Chronic pain after breast surgery: incidence, risk factors and impact on quality of life

INTRODUCTION AND OBJECTIVES

Breast cancer is the most frequently diagnosed malignancy, and chronic pain after breast surgery (CPBS) is an increasingly recognized therapy-related problem. We evaluated CPBS incidence, characteristics, associated factors, and impact on patient quality of life (QoL).

MATERIALS AND METHODS

Six-month observational prospective study conducted in patients undergoing breast surgery in a tertiary university hospital. Data were collected using several questionnaires: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4 Questionnaire, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module.

RESULTS

A total of 112 patients completed the study. Approximately, one third (34.8%) developed CPBS, and almost all with potentially neuropathic pain. CPBS interfered with patients' daily life and reduced their QoL. Diabetes (p = 0.028), catastrophizing (p = 0.042), and acute postoperative pain severity (p < 0.001) were associated with CPBS.

CONCLUSIONS

This study broadens our understanding of CPBS and shows the impact of this syndrome. Healthcare workers need to be aware of CPBS and take steps to prevent and treat it, and provide patients with adequate information.

Screening Accuracy of the Portuguese version of the Postpartum Depression Screening Scale-7 according to DSM-5 criteria

Introduction

The Portuguese shortest version of the Perinatal Depression Screening Scale/PDSS-7 proved to be valid and reliable, in Portugal and Brazil, but it is essential to analyze its operational characteristics before using it for screening purposes.

Objectives

To determine PDSS-7 cut-off points and associated conditional probabilities to screen for major depression, according to the DSM-5.

Methods

he pregnancy sample was composed of 259 women in the second trimester (Mean gestation weeks=17.83±4.750). The postpartum sample consisted of 241 women assessed between the 2^nd-6^thmonths postpartum(M=17.99±4.689 weeks postpartum). All women completed the PDSS-7 and were interviewed with the Diagnostic Interview for Psychological Distress(Pereira et al., 2017), a semi-structured clinical interview to assess the most prevalent psychiatric disorders in the perinatal period according to the DSM-5 criteria. MedCalc was used to perform ROC analysis.

Results

During pregnancy, the major depression prevalence was of 4.6%(n=12). The cut-off point that maximizes the Youden Index(J=.98, 95%CI: .97-.99; AUC=.99; se=.004; p<.001) was of 18(95%CI:17-19), which resulted in a sensitivity of 100%(71.5%-100%), a specificity of 97.98%(95.3%-99.3%), a positive predictive value/+PP of 68.8%(48.0%-84.0%) and a negative predictive value/-PP of 100%. In the postpartum, the major depression prevalence was of 10.4%(n=25). The cut-off point(J=.79, 95%CI: .63-.82; AUC=.89; se=.036; p<.001) was of 14(95%CI: 12-16), with a sensitivity of 85.0%(69.3%-93.2%), a specificity of 85.0%(69.3%-93.2%), a +PP of 56.5%(46.1%-67.3%) and a -PP of 97.5%(94.6%-98.8%).

Conclusions

The Portuguese version of PDSS-7 presents good combinations of sensitivity and specificity, being accurate and usable to screen for depression during pregnancy and in the postpartum both in research and primary health care.

Disclosure

No significant relationships.

Further validation of the European and Brazilian Portuguese short version of the Postpartum Depression Screening Scale-7

Introduction

We have recently validated the Portuguese shortest version of the Perinatal Depression Screening Scale-PDSS-7 (items selected from the PDSS-21; each one representing a dimension evaluated by the PDSS-35), for the assessment of depression severity in pregnancy, both in Portugal and Brazil.

Objectives

To analyze the validity and reliability of the PDSS-7 Portuguese version to evaluate postpartum women both from Portugal and Brazil.

