Does the coexistence of pain and depressive symptoms accelerate cognitive decline?

OBJECTIVES: Investigate whether the coexistence of pain and depressive symptoms is a risk factor for cognitive decline in individuals aged 50 or older. METHOD: Longitudinal trajectory study involving 4,718 participants from the English Longitudinal Study of Ageing (ELSA). Joint pain was self-reported, and intensity was classified as mild, moderate/intense. Depressive symptoms were investigated using the Centre for Epidemiologic Studies Depression Scale (CES-D-8 ≥ 4). The sample was divided into six groups: no pain and no depression (NP/NDe), mild pain and no depression (MP/NDe), moderate/intense pain and no depression (M-IP/NDe), no pain and depression (NP/De), mild pain and depression (MP/De), and moderate/intense pain and depression (M-IP/De). The outcome of interest was performance in memory, executive function, and global cognition. Generalised linear mixed models were used to analyse performance in the cognitive domains and global cognition score as a function of pain and depressive symptoms during 12 years of follow-up. RESULTS: Over time, individuals with M-IP/De had a greater memory decline (-0.038 SD/year, 95%CI: -0.068 to -0.007) and the global cognition score (-0.033 SD/year, 95%CI: -0.063 to -0.002) than those with NP/NDe. CONCLUSION: The coexistence of moderate/intense pain and depressive symptoms is a risk factor for the decline of global cognition and memory.

The industrial versatility of Gluconobacter oxydans: current applications and future perspectives.

Gluconobacter oxydans is a well-known acetic acid bacterium that has long been applied in the biotechnological industry. Its extraordinary capacity to oxidize a variety of sugars, polyols, and alcohols into acids, aldehydes, and ketones is advantageous for the production of valuable compounds. Relevant G. oxydans industrial applications are in the manufacture of L-ascorbic acid (vitamin C), miglitol, gluconic acid and its derivatives, and dihydroxyacetone. Increasing efforts on improving these processes have been made in the last few years, especially by applying metabolic engineering. Thereby, a series of genes have been targeted to construct powerful recombinant strains to be used in optimized fermentation. Furthermore, low-cost feedstocks, mostly agro-industrial wastes or byproducts, have been investigated, to reduce processing costs and improve the sustainability of G. oxydans bioprocess. Nonetheless, further research is required mainly to make these raw materials feasible at the industrial scale. The current shortage of suitable genetic tools for metabolic engineering modifications in G. oxydans is another challenge to be overcome. This paper aims to give an overview of the most relevant industrial G. oxydans processes and the current strategies developed for their improvement.

Behavioral profile, lifestyle and social skills in Portuguese adolescents.

BACKGROUND: Seventy percent of premature deaths in adults are due to behaviors initiated during adolescence. Therefore, it is essential to promote individual and social behaviors that educate adolescents in the ability to make healthy choices. Accordingly, the main goals of this study were to characterize Lifestyles and Social Skills, as well as identify homogeneous subgroups, in a sample of Portuguese adolescents. METHODS: A cross-sectional study was conducted, including 1008 adolescents attending the 7th to the 9th grades of five middle schools from the Tâmega and Sousa regions of Portugal, and using the My Lifestyle Questionnaire and the Social Skills Inventory. To establish a profile of the participants, a Cluster Analysis (K-means) was performed, and the Jaccard coefficient was used to assess the stability of the solution found. RESULTS: From the total sample, 556 adolescents with a mean age of 13.43 years (SD = 1.1) were included in the analysis. The majority of the sample presented a healthy lifestyle (72.26%) and 50.7% of the adolescents had a highly elaborated repertoire of Social Skills. Moreover, three clusters were found. Cluster 1 (n = 92) showed a less elaborate repertoire of Social Skills and was designated as the "Adjusted". Cluster 2 (n = 115) comprised adolescents with a good repertoire of Social Skills and was named the "Sociable". Cluster 3 (n = 258) was composed of adolescents with a highly elaborate repertoire of Social Skills and the best Lifestyle indicators and was named the "Healthy". CONCLUSIONS: The group of adolescents in the cluster called the "Sociable" needs to be included in health education and Social Skills programs. Nutrition and Monitored Safety behaviors reveal low values and, therefore, present a greater need for awareness, sensitization, and intervention in the school context. For this reason, the promotion of a healthy lifestyle should be part of the academic curriculum and transversal to all academic disciplines.

