Mentally healthy living after pandemic social distancing: a study of older Canadians reveals helpful anxiety reduction strategies.

BACKGROUND: Throughout the COVID-19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post-COVID life was expected to be especially anxiety-provoking. A study was conducted to obtain nationally representative evidence of older Canadians' self-perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting. MATERIALS AND METHODS: This study had a cross-sectional descriptive design. An e-survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS-10) and indicated which of the 16 Centre for Addictions and Mental Health's (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data. RESULTS: While, on average, older Canadians were mildly anxious, nearly one-quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety. CONCLUSION: Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people's mental health promotion efforts after social distancing, now and for future pandemics.

The Relationship Between Mental health, Metacognition, and Emotion Regulation in Older People.

OBJECTIVES: It is unclear if using emotion regulation strategies can help manage the effects of anxiety and depression on metacognitive strategies in older people. This study aimed to verify the effect of emotion regulation in the interaction between mental disorders and metacognition. METHODS: A mediation analysis was performed to assess the role of emotion regulation in the interaction between mental disorders and metacognition in older people. RESULTS: Without mediator control, higher scores indicating mental disorder are associated with reduced metacognition scores. When mediators are added to the model, the mediation effect was significant. An indirect effect of anxiety and depression on metacognition was mediated by cognitive reappraisal to a greater extent than emotional suppression. CONCLUSIONS: Cognitive reappraisal reduced the impact of anxiety and depression on metacognition in older adults. CLINICAL IMPLICATIONS: Including cognitive reappraisal techniques in anxiety and depression intervention plans can be beneficial for improving older people's metacognition functioning.

Suitability of the Attitudes to Aging Questionnaire Short Form for Use among Adults in Their 50s: A Cross-Sectional e-Survey Study.

This cross-sectional e-survey study examines the suitability (reliability and validity) of the 12-item Attitudes to Aging Questionnaire Short Form (AAQ-SF) for use among adults in their 50s. The AAQ-SF instrument was originally designed to capture subjective perceptions of physical change, psychosocial loss, and psychological growth by asking people aged 60 and beyond how they feel about growing older. Our sample comprised 517 people residing in three Canadian provinces. Respondents completed the Attitudes to Aging Questionnaire Short Form, the Rosenberg Self-Esteem Scale, and a short sociodemographic profile. Our findings replicate the original AAQ-SF structure for physical change, psychosocial loss, and psychological growth, with a promising internal consistency range for the third subscale. In our sample, psychological growth is best represented as 'Self' and 'Generativity', with a particularly greater capacity to explain variations in scores for item 18 and item 21. Physical change and psychosocial loss scores strongly differed based on perceived health and chronic illness presence. Psychosocial loss and psychological growth were moderately correlated with two aspects of self-esteem. We relate these patterns of findings within the context of prevailing growth and development theory and their perceived implications within the context of COVID-19 and post-pandemic life.

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR SYSTEMIC TREATMENT OF HEPATOCELLULAR CARCINOMA.

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

A network approach to understanding distance learners' experience of stress and mental distress whilst studying.

Research has shown that learners' stress and mental distress are linked to poorer academic outcomes. A better understanding of stress and mental distress experiences during study could foster more nuanced course and intervention design which additionally teaches learners how to navigate through to protect their academic performance. The current study draws on data collected via validated self-reported questionnaires completed by final year undergraduate students (n = 318) at a large distance education university. We examined how common features of stress, depression and anxiety link to each other using a network analysis of reported symptoms. The results included findings demonstrating the symptoms with the greatest relative importance to the network. Specifically, these included the stress symptom 'I found it difficult to relax' and the depression symptom 'I was unable to become enthusiastic about anything'. The findings could help institutions design interventions that directly correspond to common features of students' stress and distress experiences.

Depression and loneliness symptoms in Brazilian older people during the COVID-19 pandemic: a network approach.