Methods

The Portuguese sample was composed of 304 women between the 2nd-6th postpartum months (Mean=20.09±7.21 weeks postpartum). These participants were not the same who participated in the psychometric study that led to the selection of the seven items. The Brazilian sample was composed of 121 women (Mean=10.51±4.53 weeks postpartum). All the participants completed the European/Brazilian Portuguese versions of PDSS-21, which was composed of the same items and included the seven items of PDSS-7. Participants also filled in the validated versions of Perinatal Anxiety Screening Scale and Profile of Mood States.

Results

Confirmatory Factor Analysis revealed that the unidimensional model of PDSS-7 presented acceptable/good fit indexes in both samples (Portuguese/Brazilian: χ²/d.f.=2.6598/1.7897; RMSEA=.0740/.0807, CFI=.8289/.7934, TLI=.7901/.8434, GFI=.9298/.9496; p<.001). The PDSS-7 Cronbach’s alphas were of .841/.856 and all the items contributed to the internal consistency. Pearson correlations with postpartum anxiety (.646/.763) and negative affect (.666/.676) were significantly (p<.01) high. PDSS-7 mean scores were higher in the Brazilian sample (16.06±7.39 versus 11.37±4.37, p<.01).

Conclusions

PDSS-7 presented validity (construct and convergent), reliability and utility in clinical and research settings, including in transcultural studies, in Portugal and Brazil, namely in the postpartum.

Disclosure

No significant relationships.

The composition of the lipid, protein and mineral fractions of quail breast meat obtained from wild and farmed specimens of Common quail (Coturnix coturnix) and farmed Japanese quail (Coturnix japonica domestica)

The present study was intended to answer 2 scientific hypotheses: 1) the quail species has a significant influence in quail breast meat composition; 2) the wild quail's meat presents healthier composition than their farmed counterparts.

An analysis of the pectoral muscles of wild and captive common quails (Coturnix coturnix) and domestic quails (Coturnix japonica domestica) was performed. The content of fatty acids (FA), amino acids, total cholesterol, and vitamin E, some basic macro- and microminerals in the pectoral muscles of the 2 species of the genus Coturnix were analyzed.

Regarding the quail species influence on meat composition, Japanese Quail (JQ) revealed better lipid composition, characterized by lower saturated FA (SFA; less 3.17 g/100 g of total fatty acids), higher polyunsaturated FA contents (PUFA; more 5.5 g/100 g of total fatty acids) and healthier polyunsaturated FA/saturated FA (P/S) and n-6/n-3 ratios and TI value (1.08, 9.54 and 0.60 vs. 0.76, 12.58, and 0.75, correspondingly). The absence of differences observed on amino acids partial sums and ratios reveals equality between species on protein nutritional quality. On the other hand, Common Quail (CQ) proved to be a better source of copper (0.181 mg/100 g of meat), iron (2.757 mg/100 g of meat), manganese (0.020 mg/100 g of meat), and zinc (0.093 mg/100 g of meat) than JQ.

The comparison of farmed and wild specimens within CQ, showed that wild birds presented lower total cholesterol (less 8.32 mg/g of fresh meat) and total PUFA (less 4.26 g/100 g of total fatty acids), and higher n-3 PUFA contents (more 1.53 g/100 g of total fatty acids), which contributed to healthier P/S and n-6/n-3 ratios, but worst PI (1.60, 8.08, and 113.1 vs. 0.76, 12.58, and 100.8, respectively). The wild species revealed higher α-tocopherol content (2.40 vs. 1.49 µg/g of fresh meat. Differences observed on their mineral composition counterbalance each other.

Under intensive production system and similar feeding and management conditions, the CQ develops better nutritional qualities than JQ. The comparison of wild and farmed species within CQ reveals more similarities than differences. Quail´s meat presents good nutritional quality and introduces variability to human's diet, which is much valued by consumers.

Childbirth expectations questionnaire – a psychometric study with a sample from brazil

Introduction

The Childbirth Expectations Questionnaire (CEQ; Gupton, A., Beaton, J., Sloan, J. & Bramadat, I.; 1991) evaluates the women childbirth expectation’s with 34 items organized in four dimensions: Pain and coping; Significant others; Nursing support and Interventions.

