Exploiting the therapeutic potential of contracting skeletal muscle-released extracellular vesicles in cancer: Current insights and future directions.

The health benefits of exercise training in a cancer setting are increasingly acknowledged; however, the underlying molecular mechanisms remain poorly understood. It has been suggested that extracellular vesicles (EVs) released from contracting skeletal muscles play a key role in mediating the systemic benefits of exercise by transporting bioactive molecules, including myokines. Nevertheless, skeletal muscle-derived vesicles account for only about 5% of plasma EVs, with the immune cells making the largest contribution. Moreover, it remains unclear whether the contribution of skeletal muscle-derived EVs increases after physical exercise or how muscle contraction modulates the secretory activity of other tissues and thus influences the content and profile of circulating EVs. Furthermore, the destination of EVs after exercise is unknown, and it depends on their molecular composition, particularly adhesion proteins. The cargo of EVs is influenced by the training program, with acute training sessions having a greater impact than chronic adaptations. Indeed, there are numerous questions regarding the role of EVs in mediating the effects of exercise, the clarification of which is critical for tailoring exercise training prescriptions and designing exercise mimetics for patients unable to engage in exercise programs. This review critically analyzes the current knowledge on the effects of exercise on the content and molecular composition of circulating EVs and their impact on cancer progression.

Association between spinal and non-spinal health conditions reported in epidemiological studies: a scoping review protocol.

INTRODUCTION: The increasing prevalence of coexisting health conditions poses a challenge to healthcare providers and healthcare systems. Spinal pain (eg, neck and back pain) and spinal pathologies (eg, osteoporotic fractures and degenerative spinal disease) exist concurrently with other non-spinal health conditions (NSHC). However, the scope of what associations may exist among these co-occurring conditions is unclear. Therefore, this scoping review aims to map the epidemiological literature that reports associations between spine-related pain and pathologies (SPPs) and NSHCs. METHODS AND ANALYSIS: This scoping review will follow the JBI protocol and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We will systematically search the literature using key words and MeSH terms for SPPs and NSHCs. Terminology/vocabulary for NSHCs will include those for communicable and non-communicable diseases as reported by WHO Global Burden of Disease reports. Five databases will be searched from inception: MEDLINE, EMBASE, APA PsycInfo, Scopus and Web of Science Core Collection. Papers published in English, in peer-reviewed journals, including measures of association between SPPs and NSHCs and using observational epidemiologic study designs will be included. Excluded will be studies of cadaveric, animal or health behaviours; studies with no measures of association and non-observational epidemiologic studies. Results will include the number of studies, the studies that have evaluated the measures of association and the frequency of the studied associations between SPPs and NSHCs. Results will be reported in tables and diagrams. Themes of comorbidities will be synthesised into a descriptive report. ETHICS AND DISSEMINATION: This scoping review was deemed exempt from ethics review. This review will provide a comprehensive overview of the literature that reports associations between SPPs and NSHCs to inform future research initiatives and practices. Results will be disseminated through publication in peer-reviewed journals and research conferences. REGISTRATION DETAILS: https://osf.io/w49u3.

Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey.

Spinal pain and chronic health conditions are highly prevalent, burdensome, and costly conditions, both in the United States and globally. Using cross-sectional data from the 2016 through 2018 National Health Interview Survey (n = 26,926), we explored associations between spinal pain and chronic health conditions and investigated the influence that a set of confounders may have on the associations between spinal pain and chronic health conditions. Variance estimation method was used to compute weighted descriptive statistics and measures of associations with multinomial logistic regression models. All four chronic health conditions significantly increased the prevalence odds of spinal pain; cardiovascular conditions by 58%, hypertension by 40%, diabetes by 25% and obesity by 34%, controlling for all the confounders. For all chronic health conditions, tobacco use (45-50%), being insufficiently active (17-20%), sleep problems (180-184%), cognitive impairment (90-100%), and mental health conditions (68-80%) significantly increased the prevalence odds of spinal pain compared to cases without spinal pain. These findings provide evidence to support research on the prevention and treatment of non-musculoskeletal conditions with approaches of spinal pain management.

