Detection of cognitive impairment in the elderly by general internists in Brazil

BACKGROUND: Cognitive impairment, from mild forms to dementia, is an important social and health concern, principally among older individuals. Elderly patients are usually followed by general internists, who may overlook this condition. OBJECTIVE: Our aim was to determine whether cognitive impairment diagnosed by specialists had been previously detected by general internists. SUBJECTS AND METHODS: A total of 248 elderly individuals randomly selected from a list of outpatients seen by general internists in a public university hospital in São Paulo, Brazil, were evaluated by a geriatrician. Patients were then classified as having probable cognitive impairment or not, based on their performance on the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly. Cases of probable impairment were submitted to routine laboratory investigation, brain computed tomography, and neuropsychological evaluation. The final diagnoses were established by a consensus panel comprising two neurologists and the geriatrician who evaluated the patients using all available data. General internists' files for all cognitively impaired cases and for a selected sample of individuals without cognitive impairment were checked for any record of cognitive complaints or decline. RESULTS: Forty-three patients were classified as demented (n = 21) or as cognitively impaired but not demented (n = 22). The evaluation of the general internists' files revealed that information on cognitive complaints or decline was recorded for seven (16.3%) of the 43 patients with dementia or cognitive impairment without dementia. CONCLUSIONS: General internists seldom detected cognitive decline in elderly patients in Brazil. Further studies should be conducted to elucidate the reasons for this low rate of detection

A tritrophic interaction model for an olive tree pest, the olive moth - Prays oleae (Bernard)

The olive tree (Olea europaea L.) is among the oldest and most widespread crops in the Mediterranean basin. Portugal is the third olive producer in the European Union, and Trás-os-Montes region, located in northeastern Portugal, is the second Portuguese producing olive region. The olive moth, Prays oleae (Bernard) (Lepidoptera: Praydidae) is a key olive pest in Trás-os-Montes. This pest is a natural host/prey of several organisms which include larvae of generalist and specialist parasitoids as well as generalist predators and entomopathogens. Its most abundant parasitoid is the specialist Ageniaspis fuscicollis (Dalman) (Hymenoptera: Encyrtidae) and this, in Trás-os-Montes region, is commonly followed by the facultative hyperparasitoid Elasmus flabellatus (Fonscolombe) (Hymenoptera: Eulophidae). Spiders represent a relevant group of generalist predators in olive agroecosystems and encompass an important predatory action in agroecosystems as well as an ability to reduce the populations of various insect pests. In this context, a mathematical model, considering the population of the olive moth, the two parasitoids populations and the spider population as the variables in our system, was constructed. The ecosystem steady states for feasibility and stability were assessed. The possible pesticide effects, that represent essentially extra mortality rates for each one of the insect populations, and potential abundance variations on their populations under a climate change scenario were included. Results indicate that the most important natural control agent is A. fuscicollis but in certain conditions E. flabellatus or spiders may be relevant contributors for the pest reduction. This approach may provide a useful tool to assist the field researchers on this pest system and its managementinfo:eu-repo/semantics/publishedVersio

Subjective memory complaints in the elderly: a sign of cognitive impairment?

OBJECTIVES: Cognitive impairment in the elderly is frequently overlooked by general practitioners. The use of subjective memory complaints as a sign of cognitive impairment by the general practice is controversial. METHODS: Elderly individuals (N = 248) were asked whether they had memory complaints and underwent a cognitive impairment screening. Subjects classified as exhibiting “probable cognitive impairment” underwent a complete cognitive evaluation, and the final diagnoses were established by expert consensus. RESULTS: A total of 147 patients presented with subjective memory complaints, and 43 were further classified as demented or “cognitively impaired not demented”. Subjective memory complaints presented a sensitivity of 100% and a negative predictive value of 100%. CONCLUSION: Subjective memory complaints are an indicator for cognitive impairment screening

