High-touch surfaces disinfection compliance in a COVID-19 intensive care unit.

Environmental cleaning and disinfection are fundamental health care-associated infection prevention measures. This study aimed to evaluate the disinfection compliance of high-touch surfaces in a COVID-19-only intensive care unit, using a fluorescent marker. It was divided into 3 phases, baseline assessment, educational feedback, and post feedback. Disinfection compliance improved significantly from the first to the third phase, 14.3% to 51.4% (P < .001), respectively.

Adesão à quimioterapia antineoplásica oral, apoio social e bem- estar de pacientes com câncer cerebral: estudo correlacional / Adhesión a la quimioterapia antineoplásica oral, apoyo social y bienestar de pacientes con cáncer cerebral: estudio correlacional / Adherence to oral antineoplastic chemotherapy, social support and well-being of patients with brain cancer: a correlational study

Objetivos: identificar as percepções sobre o bem-estar, apoio social, intensidade dos sintomas e o seu impacto nas atividades diárias de pacientes com cânceres cerebrais e correlacionar os achados com os níveis de adesão aos quimioterápicos antineoplásicos orais. Método: estudo correlacional e transversal, realizado num ambulatório hospitalar universitário de São Paulo, Brasil, entre 2019 e 2020. Utilizou-se instrumento para caracterização da amostra e escalas específicas. Resultados: 26 participantes, mediana de 36,5 anos, 61,5% sexo masculino, 53,9% diagnosticados com glioblastoma; 73,1% apresentaram adesão, rede de apoio social e índice alto de bem-estar. O escore médio de intensidade dos sintomas foi de baixo para médio, com pior pontuação para preocupação no pior estado. A maior adesão relacionou-se ao apoio afetivo, apoio informação, interação social e apoio emocional. Conclusão: a maioria declarou níveis positivos de bem-estar, suporte social e poucos sintomas. A percepção de apoio social e bem-estar influenciaram positivamente na adesão medicamentosa.

Objetivos: identificar las percepciones sobre el bienestar, apoyo social, intensidad de los síntomas y su impacto en las actividades diarias de pacientes con cánceres cerebrales y correlacionar los resultados con los niveles de adhesión a los quimioterápicos antineoplásicos orales. Método: estudio correlacional y transversal, realizado en un ambulatorio hospitalario universitario de São Paulo, Brasil, entre 2019 y 2020. Se utilizó un instrumento para la caracterización de la muestra y escalas específicas. Resultados: 26 participantes, mediana de 36,5 años, 61,5% sexo masculino, 53,9% diagnosticados con glioblastoma; 73,1% presentaron adhesión, red de apoyo social y índice alto de bienestar. El puntaje promedio de intensidad de los síntomas fue de bajo a medio, con peor puntuación para preocupación en el peor estado. La mayor adhesión se relacionó al apoyo afectivo, apoyo información, interacción social y apoyo emocional. Conclusión: la mayoría declaró niveles positivos de bienestar, apoyo social y pocos síntomas. La percepción de apoyo social y bienestar influyó positivamente en la adhesión medicamentosa.

Objectives: to identify perceptions about well-being, social support, intensity of symptoms and their impact on the daily activities of patients with brain cancers and correlate the findings with levels of adherence to oral antineoplastic chemotherapy. Method: correlational and cross-sectional study, conducted in a university hospital outpatient clinic in São Paulo, Brazil, between 2019 and 2020. An instrument was used to characterize the sample, in addition to specific scales. Results: 26 participants, median 36.5 years, 61.5% male, 53.9% diagnosed with glioblastoma; 73.1% showed adherence, social support network and high well-being index. The mean symptom intensity score was low to medium, with a worse score for worry in the worst state. Greater adherence was related to affective support, information support, social interaction and emotional support. Conclusion: most reported positive levels of well-being, social support and few symptoms. The perception of social support and well-being positively influenced drug adherence.

Letramento digital em saúde de estudantes de enfermagem ou medicina: fatores relacionados / Alfabetización digital en salud de estudiantes de enfermería o medicina: factores relacionados / Digital health literacy of nursing or medical students: related factors

Resumo Objetivo Identificar fatores relacionados ao letramento digital em saúde de estudantes de medicina ou enfermagem. Métodos O nível de letramento digital em saúde de graduandos de enfermagem ou medicina de três instituições foi avaliado pela eHealth Literacy Scale (eHEALS), versão brasileira, cujo escore varia de 8 a 40; quanto maior a pontuação, maior o nível de letramento autorreferido. Relações entre o escore do eHEALS e variáveis sociodemográficas e acadêmicas foram verificadas por meio dos testes de Mann Whitney ou Kruskal Wallis, com significância de 5%. Quando havia significância do teste de Kruskal Wallis, foi utilizado teste de Dunn para comparações dois a dois. Resultados Participaram 346 estudantes, com idade média de 23,0±5,0 anos, 71,5% do sexo feminino, 51,6% do curso de Enfermagem. A pontuação média do eHEALS foi de 31,6±4,4. Maiores escores do eHEALS se associaram a: sexo masculino, instituição pública, curso integral, maior tempo desde o início da graduação, ter pessoas próximas que buscam informações sobre saúde online, dominar outro idioma, se sentir bem/muito bem sobre a saúde atual. O nível de letramento se correlacionou positivamente com idade, utilidade da internet e seu conteúdo de saúde. O item "Sinto-me confiante em usar informações da Internet para tomar decisões de saúde" teve pontuação mais baixa. Conclusão Características sociodemográficas e acadêmicas se relacionam ao letramento digital em saúde de estudantes universitários. Esses resultados podem subsidiar e direcionar esforços curriculares nas universidades, engajando futuros profissionais da saúde na disseminação de informações confiáveis dentro e fora do contexto acadêmico, bem como na assistência assistida por tecnologias.essionals in the dissemination of reliable information inside and outside the academic context, and in technology-assisted care.

