Use of multisensory stimulation in institutionalized older adults with moderate or severe dementia.

The Multisensory Stimulation Program can help manage behavioral and psychological symptoms of dementia. Objective: The objective of this study was to investigate the effects of the Multisensory Stimulation Program on behavioral, mood, and biomedical parameters of older adults with moderate and severe dementia compared to a control group not submitted to this program. Methods: This study is an interventional, parallel, open-label, quasi-experimental clinical trial, which is quantitative and qualitative in nature and is also an exploratory type. The sample was divided for convenience into intervention group (IG) and control group (GC) that did not participate in the Multisensory Stimulation Program. Data analysis included descriptive statistics, nonparametric tests (two-tailed alpha value of 0.1 was applied), and thematic content analysis. Results: The sample consisted of 20 older adults (IG=10 and GC=10), with a mean age of 83 years, an average of 3 years of education, and moderate or severe dementia. Reduction in intervention group behavioral changes (p=0.059) and numerical improvement in intervention group cognition were observed. A decrease in heart rate (p<0.05) and diastolic blood pressure (p<0.05) was observed before and immediately after the session in the intervention group. The caregivers described engaged behavior in intervention group, while they reported apathetic behavior in control group. Session records described verbal and nonverbal communication and sustained attention for more than 3 min regarding the sensory resource explored. Conclusions: The Multisensory Stimulation Program could be a new look at the health care practices performed in the nursing homes that consider the older adults' sensory preferences and may help with dementia behavior management.

Um programa de estimulação multissensorial pode auxiliar no manejo dos sintomas comportamentais e psicológicos da demência. Objetivo: Investigar os efeitos do programa de estimulação multissensorial sobre o comportamento, o humor e parâmetros biomédicos de idosos com demência moderada e grave, quando comparados a um grupo controle não submetido a esse programa. Métodos: Estudo de intervenção quase experimental, paralelo, mascaramento aberto, de natureza quantitativa e qualitativa, do tipo exploratório. Amostra foi dividida igualmente por conveniência entre grupo de intervenção (GI) e grupo controle (GC), que não participou do programa de estimulação multissensorial. estatística descritiva, testes não paramétricos (valor alfa bicaudal de 10% aplicado) e análise temática de conteúdo. Resultados: Amostra composta de 20 idosos (GI=10 e GC=10), com média de idade de 83 anos, média de três anos de escolaridade e demência moderada ou grave. Houve redução de alterações comportamentais (p=0.059) e melhora numérica no desempenho da cognição de Grupo de Intervenção. Observou-se diminuição da frequência cardíaca (p<0.05) e da pressão arterial diastólica (p<0.05) antes e imediatamente depois da sessão no grupo de intervenção. Os cuidadores descreveram comportamento engajado no grupo de intervenção, enquanto relataram comportamento apático no grupo controle. Os registros da sessão descreveram ações de interação verbal e não verbal e atenção sustentada por mais de três min diante do recurso sensorial explorado. Conclusões: O programa de estimulação multissensorial poderia ser um novo olhar sobre as práticas de saúde realizadas em instituições de longa permanência de idosos que considerem as preferências sensoriais do idoso, e pode auxiliar no manejo do comportamento demencial.

Use of multisensory stimulation in institutionalized older adults with moderate or severe dementia / Uso da estimulação multissensorial em idosos institucionalizados com demência moderada ou grave

ABSTRACT. The Multisensory Stimulation Program can help manage behavioral and psychological symptoms of dementia. Objective: The objective of this study was to investigate the effects of the Multisensory Stimulation Program on behavioral, mood, and biomedical parameters of older adults with moderate and severe dementia compared to a control group not submitted to this program. Methods: This study is an interventional, parallel, open-label, quasi-experimental clinical trial, which is quantitative and qualitative in nature and is also an exploratory type. The sample was divided for convenience into intervention group (IG) and control group (GC) that did not participate in the Multisensory Stimulation Program. Data analysis included descriptive statistics, nonparametric tests (two-tailed alpha value of 0.1 was applied), and thematic content analysis. Results: The sample consisted of 20 older adults (IG=10 and GC=10), with a mean age of 83 years, an average of 3 years of education, and moderate or severe dementia. Reduction in intervention group behavioral changes (p=0.059) and numerical improvement in intervention group cognition were observed. A decrease in heart rate (p<0.05) and diastolic blood pressure (p<0.05) was observed before and immediately after the session in the intervention group. The caregivers described engaged behavior in intervention group, while they reported apathetic behavior in control group. Session records described verbal and nonverbal communication and sustained attention for more than 3 min regarding the sensory resource explored. Conclusions: The Multisensory Stimulation Program could be a new look at the health care practices performed in the nursing homes that consider the older adults' sensory preferences and may help with dementia behavior management.

