Evaluation of the impact of a socio-educational intervention in quality of life and mental health of institutionalized elderly

Introduction

With the huge increase of life expectancy in developed countries, new needs for long-term care arise in order to guarantee an active ageing for an increasing older adult population. One way to promote emotional well-being and quality of life in elderly is through socio-educational interventions.

Objectives

To test the effects of a socio-educational intervention in quality of life and mental health of institutionalized elderly.

Methods

This study employed a pretest-posttest design. Measures: Portuguese version of Mental Health Inventory (Ribeiro, 2001) and WHOQOL-OLD (Vilar, Sousa & Simões, 2009). Qualitative assessment was made using a logbook. Participants: 15 institutionalized elderly, 60% females, with mean age of 82.5 years (sd=8.5). The intervention ran for 2 months, with 12 group sessions, 60 minutes each, held twice a week. A nonparametric paired samples tests was conducted to evaluate the impact of the intervention.

Results

After the intervention, results showed a significant increase of total value of mental health (p=.021). Concerning dimensions: significant increase of positive psychological well-being (p=.014), emotional ties (p=.050), positive affect (p=.004), behavioural emotional control (p=.018), and a significant decrease of depression (p=.043). Concerning quality of live, the results showed a significant increase of the mean values of the facets: social participation and intimacy (p=.005; p=.027, respectively).

Conclusions

Overall, the intervention implemented with institutionalized elderly had good results, with significant increase of positive psychological well-being and decrease of depression. Although there was no control group, the results suggest that the socio-educational intervention implemented can contribute to promote mental health in elderly.

Stress, health and lifestyle behaviours during COVID-19 home confinement in portuguese adults

Introduction

The confinement associated with COVID-19 pandemic was an experience with significant physical and mental health implications, including higher stress levels, decreased sleep quality, pain symptoms and changes in lifestyle behaviours.

Objectives

The main goal of this study was to analyze the relationship between stress and health variables (sleep, health symptoms, health perception, and lifestyle behaviours) in a Portuguese university during COVID-19 home confinement.

Methods

A cross-sectional online survey design was conducted. A sample of 263 Portuguese workers (64.3% females), with mean age of 48.3 years (sd=8.9), filled in the PSS10, answering questions concerning health symptoms (perceived health, pain symptoms and fatigue), lifestyle behaviours (sleep and eating habits, use of alcohol and tobacco) during COVID-19 home confinement. A descriptive statistical analysis, a Pearson correlation analyses and the t Student test, for independent samples, were performed.

Results

The results showed significant correlations between stress and perceived health (r=-.404; p<.0001), arms pain (r=.212; p=.002), legs pain (r=.201; p=.003), back pain (r=.219; p=.001), headache (r=.289; p<.0001) and fatigue (r=.295; p<.0001). Concerning lifestyle behaviours, the results showed significant correlations between stress and sleep (r=-.552; p<.0001) and stress is significantly higher (p<.0001) in individuals who have changed their eating habits.

Conclusions

During the COVID-19 home confinement, higher stress levels are associated with a worse perception of health, more pain symptoms (legs, arms, back, headache), worse sleep quality and more fatigue. Moreover, the individuals with higher levels of stress have changed their eating habits. Lastly, health promotion interventions are needed in order to minimize the impact of home confinement in health.

Factors associated with length of stay and readmission in acute psychiatric inpatient services in Portugal

Assessing the factors that influence duration and number of hospitalizations may support mental health services planning and delivery. This study examines the factors associated with length of stay and readmission in Portuguese psychiatric inpatient services during 2002, 2007 and 2012. Data from all admissions were extracted from clinical files. Logistic regression models estimated the association between length of stay (<17 vs ≥17 days) and number of admissions per year (1 vs >1 admission) with sociodemographic, clinical, and contextual factors. Older age, a diagnosis of psychosis, and compulsory admission were associated with higher odds of longer length of stay. Being married, secondary education, suicide attempt, a diagnosis of substance use and "other mental disorders", being admitted in 2012, and two of the psychiatric inpatient services associated with lower odds of longer length of stay. Being retired (or others), a diagnosis of psychosis, compulsory admission, and psychiatric service were associated with increased odds of readmission. Older age, and secondary and higher education were associated with lower odds of readmission. The findings indicate that multiple factors influence length of stay and readmission. Identifying these factors provides useful evidence for clinicians and policy makers to design more targeted and cost-effective interventions.

