Validation of the Portuguese version of the Integration of Stressful Life Experiences Scale (ISLES) in a sample of bereaved individuals

The Integration of Stressful Life Experiences Scale (ISLES) evaluates the ability to integrate stressful experiences into one's meaning system. The present study developed and validated a version of this scale for a bereaved Portuguese-speaking population, utilizing a sample of 242 adults who had lost a significant other to diverse causes of death. The sample was predominantly female, educated, married, or in consensual unions, and actively employed. Confirmatory factor analysis revealed a two-factor structure, consisting of 13 items, showing adequate local and global goodness-of-fit and supporting the proposed original structure. Convergent evidence based on internal structure was found for the two dimensions (Comprehensibility and Footing in the World). Regarding reliability, Cronbach's alpha and McDonald's omega computed for each factor showed good internal consistency and the average inter-item correlation was considered satisfactory. This psychometric support for ISLES underscores its relevance in enhancing the knowledge of meaning-making processes in the Portuguese context.

[Translated article] Risk factors for infection of tibial plateau fractures

INTRODUCTION

Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPFs) and to identify the risk factors for this.

MATERIAL AND METHODS

Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied.

RESULTS

One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (p=.002), Schatzker V and VI type fractures (p=.002) and the use of external fixation (p<.001). Regarding the surgical variables, only the longest ischemia time (p=.032) was identified as a risk factor. Staphylococcus aureus was the most frequently identified microorganism (43%), followed by Enterobacter cloacae (35.7%).

CONCLUSION

The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

Risk factors for infection of tibial plateau fractures

INTRODUCTION

Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this.

MATERIAL AND METHODS

Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied.

RESULTS

One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%).

CONCLUSION

The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

Utrecht grief rumination scale (UGRS): Psychometric study of validation of the Portuguese version

Grief rumination is characterized by recurring, repetitive, self-focused thoughts about the causes and consequences of loss and loss-related emotions. This cognitive process is a transdiagnostic risk factor for mental disorders, such as prolonged grief. The aim of this study was to analyze the psychometric properties of the Portuguese version of the Utrecht Grief Rumination Scale (UGRS). The sample consists of 242 bereaved adult participants with Portuguese nationality. Confirmatory Factor Analysis showed that the hierarchical model showed a better fit to the data. Average Variance Extracted was also calculated to measure convergent and divergent validity. Test-criterion validity was investigated by analyzing associations between grief rumination and measures of posttraumatic stress, prolonged grief, anxiety, and depression. Using McDonald's Omega and Cronbach's Alpha, all subscales showed adequate reliability. The UGRS showed acceptable psychometric properties, standing out as a valid instrument for practice and research in psychology in the area of ​​bereavement.

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND

Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy.

METHODS

This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems.

FINDINGS

Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124-159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality.

INTERPRETATION

The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir.

FUNDING

Penta Foundation, ViiV Healthcare, and UK Medical Research Council.

Nucleoside/nucleotide reverse transcriptase inhibitor sparing regimen with once daily integrase inhibitor plus boosted darunavir is non-inferior to standard of care in virologically-suppressed children and adolescents living with HIV - Week 48 results of the randomised SMILE Penta-17-ANRS 152 clinical trial

Background

Integrase inhibitor (INSTI) with boosted darunavir (DRV/r), a regimen with a high-resistance barrier, avoiding NRTI toxicities, might be a switching option in children living with HIV (CLWHIV).

Methods

SMILE is a randomised non-inferiority trial evaluating safety and antiviral efficacy of once-daily INSTI + DRV/r vs. continuing on current standard-of-care (SOC) triple ART (2NRTI + boosted PI/NNRTI) in virologically-suppressed CLWHIV aged 6-18 years. The primary outcome is the proportion with confirmed HIV-RNA ≥50 copies/mL by week 48, estimated by Kaplan-Meier method. Non-inferiority margin was 10%. Registration number for SMILE are: ISRCTN11193709, NCT #: NCT02383108.

Findings

Between 10th June 2016 and 30th August 2019, 318 participants were enrolled from Africa 53%, Europe 24%, Thailand 15% and Latin America 8%, 158 INSTI + DRV/r [153 Dolutegravir (DTG); 5 Elvitegravir (EVG)], 160 SOC. Median (range) age was 14.7 years (7.6-18.0); CD4 count 782 cells/mm3 (227-1647); 61% female. Median follow-up was 64.3 weeks with no loss to follow-up. By 48 weeks, 8 INSTI + DRV/r vs. 12 SOC had confirmed HIV-RNA ≥50 copies/mL; difference (INSTI + DRV/r-SOC) -2.5% (95% CI: -7.6, 2.5%), showing non-inferiority. No major PI or INSTI resistance mutations were observed. There were no differences in safety between arms. By week 48, difference (INSTI + DRV/r-SOC) in mean CD4 count change from baseline was -48.3 cells/mm3 (95% CI: -93.4, -3.2; p = 0.036). Difference (INSTI + DRV/r-SOC) in mean HDL change from baseline was -4.1 mg/dL (95% CI: -6.7, -1.4; p = 0.003). Weight and Body Mass Index (BMI) increased more in INSTI + DRV/r than SOC [difference: 1.97 kg (95% CI: 1.1, 2.9; p < 0.001), 0.66 kg/m2 (95% CI: 0.3, 1.0; p < 0.001)].

