The effectiveness of spiritual care training on medical students' self-reported competencies: A quasi-experimental study.

OBJECTIVES: To evaluate the effectiveness of spiritual care training on medical students' self-reported competencies. METHODS: This is a quasi-experimental (controlled and non-randomized) study including 115 Brazilian medical students. Participants were enrolled into 2 groups: fourth-year students (n = 64) who received spiritual care training and sixth-year students (n = 51) who did not receive this training - control group (i.e., usual teaching). Participants answered a self-reported Spiritual Care Competence Scale. Comparisons between groups were performed and effect sizes were reported. RESULTS: Providing a spiritual care training resulted in significantly higher self-reported scores for the dimensions of "Assessment" (d = 0.99), "Improvement of care" (d = 0.69), "Counseling (d = 0.88)," "Referral" (d = 0.75), and "Total Spiritual Care" (d = 1.044) as compared to the control group. Likewise, 21 out of 27 items of the Spiritual Care Competence Scale were significantly higher for the intervention group, presenting effect sizes (d) ranging between 0.428 and 1.032. SIGNIFICANCE OF RESULTS: Medical students receiving spiritual care training showed greater self-reported competencies as compared to those in the usual teaching. These results reinforce the importance of promoting spirituality teaching in medical schools.

Phase III, randomised, double-blind, placebo-controlled, multicentre trial to evaluate the efficacy and safety of rhGAD65 to preserve endogenous beta cell function in adolescents and adults with recently diagnosed type 1 diabetes, carrying the genetic HLA DR3-DQ2 haplotype: the DIAGNODE-3 study protocol.

INTRODUCTION: Type 1 diabetes (T1D) is an autoimmune disease leading to the destruction of the insulin-producing beta cells resulting in insulin deficiency and hyperglycaemic. Today, no approved therapy exists to halt this detrimental immunologic process. In a recent phase 2b study, intralymphatic administration of recombinant human glutamic acid decarboxylase 65 kDa (rhGAD65) adsorbed to Alhydrogel adjuvant to individuals recently diagnosed with T1D and carrying the HLA DR3-DQ2 haplotype showed promising results in preserving endogenous insulin secretion, confirming the results of a large meta-analysis of three randomised placebo-controlled trials of subcutaneous rhGAD65. The aim of the current precision medicine phase 3 study is to determine whether intralymphatic administration of rhGAD65 preserves insulin secretion and improves glycaemic control in presumed responder individuals with recently diagnosed T1D carrying HLA DR3-DQ2. METHODS AND ANALYSIS: Individuals ≥12 and <29 years recently diagnosed with T1D (<6 months) will be screened for the HLA DR3-DQ2 haplotype, endogenous insulin production estimated by fasting C-peptide and presence of GAD65 antibodies. 330 patients are planned to be randomised to 3 monthly intralymphatic injections of rhGAD65 or placebo (both accompanied by oral vitamin D supplementation), followed by 22 months of follow-up. The study is powered to detect a treatment effect in the two coprimary endpoints; change from baseline in AUC(0-120min) C-peptide levels during a mixed meal tolerance test, and change from baseline in glycaemic control estimated by haemoglobin A1c at 24 months. Secondary endpoints include effects on glucose patterns collected by masked continuous glucose monitoring, proportion of patients in partial remission and number of episodes of severe hypoglycaemia and/or diabetic ketoacidosis. ETHICS AND DISSEMINATION: The trial is approved by Ethics Committees in Poland (124/2021), the Netherlands (R21.089), Sweden (2021-05063), Czech Republic (EK-1144/21), Germany (2021361) and Spain (21/2021). Results will be published in international peer-reviewed scientific journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: EudraCT identifier: 2021-002731-32, NCT identifier: NCT05018585.

Effect of Helicobacter pylori Infection on Macromineral and Trace Element Status-Systematic Review and Meta-Analysis.