Contributors and Moderators of Quality of Life in Caregivers of Alzheimer´s Disease Patients.

Aim and objective: This study aimed to identify the variables that contributed to Quality of Life (QoL) of Alzheimer's Disease (AD) caregivers, taking into consideration the caregiving context, stressors, role strains, and resources.Methods: The sample included 102 caregivers of AD patients who answered the following instruments: Depression, Anxiety and Stress Scale-21; Satisfaction with Social Support Scale; Revised Memory and Behavioral Problems Checklist; Family Communication and Satisfaction Scales; Spiritual and Religious Attitudes in Dealing with Illness; and Quality of Life in Alzheimer's Disease - Caregiver Version.Results: Caregivers who were employed, chose the caregiving role, and received help in caring showed better QoL. Also, being younger, less caregiving daily hours, caring for patients with less memory and behavior problems, lower distress, and family satisfaction predicted better QoL. Finally, spirituality was a moderator between family communication and QoL but not between family satisfaction and QoL.Conclusion: Caregiving-context variables (age, professional status, choosing to care, receiving help in the caregiving role and duration of daily care); role strains (family dissatisfaction); stressors (caregivers' distress and patients' memory and behavioral problems); and resources (spirituality) had an impact on caregivers' QoL emphasizing the adequacy of the Stress Process Model. Intervention should also focus on spirituality given its moderating role.

Swedish Parents' Experiences and Their Need for Support When Having a Child with Congenital Cataract: A Qualitative Study.

PURPOSE: To explore parents' experiences of living with a child with congenital cataract, with the intention of identifying how to improve the parental support. DESIGN AND METHOD: A qualitative descriptive design using semi-structured interviews. The parents were interviewed when the children were aged 12-24 months. All children were operated on for congenital cataract before three months of age. The interviews were transcribed and analysed using qualitative content analysis with an inductive approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist. RESULTS: Three categories emerged from the data: trying to survive during a chaotic time; adapting to a different normal; being in need of support. When receiving the preliminary diagnosis, most of the parents were upset but managed well once the initial shock had subsided. However, some described feelings of despair, difficulties in accepting the situation and in connecting with the child. All parents stated that, to be valuable, a counsellor needed to have insights in how the eye works and the function of visual development. CONCLUSION: The parents' need for psychosocial support in the early post-diagnostic stage varied greatly. Early identification of those in need of specialized counselling is therefore of importance, preferably at the maternity ward or by the regional ophthalmologist when the referral is made. CLINICAL IMPLICATIONS: The study provides understanding of the importance to take the parents' well-being beyond the medical issues into consideration. This knowledge can be used to provide support at an earlier stage in the treatment programme than is currently the case.

Evaluation of PD-L1, PD-L2, PD-1 and cytotoxic immune response in oral lichen planus.

OBJECTIVE: To investigate the expression of programmed death-ligands 1 and 2 (PD-L1, PD-L2), programmed death-1 (PD-1), CD8 and granzyme B (GrB), as well as its correlation with the severity of oral lichen planus (OLP). MATERIALS AND METHODS: In a collaborative study, 33 cases of OLP were evaluated according to the latest criteria proposed by the American Academy of Oral and Maxillofacial Pathology (AAOMP/2016) and were submitted to immunohistochemistry. Positivity was measured semiquantitatively (PD-L1, PD-L2) and quantitatively (PD-1, CD8, GrB). The severity of OLP was assessed according to clinical subtype, symptomatology and response to corticosteroid therapy. RESULTS: Most OLPs were considered to be negative for PD-L1 (66.6%), but high expression of PD-L2 (96.9%) by keratinocytes and immunoinflammatory cells was observed. PD-1+ cell density/mm2 was reduced compared to CD8+ cells. A low cytotoxic immune response (CD8:GrB ratio) was also demonstrated. Interestingly, there were fewer GrB+ cells in the intraepithelial region in reticular OLP compared to erosive/bullous OLP. CONCLUSIONS: PD-L1/PD-1 pathways appear to be compromised in OLP due to low PD-L1 expression in most samples. In contrast, PD-L2 overexpression associated with a possible regulation of the cytotoxic immune response suggests an immune tolerance that may contribute to the chronic profile of OLP.