Resumen Objetivo Identificar factores relacionados a la alfabetización digital en salud de estudiantes de medicina o enfermería. Métodos El nivel de alfabetización digital en salud de estudiantes universitarios de enfermería o medicina de tres instituciones fue evaluado por la eHealth Literacy Scale (eHEALS), versión brasileña, cuya puntuación varía de 8 a 40; cuanto más alta la puntuación, más alto el nivel de alfabetización autorreferido. La relación entre la puntuación de eHEALS y variables sociodemográficas y académicas se verificó a través de las pruebas de Mann Whitney o de Kruskal Wallis, con una significancia del 5 %. Cuando había significancia en la prueba de Kruskal Wallis, se utilizó la prueba de Dunn para comparaciones de a dos. Resultados Participaron 346 estudiantes, de edad promedio de 23,0±5,0 años, 71,5 % del sexo femenino, 51,6 % del curso de Enfermería. El puntaje promedio del eHEALS fue de 31,6±4,4. Las puntuaciones más altas de eHEALS se asociaron con: sexo masculino, institución pública, curso integral, más tiempo desde el inicio del curso universitario, tener a personas próximas que buscan información sobre salud online, dominar otro idioma, sentirse bien/muy bien sobre la salud actual. El nivel de alfabetización se correlacionó positivamente con la edad, utilidad de internet y su contenido de salud. El ítem "Me siento seguro al usar información de internet para tomar decisiones de salud" obtuvo un puntaje más bajo. Conclusión Características sociodemográficas y académicas se relacionan con la alfabetización digital en salud de estudiantes universitarios. Esos resultados pueden respaldar y orientar iniciativas curriculares en las universidades, y así involucrar a futuros profesionales de salud en la diseminación de información confiable dentro y fuera del contexto académico, así como a la atención auxiliada por tecnologías.

Abstract Objective To identify factors related to the digital health literacy of medical or nursing students. Methods The level of digital health literacy of undergraduate nursing or medical students from three institutions was assessed using the Brazilian version of the eHealth Literacy Scale (eHEALS), whose score ranges from 8 to 40; the higher the score, the higher the self-reported literacy level. Relationships between the eHEALS score and sociodemographic and academic variables were assessed using the Mann Whitney or Kruskal Wallis tests, with a significance level of 5%. When the Kruskal Wallis test was significant, the Dunn's test was used for two by two comparisons. Results 346 students participated in the study, with a mean age of 23.0±5.0 years, 71.5% female, 51.6% from the Nursing course. The mean eHEALS score was 31.6±4.4. Higher eHEALS scores were associated with the male gender, attending a public institution, full-time course, longer time since enrollment in the course, having close people who seek health information online, mastering another language, and feeling good/very good about their current health. The literacy level was positively correlated with age, and the usefulness of the internet and its health content. Lower scores were reached in the item "I feel confident in using information from the internet to make health decisions". Conclusion Sociodemographic and academic characteristics are related to the digital health literacy of university students. These results can support and direct curricular efforts in universities, engaging future health professionals in the dissemination of reliable information inside and outside the academic context, and in technology-assisted care.

Valor prognóstico da amplitude de distribuição das hemácias em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronariana percutânea / Prognostic value of red cell distribution width in ST-segment elevation myocardium infarction patients undergoing percutaneous coronary intervention

Objetivo: Determinar os valores da amplitude de distribuição das hemácias em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronária percutânea primária e avaliar sua associação com resultados adversos. Métodos: Os níveis de amplitude de distribuição das hemácias foram medidos em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST antes da intervenção coronária percutânea primária e divididos conforme valor das amplitudes de distribuição das hemácias. Após a alta hospitalar, os pacientes foram acompanhados por até 3 anos para a ocorrência de eventos cardiovasculares adversos maiores e mortalidade a longo prazo. Resultados: Foram incluídos 893 pacientes com idade média de 60,7 (±12,5) anos, e 66,3% eram do sexo masculino. Na análise multivariada, a hemácia permaneceu como preditor independente de mortalidade a longo prazo. A área sob a curva para mortalidade a longo prazo foi de 0,64 (IC95% 0,61-0,67; p<0,0001). Amplitudes de distribuição das hemácias <13,3 tiveram valor preditivo negativo de 87,1% para mortalidade por todas as causas. Conclusão: Um valor elevado de amplitude de distribuição das hemácias é um preditor independente de mortalidade a longo prazo e eventos cardiovasculares adversos maiores em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST submetidos à intervenção coronária percutânea primária. Amplitudes de distribuição das hemácias baixas têm baixo tem um excelente valor preditivo negativo para mortalidade a longo prazo. (AU)

Objective: To determine red cell distribution width values in ST-elevation acute myocardial infarction patients undergoing primary percutaneous coronary intervention and to evaluate its association with adverse outcomes. Methods: Red cell distribution width levels were measured in ST-segment elevation myocardial infarction patients before primary percutaneous coronary intervention and divided into low and high red cell distribution width. After discharge, patients were followed for up to 3 years for the occurrence of long-term major adverse cardiovascular events and mortality. Results: A total of 893 patientes were with a mean age of 60.7 (±12.5) years, 66.3% were male. In multivariate analysis, the red cell distribution width remained as an independent predictor of long-term mortality. The area under the curve for long-term mortality was 0.64 (95%CI0.61-0.67; p<0.0001). Red cell distribution width<13.3 had a negative predictive value of 87.1% for all-cause mortality. Conclusion: High number of red cell distribution width is an independent predictor of long-term mortality and major adverse cardiovascular events in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. A low number of red cell distribution width has an excellent negative predictive value for long-term mortality. Patients with sustained elevated levels of red cell distribution width have worse outcomes at long-term follow-up. (AU)

Zika Virus Surveillance at the Human-Animal Interface in West-Central Brazil, 2017-2018.