Mild cognitive impairment and progression to dementia of Alzheimer's disease

The increase in life expectancy in the Brazilian population raises questions about the preparation of the public health system in identifying elderly patients with signs of cognitive impairment. Currently, as a consequence of the long duration of preclinical phase of Alzheimer's disease, efforts of early detection have been emphasized. Clinical dementia presents an important impact on the individual's caregivers, family, society and economy. Identifying individuals who already have some cognitive impairment, despite remaining functional, as well as analyzing associated comorbidities, constitutes an opportunity to analyze possibilities for future interventions. Dementias are clinical conditions that impose a burden on the health system with its high costs, whereas the identification of individuals with cognitive impairment without dementia can aid patients and their families to plan the future and mitigate costs. This narrative revision can provide general practitioners with more information on the subject.Univ Fed Sao Paulo, UNIFESP, Escola Paulista Med, Psychiat Dept, Sao Paulo, SP, BrazilUniv Estadual Paulista, UNESP, Fac Med Botucatu, Dept Internal Med,Geriatr, Botucatu, SP, BrazilFMB Unesp, Botucatu, SP, BrazilUniv Sao Paulo, Sao Paulo, BrazilHosp Santa Marcelina, Neurol Residency Program, Sao Paulo, BrazilUniv Sao Paulo, Grp Neurol Cognitiva & Comportamento, Sao Paulo, SP, Brazil|Univ Sao Paulo, Ctr Referencia Disturbios Cognit Ceredic, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, UNIFESP, Escola Paulista Med, Psychiat Dept, Sao Paulo, SP, BrazilWeb of Scienc

Combining in vitro and in ovo assays to screen for anti-cancer and anti-angiogenic effects of the leaf extracts of Mallotus cumingii Müll.Arg. (Euphorbiaceae)

Cancer treatment is often challenging and various interventions may have detrimental effects. Due to this, the development of less harmful alternatives such as herbal medicine is essential. The present study aims to determine the leaf phytoconstituents present and the bioactivities of Mallotus cumingii Müll.Arg against cancer cells through the utilization of MTT assay and anti-angiogenesis through CAM assay. The leaf extracts obtained three fractions namely, methanolic crude (MCME) extracts, hexane extracts (MCHE), and ethyl acetate extracts (MCEA), and was tested on HCT-116 for in vitro cytotoxicity, and blood vessel density and branching through in ovo CAM assay. Phytochemical analysis showed that the M. cumingii fractions contain phenolic compounds, terpenoids, cardiac glycosides, flavonoids, and saponins. For in vitro set-up, MCME of M. cumingii were separated into MCHE and MCEA partitions and were tested against HCT-116 and obtained an IC50 value of < 30 μg/mL, which is deemed active in cytotoxicity. For in ovo set-up, two concentrations of each extract were applied to the duck eggs. Blood vessel density and number of branching points were measured through the ImageJ analysis. All extracts exhibited antiangiogenic activity, either by decreasing blood vessel density or the number of branching points. Overall, the study demonstrates the potential of M. cumingii as a source of therapeutic agents

Teachers’ perceptions, difficulties, and actions facing drugs at the school environment

Objetivou-se avaliar a percepção dos professores de ensino médio sobre suas atitudes em relação à abordagem da temática do uso de álcool e outras drogas em seu trabalho. Trata se de um estudo qualitativo, através de perguntas semiestruturadas. Os participantes responderam a um questionário semiestruturado e os dados obtidos foram inseridos no software Atlas.ti, desenvolvendo-se uma análise de conteúdo do tipo temática. Produziram-se três categorias de análise: a compreensão dos professores a respeito de seu papel na discussão sobre substâncias psicoativas; dificuldades na abordagem sobre as substâncias psicoativas no âmbito do trabalho; ações e necessidades destinadas ao trabalho com a temática das substâncias psicoativas na escola. Alguns desses educadores, em sua percepção, não compreendem que discutir o tema álcool e drogas deva fazer parte de suas atribuições por não considerarem ser papel da escola. Os educadores percebem a necessidade de capacitação para trabalhar de forma interdisciplinar com a problemática, não apenas direcionada às suas próprias atuações, mas também em relação às redes de apoio e legislações sobre álcool e drogas. É necessário criar formas práticas de oferecimento de capacitações específicas sobre o uso de substâncias psicoativas aos gestores escolares e educadores, investir na implementação de espaços de discussão e reflexão dentro da escola entre docente e discentes e construir um trabalho em rede intersetorial, visando melhor enfrentamento da problemática em âmbito escolar.We aimed to evaluate the perception of high school teachers about their attitudes when approaching the topic of use of alcohol and other drugs in their work. This is a qualitative study, performed by semi-structured questions. Participants answered to a semi-structured questionnaire and the obtained data were entered into the Atlas.ti software, and thus we developed a thematic content analysis. We produced three categories of analysis: understanding the teachers regarding their role when discussing psychoactive substances; difficulties in approaching psychoactive substances in the work environment; actions and needs aimed at work with the theme of psychoactive substances at school. Some of these educators, in their perception, do not understand that discussing alcohol and drugs should be part of their work because they do not consider it as part of the role of the school. Educators realize the need for training for them to work in an interdisciplinary way with these problems not just directed to their own performances, but also concerning support networks and legislation on alcohol and drugs. It is necessary to create practical ways of providing specific training on the use of psychoactive substances to school managers and educators, investing in the implementation of spaces for discussion and reflection at the school environment between staff and students, and creating an intersectoral networking aimed at better addressing such issue