Pharmacists' Perceptions on Nutritional Counseling of Oral Nutritional Supplements in the Community Pharmacy: An Exploratory Qualitative Study.

Malnutrition has important health impacts, especially in the elderly. Oral nutritional supplements (ONS) are effective strategies to help balance the nutritional needs of malnourished persons. Multiple ONS are available at community pharmacies, enabling pharmacists to have the possibility to implement strategies for prevention and monitoring of malnourished patients. The aim of this study was to characterize the experience of community pharmacists with the counseling and follow-up of users of ONS. A sample of 19 pharmacists from 19 different community pharmacies were interviewed. Apart from dispensing ONS to support patients that are preparing for diagnostic tests, the most frequently mentioned clinical condition for ONS counseling was malnutrition and dysphagia. When pharmacists consider dispensing ONS, three themes emerge: patient care, related to counselling tailored ONS to each patient's needs; interprofessional collaboration, with a special focus in the collaboration with registered dietitians; and training and education on ONS, looking to improve their knowledge and skills in ONS counselling and follow-up. Future studies exploring new forms of interaction between pharmacists and dietitians in this context should be developed, aiming to determine the workflow of an interdisciplinary service addressing the needs of community dwelling malnourished patients.

Evaluation of the properties of WHODAS-12 measurements in individuals with Chagas disease in Brazil.

Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser-Meyer-Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

Bidirectional Comorbid Associations between Back Pain and Major Depression in US Adults.

Low back pain and depression have been globally recognized as key public health problems and they are considered co-morbid conditions. This study explores both cross-sectional and longitudinal comorbid associations between back pain and major depression in the adult population in the United States. We used data from the Midlife in the United States survey (MIDUS), linking MIDUS II and III with a sample size of 2358. Logistic regression and Poisson regression models were used. The cross-sectional analysis showed significant associations between back pain and major depression. The longitudinal analysis indicated that back pain at baseline was prospectively associated with major depression at follow-up (PR 1.96, CI: 1.41, 2.74), controlling for health behavioral and demographic variables. Major depression at baseline was also prospectively associated with back pain at follow-up (PR 1.48, CI: 1.04, 2.13), controlling for a set of related confounders. These findings of a bidirectional comorbid association fill a gap in the current understanding of these comorbid conditions and could have clinical implications for the management and prevention of both depression and low back pain.

Evaluation of the properties of WHODAS-12 measurements in individuals with Chagas disease in Brazil

ABSTRACT Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser-Meyer-Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

Glycaemic control during the COVID-19 pandemic: A catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus?

INTRODUCTION: In a person with type 1 diabetes, any change concerning daily routine may lead to changes in glycaemic control. This study aimed to evaluate the impact of work and lockdown on glycaemic control in adults with type 1 diabetes. MATERIAL AND METHODS: A retrospective cohort was stratified into three activity groups (g1-students/telework/laid-off; g2-unemployed/retired; g3-work without lockdown). Continuous and categorical variations (reductions≥0.4%) in glycated haemoglobin were obtained in 2020 (t3:December/2019-March/2020; t4:April/2020-July/2020) and in homologous periods of 2019. Intragroup comparisons between years and intergroups in the same year were made. Regression models were developed to predict the variation of glycated haemoglobin in 2020. RESULTS: 241 participants were included, with a significant reduction between t4 and t3 (vs. t2 and t1) in g1 (p<0.001) and g2 (p=0.025) and in 2020 in g1 (vs. g2, p<0.001; vs. g3, p<0.001). Only g1 presented superiority in the reduction ≥0.4% in glycated haemoglobin in 2020 (vs. 2019, p<0.001; vs. g2, p<0.001; vs. g3, p<0.001). The insulin regimens were comparable and the development of hypoglycaemia was found to be superimposed between t3 and t4, except for g1, which was higher at t3 (p=0.029). G1 correlated with continuous reductions (vs. g2, p=0.001; vs. g3, p<0.001) and ≥0.4% in glycated haemoglobin in 2020 (vs. g2, OR 3.6, p<0.001; vs. g3, OR 12.7, p<0.001), regardless of the age and duration of type 1 diabetes. CONCLUSIONS: A more stable and better glycaemic control was observed in participants who transitioned from face-to-face work to total lockdown.

