Cognitive trajectories after surgery: Guideline hints for assessment and treatment.

Elderly patients who undergo major surgery (not-neurosurgical) under general anaesthesia frequently complain about cognitive difficulties, especially during the first weeks after surgical "trauma". Although recovery usually occurs within a month, about one out of four patients develops full-blown postoperative Neurocognitive disorders (NCD) which compromise quality of life or daily autonomy. Mild/Major NCD affect approximately 10% of patients from three months to one year after major surgery. Neuroinflammation has emerged to have a critical role in the postoperative NCDs pathogenesis, through microglial activation and the release of pro-inflammatory cytokines which increase blood-brain-barrier permeability, enhance movement of leukocytes into the central nervous system (CNS) and favour the neuronal damage. Moreover, pre-existing Mild Cognitive Impairment, alcohol or drugs consumption, depression and other factors, together with several intraoperative and post-operative sequelae, can exacerbate the severity and duration of NCDs. In this context it is crucial rely on current progresses in serum and CSF biomarker analysis to frame neuroinflammation levels, along with establishing standard protocol for neuropsychological assessment (with specific set of tools) and to apply cognitive training or neuromodulation techniques to reduce the incidence of postoperative NCDs when required. It is recommended to identify those patients who would need such preventive intervention early, by including them in pre-operative and post-operative comprehensive evaluation and prevent the development of a full-blown dementia after surgery. This contribution reports all the recent progresses in the NCDs diagnostic classification, pathogenesis discoveries and possible treatments, with the aim to systematize current evidences and provide guidelines for multidisciplinary care.

Is there a Link between Non Melanoma Skin Cancer and Hydrochlorothiazide?

AIMS: Here in we evaluated the association between the use of Hydrochlorothiazide (HCTZ) and the risk of NMSC both, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BACKGROUND: Even though the use of HCTZ is not linked with the development of serious adverse drug reactions, non-melanoma skin cancer (NMSC) has been reported in patients treated with the drug in recent years, most likely due to its photosensitizing ability. OBJECTIVE: To evaluate the statistically significant difference (P<0.05) in the development of NMSC between HCTZ users and non-users and the correlation (P<0.05) between HCTZ use and NMSC. METHODS: We performed a retrospective study on patients referred to general practitioners who developed skin cancer or NMSC whether or not they were treated with antihypertensive drugs. Controls were matched with the test by age and sex. We calculated odds ratios (ORs) for skin cancer and NMSC associated with hydrochlorothiazide using conditional logistic regression. RESULTS: We enrolled 19,320 patients in the present study, out of a total of 10,110 (52.3%) who were treated with antihypertensive drugs. Of 10,110 patients, 3,870 were treated with HCTZ (38.3%). During the study, we failed to report an increased risk of NMSC in HCTZ-treated vs. untreated patients. Gender stratification revealed an OR for NMSC of 1.36 for men and 0.56 for women. We did not find a dose-response relationship between HCTZ use and NMSC. CONCLUSION: In the present study, we failed to report an association between the use of HCTZ and the development of NMSC.

Physical self-efficacy is associated to body mass index in schoolchildren / Autoeficácia física associada ao índice de massa corporal em crianças em idade escolar

Abstract: Objective: The present study aimed to investigate the relationship between physical self-efficacy and body mass index in a large sample of schoolchildren. Methods: The Perceived Physical Ability Scale for Children was administered to 1560 children (50.4% boys; 8-12 years) from three different countries. Weight and height were also recorded to obtain the body mass index. Results: In agreement with the literature, the boys reported greater perceived physical self-efficacy than girls. Moreover, the number of boys who are obese is double that of girls, while the number of boys who are underweight is half that found in girls. In the linear regression model, the increase in body mass index was negatively related to the physical self-efficacy score, differently for boys and girls. Furthermore, age and nationality also were predictors of low physical self-efficacy only for girls. Conclusion: The results of this study reinforce the importance of psychological aspect of obesity, as the perceived physical self-efficacy and body mass index were negatively associated in a sample of schoolchildren for boys and girls.