Interpretation

In virologically-suppressed children, switching to INSTI + DRV/r was non-inferior virologically, with similar safety profile, to continuing SOC. Small but significant differences in CD4, HDL-cholesterol, weight and BMI were observed between INSTI + DRV/r vs. SOC although clinical relevance needs further investigation. SMILE data corroborate adult findings and provide evidence for this NRTI-sparing regimen for children and adolescents.

Funding

Fondazione Penta Onlus, Gilead, Janssen, INSERM/ANRS and UK MRC. ViiV-Healthcare provided Dolutegravir.

Population pharmacokinetics of unbound and total dolutegravir concentrations in children aged 12 years and older: a PK substudy of the SMILE trial

BACKGROUND

SMILE, a multicentre randomized trial, compared the efficacy and safety of switching virologically suppressed children and adolescents with HIV to a once-daily dual regimen of dolutegravir plus ritonavir-boosted darunavir versus continuing standard ART. Within a nested pharmacokinetic (PK) substudy, we performed a population PK analysis to describe total and unbound dolutegravir plasma concentrations in children and adolescents receiving this dual therapy.

METHODS

Sparse blood samples were obtained during follow-up for dolutegravir quantification. A population PK model was developed to simultaneously describe total and unbound dolutegravir concentrations. Simulations were performed and were compared with the protein-adjusted 90% inhibitory concentration (IC90) and the in vitro IC50, respectively. Dolutegravir exposures in children aged ≥12 years were also compared with values in treatment-experienced adults.

RESULTS

Four hundred and fifty-five samples from 153 participants aged between 12 and 18 years were collected for this PK analysis. A one-compartment model with first-order absorption and elimination best described unbound dolutegravir concentrations. The relationship between unbound and total dolutegravir concentrations was best characterized by a non-linear model. Unbound dolutegravir apparent clearance was significantly influenced by total bilirubin concentrations and by Asian ethnicity. All children and adolescents had trough concentrations well above the protein-adjusted IC90 and the in vitro IC50 values. Dolutegravir concentrations and exposures were also similar to those obtained in adults receiving dolutegravir 50 mg once daily.

CONCLUSIONS

A once-daily 50 mg dolutegravir dose for children and adolescents produces adequate total and unbound concentrations when used as part of dual therapy with ritonavir-boosted darunavir.

Longitudinally extensive transverse myelitis (LETM) secondary to SARS‐CoV‐2 infection: A recent reality in spinal cord injury rehabilitation

Transverse myelitis can be a complication of SARS‐CoV‐2 infection. We report the case of a transverse myelitis related to SARS‐CoV‐2 infection. Beyond the disease itself, neurological involvement affects functionality. In this situation, physical and rehabilitation medicine plays a crucial role in managing patient rehabilitation.

Dolutegravir as First- or Second-Line Treatment for HIV-1 Infection in Children

BACKGROUND

Children with human immunodeficiency virus type 1 (HIV-1) infection have limited options for effective antiretroviral treatment (ART).

METHODS

We conducted an open-label, randomized, noninferiority trial comparing three-drug ART based on the HIV integrase inhibitor dolutegravir with standard care (non-dolutegravir-based ART) in children and adolescents starting first- or second-line ART. The primary end point was the proportion of participants with virologic or clinical treatment failure by 96 weeks, as estimated by the Kaplan-Meier method. Safety was assessed.

RESULTS

From September 2016 through June 2018, a total of 707 children and adolescents who weighed at least 14 kg were randomly assigned to receive dolutegravir-based ART (350 participants) or standard care (357). The median age was 12.2 years (range, 2.9 to 18.0), the median weight was 30.7 kg (range, 14.0 to 85.0), and 49% of the participants were girls. By design, 311 participants (44%) started first-line ART (with 92% of those in the standard-care group receiving efavirenz-based ART), and 396 (56%) started second-line ART (with 98% of those in the standard-care group receiving boosted protease inhibitor-based ART). The median follow-up was 142 weeks. By 96 weeks, 47 participants in the dolutegravir group and 75 in the standard-care group had treatment failure (estimated probability, 0.14 vs. 0.22; difference, -0.08; 95% confidence interval, -0.14 to -0.03; P = 0.004). Treatment effects were similar with first- and second-line therapies (P = 0.16 for heterogeneity). A total of 35 participants in the dolutegravir group and 40 in the standard-care group had at least one serious adverse event (P = 0.53), and 73 and 86, respectively, had at least one adverse event of grade 3 or higher (P = 0.24). At least one ART-modifying adverse event occurred in 5 participants in the dolutegravir group and in 17 in the standard-care group (P = 0.01).

CONCLUSIONS

In this trial involving children and adolescents with HIV-1 infection who were starting first- or second-line treatment, dolutegravir-based ART was superior to standard care. (Funded by ViiV Healthcare; ODYSSEY ClinicalTrials.gov number, NCT02259127; EUDRACT number, 2014-002632-14; and ISRCTN number, ISRCTN91737921.).

Pilot study on the effectiveness of Reminiscence Therapy on cognition, depressive symptoms, and quality of life in nursing home residents

Aim

This study aimed to assess the effectiveness of the group Reminiscence Therapy (RT) on cognition, depressive symptoms, and quality of life (QOL) in older adults recruited in nursing homes.

