Occupational stressors and mental illness in healthcare work: An intersection between gender, race, and class.

BACKGROUND: Previous studies have supported the relevance of using broad and complex approaches, including multiple explanatory categories, to analyze mental disorders in the working population. This study aimed to assess the direct and indirect effects of gender, race, social class, and occupational stressors on mental health. METHODS: A cross-sectional study used a random sample of 3343 health workers. The effort-reward imbalance (ERI) scale measured occupational stressors. The World Health Organization Self-Reporting Questionnaire (SRQ-20) evaluated common mental disorders (CMDs) as outcomes. The role of gender, race/color, and class determinants (level of schooling and income) in the relationship between occupational stressors and CMD was assessed. Structural equation modeling was used to determine associations and effects. RESULTS: Occupational stressors were directly associated with CMD and mediated the relationship between income and CMD. Gender was directly associated with occupational stressors, income, and domestic overload. Race was associated with education and with CMD through indirect paths mediated by class indicators. Class indicators contributed to increasing exposure to occupational stressors and the occurrence of CMD. CONCLUSION: The results highlight the relevance of gender, race/color, and class in understanding the unequal distribution of work stressors and mental illness in health workers.

Stressful work in primary health care and mental health: The role of gender inequities in Brazil.

BACKGROUND: This study aims to analyze the association between occupational stressors, evaluated by the Effort-Reward Imbalance Model (ERI), and the occurrence of common mental disorders (CMD) among healthcare workers (HCW), additionally considering mediation by over-commitment from work (OW) and mediation of gender effects by work stressors. METHODS: Cross-sectional study, including a random sample of 3343 HCWs, from six municipalities of Bahia, Brazil. The ERI scale measured the occupational stressors (main exposure), and the Self-Reporting Questionnaire (SRQ-20) was used to screen for CMD. Data analysis used Structural Equation Modeling techniques to understand the relationships between gender, occupational stressors, and the occurrence of CMD. RESULTS: ERI and OW were associated with CMD. OW mediated the negative effect of ERI on the mental health of HCW. Female workers had higher levels of ERI, OW, and CMD prevalence; the total gender effect on CMD prevalence was mediated by ERI and OW. CONCLUSIONS: The findings highlight the association of work psychosocial stressors and CMD among HCW, including partial mediation by OW. Gender inequalities persisted among HCW, with women most exposed to occupational stressors and CMD. ERI and OW partially mediated the effect of gender on CMD.

Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the published studies that compare lower limb muscle strength in patients with low back pain to matched healthy controls. METHODS: We searched Medline, SciELO, Cumulative Index to Nursing and Allied Health (CINAHL), and Scopus up until December 2017. Studies comparing lower limb muscle strength in people diagnosed with low back pain to healthy control participants were included in the systematic review. RESULTS: 14 studies, which included 951 healthy controls and 919 patients with low back pain, fulfilled the inclusion criteria. Meta-analysis revealed a lower muscle strength of hip abductor/extensors and knee extensors in patients with low back pain in comparison to healthy controls. The average strength of hip abductors (Five studies, SMD=0.7 95% CI: 0.49 to 0.9) and hip extensors (Two studies, SMD=0.93, 95% CI: 0.62 to 1.23) was significantly lower in patients with low back pain compared to that of healthy controls. Knee extensor muscle strength was significantly lower in patients with low back pain compared to healthy controls (Three studies, WMD=0.31 Nm/kg, 95% CI: 0.1 to 0.5). The meta-analysis indicated a no significant difference in knee flexor muscle strength in patients with low back pain compared to healthy controls. CONCLUSIONS: Lower limb muscle is impaired in patients with low back pain.

Effects of the FIFA 11 training program on injury prevention and performance in football players: a systematic review and meta-analysis.

