Translation, cultural adaptation and validation of the revised patients' attitudes towards deprescribing (rPATD) questionnaire in Romanian older adults

BACKGROUND

Deprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool may support optimizing medication use in practice.

OBJECTIVES

To translate, culturally adapt and validate the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing.

METHODS

The rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined.

RESULTS

We translated the questionnaire and administered it to 224 participants (median age 72 years [interquartile range: 68.0; 77.0]). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects.

CONCLUSIONS

The Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.

AMINO ACIDS METABOLOMIC SIGNATURE OF BLOOD PRESSURE VARIABILITY In Type 2 Diabetes

Context

Accumulating data supports the key role of disrupted amino acids (AAs) metabolism in diabetes. Conflicting data regarding the relevance of serum AAs in diabetes and hypertension suggest that their relationship needs further investigation.

Objective

To investigate serum AAs as biomarkers of increased BP variability evaluated during 24-hour ambulatory BP monitoring in the presence of type 2 diabetes.

Design

Cross-sectional.

Subjects and Methods

We analyzed serum AAs using targeted metabolomics (ultrahigh-performance liquid chromatography/mass spectrometry) in patients with type 2 diabetes (n=80). BP variability was assessed using 24-hour ambulatory BP monitoring. Participants were divided into two groups based on the 24-hour diastolic BP variability median value.

Results

Aspartic acid, isoleucine, leucine, and phenylalanine were significantly lower, while glutamine was significantly higher in the group with higher diastolic BP variability (p-value <0.05 and variable importance in the projection >1). Corresponding pathways identified as disrupted in patients with diabetes and a higher 24-hour diastolic BP variability were phenylalanine, tyrosine, and tryptophan biosynthesis, phenylalanine metabolism, and alanine, aspartate, and glutamate metabolism (pathway impact value >0).

Conclusions

We identified specific changes in serum AAs and target AAs pathways in relation to increased 24-hour diastolic BP variability in patients with type 2 diabetes.

METABOLOMIC ANALYSIS OF NORMAL WEIGHT, HEALTHY AND UNHEALTHY OBESITY: AMINO ACID CHANGE ACROSS THE SPECTRUM OF METABOLIC WELLBEING IN WOMEN

Context

Obesity is a complex and heterogeneous disorder with multiple phenotypes described. Although metabolomic biomarkers of obesity have been extensively studied, biomarkers of obesity phenotypes and differences between these phenotypes and normal-weight (NW) persons have been less investigated.

Objective

The objective of this cross-sectional analysis was to investigate serum amino acids (AA) as markers of metabolic alterations in obesity phenotypes and NW.

Design

Cross-sectional.

Subjects and Methods

By targeted metabolomics we analyzed serum samples of 70 women using ultrahigh-performance liquid chromatography/mass spectrometry. Participants were divided into 3 groups: NW, metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO).

Results

Five AAs were significantly different between study groups: cysteine, methionine, asparagine, glutamine, and lysine (p-value <0.05 and variable importance in the projection >1). Cysteine increased linearly with metabolic unwellness from NW to MUHO. Lysine and glutamine were significantly higher, and asparagine was significantly lower in NW and MHO than in MUHO.

Conclusions

By trend and group analysis we identified specific changes in serum AAs along with the progression of metabolically unwellness.

ENDOCRINE DISTURBANCES INDUCED BY LOW-DOSE ORGANOPHOSPHATE EXPOSURE IN MALE WISTAR RATS

BACKGROUND

Organophosphate exposure induces many endocrine effects.

AIM

In this study we observed the effects of acute stress induced by cholinesterase inhibition on the main hormonal axes.

MATERIALS AND METHODS

We included thirteen weanling Wistar rats that were subjected to organophosphate exposure. They were first tested for baseline levels of butyrylcholinesterase, cortisol, free triiodothyronine, thyroxine, thyroid-stimulating hormone and prolactin. Secondly, chlorpyrifos was administered. Next samples were taken to determine the level of all the above-mentioned parameters.