Resumo: Objetivo: Investigar a relação entre a autoeficácia física e o índice de massa corporal em uma grande amostra de crianças em idade escolar. Métodos: A Escala de Capacidade Física Percebida para Crianças foi administrada a 1.560 crianças (50,4% meninos; 8-12 anos) de três países diferentes. O peso e a altura também foram registrados para obter o índice de massa corporal. Resultados: De acordo com a literatura, os meninos relataram maior autoeficácia física percebida do que as meninas. Além disso, o número de meninos obesos é o dobro do de meninas, ao passo que o número de meninos abaixo do peso é metade do de meninas. No modelo de regressão linear, o aumento no índice de massa corporal foi negativamente relacionado ao escore de autoeficácia física, diferentemente em meninos e meninas. Além disso, a idade e a nacionalidade também foram preditoras de autoeficácia física baixa apenas para meninas. Conclusão: Os resultados deste estudo reforçam a importância do aspecto psicológico da obesidade, uma vez que a autoeficácia física percebida e o índice de massa corporal foram negativamente associados em uma amostra de crianças em idade escolar para meninos e meninas.

24-h actigraphic monitoring of motor activity, sleeping and eating behaviors in underweight, normal weight, overweight and obese children.

PURPOSE: Within a chronobiological perspective, the present study aimed to describe 24 h of sleep-wake cycle, motor activity, and food intake patterns in different body mass index (BMI) categories of children through 7 days of actigraphic recording. METHODS: Height and weight were objectively measured for BMI calculation in a sample of 115 Italian primary schoolchildren (10.21 ± 0.48 years, 62.61 % females). According to BMI values, 2.60 % were underweight, 61.70 % were of normal weight, 29.60 % were overweight and 6.10 % were obese. Participants wore a wrist actigraph continuously for 7 days to record motor activity and describe sleep-wake patterns. In addition, participants were requested to push the event-marker button of the actigraph each time they consumed food to describe their circadian eating patterns. RESULTS: BMI group differences were found for sleep quantity (i.e. midpoint of sleep and amplitude), while sleep quality, 24-h motor activity and food intake patterns were similar between groups. Regression analyses showed that BMI was negatively predicted by sleep duration on schooldays. BMI was also predicted by motor activity and by food intake frequencies recorded at particular times of day during schooldays and at the weekend. CONCLUSIONS: The circadian perspective seems to provide promising insight into childhood obesity, but this aspect needs to be further explored.

The difference between in bed and out of bed activity as a behavioral marker of cancer patients: A comparative actigraphic study.

The current study was conducted to provide normative data on actigraphic dichotomy index (I < O) (the percentage of in bed activity counts that are less than the median of out of bed counts) in healthy population and to assess whether the I < O could be an effective index in discriminating the circadian motor activity of cancer patients from healthy controls. In this retrospective study, we recovered 408 actigraphic records from two databases: healthy controls (n = 182; 79 males; mean age 38.7 ± 12.6) and patients with metastatic colorectal cancer (n = 226; 149 males; mean age 58.4 ± 11.4). Beside the usual actigraphic sleep parameters (time in bed, sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, number of awakenings, and mean motor activity), we also computed the dichotomy index and number of actigraphic wake parameters, namely, diurnal motor activity, diurnal total sleep time, number of sleep episodes, and the mean duration of the longest diurnal sleep episode. Using the Youden index, we calculated the cut off value that performed the best for I < O and actigraphic wake parameters. Finally, we created Receiver Operator Characteristic curves to test the efficacy of each actigraphic parameter to discriminate cancer patient from healthy controls. Mean I < O was 99.5% (SD, 0.48%) in the healthy group, as compared to 96.6% (SD, 3.6%) in the cancer group (p < 0.0001). Important age-related effects appeared unlikely after performing both the main analysis with age as a covariate, and a subset analysis in 104 subjects matched for age and sex. In the main analysis, all actigraphic parameters, except total sleep time, significantly differentiated the two groups of participants. However, the I < O was the one that clearly performed best. Here, we provide the first large dataset on I < O in healthy subjects, we confirm the relevance of this circadian index for discriminating advanced stage colorectal cancer patients from healthy subjects, and we lay the grounds for further investigations of this circadian index in patients with other chronic diseases.

Psychometric goodness of the Mini Sleep Questionnaire.