OBJECTIVE: To investigate the effects of FIFA 11 training on injury prevention and performance in football players. DESIGN AND METHODS: Systematic review and meta-analysis. We conducted a systematic search using four databases (CINAHL, Cochrane Library, EMBASE, and PubMed) to find controlled trials evaluating the effects of FIFA 11 on injury prevention and performance among football players. Weighted mean differences, standard mean differences, risk ratios, and 95% confidence intervals were calculated, and heterogeneity was assessed using the I2 test. RESULTS: We analyzed 11 trials, including 4700 participants. FIFA 11 resulted in a significant reduction in injury risk (risk ratio = 0.69; 95% confidence interval, 0.49-0.98; P = 0.02) and improvements in dynamic balance (weighted mean difference = 2.68; 95% confidence interval, 0.44-4.92; P = 0.02) and agility (standard mean difference = -0.36; 95% confidence interval, 0.70-0.02; P = 0.04). The meta-analysis indicated a non-significant improvement in jump height (standard mean difference = 0.25; 95% confidence interval, 0.08-0.59; P = 0.14) and running sprint (standard mean difference = -0.24; 95% confidence interval, 0.58-0.10; P = 0.17) in the FIFA 11 group. CONCLUSIONS: FIFA 11 can be considered as a tool to reduce the risk of injury. It may improve dynamic balance and agility and can be considered for inclusion in the training of football players.

Opportunities for translation: targeting DNA repair pathways in pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the poorest prognosis neoplasms. It is typified by high levels of genomic aberrations and copy-number variation, intra-tumoural heterogeneity and resistance to conventional chemotherapy. Improved therapeutic options, ideally targeted against cancer-specific biological mechanisms, are urgently needed. Although induction of DNA damage and/or modulation of DNA damage response pathways are associated with the activity of a number of conventional PDAC chemotherapies, the effectiveness of this approach in the treatment of PDAC has not been comprehensively reviewed. Here, we review chemotherapeutic agents that have shown anti-cancer activity in PDAC and whose mechanisms of action involve modulation of DNA repair pathways. In addition, we highlight novel potential targets within these pathways based on the emerging understanding of PDAC biology and their exploitation as targets in other cancers.

Potential of Cricket (Acheta domesticus) Flour as a Lean Meat Replacer in the Development of Beef Patties.

This study examined the incorporation of cricket (Acheta domesticus) flour (CF) (0, control; 5.0%, CF5.0; 7.5%, CF7.5; and 10.0%, CF10.0) as a lean meat replacer in beef patties and its impact on composition, microbiological, sensory, and technological properties, as well as its influence on the cooking process. The inclusion of CF led to beef patties with significantly higher protein levels than the control group. Additionally, an elevation in total viable (TVC) and lactic acid bacteria (LAB) counts was observed. However, Enterobacteriaceae counts remained at safe levels. CF5.0 demonstrated similar sensory scores and purchase intention to the control treatment. CF7.5 and CF10.0 showed comparable sensory scores to the control except for texture attributes. The inclusion of CF significantly reduced cooking loss and diameter reduction values. Beef patties with CF were notably firmer and had a browner color than the control. In general, the cooking process impacted the technological properties similarly in both the control and beef patties with CF. In all cooked samples, no significant differences in pH, redness (a*), or texture were observed. This study demonstrated that incorporating up to 5.0% CF into beef patties is optimal in terms of composition, technological, sensorial, and cooking properties.

Overexpression of mTOR in Leukocytes from ALS8 Patients.

BACKGROUND: The mutated VAPBP56S (vesicle B associated membrane protein - P56S) protein has been described in a Brazilian family and classified as Amyotrophic Lateral Sclerosis type 8 (ALS8). OBJECTIVE: We aimed to study altered biochemical and immunological parameters in cells from ALS8 patients to identify possible biomarkers or therapeutic targets. METHODS: Wild-type VAPB, VAPBP56S, mTOR, proinflammatory cytokines, and oxidant/reducing levels in serum, leucocytes, and cellular lysate from ALS8 patients and health Controls were performed by ELISA, fluorimetry, and spectrophotometry. RESULTS: Our results showed similar levels of mutant and wild-type VAPB in serum and intracellular lysate (p > 0.05) when ALS8 patients and Controls were compared. IL-1ß, IL-6, and IL-18 levels in patients and Controls showed no difference, suggesting an absence of peripheral inflammation (p > 0.05). Oxidative metabolic response, assessed by mitochondrial ROS production, and reductive response by MTT reduction, were higher in the ALS8 group compared to Controls (p < 0.05), although not characterizing typical oxidative stress in ALS8 patients. Total mTOR levels (phosphorylated or non-phosphorylated) of ALS8 patients were significantly lower in serum and higher in intracellular lysate than the mean equivalents in Controls (p < 0.05). A similar result was observed when we quantified the phosphorylated protein (p < 0.05). CONCLUSION: We demonstrate the possibility of using these biochemical and immunological parameters as potential therapeutic targets or biomarkers. Furthermore, by hypothesis, we suggest a hormetic response in which both VAPB forms could coexist in different proportions throughout life. The mutated VAPBP56S production would increase with aging and predominate over the wild-type VAPB levels, determining the onset of symptoms and aggravating the disease.