OBJECTIVES: Depression and loneliness in older people were a global challenge during the COVID-19 pandemic. Causal mechanisms to trigger depression might vary across different life events. We aimed to apply network analysis in a sample of Brazilian older people during the first wave of the COVID-19 pandemic, to investigate if loneliness and depression symptoms were connected within a psychological network. We explored how symptoms manifested and interacted, to discuss possible interventions that could mitigate late-life depression and loneliness symptoms in face of the COVID-19 pandemic. METHOD: We collected data from 384 Brazilian older people who answered an online protocol to assess sociodemographic data, loneliness symptoms (assessed by the short version of UCLA-BR), and depression symptoms (assessed by the PHQ-2). RESULTS: 'Lack of companionship' was the bridge symptom connecting loneliness and depression communities. 'I feel shut out and excluded by others' and 'People are around me, but not with me' were the most predictable symptoms of loneliness. CONCLUSION: Interventions aimed to promote older people's social participation and skills, combined with strategies to expand their sources of social support and combat ageism, might be relevant to mitigate symptoms of loneliness and depression in older people during a crisis like the COVID-19 pandemic.

Atualização das Recomendações da Sociedade Brasileira de Hepatologia para o Tratamento Sistêmico do Carcinoma Hepatocelular / Brazilian society of hepatology updated recommendations for systemic treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2020 a atualização das recomendações da SBH para o diagnóstico e tratamento do CHC. Desde então, novas evidências científicas sobre o tratamento sistêmico do CHC foram relatadas na literatura médica, incluindo novos medicamentos aprovados que não estavam disponíveis na época do último consenso, levando a diretoria da SBH a promover uma reunião monotemática on-line para discutir e rever as recomendações sobre o tratamento sistêmico do CHC. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização, baseada em evidências científicas, sobre cada tópico relacionado ao tratamento sistêmico e a apresentar os dados e recomendações resumidas durante a reunião. Todos os painelistas se reuniram para discutir os tópicos e elaborar as recomendações atualizadas. O presente documento é a versão final do manuscrito revisado, contendo as recomendações da SBH, e seu objetivo é auxiliar os profissionais de saúde, formuladores de políticas e planejadores no Brasil e na América Latina na tomada de decisões sobre o tratamento sistêmico de pacientes com CHC.

Julgamentos metacognitivos e o desempenho de idosos em tarefas de memória / Metacognitive judgments and the performance of the elderly in memory tasks / Juicios metacognitivos y el desempeño de los ancianos en tareas de memoria

O estudo objetivou investigar o monitoramento metacognitivo de idosos por meio da análise de relações entre o desempenho estimado por eles e seus reais desempenhos em tarefas de memória de curto prazo. Participaram 30 idosos não acamados, sem sinais relatados de demência ou indicados por meio do Miniexame do Estado Mental, de ambos os sexos, com idade entre 65 e 90 anos, além de uma pessoa próxima a cada um deles, totalizando 60 participantes. O contato com a amostra foi realizado por meio da estratégia de Snowball Sampling Aproach. Os materiais apresentados aos participantes idosos foram o Miniexame do Estado Mental, os subtestes Aritmética, Dígitos e Sequência de Números e Letras do WAIS III, e o Registro de Julgamentos Metacognitivos. Para os participantes que eram figuras próximas de cada idoso foi apresentado o Questionário para Informantes Múltiplos sobre o Desempenho de Idosos em Tarefas de Memória. Os resultados dos subtestes Aritmética, Dígitos e Sequência de Números e Letras do WAIS III foram correlacionados aos julgamentos dos idosos e das pessoas próximas quanto ao desempenho dos idosos nos subtestes. Foram encontradas correlações fortes e significativas entre os julgamentos e o desempenho real para os três subtestes e correlações moderadas e significativas entre julgamentos de pessoas próximas e o desempenho real dos idosos nos subtestes. Os resultados indicaram que idosos sem sinais de prejuízo cognitivo e seus cuidadores/familiares podem julgar adequadamente os desempenhos em tarefas de memória

The study aimed to investigate the metacognitive monitoring of elderly people by analyzing the relationships between their estimated performance and their actual performance in short-term memory tasks. Thirty elderly individuals who were not bedridden, with no reported signs of dementia or indicated through the Mini Mental State Examination, of both genders, aged between 65 and 90 years, in addition to a person close to each of them participated, totaling 60 participants. Contact with the sample was performed using the Snowball Sam-pling Aproach strategy. The materials presented to the elderly participants were the Mini Mental State Examination, the WAIS III Arithmetic, Digits and Sequence of Numbers and Letters subtests, the Metacognitive Judgments Registry. For participants who were figures close to each elderly person, the Questionnaire for Multiple Informers on the Performance of Elderly Persons in Memory Tasks was presented. The results of the WAIS III Arithmetic, Digits and Sequence of Numbers and Letters subtests were correlated to the judgments of the elderly and those close to them regarding the performance of the elderly in the subtests. Strong and significant correlations were found between judgments and actual performance for the three subtests and moderate and significant correlations were found between judgments of close people and the actual performance of the elderly in the subtests. The results indicated that the elderly, caregivers/family members can properly judge performance in memory tasks