Objectives

To analyze the psychometric properties (construct validity using Confirmatory Factor Analysis, discriminant validity and reliability) of the Brazilian preliminary version of CEQ.

Methods

350 women (Mean age: 30.01±5.452) in the second trimester of pregnancy (Mean weeks of gestation=25.17±6.55), with uncomplicated pregnancies, completed the CEQ. To analyze discriminant validity, thirty of these women participated in a workshop (12 hours, integrated in the GentleBirth, a specific perinatal education intervention program) and fill in the CEQ again after approximately 8 weeks.

Results

After deleting seven items (1-3-20-24-33-34-35) and some errors were correlated the four-dimensional second-order model of CEQ presented good fit (χ²=2.496; RMSEA=.071; CFI=.845, TLI=.828). The CEQ Cronbach’s alpha for the total was α=.90; all factors presented good reliability: Pain coping (α=.87); Significant others (α=.66), Nursing support (α=.84), and Interventions (α=.76). The CEQ mean scores (total, Pain coping and Nursing support) were significantly higher after the workshop, indicating more positive expectations for childbirth (p<.05).

Conclusions

This additional validation study emphasizes that CEQ is an adequate measure of expectations of labour. It will be very useful to understand the correlates of childbirth expectations and also to access the efficacy of childbirth preparation programs.

Profile of mood states-27: A valid and reliable measure of negative and positive affect for brazilian pregnant women

Introduction

The original Profile of Mood States (McNair et al. 1971) is composed of 65 items to measure six affect dimensions. There is a Portuguese shorter version (POMS-27) for the perinatal period (Bos et al. 2013), which reduced the number of items (adjectives) down to 27. Although briefer, it still covers relevant mood states with good psychometric properties, being considered a good alternative to use during this demanding and busy period.

Objectives

To test if PoMS-27, composed of four dimensions (Depression, Anxiety, Vigour, Fatigue) and one second-order factor (Negative Affect, composed by the former two) is valid and reliable to be used with pregnant women from Brazil.

Methods

After confirming the items semantic equivalence and slightly adapt two adjectives from European to Brazilian Portuguese, 350 pregnant women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55), with uncomplicated pregnancies, completed the PoMS-27 and the Brazilian recently validated versions of Perinatal Depression Screening Scale and Perinatal Anxiety Screening Scale (PDSS; PASS; Barros et al. 2021). SPSS and AMOS software were used.

Results

After deleting two items (20 and 22) and some errors were correlated, CFA indicated that the PoMS-25 four-dimensional model presented an acceptable fit (χ2=3.163; RMSEA=.079, CFI=.868, TLI=.849). The Cronbach alphas of the dimensions were: Depression (.82), Anxiety (.86), Negative Affect (.89), Fatigue (.80) and Vigor (.50).

Conclusions

Within this psychometric study we found useful, valid and reliable measure of negative and positive affect for Brazilian pregnant women. From now on we will denominate it Profile of Mood States-25Br

Validity and reliability of the perinatal anxiety screening scale in a brazilian sample of pregnant women

Introduction

The Perinatal Anxiety Screening Scale was translated and validated for European Portuguese (PASS-29; Pereira et al. 2019), from the original PASS (composed of 31 items; Somerville et al. 2014) to allow epidemiological and correlational research and early detection, which is an health policy imperative. This need also applies to Brazil, where a specific instrument to measure perinatal anxiety is not available.

Objectives

To study the psychometric properties of the PASS Brazilian version factor structure using confirmatory factor analysis (CFA), internal consistency and pattern of correlations with mood states.

Methods

350 women (Mean age: 30.01±5.452) in the second trimester of pregnancy (Mean weeks =25.17±±6.55) completed the PASS and the Brazilian version of Profile of Mood States (POMS-25; Barros et al. 2021). SPSS and AMOS software were used.