OBJECTIVES: To explore the effect of Helicobacter pylori (Hp ) infection on zinc, copper, calcium, magnesium, phosphorus, and iodine status in the pediatric population. METHODS: A protocol was registered on PROSPERO. A literature search was conducted on Embase, PubMed MEDLINE, and Web of Science, from inception to September 2020, including all studies in English, Spanish, and Portuguese languages. Reference lists were manually searched. Primary studies describing at least one micronutrient status in Hp -positive and Hp -negative or control children were included. PRISMA recommendations were applied. Pooled mean differences (MDs) and 95% confidence intervals were estimated using a random-effects model. A total of 1011 citations were screened. Six cross- sectional studies were included. No publications regarding phosphorus and iodine were identified. RESULTS: Included studies in meta-analyses comprised an overall age range of 4-18 years, with Hp positivity ranging between 29.5% and 72.3%. These meta-analyses demonstrated a lack of evidence of an association between Hp -positive and Hp -negative or control children regarding serum zinc (vs Hp -negative: MD -1.36 µg/dL; vs control: MD 326.22 µg/dL), copper (MD -0.83 µg/dL), and calcium (MD 0.09 mg/dL) status. Considerable heterogeneity was recognized, except for calcium analysis (I 2 = 0%). Meta-analysis for magnesium was not performed. Five studies presented a low risk of bias. CONCLUSIONS: The study demonstrated a lack of evidence of an effect of Hp infection on serum zinc, copper, and calcium status. Studies concerning magnesium, phosphorus, and iodine status are warranted. Furthermore, larger and well-controlled studies are recommended.

Microbial Source Tracking as a Method of Determination of Beach Sand Contamination.

Beach sand may act as a reservoir for numerous microorganisms, including enteric pathogens. Several of these pathogens originate in human or animal feces, which may pose a public health risk. In August 2019, high levels of fecal indicator bacteria (FIB) were detected in the sand of the Azorean beach Prainha, Terceira Island, Portugal. Remediation measures were promptly implemented, including sand removal and the spraying of chlorine to restore the sand quality. To determine the source of the fecal contamination, during the first campaign, supratidal sand samples were collected from several sites along the beach, followed by microbial source tracking (MST) analyses of Bacteroides marker genes for five animal species, including humans. Some of the sampling sites revealed the presence of marker genes from dogs, seagulls, and ruminants. Making use of the information on biological sources originating partially from dogs, the municipality enforced restrictive measures for dog-walking at the beach. Subsequent sampling campaigns detected low FIB contamination due to the mitigation and remediation measures that were undertaken. This is the first case study where the MST approach was used to determine the contamination sources in the supratidal sand of a coastal beach. Our results show that MST can be an essential tool to determine sources of fecal contamination in the sand. This study shows the importance of holistic management of beaches that should go beyond water quality monitoring for FIB, putting forth evidence for beach sand monitoring.

The dual-targeted prolyl aminopeptidase PAP1 is involved in proline accumulation in response to stress and during pollen development.

Plant endosymbiotic organelles such as mitochondria and chloroplasts harbour a wide array of biochemical reactions. As a part of protein homeostasis to maintain organellar activity and stability, unwanted proteins and peptides need to be completely degraded in a stepwise mechanism termed the processing pathway, where at the last stage single amino acids are released by aminopeptidases. Here, we determined the molecular and physiological functions of a prolyl aminopeptidase homologue PAP1 (At2g14260) that is able to release N-terminal proline. Transcript analyses demonstrate that an alternative transcription start site gives rise to two alternative transcripts, generating two in-frame proteins PAP1.1 and PAP1.2. Subcellular localization studies revealed that the longer isoform PAP1.1, which contains a 51 residue N-terminal extension, is exclusively targeted to chloroplasts, while the truncated isoform PAP1.2 is located in the cytosol. Distinct expression patterns in different tissues and developmental stages were observed. Investigations into the physiological role of PAP1 using loss-of-function mutants revealed that PAP1 activity may be involved in proline homeostasis and accumulation, required for pollen development and tolerance to osmotic stress. Enzymatic activity, subcellular location, and expression patterns of PAP1 suggest a role in the chloroplastic peptide processing pathway and proline homeostasis.