Glycaemic control during the COVID-19 pandemic: A catastrophe or a sign of hope for the person with type 1 Diabetes Mellitus?

Introduction: In a person with type 1 diabetes, any change concerning daily routine may lead to changes in glycaemic control. This study aimed to evaluate the impact of work and lockdown on glycaemic control in adults with type 1 diabetes. Material and methods: A retrospective cohort was stratified into three activity groups (g1-students/telework/laid-off; g2-unemployed/retired; g3-work without lockdown). Continuous and categorical variations (reductions ≥ 0.4%) in glycated haemoglobin were obtained in 2020 (t3:December/2019-March/2020; t4:April/2020-July/2020) and in homologous periods of 2019. Intragroup comparisons between years and intergroups in the same year were made. Regression models were developed to predict the variation of glycated haemoglobin in 2020. Results: 241 participants were included, with a significant reduction between t4 and t3 (vs. t2 and t1) in g1 (p < 0.001) and g2 (p = 0.025) and in 2020 in g1 (vs. g2, p < 0.001; vs. g3, p < 0.001). Only g1 presented superiority in the reduction ≥0.4% in glycated haemoglobin in 2020 (vs. 2019, p < 0.001; vs. g2, p < 0.001; vs. g3, p < 0.001). The insulin regimens were comparable and the development of hypoglycaemia was found to be superimposed between t3 and t4, except for g1, which was higher at t3 (p = 0.029). G1 correlated with continuous reductions (vs. g2, p = 0.001; vs. g3, p < 0.001) and ≥0.4% in glycated haemoglobin in 2020 (vs. g2, OR 3.6, p < 0.001; vs. g3, OR 12.7, p < 0.001), regardless of the age and duration of type 1 diabetes. Conclusions: A more stable and better glycaemic control was observed in participants who transitioned from face-to-face work to total lockdown.

Introducción: En una persona con diabetes tipo 1, cualquier cambio en la rutina diaria puede provocar cambios en el control glucémico. Este estudio tuvo como objetivo evaluar el impacto del trabajo y el confinamiento en el control glucémico en adultos con diabetes tipo 1. Material y métodos: Se estratificó una cohorte retrospectiva en tres grupos de actividad (g1-estudiantes/teletrabajo/despido; g2-desempleados/jubilados; g3-trabajo sin encierro). Se obtuvieron variaciones continuas y categóricas (reducciones ≥ 0,4%) en la hemoglobina glucosilada en 2020 (t3: diciembre/2019-marzo/2020; t4: abril/2020-julio/2020) y en períodos homólogos de 2019. Se desarrollaron modelos de regresión para predecir la variación de la hemoglobina glucosilada en 2020. Resultados: Se incluyeron 241 participantes, con una reducción significativa entre t4 y t3 (vs. t2 y t1) en g1 (p < 0,001) y g2 (p = 0,025) y en 2020 en g1 (vs. g2, p < 0,001; vs. g3, p < 0,001). Solo g1 demostró superioridad en la reducción ≥ 0,4% de la hemoglobina glucosilada en 2020 (vs. 2019, p < 0,001; vs. g2, p < 0,001; vs. g3, p < 0,001). Los regímenes de terapia con insulina fueron comparables y el desarrollo de hipoglucemia fue superponible entre t3 y t4, excepto para g1, que fue mayor en t3 (p = 0,029). G1 se correlacionó con reducciones continuas (vs. g2, p = 0,001; vs. g3, p < 0,001) y ≥ 0,4% en la hemoglobina glucosilada en 2020 (vs. g2, odds ratio [OR] 3,6, p < 0,001; vs. g3, OR 12,7, p < 0,001), independientemente de la edad y la duración de la diabetes tipo 1. Conclusiones: Se observó un control glucémico más optimizado a los participantes que pasaron del trabajo presencial al confinamiento total.