Zika virus (ZIKV) was first discovered in 1947 in Uganda but was not considered a public health threat until 2007 when it found to be the source of epidemic activity in Asia. Epidemic activity spread to Brazil in 2014 and continued to spread throughout the tropical and subtropical regions of the Americas. Despite ZIKV being zoonotic in origin, information about transmission, or even exposure of non-human vertebrates and mosquitoes to ZIKV in the Americas, is lacking. Accordingly, from February 2017 to March 2018, we sought evidence of sylvatic ZIKV transmission by sampling whole blood from approximately 2000 domestic and wild vertebrates of over 100 species in West-Central Brazil within the active human ZIKV transmission area. In addition, we collected over 24,300 mosquitoes of at least 17 genera and 62 species. We screened whole blood samples and mosquito pools for ZIKV RNA using pan-flavivirus primers in a real-time reverse-transcription polymerase chain reaction (RT-PCR) in a SYBR Green platform. Positives were confirmed using ZIKV-specific envelope gene real-time RT-PCR and nucleotide sequencing. Of the 2068 vertebrates tested, none were ZIKV positive. Of the 23,315 non-engorged mosquitoes consolidated into 1503 pools tested, 22 (1.5%) with full data available showed some degree of homology to insect-specific flaviviruses. To identify previous exposure to ZIKV, 1498 plasma samples representing 62 species of domestic and sylvatic vertebrates were tested for ZIKV-neutralizing antibodies by plaque reduction neutralization test (PRNT90). From these, 23 (1.5%) of seven species were seropositive for ZIKV and negative for dengue virus serotype 2, yellow fever virus, and West Nile virus, suggesting potential monotypic reaction for ZIKV. Results presented here suggest no active transmission of ZIKV in non-human vertebrate populations or in alternative vector candidates, but suggest that vertebrates around human populations have indeed been exposed to ZIKV in West-Central Brazil.

Anemia and the frailty syndrome amongst the elderly living in the community: a systematic review / Anemia e síndrome da fragilidade em idosos da comunidade: revisão sistemática

Objective: To evaluate the association between anemia and the onset of the frailty syndrome amongst the elderly living in the community. Method: A systematic literature review of articles from the MEDLINE and LILACS databases published in English, Spanish and Portuguese over the last ten years was carried out. Articles were included in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The search identified 193 studies. After deleting duplicated articles and applying the exclusion criteria only seven articles remained. Three articles used standardized criteria to define frailty, whereas four evaluated functional capacity as a synonym for the frailty syndrome. Conclusion: Anemia was related to a worsening of functional capacity and to the presence of the frailty syndrome in elderly persons living in the community. However, the risk of bias in the studies was high in relation to the selection of the criteria and instruments used to assess and define frailty.

Objetivo: Avaliar a associação entre anemia e síndrome de fragilidade em idosos da comunidade. Método: Trata-se de uma revisão sistemática da literatura nos idiomas inglês, espanhol e português, nas bases de dados MEDLINE e LILACS no período de 2007 a 2016. A inclusão dos artigos foi guiada pelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Essa revisão identificou 193 artigos e após eliminação dos artigos duplicados e dos critérios de exclusão, foram incluídos sete artigos. Três artigos utilizaram critérios padronizados para definição de fragilidade e quatro estudos avaliaram a capacidade funcional como sinônimo de síndrome de fragilidade. Conclusão: A anemia mostrou-se relacionada à piora da capacidade funcional e à presença da síndrome de fragilidade em idosos da comunidade. Entretanto, o risco de viés dos estudos foi alto durante a seleção dos critérios e dos instrumentos utilizados para avaliação e definição da fragilidade.

Association between inflammatory mediators, grip strength and mobility in community-dwelling elderly / Associação entre mediadores inflamatórios, força de preensão manual e mobilidade em idosos da comunidade / Asociación entre mediadores inflamatorios, fuerza de la empuñadura y la movilidad en ancianos de la comunidad

Abstract Introduction: Aging is associated with loss of muscle mass, immunosenescence and increased production of inflammatory mediators, high levels being predictors of a decline in functional capacity in the elderly. Objective: To assess the association between inflammatory mediators, interleukin 6 (IL-6) and C-reactive protein (CRP) and functional capacity in the elderly. Methods: Cross-sectional study with 308 community-dwelling elderly. The study was approved by the Research Ethics Committee, under protocol number 067/2010. Grip strength (GS) was measured using a JAMAR® dynamometer and functional capacity by the Timed Up and Go (TUG) test. Blood tests were performed and serum levels of C-reactive protein and interleukin 6 assessed. Spearman's coefficient was applied to analyze the correlation between variables and the Mann-Whitney for intergroup comparison. Significance was set at 0.05. Results: There was no significant correlation between GS, the TUG and inflammatory mediators (CRP and IL-6). However, by adjusting for variables such as age, sex and muscle mass, a significant and inverse correlation (p = 0.023) was observed between GS and CPR. Conclusion: Elderly subjects with low C-reactive protein levels performed better in the grip strength test. It is important to investigate the adverse effects on functional capacity that can be influenced by inflammatory cytokines in the elderly during aging.