El estudio tuvo como objetivo investigar el seguimiento metacognitivo de las personas mayores mediante el análisis de las relaciones entre su rendimiento estimado y su rendimiento real en tareas de memória a corto plazo. Participaron 30 ancianos que nos se encontraban postrados en cama, sin signos reportados de demencia o índicados a través del Mini Examen del Estado Mental, de ambos sexos, con edades entre 65 y 90 años, además de una persona cercana a cada uno de ellos, totalizando 60 participantes. El contacto con la muestra se realizó mediante la estrategia Snowball Sampling Aproach. Los materiales presentados a los participantes mayores fueron el Mini Examen del Estado Mental, las subpruebas de Aritmética, Dígitos y Secuencia de Números y Letras WAIS III, el Registro de Juicios Metacognitivos. Para los participantes que eran figuras cercanas a cada anciano, se presentó el Cuestionario para Informantes Múltiples sobre el Desempeño de las Personas Mayores en Tareas de Memória. Los resultados de las subpruebas de Aritmética, Dígitos y Secuencia de Números y Letras WAIS III se correlacionaron con los juicios de los ancianos y sus allegados sobre el desempeño de los ancianos en las subpruebas. Se encontraron correlaciones fuertes y significativas entre los juicios y el desempeño real para las tres subpruebas y se encontraron correlaciones moderadas y significativas entre los juicios de personas cercanas y el desempeño real de los ancianos en las subpruebas. Los resultados indicaron que los ancianos, los cuidadores / miembros de la familia pueden juzgar adecuadamente el desempeño en las tareas de memória

National Brazilian survey on the outcomes of hepatitis c retreatment in patients non-responders to direct antiviral agents.

BACKGROUND AND AIMS: Treatment of hepatitis C with direct antiviral agents (DAA) is associated with almost 95% of sustained virological response. However, some patients need retreatment. In Brazil, it should be done according to the Ministry of Health guidelines, frequently updated to include newly available drugs. This study aimed to conduct a national survey about the characteristics and outcomes of retreatment of hepatitis C in previously non-responders to DAAs. PATIENTS AND METHODS: Institutions from all over the country were invited to participate in a national registry for retreatment, including information about clinical and epidemiological characteristics of the patients, type and outcomes of retreatment regimens. Only patients previously treated with interferon-free regimens were included. RESULTS: As previous treatments the distribution was: SOF/DCV (56%), SOF/SIM (22%), 3D (11%), SOF/LED (6%) and SOF/RBV (5%). For retreatment the most frequently used drugs were SOF/GP (46%), SOF/DCV (23%) and SOF/VEL (11%). From 159 patients retreated, 132/159 (83%) had complete information in the registry and among them only seven patients were non-responders (SVR of 94.6%). All retreatments were well tolerated, without any serious adverse events or interruptions. CONCLUSION: The retreatment of patients previously non-responders to DAAs was associated with high rate of SVR in this sample of Brazilian patients. This finding allows us to conclude that the retreatment options available in the public health system in Brazil are effective and safe and are an important component of the strategy of elimination of hepatitis C in our country.

Outcome of liver cancer patients with SARS-CoV-2 infection: An International, Multicentre, Cohort Study.

BACKGROUND & AIMS: Information about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with liver cancer is lacking. This study characterizes the outcomes and mortality risk in this population. METHODS: Multicentre retrospective, cross-sectional, international study of liver cancer patients with SARS-CoV-2 infection registered between February and December 2020. Clinical data at SARS-CoV-2 diagnosis and outcomes were registered. RESULTS: Two hundred fifty patients from 38 centres were included, 218 with hepatocellular carcinoma (HCC) and 32 with intrahepatic cholangiocarcinoma (iCCA). The median age was 66.5 and 64.5 years, and 84.9% and 21.9% had cirrhosis in the HCC and iCCA cohorts respectively. Patients had advanced cancer stage at SARS-CoV-2 diagnosis in 39.0% of the HCC and 71.9% of the iCCA patients. After a median follow-up of 7.20 (IQR: 1.84-11.24) months, 100 (40%) patients have died, 48% of the deaths were SARS-CoV-2-related. Forty (18.4%) HCC patients died within 30-days. The death rate increase was significantly different according to the BCLC stage (6.10% [95% CI 2.24-12.74], 11.76% [95% CI 4.73-22.30], 20.69% [95% CI 11.35-31.96] and 34.52% [95% CI 17.03-52.78] for BCLC 0/A, B, C and D, respectively; p = .0017). The hazard ratio was 1.45 (95% CI 0.49-4.31; p = .5032) in BCLC-B versus 0/A, and 3.13 (95% CI 1.29-7.62; p = .0118) in BCLC-C versus 0/A in the competing risk Cox regression model. Nineteen out of 32 iCCA (59.4%) died, and 12 deaths were related to SARS-CoV-2 infection. CONCLUSIONS: This is the largest cohort of liver cancer patients infected with SARS-CoV-2. It characterizes the 30-day mortality risk of SARS-CoV-2 infected patients with HCC during this period.