Overview of conditions seen on a Canadian Memorial Chiropractic College outreach to the Dominican Republic.

OBJECTIVE: This study aims to gather information on conditions seen, treatments rendered, and referrals made during a Canadian Memorial Chiropractic College outreach to the Dominican Republic serving those in need. METHODS: Data was extracted from templated patient files retrospectively. RESULTS: Spinal, extremity and other/whole body chief complaints accounted for 71.79%, 24.64% and 3.57% respectively in patients ranging in age from 1.5 to 106 years whose data was collected. Mechanical pain accounted for 95.07% of all cervical, 96.81% of thoracic and 91.27% of lumbar spine diagnoses. Various non-mechanical conditions were also encountered.Manual therapy was performed in 96.10% of cases. Twenty referrals were made to urgent care, six to a World Spine Care clinic and 46 for further investigation, including local medical doctors or surgery. CONCLUSION: This study reports empirical data collected from an 11-day outreach to the Dominican Republic that provided otherwise unattainable chiropractic care for musculoskeletal complaints.

OBJECTIF: Cette étude vise à recueillir des données sur les conditions observées, les traitements administrés et les renvois effectués pendant la mission d'un établissement d'enseignement de la chiropratique en République dominicaine, au service des personnes dans le besoin. MÉTHODOLOGIE: Les données ont été extraites de dossiers de patients. RÉSULTATS: Les principaux symptômes des patients étaient des douleurs à la colonne vertébrale, aux extrémités et à toutes les parties du corps; elles étaient apparues respectivement chez 71,79 %, 24,64 % et 3,57 % des patients âgés de 1,5 à 106 ans. La douleur mécanique comptait pour 95,07 % de tous les symptômes cervicaux, 96,81 % des douleurs thoraciques et 91,27 % des douleurs lombaires. Divers troubles non mécaniques étaient aussi observés.Des thérapies manuelles ont été pratiquées dans 96,1 % des cas. Vingt patients ont été orientés vers des établissements de soins d'urgence; 6 vers une clinique World Spine Care et 46 vers des médecins de la région pour subir d'autres examens, ou une intervention chirurgicale. CONCLUSION: Cette étude rend compte des données empiriques recueillies au cours d'une mission de 11 jours en République dominicaine au cours de laquelle des soins chiropratiques ont été offerts à des patients qui autrement n'auraient pas pu en bénéficier.

Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study.

Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η2 = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.

Revisiting the clinical usefulness of C-reactive protein in the set of cancer cachexia.

Cancer cachexia is a highly complex multifactorial disorder that is often misdiagnosed, leading to suboptimal health outcomes. Indeed, cachexia is a concern in cancer, typifying lower response to treatment and risk of death. Thus, efforts have been made to better understand the molecular basis of this syndrome, envisioning to improve its diagnosis and management. C-reactive protein (CRP) has been reported to be consistently increased in the circulation of patients with body wasting associated to chronic diseases. However, the role of CRP in the pathogenesis of cachexia remains elusive. Several hypotheses have been advanced but most of experimental findings support an indirect effect on the activation of muscle proteolysis, mostly through its interplay with pro-inflammatory cytokines. Herein, we overview the contribution of CRP to body wasting and its putative biomarker value for the diagnosis and follow-up of the therapeutic management of cachexia.

Antifungal activity of Acylhydrazone derivatives against Sporothrix spp.