RESUMO. Um programa de estimulação multissensorial pode auxiliar no manejo dos sintomas comportamentais e psicológicos da demência. Objetivo: Investigar os efeitos do programa de estimulação multissensorial sobre o comportamento, o humor e parâmetros biomédicos de idosos com demência moderada e grave, quando comparados a um grupo controle não submetido a esse programa. Métodos: Estudo de intervenção quase experimental, paralelo, mascaramento aberto, de natureza quantitativa e qualitativa, do tipo exploratório. Amostra foi dividida igualmente por conveniência entre grupo de intervenção (GI) e grupo controle (GC), que não participou do programa de estimulação multissensorial. estatística descritiva, testes não paramétricos (valor alfa bicaudal de 10% aplicado) e análise temática de conteúdo. Resultados: Amostra composta de 20 idosos (GI=10 e GC=10), com média de idade de 83 anos, média de três anos de escolaridade e demência moderada ou grave. Houve redução de alterações comportamentais (p=0.059) e melhora numérica no desempenho da cognição de Grupo de Intervenção. Observou-se diminuição da frequência cardíaca (p<0.05) e da pressão arterial diastólica (p<0.05) antes e imediatamente depois da sessão no grupo de intervenção. Os cuidadores descreveram comportamento engajado no grupo de intervenção, enquanto relataram comportamento apático no grupo controle. Os registros da sessão descreveram ações de interação verbal e não verbal e atenção sustentada por mais de três min diante do recurso sensorial explorado. Conclusões: O programa de estimulação multissensorial poderia ser um novo olhar sobre as práticas de saúde realizadas em instituições de longa permanência de idosos que considerem as preferências sensoriais do idoso, e pode auxiliar no manejo do comportamento demencial.

Caregivers of family members with chronic diseases: coping strategies used in everyday life / Cuidadores de familiares com doenças crônicas: estratégias de enfrentamento utilizadas no cotidiano

Abstract Introduction: Caring for a family member with a disease causes an adverse daily life involving suffering for the caregiver. The literature on occupational therapy does not debate coping strategies that caregivers adopt with family members with chronic illness, or how perceptions about the role played interfere with occupations and projects. Objective: To characterize the caregivers' coping ways in daily life after a month of hospital discharge from a family member with chronic noncommunicable disease (NCDs) and to identify the perception they elaborate about themselves. Method: Descriptive study with qualitative-quantitative approach and cross-sectional design composed of 30 family caregivers of familiar members with NCDs followed in medical ward of a general hospital. Instruments used were sociodemographic questionnaire, Barthel index, Coping Mode Scale, and semi-structured questionnaire. Quantitative data analysis was performed with descriptive statistics, analysis of variance (ANOVA) test for repeated measurements, and Duncan and Tukey tests. The thematic content analysis was used to treat qualitative data. Results: The main modes of coping used were focused on the problem and on religious-fantastical thoughts. Participants expressed "feelings about everyday problems", pointing to the positive perception of the beneficial feelings of care, but also a negative perception of changes in occupational life. The "coping strategies" of the participants were the accomplishment of "pleasurable activities, spirituality, and search for informal social support" that contributed to alleviate the problems experienced. Conclusion: Characterized the coping strategies of family caregivers with NCDs, highlighting how complex the experience of being a caregiver.

Resumo Introdução: Cuidar de um familiar adoecido gera um cotidiano adverso envolvendo sofrimento para o cuidador. A literatura da terapia ocupacional não aborda as estratégias de enfrentamento que cuidadores adotam com familiares com doença crônica ou como a percepção sobre o papel desempenhado interfere nas ocupações e projetos. Objetivos: Caracterizar os modos de enfrentamento dos cuidadores no cotidiano após um mês da alta hospitalar de um familiar com doença crônica não transmissível (DCNT) e identificar a percepção que eles elaboram sobre si. Método: Estudo quantitativo-qualitativo, descritivo e transversal composto por 30 cuidadores de familiares com DCNT acompanhados em enfermaria clínica de um hospital geral. Instrumentos: questionário sociodemográfico, Índice de Barthel, Escala de Modo de Enfrentamentos de Problemas e questionário semiestruturado. A análise dos dados quantitativos foi realizada com estatística descritiva, testes ANOVA para medições repetidas e teste de Duncan e Tukey. A análise temática de conteúdo foi empregada para tratamento dos dados qualitativos. Resultados: Os principais modos de enfrentamento foram focalizados no problema e em pensamentos religiosos e fantasiosos. Os participantes expressaram os "sentimentos frente aos problemas cotidianos", apontando a percepção positiva em face dos sentimentos benéficos advindos dos cuidados, mas também uma percepção negativa pelas alterações da vida ocupacional. As "estratégias de enfrentamento" dos participantes foram a realização de atividades prazerosas, a espiritualidade e busca por suporte social informal, que contribuíram para aliviar os problemas vividos. Conclusão: Foram caracterizadas as estratégias de enfrentamento dos cuidadores de familiares com DCNT, destacando quão complexa é a experiência de ser um cuidador.