Ultrafast photochemistry produces superbright short-wave infrared dots for low-dose in vivo imaging

12 p.-5 fig.Optical probes operating in the second near-infrared window (NIR-II, 1,000-1,700 nm), where tissues are highly transparent, have expanded the applicability of fluorescence in the biomedical field. NIR-II fluorescence enables deep-tissue imaging with micrometric resolution in animal models, but is limited by the low brightness of NIR-II probes, which prevents imaging at low excitation intensities and fluorophore concentrations. Here, we present a new generation of probes (Ag2S superdots) derived from chemically synthesized Ag2S dots, on which a protective shell is grown by femtosecond laser irradiation. This shell reduces the structural defects, causing an 80-fold enhancement of the quantum yield. PEGylated Ag2S superdots enable deep-tissue in vivo imaging at low excitation intensities (<10 mW cm-2) and doses (<0.5 mg kg-1), emerging as unrivaled contrast agents for NIR-II preclinical bioimaging. These results establish an approach for developing superbright NIR-II contrast agents based on the synergy between chemical synthesis and ultrafast laser processing.Authors thank Dr A. Benayas (CICECO, U. Aveiro, Portugal), Prof G. Lifante and Prof J. García Sole (UAM) for helpful discussions. This work has been founded by Ministerio de Economı́a y Competitividad-MINECO (MAT2017-83111R and MAT2016-75362-C3-1-R) and the Comunidad de Madrid (B2017/BMD-3867 RENIM-CM) co-financed by European Structural and Investment Fund. D.M.-G. thanks UCM-Santander for a predoctoral contract (CT17/17-CT18/17). We thank the staff at the ICTS-National Centre for Electron Microscopy at the UCM for the help in the electron microscopy studies and C.M. at the beamline BL22-CLAESS of the Spanish synchrotron ALBA for his help in the XANES experiments. We also thank J.G.I at the Ultrafast Laser Laboratory at UCM for his help and fruitful discussion. Y.S. acknowledges the support from the China Scholarship Council (CSC File No. 201806870023). Additional funding was provided by the European Commission Horizon 2020 project NanoTBTech, the Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal project IMP18_38 (2018/0265). Ajoy K. Kar and Mark D. Mackenzie acknowledge support from the UK Engineering and Physical Sciences Research Council (Project CHAMP, EP/M015130/1). C. Jacinto thanks the financial support of the Brazilian agencies: CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) through the grants: Projeto Universal Nr. 431736/2018-9 and Scholarship in Research Productivity 1C under the Nr. 304967/20181; FINEP (Financiadora de Estudos e Projetos) through the grants INFRAPESQ-11 and INFRAPESQ-12; FAPEAL (Fundação de Amparo à Pesquisa do Estado de Alagoas) grant Nr. 1209/2016. H. D. A. Santos was supported by a graduate studentship from CNPq and by a sandwich doctoral program (PDSE-CAPES) developed at Universidad Autonoma de Madrid, Spain, Project Nr. 88881/2016-01.Peer reviewe

Expression of IL-1α correlates with distant metastasis in patients with head and neck squamous cell carcinoma

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER)The presence of IL-1 in human cancers is associated with aggressive tumor biology but its prognostic value is unknown. We studied whether IL-1α expression is a prognostic marker of distant metastasis in patients with head and neck squamous cell carcinoma (HNSCC). IL-1α mRNA and protein levels were determined in tumor samples and cancer cell lines using RT-PCR and ELISA. The effects of constitutive IL-1α expression by tumor lines were characterized. IL-1α mRNA and protein secretion were higher in tumor samples from patients who later developed distant metastasis than in patients who did not. By using distant metastasis as a dependent variable, patients were classified into two categories of IL-1α transcript-levels. The high-IL-1α group had a significantly lower five-year distant metastasis-free survival than the low-IL-1α group [70.0% (CI 95%: 55.9-84.1%) vs 94.7% (CI 95%:90.2-99.2%)]. When IL-1α transcript-levels were combined with clinical factors related to tumor metastasis, the predictive power of the model increased significantly. Additionally, transcript levels of IL-1α correlated significantly with those of the IL-1 family genes and genes related to the metastatic process. IL-1 treatment of microvascular endothelial cells increased adhesion of HNSCC cells but no differences were found based on constitutive IL-1α expression by tumor cells. Nevertheless, IL-1α produced by tumor cells effectively increased their transmigration across the endothelium. We found a significant relationship between IL-1α expression and development of distant metastasis in HNSCC patients. IL-1α expression could help to define a subset of patients at high risk of distant metastasis who could benefit from adjuvant treatment

Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde

OBJECTIVE: To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS: The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS: The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; pOBJETIVO: Analizar los escores de instrumento que evalúa habilidad de lectura y comprensión de materiales del área de salud según escolaridad y edad. MÉTODOS: Fueron evaluados 312 participantes saludables de diferentes edades por medio de la versión reducida del instrumento Test of Functional Health Literacy in Adults. El estudio fue realizado entre 2006 y 2007 en la ciudad de Sao Paulo (Sureste de Brasil). El instrumento incluye materiales como frascos de medicamentos y cartones de para marcar consultas, evaluando la comprensión de lectura y de conceptos numéricos. Las pruebas de correlación parcial y de Pearson y un modelo de regresión múltiple fueron usados para verificar la asociación entre los escores en el instrumento, escolaridad y edad. RESULTADOS: Los promedios de edad y de escolaridad de la muestra fueron respectivamente 47,3 (dp=16,8) y 9,7 (dp=5; de uno a 17 años de estudio). El total de 32,4% de la muestra mostraron déficit de alfabetización funcional/uso de conceptos numéricos en el área de salud, con desempeño inadecuado o limítrofe en el instrumento. Entre ancianos (65 años o más) esta tasa afectó 51,6%. Se encontró correlación positiva entre años de estudio y escores en el instrumento (r=0,740; p< 0,01) y correlación negativa entre edad y escores en el instrumento (r=-0,259; p< 0,01).La correlación entre escores en el instrumento y edad no fue significativa cuando los efectos de la escolaridad fueron controlados (r=-0,031, p=0,584). Una asociación significativa (B=3,877, Beta=0,733; p< 0,001) fue encontrada entre años de estudio y escores en el instrumento. La edad no fue una variable predictiva en el modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSIONES: El instrumento es adecuado para evaluar la alfabetización funcional en salud en la población brasilera. El elevado número de individuos clasificados como analfabetos funcionales indica la importancia de adopción de medidas especiales para ayudar estos individuos a comprender correctamente las orientaciones para cuidados de salud.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensão de materiais da área da saúde segundo escolaridade e idade. MÉTODOS: Foram avaliados 312 participantes saudáveis de diferentes idades por meio da versão reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de São Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartões de agendamento de consultas, avaliando a compreensão de leitura e de conceitos numéricos. Os testes de correlação parcial e de Pearson e um modelo de regressão múltipla foram usados para verificar a associação entre os escores no instrumento, escolaridade e idade. RESULTADOS: As médias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram déficits de alfabetização funcional/ uso de conceitos numéricos na área de saúde, com desempenho inadequado ou limítrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlação positiva entre anos de estudo e escores no instrumento (r=0,740;

Intervenção educativa e expectativas positivas sobre o uso do álcool entre estudantes

Objetivou-se avaliar as expectativas positivas sobre o uso recente de álcool por estudantes de ensino Fundamental e Médio antes e após uma intervenção educativa e verificar diferenças na frequência de uso e nas informações sobre essa substância, segundo o sexo. Estudo quase-experimental, realizado com 231 estudantes. Foram utilizados: Formulário sociodemográfico; Inventário de Triagem do Uso de Drogas; Escala de Expectativas Positivas acerca do Álcool, aplicados antes e após 60 dias da intervenção. Foram realizadas análises estatísticas descritivas e inferenciais. A hipótese do estudo não foi confirmada. Para o grupo geral, não foram observadas mudanças significativas nas expectativas positivas sobre o álcool após a intervenção. A frequência de consumo se manteve elevada após a atividade, com destaque para o sexo feminino. Os resultados demonstraram que a intervenção educativa não foi efetiva para influenciar mudanças do uso do álcool, todavia, foi eficaz para a aquisição de informações sobre a substância