Results

After deleting two items (1 and 2) and some errors correlated, CFA indicated a good fit for the second-order model (X2/df=2.987; CFI=.903; TLI=.889; GFI=.797, RMSEA=.075; p[rmsea≤0.01]<0.001). The Cronbach alpha was α=.937, and for the four dimensions (general anxiety and specific fear, perfectionism and control, social anxiety and adjustment disorder, acute anxiety and trauma.), were all α>.800. PASS total and dimensional scores significantly (p<.01) and moderately correlated with Profile of Mood States dimensions: negative affect (.471), Depression (.294), Anxiety (.548), Fatigue (.438) and Vigour (-.288).

Conclusions

Similarly, to what has been found for Portuguese version, the Brazilian PASS resulted in a 29-items-and-four-factors version, with good construct and convergent validity and reliability. In the near future we will determine the PASS cut-offs to screen for anxiety disorders in pregnancy and postpartum.

Brazilian version of the postpartum depression screening scale-24

Introduction

The PDSS-24 is a Portuguese short version of the Postpartum Depression Screening Scale (Beck and Gable, 2002). Items were selected on the basis of exploratory factor analysis (those with loadings >.60). The PDSS-24 proved to be superior to the 35-items PDSS in reliability, validity and screening ability (Pereira et al. 2013).

Objectives

To analyze the psychometric properties (construct validity using Confirmatory Factor Analysis, discriminant validity and reliability) of the Brazilian preliminary version of PDSS-24

Methods

After confirming the items semantic equivalence and slightly adapt two adjectives from European to Brazilian Portuguese, 350 pregnant women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55), with uncomplicated pregnancies, completed the PDSS-24 and the Brazilian recently validated versions of Profile of Mood States-25 (PoMS; Barros et al. 2021). SPSS and AMOS software were used.

Results

After some errors were correlated the multidimensional second-order model of PDSS-24 presented an aceptable fit (χ2=3.448; RMSEA=.099; CFI=.817, TLI=.886, GFI=.886). The PDSS Cronbach’s alpha for the total was α=.90. Cronbach alpha was .90 for the total and >.75 for the dimensions. Appling the Portuguese validated cut-off score for Major Depression/DSM-5 (>42) to this sample 224 (64.0%) participants presented clinical relevant depressive symptoms.

Conclusions

The Brazilian PDSS-24 has acceptable validity and reliability. The percentage of women with high depressive symptomatology is three times higher than the figures reported in Portuguese Studies. This can be partly explained by the fact that data collection was done during the COVID19 pandemic. It is important to determine the PDSS cut-offs to screen for perinatal depression in Brazil.

Postpartum depression screening scale-7: A valid and reliable short version both for portugal and brasil

Introduction

Screening programs for perinatal depression are systematicly implemented in developed countries. To circumvent the most commonly pointed limitation by the primary healthcare professionals (the questionnaires length), we have developed shorter forms of the Beck and Gable Postpartum Depression Screening Scale-35. The shortest version consists of seven items, each one representing a dimension evaluated by the PDSS. This PDSS-7 demonstrated equal levels of reliability and validity as the 35-item PDSS with the advantage of being completed in as little as 1-2 minutes(Pereira et al. 2013).

Objectives

To analyze the construct validity of the PDSS-7 using Confirmatory Factor Analysis, to use both in Portugal and in Brazil.

Methods

The Portuguese sample was composed of 616 women (Mean age: 32.29±4.466; Mean gestation weeks=17.13±4.929). These participants were not the same who participated in the psychometric study that led to the selection of the seven items. The Brazilian sample was composed of 350 women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55). They all had uncomplicated pregnancies and completed the European/Brazilian Portuguese versions of PDSS-24 (Pereira et al. 2013/ Barros et al. 2021), which was composed of the same items and included the seven items that compose the PDSS-7.

Results

The unidimensional model of PDSS-7 presented a good fit in both samples (Portuguese/Brazilian: χ²/d.f.=3.439/2.653; RMSEA=.066/.069, CFI=.974/.981, TLI=.947/.957, GFI=.939/.957; p<.001). The PDSS-7 Cronbach’s alphas were .82/.83 and all the items contribute to the internal consistency.