AIM: The current study was conducted to evaluate the psychometric properties and analyze the convergent validity of the Italian version of the Mini Sleep Questionnaire (MSQ). In addition, it was aimed to put forward cut-off values to be used in screening protocols. METHODS: The MSQ was administered to 1830 participants (age range 18-87 years), of whom 1208 also completed the Sleep Disorder Questionnaire (age range 18-87 years). A subgroup of 187 (age range 18-71 years) participants was randomly chosen to test the test-retest reliability. A complete psychometric evaluation was performed on the MSQ. To study the validity of the tool, the Sleep Disorder Questionnaire was used as an external criterion to validate the MSQ. Using the Youden index, we calculated the cut-off values that performed best. Finally, we created receiver-operator curves to test the accuracy of each cut-off value identified. RESULTS: For the MSQ, Cronbach's alpha score was 0.77 while homogeneity was 0.26. Factorial analyses confirmed the presence of two dimensions: sleep (Cronbach's alpha 0.75; homogeneity 0.37) and wake (Cronbach's alpha 0.75; homogeneity 0.44). For each dimension, a cut-off value was identified (>16 and >14, respectively). Both cut-off values obtained an area under the curve higher than 0.80. CONCLUSIONS: Psychometric evaluation of the MSQ was satisfactory. The cut-off values analyzed in the present study showed good performance. On the whole, the results of this study suggest that the MSQ can be a useful screening tool.

Individual differences affecting caffeine intake. Analysis of consumption behaviours for different times of day and caffeine sources.

The main purpose of the present study was to investigate the individual variables contributing to determine the high variability in the consumption behaviours of caffeine, a psychoactive substance which is still poorly investigated in comparison with other drugs. The effects of a large set of specific personality traits (i.e., Impulsivity, Sensation Seeking, Anxiety, Reward Sensitivity and Circadian Preference) were compared along with some relevant socio-demographic variables (i.e., gender and age) and cigarette smoking behaviour. Analyses revealed that daily caffeine intake was significantly higher for males, older people, participants smoking more cigarettes and showing higher scores on Impulsivity, Sensation Seeking and a facet of Reward Sensitivity. However, more detailed analyses showed that different patterns of individual variables predicted caffeine consumption when the times of day and the caffeine sources were considered. The present results suggest that such detailed analyses are required to detect the critical predictive variables that could be obscured when only total caffeine intake during the entire day is considered.

Female gender but not season of birth is associated with mood seasonality in a near-equatorial Brazilian city / Sexo feminino, mas não época de nascimento, está associado com alterações sazonais do humor em uma cidade brasileira próxima ao Equador

OBJECTIVE: Studies conducted mainly in countries located in the Northern Hemisphere have shown that season of birth influences mood seasonality. Greater mood seasonality has been observed for individuals born during spring/summer months than those born during autumn/winter months. Expanding past research to the Southern Hemisphere, in this study we examine the influence of season of birth on mood seasonality in a sample of 1,247 healthy young Brazilians. METHOD: The Seasonal Pattern Assessment Questionnaire was used to compute a global seasonality score as a measure of mood seasonality in a cross-sectional study. RESULTS: Analysis of covariance was conducted to examine the effects of month of birth and gender on mood seasonality, with age entered as a covariate. A main effect of gender was observed, F (1, 1197) = 17.86, p < .01; partial Eta-squared = .02, with mood seasonality being higher for females (M = 8) than for males (M = 7). Contradicting previous findings, no significant main effect for month of birth was observed, F (1, 1197) = 0.65, p > .05. CONCLUSION: The unexpected finding is tentatively explained by differences in geographic location and weather fluctuations between the sampling location in Brazil and other countries where season of birth has been found to influence mood seasonality. Additional studies with larger samples from the Southern Hemisphere are necessary to shed additional light on the possible significant influence of season of birth on mood.