Methods

A pilot study with a one-group pretest-posttest design was conducted between September 2017 and March 2018 in five nursing homes from central Portugal. A comprehensive RT program (Core program followed by a Follow-up program) was provided to clinically stable volunteers aged 65 years or more, who did not have severe cognitive impairment.

Results

From the 50 older adults (32 women and 18 men, with mean age of 83.32±7.76, and mean education level of 5.48±4.05) considered eligible to participate in the study, 35 (mean age: 84.17±7.46, mean education level of 6.14±4.49) completed the Core Program and 28 completed the Follow-up Program (mean age: 84.25±7.66, mean education level of 6.18±4.57). Based on the Wilcoxon Test, it was observed that the participants' cognitive performance did not change during the two RT programs. No significant changes were confirmed in relation to depressive symptomatology and QOL.

Conclusion

Although no statistically significant improvements of the older adults' cognitive function, depressive symptomatology, and quality of life were found, the stabilization of such outcomes are relevant from a clinical viewpoint. Further studies are necessary to confirm these findings.

Factors associated with nicotine dependence in a Brazilian rural town

Introduction

Nicotine dependence is a serious global health issue. Over a billion people are estimated to smoke in the world. Withdrawing from smoking contributes significantly to reducing morbimortality. Low income, poor education and smoking from a young age are some of the factors that contribute to the prevalence of tobacco use and to smoking cessation. In Brazil, the National Programme of Tobacco Control is responsible for helping smokers undergoing treatment in primary care units.

Objective

To highlight the association between the results of a nicotine dependence treatment in a Brazilian town, its sociodemographic factors and smoking habits of patients.

Methodology

A cross-sectional study in Santa Cecília, Paraíba, a town in the northeast of Brazil in 2016, relying on data from the medical history of 85 smokers who received treatment in primary care units. Dropout rates and successful results were both considered. Pearson's chi-squared test with 95% significance level was used to assess the association between variables.

Results

51.8% of patients quit smoking while 37.6% abandoned treatment. Around 4.7% of patients smoked fewer cigarettes after treatment and 5.9% did not have a successful result. Among the successful cases, the majority were women (54.4%). Considering smoking habits of those who quit smoking, the following was observed: 29.4% smoked 20 cigarettes per day, 27% were highly dependent on nicotine, 33% spent 20 to 40 years smoking and 18.9% underwent nicotine replacement therapies. Income, marital status and number of cigarettes were variables that showed significant differences (p &lt; 0.001) after treatment.

Conclusions

Smoking cessation after treatment indicates the effectiveness of the programme. The engagement of healthcare professionals is paramount to successfully implement such treatments in primary health care. Further qualitative research is recommended to investigate other Brazilian cities and to assess patient progress individually.

Key messages

This work analyses factors related to nicotine dependence in groups of smokers undergoing treatment developed by the National Programme of Tobacco Control in a Brazilian rural town. Analysing the prevalence of smoking cessation and its related factors among patients undergoing treatment by the National Programme of Tobacco Control in a Brazilian rural town.

Caregiving and bereavement in palliative care: A cross-cultural study between Brazil and Portugal

Caregiving and bereavement outcomes are strongly influenced by socio-cultural context. Past research has found higher levels of caregiver burden and psychological morbidity in Portuguese compared to Brazilian caregivers. This study compared Brazilian and Portuguese family caregivers in palliative care to identify differences in psychological morbidity and caregiver burden and their relationship with psychosocial factors such as sociodemographic variables, circumstances of end-of-life care and dying, social support, family functioning, and perception of quality of care. Prospective data were collected from convenience samples of family caregivers in Brazil (T0 n = 60; T1 n = 35) and Portugal (T0 n = 75; T1 n = 29) at two separate time points-during caregiving (T0), and during the first two months of bereavement (T1). The study samples consisted mostly of women, offspring, and spouses. In both countries, family caregivers devoted most of their day to taking care of their sick relatives and reported a lack of practical support. Portuguese caregivers had higher levels of burden than Brazilian caregivers, and in both populations a greater burden was associated with more psychopathological symptoms. Higher caregiver burden among Portuguese caregivers was associated with the circumstances of death and the perceived lack of emotional support. Among Portuguese caregivers, symptomatology persisted during bereavement, reaching significantly higher levels of anxiety, somatization, and peritraumatic symptoms compared to the Brazilian sample. These results show differences between family caregiver samples in Portugal and Brazil during the bereavement process. Understanding the underlying cultural patterns and mechanisms requires future research.

Family Caregivers' Anticipatory Grief: A Conceptual Framework for Understanding Its Multiple Challenges

The end-of-life trajectory of cancer patients in palliative care (PC) elicits an anticipatory grief (AG) process in family caregivers (FCs). Although widely recognized, AG lacks conceptual clarification. This study aims to qualitatively explore the experience of FCs of patients with terminal cancer to identify the core characteristics and the specific adaptive challenges related to AG in the context of end-of-life caregiving. Data were collected through in-depth semi-structured interviews conducted in a clinical sample of 26 FCs of cancer patients in PC. Findings from thematic analysis suggest that the AG experience is characterized by traumatic distress from being exposed to life-threatening conditions and the separation distress induced by loss anticipation and current relational losses, challenging the FCs to long-term emotional regulation effort demands. These results contribute to the conceptualization of AG and may inform intervention programs for the main challenges the FCs face when adjusting to loss during end-of-life caregiving.