Exploring Depressive Symptoms Among Healthcare Professionals and the General Population During the COVID-19 Pandemic in Brazil.

Our study aimed to examine the symptoms that might play a role in the co-occurrence of 9 DSM-5 symptom criteria of major depression among Brazil's adult population and healthcare professionals after three months of detecting the new coronavirus in Brazil. We estimated regularized Gaussian graphical models for both samples and compared the network structures. Depressed mood was the most central symptom in the general population network compared to the healthcare professional network. The findings revealed some individual symptoms showed a differential association between the general population and healthcare professionals. Those symptoms may be valuable targets for future research and treatment.

National Brazilian survey on the outcomes of hepatitis c retreatment in patients non-responders to direct antiviral agents

ABSTRACT Background and aims: Treatment of hepatitis C with direct antiviral agents (DAA) is associated with almost 95% of sustained virological response. However, some patients need retreatment. In Brazil, it should be done according to the Ministry of Health guidelines, frequently updated to include newly available drugs. This study aimed to conduct a national survey about the characteristics and outcomes of retreatment of hepatitis C in previously non-responders to DAAs. Patients and methods: Institutions from all over the country were invited to participate in a national registry for retreatment, including information about clinical and epidemiological characteristics of the patients, type and outcomes of retreatment regimens. Only patients previously treated with interferon-free regimens were included. Results: As previous treatments the distribution was: SOF/DCV (56%), SOF/SIM (22%), 3D (11%), SOF/LED (6%) and SOF/RBV (5%). For retreatment the most frequently used drugs were SOF/GP (46%), SOF/DCV (23%) and SOF/VEL (11%). From 159 patients retreated, 132/159 (83%) had complete information in the registry and among them only seven patients were non-responders (SVR of 94.6%). All retreatments were well tolerated, without any serious adverse events or interruptions. Conclusion: The retreatment of patients previously non-responders to DAAs was associated with high rate of SVR in this sample of Brazilian patients. This finding allows us to conclude that the retreatment options available in the public health system in Brazil are effective and safe and are an important component of the strategy of elimination of hepatitis C in our country.

Avaliação de Crenças sobre Violência no Namoro (ACVN): Um Novo Instrumento Brasileiro / Evaluation of Attitudes on Dating Violence (EADV): A New Brazilian Instrument / Evaluación de Actitudes sobre la Violencia en el Noviazgo (EADV): Un Nuevo Instrumento Brasileño

Resumo As pesquisas sobre violência no namoro são desafiadoras pela falta de instrumentos validados na população brasileira. O objetivo deste estudo foi analisar propriedades psicométricas do instrumento Avaliação de Crenças sobre Violência no Namoro (ACVN). A amostra foi composta por 1.027 estudantes universitários das 5 regiões brasileiras, com idade média de 22,5 anos (DP = 3,7), que responderam 39 itens. Uma Exploratory Graph Analysis (EGA) foi utilizada em 513 respostas, estabelecendo 3 dimensões com boa consistência interna: Violência Psicológica e Física (α = 0,85), Empatia (α = 0,78) e Stalking (α = 0,87). Uma análise fatorial confirmatória com 514 participantes apresentou adequação. Os resultados demonstram a adequação do instrumento e a possibilidade de uso para população brasileira em pesquisas e intervenções.

