Past trends and future projections of palliative care needs in Chile: analysis of routinely available death registry and population data.

BACKGROUND: The number of people with palliative care needs is projected to increase globally. Chile has recently introduced legislation for universal access to palliative care services for patients with severe and terminal illnesses, including non-cancer conditions. We aimed to estimate the number of people affected by serious health-related suffering and need for palliative care in Chile to 2050. METHODS: We used data on all deaths registered in Chile between 1997-2019 and population estimates for 1997-2050. We used Poisson regression to model past trends in causes of death adjusted by age, sex and population estimates, to project the number of deaths for each cause from 2021 to 2050. We applied the Lancet Commission on Palliative Care and Pain Relief weights to these projections to identify decedents and non-decedents with palliative care needs. RESULTS: Population palliative care needs in Chile are projected to increase from 117 (95% CI 114 to 120) thousand people in 2021 to 209 (95% CI 198 to 223) thousand people in 2050, a 79% increase (IRR 1.79; 95% CI 1.78-1.80). This increase will be driven by non-cancer conditions, particularly dementia (IRR 2.9, 95% CI 2.85-2.95) and cardiovascular conditions (IRR 1.86, 95% CI 1.83-1.89). By 2050, 50% of those estimated to need palliative care will be non-decedents (not expected to die within a year). CONCLUSIONS: Chile will experience a large increase in palliative care needs, particularly for people with dementia and other non-cancer conditions. Improved availability of high-quality services, expanded clinician training and new sustainable models of care are urgently required to ensure universal access to palliative care.

Examining posttraumatic growth among Turkish family caregivers of cancer patients.

Cancer is a deadly disease that affects millions of people worldwide and is a source of great difficulty, stress, and trauma not only for patients but also for their caregivers. The physical and emotional suffering that patients experience by patients can lead their caregivers to cope with constant anxiety, sadness, and uncertainty. Moreover, during the cancer treatment process, caregivers must make a great effort to meet the needs of patients and support them. This situation may negatively affect the quality of life and psychological health of cancer patients' caregivers and may lead them to experience trauma. The aim of this cross-sectional study was to examine posttraumatic growth's relationship with age, the transformative power of suffering, and hope in family caregivers of cancer patients. Participants consisted of 314 Turkish family caregivers of cancer patients (73.2% women; Mage = 39.89 years) selected by using convenience sampling method. Participants answered a data collection tool consisting of a demographic information form, the Posttraumatic Growth Inventory, Trait Hope Scale, and Transformative Power of Suffering Scale. Data were analyzed using descriptive statistics, the Pearson product-moment correlation coefficient analysis, simple mediation analysis, and moderated mediation analysis. The results of this study revealed that hope mediated the association between the transformative power of suffering and posttraumatic growth in family caregivers of cancer patients, whereas age moderated this relationship. Psychosocial support programs for cancer caregivers could benefit from incorporating interventions that explore the transformative potential of suffering and cultivate hope. Tailoring these interventions to address the specific needs of different age groups may enhance their effectiveness. Future researchers should investigate the factors associated with posttraumatic growth in caregivers across diverse cultures, age ranges, and cancer diagnoses.

Excruciating existential suffering and complicated grief: The essence of surviving the suicide of a son or daughter.

BACKGROUND: Suicide is the fourth most common cause of death for the 15-29 age group. Research on the impact of suicide on parents is scarce and, therefore, poorly understood. AIM: To explore parents' experiences who have lost a son or a daughter due to suicide and their experience of the services available to them. METHODS: This phenomenological study involved 1-2 interviews with ten parents aged 40-65, seven mothers and three fathers in all 13 interviews. The age range of their sons and daughters was 17-37 years when they died. RESULTS: For the parents, losing a son or a daughter to suicide is an overwhelming life experience characterised by Excruciating existential suffering and complicated grief where they are confronted with deep meaning-making and existential questions without answers since the person who can answer most of them is no longer alive. They, therefore, felt stuck in their grief for up to 4 years. The initial experience was an immense paralysing shock and sense of unreality. The subsequent period was a blur, and they were numb. Then, their psyche and bodies collapsed, and for a long time, they felt no grief processing was taking place. They sorely needed long-term professional trauma-informed support and felt that, in too many cases, they had to reach out for help themselves. They would have liked to see the healthcare system embrace them with more open arms, offer help and be met with information and individualised support. CONCLUSIONS: Standard operating procedures must be installed to support suicide-bereaved parents better. Long-term professional support and trauma-focused care are required following such major trauma, and providing such support could help to reduce their adverse health impacts. Nurses and other health professionals must be better educated on existential suffering in this context.