Implementation process of social prescribing to improve primary care patients’ health and well-being

Key messages

The social prescribing intervention has been effective in tackling multiple social determinants of health. Intervention evaluation is being key to identify facilitators and opportunities for scale up.

A Study Protocol for Development and Validation of a Clinical Prediction Model for Frailty (ModulEn): a new European Commitment to Tackling Frailty

There is a growing need to implement and evaluate the technological solutions that allow the early detection of age-related frailty and enable assessment of the predictive values of frailty components. The broad use of these solutions may ensure an efficient and sustainable response of health and social care systems to the challenges related to demographic aging. In this paper, we present the protocol of the ModulEn study that aims to develop and validate a predictive model for frailty. For this purpose, the sample composed by older adults aged 65-80 years and recruited from the community will be invited to use an electronic device ACM Kronowise® 2.0. This device allows proactive and continuous monitoring of circadian health, physical activity, and sleep and eating habits. It will be used during a period of seven to ten days. The participants will also be given the questionnaires evaluating the variables of interest, including frailty level, as well as their experience and satisfaction with the device use. Data provided from these two sources will be combined and the relevant associations will be identified. In our view, the implications of this study' findings for clinical practice include the possibility to develop and validate tools for timely prevention of frailty progress. In the long term, the ModulEn may contribute to the critical reduction of frailty burden in Europe.

Contributos para a validação portuguesa do Family Relationship Index (FRI) reduzido

Objetivo

Considerando a importância das relações e do funcionamento familiar para o bem-estar psicológico dos seus membros e o desenvolvimento de psicopatologias, este estudo teve como principal objetivo contribuir para a validação portuguesa da versão reduzida do Family Relationship Index (FRI).

Método

A amostra foi constituída por 193 participantes portugueses que responderam ao questionário online. Dos participantes, 65.3% eram do sexo feminino, com idade média de 44.65 anos e 63.2% eram casados.

Resultados

Através da análise fatorial confirmatória da escala, foram encontrados dois fatores (conflito e coesão/expressividade), ao invés de três como na escala original e o modelo fatorial final apresentou bons índices de qualidade de ajustamento. A consistência interna para o fator coesão/expressividade foi de 0.902 e 0.741 para o fator conflito. À exceção do item seis, os demais itens do FRI apresentaram pesos fatoriais superiores a 0.5 e todos os itens eram estatisticamente significativos. Relativamente às tipologias familiares, os resultados revelam que a maioria das famílias pertencia à tipologia solucionadora de conflitos (34.7%).

Conclusão

Daqui se conclui que o instrumento apresenta boa consistência interna e fiabilidade de constructo, assumindo-se como um instrumento útil para a identificação de famílias disfuncionais.

Influence of self-etch all-in-one adhesives on fissure sealant shear bond strength under contaminated enamel conditions

AIM

To determine the influence of two all-in-one self-etching adhesive systems on shear bond strength of a fissure sealant applied under different enamel surface conditions.

METHODS

A total of 180 bovine enamel specimens were randomly distributed to nine experimental groups, defined by the combination of the sealant application technique (using phosphoric acid, or a self-etching water-based adhesive or a self-etching ethanol and water-based adhesive) and enamel surface conditions (dry enamel, saliva or water contaminated enamel). The specimens were submitted to thermocycling prior to the shear bond strength test.

RESULTS

High shear bond strength mean values were obtained with the classic technique for dry enamel (31.47 MPa), statistically similar values were obtained when the sealant was combined with a self-etching water-based adhesive, in dry enamel (32.36 MPa), and when the sealant was combined with a self-etching water-based adhesive in water contaminated enamel (32.62 MPa). Under enamel salivary contamination, the best results were achieved using a water-based adhesive (24.78 MPa).

CONCLUSIONS

In saliva contaminated enamel, the combination of a sealant with a water-based self-etching adhesive can maintain high and satisfactory values of bond strength.

Intervenção em situações de violência doméstica: Atitudes e crenças de polícias

Objetivo

O presente estudo visa perceber quais as crenças dos polícias relativamente ao fenómeno da violência doméstica contra a mulher e avaliar de que forma estas podem estar relacionadas com o seu modo de atuação.

Método

A amostra foi constituída por 453 polícias do Comando Metropolitano da Polícia de Segurança Pública do Porto, aos quais foram administradas a Escala de Crenças sobre Violência Conjugal (E.C.V.C.) e a Escala de Intervenção que integra as Escalas de Atitudes da Polícia (E.A.P.).

Resultados

Os resultados revelaram uma maior discordância quanto ao conjunto de mitos legitimadores da violência conjugal e uma maior percentagem de sujeitos orientados para executar diligências de serviço (atuação incondicional, independentemente de a vítima querer denunciar o crime), sobretudo quando estão perante situações de violência física. Os resultados correlacionais sugerem que níveis mais elevados de crenças legitimadoras da violência conjugal estão associados a uma atuação policial mais condicionada. A análise comparativa de dois grupos com mais ou menos crenças legitimadoras da violência contra a mulher revelou que não há uma diferenciação estatisticamente significativa quanto ao tipo da ação dos polícias em situações de violência doméstica.