Abstract Lack of assessment tools for the Brazilian population is a challenge regarding dating violence. Aim of this study was to analyze psychometric properties of the instrument Evaluation of attitudes on dating violence (EADV). Sample comprised 1,027 university students from five Brazilian regions with a mean age of 22.5 years (SD = 3.7) who answered 39 items. An Exploratory Graph Analysis (EGA) was used with 513 participants establishing three dimensions with good internal consistency (Psychological and Physical Violence (α = 0.85), Empathy (α = 0.78), Stalking (α = 0.87)). A confirmatory factorial analysis with 514 participants showed adequate results. Results show the scale reliability and adequacy to its use with the Brazilian population on research and intervention.

Resumen Investigaciones sobre violencia en noviazgo es desafiada por la falta de herramientas de evaluación validadas para la población brasileña. El objetivo de este estudio fue analizar las propiedades psicométricas del instrumento Evaluación de actitudes sobre violencia de pareja (EADV). La muestra consistió en 1.027 estudiantes universitarios de cinco regiones brasileñas con edad media de 22.5 años (DE = 3.7) que respondieron 39 ítems. Se utilizó análisis gráfico exploratorio (EGA) con 513 participantes estableciendo tres dimensiones con buena consistencia interna (violencia psicológica y física (α = 0.85), empatía (α = 0.78), stalking (α = 0.87)). Análisis factorial confirmatorio con 514 participantes mostró resultados adecuados. Los resultados demuestran la adecuación del instrumento y la posibilidad de uso para la población brasileña en investigaciones e intervenciones.

Association of IL-9, IL-10, and IL-17 Cytokines With Hepatic Fibrosis in Human Schistosoma mansoni Infection.

This is a case series study to evaluate immunological markers associated with schistosomiasis advanced fibrosis, including 69 patients from an endemic area from the State of Sergipe and from the Hepatology Service of the University Hospital in Sergipe, Brazil. Hepatic fibrosis was classified based on Niamey protocol for ultrasonography (US). Immune response to Schistosoma mansoni antigens was evaluated by stimulating peripheral blood mononuclear cells (PBMCs) from these patients with either adult worm (SWAP-10 µg/ml) or egg (SEA-10 µg/ml) antigens or purified protein derivative of turberculin (PPD-10 µg/ml) or phytohemagglutinin (PHA-1 µg/ml) for 72 h. The levels of IFN-γ, TNF-α, IL-5, IL-10, and IL-17 were measured in these supernatants by ELISA and IL-9 by Luminex. Single nucleotide polymorphisms in IL-17, IL10, and CD209 genes were genotyped using TaqMan probe by qPCR. Higher levels of IL-9, IL-10, and IL-17 were found in PBMC supernatants of patients with advanced hepatic fibrosis. Direct correlations were detected between IL-9 and IL-17 levels with US spleen sizes, portal vein diameters, and periportal thickening. The CD209 rs2287886 AG polymorphism patients produce higher IL-17 levels. Together, these data suggest a role of these cytokines in the immunopathogenesis of advanced fibrosis in human schistosomiasis.

Factors associated with mental health and quality of life during the COVID-19 pandemic in Brazil.

BACKGROUND: Although mental distress and quality of life (QoL) impairments because of the pandemic have increased worldwide, the way that each community has been affected has varied. AIMS: This study evaluated the impact of social distancing imposed by coronavirus disease-2019 (COVID-19) on Brazilians' mental health and QoL. METHOD: In this cross-sectional community-based online survey, data from 1156 community-dwelling adults were gathered between 11 May and 3 June 2020. We examined independent correlates of depression, anxiety and QoL, including sociodemographic and clinical characteristics, optimism/pessimism and spiritual/religious coping. Dependent variables were assessed using the 9-item Patient Health Questionnaire for depressive symptoms, the 7-item Generalized Anxiety Disorder Scale for anxiety symptoms, and the World Health Organization Quality of Life-BREF for QoL. Correlates of depressive and anxiety disorder were estimated using logistic regression. RESULTS: There were high levels of depressive symptoms (41.9%) and anxiety symptoms (29.0%) in participants. Negative spiritual/religious coping was positively correlated with depressive disorder (odds ratio (OR) = 2.14 95% CI 1.63-2.80; P < 0.001) and with anxiety disorder (OR = 2.46 95% CI 1.90-3.18; P < 0.001), and associated with worse social and environmental QoL (P < 0.001). Healthcare professionals were less likely to have depressive symptoms (OR = 0.71, 95% CI 0.55-0.93; P < 0.001). Participants with friend/family with COVID-19 scored lower on psychological and environmental QoL (P < 0.05). Participants with a longer duration of social isolation were less likely to experience anxiety disorder (OR = 0.99, 95% CI 0.98-0.99; P = 0.004). CONCLUSIONS: We found high levels of depressive and anxiety symptoms and low levels of QoL in Brazil, which has become a pandemic epicentre. Several characteristics were associated with negative mental health symptoms in this study. This information may contribute to local health policies in dealing with the mental health consequences of COVID-19.

