Aromaterapia em residentes de emfermagem na pandemia de COVID-19: um estudo piloto / Aromaterapia en residentes de enfermería en la pandemia de COVID-19: un estudio piloto / Aromatherapy in Nursing Residents in the COVID-19 Pandemic: A Pilot Study

Objetivo: verificar o efeito da aromaterapia nos sintomas emocionais e fadiga de residentes de Enfermagem que atuavam em hospitais durante a pandemia de COVID-19. Método: estudo piloto do tipo pré e pós intervenção com abordagem quantitativa. Os residentes utilizaram uma sinergia de óleos essenciais (limão siciliano, lavanda, bergamota e tea tree) a 2 %, via cutânea, por três semanas. Foram aplicados o Self-Report Questionnaire-20 (SRQ-20) e o Pictograma de fadiga antes, após a intervenção e três semanas após o término (follow up). Resultados: participaram 15 residentes. As médias dos três momentos do SRQ-20 foram 9,73; 7,00 e 8,13, respectivamente. Houve redução dos sintomas emocionais pós-intervenção (p = 0,026) e no follow up não houve aumento significativo do escore do SRQ-20 (p=0,666). Não houve evidência significativa de mudança de estado do nível de fadiga para as três fases do estudo. Conclusões: o uso da aromaterapia impactou na melhora de sintomas emocionais dos residentes de Enfermagem que atuaram em hospitais durante a pandemia de COVID-19.

Objective: to verify the effect of aromatherapy on emotional symptoms and fatigue in nursing residents working in hospitals during the COVID-19 pandemic. Method: pre- and post-intervention pilot study with quantitative approach. The residents used a combination of essential oils (Sicilian lemon, lavender, bergamot and tea tree) at 2%, via the skin, for three weeks. The Self-Report Questionnaire-20 (SRQ-20) and the Fatigue Pictogram were applied before and after the intervention and three weeks after its completion (follow up). Results: 15 residents participated. The averages of the three moments of the SRQ-20 were 9.73, 7.00 and 8.13, respectively. There was a reduction in emotional symptoms post-intervention (p=0.026) and in the follow up there was no significant increase in the SRQ-20 score (p=0.666). There was no significant evidence of change in fatigue level status for the three study phases. Conclusions: the use of aromatherapy had an impact on the improvement of emotional symptoms of nursing residents working in hospitals during the COVID-19 pandemic.

Objetivo: verificar el efecto de la aromaterapia en los síntomas emocionales y la fatiga de residentes de Enfermería que trabajaban en hospitales durante la pandemia de COVID-19. Método: estudio piloto de tipo pre y post intervención con enfoque cuantitativo. Los residentes utilizaron una combinación de aceites esenciales (limón siciliano, lavanda, bergamota y tea tree) al 2%, vía cutánea, por tres semanas. El Self-ReportQuestionnaire-20 (SRQ-20) y el Pictograma de fatiga fueron aplicados antes y después de la intervención y tres semanas después de terminado (follow up). Resultados: participaron 15 residentes. Los promedios de los tres momentos del SRQ-20 fueron 9,73; 7,00 y 8,13, respectivamente. Hubo reducción de los síntomas emocionales post-intervención (p = 0,026) y en el follow up no hubo aumento significativo del puntaje del SRQ-20 (p=0,666). No hubo evidencia significativa de cambio de estado del nivel de fatiga para las tres fases de estudio. Conclusiones: el uso de la aromaterapia impactó en el mejoramiento de síntomas emocionales de los residentes de Enfermería que trabajaron en hospitales durante la pandemia de COVID-19.

The effectiveness of Chair Massage on Stress and Pain in Oncology.

BACKGROUND: There is a high prevalence of moderate-to-high levels of chronic stress among nurses, as well as an occurrence of musculoskeletal disorders. PURPOSE: To evaluate the effectiveness of chair massage to reduce chronic stress and musculoskeletal pain in the Oncology Nursing team. SETTING: Two teaching cancer hospitals, one public and the other private, in São Paulo city, Brazil. PARTICIPANTS: A total of 60 women from the Oncology Nursing team. RESEARCH DESIGN: A randomized controlled trial divided into two groups: chair massage and control without intervention. INTERVENTION: The massage group received two chair massage sessions lasting 15 minutes, twice a week, for three weeks. MAIN OUTCOME MEASURE: Reduction of stress and pain measured by the List of Signs and Symptoms (LSS) and the Brief Pain Inventory (BPI), respectively. RESULTS: The average age was 32 (± 5.3) years. There was a reduction of stress measured by the LSS with a statistical difference in the group-time interaction (p < .001), with a Cohen's d value of 1.21 between groups. The BPI analysis showed a statistically significant difference in the group-time interaction for general activity (p < .008), mood (p < .03), work (p < .000), and sleep (p = .03), with reduced pain interference in these components. CONCLUSION: Chair massage reduced stress and pain interference in the team's daily life activities, bringing a positive impact in the context of work stress and pain in Oncology nursing professionals.