Conclusão

Os resultados apoiam a associação entre crenças sobre o fenómeno da violência doméstica e a atuação da polícia nestes casos.

Circunstâncias e consequências do cuidar: estudo prospetivo em cuidados paliativos

Resumo As várias circunstâncias que afetam a prestação de cuidados em fim-de-vida podem ter um papel determinante no resultado desta experiência, nomeadamente nos níveis de morbilidade psicológica antes e depois da perda. Este estudo tem por objetivos descrever a prevalência da sobrecarga e sintomatologia psicopatológica dos cuidadores familiares em cuidados paliativos e identificar as circunstâncias que lhe estão associadas. Pretendemos ainda avaliar a evolução da sintomatologia, identificando os fatores circunstanciais que interferem na fase aguda do luto. A amostra foi constituída por 75 cuidadores portugueses, a maioria do sexo feminino e filhas do doente. Os resultados revelam que as pessoas mais envolvidas nos cuidados ao doente apresentam mais sobrecarga e estão mais propensas a sintomatologia psicopatológica, a qual tem tendência a manter-se no luto. Ficou também demonstrada a existência de sintomas peritraumáticos que parecem contribuir significativamente para o estado geral de distress no luto agudo. O suporte social tem efeito protetor nos diferentes quadros sintomatológicos e está relacionado com o funcionamento familiar. Estes resultados sugerem a possibilidade de identificar precocemente os cuidadores mais vulneráveis e as circunstâncias adversas que os afetam.

Selection of an Artificial Diet for Laboratory Rearing of Opogona sacchari (Lepidoptera: Tineidae) (Bojer, 1856)

The banana moth Opogona sacchari (Bojer) (Lepidoptera: Tineidae) is a polyphagous pest that can cause serious damage, in particular to banana crops in southern Brazil. The insect is a quarantine pest in several countries, including Argentina, the main consumer market for bananas from southern Brazil. Little information is available about the biology and ecology of this moth, such as a suitable diet for laboratory rearing. In order to provide support for integrated pest management of the pest, this study furnished data for selecting two diets suitable for continuous laboratory rearing of O. sacchari, one based on dried beans, wheat germ, soy bran, brewer's yeast, and casein and another diet with wheat germ and casein as protein sources. With both diets, the viability of the egg-adult period exceeded 68%, with fertility over 338 eggs per female. A corrected biotic potential analysis gave similar values for the two diets.

[Post-appendectomy intra-abdominal abscesses: six years' experience in a Pediatric Surgery Department]

OBJECTIVES

Post-appendectomy intra-abdominal abscesses are estimated to complicate up to 4.2% of acute non-perforated appendicitis and between 6.7% and 28% acute perforated appendicitis. This study was performed with the aim to review and characterize post-appendectomy intra-abdominal abscesses in our Pediatric Surgery department; to calculate their incidence and to evaluate the efficacy of the treatment modality.

MATERIAL AND METHODS

A retrospective analysis of all patients, under 18 years and with the diagnosis of intra-abdominal abscess post-appendectomy, between January 2010 and December 2015 was performed, taking in account initial surgical approach, type of acute appendicitis, length of hospital stay and the treatment applied. Data were collected by reviewing clinical files.

RESULTS

In a total of 1,340 appendectomies performed, there were 24 intra-abdominal abscesses identified (1.79%). Eight were feminine and sixteen masculine, and mean age was 11.9 years. In 52% of cases the diagnosis was made in the initial admission. Twelve have been submitted to laparoscopic appendectomy and the other 12 to open appendectomy. Of the 24 patients, only 4 needed a surgical re-intervention, which leaves medical treatment an 83.3% success rate.

CONCLUSIONS

TThe incidence of intra-abdominal abscesses post-appendectomy, in the studied population, is what was expected and inferior to what's described in the literature. In our sample, conservative management for intra-abdominal abscesses post-appendectomy was successful in most of the cases, only 4 needing further surgical intervention.

Bladder pain induced by prolonged peripheral alpha 1A adrenoceptor stimulation involves the enhancement of transient receptor potential vanilloid 1 activity and an increase of urothelial adenosine triphosphate release

AIM

Pathophysiological mechanisms of chronic visceral pain (CVP) are unknown. This study explores the association between the sympathetic system and bladder nociceptors activity by testing the effect of a prolonged adrenergic stimulation on transient receptor potential vanilloid 1 (TRPV1) activity and on urothelial adenosine triphosphate (ATP) release.

METHODS

Female Wistar rats received saline, phenylephrine (PHE), PHE + silodosin, PHE + naftopidil or PHE + prazosin. TRPV1 knockout and wild-type mice received saline or PHE. Visceral pain behaviour tests were performed before and after treatment. Cystometry was performed, during saline and capsaicin infusion. Fos immunoreactivity was assessed in L6 spinal cord segment. Human urothelial ATP release induced by mechanical and thermal stimulation was evaluated.