Resumo Introdução: O envelhecimento está relacionado a perda de massa muscular, imunossenescência e o aumento da produção de mediadores inflamatórios, cujos níveis elevados são preditores do declínio da capacidade funcional na população idosa. Objetivo: Avaliar a associação entre mediadores inflamatórios, interleucina-6 (IL-6) e proteína C-reativa (PCR) e capacidade funcional no idoso. Métodos: Estudo transversal com 308 idosos da comunidade. O estudo foi aprovado pelo Comitê de Ética e Pesquisa, 067/2010. A força de preensão manual (FPM) foi avaliada através do dinamômetro de JAMAR® e a capacidade funcional pelo teste Timed Up and Go. Foi realizado um exame de sangue e analisados os níveis séricos de proteína C-reativa e interleucina-6. Utilizou-se o coeficiente de Spearman para verificar a correlação entre as variáveis e o teste de Mann-Whitney para comparação entre os grupos. O nível de significância utilizado foi de 0,05. Resultados: Não houve correlação significativa entre a FPM e o Timed Up and Go e os mediadores inflamatórios (PCR e IL-6). Porém, ao controlar as variáveis como idade, gênero e índice de massa muscular encontrou-se uma associação significativa e inversa (p = 0,023) entre a FPM e os níveis de PCR. Conclusão: Idosos com baixos índices de proteína C-reativa apresentaram melhor desempenho no teste de força muscular manual. É destacável a importância da investigação dos desfechos adversos que podem ser influenciados pela citocinas inflamatórias na capacidade funcional dos idosos durante o envelhecimento.

Resumen Introducción: El envejecimiento se relaciona con una pérdida de masa muscular, inmunosenescencia, tanto el aumento de la producción de mediadores inflamatorios, cuyos niveles elevados son predictores de disminución de la capacidad funcional en la población de edad avanzada. Objetivo: Investigar la asociación entre mediadores inflamatorios, interleucina-6 (IL-6) y proteína C reactiva (CRP) y capacidad funcional en los ancianos. Métodos: Estudio transversal con 308 ancianos de la comunidad. El estudio fue aprobado por el Comité de Ética e Investigación, 067/2010. La fuerza de la empuñadura (GS) se evaluó utilizando el dinamómetro JAMAR® y la capacidad funcional mediante la prueba Timed Up and Go. Se realizó un análisis de sangre y se analizaron los niveles séricos de proteína C reactiva e interleucina-6. El coeficiente de Spearman se utilizó para verificar la correlación entre las variables y la prueba de Mann-Whitney para la comparación entre los grupos. El nivel de significancia fue 0,05. Resultados: No hubo correlación significativa entre GS y Timed Up and Go y mediadores inflamatorios (CRP e IL-6). Sin embargo, cuando se controlaron variables como la edad, el sexo y el índice de masa muscular, hubo una asociación significativa (p = 0,023) entre los niveles de GS y CRP, es decir, los individuos que obtuvieron buenos resultados en el GS obtuvieron niveles más bajos de PCR circulante. Conclusión: Los pacientes ancianos con bajos niveles de proteína C reactiva, presentaron mejor desempeño en la prueba de fuerza muscular manual. Es importante investigar los efectos adversos que pueden estar influenciados por las citosinas inflamatorias sobre la capacidad funcional de los ancianos durante el envejecimiento.

Medo de cair e qualidade de vida em idosos com catarata / Fear of falling and quality of life in elderly with cataract

INTRODUÇÃO: O medo de cair é definido como baixa autoeficácia ou confiança no próprio equilíbrio para evitar quedas, causando declínio no desempenho físico e funcional, alterações no equilíbrio e na marcha dos idosos, tendo impacto negativo na qualidade de vida. Vários estudos têm identificado o déficit visual como fator contributivo para a ocorrência de quedas e do medo de cair em idosos. OBJETIVOS: Avaliar a associação entre o medo de cair e as alterações na visão funcional e na qualidade de vida relacionada à visão de idosos com catarata. MÉTODOS: Trata-se de estudo observacional com 139 idosos com catarata (71,4±6,2 anos). A qualidade de vida relacionada à visão foi avaliada pelo Visual Function Questionnaire (VFQ) e a preocupação com a possibilidade de quedas foi avaliada pela Falls Efficacy Scale International (FES-I-Brasil). RESULTADOS: Idosos que relataram algum grau de medo de cair apresentaram médias mais altas na escala FES-I-Brasil, quando comparados aos que não o relataram, indicando maior preocupação com a possibilidade de cair (p=0,000; Kruskal-Wallis). Com relação à visão funcional (VFQ) e à qualidade de vida relacionada à visão, quanto maior o medo de cair, piores eram a visão e a qualidade de vida (p=0,003; Kruskal-Wallis). CONCLUSÃO: Idosos com catarata e com relato de medo de cair apresentaram menor confiança no seu equilíbrio para evitar quedas e pior qualidade na visão funcional e na qualidade de vida relacionada à visão.

INTRODUCTION: Fear of falling is defined as low self-efficacy or self-confidence in one's own balance to avoid falls. It causes limitations in physical and functional performance, balance and walking impairment, and has negative impact on quality of life. Many research works have identified visual impairment as one of the factors that contribute to falls and fear of falling. OBJECTIVES: Evaluate the association between fear of falling and visual function impairment and the related-vision quality of life in elderly patients with cataract. METHODS: Observational study conducted with 139 elderly patients with cataract (71.4±6.2 years). Vision-related quality of life was assessed through the Visual Function Questionnaire (VFQ). Interviews were made by means of the Falls Efficacy Scale International (FES-I Brazil) to evaluate the concern with falling. RESULTS: Elderly patient with fear of falling had higher averages in FES-I-Brazil than other elderly patients (p=0.000; Kruskal-Wallis). The greater the fear of falling, the worst were the visual function (VFQ) and the related-vision quality of life (p=0,003; Kruskal-Wallis). CONCLUSION: Elderly patients with cataract and fear of falling had less self-confidence in their balance to avoid falls and worst functional vision and related-vision quality of life.