A mitochondrial prolyl aminopeptidase PAP2 releases N-terminal proline and regulates proline homeostasis during stress response.

Most mitochondrial proteins are synthesised in the cytosol and targeted into the organelle via N-terminal targeting peptides that are cleaved upon import. The free targeting peptide is subsequently processed in a stepwise manner, with single amino acids released as final products. Here, we have characterised a proline-cleaving aminopeptidase in Arabidopsis thaliana, prolyl aminopeptidase-2 (PAP2, At3g61540). Activity assays show that PAP2 has a preferred activity to hydrolyse N-terminal proline. Protein localisation studies revealed that PAP2 is exclusively targeted to mitochondria. Characterisation of pap2 mutants show defective pollen, enhanced dark-induced senescence and increased susceptibility to abiotic stresses, which are likely attributed to a reduced level of accumulated free proline. Taken together, these results demonstrate the role of PAP2 in proline cleavage from mitochondrial peptides and proline homeostasis, which is required for the development of male gametophyte, tolerance to abiotic stresses, and leaf senescence.

Prevalence of vitamin D deficiency amongst soccer athletes and effects of 8 weeks supplementation.

BACKGROUND: High prevalence of vitamin D deficiency is well known around the world in risk populations. Although less is known about the athletic population, some studies report vitamin D deficiency amongst athletic population and adequate vitamin D levels are crucial for athletic population as they can prevent injuries such as stress fractures and might even have ergogenic effects for example on muscle function. The main objectives were to evaluate the basal serum levels of 25(OH)D and calcium in professional soccer athletes on the latitude 40°N, to evaluate the effects in 25(OH)D and calcium serum levels following supplementation of 1667 IU/day of cholecalciferol during a period of 8 weeks and evaluate eventual toxicity arising from it. METHODS: Twenty-eight professional athletes were evaluated according to the skin type. Basal serum levels of 25(OH)D and calcium were evaluated during winter months. Athletes were then supplemented with cholecalciferol 25.000 IU every two weeks. Serum levels of 25(OH)D and calcium were evaluated after supplementation. RESULTS: 25(OH)D initially ranged between 9.9 ng/mL and 32.9 ng/mL with a median of 19.2 IQR 7.24 ng/mL. A statistically significant inverse correlation exists between vitamin D deficiency and the Fitzpatrick Scale (ρ=-0.555 P=0.003). After 8 weeks, 25(OH)D ranged between 10.6 ng/mL and 43.4 ng/mL with a median of 33.2 ng/mL IQR 6.1 ng/mL. We verified a statistically significant increase of serum 25(OH) D levels (11.74±5.988; CI 95% [9,02; 14,47]; P<0.001. In addition, there was a statistically significant reduction of calcium: -0.36±0.457; CI 95% [- 0.57; -0.15]; P=0.002. CONCLUSIONS: Professional athletes have a high prevalence of vitamin D deficiency. Supplementation with cholecalciferol in winter months during 8 weeks is safe and effective in raising 25(OH)D serum levels. However, it may not be sufficient for athletes to reach adequate vitamin D levels.

Antibacterial photosensitization through activation of coproporphyrinogen oxidase.

Gram-positive bacteria cause the majority of skin and soft tissue infections (SSTIs), resulting in the most common reason for clinic visits in the United States. Recently, it was discovered that Gram-positive pathogens use a unique heme biosynthesis pathway, which implicates this pathway as a target for development of antibacterial therapies. We report here the identification of a small-molecule activator of coproporphyrinogen oxidase (CgoX) from Gram-positive bacteria, an enzyme essential for heme biosynthesis. Activation of CgoX induces accumulation of coproporphyrin III and leads to photosensitization of Gram-positive pathogens. In combination with light, CgoX activation reduces bacterial burden in murine models of SSTI. Thus, small-molecule activation of CgoX represents an effective strategy for the development of light-based antimicrobial therapies.

mcr-1 and blaKPC-3 in Escherichia coli Sequence Type 744 after Meropenem and Colistin Therapy, Portugal.