Occupational stress and common mental disorders: how do coping strategies work?

Introduction: Coping strategies are described as devices capable of minimizing the effects of occupational stress on workers' mental health. Objectives: To evaluate the association between occupational stressors and occurrence of common mental disorders and how coping strategies work in this relationship. Methods: This is a cross-sectional study with 3,343 healthcare workers from six municipalities in the state of Bahia, Brazil. Common mental disorders were measured by the Self-Reporting Questionnaire, and occupational stressors by the Job Content Questionnaire. Coping strategies included physical activity, leisure activities, social support at work, alcohol consumption, and smoking. Bivariate and multivariate analyses were performed, stratified by sex. Results: Occupational stressors were associated with common mental disorders, more strongly among women. The practice of physical activity contributed to reduce the prevalence of common mental disorders, regardless of occupational stressors. Leisure activities were associated with lower prevalence of common mental disorders, but without statistical significance, losing relevance in the presence of occupational stressors. Social support and smoking or drinking habits were not associated with common mental disorders and did not influence the relationship with occupational stressors. Conclusions: Occupational stressors are associated with common mental disorders, with emphasis on high demand, even after adjusted for coping strategies. The relationship between occupational stressors and mental is corroborated, with greater female vulnerability, as well as the role of positive coping strategies in protecting mental health. The pertinence of adopting measures that reduce stress at work, promote the adoption of positive coping strategies, and consider gender inequalities in these relationships.

Neuroendoscopic Approach of a Massive Bilateral Chronic Subdural Hematoma in a Child Using a Single Burr Hole.

There are several treatment modalities for the management of subdural fluid collection in infants, such as fontanelle puncture and drainage, burr hole irrigation, and subduroperitoneal shunt. This report describes the case of a girl born with congenital neurological impairment due to severe injury of the brain with unknown etiology. At five months of age, she suffered from head trauma and developed somnolence after three days and was diagnosed with a bilateral massive chronic subdural hematoma. Normal fundoscopy did not confirm the non-accidental head trauma. Neuroendoscopy using a single burr hole was performed and complete drainage was achieved. Arachnoid tearing was observed during the procedure. Postoperatively, the patient showed clinical improvement, and brain expansion was observed after one month. The main advantages of neuroendoscopy for bilateral massive chronic subdural hematoma are accurate visualization of the space, minimal invasiveness, and treatment of both sides with reliable drainage control.

Tethered Cord Syndrome After Myelomeningocele Repair: A Literature Update.

Tethered cord syndrome (TCS) after myelomeningocele (MMC) repair (or secondary TCS) is a challenging condition characterized by neurological, orthopedic, and urological symptoms, which are combined with a low-lying position of the conus medullaris and damage to the stretched spinal cord owing to metabolic and vascular derangements. It has been reported that this syndrome affects, on average, 30% of children with MMC. In this review, we revisit the historical aspects of secondary TCS and highlight the most important concepts of diagnosis, treatment, and outcomes for secondary TCS as well as the current research regarding the impact of fetal MMC repair in the incidence and management of TCS. In the future, the development of synthetic models of TCS could shorten the learning curve of pediatric neurosurgeons, and research into the cellular proapoptotic features and increased inflammation biomarkers associated with TCS will also improve the treatment of this condition and minimize retethering of the spinal cord.

Selective Neuroendoscopic Resection of the Choroid Plexus as an Alternative Technique for Optimizing the Standard Endoscopic Approach to Hydrocephalus.