Durum wheat diversity for heat stress tolerance during inflorescence emergence is correlated to TdHSP101C expression in early developmental stages.

The predicted world population increase along with climate changes threatens sustainable agricultural supply in the coming decades. It is therefore vital to understand crops diversity associated to abiotic stress response. Heat stress is considered one of the major constrains on crops productivity thus it is essential to develop new approaches for a precocious and rigorous evaluation of varietal diversity regarding heat tolerance. Plant cell membrane thermostability (CMS) is a widely used method for wheat thermotolerance assessment although its limitations require complementary solutions. In this work we used CMS assay and explored TdHSP101C genes as an additional tool for durum wheat screening. Genomic and transcriptomic analyses of TdHSP101C genes were performed in varieties with contrasting CMS results and further correlated with heat stress tolerance during fertilization and seed development. Although the durum wheat varieties studied presented a very high homology on TdHSP101C genes (>99%) the transcriptomic assessment allowed the discrimination between varieties with good CMS results and its correlation with differential impacts of heat treatment during inflorescence emergence and seed development on grain yield. The evidences here reported indicate that TdHSP101C transcription levels induced by heat stress in fully expanded leaves may be a promising complementary screening tool to discriminate between durum wheat varieties identified as thermotolerant through CMS.

Involvement of disperse repetitive sequences in wheat/rye genome adjustment.

The union of different genomes in the same nucleus frequently results in hybrid genotypes with improved genome plasticity related to both genome remodeling events and changes in gene expression. Most modern cereal crops are polyploid species. Triticale, synthesized by the cross between wheat and rye, constitutes an excellent model to study polyploidization functional implications. We intend to attain a deeper knowledge of dispersed repetitive sequence involvement in parental genome reshuffle in triticale and in wheat-rye addition lines that have the entire wheat genome plus each rye chromosome pair. Through Random Amplified Polymorphic DNA (RAPD) analysis with OPH20 10-mer primer we unraveled clear alterations corresponding to the loss of specific bands from both parental genomes. Moreover, the sequential nature of those events was revealed by the increased absence of rye-origin bands in wheat-rye addition lines in comparison with triticale. Remodeled band sequencing revealed that both repetitive and coding genome domains are affected in wheat-rye hybrid genotypes. Additionally, the amplification and sequencing of pSc20H internal segments showed that the disappearance of parental bands may result from restricted sequence alterations and unraveled the involvement of wheat/rye related repetitive sequences in genome adjustment needed for hybrid plant stabilization.

Size matters in Triticeae polyploids: larger genomes have higher remodeling.

Polyploidization is one of the major driving forces in plant evolution and is extremely relevant to speciation and diversity creation. Polyploidization leads to a myriad of genetic and epigenetic alterations that ultimately generate plants and species with increased genome plasticity. Polyploids are the result of the fusion of two or more genomes into the same nucleus and can be classified as allopolyploids (different genomes) or autopolyploids (same genome). Triticeae synthetic allopolyploid species are excellent models to study polyploids evolution, particularly the wheat-rye hybrid triticale, which includes various ploidy levels and genome combinations. In this review, we reanalyze data concerning genomic analysis of octoploid and hexaploid triticale and different synthetic wheat hybrids, in comparison with other polyploid species. This analysis reveals high levels of genomic restructuring events in triticale and wheat hybrids, namely major parental band disappearance and the appearance of novel bands. Furthermore, the data shows that restructuring depends on parental genomes, ploidy level, and sequence type (repetitive, low copy, and (or) coding); is markedly different after wide hybridization or genome doubling; and affects preferentially the larger parental genome. The shared role of genetic and epigenetic modifications in parental genome size homogenization, diploidization establishment, and stabilization of polyploid species is discussed.

Genome merger: from sequence rearrangements in triticale to their elimination in wheat-rye addition lines.

Genetic and epigenetic modifications resulting from different genomes adjusting to a common nuclear environment have been observed in polyploids. Sequence restructuring within genomes involving retrotransposon/microsatellite-rich regions has been reported in triticale. The present study uses inter-retrotransposon amplified polymorphisms (IRAP) and retrotransposon microsatellite amplified polymorphisms (REMAP) to assess genome rearrangements in wheat-rye addition lines obtained by the controlled backcrossing of octoploid triticale to hexaploid wheat followed by self-fertilization. The comparative analysis of IRAP and REMAP banding profiles, involving a complete set of wheat-rye addition lines, and their parental species revealed in those lines the presence of wheat-origin bands absent in triticale, and the absence of rye-origin and triticale-specific bands. The presence in triticale x wheat backcrosses (BC) of rye-origin bands that were absent in the addition lines demonstrated that genomic rearrangement events were not a direct consequence of backcrossing, but resulted from further genome structural rearrangements in the BC plant progeny. PCR experiments using primers designed from different rye-origin sequences showed that the absence of a rye-origin band in wheat-rye addition lines results from sequence elimination rather than restrict changes on primer annealing sites, as noted in triticale. The level of genome restructuring events evaluated in all seven wheat-rye addition lines, compared to triticale, indicated that the unbalanced genome merger situation observed in the addition lines induced a new round of genome rearrangement, suggesting that the lesser the amount of rye chromatin introgressed into wheat the larger the outcome of genome reshuffling.