Individuals with mild-to-moderate hip osteoarthritis walk with lower hip joint contact forces despite higher levels of muscle co-contraction compared to healthy individuals

OBJECTIVE

To compare hip joint contact forces (HJCF), hip muscle forces, and hip muscle co-contraction levels between individuals with mild-to-moderate hip osteoarthritis (OA) and healthy controls during walking.

DESIGN

Eighteen participants with mild-to-moderate hip OA and 23 healthy controls walked at a self-selected speed while motion capture and electromyographic data were synchronously collected. HJCF were computed using a calibrated electromyography-informed neuromusculoskeletal model. Hip joint contact forces, muscle forces, and co-contraction indices for flexor/extensor and adductor/abductor muscle groups were compared between groups using independent sample t-tests (P < 0.05).

RESULTS

There was no between-group difference in self-selected walking speed. On average, participants with hip OA walked with 11% lower first peak (mean difference 235 [95% confidence interval (CI) 57-413] N) and 22% lower second peak (mean difference 574 [95%CI 304-844] N) HJCF compared to controls. Hip muscle forces were also significantly lower in the hip OA compared to control group at first (mean difference 224 [95%CI 66-382] N) and second (mean difference 782 [95%CI 399-1164] N) peak HJCF. Participants with hip OA exhibited higher levels of hip muscle co-contraction in both flexor/extensor and adductor/abductor muscle groups. Consistent with existing literature, hip joint angles (extension, adduction) and external moments (flexion, extension, adduction) were lower in hip OA compared to controls.

CONCLUSION

Lower HJCF were detected in mild-to-moderate hip OA, primarily due to lower hip muscle force production, and despite higher levels of hip muscle co-contraction. Findings suggest that lower loading of the hip joint during walking is a feature of mild-to-moderate hip OA, which could have implications for the pathogenesis of hip OA and/or disease progression.

Cross-Talk between Inflammation, Coagulation/Fibrinolysis and Vascular access in Hemodialysis Patients

This work aimed to study the association between fibrinolytic/endothelial cell function and inflammatory markers in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) and recombinant human erythropoietin (rhEPO) therapies, and its relationship with the type of vascular access (VA) used for the HD procedure. As fibrinolytic/endothelial cell function markers we evaluated plasminogen activator inhibitor type-1 (PAI-1), tissue plasminogen activator (tPA) and D-dimers, and as inflammatory markers; C-reactive protein (CRP), soluble interleukin (IL)-2 receptor (s-IL2R), IL-6 and serum albumin levels. The study was performed in 50 CKD patients undergoing regular HD, 11 with a central venous dialysis catheter (CVC) and 39 with an arteriovenous fistula (AVF), and in 25 healthy controls. Compared to controls, CKD patients presented with significantly higher levels of CRP, s-IL2R, IL-6 and D-dimers, and significantly lower levels of PAI-1. The tPA/PAI-1 ratio was significantly higher in CKD patients. We also found statistical significant correlations in CKD patients between D-dimers levels and inflammatory markers: CRP, albumin, s-IL2R and IL-6. When comparing the two groups of CKD patients, we found that those with a CVC presented statistically significant lower levels of hemoglobin concentration and albumin, and higher levels of CRP, IL-6, D-dimers and tPA. Our results showed an association between fibrinolytic/endothelial cell function and increased inflammatory markers in CKD patients. The increased levels of D-dimer, tPA and inflammatory markers in CKD patients using a CVC, led us to propose a relationship between the type of VA chosen for HD, and the risk of thrombogenesis.

Early tooth loss in end-stage renal disease patients on haemodialysis

OBJECTIVE

This article sets out to evaluate the prevalence and aetiopathogenesis of edentulism in patients on haemodialysis.

SUBJECTS AND METHODS

The study group comprised 44 adult patients with end-stage renal disease (ESRD) on haemodialysis. A control group was formed of 44 individuals matched for age and sex and with a glomerular filtration rate >90 ml min(-1) . All participants underwent intra-oral examination, gathering information on dental and periodontal status, and a saliva sample was taken to determine saliva debit and its biochemical composition.