Societal Perception of Animal Videos on Social Media-Funny Content or Animal Suffering? A Survey.

On social media, numerous animal videos are uploaded and viewed every day. However, these videos, which are apparently funny for humans, are often associated with animal suffering. In this study, 3246 participants of an online survey were asked about their personal perception of animal videos on social media, about recognising animal suffering in these videos, and about their respective reactions. A total of 98.5% of participants who used social media already saw animal videos. Participants most frequently viewed informative videos (52.9%), followed by funny/entertaining animal videos (41.8%). For 45.8% of participants, animal suffering was often recognisable in animal videos. Female participants were more likely to recognise animal suffering than male participants (p < 0.001), and participants living in a rural residence were more likely to recognise it than those from an urban residence (p = 0.017). Furthermore, 62.5% of participants had left a critical comment or disliked a video with animal suffering. Animal videos seem to be highly popular on social media, but animal suffering may go unnoticed in funny videos. The fact that 91.8% of participants want a warning label for animal suffering in videos shows that social media users would like to see animal welfare be given more prominence on social media.

Examining Relationships Among Nursing Students' Views of Suffering, Positive Thinking, and Professional Quality of Life.

BACKGROUND: Exposure to suffering can lead to compassion fatigue in undergraduate nursing students. OBJECTIVE: Guided by resilience theory, a cross-sectional, correlational design was used to investigate the potential moderating effect of positive thinking skills on the relationships between views of suffering, compassion fatigue, and compassion satisfaction. RESULTS: In 157 undergraduate nursing students, multiple regressions revealed that views of suffering and positive thinking explained 23.8% of the variance in compassion satisfaction (F11,145 = 4.121, P < .001), and 21.9% of the variance in burnout (F11,144 = 3.786, P < .001). The Suffering God view, which stresses the presence of a compassionate deity amid suffering, and positive thinking had significant main effects on compassion satisfaction (ß = 0.349, P = .025; and ß = 0.309, P < .001, respectively). Positive thinking, the Suffering God view, and the Random view, in which the occurrence of suffering is random and purposeless, had significant main effects on burnout (ß = -0.280, P < .001; ß = -0.392, P = .014; and ß = -0.206, P = .014, respectively). The Unorthodox view, in which a deity exists that allows suffering, had a significant main effect on secondary traumatic stress (ß = 0.232, P = .027). Positive thinking did not moderate any of the relationships between the views of suffering and the dependent variables. CONCLUSIONS: Knowledge of these relationships can aid in the assessment of nursing students at risk for poor outcomes and guide intervention development to promote professional quality of life.

A Post-reflective Examination of the Physical and Mental Health Suffering During COVID-19 Through the Lens of Christ's Kenotic and Redemptive Act.

The COVID-19 global pandemic has brought unprecedented physical and mental health challenges to many, making the exploration of the spiritual dimension of suffering increasingly meaningful and relevant. Pope John Paul II's theologico-pastoral approach in Salvifici Doloris (SD) sheds light on how spiritual reflections and pastoral care anchored on the theology of Jesus Christ's sufferings can be put together to contribute to post-COVID-19 reflections. Given this context, this paper explores the perceptions and coping mechanisms of COVID-19 patients as they navigate the challenges of their illness. By examining patient experiences gleaned from medical and scientific journals, the study underscores the necessity of supporting individuals suffering from various diseases. As John Paul II thoughtfully remarks in Salvifici Doloris, there is a profound need to address patients' inquiries about "the cause, the reason, and equally, the purpose of suffering, and, in brief, a question about its meaning." Taking this into account, this paper contextualizes the theology of suffering articulated by Pope John Paul II in SD within the experiences of patients who contracted COVID-19 during the global pandemic. To embark on this discussion, the following themes about suffering are expounded: First, Insights into the Weight of Suffering Among Persons who Contracted COVID-19. Second, Understanding of Suffering in Salvifici Doloris, and Third, The Salvific Meaning of Suffering in COVID-19 and its Transformative Experience.

