Physical, psychological and social impact of scleroderma in Europe and Brazil

Scleroderma involves several physical changes in visible parts of the body, as face and hands. Scleroderma affects body image and is associated with depressive and anxiety symptoms and sexual dysfunction. These physical disfiguring changes are in visible and important interpersonal contact body parts. Scleroderma symptoms can be painful, such as digital ulcers, Raynaud's phenomenon, skin changes, joint contractures and gastroesophageal reflux, and the severity of these symptoms is associated with depression. This study aims mainly to characterize the most common symptoms of scleroderma, the impact felt by patients, assess satisfaction with medical care, psychological symptoms and illness perception. This study has 563 participants belonging to various European countries and Brazil. These participants are mostly woman. The instruments used in this study were the Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities and The Brief Illness Perception Questionnaire. The five most common symptoms reported by patients were: joint pain, fatigue, Raynaud's, muscle pain and hardening / tightening skin. Fatigue was the symptom reported as having more impact on the daily lives of participants. Participants who reported more symptoms, also reported higher impact of symptoms. Just under one fifth of the participants had a diagnosis of scleroderma with the first doctor consulted. Participants with more years of diagnosis revealed to be more satisfied with the medical care they receive. Almost a third of participants reported that they do not have access to all medical care due to its cost. In sum, almost half the participants showed that scleroderma affects their ability to work. Regarding depression, 38% of participants have sensitivity for sever depression, and younger participants reported more symptoms of depression. Depressive symptoms are associated with the impact perceived of symptoms and not with the frequency of symptoms. In relation to anxiety, 32% of participants reported symptoms of generalized anxiety and participants with worse body image reported more symptoms of anxiety. Participants with symptoms of generalized anxiety reported more symptoms of pain. The symptoms of social phobia are reported by 30% of the participants. More than half of participants reported that they avoid activities which they are the center of attention. Participants with social phobia reported worse body image. Participants reported a high degree of concern with scleroderma and 84% reported concerns with body image due scleroderma

Sintomas de doença e adaptação psicológica em pacientes brasileiros com esclerodermia

OBJECTIVE: To characterize the prevalence and impact of symptoms of scleroderma in Brazilian patients and to describe their satisfaction with medical care and psychological symptoms. METHODS: One-hundred and twenty eight Brazilian scleroderma patients participated in an online survey by filling out a Portuguese version of the Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities. The mean age of participants was 38 years old (SD = 12.33), and most of the participants were females (n = 108, 88%). RESULTS: Hardening/tightening of skin, itchy skin and joint pain were symptoms reported as being most frequent, whereas muscle pain and difficulty climbing stairs were symptoms reported as having a higher impact. Participants reported dissatisfaction regarding the medical care. Psychological evaluations suggested that participants who scored above clinical values for depression was significantly high (90%; n = 77). In addition, 48% (n = 42) of participants fit the clinical criteria for anxiety disorder, and 40% (n = 35) of participants fit the clinical criteria of social phobia. Finally, body image disturbance was reported by 69% (n = 88) of participants. CONCLUSIONS: The physical and psychological symptoms associated with scleroderma have a significant impact on patient quality of life. The Brazilian patients in the current sample report higher levels of dissatisfaction with medical care than patients from Canada and European countries. These Brazilian patients also report more psychopathology, particularly symptoms of depression. The current results suggest that there is a need for professionals to consider and attend to the individual problems of scleroderma patientsObjetivo: Caracterizar a prevalência e o impacto dos sintomas de esclerodermia em pacientes brasileiros e descrever sua satisfação com o atendimento médico e sintomas psicológicos. Métodos: Cento e vinte e oito pacientes brasileiros com esclerodermia participaram em uma pesquisa online preenchendo a versão portuguesa do Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities. A média de idade dos participantes foi 38 anos (DP = 12,33) e a maioria dos participantes era constituída por mulheres (n = 108, 88%). Resultados: Endurecimento/retesamento da pele, coceira na pele e dor articular foram sintomas informados como mais freqüentes, enquanto que dor muscular e difi culdade para subir escadas foram sintomas informados como tendo maior impacto. Os participantes informaram insatisfação em relação ao atendimento médico. As avaliações psicológicas sugeriram que o percentual de participantes com pontuação acima dos valores clínicos para depressão foi signifi cativamente elevado (90%; n = 77). Além disso, 48% (n = 42) dos participantes se enquadravam nos critérios clínicos para transtorno da ansiedade e 40% (n = 35) dos participantes se enquadravam nos critérios clínicos de fobia social. Finalmente, 69% (n = 88) dos participantes informaram transtornos da imagem corporal. Conclusões: Os sintomas físicos e psicológicos associados com esclerodermia têm impacto signifi cativo na qualidade de vida dos pacientes. Na presente amostra, os pacientes brasileiros informam níveis mais altos de insatisfação com o atendimento médico, em comparação com pacientes do Canadá e de países europeus. Esses pacientes brasileiros também informam mais casos de psicopatologia, particularmente sintomas de depressão. Nossos resultados sugerem que há necessidade que os profi ssionais levem em consideração os problemas individuais dos pacientes com esclerodermia e cuidem desses problemas.(undefined