Sporotrichosis is an emerging mycosis caused by members of the genus Sporothrix The disease affects humans and animals, particularly cats, which plays an important role in the zoonotic transmission. Feline sporotrichosis treatment options include itraconazole (ITC), potassium iodide and amphotericin B, drugs usually associated with deleterious adverse reactions and refractoriness in cats, especially when using ITC. Thus, affordable, non-toxic and clinically effective anti-Sporothrix agents are needed. Recently, acylhydrazones (AH), molecules targeting vesicular transport and cell cycle progression, exhibited a potent antifungal activity against several fungal species and displayed low toxicity when compared to the current drugs. In this work, the AH derivatives D13 and SB-AF-1002 were tested against Sporothrix schenckii and Sporothrix brasiliensis Minimal inhibitory concentrations of 0.12 - 1 µg/mL were observed for both species in vitro D13 and SB-AF-1002 showed an additive effect with itraconazole. Treatment with D13 promoted yeast disruption with release of intracellular components, as confirmed by transmission electron microscopy of S. brasiliensis exposed to the AH derivatives. AH-treated cells displayed thickening of the cell wall, discontinuity of the cell membrane and an intense cytoplasmic degeneration. In a murine model of sporotrichosis, treatment with AH derivatives was more efficient than ITC, the drug of choice for sporotrichosis. The results of the preliminary clinical study in cats indicate that D13 is safe and has potential to become a therapeutic option for sporotrichosis when associated to ITC. Our results expand the antifungal broadness of AH derivatives and suggest that these drugs could be exploited to combat sporotrichosis.

Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative.

BACKGROUND: The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. OBJECTIVE: The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. METHODS: Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. RESULTS: The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient's spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. CONCLUSIONS: The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

Recommendations for the provision of palliative care to people with COVID-19.

The pandemic of SARS-CoV-2 infection, which causes COVID-19, has deeply affected health systems and has had a significant impact on families, communities and nations. A comprehensive response strategy requires, in addition to epidemiological, scientific and technical considerations, for human suffering associated with disease, vulnerability and death not to be forgotten. Palliative care for people with suspicion or diagnosis of COVID-19 with serious evolution, and their families should also be a key part of organized actions that help alleviate suffering and improve quality of life by controlling symptoms, addressing psychological, emotional, social and spiritual needs, support for advanced care planning and its goals, end-of-life care, as well as support in complex decision-making and ethical problems, among others. Recommendations are provided for offering palliative care in COVID-19 pandemic context.

La pandemia de infección por SARS-CoV-2, la cual es causada por COVID-19, ha afectado profundamente a los sistemas de salud y ha ocasionado un enorme impacto en las familias, las comunidades y las naciones. La estrategia de respuesta integral requiere que además de las consideraciones epidemiológicas, científicas y técnicas, no se olvide el sufrimiento humano asociado a la enfermedad, la vulnerabilidad y la muerte. La atención paliativa a personas con sospecha o diagnóstico de COVID-19 con evolución grave y sus familias debe ser también parte clave de la acción organizada que ayude al alivio del sufrimiento y mejore la calidad de vida mediante el control de los síntomas, el abordaje de las necesidades psicológicas, sociales y espirituales, el apoyo para la planificación de la atención avanzada y la articulación de los objetivos de la misma, el cuidado de la persona en la fase final de la vida, así como el soporte ante la toma de decisiones complejas y problemas éticos, entre otros. Se ofrecen recomendaciones para brindar los cuidados paliativos en el contexto de la pandemia de COVID-19.

Nível de dependência e motivação para a cessação tabágica em adolescentes fumadores / Level of dependence and motivation for smoking cessation in adolescent smokers