Dor, cinesiofobia e qualidade de Vida em pacientes com lombalgia crônica e depressão / Pain, kinesiophobia and quality of life in chronic low back pain and depression

Objetivo: Descrever características de dor, cinesiofobia e qualidade de vida em pacientes com lombalgia crônica associada a depressão. Métodos: Estudo de delineamento transversal em que foram incluídos 193 indivíduos com lombalgia crônica. A presença de depressão foi determinada pelo Inventário de Depressão de Beck, a partir de ponto de corte validado pela Mini International Neuropsychiatric Interview. A intensidade e a qualidade da dor nos grupos com e sem depressão foram avaliadas pelo Questionário McGill. A Escala Tampa para Cinesiofobia foi aplicada para avaliar medo do movimento. Com relação à qualidade de vida, utilizou-se o Medical Outcomes Study 36. O nível de significância estatístico estabelecido foi p< 0,05. Resultados: A prevalência de depressão foi de 32,1%. O grupo com depressão teve pior pontuação com relação à dor, cinesiofobia e qualidade de vida (capacidade funcional, aspectos físicos, dor, estado geral de saúde, vitalidade, aspectos sociais, aspectos emocionais e saúde mental). Conclusão: Pacientes com lombalgia e depressão apresentaram maior intensidade de dor, maior medo de movimento e pior qualidade de vida. Nível de Evidência III, Corte Transversal.

Objective: To describe the characteristics of pain, kinesiophobia and quality of life in patients with chronic low back pain and depression. Methods: Cross-sectional study in which 193 individuals with chronic low back pain were included. The presence of depression was measured by the Beck Depression Inventory, using a cutoff validated by the Mini International Neuropsychiatric Interview. The intensity and quality of pain in the groups with and without depression were assessed by the McGill Questionnaire. The Tampa Scale for Kinesiophobia was applied to assess fear of movement. With respect to quality of life, the Medical Outcomes Study 36 was used. The statistical significance level was set at p <0.05. Results: The prevalence of depression was 32.1%. The group with depression had worse scores in relation to pain, kinesiophobia and quality of life (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Conclusion: Patients with low back pain and depression had higher pain intensity, greater fear of movement and poorer quality of life. Level of Evidence III, Cross-sectional.

Lipidomic analysis of phospholipids from human mammary epithelial and breast cancer cell lines.

Alterations of phospholipid (PL) profiles have been associated to disease and specific lipids may be involved in the onset and evolution of cancer; yet, analysis of PL profiles using mass spectrometry (MS) in breast cancer cells is a novel approach. Previously, we reported a lipidomic analysis of PLs from mouse mammary epithelial and breast cancer cells using off-line thin layer chromatography (TLC)-MS, where several changes in PL profile were found to be associated with the degree of malignancy of cells. In the present study, lipidomic analysis has been extended to human mammary epithelial cells and breast cancer cell lines (MCF10A, T47-D, and MDA-MB-231), using TLC-MS, validated by hydrophilic interaction liquid chromatography-MS. Differences in phosphatidylethanolamine (PE) content relative to total amount of PLs was highest in non-malignant cells while phosphatidic acid was present with highest relative abundance in metastatic cells. In addition, the following differences in PL molecular species associated to cancer phenotype, metastatic potential, and cell morphology were found: higher levels of alkylacyl PCs and phosphatidylinositol (PI; 22:5/18:0) were detected in migratory cells, epithelial cells had less unsaturated fatty acyl chains and shorter aliphatic tails in PE and sphingomyelin classes, while PI (18:0/18:1) was lowest in non-malignant cells compared to cancer cells. To date, information about PL changes in cancer progression is scarce, therefore results presented in this work will be useful as a starting point to define possible PLs with prospective as biomarkers and disclose metabolic pathways with potential for cancer therapy.

Pain, kinesiophobia and quality of life in chronic low back pain and depression.

OBJECTIVE: To describe the characteristics of pain, kinesiophobia and quality of life in patients with chronic low back pain and depression. METHODS: Cross-sectional study in which 193 individuals with chronic low back pain were included. The presence of depression was measured by the Beck Depression Inventory, using a cutoff validated by the Mini International Neuropsychiatric Interview. The intensity and quality of pain in the groups with and without depression were assessed by the McGill Questionnaire. The Tampa Scale for Kinesiophobia was applied to assess fear of movement. With respect to quality of life, the Medical Outcomes Study 36 was used. The statistical significance level was set at p <0.05. RESULTS: The prevalence of depression was 32.1%. The group with depression had worse scores in relation to pain, kinesiophobia and quality of life (physical functioning, rolephysical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. CONCLUSION: Patients with low back pain and depression had higher pain intensity, greater fear of movement and poorer quality of life. Level of Evidence III, Cross-sectional.

Profiling changes triggered during maturation of dendritic cells: a lipidomic approach.

