OBJECTIVE Numerous pharmacological agents have been implicated in elevating the risk of dementia onset. The present study employs a systematic methodology to examine drugs associated with dementia-related adverse event reports. METHODS The present study extracted case of drugs associated with dementia-related adverse event reports from the FDA Adverse Event Reporting System (FAERS) covering the period from the first quarter of 2004 to the first quarter of 2025. The Reporting Odds Ratio (ROR) was employed as the principal metric for disproportionality analysis. Methodological robustness was validated through the application of the Proportional Reporting Ratio (PRR), the Bayesian Confidence Propagation Neural Network (BCPNN), and the Multi-item Gamma Poisson Shrinker (MGPS). Variable selection was facilitated using least absolute shrinkage and selection operator (LASSO) regression. Temporal relationships were examined via Time-to-Onset analysis. Clinical outcomes among patients with dementia-related adverse event reports were evaluated, including rates of mortality and disability. Furthermore, the clinical indications for the implicated pharmaceuticals were systematically investigated. RESULTS A total of 13 pharmaceutical agents were ultimately identified as exhibiting a potential association with dementia onset: Apixaban, Insulin glargine, Tafamidis, Insulin lispro, Sacubitril valsartan, Quetiapine, Zoledronic acid, Alendronic acid, Enzalutamide, Pregabalin, Rofecoxib, Dapagliflozin, and Valproic acid. The median time to dementia development following drug initiation was 73 days (interquartile range: 529 days), indicating that 75% of reported cases occurred within approximately 1.45 years post-exposure. Furthermore, the top five agents associated with the highest mortality rates in dementia-related adverse event reports associated with drug exposure were identified as Rofecoxib, Zoledronic acid, Tafamidis, Alendronic acid and Enzalutamide, while the top five agents linked to the highest disability rates included Valproic acid, Alendronic acid, Insulin glargine, Rofecoxib and Zoledronic acid. Finally, the primary clinical indications for these 13 drugs were analyzed. Clinicians should exercise heightened vigilance regarding the potential onset of dementia when utilizing these medications in patient care. CONCLUSION These findings contribute to early signal detection for pharmacologically associated dementia and may guide clinical medication management, yet they remain pharmacovigilance signals that require prospective confirmation.
OBJECTIVE Alcohol use disorder (AUD) is an established suicide risk factor, but evidence from low and middle-income countries (LMICs) is scarce. In Brazil, suicide has risen over the past two decades, especially in young adults, and alcohol consumption is among the highest in the Americas. The contribution of AUD to suicide risk in Brazil remains unclear. METHODS We used the 100 Million Brazilian Cohort linking nationwide sociodemographic, hospitalization, and mortality records (2008-2018). The analytic sample comprised 2,718,856 individuals. Multilevel Cox proportional hazards models estimated the association between time-varying AUD-related hospitalization and subsequent suicide, adjusting for municipal hospital availability and time-varying mood disorder hospitalizations. RESULTS Hospitalization for alcohol use was associated with a 263% increase in the hazard of suicide (HR 3.63, 95% CI 2.81-4.69, p<0.001). Elevated risk was also observed among persons aged 30-44 years (HR 1.25, 95% CI 1.11-1.40, p<0.001), men (HR 2.17, 95% CI 1.95-2.40, p<0.001), the unemployed (HR 1.55, 95% CI 1.40-1.71, p<0.001), and retirees (HR 1.39, 95% CI 1.08-1.79, p=0.010). CONCLUSIONS In this national cohort, AUD-related hospitalization strongly predicted suicide. As a modifiable condition, AUD is a critical target for suicide prevention in Brazil. Findings underscore urgent national prevention needs.
Long-stay psychiatric patients frequently experience persistent negative symptoms, functional disability, institutional dependence, and limited opportunities for recovery. Group rehabilitation therapy combines behavioral activation, social-skills practice, illness management, and structured activity, but its effectiveness in long-stay psychiatric populations remains insufficiently quantified. This systematic review and meta-analysis evaluated the effects of structured group rehabilitation therapy on negative symptoms and functional recovery and examined factors associated with treatment response. Eighteen controlled studies involving 1,928 participants were included. Study-level meta-analysis showed reduced negative symptoms (SMD -0.48, 95% CI -0.57 to -0.39; I²=0%) and improved functional recovery (SMD 0.53, 95% CI 0.44 to 0.62; I²=0%). Eleven randomized studies (9 individually randomized and 2 cluster-randomized) were directionally consistent after the prespecified central cluster-precision adjustment. Programmes lasting at least 12 weeks or providing at least 24 contact hours showed larger effects in exploratory subgroup analyses. The review protocol was reported as prospectively registered in PROSPERO (CRD216362732). The findings support an association between structured rehabilitation and short-term symptom and functional improvement, while limited primary-study identification and sparse long-term outcome reporting constrain causal and longitudinal interpretation.
OBJECTIVE This study aimed to evaluate the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) for measuring postnatal depression in fathers in Brazil and tested its invariance across different modes of questionnaire administration. METHODS Data were collected from the Birth in Brazil II study, a nationally representative survey of hospital births. A total of 4,600 fathers were interviewed three months after childbirth, either through telephone interviews or online self-reports. The construct validity of the EPDS was evaluated through factor analyses, and the reliability was assessed using the composite reliability coefficient (CR). Measurement invariance was tested using multi-group confirmatory factor analysis (CFA). RESULTS The EPDS demonstrated a two-factor structure (anhedonia and anxiety/depression) with adequate fit (CFI = 0.969; TLI = 0.960; RMSEA = 0.032). Both factors demonstrated good reliability (CR = 0.82 and 0.90). Higher EPDS scores were positively associated with anxiety symptoms, self-reported mental health problems, and psychiatric medication use (p < 0.001), and inversely associated with better self-rated health (p < 0.001). Measurement invariance across administration modes was supported at configural, metric, scalar, and strict levels. CONCLUSIONS The EPDS demonstrated adequate psychometrics properties of construct validity and reliability, and invariant two-factor structure for assessing paternal postpartum depressive symptoms, indicating its use in scientific studies and clinical screening of fathers.