Spirituality and quality of life in older adults: a path analysis model.

BACKGROUND: Study older adults' quality of life is becoming increasingly important in the assessment, quality improvement and allocation of health and social care service. The purpose of this study was to enhance knowledge on the relationship between modifiable (psychological variables) and non-modifiable variables (sociodemographic), and quality of life in elderly, regarding psychological and social variables in Portuguese context. METHODS: This is a cross-sectional study, including 604 older adults from general community. 63.6% of the sample was composed by female gender with a mean age of 71.6(SD = 4.81). Participants completed the following instruments: Barthel Index to assess functionality; Satisfaction with Social Support Scale to assess social support; The Spiritual and Religious Attitudes in Dealing with Illness to assess spirituality and Short Form Health Survey 36, to assess mental and physical quality of life. RESULTS: A path analysis model was performed where the presence of a chronic disease, age and functionality has a direct effect on physical quality of life and spirituality had a direct effect on mental quality of life. Social support mediated the relationship between functionality and mental quality of life, and in turn, functionality mediated the relationship between age and physical quality of life. CONCLUSIONS: Results reinforce the effect of age and chronic disease as non-modifiable variables as well as functionality, spirituality and satisfaction with social support as modifiable variables, in the quality of life of older people. Social support, health and education programs in the community should be promoted in order to improve quality of life in this population. Strategies to promote functionality and enhance the social support network, especially in the elder with chronic illness, should be a priority.

Quality of life in patients with mild Alzheimer disease: the mediator role of mindfulness and spirituality.

OBJECTIVES: This study examined the mediator role of mindfulness and spirituality in the relationship between psychological morbidity, awareness of the disease, functionality, social support, family satisfaction, and quality of life (QoL) in patients with mild AD. METHOD: The sample consisted of 128 patients who answered the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Hospital Anxiety and Depression Scales (HADS), the Satisfaction with Social Support Scale (SSSS), the Family Satisfaction Scale (FSS), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), the Index of Barthel, and the Quality of Life-Alzheimer's Disease (QoL-AD). RESULTS: Mindfulness and spirituality mediated the relationship between functionality, awareness of the disease, family satisfaction and QoL. Psychological morbidity had a direct negative impact on QoL and was negatively associated with awareness of the disease, family satisfaction and social support. Mindfulness was negatively associated with spirituality and the latter was negatively associated with QoL. More social support was associated with greater awareness of the disease and family satisfaction. More functionality, awareness of the disease and family satisfaction contributed to more QoL and this relationship was mediated by mindfulness and spirituality. CONCLUSION: Interventions directed at the promotion of the QoL of patients with mild AD should focus on the promotion of mindfulness skills in AD patients, in addition to the reduction of psychological morbidity and the promotion of functionality, awareness of the disease, family relationships and social support.

Quality of life in early-stage Alzheimer's disease: the moderator role of family variables and coping strategies from the patients' perspective.

AIM: This study assessed the effects of sociodemographic and psychological variables on quality of life (QOL), as well as the moderator role of family variables and coping strategies in the relationship between psychological morbidity and QOL, based on patients' perspective. METHODS: This study used a cross-sectional design. A total of 158 patients with early Alzheimer's disease completed the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Hospital Anxiety and Depression Scale, the Ways of Coping Questionnaire, the Spiritual and Religious Attitudes in Dealing with Illness, the Family Adaptability and Cohesion Evaluation Scales, the Family Satisfaction Scale, the Family Communication Scale, the Barthel Index, and the Quality of Life in Alzheimer's Disease Scale. RESULTS: Being a man, having a higher education, and engaging in more exercise activity were associated with better QOL. Lower levels of cognitive impairment, psychological morbidity, and spirituality predicted better QOL. Also, lower levels of functionality, family communication, family satisfaction, and family functioning contributed to worse QOL. Gender, psychological morbidity, and functionality contributed significantly to QOL. Family satisfaction, family communication, and coping strategies moderated the relationship between psychological morbidity and QOL. CONCLUSION: Intervention in early-stage Alzheimer's disease should focus on patients' coping strategies and family context, particularly family satisfaction and communication, to foster QOL.