Lipids are important in several biological processes because they act as signalling and regulating molecules, or, locally, as membrane components that modulate protein function. This paper reports the pattern of lipid composition of dendritic cells (DCs), a cell type of critical importance in inflammatory and immune responses. After activation by antigens, DCs undergo drastic phenotypical and functional transformations, in a process known as maturation. To better characterize this process, changes of lipid profile were evaluated by use of a lipidomic approach. As an experimental model of DCs, we used a foetal skin-derived dendritic cell line (FSDC) induced to mature by treatment with lipopolysaccharide (LPS). The results showed that LPS treatment increased ceramide (Cer) and phosphatidylcholine (PC) levels and reduced sphingomyelin (SM) and phosphatidylinositol (PI) content. Mass spectrometric analysis of a total lipid extract and of each class of lipids revealed that maturation promoted clear changes in ceramide profile. Quantitative analysis enabled identification of an increase in the total ceramide content and enhanced Cer at m/z 646.6, identified as Cer(d18:1/24:1), and at m/z 648.6, identified as Cer(d18:1/24:0). The pattern of change of these lipids give an extremely rich source of data for evaluating modulation of specific lipid species triggered during DC maturation.

Lipidomic approach to identify patterns in phospholipid profiles and define class differences in mammary epithelial and breast cancer cells.

Breast cancer is the leading cause of cancer-related deaths in women. Altered cellular functions of cancer cells lead to uncontrolled cellular growth and morphological changes. Cellular biomembranes are intimately involved in the regulation of cell signaling; however, they remain largely understudied. Phospholipids (PLs) are the main constituents of biological membranes and play important functional, structural and metabolic roles. The aim of this study was to establish if patterns in the PL profiles of mammary epithelial cells and breast cancer cells differ in relation to degree of differentiation and metastatic potential. For this purpose, PLs were analyzed using a lipidomic approach. In brief, PLs were extracted using Bligh and Dyer method, followed by a separation of PL classes by thin layer chromatography, and subsequent analysis by mass spectrometry (MS). Differences and similarities were found in the relative levels of PL content between mammary epithelial and breast cancer cells and between breast cancer cells with different levels of aggressiveness. When compared to the total PL content, phosphatidylcholine levels were reduced and lysophosphatydilcholines increased in the more aggressive cancer cells; while phosphatidylserine levels remained unchanged. MS analysis showed alterations in the classes of phosphatidylcholine, lysophosphatidylcholine, sphingomyelin, and phosphatidylinositides. In particular, the phosphatidylinositides, which are signaling molecules that affect proliferation, survival, and migration, showed dramatic alterations in their profile, where an increase of phosphatdylinositides saturated fatty acids chains and a decrease in C20 fatty acids in cancer cells compared with mammary epithelial cells was observed. At present, information about PL changes in cancer progression is lacking. Therefore, these data will be useful as a starting point to define possible PLs with prospective as biomarkers and disclose metabolic pathways with potential for therapy.

Association between funcional vision, balance and fear of falling in older adults with cataracts / Associação entre visão funcional, equilíbrio e medo de cair em idosos com catarata

BACKGROUND: Cataract is the most common visual problem in the elderly population. It affects mobility and balance as it reduces the perception of the edges of steps and sidewalks, as well as altering depth perception of the ground. It has been shown that poor performances in tests of distant contrast sensitivity and depth perception were independent predictors of increased sway in older people. OBJECTIVES: this study aimed to verify the association between functional balance, visual functioning and fear of falling in older adults with cataracts. METHOD: it was a transversal observational study in which 139 elderly patients (aged 71.4 ± 6.2 years) participated. Their vision was assessed using the Snellen chart and the Visual Function Questionnaire (VFQ). The Berg Balance Scale was used to assessment functional balance, the Timed Up and Go to assess mobility and Falls Efficacy Scale International (FES-I) to assess the fear of falling. RESULTS: Statistically significant associations were found in the bivariate analyses between balance (Berg) and the variables: visual acuity (Kruskal-Wallis, p=0.006); TUG (Pearson=-0.528, p=0.000) and FES-I, (Pearson=-0.355, p=0.000). Analysis of the multivariate regression between the BBS and the variables gender, age, visual acuity, VFQ, FES-I-Brazil and number of medicines used. The regression analysis explained a 32.8% variance in the dependent variable (Berg). CONCLUSIONS: visual deficits in the elderly can cause alterations in balance and mobility, contributing to a subsequent fear of falling.

CONTEXTUALIZAÇÃO: catarata é o problema visual mais comum na população idosa. Afeta a mobilidade e o equilíbrio, uma vez que reduz a percepção das bordas dos degraus e calçadas e a percepção de profundidade do solo. Estudos mostraram que performance ruim em testes de sensibilidade ao constraste à distância e de percepção de profundidade foram preditores independentes de aumento da oscilação corporal em idosos. OBJETIVOS: o objetivo do estudo foi verificar a associação entre equilíbrio funcional, visão funcional e medo de cair em idosos com catarata. MÉTODO: trata-se de um estudo transversal, observacional com 139 idosos (71,4 ± 6.2 anos). A visão foi avaliada pelo quadro de Snellen e pelo Visual Function Questionnaire (VFQ). A escala de Berg (BBS) foi usada para avaliar equilíbrio funcional, o Timed Up and Go para avaliar mobilidade e o medo de cair pela Falls Efficacy Scale International (FES-I Brazil). RESULTADOS: encontraram-se associações significativas nas análises bivariadas entre equilíbrio e acuidade visual (Kruskal-Wallis, p=0,006); TUG (Pearson=-0,528, p=0,000) e FES-I, (Pearson=-0,355, p=0,000). A análise de regressão multivariada entre a BBS e as variáveis como sexo, idade, acuidade visual, VFQ, FES-I Brasil e número de medicamentos foi realizada. A análise de regressão foi capaz de explicar 32,8% da variância na variável dependente (Berg). CONCLUSÃO: déficits visuais em idosos podem ocasionar alterações no equilíbrio ou na mobilidade, desencadeando o medo de cair.