RESULTS

The average number of missing teeth was higher in ESRD patients than in controls (P = 0.018). Six (13.6%) fully edentulous individuals were detected in the study group and 1 (2.2%) in the control group. Some of the clinical and biochemical variables with statistically significant differences between the study group and the control group showed a significant relationship with the number of missing teeth, but the depth of the periodontal pockets presented the highest coefficient of determination (OR = 3511.1; 95%CI = 82.2-6834.3; P < 0.001; R(2)  = 0.827).

CONCLUSIONS

Premature tooth loss is common in haemodialysis patients. Although the aetiology and pathogenesis of this finding has still not been fully clarified, it appears that severe periodontal disease may play a relevant role.

Keratin-based peptide: biological evaluation and strengthening properties on relaxed hair

A peptide based on a fragment of hair keratin type II cuticular protein, keratin peptide (KP), was studied as a possible strengthening agent for weakened relaxed hair. The peptide was prepared both in aqueous water formulation (WF) and organic solvent formulations (OF), to determine the effect of organic solvents on peptide interaction with hair and the differences in hair recovery. Both peptide formulations were shown to improve mechanical and thermal properties of weakened hair with peptide in OF showing the stronger effect. As a potential new hair care product, and so would necessitate contact with skin, the cytotoxicity and genotoxicity of the peptide were also evaluated through different methodologies (Alamar Blue assay, 2'-7'-dichlorofluorescein probe, cell morphology and growth and evaluation of DNA damage by an alkaline version of the comet assay) in skin fibroblasts. These tests are indicators of the potential of peptide to cause irritation on skin or to be carcinogenic, respectively. The peptide in WF did not cause cytotoxicity or genotoxicity in any of the concentrations tested. The presence of OF, however, induced a 20% decrease in cell viability in all of the range of concentrations used after 72-h incubation. Moreover, OF inhibited cell growth and was considered genotoxic at first contact with cells. The peptide was therefore considered a promising strengthening agent for hair and was shown to be innocuous when applied in WF.

Comparison of the efficacy and safety of bilastine 20 mg vs desloratadine 5 mg in seasonal allergic rhinitis patients

BACKGROUND

Bilastine is a novel, nonsedating H(1)-antihistamine developed for symptomatic treatment of Allergic Rhinitis and Chronic Idiopathic Urticaria. The objective of this study was to compare the efficacy and safety of bilastine 20 mg vs placebo and desloratadine 5 mg in subjects with seasonal allergic rhinitis (SAR).

METHODS

This randomized, double blind, placebo-controlled, parallel-group multicentre study evaluated the effect of 2 weeks' treatment with bilastine 20 mg, desloratadine 5 mg or matched placebo once daily, in 12-70 years old symptomatic SAR patients. All subjects assessed the severity of nasal (obstruction, rhinorrhoea, itching, and sneezing) and nonnasal (ocular itching, tearing, ocular redness, itching of ears and/or palate) symptoms on a predetermined scale to provide a total symptom score (TSS), composed of nasal and nonnasal symptom scores (NSS and NNSS, respectively). The primary efficacy measure was the area under the curve (AUC) for the TSS over the entire treatment period.

RESULTS

Bilastine 20 mg significantly reduced the AUC of TSS to a greater degree from baseline compared to placebo (98.4 with bilastine vs 118.4 with placebo; P < 0.001), but not compared to desloratadine 5 mg (100.5). Bilastine 20 mg was not different from desloratadine 5 mg but significantly more effective than placebo in improving the NSS, NNSS, and rhinitis-associated discomfort scores (P < 0.05), and rhinoconjunctivitis quality of life questionnaire total (P < 0.005) and four out of seven individual domain (P < 0.05) scores. The incidence of treatment emergent adverse events was similar for bilastine (20.6%), desloratadine (19.8%), and placebo (18.8%).

CONCLUSION

Bilastine 20 mg once daily was efficacious, safe and not different from desloratadine 5 mg once daily in the treatment of SAR symptoms.