Conclusions

The PDSS-7 is a valid and precise, economic, fast and easy screening instrument for perinatal depression, a major public health problem, both in Portugal and in Brazil.

Levels of depressive and anxious symptoms of pregnant women before vs. during the COVID-19 pandemic

Introduction

The effects on the population’s mental health due to the rapid global spread of COVID-19 are even greater for specific groups such as pregnant women.

Objectives

To compare levels of depressive and anxiety symptoms of pregnant women before vs. during the COVID-19 pandemic and to analyze the role of COVID-19 fear in perinatal psychological disorder.

Methods

200 Brazilian women evaluated during the pandemic in May-June 2020 (Sample-1) with the Brazilian Covid-19 Fear Scale for the Perinatal Period (Barros et al. 2020) and Screening for Perinatal Depression and the Perinatal Anxiety Crawl Scale, both with α> .90. Sample-1 was compared with a sample of 300 Portuguese women; these responded to the same questionnaires, before the pandemic, in 2017 and 2018 (Sample-2).

Results

Sample-1 had significantly higher mean scores of depression (52.73 ± 20.26 vs. 35.87 ± 16.98, t = 10.77, p <.001) and anxiety (36.58 ± 18.23 vs. 18.50 ± 13.71, t = 11.94, p <.001) and correlated significantly (p <.05) and moderate (r.30) with the fear of COVID-19. Hierarchical regression analyzes showed that, even after controlling for the effect of risk factors for PPP (Pereira et al. 2020), fear of COVID-19 is a significant predictor of depressive symptomatology levels (increments of 2-5%) and anxious (10-15%) during the pandemic.

Conclusions

The Sample-1 being from a different country may be a confusing factor, however, the magnitude of differences in PPP levels and the relevant role of fear in COVID-19, alert us to be aware of perinatal mental health.

Evaluation of training effects in the person-centered clinical method through active methodologies

The Patient-Centered Clinical Method (PCCM) recognizes the particularities of each person who falls ill and values the therapeutic role of the doctor; promotes a holistic approach to the patient and / or the disease in its context; highlights the reasoning and decision-making process leading to the diagnosis taking into account the patient's expectations, feelings and fears. The proportion of patients who remain without a specific diagnosis is high because the clinical conditions present with nonspecific symptoms and the patient's understanding is the key to understanding. The challenge that is faced is training professionals with these skills and competences. The PCCM is an approach that respects the patient's preferences and in which communication has an effect on health outcomes, through self-confidence and motivation for change that can contribute to adherence and self-care. This work aims to present an experience of training new professionals at PCCM based on active methodology and mentoring in which the student himself is a source of reflection and study. The course was taught within the Residency Program in Family and Community Medicine in the Municipality of Vitória da Conquista, Bahia, Brazil, developed in 9 meetings of 4 hours each with themes such as, family, life cycle, genogram, ecomap, sexuality, death, diagnostic disclosure, ICU experience, psychosomatics. Many group dynamics and participatory techniques were used to enable involvement, at the end of the course they were asked to evaluate it, the writings were analyzed qualitatively through discourse analysis. The students showed a great willingness to bring their own experience of illness and style of illness, producing a greater empathy with the patient's condition. Trained professionals change from the authority paradigm to that of partnership, solidarity, empathy and collaboration. Training at the PCCM is a differential in the quality of care of any health professional.

Key messages

Allows to get closer to the user, facilitates understanding his problems and propose the developing joint strategies or plans - based on your expectations, limitations, feelings. PCCM tools contributed to the structuring of the clinical consultation in Primary Health Care (PHC), valuing the listening and the use of open questions.