In the past four decades, enormous advances have been made in the neuroendoscopic techniques, along with improvement of illumination, and the development of effective instruments. As a result, endoscopic third ventriculostomy (ETV) and choroid plexus cauterization (CPC) have become consolidated techniques for the treatment of hydrocephalus. In particular, endoscopic cauterization of the choroid plexus has increased the effectiveness of hydrocephalus treatment in combination with ETV. In the past decade, the use of flexible endoscopes has enabled surgeons to resect even the temporal segment of the choroid plexus at the lateral ventricles, which has increased the success of treatment. In this technical note, we describe CPC with the use of a rigid endoscope, which we used to selectively disconnect the glomus of the choroid plexus, in addition to choroid plexus coagulation, as an alternative way to facilitate ETV. This new procedure optimized the visualization of the choroid plexus and the temporal horn and prevented additional difficulties in coagulation of this mobile region of the choroid plexus in selected patients. To achieve the best outcome, avoid bleeding, and optimize the standard technique, it was important to recognize both the classical anatomic structure of the choroid plexus and some variations, and previous expertise in ETV and CPC were necessary. We demonstrate that resection of the glomus of the choroid plexus in selected patients is safe and feasible.

Measurement of low-derivative surface lenses by two-laser holography with Bi12TiO20 crystals.

Refractive and profilometric analyses of lenses with large radii of curvature and/or large focal distance were performed through photorefractive holography using a Bi12TiO20 crystal as the recording medium and two red diode lasers as light sources. Both lasers were properly aligned and tuned in order to provide submillimetric synthetic wavelengths providing real-time interferograms in a two-color holography experiment. The resulting contour interferogram describes the form of the wavefront after the beam traveled back and forth through the lens. The fringe quantitative evaluation was carried out through the four-stepping technique, and the resulting phase map and the branch-cut method were employed for phase unwrapping. Exact ray tracing calculation was performed in order to establish a relation between the output wavefront geometry and the lens parameters such as radii of curvature, thickness, and refractive index. By quantitatively comparing the theoretically calculated wavefront geometry with the experimental results, errors below 1% for both refractive index and focal length were obtained.

Occupational stress and job dissatisfaction with health work.

OBJECTIVE: The purpose of this study is to evaluate the association between psychosocial aspects at work and dissatisfaction among health workers in five cities in Bahia, Brazil. METHODS: The evaluation was based on different models proposed to measuring occupational stress and possible combinations between them: demand-control model (DCM) and effort-reward imbalance (ERI). We conducted a cross-sectional epidemiological study including 3084 health workers. The analysis considered the association between partial/full/partial (combined) occupational stress models (the variable "exposure") and job dissatisfaction (the variable "outcome"). RESULTS: Dissatisfaction rate was 26%. Full DCM and ERI models were better than partial ones to investigate job dissatisfaction. After adjustments, the combined models presented more robust measures of prevalence ratio than models evaluated separately (PR 2.93; CI 2.26-3.80). CONCLUSIONS: The combination of models has shown greater capacity to identify situations of job dissatisfaction and provided more potential information to support actions for workers' health.

The endemic plants of Mozambique: diversity and conservation status.

An annotated checklist of the 271 strict-endemic taxa (235 species) and 387 near-endemic taxa (337 species) of vascular plants in Mozambique is provided. Together, these taxa constitute c. 9.3% of the total currently known flora of Mozambique and include five strict-endemic genera (Baptorhachis, Emicocarpus, Gyrodoma, Icuria and Micklethwaitia) and two near-endemic genera (Triceratella and Oligophyton). The mean year of first publication of these taxa is 1959, with a marked increase in description noted following the onset of the two major regional floristic programmes, the "Flora of Tropical East Africa" and "Flora Zambesiaca", and an associated increase in botanical collecting effort. New taxa from Mozambique continue to be described at a significant rate, with 20 novelties described in 2018. Important plant families for endemic and near-endemic taxa include Fabaceae, Rubiaceae and Euphorbiaceae s.s. There is a high congruence between species-rich plant families and endemism with the notable exceptions of the Poaceae, which is the second-most species rich plant family, but outside of the top ten families in terms of endemism, and the Euphorbiaceae, which is the seventh-most species rich plant family, but third in terms of endemism. A wide range of life-forms are represented in the endemic and near-endemic flora, with 49% being herbaceous or having herbaceous forms and 55% being woody or having woody forms. Manica Province is by far the richest locality for near-endemic taxa, highlighting the importance of the cross-border Chimanimani-Nyanga (Manica) Highlands shared with Zimbabwe. A total of 69% of taxa can be assigned to one of four cross-border Centres of Endemism: the Rovuma Centre, the Maputaland Centre sensu lato, and the two mountain blocks, Chimanimani-Nyanga and Mulanje-Namuli-Ribaue. Approximately 50% of taxa have been assessed for their extinction risk and, of these, just over half are globally threatened (57% for strict-endemics), with a further 10% (17% for strict-endemics) currently considered to be Data Deficient, highlighting the urgent need for targeted conservation of Mozambique's unique flora. This dataset will be a key resource for ongoing efforts to identify "Important Plant Areas - IPAs" in Mozambique, and to promote the conservation and sustainable management of these critical sites and species, thus enabling Mozambique to meet its commitments under the Convention on Biological Diversity (CBD).