Serious Health-Related Suffering Impairs Treatments and Survival in Older Patients With Cancer.

CONTEXT: More than half of new cancer cases occurred in older adults. Older patients with cancer are particularly at risk of physical, psycho-existential or socio-familial suffering as defined by the concept of Serious Health-related Suffering (SHS). OBJECTIVES: To assess the direct and indirect effects of physical, psycho-existential and socio-familial dimensions of suffering on cancer treatability, supportive care needs and 12-month mortality in older patients with cancer. METHODS: We included patients with cancer aged 70 years and over from the Elderly Cancer Patients cohort (ELCAPA, Ile-de-France), referred for geriatric assessment between 2007 and 2019 before cancer treatment. Structural equation modelling examined the direct and indirect relationships between SHS dimensions (latent variables), patients' characteristics (age, sex, tumor location and metastatic status, comorbidity, period of care), and outcomes. RESULTS: The analysis included 4,824 patients (mean age: 82.2 ± 4 years; women: 56%; main cancer sites: breast [22.3%], colorectal [15.2%], prostate [8.5%], and lung [6.8%]; metastatic cancer: 46%). Physical suffering had direct pejorative effects on cancer treatability, and mortality (standardized coefficient [SC] = 0.12 [P < 0.001], SC = 0.27 [P < 0.001], respectively). Psycho-existential and socio-familial sufferings had indirect pejorative effects on survival through decreased cancer treatability (SC = 0.08 [P < 0.001], SC = 0.03 [P < 0.001], respectively). Psycho-existential dimension had the main direct effect size on supportive care needs (SC = 0.35 [P < 0.001]) and was interrelated with physical suffering. CONCLUSION: Physical suffering has direct pejorative effect on survival. All dimensions indirectly decrease survival due to poorer cancer treatability. Our findings support concomitant management of physical and psycho-existential suffering.

Why do people engage with the suffering of strangers? Exploring epistemic, eudaimonic, social, and affective motives.

Reading violent stories or watching a war documentary are examples in which people voluntarily engage with the suffering of others whom they do not know. Using a mixed-methods approach, we investigated why people make these decisions, while also mapping the characteristics of strangers' suffering to gain a rich understanding. In Study 1 (N = 247), participants described situations of suffering and their reasons to engage with it. Using qualitative thematic analysis, we developed a typology of the stranger (who), the situation (what), the source (how), and the reason(s) for engaging with the situation (why). We categorised the motives into four overarching themes - epistemic, eudaimonic, social, and affective - reflecting diversity in the perceived functionality of engaging with a stranger's suffering. Next, we tested the robustness of the identified motives in a quantitative study. In Study 2, participants (N = 250) recalled a situation in which they engaged with the suffering of a stranger and indicated their endorsement with a variety of possible motives. Largely mirroring Study 1, Study 2 participants engaged to acquire knowledge, for personal and social utility, and to feel positive and negative emotions. We discuss implications for understanding the exploration of human suffering as a motivated phenomenon.

Successful Use of Propofol After Failed Palliative Sedation in Patients With Refractory Symptoms.

Context: Propofol is a general anesthetic used in multiple clinical scenarios. Despite growing evidence supporting its use in palliative care, propofol is rarely used in palliative sedation. Reluctance toward the adoption of propofol as a sedative agent is often associated with fear of adverse events such as respiratory arrest. Objectives: We aimed to describe efficacy and safety of palliative sedation in refractory sedation with propofol using a protocol based on low, incremental dosing. Methods: A retrospective observational study featuring inpatients receiving sedative treatment with propofol in our palliative care unit in Madrid (Spain) between March 1, 2018 and February 28, 2023, following a newly developed protocol. Results: During the study period, 22 patients underwent sedation with propofol. Propofol was used successfully to control different refractory symptoms, mainly psychoexistential suffering and delirium. All patients had undergone previous failed attempts at sedation with other medications (midazolam or lemovepromazine) and presented risk factors for complicated sedation. All patients achieved satisfactory (profound) levels of sedation measured with the Ramsay Sedation Scale, but total doses varied greatly between patients. Most patients (17, 77%) received combined therapy with propofol and other sedative medications to harness synergies. The median time between start of sedation with propofol and death was 26.0 hours. No cases of apnea or death during induction were recorded. Conclusion: A protocol for palliative sedation with propofol based on low, incremental dosing, with the option of administering an initial induction bolus, shows excellent results regarding adequate levels of sedation, without observing apnea or respiratory depression. Our results promote the use of propofol to achieve palliative sedation in patients with refractory symptoms and risk factors for complicated sedation at the end of life.