Influence of overcommitment on the quality of life and on climacteric symptoms in nursing professionals.

OBJECTIVE: To describe the general characteristics of nursing professionals and assess the influence of overcommitment on perceived climacteric symptoms and on the quality of life of nursing professionals. METHOD: A cross-sectional, analytical study of 152 nursing auxiliaries and assistants aged 40 years or older was conducted at 3 hospitals in the interior of São Paulo state. Sociodemographic data were collected and the Blatt-Kupperman Menopausal Index, Women´s Health Questionnaire, Medical Outcome Study 36-item Short Form Health Survey and Effort-Reward Imbalance were applied in 2017. A descriptive analysis was performed and network analysis was carried out. RESULTS: Participants had a mean age of 50.23 years (SD ±7.1). Group 1 comprising 61 (40.1%) women with overcommitment had poorer quality of life as well as more severe climacteric symptoms. CONCLUSIONS: Presence of overcommitment seems to influence the negative perception of climacteric symptomatology and quality of life.

Psychometric properties of the falls efficacy scale-international and validating the short version among older Brazilians.

OBJECTIVES: The aim of this study was to: (1) confirm the reliability and validity of a single factor structure for the 16-item FES-I within a Brazilian context; and (2) confirm the reliability and validity of the abbreviated Short FES-I (7 items) within a Brazilian context. METHODS: We compared the reliability and construct validity of the unidimensional FES-I and the Short FES-I among older Brazilians. Our analyses included confirmatory factor analyses, and discriminatory validity and internal reliability consistency comparisons. RESULTS: The unidimensional FES-I (α = 0.94; CFI = 0.98; RMSEA = 0.08) and the Short FES-I (α = 0.87; CFI = 0.98; RMSEA = 0.07) are equally valid and reliable measures. CONCLUSION: The FES-I is best represented as a unifactorial structure yielding a total Fear of Falling score. Researchers and healthcare professionals can also use the equally robust Short-FES-I to best minimize responder burden.

Influence of overcommitment on the quality of life and on climacteric symptoms in nursing professionals / Influencia del compromiso excesivo sobre la calidad de la vida y en los síntomas del climaterio de profesionales de enfermería / Influência do comprometimento excessivo na qualidade de vida e nos sintomas do climatério de profissionais da enfermagem

ABSTRACT Objective: To describe the general characteristics of nursing professionals and assess the influence of overcommitment on perceived climacteric symptoms and on the quality of life of nursing professionals. Method: A cross-sectional, analytical study of 152 nursing auxiliaries and assistants aged 40 years or older was conducted at 3 hospitals in the interior of São Paulo state. Sociodemographic data were collected and the Blatt-Kupperman Menopausal Index, Women´s Health Questionnaire, Medical Outcome Study 36-item Short Form Health Survey and Effort-Reward Imbalance were applied in 2017. A descriptive analysis was performed and network analysis was carried out. Results: Participants had a mean age of 50.23 years (SD ±7.1). Group 1 comprising 61 (40.1%) women with overcommitment had poorer quality of life as well as more severe climacteric symptoms. Conclusions: Presence of overcommitment seems to influence the negative perception of climacteric symptomatology and quality of life.

RESUMEN Objetivo: Describir las características generales de los profesionales de enfermería y evaluar cómo el compromiso excesivo puede influir en la percepción de los síntomas del climaterio y la calidad de vida de estas mujeres. Métodos: Este es un estudio analítico de corte transversal que evaluó a 152 auxiliares de enfermería y técnicas en el grupo de edad de 40 años en 3 hospitales em el interior del estado de São Paulo. En 2017, se recopilaron los datos sociodemográficos y se aplicaron el Índice de Menopausia de Blatt-Kupperman, Women´s Health Questionnaire, El Cuestionario de Salud SF-36 y El Cuestionario Effort-reward Imbalance. Análisis descriptivo y análisis de red se realizó. Resultados: La edad promedio de los participantes fue de 50,23 años (DP = ± 7,1). Grupo 1 compuesto por 61 (40.1%) mujeres con compromiso excesivo fue la peor calidad de vida y la mayor intensidad de síntomas climáticos. Conclusiones: La presencia de compromiso excesivo parece influir en una percepción negativa de la sintomatología climática y una peor calidad de vida.

