low-resourced settings are urgently needed. The PRODIGITAL-D pragmatic, single-blind, two-arm, individually randomized controlled trial assessed the effectiveness of a mobile messaging psychosocial intervention in improving d ep re ssive s ym pt om at ology among older adults in socioeconomically deprived areas of Guarulhos, Brazil. Older adults (aged 60+ years) registered with 24 primary care clinics and identified with depressive symptomatology (9-item Patient Health Questionnaire (PHQ-9) scores ≥ 10) received the 6-week Viva Vida intervention based on psychoeducation and behavioral activation (n = 298) or a single message (n = 305). No health professional support was offered. The primary outcome was improvement from d ep re ss ive s ym pt omat ology (PHQ-9 < 10) at 3 months. Of the 603 participants enrolled (mean age = 65.1 years; 451 (74.8%) women), 527 (87.4%) completed the follow-up assessment. In the intervention arm, 109 of 257 (42.4%) participants had an improved depressive s y m pt o m at ology, compared with 87 of 270 (32.2%) participants in the control arm (adjusted odds ratio = 1.57; 95% confidence interval = 1.07-2.29; P = 0.019). No severe adverse events related to trial participation were observed. These results demonstrate the usefulness of a digital messaging psychosocial intervention in the short-term improvement from depressive s ym pt om at ology that can potentially be integrated into primary care programs for treating older adults with depression. Brazilian Registry of Clinical Trials registration: ReBEC (RBR-4c94dtn). Reducing the burden of depression in older adults is a global health priority, key to ensuring healthy aging and promoting well-being, especially in low-and middle-income countries (LMICs) where 69% of the world's older population live 1. In Brazil, the number of adults aged 65 years or older has increased by 57% since 2010, now representing 11% of the total population 2. Of the older adults interviewed in the Brazilian National Health Survey of 2019, 12% reported that they had experienced depression in the past 3. Estimates from low-resource settings in Brazil found that 30% of the older population had experienced depressive symptoms suggestive of clinical depression; only one-third of them had received a previous diagnosis 4. Programs led by trained nonmental health specialists (task-sharing) and with a team-based approach (collaborative care) have been effective in treating depression in all ages 5,6 , including

Addiction, Sep 4, 2022

Aim: To synthesize international findings on the alcohol-dementia relationship, including represe... more Aim: To synthesize international findings on the alcohol-dementia relationship, including representation from low-and middle-income countries. Methods: Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in six continents. Cox regression investigated the dementia risk associated with alcohol use in older adults aged over 60 years. Additional analyses assessed the alcohol-dementia relationship in the sample stratified by sex and by continent. Participants included 24 478 community dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. The main outcome measure was all-cause dementia as determined by clinical interview. Results: At baseline, the mean age across studies was 71.8 (standard deviation = 7.5, range = 60-102 years), 14 260 (58.3%) were female and 13 269 (54.2%) were current drinkers. During 151 636 person-years of follow-up, there were 2124 incident cases of dementia (14.0 per 1000 person-years). When compared with abstainers, the risk for dementia was lower in occasional [hazard ratio (HR) = 0.78; 95% confidence interval (CI) = 0.68-0.89], light-moderate (HR = 0.78; 95% CI = 0.70-0.87) and moderate-heavy drinkers (HR = 0.62; 95% CI = 0.51-0.77). There was no evidence of differences between lifetime abstainers and former drinkers in terms of dementia risk (HR = 0.98; 95% CI = 0.81-1.18). In dose-response analyses, moderate drinking up to 40 g/day was associated with a lower risk of dementia when compared with lif-time abstaining. Among current drinkers, there was no consistent evidence for differences in terms of dementia For affiliations of authors refer to page 422.

Value in health regional issues, Jul 1, 2022

Objectives This study aimed to assess the known-groups validity of the EQ-5D-5L and the ICECAP-O,... more Objectives This study aimed to assess the known-groups validity of the EQ-5D-5L and the ICECAP-O, two outcome measures used in economic evaluation, among older adults with depressive symptoms in socioeconomically deprived areas of Brazil. We also explored the role of education and income on responses to these measures. Methods This cross-sectional study used baseline data from PROACTIVE, a cluster randomised controlled trial to evaluate a psychosocial intervention for late life depression among older adults. Participants aged 60 years or over with a Patient Health Questionnaire (PHQ-9) score≥10 were recruited from 20 primary healthcare clinics. Ordered logistic regression models assessed the association between depression severity, income and education and dimension level responses on the EQ-5D-5L and

RePEc: Research Papers in Economics, Jul 29, 2019

Alzheimer's & Dementia

IntroductionSex differences in dementia risk, and risk factor (RF) associations with dementia, re... more IntroductionSex differences in dementia risk, and risk factor (RF) associations with dementia, remain uncertain across diverse ethno‐regional groups.MethodsA total of 29,850 participants (58% women) from 21 cohorts across six continents were included in an individual participant data meta‐analysis. Sex‐specific hazard ratios (HRs), and women‐to‐men ratio of hazard ratios (RHRs) for associations between RFs and all‐cause dementia were derived from mixed‐effect Cox models.ResultsIncident dementia occurred in 2089 (66% women) participants over 4.6 years (median). Women had higher dementia risk (HR, 1.12 [1.02, 1.23]) than men, particularly in low‐ and lower‐middle‐income economies. Associations between longer education and former alcohol use with dementia risk (RHR, 1.01 [1.00, 1.03] per year, and 0.55 [0.38, 0.79], respectively) were stronger for men than women; otherwise, there were no discernible sex differences in other RFs.DiscussionDementia risk was higher in women than men, with...