ResumoApresenta-se a lista das plantas vasculares de Moçambique, que compreende 271 taxa endémicos (235 espécies) e 387 taxa quase-endémicos (337 espécies). Estes taxa constituem cerca de 9,3% da flora total actualmente conhecida em Moçambique e incluem cinco géneros estritamente endémicos (Baptorhachis, Emicocarpus, Gyrodoma, Icuria e Micklethwaitia) e dois géneros quase-endémicos (Triceratella e Oligophyton). O ano médio das primeiras publicações destes taxa é 1959. Um aumento significativo na descrição de espécies novas foi verificado, relacionado com o início de dois projectos regionais, a "Flora of Tropical East Africa" e a "Flora Zambesiaca", permitindo um esforço maior de colheitas botânicas. Novos taxa têm vindo a ser descritos a um ritmo significativo, com 20 novas espécies descritas em 2018 para a flora de Moçambique. As famílias Fabaceae, Rubiaceae e Euphorbiaceae, incluem importantes taxa endémicos e quase-endémicos. Existe uma estreita relação entre as famílias de plantas com elevado número de espécies e o grau de endemismo, excepção feita às Poaceae, que embora seja a segunda família mais rica em espécies não se posiciona no grupo das dez principais famílias em termos de endemismo. Por outro lado a família Euphorbiaceae, que é a sétima mais rica em espécies, posiciona-se em terceiro lugar quanto ao número de endemismo. A flora endémica apresenta diferentes formas de vida, sendo 49% das espécies herbáceas e 55% lenhosas. A Província de Manica é o local mais rico em taxa quase-endémicos, realçando assim a importância da área transfronteiriça Chimanimani-Nyanga (Manica) entre Moçambique e Zimbabwe. Refira-se ainda que 69% dos taxa encontra-se num dos quatro centros de endemismo transfronteiriços: o Centro do Rovuma, o Centro de Maputaland sensu lato e nas regiões montanhosas de Chimanimani-Nyanga e Mulanje-Namuli-Ribáuè. Cerca de 50% dos taxa foram avaliados quanto ao risco de extinção, estando mais da metade ameaçados globalmente (57% de endemismos) e 10% (17% de endemismos) foram incluídos na categoria Informação Insuficiente (DD), revelando que a maioria das plantas endémicas de Moçambique necessitam de conservação urgente. Este estudo fornece novos dados indispensáveis à identificação das "Áreas Importantes de Plantas ­ IPAs" em Moçambique, contribuindo ainda para implementar as estratégias de conservação anteriormente estabelecidas pela Convenção sobre a Diversidade Biológica (CBD).

Linagliptin safety profile: A systematic review.

OBJECTIVE: To describe the safety profile of linagliptin. METHODOLOGY: Systematic review using PubMed/MEDLINE, BVS and Web of Science. The search strategy "Linagliptin" AND "safety" was used. The inclusion criteria were clinical trials with a control group composed of conventional DM2 pharmacotherapy. RESULTS: We identified 16 studies, and the most frequent adverse events (AEs) were nasopharyngitis with linagliptin at 5 and 10mg in monotherapy (31.6% and 29.6%, respectively) and gastrointestinal events (>10.0%) with linagliptin in combination. Of the AEs, 14.9 (±3.1)% were associated with the use of linagliptin in monotherapy, and 17.6 (±6.0)% in combination. The linagliptin AEs have a varied occurrence and frequency, ranging from mild to moderate intensity.