Cortisol reactivity to a psychosocial stressor significantly increases the risk of developing Cognitive Impairment no Dementia five years later.

Alzheimer's disease (AD) patients show high cortisol levels suggesting that biological mediators of stress may play a role in the neurodegenerative process of cognitive disorders. However, there is no consensus as to whether cortisol concentrations represent a risk factor for the development of cognitive impairment. We analyzed the potential association between the incidence of cognitive impairment and cortisol concentrations under basal and acute stress conditions in 129 individuals aged 50 years or older, with preserved cognitive and functional abilities. All participants were recruited in 2011 for assessment of cognitive performance and cortisol levels. Cortisol was analyzed in saliva samples collected during two typical and consecutive days, in the morning, afternoon, and night, and also during exposure to an acute psychosocial stressor (Trier Social Stress Test - TSST). After a five-year follow-up, 69 of these volunteers were reassessed for cognitive performance, functional evaluation, memory complaints, and depression. The incidence of cognitive impairment not dementia (CIND) was 26.1 %, and was positively associated with greater TSST-induced cortisol release (responsiveness) [(95 % CI = 1.001-1.011; B = 0.006), p = 0.023]. Moreover, five years before diagnosis, participants who later developed CIND had greater responsiveness to TSST (p = 0.019) and lower cortisol awakening response (CAR: p = 0.018), as compared to those who did not develop CIND. These findings suggest that higher psychosocial stress responsiveness profiles may represent a preclinical sign of cognitive impairment.

Work-related stress and cognitive performance among middle-aged adults: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Assessing risk factors exposure, such as stress in the workplace during adulthood, may contribute to detecting early signs of cognitive impairment in order to implement effective actions to improve brain health and consequently to decrease cognitive disorders later in life. In this cross-sectional study, we aimed to investigate whether work-related stress is associated with low cognitive performance in middle-aged adults from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and whether social support mediates this relationship. Work-related stress was evaluated in 9,969 workers using the Demand-Control-Support Questionnaire. Cognitive function was assessed using the verbal fluency, trail-making version B, and delayed recall word tests. Work-related stress was associated with lower performance on the delayed recall, verbal fluency, and executive function tests in middle-aged adults. Social support may mediate the association between work demands and cognitive performance. These findings support that work-related stress is associated with cognitive performance during adulthood.

Relationship between cortisol reactivity to psychosocial stress and declarative memory decline during aging: Impact of age and sex.

AIM: To analyze the relationship between memory performance and the neuroendocrine and cardiovascular response to acute psychosocial stress in healthy older people, and the sex and age impact in this relationship. METHODS: We randomly selected 100 literate older adults, without cognitive or functional impairment. The neuroendocrine stress response was evaluated by measuring the concentration of salivary cortisol, whereas cardiovascular reactions were determined based on blood pressure and heart rate measures taken before, during and after participant exposure to an acute psychosocial stressor (the Trier social stress test [TSST]). Memory performance was evaluated by applying the word pairs test before and after the TSST. RESULTS: A significant reduction in the word pair test scores was observed after the TSST, and a negative correlation between cortisol concentration and immediate and delayed recall of the word pair. Cortisol concentration associated with age, sex and education explained memory performance variability before and after the TSST. CONCLUSIONS: The results showed that the influence of acute stress on memory performance during aging might vary according to age and sex, highlighting potential differences in the vulnerability of older individuals to the neurotoxic effects of stress exposure on memory and consequently on the development of cognitive disorders. Geriatr Gerontol Int 2018; 18: 169-176.

Association between perceived psychological stress and cognitive decline in aging: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify, appraise and synthesize the best available evidence on the association between perceived psychological stress and cognitive decline in aging.

Cardiovascular risk factors and cognitive performance in aging.