Psychosocial characterization, symptoms and illness perception in scleroderma patients: an international study

Dissertação de mestrado integrado em Psicologia (área de especialização em Psicologia da Saúde)Introduction: Scleroderma, also known as systemic sclerosis, is a rare, complex and autoimmune disease, with unknown origin and cause (Coelho, Oliveira, & Kroon, 2008). It affects the connective tissue and is characterized by vascular dysfunction, inflammatory and fibrotic of multiple organ systems (Nadashkevich, Davis, &Fritzer, 2004). The symptoms that suggest the existence of scleroderma include: Raynaud phenomenon, skin thickening, calcinosis and telangiectasia (Li, Sahhar, & Littlejohn, 2008). In addition to the swelling of the fingers and hands that may hinder mobility and become a very painful phenomenon (Li et al, 2008), the alterations in internal organs results in significant morbidity and mortality (Assassi, del Junco, Sutter, McNearney, Reveille, Karvanas, …,Gourh, 2009). Despite its severity, the disease remains unknown to many health professionals and may take several years before those affected are diagnosed. This disease is associated with pain, fatigue and progressive disability. Among the physical changes with more psychological impact are the changes in the skin (Malcarne, Hansdottir, Greenbergs, Clements & Weisman, 1999). Due to the disfigurement and physical changes that are typical of the disease, psychological morbidity is high and includes depression, body image problems. Method: The participants in this study are 563 scleroderma patients from 12 European countries and Brazil. These participants are mostly women. The instruments used in this study were the “Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities” and “The Brief Illness Perception Questionnaire (Brief IPQ)”. Results: The most common symptoms and with more impact on the lives of the participants were joint pain, fatigue and Raynaud’s. Just under one fifth of the participants had a diagnosis of scleroderma with the first doctor consulted. Participants with more years of diagnosis revealed to be more satisfied with the medical care they receive. Participants reported a high degree of concern with scleroderma and 84% reported concerns with body image due scleroderma. Depression, anxiety and social phobia are common among scleroderma patients. Conclusion: Due to gravity, lack of knowledge, unpredictability and disfigurement of scleroderma, the existence of psychological disorders in these patients is common

Tunning pectinase activity under the effects of electric fields in the enhanced clarification of wine must