Thrombosis of the Azygos Anterior Cerebral Artery.

The azygos anterior cerebral artery is a rare variant, characterized by the absence of the anterior communicating artery and the union of two proximal segments of the anterior cerebral artery, forming a single trunk and ascending through the interhemispheric fissure. The incidence in the population varies from 0.3 to 2%. The presence of occlusion for this vessel causes bifrontal infarcts, with potentially devastating functional consequences, hence the importance of recognizing this anatomical variation in imaging exams.

The role of interleukin-8 (IL-8) and IL-8 receptors in platinum response in high grade serous ovarian carcinoma.

Platinum based drugs are the cornerstone of chemotherapy for ovarian cancer, however the development of chemoresistance hinders its success. IL-8 is involved in regulating several pro-survival pathways in cancer. We studied the expression of IL-8 and IL-8 receptors in platinum sensitive and resistant cell lines. Using qRT-PCR and immunohistochemistry, both platinum sensitive (PEA1, PEO14) and resistant (PEA2, PEO23) show increased expression of IL-8 and IL-8 receptors. IL-8RA shows nuclear and cytoplasmic expression, whilst IL-8RB is present solely in the cytoplasm. Knockdown of IL-8 increased sensitivity to cisplatin in platinum sensitive and reversed platinum resistance in resistant cell lines, decreased the expression of anti-apoptotic Bcl-2 and decreased inhibitory phosphorylation of pro-apoptotic Bad. IL-8 receptor antagonist treatment also enhanced platinum sensitivity. Nuclear localisation of IL-8RA was only detected in platinum resistant tumours. Inhibition of IL-8 signalling can enhance response in platinum sensitive and resistant disease. Nuclear IL-8RA may have potential as a biomarker of resistant disease.

Characteristics relating to the interiorization of acquired immunodeficiency syndrome in Brazil: a cross-sectional study.

BACKGROUND: In recent years there has been changes in the social and geographic profile of acquired immunodeficiency syndrome (AIDS). The aim of this study was to evaluate the internalization of AIDS in the state of Rondônia, Brazil. FINDINGS: In Rondônia, 1473 AIDS cases were reported, with an average annual incidence of 15.8/100,000 persons (42.7 % women). The most common mode of viral transmission was sexual (96.5 %), and the majority of the individuals had not completed their primary education (64.8 %). There was heterogeneity in relation to case distribution, involving almost all of the municipalities in the state. The average annual mortality rate was 2.5/100,000 persons. CONCLUSION: Rondônia has a higher incidence of AIDS than the national average and the northern region. Efforts to provide access to treatment and follow-up of these individuals should be implemented, prioritizing areas where the incidence is higher and decentralizing the treatment of patients with AIDS in the state.

Reduction of incidence and relapse or recrudescence cases of malaria in the western region of the Brazilian Amazon.

INTRODUCTION: Malaria is one of the major parasitic diseases in the State of Rondônia, located in the western Brazilian Amazon. The basic treatment scheme for this disease is chloroquine and primaquine. This study evaluated the epidemiological profile of malaria in Rondônia between 2008 and 2012. METHODOLOGY: The epidemiological data were provided by the Health Surveillance Agency from the State of Rondônia, and socioeconomic indicators were obtained from the Brazilian Institute of Geography and Statistics, Department of Informatics of the Unified Health System, and from the National Institute for Space Research. The analyzed variables included year of diagnosis, gender, age group, main activity performed in the 15 days previous to the diagnosis, parasite species, level of parasitemia, number of relapse/recrudescence cases, and socioeconomic and environmental data for Rondônia. RESULTS: A total of 238,626 cases of malaria were recorded in Rondônia during the study period. Of this total, 65.6% were men and the most prevalent age group was 20-39 years. Plasmodium vivax was the most common parasite (89.8%), followed by Plasmodium   falciparum (9.4%). An average of 30.9% of the individuals who were tested presented with relapse/recrudescence malaria. The API value was highest in 2008 and lowest in 2012, corresponding to 42.3 cases and 19.2 cases per 1,000 inhabitants, respectively. CONCLUSIONS: A 58% reduction in the number of malaria cases and a 36.2% reduction in the number of relapse/recrudescence malaria cases were observed, due to increases in the economy, improvements in the health system, and reduction of deforestation in this region.