Investigating the role of adversity and benevolence beliefs in predicting prosociality.

BACKGROUND: Does experiencing adversity engender kindness, and if so, for whom? Two studies tested the hypothesis that adversity predicts increased pro-social outcomes, and that this relationship is strongest for individuals who view others as good and trustworthy, or benevolent. METHOD: In Study 1, a cross-sectional survey design was utilized, and in Study 2 a longitudinal survey was conducted. RESULTS: In Study 1 (N = 359), the number of lifetime adverse life events was associated with increased volunteering, empathic concern, and self-reported altruism. The association of adversity and altruism was stronger for those with greater benevolence beliefs. In Study 2 (N = 1157), benevolence beliefs were assessed, and in subsequent years, adverse life events were reported. The number of past-year adverse life events predicted more volunteering and charitable involvement, but only among people with high benevolence beliefs. CONCLUSION: Exposure to adversity may be associated with increased pro-social behavior among those with higher benevolence beliefs. In part, this could be due to benevolence beliefs increasing the expectation that one's efforts will be appreciated and reciprocated.

Comparing the Need and Development of Pediatric Palliative Care in Mexico: A Geographical Analysis.

CONTEXT: The Global Atlas of Palliative Care (GAPC) ranked Mexico's palliative care services at a preliminary integration stage into mainstream healthcare services. However, this data does not reflect pediatric palliative care (PPC) development. OBJECTIVES: To analyze the current need and level of development of PPC within Mexico. METHODS: PPC need was estimated using causes of death associated with serious health-related suffering from national mortality data from the General Directorate of Health Information. The level of development was measured through six indicators involving access to PPC services and opioids, then classified using the GAPC development categories adapted to regional territories based on available data. RESULTS: In 2021, 37,444 children died in Mexico. Of those, 10,677 (28.29%) died from conditions with serious health-related suffering, averaging a need for PPC of 25/100,000 children. Out of Mexico's 32 states, two (6.2%) had no PPC activity (category 1), twenty (62.6%) were in a capacity-building phase (category 2), eight (25%) had isolated PPC provision (category 3a), while two (6.2%) had generalized PPC provision (category 3b). No state had early (category 4a) or advanced PPC integration (category 4b). Overall, Mexico was classified as category 2. CONCLUSIONS: PPC services are distributed unevenly across the country, leading to inequitable access to care and an inability to meet the needs of patients and families. There is a disparity between the level of development of adult palliative care services and the underdevelopment of PPC in Mexico. This information can help stakeholders guide the development of PPC where it is needed most.

The postmodern subject from a psychopolitical perspective: An analysis from logotherapy. / El sujeto posmoderno desde una visión psicopolítica: análisis desde la logoterapia.

From a hermeneutic interpretation, this article analyzed the new psychic pandemic configuring a typology of psychopolitical man, provided by digital swarms and mass psychology, that, from logotherapy, can be perceived as a postmodern collective neurosis. We also analyze a self's hyper-reflection as a social phenomenon of psychopolitics, suffering as repression, and the love of narcissistic consumption. Consolidating a sense of life as a social ethos is the answer to finding compromises and responsibility for the individual mission that every human being has as a member of a community and society.En este ensayo se abordó la nueva pandemia psíquica desde una interpretación hermenéutica. Esta pandemia configura una tipología de persona psicopolítica, dada por enjambres digitales y una psicología de masas que, desde la logoterapia, se puede percibir como neurosis colectivas postmodernas. También se puede analizar como fenómenos sociales de la psicopolítica. Esta es una hiperreflexión del propio yo, el sufrimiento como represión y el amor de consumo narcisista. El consolidar un sentido de vida como ethos social, es la respuesta para hallar compromisos y responsabilidad ante la misión personal que tiene cada ser humano como miembro de una comunidad y sociedad.

Relational vulnerability in motherhood-an existential perspective on pain and exhaustion among women.