Cross-talk between inflammation,coagulation/fibrinolysis and vascular access in hemodialysis patients

This work aimed to study the association between fibrinolytic/endothelial cell function and inflammatory markers in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) and recombinant human erythropoietin (rhEPO) therapies, and its relationship with the type of vascular access (VA) used for the HD procedure. As fibrinolytic/endothelial cell function markers we evaluated plasminogen activator inhibitor type-1 (PAI-1), tissue plasminogen activator (tPA) and D-dimers, and as inflammatory markers; C-reactive protein (CRP), soluble interleukin (IL)-2 receptor (s-IL2R), IL-6 and serum albumin levels. The study was performed in 50 CKD patients undergoing regular HD, 11 with a central venous dialysis catheter (CVC) and 39 with an arteriovenous fistula (AVF), and in 25 healthy controls. Compared to controls, CKD patients presented with significantly higher levels of CRP, s-IL2R, IL-6 and D-dimers, and significantly lower levels of PAI-1. The tPA/PAI-1 ratio was significantly higher in CKD patients. We also found statistical significant correlations in CKD patients between D-dimerslevels and inflammatory markers: CRP, albumin, s-IL2R and IL-6. When comparing the two groups of CKD patients, we found that those with a CVC presented statistically significant lower levels of hemoglobin concentration and albumin, and higher levels of CRP, IL-6, D-dimers and tPA. Our results showed an association between fibrinolytic/ endothelial cell function and increased inflammatory markers in CKD patients. The increased levels of Ddimer, tPA and inflammatory markers in CKD patients using a CVC, led us to propose a relationship between the type of VA chosen for HD, and the risk of thrombogenesis.

Comparison of the frequency of interleukin (IL)-2-, interferon-gamma-, and IL-4-producing T cells in 2 diseases, human immunodeficiency virus types 1 and 2, with distinct clinical outcomes

Human immunodeficiency virus (HIV) type 2 infection is associated with a better clinical outcome, slower rates of CD4 T cell decline, and lower viremia than is HIV-1. This study compares HIV-1 and HIV-2 in regard to the percentages of interleukin (IL)-2-, interferon (IFN)-gamma-, and IL-4-producing cells at the single-cell level, as determined by flow cytometry. At a given degree of CD4 T cell depletion, the frequency of T cells able to produce IL-2 is better preserved in HIV-2 than in HIV-1 infection, particularly within the CD4 T cell subset. As described for HIV-1 immunodeficiency, HIV-2-positive patients exhibit a marked expansion of terminally differentiated effector CD8 T cells (CD28(-)CD27(-)IFN-gamma(+)). However, the proportion of CD8 T cells able to simultaneously produce IL-2 and IFN-gamma is higher in HIV-2 disease. Considering the central role of IL-2 as a lymphocyte proliferative and survival factor, these findings provide a possible immunologic basis for the distinct course of HIV-2 immunodeficiency.

Marked immunosuppressive effects of the HIV-2 envelope protein in spite of the lower HIV-2 pathogenicity

OBJECTIVE

HIV-1 envelope proteins have immunosuppressive properties and it is thought that they have a role in the establishment of immunodeficiency. This study characterizes the immunological effects of HIV-2 envelope protein gp105, a virus which is associated with a slower rate of disease progression.

METHODS

The effects of recombinant baculovirus-expressed envelope proteins from HIV-IIIB HIV-1MN, HIV-2ROD and SIVmac251 on anti-CD3-stimulated peripheral blood mononuclear cells (PBMC) from healthy donors were evaluated by incorporation of 3H-thymidine, flow cytometric analysis of bromodeoxyuridine incorporation in different T cell subsets, kinetics of expression of costimulatory molecules (CD40L/OX40) and assessment of cell death by annexin V/propidium iodide staining. The effects on production of tumour necrosis factor alpha (TNF-alpha) by monocytes were assessed at the single-cell level after a 6 h culture of unstimulated PBMC.

RESULTS

HIV-2 gp105 was more inhibitory than HIV-1 gp120 of T cell proliferation and the upregulation of CD40L and OX40; in the absence of signficant induction of apoptosis. This inhibition affected both CD4 and CD8 T cells and was only partially reversed by costimulation with interleukin 2 or CD28. gp105 strongly inducted TNF-alpha production by monocytes.