Toxoplasma gondii infection in wild mustelids and cats across an urban-rural gradient

The increase in human population and domestic pets, such as cats, are generating important consequences in terms of habitat loss and pathogen pollution of coastal ecosystems with potential to generate negative impacts in marine biodiversity. Toxoplasma gondii is the etiological agent of zoonotic disease toxoplasmosis, and is associated with cat abundance and anthropogenic disturbance. The presence of T. gondii oocysts in the ocean has negatively affected the health status of the threatened Southern sea otter (Enhydra lutris nereis) populations. The present study analyzed seroprevalence and presence of T. gondii DNA in American mink (Neovison vison), Southern river otters (Lontra provocax) and domestic cats (Felis silvestris catus) in four different areas in Southern Chile comprising studies in rivers and lakes in Andean foothills and mountains, marine habitat and island coastal ecosystems. Mean seroprevalence of T. gondii in the study was 64% of 151 total animals sampled: 59% of 73 American mink, 77% of 13 Southern river otters, 68% of 65 domestic cats and in two of two kodkods (Leopardus guigna). Toxoplasma gondii DNA was detected in tissues from one American mink and one Southern river otter. The present study confirms the widespread distribution of T. gondii in Southern Chile, and shows a high exposure of semiaquatic mustelids and domestic cats to the parasite. Cats and anthropogenic disturbance have a role in the maintenance of T. gondii infection in ecosystems of southern Chile.

Knowledge Representation and Management: a Linked Data Perspective

INTRODUCTION

Biomedical research is increasingly becoming a data-intensive science in several areas, where prodigious amounts of data is being generated that has to be stored, integrated, shared and analyzed. In an effort to improve the accessibility of data and knowledge, the Linked Data initiative proposed a well-defined set of recommendations for exposing, sharing and integrating data, information and knowledge, using semantic web technologies.

OBJECTIVE

The main goal of this paper is to identify the current status and future trends of knowledge representation and management in Life and Health Sciences, mostly with regard to linked data technologies.

METHODS

We selected three prominent linked data studies, namely Bio2RDF, Open PHACTS and EBI RDF platform, and selected 14 studies published after 2014 (inclusive) that cited any of the three studies. We manually analyzed these 14 papers in relation to how they use linked data techniques.

RESULTS

The analyses show a tendency to use linked data techniques in Life and Health Sciences, and even if some studies do not follow all of the recommendations, many of them already represent and manage their knowledge using RDF and biomedical ontologies.

CONCLUSION

These insights from RDF and biomedical ontologies are having a strong impact on how knowledge is generated from biomedical data, by making data elements increasingly connected and by providing a better description of their semantics. As health institutes become more data centric, we believe that the adoption of linked data techniques will continue to grow and be an effective solution to knowledge representation and management.

Influence of different behavioural factors and obesity status on systolic blood pressure among pre-school children

AIM

The aim of this study was to examine the association between sleeping time (SLT), time spent using screen (ST) and weight status with Systolic Blood Pressure (SBP) among pre-school children.

SUBJECTS AND METHODS

The sample comprised 628 pre-school children (50% female), aged 3-6 years-old. SLT and ST were reported by parents. BMI values were categorized according to IOTF. SBP cut points were based on SBP percentiles for age, sex and height. ST was dichotomized according to the following criteria: ≤1 hour vs >1 hour and SLT: ≤10.5 hours vs >10.5 hours. Participants were then categorized into one of four category profiles: Low ST/High SLT; High ST/Low SLT; Low ST/Low SLT and High ST/High SLT.

RESULTS

Children assigned to the High ST/Low SLT group were 2-times more likely to have high SBP values compared to those who were assigned to the Low ST/High SLT group (OR = 2.4; 95% CI = 1.1-5.1). Furthermore, those who were assigned as overweight and obese were more likely to be classified as having elevated BP (OR = 1.8; 95% CI = 1.1-3.2 for overweight and OR = 3.1; 95% CI = 1.6-5.8 for obese, respectively).

CONCLUSION

The data showed that high ST exposure time and low SLT are associated with enhanced blood pressure in children at pre-school.