RESULTS

Butyrylcholinesterase was significantly decreased after exposure (p<0.001). Cortisol levels were significantly higher after clorpyrifos administration (358.75±43 vs. 241.2±35 nmoL/L)(p<0.01). Although prolactin had a growing trend (450.25±24.65 vs. 423±43.4 uI/mL), the results were not statistically significant. Both free triiodothyronine and thyroxine were significantly higher after exposure. Surprisingly, thyroid-stimulating hormone level almost doubled after exposure with high statistical significance (p<0.001), suggesting a central stimulation of thyroid axis. Butyrylcholinesterase level was proportional with thyroid-stimulating hormone level (p=0.02) and thyroxine level was inversely correlated to the cortisol level (p=0.01). Acute cholinesterase inhibition may induce high levels of cortisol, free triiodothyronine, thyroxine and thyroid-stimulating hormone. From our knowledge this is the first study dedicated to the assessment of acute changes of hormonal status in weanling animals after low-dose organophosphate exposure.Conclusion. Acute cholinesterase inhibition may cause acute phase hormonal disturbances specific to shocked patients.

DIETARY PATTERNS AND THEIR ASSOCIATION WITH OBESITY: A CROSS-SECTIONAL STUDY

Context

Scarce data on dietary habits in Eastern European countries is available and reports investigated individual food items and not dietary patterns in these populations.

Objective

To identify dietary patterns and to explore their association with obesity in a sample from Romanian population.

Design

Cross-sectional.

Subjects and Methods

This was an analysis of data collected from 1398 adult participants in ORO study. Data on lifestyle, eating habits and food frequency consumption were collected.

Results

By principal component analysis we identified 3 dietary patterns explaining 31.4% of the diet variation: High meat/High fat pattern, Western pattern and Prudent pattern. High meat/High fat pattern was associated with male gender, lower educational level, living in a rural, smoking and a higher probability for the presence of obesity (OR 1.2 [95%CI: 1.1-1.4]). Western pattern was associated with younger age, a higher level of physical activity and smoking. Prudent pattern was associated with older age, female gender, a higher level of physical activity, not smoking status and a lower probability for the presence of obesity (OR 0.8 [95%CI: 0.7-0.9]).

Conclusions

This study provides for the first-time information on the association between dietary patterns in adults from an Eastern European country and the presence of obesity.

EATING PATTERNS, PHYSICAL ACTIVITY AND THEIR ASSOCIATION WITH DEMOGRAPHIC FACTORS IN THE POPULATION INCLUDED IN THE OBESITY STUDY IN ROMANIA (ORO STUDY)

Context

Four major modifiable behavioral risk factors are considered responsible for the current burden of the non-communicable diseases: tobacco use, physical inactivity, unhealthy diet and excessive alcohol consumption. Limited data on the lifestyle habits in Romanian population is currently available.

Objective

To assess the eating patterns and physical activity habits and other lifestyle components in various age groups in the population included in the ORO study.

Design

ORO was a cross-sectional, epidemiologic, multicenter non-interventional study conducted from January 2014 until August 2014 in 8 study centers spread in the main historical regions of Romania.

Results

Eating 3 meals/day every day was more frequently reported in the 60-79 years and ≥ 80 years age groups (53.0% and 51.7%) than in the 18-39 years and 40-59 years age groups (26.8% and 35.8%), p <0.001. The frequency of eating breakfast every day increased with age from 43.5% in the youngest age group to 79.3% in the oldest one (p <0.001). Intense and moderate leisure-time physical activity was more frequent among participants in the 18- 39 years age group. Leisure time physical activities were associated with younger age groups, male sex, rural area, higher educational level and non-smoking status. Regular breakfast and regular consumption of 3 meals/day was associated with older age group, male sex and non-smoking status.