Escherichia coli Ec36 was recovered from a patient in Portugal after treatment with meropenem and colistin. Besides an IncF plasmid with Tn1441d-blaKPC-3, already reported in clinical strains in this country, E. coli Ec36 co-harbored an IncX4::mcr-1 gene. Results highlight emerging co-resistance to carbapenems and polymyxins after therapy with drugs from both classes.

Johrei Effects on Water: A Pilot Study by Counting Drops.

BACKGROUND: Water is a key ingredient in the creation and sustainment of life. Moreover, water may be a key vehicle in the processes of energy healing, such as in the preparation of homeopathic remedies and spiritual treatments. Given these properties, the purpose of this study was to investigate whether the application of Johrei to water could lead to significant changes in the hydrodynamic behaviour of the fluid. METHODS: Four regular Johrei practitioners (P1, P2, P3 and P4) were selected for this study. Dripping water produced at the tip of a capillary was used as the hydrodynamic behaviour model. This behaviour was modelled mathematically, and tuning parameters φ4 and τ were used to assess significant differences in the dripping water samples that were subjected to Johrei compared with the samples that were not so treated. The tuning parameters were obtained using the Levenberg-Marquardt fitting algorithm. The data sets for each Johrei practitioner and the control experiment were analysed using ANOVA and a paired t-test. RESULTS: The mathematical model exhibited an excellent fit to our data, generating correlation coefficients (r) greater than or equal to 0.999. Significant differences were observed in both τ (P1 and P2, P < 0.05 and P < 0.01, respectively) and φ4 (P2, P < 0.01). As expected, no significant difference for the control experiment (without Johrei) was observed. CONCLUSIONS: Our results indicated a statistically significant change in the hydrodynamic behaviour of water correlated with Johrei treatment for 50% of the participating Johrei practitioners.

Local knowledge and exploitation of the avian fauna by a rural community in the semi-arid zone of northeastern Brazil.

BACKGROUND: The present study examined the exploitation of bird species by the residents of a rural community in the Brazilian semi-arid zone, and their preferences for species with different characteristics. METHODS: The 24 informants were identified using the "snowball" approach, and were interviewed using semi-structured questionnaires and check-sheets for the collection of data on their relationship with the bird species that occur in the region. The characteristics that most attract the attention of the interviewees were the song and the coloration of the plumage of a bird, as well as its body size, which determines its potential as a game species, given that hunting is an important activity in the region. RESULTS: A total of 98 species representing 32 families (50.7% of the species known to occur in the region) were reported during interviews, being used for meat, pets, and medicinal purposes. Three species were used as zootherapeutics - White-naped Jay was eaten whole as a cure for speech problems, the feathers of Yellow-legged Tinamou were used for snakebite, Smooth-billed Ani was eaten for "chronic cough" and Small-billed Tinamou and Tataupa Tinamou used for locomotion problems. The preference of the informants for characteristics such as birdsong and colorful plumage was a significant determinant of their preference for the species exploited. Birds with cynegetic potential and high use values were also among the most preferred species. Despite the highly significant preferences for certain species, some birds, such as those of the families Trochilidae, Thamnophilidae, and Tyrannidae are hunted randomly, independently of their attributes. CONCLUSION: The evidence collected on the criteria applied by local specialists for the exploitation of the bird fauna permitted the identification of the species that suffer hunting pressure, providing guidelines for the development of conservation and management strategies that will guarantee the long-term survival of the populations of these bird species in the region.

Sustainable prevention of obesity through integrated strategies: The SPOTLIGHT project's conceptual framework and design.