Carvedilol treatment reduces transthyretin deposition in a familial amyloidotic polyneuropathy mouse model.

Carvedilol is a ß-antagonist with strong anti-oxidant effect in lipids, proteins and superoxide production protecting biological membranes from oxidative stress. We hypothesised a possible therapeutical application of carvedilol in familial amyloidotic polyneuropathy (FAP), a neurodegenerative disease caused by deposition of transthyretin (TTR) amyloid fibrils. Oxidative stress, apoptosis and inflammation related to aggregation of non-fibrillar and fibrillar TTR have been detected both in pre-symptomatic and symptomatic stages of the disease, respectively. In this study we show by semi-quantitative immunohistochemistry and western blot analysis that administration of carvedilol to a transgenic mouse model of FAP influences the expression of oxidative and apoptotic biomarkers usually associated with TTR deposition, namely oxidation products such as HNE and 8-OHdG, and markers of ER stress. Most important, carvedilol treatment significantly reduced TTR aggregates in as much as 50%. We also observed that carvedilol rescues a mice neuroblastoma cell line from death induced by TTR oligomers, by decreasing activation of BiP and other ER stress biomarkers. Since carvedilol has no effect on TTR aggregation "in vitro", this finding points for the "in vivo" modulation of TTR aggregation by oxidative stress and apoptosis and prompts for the use of this safe drug in prophylactic and therapeutical measures in the FAP population.

Factors associated with depressive symptoms in a sample of Brazilian medical students / Fatores associados a sintomas depressivos entre estudantes de medicina da UNILUS

OBJECTIVES: 1 - Verify the prevalence of depressive symptoms in first to fourth-year medical students using the Beck Depression Inventory (BDI). 2 - Establish correlations between target factors and higher or lower BDI scores. 3 - Investigate the relationship between the prevalence of depressive symptoms and the demand for psychological care offered by the Centro Universitário Lusíada. METHOD: Cross-sectional study of 290 first to fourth-year medical students; implementation of the BDI, socio-demographic survey, and evaluation of satisfaction with progress. RESULTS: The study sample was 59 percent female and 41 percent male. Mean BDI was 6.3 (SD 5.8). Overall prevalence of depressive symptoms was 23.1 percent. The following associations were statistically significant (p<0.05): among students for whom the course failed to meet original expectations, who were dissatisfied with the course, or who came from the interior of the State (20.5 percent, 12.5 percent, and 24.4 percent of the total sample, respectively), for 40 percent, 36.1 percent and 36.4 percent, respectively, the BDI was consistent with some degree of depression. CONCLUSION: The study showed that there is higher prevalence of depressive symptoms in medical students than in the general population

OBJETIVOS: 1- Verificar prevalência de sintomas depressivos nos estudantes de medicina do 1º a 4º ano através do Inventário de Depressão de Beck (IDB). 2- Estabelecer correlações entre os fatores questionados e a incidência de maior ou menor pontuação no IDB. 3- Investigar relação entre a prevalência de sintomas depressivos e a procura por atendimento psicológico oferecido pela Universidade Lusíada. MÉTODO: Desenho transversal realizado com 290 acadêmicos do curso de medicina, do 1º ao 4º ano. Realizada aplicação do IDB, questionário sócio-demográfico e avaliação sobre satisfação com curso. RESULTADOS: Da amostra estudada, 59 por cento sãomulheres e 41 por cento homens. O escore médio do IDB foi de 6,3 com DP de 5,8. Aprevalência total desintomas depressivos foi de 23,1 por cento. As seguintes relaçõesapresentaram significância estatística (P<0,05): Dosestudantes queafirmam que o curso não corresponde às expectativas iniciais,dosestudantes insatisfeitos com o curso e dosestudantes procedentes do Interior do Estado(20,5 por cento; 12,5 por centoe 24,4 por cento da amostra total, respectivamente), 40 por cento, 36,1 por cento e 36,4 por cento respectivamente, tem escore compatível com algum grau de depressão. CONCLUSÃO: O presente estudo mostrou que há maior prevalência de sintomas depressivos nos estudantes de Medicina que na população geral

Impacto das alterações visuais nas quedas, desempenho funcional, controle postural e no equilíbrio dos idosos: uma revisão de literatura / The impact of visual alterations on falls, functional performance, postural control and balance in the elderly: a literature review

Idosos com déficits visuais podem alterar seu estilo de vida e sua independência funcional. As alterações visuais podem ocasionar a redução na interação social e na qualidade de vida, presença de depressão e quedas. O controle do equilíbrio corporal pode estar diminuído em indivíduos com déficits visuais. O objetivo deste estudo é realizar uma revisão da literatura dos últimos 15 anos sobre o impacto das alterações visuais nas quedas, no desempenho funcional, no controle postural e no equilíbrio dos idosos. A avaliação da acuidade visual pode não ser suficiente para identificar indivíduos com risco de quedas. Outras medidas relacionadas à função visual, como contraste, sensibilidade e profundidade, também são importantes. Muitos problemas relacionados à baixa visão em idosos são passíveis de correção e tratamento, seja através das órteses ou mesmo da extração da catarata, melhorando, assim, a função visual e motora.

Visual impairment in the elderly may alter their life style and functional independence. Visual alterations may cause depression, falls and a reduction in social interaction, altering the quality of life. The control of body balance may be impaired in individuals with visual deficits. The objective of this study was to review the last 15 years of literature on the impact of visual alterations through feedback from the visual system, on functional performance, on postural control and on balance in the elderly. The assessment of visual acuity may not be sufficient to identify those individuals who are at risk of falling. Other measurements related to visual function, such as contrast, sensitivity and depth perception, are also important. Many problems related to impaired vision in the elderly are correctable or treatable, either by the use of reflective vision correction or by extraction of cataracts, thus improving both visual and motor functions.