Conclusions

Our analysis showed a high frequency of unhealthy lifestyle habits among the younger age groups as compared to the older ones, with the highest frequency of these unhealthy behavior reported in the 18-39 years age group.

Adiponectin predicts cardiovascular events in diabetes dialysis patients

OBJECTIVES

Adiponectin is an insulin-sensitizing, anti-inflammatory adipokine with anti-atherogenic actions in the general population. In dialysis patients it is unclear whether adiponectin conserves its protective value or is, on the contrary, associated to worse prognosis. We assessed the predictive value of adiponectin for atherosclerosis related cardiovascular events in type 2 diabetic dialysis patients.

DESIGN AND METHODS

Prevalent diabetic dialysis patients from three dialysis units (n=77) were enrolled in a 3years' prospective observational study. Serum adiponectin, clinical and laboratory parameters were determined at baseline; new occurrence of atherosclerosis related events (coronary events, atherosclerosis obliterans, and stroke) was recorded.

RESULTS

Baseline adiponectin was 17.25(9.53-31.97) μg/mL and significantly correlated to HDL cholesterol (r=0.29, p=0.01), triglycerides (r=-0.40, p=0.0004), ferritin (r=-0.29, p=0.02), transferrin (r=-0.28, p=0.02), and uric acid (r=-0.24, p=0.04). In multivariate analysis association to triglycerides (p=0.001), HDL cholesterol (p=0.01) and ferritin (p=0.04) remained significant. 36 new fatal and non-fatal new cardiovascular events occurred, 29 patient died. Cox proportional regression analysis showed that adiponectin below or above a ROC-derived cut-off of 27.33μg/mL significantly influenced event-free survival: hazard ratio (HR) 2.48, 95% confidence interval (CI) (1.09-5.66), p=0.031 along with fasting glucose HR 1.01, 95%CI(1.00-1.02), p=0.01 and history of cardiovascular events at inclusion HR 3.16, 95%CI(1.36-7.32), p=0.007. In multivariate analysis baseline adiponectin HR 5.02, 95%CI(0.98-25.06), p=0.05 and glycemia HR 1.01, 95%CI(1.00-1.02), p=0.01 influenced event-free survival. Adiponectin also predicted cardiovascular events in patients without cardiovascular disease at inclusion but was not associated to overall mortality.

CONCLUSIONS

In diabetes dialysis patients low adiponectin favors occurrence of atherosclerosis related cardiovascular events.

Revisión de bases de datos existentes y relevantes en el fraude y autenticidad alimentarias

El fraude y la autenticidad alimentaria es un problema global que va en aumento y afecta a todas las etapas de la cadena alimentaria. Los consumidores demandan que los alimentos cumplan con las especificaciones que se indican en el etiquetado y las autoridades tienen el papel de establecer medidas para garantizar que éstos sean seguros. Desafortunadamente, debido a la gran complejidad para detectar el fraude alimentario, muchos casos pasan desapercibidos provocando que se mantengan dentro de la cadena de suministro de alimentos hasta llegar al consumidor final. A pesar de que los principios de las buenas prácticas en la fabricación alimentaria deben garantizar que los productos fabricados cumplan con las especificaciones de calidad marcadas por los organismos de salud, las empresas alimentarias necesitan tener acceso a herramientas de consulta fiables para asegurar la procedencia y seguridad de los productos que reciben. Este estudio recoge información relacionada con el fraude y la autenticidad alimentaria, y evalúa el acceso que tiene la industria y en particular, las pequeñas y medianas empresas (PYMES), a la información contenida en bases de datos on-line. Se han establecido varias categorias, y todas las bases de datos contenidas en cada una de ellas, han sido analizadas y seleccionadas según su estructura y relevancia para los usuarios. Todas las bases de datos incluidas han sido extraidas de internet y están desarrolladas tanto por organismos públicos, como privados, por lo que están destinadas a llegar a un gran número de usuarios. También se ha realizado un estudio general de bases de datos relevantes que han sido desarrolladas en proyectos europeos.