Enquadramento: O sucesso da cessação tabágica não depende apenas do programa implementado, está também associado à motivação do indivíduo e da dependência do mesmo à nicotina (Granda-Orive et al., 2019). Segundo dados da OMS globalmente uma em cada dez raparigas, com idade entre os 13 e os 15 anos e um em cada cinco rapazes no mesmo intervalo de idades, consome tabaco (World Health Organizaton, 2014). Estudos comprovam que a maioria dos fumadores iniciou o consumo de tabaco na adolescência, sendo por isso um indicador de um maior risco de dependência (Muniz, 2018). Objetivos: Avaliar o nível de dependência tabágica de adolescentes fumadores e a sua motivação para a cessação tabágica; verificar se existe relação entre ambas as variáveis. Metodologia: Investigação quantitativa, descritiva e correlacional. A amostra é constituída por 88 adolescentes com idade entre os 16 e os 19 anos fumadores, que frequentam o 3ºciclo do ensino básico ou ensino secundário de escolas profissionais da zona centro. Para a colheita de dados foi aplicado um questionário de autopreenchimento constituído por um questionário de caraterização sociodemográfica da amostra e por duas escalas: Teste de Fagerström para a Dependência da Nicotina (FTND), que avalia o nível de dependência tabágica e a University of Rhode Island Change Assessment (URICA), que avalia a motivação para a cessação tabágica, validadas para a língua Portuguesa. Resultados: Verificou-se uma prevalência do género masculino (61,4%) na amostra, com uma média de idade de 17,19 anos, sendo que 82,9% frequentam o ensino secundário e 62,5% dos alunos refere que pelo menos um dos progenitores fuma. Relativamente à dependência tabágica 71,6% apresenta um nível de dependência tabágica baixo. No que se refere à motivação para a cessação tabágica 48,9% dos alunos encontra-se no estádio da pré-contemplação. Observou-se que a idade dos adolescentes se relaciona negativamente com a sua dependência tabágica (p=0,019). Foi também possível constatar que as restantes variáveis independentes (género, hábitos tabágicos parentais) não apresentam relação estatística com a dependência tabágica. Também nenhuma das variáveis independentes apresenta relação com a motivação para a cessação tabágica. Não se verificou relação entre a dependência tabágica e a motivação para a cessação tabágica. Conclusão: A cessação tabágica é um processo complexo que é influenciada por vários fatores, tais como a dependência tabágica e a motivação para a cessação tabágica. O conhecimento do estádio de motivação para a mudança é importante, como forma de adequar a intervenção a implementar ao estádio. Deste modo, consideramos essencial a criação de um programa de apoio específico para a cessação tabágica nos adolescentes, baseado na entrevista motivacional.

Composition of the soil fauna community and leaf litter stock in agro-forestry systems and secondary forestry / Composição da comunidade da fauna do solo e estoque da serapilheira foliar em sistemas agroflorestais e floresta secundária

Agro-Forestry Systems (AFS), in addition to being a means of providing income, can be considered an alternative way of helping conserve biodiversity, both above and below ground. The aim of this study was to evaluate the accumulation of tree leaf litter and its nutrient content as well as the composition of fauna in the soil-litter layer in two Agro-Forestry Systems (AFS-1 and AFS-2), using as reference an area of secondary Forest (SF), in the Quilombola do Campinho da Independência community, Paraty, in the state of Rio de Janeiro (RJ), Brazil. The collection of accumulated leaf litter and soil-litter fauna was carried out from four sample points in each area and at two different seasons of the year, the rainy and the dry season. The leaf litter stock and its nutrient content (Ca, Mg, P, K and N) were measured. The extraction of fauna was carried out according to Tüllgren's method, modifying the Berlese funnel. The stock of accumulated leaf litter differed between the two areas only in the rainy season; the amounts were smaller in AFS-2. In general, the Agro-Forestry Systems were very similar to the secondary forest in terms of levels and/or stock of nutrients in the majority of cases, at least in one of the seasons studied. The composition of the soil fauna groups in the Agro-Forestry System (AFS-1 and AFS-2) had a high degree of similarity to that found in the forest, and these systems mainly favour the populations of groups like Collembola and Formicidae.