Anti-apoptotic treatment reduces transthyretin deposition in a transgenic mouse model of Familial Amyloidotic Polyneuropathy.

Tauroursodeoxycholic acid (TUDCA) is a unique natural compound that acts as a potent anti-apoptotic and anti-oxidant agent, reducing cytotoxicity in several neurodegenerative diseases. Since oxidative stress, apoptosis and inflammation are associated with transthyretin (TTR) deposition in Familial Amyloidotic Polyneuropathy (FAP), we investigated the possible TUDCA therapeutical application in this disease. We show by semi-quantitative immunohistochemistry and western blotting that administration of TUDCA to a transgenic mouse model of FAP decreased apoptotic and oxidative biomarkers usually associated with TTR deposition, namely the ER stress markers BiP and eIF2alpha, the Fas death receptor and oxidation products such as 3-nitrotyrosine. Most important, TUDCA treatment significantly reduced TTR toxic aggregates in as much as 75%. Since TUDCA has no effect on TTR aggregation "in vitro", this finding points for the "in vivo" modulation of TTR aggregation by cellular responses, such as by oxidative stress, ER stress and apoptosis and prompts for the use of this safe drug in prophylactic and therapeutic measures in FAP.

Biomarkers in the assessment of therapies for familial amyloidotic polyneuropathy.

The identification of specific biomarkers provides opportunities to develop early diagnostic parameters, monitor disease progression, and test drug efficiency in clinical trials. We previously demonstrated that in familial amyloidotic polyneuropathy (FAP) related to the abnormal extracellular tissue deposition of mutant transthyretin (TTR), inflammatory and apoptotic pathways are triggered in the presymptomatic stages of the disease, when nonfibrillar TTR deposits are present. In the present work, to better define biomarkers for future assessment of prophylactic and therapeutic drugs in the treatment of FAP, we extended the search for oxidative stress and apoptotic biomarkers to clinical samples and animal models presenting nonfibrillar and fibrillar TTR. We found that lipid peroxidation measured by hydroxynonenal, oxidative DNA damage measured by 8-hydroxy-2'-deoxyguanosine, and cellular redox homeostasis measured by glutaredoxin 1 were consistently increased in biopsy specimens from FAP patients and in tissues from transgenic mouse models presenting nonfibrillar TTR deposition. Death-receptor Fas, caspase-8, and Bax were also found to be increased, indicative of the involvement of death receptors in the observed apoptosis process. Removal of TTR deposition by an immunization protocol resulted in significant decreases of the selected markers we describe, corroborating the relationship between TTR deposition, oxidative stress, and apoptosis. Taken together, our results provide a robust biomarker profile for initial experimental animal studies and clinical trials to assess the application of the selected markers in therapies aimed at removal and/or inhibition of TTR polymerization.

Análise das propriedades psicométricas de uma avaliação clínica para detectar medo de cair em idosos / Evaluation of psychometric properties of clinical assessment to detect fear of falling in elderly

O objetivo deste estudo foi avaliar a confiabilidade intra e interexaminadores de uma avaliação desenvolvida pelas pesquisadoras para detectar o medo de cair em idosos e sua aplicação clínica. A avaliação foi construída para investigar se o medo de cair relatado pelos idosos se correlacionava com manifestações clínicas objetivas como: alterações autonômicas (aumento da pressão sistólica, freqüência cardíaca e respiratória), alterações posturais e da marcha, quando era solicitado ao idoso o ortostatísmo e uma deambulação de 5 metros. A avaliação foi aplicada em 30 idosos (86 „bƒn12 anos) de ambos os sexos com relato de medo de cair, de um ambulatório de fisioterapia. Utilizou-se o índice de Kappa para avaliar confiabilidade intra e interexaminadores e o teste t-Student (p < 0,05) para detectar a correlação entre as manifestações clínicas e o medo de cair. A confiabilidade intra e interexaminadores foi de 0,81 e 0,70, respectivamente. Os itens da avaliação que mostraram correlação significativa com o medo de cair foram: aumento da pressão sistólica, da freqüência cardíaca e respiratória (p = 0,00) e base de suporte (p = 0,01). A confiabilidade da avaliação foi considerada boa. O instrumento permitiu detectar de maneira objetiva as manifestações clínicas do medo de cair em idosos.

The aim of this study was to evaluate reliability inter and intra- examiners of assessment developed by researchers to detect the fear of falling in elderly and its clinical application. The assessment was designed to investigate if fear of falling reported by elderly was correlated with clinical manifestations such as: autonomic alterations (increase of systolic pressure, heart rate and respiratory frequency), and postural and gait alterations, when elderly were asked to stay in standing position and perform a 5 m walk. The assessment was applied to 30 elderly from both genders, age 86 ± 12, from an outpatient physical therapy clinic, who reported fear of falling. The Kappa index was used to evaluate reliability intra and inter examiners, t-Student test (p < 0.05) to detect correlation between clinical manifestations and fear of falling. The reliability intra and inter-examiners was 0.81 e 0.70, respectively. The items that the assessment proved significant were: increased systolic pressure, heart rate and respiratory frequency (p = 0.00), longer double stand phase (p = 0.02), diminished gait speed, pace length and bigger support base (p = 0.00). In conclusion, the reliability of the assessment was considered good. The instrument allowed the objective detection of clinical manifestations of fear of falling in elderly. A correlation of the autonomic manifestations with the fear of falling was found.