Introduction: Pectinolytic enzymes are of great importance for the clarification process of “Vinho Verde” wine must, contributing to the reduction of haze development. During the last decade, a growing body of knowledge has been established about the effects of electric fields on the activation of important food enzymes. However, the influence of electrical parameters on catalytic activity is enzyme-dependent and should be evaluated on a case-by-case basis. This work describes, for the first time, the effects of electric fields and electrical frequency on the activity of pectinase (PEC) in the accelerated clarification of “Vinho Verde” must. Method: Moderate electric fields (MEF) with intensities below 20 V/cm and at electrical frequencies ranging from 50 to 20 kHz were applied at temperatures between 15 and 35°C. Enzymatic activity was measured for 25 min, and the initial rate of reaction was determined by the coefficient of the linear plot of galacturonic acid (GAL) production as a function of time. Results: The results show that electrical frequency can increase enzymatic activity depending on temperature conditions; at 20°C and with electrical frequencies of 2 and 20 kHz, enzymatic activity increased by up to 40 and 20%, respectively, when compared with the control sample (without the application of MEF). Temperature dependence was evaluated through the Arrhenius equation, showing that energy of activation (Ea) can be reduced from 9.2 to 6.6 kJ/mol at sub-optimal temperatures for PEC activity when MEF is applied. Discussion: Electrical parameters, when combined with temperatures below 20°C, reduced pectin concentration in “Vinho Verde” wine must by up to 42% of its initial content. This emergent treatment can be integrated in relevant environmental conditions, presenting an opportunity to increase enzyme efficiency even in low-temperature conditions, which favors the winemaking process.This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UIDB/04469/2020 unit, LABBELSAssociate Laboratory in Biotechnology, Bioengineering and Microelectromechanical Systems, LA/P/0029/2020, and funded by BIOECONORTE (ref. NORTE-01-0145-FEDER-000070) with a funding body from the Norte Portugal Regional Coordination and Development Commission (CCDR-N), NORTE2020, Portugal 2020 and ESIF - European Structural and Investment Funds.info:eu-repo/semantics/publishedVersio

Local bone metabolism balance regulation via double-adhesive hydrogel for fixing orthopedic implants

© 2021 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)The effective osteointegration of orthopedic implants is a key factor for the success of orthopedic surgery. However, local metabolic imbalance around implants under osteoporosis condition could jeopardize the fixation effect. Inspired by the bone structure and the composition around implants under osteoporosis condition, alendronate (A) was grafted onto methacryloyl hyaluronic acid (H) by activating the carboxyl group of methacryloyl hyaluronic acid to be bonded to inorganic calcium phosphate on trabecular bone, which is then integrated with aminated bioactive glass (AB) modified by oxidized dextran (O) for further adhesion to organic collagen on the trabecular bone. The hybrid hydrogel could be solidified on cancellous bone in situ under UV irradiation and exhibits dual adhesion to organic collagen and inorganic apatite, promoting osteointegration of orthopedic implants, resulting in firm stabilization of the implants in cancellous bone areas. In vitro, the hydrogel was evidenced to promote osteogenic differentiation of embryonic mouse osteoblast precursor cells (MC3T3-E1) as well as inhibit the receptor activator of nuclear factor-κ B ligand (RANKL)-induced osteoclast differentiation of macrophages, leading to the upregulation of osteogenic-related gene and protein expression. In a rat osteoporosis model, the bone-implant contact (BIC) of the hybrid hydrogel group increased by 2.77, which is directly linked to improved mechanical stability of the orthopedic implants. Overall, this organic-inorganic, dual-adhesive hydrogel could be a promising candidate for enhancing the stability of orthopedic implants under osteoporotic conditions.This work was supported by the National Key R&D Program of China (2020YFA0908200), National Natural Science Foundation of China (82120108017), Six talent peaks project in Jiangsu Province (WSW-018). This work was financed by Portuguese funds through FCT - Fundação para a Ciência e a Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior in the framework of the project “Institute for Research and Innovation in Health Sciences” UID/BIM/04293/2019.info:eu-repo/semantics/publishedVersio

The COVID-19 pandemic and professional nursing practice in the context of hospitals

The COVID-19 pandemic has imposed challenges to health systems and institutions, which had to quickly create conditions to meet the growing health needs of the population. Thus, this study aimed to assess the impact of COVID-19 on professional nursing practice environments and to identify the variables that affected their quality. Quantitative, observational study, conducted in 16 Portuguese hospitals, with 1575 nurses. Data were collected using a questionnaire and participants responded to two different moments in time: the pre-pandemic period and after the fourth critical period of COVID-19. The pandemic had a positive impact on the Structure and Outcome components, and a negative trend in the Process component. The variables associated with the qualification of the components and their dimensions were predominantly: work context, the exercise of functions in areas of assistance to COVID-19 patients, length of professional experience and length of experience in the service. The investment in professional practice environments impacted the improvement of organizational factors, supporting the development of nurses’ work towards the quality of care. However, it is necessary to invest in nurses’ participation, involvement and professional qualifications, which are aspects strongly dependent on the institutions’ management strategies.info:eu-repo/semantics/publishedVersio