BACKGROUND: Atherosclerosis in cerebral blood vessels, especially those which compose the Circle of Willis, can lead to reduced supply of oxygen and nutrients to different cortical structures, affecting cognitive function. OBJECTIVE: To analyze whether cardiovascular risk factors negatively influence cognitive performance in adults and elderly. METHODS: One hundred twenty-nine participants of both sexes, aged over 50 years, without cognitive or functional impairment were included. Body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), smoking history, plasma levels of total cholesterol, low density lipoproteins (LDL), high density lipoproteins (HDL) and very low density lipoproteins (VLDL) cholesterol, triglycerides, and glucose were the cardiovascular risk factors analyzed. Cognitive assessment was performed using tests of attention, working memory, category fluency and declarative memory. RESULTS: Controlling for age and education, multivariate linear regression models revealed that higher concentrations of triglycerides, as well as total, LDL and VLDL cholesterol, were associated with poorer performance on the digit span and category fluency tests. Higher HDL concentrations were associated with higher scores on category fluency tasks. Furthermore, higher BMI was associated with poorer delayed recall performance. CONCLUSION: The findings revealed that cardiovascular risk factors may negatively impact cognitive performance in aging.

INTRODUÇÃO: A aterosclerose nos vasos sanguíneos cerebrais, especialmente naqueles que compõem o Círculo de Willis, pode levar à redução da oferta de oxigênio e nutrientes para diferentes estruturas corticais, afetando a função cognitiva. OBJETIVO: Analisar se fatores de risco cardiovascular influenciam negativamente o desempenho cognitivo em adultos e idosos. MÉTODOS: Foram incluídos cento e vinte e nove participantes de ambos os sexos, com idade superior a 50 anos, sem comprometimento cognitivo ou funcional. Índice de massa corporal (IMC), hipertensão arterial (HAS), diabetes mellitus (DM), história de tabagismo, níveis plasmáticos de colesterol total e lipoproteínas de baixa densidade (LDL), lipoproteínas de alta densidade (HDL) e lipoproteínas de baixa densidade (VLDL), triglicerídeos e glicemia foram os fatores de risco cardiovascular analisados. A avaliação cognitiva foi realizada utilizando testes de atenção, memória operacional, fluência verbal e memória declarativa. RESULTADOS: Controlando para idade e escolaridade, os modelos de regressão linear multivariada revelaram que concentrações mais elevadas de triglicerídeos, bem como colesterol total, LDL e VLDL, estão associadas com pior desempenho nos testes de extensão de dígitos e fluência verbal. Além disso, concentrações maiores de HDL se correlacionaram com pontuações maiores nas tarefas de fluência verbal. IMC maior se associou com menor desempenho na evocação tardia. CONCLUSÃO: Os achados revelaram que fatores de risco cardiovascular podem afetar negativamente o desempenho cognitivo durante o envelhecimento.

[Subjective memory complain in healthy elderly: influence of depressive symptoms, perceived stress and self-esteem]. / Queixa subjetiva de comprometimento da memória em idosos saudáveis: influência de sintomas depressivos, percepção de estresse e autoestima.

The current study analyzed the relationship between perceived stress, depressive symptoms and self-esteem in elderly with and without subjective memory complain. Two-hundred four elderly were included (104 without and 100 with subjective memory complain) assesse using the Memory Assessment Complain Questionnaire (MAC-Q). The study protocol was composed by the Perceived Stress Scale (PSS), the Geriatric Depression Scale (GDS) and the Self-Esteem Scale of Rosenberg (SES). The elderly with subjective memory complain showed higher PSS and GDS scores (p < 0.001) and lower SES scores (p = 0.045). Negative correlation was observed between MAC-Q and PSS (p < 0.001) and GDS (p = 0.01). Multiple regression analysis showed predictor effect of perceived stress in the subjective memory complain. These findings suggest that the perceived stress and depressive symptoms are associated with subjective memory complain in elderly.

Peripheral oxidative stress biomarkers in mild cognitive impairment and Alzheimer's disease.