Introduction: Stress-related ill-health like pain and exhaustion are demanding public health problems in Europe. In Sweden, women are particularly at risk to develop stress-related ill-health during a period in life that coincides with child-rearing years. When entering motherhood, Swedish women's sick leave substantially increases. Yet, motherhood is rarely acknowledged in clinical encounters concerning pain and exhaustion although women suffer from these ailments more often than men. To incorporate motherhood as an existential dimension of health in the care of women living with pain and exhaustion might alleviate women's suffering. But knowledge on women's experiences of motherhood and health is scarce. Therefore, the aim of the study is to reach a deeper understanding of how women suffering from long-lasting pain and exhaustion experience their health in relation to motherhood. Methods: Ricoeur's interpretation theory has been applied to analyze 27 phenomenological interviews with 14 mothers suffering from long-lasting pain and exhaustion. Results: These women's experiences shed light on how closely motherhood is interwoven with the experience of their health and suffering: The women's suffering seems to be rooted in a relational vulnerability that has been uncovered during motherhood. Further, the women suffer from a burden of difficult life experiences and inner conflicts. Reconciliation with life is possible when women find an existential shelter, which offers ways to relate to their suffering making the own suffering more bearable.

Pigs in heaven: Enhancing the lives of breeding boars.

The recognition of animals as sentient beings has raised societal awareness of the welfare of farmed animals. This has been instrumental in increasing the legislative pressure towards welfare-conscious farming practices and, more lately, greater consumer demand for ethically sourced products. Besides, improved animal welfare is a key driver for enhanced performance, particularly in breeding boars, as welfare conditions strongly influence reproductive outcomes. The stressors associated with confinement impact testicular physiology and semen quality and the efforts to improve the welfare of breeding boars have so far focused on mitigating the negative consequences associated with stressors. The Five Freedoms framework and the European Food Safety Authority (EFSA)'s 'welfare consequences' approach prioritise the alleviation of suffering. In breeding boars, key welfare negative consequences include movement restriction, isolation stress, inability to engage in exploratory behaviours, locomotory disorders, and prolonged hunger. The negative consequences, which can be mitigated by improved housing and management practices, should be tackled in any commitment to improve the welfare of breeding boars. Animal welfare science, however, has recently shifted towards cultivating positive welfare experiences and a life worth living, beyond just alleviating suffering. The Five Domain Model systematically evaluates animal welfare, considering both negative and positive aspects. Encouraging positive welfare states involves facilitating species-specific behaviours, such as exploration and play, and fostering positive human-animal interactions. In breeding boars, strategies promoting positive welfare include providing enriching environments, encouraging exploration, and cultivating positive interactions with caretakers. Thus, for an overall welfare improvement of breeding boars, not only should the absence of suffering be guaranteed, but also the promotion of positive experiences that make their lifes worth living.

Dehumanization and Minimization of Informal Caregivers Suffering: The Legitimizing Role of Justice Perceptions.

Informal caregivers, who provide unpaid care work to individuals with disabilities, are devalued despite their important contributions to society. Identifying the factors contributing to their devaluation is crucial for recognizing and valuing their work. In two experimental studies, we examined (a) whether informal caregivers are dehumanized; (b) the moderating impact of belief in a just world (BJW) on this process; and (c) the predictive impact of BJW and the dehumanization of informal caregivers on the perception of informal caregivers' suffering. In Study 1 (N = 180), a 2 (informal caregiver vs. non-caregiver) X 2 (female vs. male) between-participants design was used; in Study 2 (N = 205), there were two experimental conditions: female informal caregiver vs. male informal caregiver. Participants were randomly assigned to one description of a target and were asked to complete measures assessing the dehumanization of the target (Studies 1 and 2), the perception of the suffering of the target (Study 2), and a measure of BJW referring to themselves (Study 2). Results showed the expected dehumanization effect, such that participants attributed fewer uniquely human emotions to informal caregivers compared to non-caregivers, regardless of their gender (Studies 1 and 2). However, this effect was observed only among participants with higher BJW (Study 2). Furthermore, BJW and the dehumanization of informal caregivers predicted the minimization of the perception of informal caregivers' suffering (Study 2). These results establish a theoretical relationship between these research areas and offer insights for practical implications and future research.