RESUMO Objetivo: Descrever as características gerais das profissionais de enfermagem e avaliar como o comprometimento excessivo pode influenciar na percepção dos sintomas do climatério e na qualidade de vida dessas mulheres. Método: trata-se de estudo transversal analítico, que avaliou 152 auxiliares e técnicas da enfermagem, na faixa etária de 40 anos ou mais, em 3 hospitais do interior do estado de São Paulo. Em 2017, foram coletados dados sociodemográficos e aplicados os instrumentos Índice Menopausal de Blatt-Kupperman, Questionário Saúde da Mulher, Medical Outcome Study 36-item short form Health Survey e Effort Reward Imbalance. Foi realizada análise descritiva e análise de rede. Resultados: A idade média das participantes foi de 50,23 anos (DP = ±7,1). O grupo 1, composto por 61(40,1%) mulheres com comprometimento excessivo apresentou pior qualidade de vida e maior intensidade de sintomas climatéricos. Conclusões: Presença de comprometimento excessivo parece influenciar em uma percepção negativa da sintomatologia do climatério e em uma pior qualidade de vida.

International and multicenter real-world study of sorafenib-treated patients with hepatocellular carcinoma under dialysis.

BACKGROUND & AIMS: Information on safety and efficacy of systemic treatment in patients with hepatocellular carcinoma (HCC) under dialysis are limited due to patient exclusion from clinical trials. Thus, we aimed to evaluate the rate, prevalence, tolerability, and outcome of sorafenib in this population. METHODS: We report a multicenter study comprising patients from Latin America and Europe. Patients treated with sorafenib were enrolled; demographics, dose modifications, adverse events (AEs), treatment duration, and outcome of patients undergoing dialysis were recorded. RESULTS: As of March 2018, 6156 HCC patients were treated in 44 centres and 22 patients were concomitantly under dialysis (0.36%). The median age was 65.5 years, 40.9% had hepatitis C, 75% had Child-Pugh A, and 85% were Barcelona Clinic Liver Cancer-C. The median time to first dose modification, treatment duration and overall survival rate were 2.4 months (interquartile ranges [IQR], 0.8-3.8), 10.8 months (IQR, 4.5-16.9), and 17.5 months (95% CI, 7.2-24.5), respectively. Seventeen patients required at least 1 dose modification. The main causes of first dose modification were asthenia/worsening of Eastern Cooperative Oncology Group-Performance Status and diarrhoea. At the time of death or last follow-up, four patients were still on treatment and 18 had discontinued sorafenib: 14 were due to tumour progression, 2 were sorafenib-related, and 2 were non-sorafenib-related AE. CONCLUSIONS: The outcomes observed in this cohort seem comparable to those in the non-dialysis population. Thus, to the best of our knowledge, this is the largest and most informative dataset regarding systemic treatment outcomes in HCC patients undergoing dialysis.

Symptoms of mood disorders in family carers of older people with dementia who experience caregiver burden: a network approach.

BACKGROUND: informal carers of people with dementia are at greater risk of anxiety and depressive disorders if they find caregiving to be a burden. The aim of this study was to use a network analysis of cross-sectional data to investigate the relationships between anxiety and depressive symptoms in family carers of older people with dementia who experience burden. METHODS: sixty family carers exhibiting high levels of burden using the Zarit Burden Interview were included in the study. Participants completed the Hospital Anxiety and Depression Scale. The network analysis identified the depression and anxiety symptom network using features including a topological graph, network centrality metrics and community analysis. The network was estimated through the graphical LASSO technique in combination with a walktrap algorithm to obtain the clusters within the network and the connections between the nodes (symptoms). A directed acyclic graph was generated to model symptom interactions. RESULTS: the resulting network architecture shows important bridges between depression and anxiety symptoms. Lack of pleasure and loss of enjoyment were identified as potential gateway symptoms to other anxiety and depression symptoms and represent possible therapeutic targets for psychosocial interventions. Fear and loss of optimism were highly central symptoms, indicating their importance as warning signs of more generalised anxiety and depression. CONCLUSIONS: this network analysis of depressive and anxiety symptoms in overburdened family carers provides important insights as to what symptoms may be the most important targets for behavioural interventions.