OBJETIVO: Estudos realizados principalmente em países do Hemisfério Norte têm demonstrado que indivíduos nascidos durante os meses de primavera/verão tendem a apresentar maiores alterações sazonais do humor do que aqueles nascidos durante os meses de outono/inverno. Expandindo essas pesquisas para o Hemisfério Sul, o presente estudo examinou a relação entre época do nascimento e a flutuação sazonal do humor em uma amostra de 1.247 jovens brasileiros saudáveis de João Pessoa, Paraíba. MÉTODO: Uma versão traduzida do Seasonal Pattern Assessment Questionnaire (SPAQ) foi utilizada para calcular uma pontuação global de alterações sazonais do humor em um estudo transversal. RESULTADOS: Análise de covariância foi utilizada para examinar os efeitos de mês de nascimento e do sexo sobre o humor sazonal, com idade como covariável. Alterações de humor sazonal foram maiores para mulheres (M = 8) do que homens (M = 7), F (1, 1197) = 17,86, p < ,01; parcial Eta-quadrado = 0,02. Contrariando achados anteriores, nenhum efeito significativo foi observado entre mês de nascimento e humor sasonal, F (1, 1197) = 0,65, p > ,05. CONCLUSÃO: Este achado inesperado é tentativamente explicado pelas diferenças na localização geográfica e nas flutuações climáticas entre o Brasil e os outros países descritos na literatura. Estudos adicionais com amostras maiores do Hemisfério Sul são necessários para lançar luz sobre a possível influência significativa da época de nascimento no humor.

Propiedades psioométricas de la versión castellna del cuestionario de evaluaciión de patrón estacional (spaq) / Pschometric propperties of the spanish version of he seasonal patttern assessment questionnaire (spaq)

The Seasonal Pattern Assessment Questionnaire (SPAQ- Rosenthal, Bradt Wehr, 1984) is the most frequently used self-evaluation instrument for identifying the subject's sensibility to seasonal changes. The objective of this study is to present the psychometric properties of the Spanish version of the SPAQ in young subjects. The questionnaire was administered to 592 university students (395 women and 197 men). Good psychometric properties of the SPAQ reported by authors from several countries are replicated (descriptive statistics, internal consistency, inter-item correlation and factor analysis). On the grounds of the patterns of the results we believe that the Spanish version of the SPAQ is a valuable instrument in order to further study the chronobiological aspects of psychopathologies, which are highly useful in epidemiological research and, with the due precautions, also in the clinical environment.

El cuestionario de evaluación de patrón estacional (Seasonal Pattern Assessment Questionnaire, SPAQ– Rosenthal, Bradt & Wehr, 1984) es el instrumento de auto-evaluación más usado para determinar la sensibilidad de los individuos a los cambios estacionales. El objetivo de este estudio consiste en presentar las propiedades psicométricas de la versión castellana del SPAQ en sujetos jóvenes. Se administró la traducción castellana del SPAQ a 592 estudiantes universitarios (395 mujeres y 197 varones). Los resultados confirman unas propiedades psicométricas adecuadas del SPAQ también para la versión castellana (distribución de las puntuaciones, consistencia interna, homogeneidad, estructura factorial), en consonancia con los datos obtenidos en otros países. El cuestionario es un instrumento que permitirá profundizar en el estudio de los aspectos cronobiológicos de las psicopatologías, de gran utilidad en investigación epidemiológica y, aunque con algunas precauciones, también en el ámbito clínico en países de habla hispana.

Effects of raloxifene on mood, sleep, libido and cognitive function in postmenopausal healthy women: a pilot study.

OBJECTIVE: To assess the effect of raloxifene (60 mg) on psychological functions. MATERIAL AND METHODS: A total of 49 women were enrolled in a 3-month case-control study. Psychological testing was performed at baseline and at the end of 3 months of treatment. On both occasion measurements were repeated twice at 1 week apart. Scores were averaged. RESULTS: Raloxifene appeared to adversely affect the performance in the letter search test hence to worsen attention (t19 = 3.55, P = 0.002) but it reduced wakening episodes compared with baseline (t19 = 3.33, P = 0.005). Memory improved compared with baseline both in the raloxifene group (t19 = 2.99, P = 0.008) and in the controls (t19 = 4.64, P = 0.003). No significant differences were found in mood, well-being and indices of sexual activity. CONCLUSION: Raloxifene does not appear to adversely affect psychological function such libido, mood and memory. It may worsen attention but it reduces wakening episodes so it may thus improve sleep.