Cultivating staff equality, diversity, and inclusion in higher education in the post-pandemic era: an organizational compassion perspective.

The COVID-19 pandemic has exacerbated pre-existing challenges faced by academic staff in UK higher education and drawn attention to issues of Equality, Diversity, and Inclusion (EDI). Amidst global competitiveness and workplace pressures, challenges such as managerialism, increased workload, and inequalities have worsened, significantly impacting mental health. This paper presents a conceptual analysis connecting EDI with organizational compassion within the context of Higher Education. The prioritization of organizational compassion is presented as a means to enhance sensitivity to EDI in the reconstruction of post-pandemic learning environments. Anchored in the organizational compassion theory and the NEAR Mechanisms Model, our study contributes to the intersection of the organizational compassion, EDI and higher education literatures by exploring how fostering compassion relations can contribute to enhancing EDI. This offers a new perspective to creating a more humane and supportive higher education environment.

Experience of pre-suicidal suffering: insights from suicide attempt survivors.

PURPOSE: Psychache significantly contributes to the suicidal process. However, the transition from pre-suicidal suffering to a suicide crisis remains one of the least explored stages in suicidology. METHODS: We retrospectively explored experience of pre-suicidal suffering through semi-structured, in-depth interviews with 12 individuals recruited from the Vilnius City Mental Health Center, Lithuania. Interpretative phenomenological analysis was employed to identify recurring patterns. RESULTS: Nine primary group experiential themes emerged: Certain adverse life events occurring during the suicidal process were not immediately perceived as connected; Complex traumatic events laid the groundwork for a profound sense of lack; A compensatory mechanism balanced the experience of profound lack; Exhaustion ensued from efforts to sustain the compensatory mechanism; The main trigger directly challenged the compensatory mechanism; The affective state followed the experience of the main triggering event; Dissociation served to isolate psychache; Thoughts of suicide experienced as automatic; Suicide was perceived as a means to end suffering. CONCLUSION: The findings suggest that the suicidal process unfolds over an extended period of suffering, culminating in a crisis to alleviate unbearable psychological pain. In clinical practice, identifying the main triggering event discussed in this study can be pivotal in understanding the essence of suffering characterized by profound lacking and developed compensatory mechanisms.

Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico.

Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people's uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.

Is Suffering a Useless Concept?

"Suffering" is a central concept within bioethics and often a crucial consideration in medical decision making. As used in practice, however, the concept risks being uninformative, ambiguous, or even misleading. In this paper, we consider a series of cases in which "suffering" is invoked and analyze them in light of prominent theories of suffering. We then outline ethical hazards that arise as a result of imprecise usage of the concept and offer practical recommendations for avoiding them. Appeals to suffering are often getting at something ethically important. But this is where the work of ethics begins, not where it ends.

Exposure to tungsten particles via inhalation triggers early toxicity marker expression in the rat brain.

OBJECTIVE: Our work is focused on tungsten, considered as an emerging contaminant. Its environmental dispersion is partly due to mining and military activities. Exposure scenario can also be occupational, in areas such as the hard metal industry and specific nuclear facilities. Our study investigated the cerebral effects induced by the inhalation of tungsten particles. METHODS: Inhalation exposure campaigns were carried out at two different concentrations (5 and 80 mg/m3) in single and repeated modes (4 consecutive days) in adult rats within a nose-only inhalation chamber. Processes involved in brain toxicity were investigated 24 h after exposure. RESULTS AND DISCUSSION: Site-specific effects in terms of neuroanatomy and concentration-dependent changes in specific cellular actors were observed. Results obtained in the olfactory bulb suggest a potential early effect on the survival of microglial cells. Depending on the mode of exposure, these cells showed a decrease in density accompanied by an increase in an apoptotic marker. An abnormal phenotype of the nuclei of mature neurons, suggesting neuronal suffering, was also observed in the frontal cortex, and can be linked to the involvement of oxidative stress. The differential effects observed according to exposure patterns could involve two components: local (brain-specific) and/or systemic. Indeed, tungsten, in addition to being found in the lungs and kidneys, was present in the brain of animals exposed to the high concentration. CONCLUSION: Our data question the perceived innocuity of tungsten relative to other metals and raise hypotheses regarding possible adaptive or neurotoxic mechanisms that could ultimately alter neuronal integrity.