RESULTS

Subcutaneous, but not intrathecal, PHE administration induced pain, which was reversed by silodosin, a selective alpha 1A adrenoceptor antagonist, but not by naftopidil, a relatively selective antagonist for alpha 1D adrenoceptor. Silodosin also reversed PHE-induced bladder hyperactivity and L6 spinal cord Fos expression. Thus, in subsequent experiments, only silodosin was used. Wild-type, but not TRPV1 knockout, mice exhibited phenylephrine-induced pain. Capsaicin induced a greater increase in voiding contractions in PHE-treated rats than in control animals, and silodosin reversed this effect. When treated with PHE, ATP release from human urothelial cells was enhanced either by mechanical stimulation or by lowering the thermal threshold of urothelial TRPV1, which becomes abnormally responsive at body temperature.

CONCLUSION

This study suggests that the activation of peripheral alpha 1A adrenoceptors induces CVP, probably through its interaction with TRPV1 and ATP release.

Serratia liquefaciens Infection of a Previously Excluded Popliteal Artery Aneurysm

Introduction

Popliteal artery aneurysms (PAAs) are rare in the general population, but they account for nearly 70% of peripheral arterial aneurysms. There are several possible surgical approaches including exclusion of the aneurysm and bypass grafting, or endoaneurysmorrhaphy and interposition of a prosthetic conduit. The outcomes following the first approach are favorable, but persistent blood flow in the aneurysm sac has been documented in up to one third of patients in the early post-operative setting. Complications from incompletely excluded aneurysms include aneurysm enlargement, local compression symptoms, and sac rupture. Notably infection of a previously excluded and bypassed PAA is rare. This is the third reported case of PAA infection after exclusion and bypass grafting and the first due to Serratia liquefaciens.

Methods

Relevant medical data were collected from the hospital database.

Results

This case report describes a 54 year old male patient, diagnosed with acute limb ischaemia due to a thrombosed PAA, submitted to emergency surgery with exclusion and venous bypass. A below the knee amputation was necessary 3 months later. Patient follow-up was lost until 7 years following surgical repair, when he was diagnosed with aneurysm sac infection with skin fistulisation. He had recently been diagnosed with alcoholic hepatic cirrhosis Child–Pugh Class B. The patient was successfully treated by aneurysm resection, soft tissue debridement and systemic antibiotics.

Conclusion

PAA infection is a rare complication after exclusion and bypass procedures but should be considered in any patient with evidence of local or systemic infection. When a PAA infection is diagnosed, aneurysmectomy, local debridement, and intravenous antibiotic therapy are recommended. The “gold standard” method of PAA repair remains controversial. PAA excision or endoaneurysmorrhaphy avoids complications from incompletely excluded aneurysms, but is associated with a high risk of neurological damage.

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Popliteal artery aneurysms (PAAs) are the most common cause of non-traumatic leg amputation.

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Potential complications from PAA exclusion are aneurysm enlargement, local compression symptoms, sac rupture, and infection.

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Infection of a previously excluded and bypassed popliteal artery aneurysm is exceedingly rare.

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This is the third case of excluded aneurysm infection, and the first by the Serrate genus.

Metabolomic and Genome-wide Association Studies Reveal Potential Endogenous Biomarkers for OATP1B1

Transporter-mediated drug-drug interactions (DDIs) are a major cause of drug toxicities. Using published genome-wide association studies (GWAS) of the human metabolome, we identified 20 metabolites associated with genetic variants in organic anion transporter, OATP1B1 (P < 5 × 10-8 ). Of these, 12 metabolites were significantly higher in plasma samples from volunteers dosed with the OATP1B1 inhibitor, cyclosporine (CSA) vs. placebo (q-value < 0.2). Conjugated bile acids and fatty acid dicarboxylates were among the metabolites discovered using both GWAS and CSA administration. In vitro studies confirmed tetradecanedioate (TDA) and hexadecanedioate (HDA) were novel substrates of OATP1B1 as well as OAT1 and OAT3. This study highlights the use of multiple datasets for the discovery of endogenous metabolites that represent potential in vivo biomarkers for transporter-mediated DDIs. Future studies are needed to determine whether these metabolites can serve as qualified biomarkers for organic anion transporters. Quantitative relationships between metabolite levels and modulation of transporters should be established.

[Bilateral submandibulectomy for the treatment of drooling in pediatric age: 10 years of experience]

INTRODUCTION

Sialorrhea is a medical problem and can become a social issue, common in children with neurological disabilities. The bilateral submandibulectomy is one of the available treatment options for managing this pathology.

AIM OF THE STUDY

The aim of this study is to evaluate the effectiveness of bilateral submandibulectomy in the management of sialorrhea in children with neurological disabilities through the parents' satisfaction grade.

PATIENTS AND METHODS

We retrospectively analyzed 91 bilateral submandibulectomies for a period of time of 10 years (2004-2015). Data were taken from surgical records and patients files and were informatically processed. The severity grade before and after surgery was evaluated in line with the modified Teacher scale. Parental satisfaction was evaluated by applying a scale graded into five classes, according to the degree of sialorrhea severity in postoperative period.

RESULTS

During the reporting period, 91 children underwent bilateral submandibulectomy in our center. Of these, 7 cases were excluded for lack of data. The average age of the children was 8,9 [± 3,5] years; 58,3% were male. The degree of preoperative sialorrhea severity was, in 52,4% of cases, level 4 (severe drooling), and in 28,6%, level 5 (very severe). The grade of parental satisfaction in postoperative period was ranked, in 73,8% of cases, between 81-100%.