CONCLUSION

The immunosuppressive properties of the HIV envelope proteins could be beneficial rather than detrimental to the host by interfering with the heightened state of immunocellular activation that characterizes HIV infection and by limiting the bursts of viral replication. This hypothesis could in part explain the slower decline of CD4 cell numbers in HIV-2 infection and deserves further exploration.

The effect of membrane permeability on ESRD: design of a prospective randomised multicentre trial

The different permeability of high-flux and low-flux dialysis membranes results in different removal capacity, particularly for uremic toxins of middle and large molecular weight. High-flux dialysers have been evaluated in clinical and epidemiological studies for their effect on mortality, morbidity, dialysis-related amyloidosis, nutritional status, response to erythropoietin treatment, dialysis tolerance and the preservation of residual renal function. Many of these studies, however, lack a prospective design and randomised treatment allocation, or have too few patients and too short a follow-up. Therefore, this clinical trial was designed to prospectively investigate the long-term effect of membrane permeability on clinical outcome in a larger number of patients. The primary objective is to compare the effect of membrane permeability on mortality of patients on bicarbonate hemodialysis and treated with a minimum dialysis dose. Patients included in the study should have been on hemodialysis for no longer than one month and have serum albumin 4 g/dl or lower. Patients will be randomised to either the experimental or the control group. During the four-week run-in period the treatment parameters will be established in order to achieve the required dialysis dose. During the maintenance period of three to five years regular visits are scheduled to record clinical and laboratory parameters, to measure Kt/V and to adapt the treatment parameters. Altogether a minimum of 660 patients should be enrolled within a two-year recruitment period.

Functional aspects of cord blood lymphocytes response to polyclonal and allogeneic activation

With the purpose of contributing to a better knowledge of the phenotypic characteristics and functional activity of umbilical cord blood (UCB) lymphocytes, we have carried out extensive immunophenotyping of these cells, evaluated their immune response to polyclonal and allogeneic activation and then compared these results with those obtained with peripheral blood lymphocytes of healthy donors (PBHD). Our results showed, in CD4+ UCB lymphocytes, an increase of CD38 and CD45RA and a decrease of CD11a (S6F1), CD54 and HLA-DR double positive cells. An increase of CD38, CD45RA and CD56, and a decrease of CD28, CD57 and HLA-DR were observed in CD8+ UCB lymphocytes. Most natural killer UCB cells are CD16+, CD56+, CD57-, and among the UCB cells there is a lower number of CD8+ and TCRgammadelta+ (either CD8- or CD8+), and higher number of CD4+ lymphocytes. After allogeneic stimulus the majority of these phenotypic differences disappeared, which seems to be in agreement with the normal allogeneic response (assessed through MLR, frequency of CTL and helper T lymphocytes precursors) presented by UCB lymphocytes. Regarding the response to polyclonal activation, among the mitogens used, only PHA induced a different result: a lower IFNgamma production by UCB cells.

[Amiodarone and the lung]

The pulmonary toxicity induced by amiodarone is one of the major complications that can limit the use of this potent antidysrhythmic agent. The authors perform a bibliographical revision concerning the toxic effects of amiodarone in the lung, pathogenesis, clinical, radiologic and pathologic features, diagnostic problems, risk factors and prognostic data.

Impact of dialysis room and reuse strategies on the incidence of hepatitis C virus infection in haemodialysis units