Prevalence and profile of adverse drug reactions in high-risk pregnancy: a cohort study.

BACKGROUND: Commonly used drugs in pregnant women include antihypertensives, hypoglycemic agents, analgesics, antimicrobials, antiemetics and antispasmodics but the use of medicines during pregnancy, especially in high-risk pregnancy, may be associated with high risk of adverse drug reactions (ADR). The objective of this study was to determine the risk of an adverse drug reaction in hospitalized high-risk pregnant women and the factors associated with their occurrence. METHODS: The study received IRB approval and all patients gave written informed consent. Observational cohort study conducted from September 2015 to November 2016 in 1070 pregnant women consecutively admitted to the high risk sector of the University Maternity Januário Cicco in Brazil. ADR were detected through daily active search. Risk factors for the occurrence of ADR were determined using multivariate logistic regression. RESULTS: The mean age of the study population was 26.2 ± 7.2 years and gestational age was 31.2 ± 7.2 weeks. The average number of previous pregnancies was 2.4 ± 1.8 and 46.4% reported cases of previous abortion/miscarriage. ADR were observed in 10.7% of women. The main medicines involved, with the incidence rate of ADR per 100 prescriptions of the drug (IR), were parenteral scopolamine (IR 14.9%), methyldopa (IR 15.9%), insulin (IR 8.46%), oral scopolamine (IR 3.58%), captopril (IR 2.38%) and ceftriaxone (IR 18.4%). Multivariate analysis showed that only gestational age in weeks (odds-ratio 0.97, 95% confidence interval 0.95-0.98) was related to the occurrence of adverse reactions. CONCLUSION: Lower gestational age is a risk factor for high-risk pregnant women, increasing the likelihood of adverse reactions, with parenteral medications being those that have the highest potential risk of harm.

Well-being and academic achievement in secondary school pupils: The unique effects of burnout and engagement.

The main goal of this study was to examine the relationship among burnout, engagement, well-being, and academic performance in Portuguese secondary school pupils. The existence of gender related differences in these relationships was also investigated. The sample was composed of 489 pupils who attended an academic track at secondary school. Results of multi-group structural equation modelling indicated that higher levels of cynicism towards studies were associated with lower academic achievement. Exhaustion was not uniquely related to the adolescents' academic achievement or well-being. However, higher levels of engagement, namely dedication and vigour, were related to higher levels of well-being. Moreover, vigour was also uniquely associated with academic achievement. The results were similar for boys and girls. Implications for intervention and future research are discussed.

ERK1/2 acts as a switch between necrotic and apoptotic cell death in ether phospholipid edelfosine-treated glioblastoma cells.

Glioblastoma is characterized by constitutive apoptosis resistance and survival signaling expression, but paradoxically is a necrosis-prone neoplasm. Incubation of human U118 glioblastoma cells with the antitumor alkylphospholipid analog edelfosine induced a potent necrotic cell death, whereas apoptosis was scarce. Preincubation of U118 cells with the selective MEK1/2 inhibitor U0126, which inhibits MEK1/2-mediated activation of ERK1/2, led to a switch from necrosis to caspase-dependent apoptosis following edelfosine treatment. Combined treatment of U0126 and edelfosine totally inhibited ERK1/2 phosphorylation, and led to RIPK1 and RelA/NF-κB degradation, together with a strong activation of caspase-3 and -8. This apoptotic response was accompanied by the activation of the intrinsic apoptotic pathway with mitochondrial transmembrane potential loss, Bcl-xL degradation and caspase-9 activation. Inhibition of ERK phosphorylation also led to a dramatic increase in edelfosine-induced apoptosis when the alkylphospholipid analog was used at a low micromolar range, suggesting that ERK phosphorylation acts as a potent regulator of apoptotic cell death in edelfosine-treated U118 cells. These data show that inhibition of MEK1/2-ERK1/2 signaling pathway highly potentiates edelfosine-induced apoptosis in glioblastoma U118 cells and switches the type of edelfosine-induced cell death from necrosis to apoptosis.