Os sistemas agroflorestais (SAFs) além de proporcionarem geração de renda, podem ser considerados como uma alternativa para conservação da biodiversidade, tanto acima quanto abaixo da superfície do solo. O objetivo desse estudo foi avaliar o estoque de serapilheira acumulada e seus estoques de nutrientes, bem como, a composição da fauna do conjunto solo-serapilheira, em dois sistemas agroflorestais (SAF-1 e SAF-2), utilizando como referência uma área de floresta secundária (FS), na comunidade Quilombola do Campinho da Independência, Paraty - RJ. A coleta da serapilheira acumulada e da fauna do sistema solo-serapilheira foi realizada a partir de quatro pontos amostrais em cada área, em duas épocas do ano, seca e chuvosa. Foi quantificado o estoque de serapilheira foliar, e seus estoques e teores de nutrientes (Ca, Mg, P, K e N). A extração da fauna foi realizada a partir do método modificado de Tüllgren, baseado no funil de Berlese. O estoque de serapilheira foliar acumulada só variou entre as áreas na estação chuvosa, sendo os menores valores quantificados no SAF-2. De maneira geral, os sistemas agroflorestais apresentaram semelhanças em comparação com a floresta para a maioria dos teores e/ou estoques de nutrientes, em pelo menos uma das épocas de avaliação. A composição dos grupos da fauna do solo dos sistemas agroflorestais (SAF-1 e SAF-2) apresentou um elevado grau de similaridade com a floresta, e estes sistemas favoreceram principalmente as populações de grupos como os Collembola e Formicidae.

Insulinoma masquerading as neurologic disease - Case report and review of the literature

Insulinomas are the most frequent etiology of hypoglycemia in a non-diabetic patient and the most common functional neuroendocrine tumors of the pancreas, with an annual incidence of about 4 cases per million. The majority of insulinomas are "well-differentiated endocrine tumors" or grade 1 tumors, as defined by World Health Organization. Most tumors are benign, solitary and occur sporadically. However, about 10% are associated with multiple endocrine neoplasia type 1 (MEN-1). Despite the majority being benign tumors, hypoglycemic symptoms caused by the hyperinsulinemia are frequently debilitating. Whipple triad (hypoglycemia, symptoms of hypoglycemia - either adrenergic or neuroglycopenic - and relief of these symptoms after administration of glucose) is usually present and should alert to the diagnosis.After the diagnosis is made, locating the tumor can be challenging because most tumors are small. Nonetheless, locating the tumor is crucial, once the only definite treatment is surgical excision. The majority of patients reach normalization of glucose levels after surgery. Incomplete resection leads to persistent symptoms and although uncommon in sporadic insulinomas, recurrence can be as high as 20% in patients with MEN-1 syndrome

No disponible

Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Postpartum Ontario Population.

OBJECTIVE: The purpose of this study was to determine the point prevalence of low back pain (LBP), pelvic girdle pain (PGP), and/or combination pain (COMBO pain) and period prevalence (presence or absence of any of those pains), as well as to identify risk factors at 1, 3, and 6 months postpartum in a Canadian population. METHODS: Participants from a previous pregnancy study participated in a postpartum survey administered over the telephone at 1, 3, and 6 months following delivery. The survey included questions about LBP, PGP, or COMBO pain during the postpartum period, as well as questions related to risk factors (Canadian Task Force Classification II-3). RESULTS: At 1, 3, and 6 months postpartum, responses from 46, 58, and 64 participants, respectively, demonstrated that 15%-21% of women experienced LBP and up to 4% of women experienced COMBO pain (point prevalence). At no time point was PGP reported to occur alone. Period prevalence of back pain for the participants returned to pre-pregnancy levels at each time point. Back pain during pregnancy was the only risk factor identified for back pain at 3 and 6 months postpartum. CONCLUSION: This study demonstrated that 76% to 80% of respondents were pain free at 1, 3, and 6 months postpartum. Pregnancy-related back pain was the only risk factor associated with postpartum-related pain at the 1 to 3 and 3 to 6 month time interval. Identification of site-specific postpartum-related back pain may assist in determination of management and treatment plans for this population.