Interplay of ribosomal DNA loci in nucleolar dominance: dominant NORs are up-regulated by chromatin dynamics in the wheat-rye system.

BACKGROUND: Chromatin organizational and topological plasticity, and its functions in gene expression regulation, have been strongly revealed by the analysis of nucleolar dominance in hybrids and polyploids where one parental set of ribosomal RNA (rDNA) genes that are clustered in nucleolar organizing regions (NORs), is rendered silent by epigenetic pathways and heterochromatization. However, information on the behaviour of dominant NORs is very sparse and needed for an integrative knowledge of differential gene transcription levels and chromatin specific domain interactions. METHODOLOGY/PRINCIPAL FINDINGS: Using molecular and cytological approaches in a wheat-rye addition line (wheat genome plus the rye nucleolar chromosome pair 1R), we investigated transcriptional activity and chromatin topology of the wheat dominant NORs in a nucleolar dominance situation. Herein we report dominant NORs up-regulation in the addition line through quantitative real-time PCR and silver-staining technique. Accompanying this modification in wheat rDNA trascription level, we also disclose that perinucleolar knobs of ribosomal chromatin are almost transcriptionally silent due to the residual detection of BrUTP incorporation in these domains, contrary to the marked labelling of intranucleolar condensed rDNA. Further, by comparative confocal analysis of nuclei probed to wheat and rye NORs, we found that in the wheat-rye addition line there is a significant decrease in the number of wheat-origin perinucleolar rDNA knobs, corresponding to a diminution of the rDNA heterochromatic fraction of the dominant (wheat) NORs. CONCLUSIONS/SIGNIFICANCE: We demonstrate that inter-specific interactions leading to wheat-origin NOR dominance results not only on the silencing of rye origin NOR loci, but dominant NORs are also modified in their transcriptional activity and interphase organization. The results show a cross-talk between wheat and rye NORs, mediated by ribosomal chromatin dynamics, revealing a conceptual shift from differential amphiplasty to 'mutual amphiplasty' in the nucleolar dominance process.

Polyploidization as a retraction force in plant genome evolution: sequence rearrangements in triticale.

BACKGROUND: Polyploidization is a major evolutionary process in plants where hybridization and chromosome doubling induce enormous genomic stress and can generate genetic and epigenetic modifications. However, proper evaluation of DNA sequence restructuring events and the precise characterization of sequences involved are still sparse. METHODOLOGY/PRINCIPAL FINDINGS: Inter Retrotransposons Amplified Polymorphism (IRAP), Retrotransposons Microsatellite Amplified Polymorphism (REMAP) and Inter Simple Sequence Repeat (ISSR) largely confirmed the absence of any intraspecific variation in wheat, rye and triticale. The comparative analysis of banding profiles between wheat and rye inbred lines revealed 34% of monomorphic (common to both parental species) bands for the ten different primer combinations used. The analysis of triticale plants uncovered nearly 51% of rearranged bands in the polyploid, being the majority of these modifications, due to the loss of rye bands (83%). Sequence analysis of rye fragments absent in triticale revealed for instance homology with hydroxyproline-rich glycoproteins (HRGP), a protein that belongs to a major family of inducible defence response proteins. Conversely, a wheat-specific band absent in triticale comprises a nested structure of copia-like retrotransposons elements, namely Claudia and Barbara. Sequencing of a polyploid-specific band (absent in both parents) revealed a microsatellite related sequence. Cytological studies using Fluorescent In Situ Hybridization (FISH) with REMAP products revealed a widespread distribution of retrotransposon and/or microsatellite flanking sequences on rye chromosomes, with a preferential accumulation in heterochromatic sub-telomeric domains. CONCLUSIONS/SIGNIFICANCE: Here, we used PCR-based molecular marker techniques involving retrotransposons and microsatellites to uncover polyploidization induced genetic restructuring in triticale. Sequence analysis of rearranged genomic fragments either from rye or wheat origin showed these to be retrotransposon-related as well as coding sequences. Further FISH analysis revealed possible chromosome hotspots for sequence rearrangements. The role of chromatin condensation on the origin of genomic rearrangements mediated by polyploidization in triticale is also discussed.