BACKGROUND: The prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project "sustainable prevention of obesity through integrated strategies" (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM). METHODS/DESIGN: SPOTLIGHT comprises a series of systematic reviews on: individual-level predictors of success in behaviour change obesity interventions; social and physical environmental determinants of obesity; and on the RE-AIM of multi-level interventions. An interactive web-atlas of currently running multi-level interventions will be developed, and enhancing and impeding factors for implementation will be described. At the neighbourhood level, these elements will inform the development of methods to assess obesogenicity of diverse environments, using remote imaging techniques linked to geographic information systems. The validity of these methods will be evaluated using data from surveys of health and lifestyles of adults residing in the neighbourhoods surveyed. At both the micro- and macro-levels (national and international) the different physical, economical, political and socio-cultural elements will be assessed. DISCUSSION: SPOTLIGHT offers the potential to develop approaches that combine an understanding of the obesogenicity of environments in Europe, and thus how they can be improved, with an appreciation of the individual factors that explain why people respond differently to such environments. Its findings will inform governmental authorities and professionals, academics, NGOs and private sector stakeholders engaged in the development and implementation of policies to tackle the obesity epidemic in Europe.

Johrei, a Japanese healing technique, enhances the growth of sucrose crystals.

The effect of Johrei treatment on the crystallization of sucrose from supersaturated solutions was studied in comparison with the crystallization in untreated solutions. This work was performed assuming that Johrei enhances the natural mechanisms of equilibrium restoration in biological and nonbiological systems. The crystallization in Johrei-treated solutions as judged by statistical analysis was found to be faster than the crystallization in untreated solutions. A discussion is presented about the mechanisms possibly involved.

Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy.

Osteoporosis is a major public health concern. The combination of exercise, hormone replacement therapy, and calcium supplementation may have added benefits for improving bone mineral density compared to a single intervention. To test this notion, 320 healthy, non-smoking postmenopausal women, who did or did not use hormone replacement therapy (HRT), were randomized within groups to exercise or no exercise and followed for 12 months. All women received 800 mg calcium citrate supplements daily. Women who exercised performed supervised aerobic, weight-bearing and weight-lifting exercise, three times per week in community-based exercise facilities. Regional bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry. Women who used HRT, calcium, and exercised increased femoral neck, trochanteric and lumbar spine bone mineral density by approximately 1-2%. Trochanteric BMD was also significantly increased by approximately 1.0% in women who exercised and used calcium without HRT compared to a negligible change in women who used HRT and did not exercise. The results demonstrate that regional BMD can be improved with aerobic, weight-bearing activity combined with weight lifting at clinically relevant sites in postmenopausal women. The response was significant at more sites in women who used HRT, suggesting a greater benefit with hormone replacement and exercise compared to HRT alone.

Weight lifted in strength training predicts bone change in postmenopausal women.

PURPOSE: The aim of this study was to examine the relationship between weight lifted in 1 yr of progressive strength training and change in bone mineral density (BMD) in a group of calcium-replete, postmenopausal women. METHODS: As part of a large clinical trial, 140 calcium-supplemented women, 44-66 yr old, were randomized to a 1-yr progressive strength-training program. Half of the women were using hormone replacement therapy. Three times weekly, subjects completed two sets of six to eight repetitions in eight core exercises at 70-80% of one repetition maximum. BMD was measured at baseline and 1 yr. RESULTS: In multiple linear regression, the increase in femur trochanter (FT) BMD was positively related to total weight lifted (0.001 g.cm (-2)) for a SD of weight lifted, P< 0.01) after adjusting for age, baseline factors, HRT status, weight change, cohort, and fitness center. The weighted squats showed the strongest (0.002 g.cm(-2)) for a SD of weight lifted, P< 0.001), whereas the back extension exhibited the weakest (0.0005 g.cm(-2)) for a SD of weight lifted, P< 0.26) association with change in FT BMD. The amount of weight lifted in the weighted march exercise was significantly related to total body BMD (0.0006 g.cm(-2)) for a SD of weight lifted, P< 0.01). The associations between weight lifted and BMD for the femur neck or lumbar spine were not significant. CONCLUSION: Evidence of a linear relationship between BMD change and total and exercise-specific weight lifted in a 1-yr strength-training program reinforces the positive association between this type of exercise and BMD in postmenopausal women.