Correction: Risk factors for drug-related problems in a general hospital: A large prospective cohort.

[This corrects the article DOI: 10.1371/journal.pone.0230215.].

Construction and validation of a scenario for sedation training in the emergency room for pediatric surgical procedures by in-situ simulation.

INTRODUCTION: sedation and analgesia are fundamental procedures for children undergoing invasive interventions, and complications must be avoided during their implementation. In situ simulation allows, in turn, training in real practice environments to improve the technical and non-technical skills of professionals for such procedures. Although it is a very useful tool, it is often not used due to lack of preparation for its planning and application. OBJECTIVE: develop and validate an in situ simulation scenario in pediatric emergency care using sedation to perform an invasive procedure. METHOD: descriptive study of construction and content validation of an in situ simulation scenario, using the Delphi method, following the following steps: 1) definition of the problem and selection of experts; 2) development of the initial document; 3) rounds for validation with analysis of responses and feedback (until consensus is reached by the Content Validation Index); 4) final report. Results: The experts indicated suggestions that were duly used and the scenario obtained, in all items, a CVI greater than 80.0%, demonstrating its high validity and reliability. By using experts to validate the scenario, their insights guarantee greater precision and reliability in scenario construction engineering. CONCLUSION: It is expected that this study will allow the replication of the scenario in different training contexts, facilitating and encouraging professional training based on a scenario model based on best evidence and practices.

Translation and cross-cultural adaptation of the Mayo High Performance Team Scale (MHPTS) into Brazilian Portuguese.

OBJECTIVE: describe the process of translation and cross-cultural adaptation of the Mayo High Performance Team Scale into Brazilian Portuguese. METHOD: descriptive study of validation and cross-cultural adaptation of the scale, carried out virtually, following assumptions proposed by Beaton and collaborators. It had a sample of 40 experts, and carried out two rounds, one for validation and one for final assessment. RESULTS: after following all translation steps, the scale was presented to the committee of experts who reached a consensus (IVC between 0.9 and 1.0) that there was no discrepancy, after evaluating the semantic, idiomatic, experiential and conceptual equivalences between the original scale and the translated version. CONCLUSION: The Brazilian Portuguese version of the MHPTS was adequately translated and validated, revealing excellent potential for use in clinical simulation contexts for multidisciplinary scenarios.

Electrooxidative C(sp3)‒H Cyanation of Sparteine and Lupanine in Undivided Batch and Continuous-Flow Cells.

Sparteine is widely used as a chiral ligand in asymmetric synthesis, but methods for providing efficient access to functionalized sparteine derivatives are still limited. Herein, we describe an electrochemical α-cyanation of sparteine-type bis-quinolizidine alkaloids. This method features commercially available setups for batch and single-pass continuous flow conditions, enabling easy gram scale synthesis of valuable racemic and enantiopure products. Moreover, insights into the selectivity of the reaction and overoxidation mechanisms are disclosed. This allows for the development of divergent oxidation pathways depending on the electrolysis conditions.

Rupture and chemical accumulation in contact lenses with dexamethasone eye drop administration after congenital cataract surgery.

PURPOSE: To investigate whether contact lenses used after surgery for congenital cataracts act as a depot for dexamethasone, which would allow the prescribed amount of drops to be reduced, and to examine whether the preservative benzalkonium chloride accumulates in the contact lens matrix, which would suggest a need for more frequent replacements. METHODS: Contact lenses (n = 10) worn by infants treated with dexamethasone eye drops after congenital cataract surgery were analysed with scanning electron microscopy, UV-vis, 1 H-NMR and LDI-MS for chemical deposits and for changes on the contact lens surface. Unused lenses (n = 5) and lenses (n = 4) from patients with no eye drop treatment were analysed as reference. RESULTS: The treated contact lenses displayed ruptured surfaces in comparison with unused and reference lenses. Dexamethasone and BAK were not detected in any of the lenses. A polyethylene oxide component was found in the treated lenses, likely originating from the dexamethasone eye drops or the contact lens solution. CONCLUSION: Dexamethasone and BAK do not accumulate in the contact lenses, and a depot effect of any clinical significance is unlikely. Therefore, the number of drops given after surgery should remain the same regardless of whether the child has contact lenses. The ruptured surface may both decrease the child's comfort and increase the risk of microbial adhesion, and so it is recommended that contact lenses should be replaced once a month throughout the course of anti-inflammatory eye drop treatment after surgery for congenital cataract.