Revisión de bases de datos existentes y relevantes en el fraude y autenticidad alimentarias

El fraude y la autenticidad alimentaria es un problema global que va en aumento y afecta a todas las etapas de la cadena alimentaria. Los consumidores demandan que los alimentos cumplan con las especificaciones que se indican en el etiquetado y las autoridades tienen el papel de establecer medidas para garantizar que éstos sean seguros. Desafortunadamente, debido a la gran complejidad para detectar el fraude alimentario, muchos casos pasan desapercibidos provocando que se mantengan dentro de la cadena de suministro de alimentos hasta llegar al consumidor final. A pesar de que los principios de las buenas prácticas en la fabricación alimentaria deben garantizar que los productos fabricados cumplan con las especificaciones de calidad marcadas por los organismos de salud, las empresas alimentarias necesitan tener acceso a herramientas de consulta fiables para asegurar la procedencia y seguridad de los productos que reciben. Este estudio recoge información relacionada con el fraude y la autenticidad alimentaria, y evalúa el acceso que tiene la industria y en particular, las pequeñas y medianas empresas (PYMES), a la información contenida en bases de datos on-line. Se han establecido varias categorias, y todas las bases de datos contenidas en cada una de ellas, han sido analizadas y seleccionadas según su estructura y relevancia para los usuarios. Todas las bases de datos incluidas han sido extraidas de internet y están desarrolladas tanto por organismos públicos, como privados, por lo que están destinadas a llegar a un gran número de usuarios. También se ha realizado un estudio general de bases de datos relevantes que han sido desarrolladas en proyectos europeos.

A single active nanoelectromechanical tuning fork front-end radio-frequency receiver

Nanoelectromechanical systems (NEMS) offer the potential to revolutionize fundamental methods employed for signal processing in today's telecommunication systems, owing to their spectral purity and the prospect of integration with existing technology. In this work we present a novel, front-end receiver topology based on a single device silicon nanoelectromechanical mixer-filter. The operation is demonstrated by using the signal amplification in a field effect transistor (FET) merged into a tuning fork resonator. The combination of both a transistor and a mechanical element into a hybrid unit enables on-chip functionality and performance previously unachievable in silicon. Signal mixing, filtering and demodulation are experimentally demonstrated at very high frequencies ( > 100 MHz), maintaining a high quality factor of Q = 800 and stable operation at near ambient pressure (0.1 atm) and room temperature (T = 300 K). The results show that, ultimately miniaturized, silicon NEMS can be utilized to realize multi-band, single-chip receiver systems based on NEMS mixer-filter arrays with reduced system complexity and power consumption.

[Trials to improve the media used for the methyl red reaction (MRT). II]

The evolution of the methyl rot reaction (MRT), expressed by the pH dynamics in the first 18 hours was examined. A medium made of caseine or soya hydrolysate distributed in small volumes, was experimented versus a control broth made of meat peptone (Clark-Lubs). For Klebsiella the results showed that in the control group the pH acidifies and remains low, thus mimicking a positive reaction. In the caseine/soya medium, a decrease of pH at 4-8 hours is first noticed. Initial acidification, consecutive to glucose fermentation, is then counteracted by another type of processes that change the reaction direction. pH increases at 12-18 hours towards neutrality hat can be easily exceeded in 24 hours. Alkaline reversion is favoured by: a--the richer content in aa diaminomonocarboxylic and b--assurance of a large aeration by increase of the ratio between surface and volume. For evidencing realkalinization, characteristic of Klebsiellae, the medium with caseine/soya, including "ab initio" either Bromkresolpurpur (pH = 5.2-6.2) or Bromtimolblau (pH = 6.7-7.6) is experimented. The medium ensures the direct reading of the reaction, at 18-24 hours, by the colour change. The results correspond to metric pH recording. When the results are not clear (slowly metabolic strains), the culture may be reincubated, an important advantage versus the Clark-Lubs procedure.