CONCLUSIONS

For children with drooling, a bilateral submandibulectomy emerges as an effective and efficient treatment, leaving parents with an extremely high satisfaction grade.

Is there a role for urokinase-type plasminogen activator inhibitors as maintenance therapy in patients with ovarian cancer?

There is abundant evidence that the urokinase-type plasminogen activator (uPA), its inhibitors PAI-1 and PAI-2 (plasminogen activator inhibitor type-1 and type-2) and its cells surface receptor (uPA-R, CD87) play a fundamental role in tumor invasion and metastasis and are of significant prognostic significance for many tumor types. We performed a systematic Med-line search on uPA, PAI, uPA-R and (epithelial) ovarian cancer (EOC). The majority of malignant EOC specimens show moderate to strong immunostating of tumor and stromal cells. Overexpression of u-PA and PAI-1 can be found in more the 75% of primary ovarian carcinomas, in most metastatic EOC samples and all examined epithelial ovarian cancer cell lines. uPA overexpression in primary specimens was significantly associated with tumor stage, grade, residual disease status after cytoreductive surgery, and poor clinical outcome. This may be explained by increased chemoresistance, a lower resectability and more aggressive tumor biology and tumor dissemination in patients with high uPA and PAI-1. Several therapeutical approaches aimed at inhibiting the uPA/uPAR functions have shown to possess anti-tumor effects in vitro and in animal models. When treating a patient with advanced ovarian cancer it may to be assumed that inhibiting the progression of established (micro) metastases may be more therapeutically relevant than trying to destroy all tumor cells which is not possible in most cases with current systemic treatment modalities. Taking into account the role of uPA and PAI in cell detachment, formation of new stroma, tumor cell reimplantation and metastasis uPA inhibition should be further investigated as maintenance treatment in patients with advanced EOC.

Family Anticipatory Grief: An Integrative Literature Review

Despite all the investment in research, uncertainty persists in anticipatory grief (AG) literature, concerning its nuclear characteristics and definition. This review aimed to synthesize recent research in order to develop further knowledge about the family experience of AG during a patient’s end of life. An integrative review was performed using standard methods of analysis and synthesis. The electronic databases Medline, Web of Knowledge, and EBSCO and relevant journals were systematically searched since 1990 to October 2015. Twenty-nine articles were selected, the majority with samples composed of caregivers of terminally ill patients with cancer. From systematic comparison of data referring to family end-of-life experience emerged 10 themes, which correspond to AG nuclear characteristics: anticipation of death, emotional distress, intrapsychic and interpersonal protection, exclusive focus on the patient care, hope, ambivalence, personal losses, relational losses, end-of-life relational tasks, and transition. For the majority of family caregivers in occidental society, AG is a highly stressful and ambivalent experience due to anticipation of death and relational losses, while the patient is physically present and needed of care, so family must be functional and inhibit grief expressions. The present study contributes to a deeper conceptualization of this term and to a more sensitive clinical practice.

Family dynamics during the grieving process: a systematic literature review

The loss of a loved one can affect family dynamics by changing the family system and creating the need for family members to reorganize. Good family functioning, which is characterized by open communication, expression of feelings and thoughts and cohesion among family members, facilitates adaptive adjustment to the loss. This study conducted a systematic review of the literature on family dynamics during the grieving process. A search was conducted in the EBSCO, Web of Knowledge and Bireme databases for scientific articles published from January 1980 to June 2013. Of the 389 articles found, only 15 met all the inclusion criteria. The selected studies provided evidence that dysfunctional families exhibit more psychopathological symptoms, more psychosocial morbidity, poorer social functioning, greater difficulty accessing community resources, lower functional capacity at work, and a more complicated grieving process. Family conflicts were also emphasized as contributing to the development of a complicated grieving process, while cohesion, expression of affection and good communication in families are believed to mitigate grief symptoms.

Prolonged Grief in Palliative Family Caregivers

Caregivers are particularly vulnerable to experience intense levels of distress following the loss. The aim of this prospective pilot study is to determine the incidence of prolonged grief disorder symptoms among caregivers. A total of 73 bereaved families responded to the Prolonged Grief Disorder Evaluation Instrument (PG-13) at 6 and 12 months following their loss. The incidence of prolonged grief disorder at the first assessment was 28.8%, and it decreased to 15.1% at the second assessment. The prevalence of prolonged grief disorder declined significantly over time ( p = .041). In the second evaluation, six bereaved individuals continued to meet criteria for a diagnosis of prolonged grief disorder, 15 remitted, and 4 new (incident) cases emerged. The important differences in values that occur after 12 months suggest time is important in distinguishing between those at risk for persistent distress and those whose grief symptomatology will decrease with time.

Urinary bladder inflammation induces changes in urothelial nerve growth factor and TRPV1 channels

BACKGROUND AND PURPOSE

The urinary bladder urothelium expresses various receptors and in response to chemical and mechanical stimuli releases mediators, thereby modulating bladder sensory pathways. Transient receptor potential vanilloid 1 (TRPV1) ion channels and nerve growth factor (NGF) in those cells are implicated in this modulatory effect and play a role in sensitizing pain-related afferent pathways during inflammation. In this study, we investigated the interaction between NGF and TRPV1 channels in urothelial cells.