Social participation and self-assessment of health status among older people in Brazil.

To estimate the prevalence of social participation (exposure) and its association with positive self-assessment of overall health status (SAH) (outcome) among 7,712 Brazilian elderly interviewed in the National Health Survey 2013. A cross-sectional study that used Propensity Score (PS) to improve comparability between the group exposed and no exposed to social participation. Poisson regression was performed to determine the prevalence and association of interest using crude and adjusted by inverse probability of selection of PS. Social participation was reported by 25.1% (CI95%: 23.4-26.9) and was lower among poor older people, who depend on public transportation and live in more precarious contexts. Most did not SAH positively, but the proportion was higher when they had social participation (48.0%; CI95%: 46.0-51.0). There was a positive association of social participation with SAH positive. The association using the adjusted model (PR: 1.15; CI95%: 1.08-1.22) attenuated the estimated in the crude model. Elderly exposed were 15% more likely to provide a positive SAH. Despite low levels in Brazil, there was a positive association between of social participation and SAH, confirming that engagement in such activities provides important gains for the health and quality of life.

Association of Salt Iodization and Urine Iodine Concentration in Schoolchildren from Public Schools in Northeast of Brazil.

Iodine deficiency (ID) is recognized as a leading risk factor for child development. Universal salt iodization (USI) is an effective and well-established intervention strategy for the prevention of iodine deficiency disorders (IDD). To evaluate the levels of iodine in household salt samples and the urinary iodine concentration (UIC) in schoolchildren aged 6 to 14 years in public schools in Bahia, Brazil. A cross-sectional study was conducted with 1231 students (6 to 14 years old) from 17 public schools in Bahia. The iodine concentration was evaluated in salt and UIC samples. The adapted Sandell-Kolthoff reaction was used to determine urinary iodine levels. A spectrophotometer (UV-Vis) was used to examine the reduction of ceric ammonium sulfate. A standard iodine solution using a potassium iodate was used to extrapolate the iodine concentrations. The total of 665 salt samples had a median iodine concentration of 24 mg/kg (25th-75th percentile 17.0 to 28.5 mg/kg). The largest proportion (79.6%) of salt samples had iodine concentration in the recommended range, 17.6% of the samples presented iodine at a salt concentration below the established level (<15 mg/kg) and a small proportion was above it (2.8%). The general mean urinary iodine concentration (MUIC) was 217.53 ± 28.30 µg/L and median was 205.50 µg/L. The students evaluated and the salt samples analyzed showed satisfactory results, as recommended by Brazilian legislation and nutritional recommendations of the World Health Organization (WHO).

Congenital cataract in newborns: A qualitative study on parents' experiences of the surgery and subsequent care.

PURPOSE: Having a child with congenital cataract that requires surgery, contact lens treatment, and frequent medication is a life-altering experience. The aim of this study was to provide more in-depth knowledge of parents' experiences of diagnosis, surgery, and subsequent care, in order to find the areas for improvement. METHODS: Data were collected via semi-structured interviews with parents recruited from St. Erik Eye Hospital, Sweden. The children were operated for congenital cataract before 3 months of age and were aged 12-24 months at the time of the interviews. The interviews were analysed using qualitative content analysis with an inductive approach. RESULTS: Three themes emerged from the data: living in a turbulent time before the diagnosis, coping during the time of initial treatment, and managing the responsibility of their child's visual development. All parents expressed confidence in the operating unit. However, there was a clear need for reliable information on the condition, the surgery, and likely the long-term outcome in the time between receiving the preliminary diagnosis at the maternity ward and getting it confirmed by a paediatric ophthalmologist. CONCLUSION: Much of the parents' concern in this turbulent time is linked to poor information before the visit to the eye hospital. We, therefore, recommend earlier contact with the eye hospital, preferably at the time of writing the referral. Moreover, the possibility of providing up-to-date information via alternative information channels such as smartphone apps should be investigated.