Oxidative stress has been associated with normal aging and Alzheimer's disease (AD). However, little is known about oxidative stress in mild cognitive impairment (MCI) patients who present a high risk for developing AD. The aim of this study was to investigate plasma production of the lipid peroxidation marker, malonaldehyde (MDA) and to determine, in erythrocytes, the enzymatic antioxidant activity of catalase, glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione S-transferase (GST) in 33 individuals with MCI, 29 with mild probable AD and 26 healthy aged subjects. GR/GPx activity ratio was calculated to better assess antioxidant defenses. The relationship between oxidative stress and cognitive performance was also evaluated by the Mini Mental State Examination (MMSE). AD patients showed higher MDA levels than both MCI and healthy elderly subjects. MCI subjects also exhibited higher MDA levels compared to controls. Catalase and GPx activity were similar in MCI and healthy individuals but higher in AD. GR activity was lower in MCI and AD patients than in healthy aged subjects. Additionally, GR/GPx ratio was higher in healthy aged subjects, intermediate in MCI and lower in AD patients. No differences in GST activity were detected among the groups. MMSE was negatively associated with MDA levels (r = -0.31, p = 0.028) and positively correlated with GR/GPx ratio in AD patients (r = 0.68, p < 0.001). MDA levels were also negatively correlated to GR/GPx ratio (r = -0.31, p = 0.029) in the AD group. These results suggest that high lipid peroxidation and decreased antioxidant defenses may be present early in cognitive disorders.

Effects of stress hormones on the brain and cognition: Evidence from normal to pathological aging.

Several studies have demonstrated a wide cognitive variability among aged individuals. One factor thought to be associated with this heterogeneity is exposure to chronic stress throughout life. Animal and human evidence demonstrates that glucocorticoids (GCs), the main class of stress hormones, are strongly linked to memory performance whereby elevated GC levels are associated with memory performance decline in both normal and pathological cognitive aging. Accordingly, it is believed that GCs may increase the brain's vulnerability to the effects of internal and external insults, and thus may play a role in the development of age-related cognitive disorders such as Alzheimer's disease (AD). The aim of this review article was to investigate the effects of GCs on normal and pathological cognitive aging by showing how these hormones interact with different brain structures involved in cognitive abilities, subsequently worsen memory performance, and increase the risk for developing dementia.

Vários estudos têm demonstrado uma ampla variabilidade cognitiva entre indivíduos idosos. Um dos fatores que tem sido associado com esta heterogeneidade é a exposição crônica ao estresse ao longo da vida. Evidências em humanos em animais têm mostrado que os glicocorticóides (GCs), principal classe de hormônios do estresse, estão fortemente associados com o desempenho da memória, sendo que concentrações elevadas de GCs está correlacionada com declínio da memória no envelhecimento cognitivo normal e patológico. Consequentemente, alguns autores têm proposto que os GCs podem aumentar a vulnerabilidade do cérebro aos efeitos de insultos internos e externos desempenhando, portanto, papel importante no desenvolvimento de transtornos cognitivos associados à idade como a doença de Alzheimer (AD). Este artigo de revisão discute os efeitos dos GCs no envelhecimento cognitivo normal e patológico demonstrando como estes hormônios interagem com diferentes estruturas cerebrais envolvidas em habilidades cognitivas e subsequentemente pioram o desempenho da memória e aumentam o risco para o desenvolvimento de demência.

[Stress symptoms and coping strategies in healthy elderly subjects]. / Sintomas de estresse e estratégias de coping em idosos saudáveis.

Elderly subjects may present stress symptoms due to physical, psychological and social changes during aging process. The aim of this study was to identify stress symptoms in elderly subjects and the coping strategies they used, verifying the relationship between these variables. The Stress Symptoms List (SSL) and the Jalowiec Coping Scale were administered to 41 healthy elderly subjects. Elderly subjects presented stress symptoms with a mean score of 42.8. Although problem-focused coping was predominantly observed, no significant difference was observed between mean SSL scores among elderly subjects who used problem-focused or emotion-focused coping. Although elderly subjects mainly elected problem-focused coping, stress intensity was independent of the coping style, showing that both problem- and emotion-focused coping are associated with similar stress levels.

Stress and coping in older people with Alzheimer's disease.