BACKGROUND

Despite the advent of screening of blood products for anti-hepatitis C virus (HCV), the incidence of HCV infection among haemodialysis (HD) patients is alarmingly high and suggest transmission within the HD unit. To analyse trends in the prevalence and incidence of HCV infection, and evaluate the impact of dialysis room and reuse policies on the incidence of HCV infection, a hospital survey instrument was sent out to medical directors of all 71 HD units in Portugal in August 1994. Information for the years 1991, 1992 and 1993 was requested with respect to HCV infection, defined as positive anti-HCV test. Sixty-two of 71 units (87%) treating 4232 patients in 1993 responded. Overall, data from 5774 patient-years were available for analyses. Observations over multiple intervals were pooled into a single sample, and pooled logistic regression was used to evaluate the relationship between risk factors/strategies and incidence of HCV infection. By 1993, regular anti-HCV testing of patients and staff was practised by 98% and 82% of units, respectively. There was a significant decline in the incidence of HCV infection from 9.9% in 1991 to 5.7% in 1992 and 5.1% in 1993. The incidence was directly related to the prevalence in the dialysis unit. Units with a prevalence of less than 19% had an annual incidence of 2.5% compared to a 35.3% incidence in units with a prevalence greater than 60%. There was wide variation in the incidence of HCV infection in HD units across the country, with geographical location, unit ownership and socioeconomic factors playing a significant role. The incidence was lowest among units that: (i) were located in the northern regions of the country; (ii) were private hospital-based units; and (iii) used dedicated machines or separate rooms for anti-HCV-positive patients. The incidence among units that reprocessed dialysers (6.1%) was not significantly different from that among units that did not reprocess dialysers (7.4%). However, among units that did reprocess dialysers, the incidence of HCV infection was lowest in: (i) units that used separate rooms for reprocessing dialysers from anti-HCV-positive patients or did not reprocess these dialysers; and (ii) units that used Renalin as the sterilant. These results suggest the transmission of HCV infection in HD units and that use of dedicated machines and isolation of anti-HCV-positive patients and their dialysers may reduce the incidence of HCV infection.

[Significance of the persistence of ST segment elevation in anterior infarction]

OBJECTIVE

Persistent ST segmentary elevation in anterior myocardial infarction was classically attributed to ventricular aneurysm. This association is now considered controversial. We studied the association between this electrocardiographic finding and the left ventricular wall motion abnormalities and global function.

DESIGN

Retrospective study.

SETTING

Patients admitted to Hospital de Pulido Valente Coronary Care Unit in Lisbon with anterior myocardial infarction who were submitted to angiographic study.

PATIENTS

94 patients were included in the study.

METHODS

The global ejection fraction, the regional wall motion abnormalities, the coronary artery disease extension, the patency and the proximal involvement of the left anterior descending artery were investigated.

RESULTS

56 of the 94 patients (60%) had persistent ST segment elevation and 38 (40%) had isoelectric ST segment. The ejection fraction was markedly depressed in the group with elevated ST segment (36.2 SD 17.6) in contrast with the group with isoelectric ST segment (49.3 SD 14.8) (p < 0.001). The group with persistent ST segment elevation had more advanced degrees of left ventricular asynergy (42/58-75%) than the group with isoelectric ST segment (12/38-32%) (p = 0.02). The other studied angiographic variables did not differ between the two groups.

CONCLUSIONS

The group with persistent ST segment elevation was associated with advanced degrees of left ventricular asynergy and greater left ventricular function depression. The ventricular aneurysm was exclusive of the first group.

[Electrocardiographic symptom-signal correspondence in Holter records]

STUDY OBJECTIVE

To determine the correspondence symptom-sign in 24-hours ambulatory electrocardiography records.

DESIGN

Retrospective study.

SETTING

Pulido Valente Hospital (Lisbon). Serviço de Cardiologia. Department of Ambulatory Electrocardiography.

PATIENTS

80 patients, who made 24-hours ambulatory electrocardiography and wrote correctly the diary. Two observators analysed the correspondence symptom-sign of 269 symptomatic moments, 10 minutes before and after the symptom by reviewing the compressed print.

RESULTS

We found correspondence symptom-sign in 50% of the symptomatic moments. The correspondence change with the symptom type (increased for palpitations and dyspnea), the presence of Cardiopathy (increased for chest pain and dyspnea in patients with cardiopathy) type of cardiopathy (increased in patients with Mitral Valve Prolapse and Valvular disease) and expression used by the patient.

Acute renal failure and nephrotic syndrome after maneb exposure. A new case with light and electron microscopic study

A new case of nephrotoxic effect of Maneb is related. The patient used this product as fungicide and developed a progressive illness with acute renal failure. The study by light and electron microscopy revealed severe tubular lesions that disappeared some months later with tubular cell regeneration. However, in spite of the renal function returning to normal, a steroid-dependent nephrotic syndrome persisted with glomerular minimal change like lesions.