Evaluación de la espiritualidad en pacientes con duelo utilizando la terapia de aceptación y compromiso en la Clínica de Duelo por Suicidio del Centro Universitario de Ciencias de la Salud de la Universidad de Guadalajara, México / Evaluation of complicated spiritual grief in patients with loss of results in acceptance and commitment therapy at the suicide clinic of the CUCS / Avaliação da espiritualidade em pacientes enlutados em processo terapéutico de aceitação e compromisso na Clínica de luto por suicídio do Centro Universitário de Ciências da Saúde da Universidade de Guadalajara

Introducción. El apego se define como aquel vínculo significativo que se establece entre personas. Cuando este se rompe, ocurre lo que se denomi-na una pérdida significativa seguida de un proceso de duelo, el cual con-siste en una reacción de dolor natural ante el desprendimiento de algo o de alguien. Durante este proceso, la espiritualidad es una estrategia central para sobreponerse a una experiencia dolorosa; sin embargo, esta también puede verse afectada por los significados que se le atribuyen. La terapia de aceptación y compromiso se emplea en distintos desórdenes psicológicos que involucran la evitación experiencial, incluyendo el duelo.Objetivo. Evaluar el duelo complicado espiritual en pacientes tratados con terapia de aceptación y compromiso, antes y después de la intervención.Materiales y métodos. Se aplicó el cuestionario Inventory of Complicated Spiritual Grief a pacientes con duelo antes y después de ser tratados con terapia de aceptación y compromiso en la Clínica del Duelo del Cen-tro Universitario de Ciencias de la Salud de la Universidad de Guadalaja-ra, México.Resultados y conclusiones. La terapia de aceptación y compromiso ha de-mostrado ser útil en el proceso del duelo, así como en el restablecimiento de la espiritualidad, toda vez que esta es resignificada y da sentido a las experiencias dolorosas.Palabras clave: Duelo; Apego; Espiritualidad; Terapia de aceptación y compromiso.

Introduction: Attachment refers to the significant bond we establish with a person, when this is broken, what we call a significant loss occurs, followed by a grieving process: natural pain reaction to the detachment of something or someone who had a It was worth it During this, spirituality appears as a cen-tral strategy to overcome painful experiences, but it can also be affected by the meanings attributed to it. Acceptance and commitment therapy has been used in different psychological disorders that involve experiential avoidance, including grief.Objectives: The central objective of the study is to evaluate the complicated spiritual duel. Material and methods: The Inven-tory of Complicated Spiritual Grief (ICSG) was applied in pa-tients with grief, before and after being treated with Acceptance and Commitment Therapy in the grief clinic of the University Center of Health Sciences.Results and Conclusions: Acceptance Therapy and commitment has proven to be useful in facilitating the elaboration of grief, as well as in restoring spirituality since it is resignified and gives meaning to painful experiences.

Introdução. O apego refere-se ao vínculo significativo estabe-lecido entre pessoas, se vier a quebrar acontece uma perda significativa, seguida de um processo de luto que envolve uma reação natural de dor ao desapego. Durante esse processo, a espiritualidade é uma estratégia central para superar uma expe-riência dolorosa, no entanto, esteja afetada pelos significados atribuídos a ela. A Terapia de aceitação e comprometimento é usada em várias circunsatâncias que envolvem evasão expe-riencial, incluindo luto.Objetivo. O principal objetivo do estudo é avaliar o luto com-plicado espiritual.Materiais e métodos. O questionário Inventory of Complicated Spiritual Grief foi aplicado em pacientes com perdas significa-tivas, antes e depois de serem tratados com a Terapia de acei-tação e compromisso na clínica de luto do Centro Universidade de Ciências da Saúde da Universidade de Guadalajara.Resultados e conclusões. Terapia de aceitação e compromisso mostrou ser útil no processo de luto, bem como na restauração da espiritualidade, uma vez que é ressignificada e dá sentido à experiências dolorosas