EXPERIMENTAL APPROACH

Urothelial cells from female Sprague-Dawley rat bladders were cultured to quantify membrane expression of TRPV1 channels and capsaicin-induced ATP release in the presence of NGF alone or with TrKA or PI3K inhibitors. Pain scores from rats with cyclophosphamide (CYP)-induced bladder inflammation were assessed after treatment with a TrkA antagonist. Bladders (from control and CYP rats) were collected and analysed for NGF content and TRPV1 channel expression.

KEY RESULTS

Cultured cells responded to NGF with increased TRPV1 channel expression in the cell membrane and increased release of ATP. Both responses were blocked by either a TrkA antagonist or a PI3K inhibitor. Treatment in vivo with the TrkA antagonist alleviated pain symptoms and reduced CYP-induced NGF overexpression in the mucosa. Furthermore, in urothelial cells from animals with bladder inflammation, expression of TRPV1 channels in the membrane was significantly increased.

CONCLUSIONS AND IMPLICATIONS

During bladder inflammation, increased production of NGF in urothelial cells induced increased expression and activity of TRPV1 channels in the cell membrane. This effect was primarily mediated by the PI3K pathway.

Cytochrome P450-dependent metabolism of caffeine in Drosophila melanogaster

Caffeine (1, 3, 7-trimethylxanthine), an alkaloid produced by plants, has antioxidant and insecticide properties that can affect metabolism and cognition. In vertebrates, the metabolites derived from caffeine have been identified, and their functions have been characterized. However, the metabolites of caffeine in insects remain unknown. Thus, using radiolabelled caffeine, we have identified some of the primary caffeine metabolites produced in the body of Drosophila melanogaster males, including theobromine, paraxanthine and theophylline. In contrast to mammals, theobromine was the predominant metabolite (paraxanthine in humans; theophylline in monkeys; 1, 3, 7-trimethyluric acid in rodents). A transcriptomic screen of Drosophila flies exposed to caffeine revealed the coordinated variation of a large set of genes that encode xenobiotic-metabolizing proteins, including several cytochromes P450s (CYPs) that were highly overexpressed. Flies treated with metyrapone—an inhibitor of CYP enzymes—showed dramatically decreased caffeine metabolism, indicating that CYPs are involved in this process. Using interference RNA genetic silencing, we measured the metabolic and transcriptomic effect of three candidate CYPs. Silencing of CYP6d5 completely abolished theobromine synthesis, whereas CYP6a8 and CYP12d1 silencing induced different consequences on metabolism and gene expression. Therefore, we characterized several metabolic products and some enzymes potentially involved in the degradation of caffeine. In conclusion, this pioneer approach to caffeine metabolism in insects opens novel perspectives for the investigation of the physiological effects of caffeine metabolites. It also indicates that caffeine could be used as a biomarker to evaluate CYP phenotypes in Drosophila and other insects.

Craniofacial features and specific oral characteristics of Down syndrome children

AIM

This article intends to describe the characteristics of Down syndrome children in order to facilitate their management in the dental office.

METHODS

A review of literature was made limited to articles published between 2003 and 2013. The article is based on a literature search in PubMed and the authors' clinical experience with the patient group.

DISCUSSION

Individuals with Down syndrome are clinically characterized by generalized hypotonia, neurological, cardiac and respiratory problems and changes in their stomatognathic system. Almost all these patients have an occlusal disharmony, including anterior open bite, anterior and posterior crossbite, anterior proclination and underdevelopment of the maxilla and the midface. Dental anomalies such as hypodontia, peg-shaped teeth and enamel hypocalcification are also found. The dentomaxillofacial features have clinical implications in speech, nutrition, posture, ventilation and aesthetics, with enormous consequences in growth, development and social integration.

CONCLUSIONS

When planning the dental treatment of patients with Down syndrome, dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach.

The effect of rearing in different temperature regimes on the reproduction of Anagasta kuehniella (Lepidoptera: Pyralidae)

Eggs of Anagasta kuehniella (Zeller) are widely used in mass rearing of parasitoids, especially Trichogramma spp. and predators in many biological-control programs. The objective of this study was to improve the efficiency of mass rearing of A. kuehniella through determining the optimal temperature conditions for rearing, by assessing the effect of temperature during the developmental stages on the reproduction of A. kuehniella. We evaluated 1) the effect of temperature at which A. kuehniella was kept from egg to adult death, on reproduction; 2) the effect of temperature during the larval and pupal stages on oviposition; and 3) the effect of different temperatures on adults that originated from larvae kept in a constant temperature of 25°C. The results indicated that the optimal temperature range for the development of A. kuehniella is between 20-30°C, as at 30°C there was a marked decrease in viability of the egg and larval stages. The best temperature for maintaining A. kuehniella from egg to adult death is 25°C. Temperatures of 30 and 32°C lead to deformations in genitalia of males, reducing the viability of eggs, and also eggs and females from these temperatures have lower weights. The rearing temperature of immatures affects the egg-laying capacity of adults and the egg viability. The oviposition capacity of adults kept in different temperatures ranging from 18 to 32°C, after being reared in constant temperature (25°C) during the larval stages, was not affected.