AIM: To investigate stress intensity and coping style in older people with mild Alzheimer's disease. BACKGROUND: The potential risk assessment of a stress event and the devising of coping strategies are dependent on cognitive function. Although older individuals with Alzheimer's disease present significant cognitive impairment, little is known about how these individuals experience stress events and select coping strategies in stress situations. DESIGN: Survey. METHOD: A convenient sample of 30 cognitively healthy older people and 30 individuals with mild Alzheimer's disease were given an assessment battery of stress indicators (Symptom Stress List, Cornell Scale for Depression in Dementia, State-Trait Anxiety Inventory), coping style (Jalowiec Coping Scale) and cognitive performance (mini-mental state exam) were applied in both groups. Statistical analysis of the data employed the Mann-Whitney test to compare medians of stress indicators and coping style, Fischer's exact test to compare proportions when expected frequencies were lower than five, and Spearman's correlation coefficient to verify correlation between coping style and cognitive performance. RESULTS: Both groups suffered from the same stress intensity (p = 0.254). Regarding coping styles, although differences were not statistically significant (p = 0.124), emotion-oriented coping was predominant in the patients with Alzheimer's disease. However, those individuals displaying better cognitive performance in the Alzheimer's disease group had selected coping strategies focused on problem solving (p = 0.0074). CONCLUSIONS: Despite a tendency for older people with Alzheimer's disease to select escape strategies and emotional control, rather than attempting to resolve or lesser the consequences arising from a problem, coping ultimately depends on cognitive performance of the individual. RELEVANCE TO CLINICAL PRACTICE: The findings of this study provide information and data to assist planning of appropriate support care for individuals with Alzheimer's disease who experience stress situations, based on their cognitive performance.

The influence of schooling on working memory performance in elderly individuals without cognitive decline.

Over recent decades, research on cognition has been developed rapidly toward better understanding the cognitive changes that usually occur during normal aging. There is evidence that elderly individuals have worse working memory performance than young adults. However, the effect of education on this cognitive function remains unclear. OBJECTIVES: To analyze the performance of healthy elderly subjects on working memory tasks and to verify the influence of educational level on this performance. METHODS: Forty elderly individuals without cognitive impairment and fully independent, were randomly chosen from a group of subjects participating in cultural activities at the university campus. The Digit Span Forward (DSF) test was used to evaluate attention performance. The working memory performance was assessed by the Digit Span Backward (DSB) and the difference between DSF and DSB. The data were statistically analyzed using the Spearman's correlation coefficient to verify the correlation between the Digit Span (DS) scores and the variables age and schooling, while the Multiple Linear Regression Model was used to verify the effect of these variables on the DS scores. RESULTS: A significant positive correlation (r=0.41, p<0.01) as well as a significant association (ß=0.506; p=0.001; CI 95%= 0.064/0.237) were found between years of schooling and DSB scores. It was not observed statistical correlation (r= -0.08, p=0.64) or association (ß=0.41; p=0.775; CI 95%= -0.049/0.065) between age and DSB scores. CONCLUSION: In this study, higher levels of schooling were associated with better working memory performance in cognitively healthy elders.

Ao longo das últimas décadas pesquisas em cognição têm sido desenvolvidas rapidamente na tentativa de compreender as mudanças cognitivas que acontecem durante o processo de envelhecimento. Existem evidências de que indivíduos idosos têm pior desempenho de memória operacional do que adultos jovens. No entanto, o efeito da escolaridade sobre desempenho ainda não foi totalmente esclarecido. OBJETIVOS: Analisar o desempenho da memória operacional de idosos sem comprometimento cognitivo e verificar a influência da escolaridade neste desempenho. MÉTODOS: Foram avaliados 40 idosos sem comprometimento cognitivo, independentes, escolhidos aleatoriamente em um grupo de idosos que participaram de uma atividade cultural no campus universitário. Foi utilizado o teste de extensão de dígitos na ordem direta (EDOD) para avaliar a atenção. A memória operacional foi examinada a partir do teste de extensão de dígitos na ordem inversa (EDOI) e a partir da diferença entre EDOD e EDOI. Os dados foram estatisticamente analisados, sendo o Coeficiente de Correlação de Spearman utilizado para verificar correlação entre os escores dos testes de extensão de dígitos (ED) e as variáveis idade e escolaridade e o Modelo de Regressão Linear Múltipla para verificar o efeito destas variáveis nos escores do teste ED. RESULTADOS: Foi observada correlação positiva significativa (r=0,41, p<0,01) e associação significativa (b=0,506; p=0,001; CI 95%=0,064/0,237) entre escolaridade e o escore do EDOI. Não foi observada correlação (r= ­0,08, p=0,64) ou associação ((ß=0,041; p=0,775; CI 95%= ­0,049/0,065) entre idade e os escores do EDOI. CONCLUSÃO: Neste estudo, maiores níveis de escolaridade associaram-se com melhor desempenho de memória operacional.