This article cites 0 articles, 0 of which you can access for free at: permissions

Major compulsory revisions Comment 1. "The rationale of the study is not well stated in the intro... more Major compulsory revisions Comment 1. "The rationale of the study is not well stated in the introduction section. Why did the authors choose to study the association between thyroid function and dementia? Did the study want to explore the risk factors of dementia, or to contribute to the prevention or treatment of dementia?" Answer to comment 1 The objective of the study is to explore the possible association of subclinical thyroid disease and dementia in a cross-sectional population sample of elderly people in São Paulo, Brazil. Upon follow-up, it will also be possible to prospectively analyse thyroid function and risk of dementia. We rewrote the introduction to state this objective more clearly. Changes in the manuscript were marked in yellow. Comment 2. "The authors only listed several findings from different studies in the introduction section, but didn't explain why those findings were listed. Some clearer statements are supposed to be added to describe the rationale of the current study. For example, it is clear that those results are inconsistent. Some of the researches didn't find any association between thyroid function and cognitive impairment. Moreover, there is no (or few) research from population-based settings in Brazil. Therefore, the current study is essential to..." Answer to comment 2 We rewrote the introduction to focus on the main inconsistencies among the studies. We also added to the manuscript the information that this study is the first population-based study in elderly people with the ability to evaluate the association of subclinical thyroid disorders and dementia in Brazil. Changes in the manuscript were marked in yellow. Comment 3. "Six hundred and ninety-nine participants without data about thyroid function were excluded from this study. Who were those participants? Were they older or younger than the participants with data about thyroid function? Was there gender difference between the two groups? More statistic tests should be carried out here." Answer to comment 3 The main study included elderly people from 66 census areas living in the neighborhood of Butantan. There were a total of 2267 individuals of whom 2072 agreed to participate. When

Alzheimer's & Dementia, 2019

eLife, Jul 26, 2016

Being taller is associated with enhanced longevity, and higher education and earnings. We reanaly... more Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increas...

Lancet (London, England), Apr 9, 2016

One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-... more One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. We used data from 751 studies including 4,372,000 adults from 146 ...

The Journal of Urology, 2012

Journal of the American Society of Nephrology, 2008

Objective: To synthesise international findings on the alcohol-dementia relationship and provide ... more Objective: To synthesise international findings on the alcohol-dementia relationship and provide a cross-national comparison of the alcohol-dementia relationship with critical evidence for the relationship between alcohol use and dementia in under-studied populations. Design and setting: Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in five continents. Cox regression investigated the dementia risk associated with alcohol use. Sensitivity analyses compared lifetime abstainers with former drinkers, adjusted extensively for demographic and clinical characteristics, and assessed the competing risk of death. Participants: 24,472 community-dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. Main outcome measure: All-cause dementia as determined by clinical interview. Results: During 151,574 person-years of follow-up, there were 2,137 incident cases of dementia (1...

Aging & Mental Health, Aug 19, 2021

Objectives: To obtain evidence on the psychometric properties of the Patient Health Questionnaire... more Objectives: To obtain evidence on the psychometric properties of the Patient Health Questionnaire − 9 (PHQ-9, one of the most extensively used tools for assessing depression) in the Brazilian older population. Method: Data on 3,356 Brazilian adults aged 60+ years living in Guarulhos, São Paulo state were used. The factor structure of the questionnaire was analysed using a factor analysis approach. The questionnaire's measurement equivalence was tested across gender, age, personal income, and education level groups. The scores were compared across groups based on the highest level of equivalence achieved. The questionnaire's internal consistency was analysed considering its factor structure. Results: A one-factor solution was identified as the most adequate factor structure, with the factor explaining 57.6% of the items' variance. The correlation of the resulting latent score with the overall raw sum score in the PHQ-9 was r = 0.96. Measurement equivalence regarding thresholds and loadings was achieved for all tested groups. On average, women, older, less educated, and poorer people had higher latent scores on the depression factor. The measure showed a good internal consistency with Revelle's omega total ω t =0.92. Conclusion: The results suggest that, among Brazilian older adults living in Guarulhos, São Paulo state, the PHQ-9 measures depressive symptomatology equivalently across different sociodemographic subgroups. Moreover, it can be scored using the raw sum of the item scores to adequately reflect different levels of depressive symptomatology.

medRxiv (Cold Spring Harbor Laboratory), Jun 28, 2023