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The fibrous scaffolds for bone tissue engineering that mimic the extracellular matrix with bioactive and bactericidal properties could provide adequate conditions for regeneration of damaged bone. Electrospun ultrathin fiber covered with nano-hydroxyapatite is a favorable fibrous scaffold design. We developed a fast and reproducible strategy to produce polyvinylidene fluoride (PVDF)/nano-hydroxyapatite (nHAp) nanofibrous scaffolds with bactericidal and bioactive properties. Fibrous PVDF scaffolds were obtained first by the electrospinning method. Then, their surfaces were modified using oxygen plasma treatment followed by electrodeposition of nHAp. This process formed nanofibrous and superhydrophilic PVDF fibers (133.6 nm, fiber average diameter) covered with homogeneous nHAp (202.6 nm, average particle diameter) crystals. Energy-dispersive X-ray spectrometry demonstrated the presence of calcium phosphate, indicating a Ca/P molar ratio of approximately 1.64. X-ray diffraction, Fourier transform infrared spectroscopy, and Raman spectroscopy spectra identified β-phase of nHAp. Thermal analysis indicated a slight reduction in stability after nHAp electrodeposition. Bactericidal assays showed that nHAp exhibited 99.8% efficiency against Pseudomonas aeruginosa bacteria. The PVDF/Plasma and PVDF/nHAp groups had the highest cell viability, total protein, and alkaline phosphatase activity by 7 days after exposure of the scaffolds to MG63 cell culture. Therefore, the developed scaffolds are an exciting alternative for application in bone regeneration.
To determine nutritional adequacy of school lunch and to assess the impact of food waste on nutrient intake of primary school children.
The weighing method was used for evaluating initial servings and plate waste for lunch. Energy and nutritional content of meals served, consumed and wasted were estimated using the software Food Processor Plus. The mean nutritional value of food served and consumed, was compared with dietary guidelines.
Portuguese public primary schools in the city of Porto.
All 525 fourth-grade children, aged from 9 to 10 years old, attending to 21 public primary schools.
Overall, school lunches served did not meet the dietary guidelines for energy and nutrients, as only 12.5% of the evaluated meals were adequate for energy, 33.5% for proteins, 11.9% for carbohydrates and 57.1% for lipids. The majority of meals served were below the age-specific lower limit, namely for energy (83.7%) and carbohydrates (86.8%). The only exception, also unbalanced, was observed for proteins, as 42.4% of lunches served exceeded the recommended upper limit. Furthermore, lunches served and consumed by children did not meet the dietary guidelines for fibre and for the micronutrients evaluated.
Children wasted 26% of the calories provided in lunches, corresponding to 91.5kcal, 25% of proteins and 29% of carbohydrates supplied.
The lunches served and consumed by children at school canteens failed to meet nutritional standards. These results are not only a consequence of inadequate food portions served but also a result of the high plate waste values observed.
Background: Loss of a spouse is a frequent occurrence in later life, with about 10% of the individuals finding themselves unable to cope and progressing to prolonged grief, risking further mental and physical problems.
Objective: The development and implementation of an online grief program, such as LEAVES (optimizing the menta L hEalth and resilience of older Adults that haVe lost th Eir spou Se via blended, online therapy), intends to improve prevention and treatment of prolonged grief, so that elderly mourners can continue to lead an active, meaningful and dignified life.
Methods: The LEAVES program, a project under AAL (Active and Assisted Living) 2019 Call for Sustainable Smart Solutions for Ageing Well, is in development by an international consortium and integrates academical, clinical and technical experts. The project will take place between February 2020 and January 2023 and involve real-life evaluation of 315 end-users. The Psychiatric Department at the Health Unit of Baixo Alentejo (ULSBA) will offer the service to its primary users, blending online services with telephone, video calls and face-to-face sessions. Widowed older adults >65 that express the need for help in mourning their spouse will be recruited in the community as well as via the geriatric psychiatry team and primary care.
Results: With LEAVES program we aim for older adults to process the loss of a spouse in a blended online/presential environment, detecting olders at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The evaluation will focus on wellbeing and involve several measures to assess grief symptoms, loneliness, hopelessness, satisfaction and quality of life. Conclusions: ULSBA will use LEAVES to improve clinical practice on preventing and managing prolonged grief as well as, after testing and validating it in this project, to save economical costs and improve effectiveness, both to hospital and patients.
This is a cross-sectional analysis of data obtained in the baseline of the Longitudinal Study on the Lifestyle and Health of University Students (n 685) carried out in a public Brazilian university. Food intake was assessed using a 24-h dietary recall. Dietary patterns (DP) for breakfast, lunch and dinner were identified using principal component analysis. Generalised linear models were used to analyse the variables associated with each DP. Three DP were extracted for each meal: breakfast: ‘White bread and butter/margarine’, ‘Coffee and tea’ and ‘Sausages, whole wheat bread and cheese’; lunch: ‘Traditional’, ‘Western’ and ‘Vegetarian’ and dinner: ‘Beans, rice and processed juice’, ‘White bread and butter/margarine’ and ‘White meat, eggs and natural juice’. Students who had meals at the campus showed greater adherence to the ‘White bread and butter/margarine’ (exp (βadj) = 1·15, 95 % CI 1·11, 1·19) and ‘Coffee and tea’ (exp (βadj) = 1·06, 95 % CI 1·02, 1·10) breakfast patterns; ‘Western’ lunch pattern (exp (βadj) = 1·04, 95 % CI 1·01, 1·08) and to the ‘Beans, rice and processed juice’ dinner pattern (exp (βadj) = 1·10, 95 % CI 1·06, 1·14). Having meals at the campus was associated with lower adherence to the ‘Sausages, whole wheat bread and cheese’ breakfast pattern (exp (βadj) = 0·93, 95 % CI 0·89, 0·97), ‘Traditional’ lunch pattern (exp (βadj) = 0·96, 95 % CI 0·93, 0·99) and to the ‘White bread and butter/margarine’ (exp (βadj) = 0·96, 95 % CI 0·93, 0·99) and ‘White meat, eggs and natural juice’ (exp (βadj) = 0·96, 95 % CI 0·93, 0·99) dinner pattern. The food environment at campus may influence students’ DP. Recognising meal eating patterns is important to support healthy eating promotion strategies on campus. Adjustments in the University Canteen menu could contribute to healthier eating choices among students.
Pelagic seabird populations have declined strongly worldwide. In the North Atlantic there was a huge reduction in seabird populations following the European colonization of the Azores, Madeira and Canary archipelagos but information on seabird status and distribution for the subtropical region of Cabo Verde is scarce, unavailable or dispersed in grey literature. We compiled and compared the historical and current distribution of all seabird species breeding in the Cabo Verde archipelago, updated their relative abundance, investigated their inland habitat preferences, and reviewed their threats. Currently, the breeding seabird community in Cabo Verde is composed of Bulwer’s Petrel Bulweria bulwerii, White-faced Storm-petrel Pelagodroma marina aedesorum, Cape Verde Shearwater Calonectris edwardsii, Cape Verde Storm-petrel Hydrobates jabejabe, Cape Verde Petrel Pterodroma feae, Boyd's Shearwater Puffinus lherminieri boydi, Brown Booby Sula leucogaster, and Red-billed Tropicbird Phaethon aethereus. One breeding species is currently extinct, the Magnificent Frigatebird Fregata magnificens. The relative abundance of Cape Verde Shearwater, Boyd’s Shearwater, Cape Verde Petrel, and Cape Verde Storm-petrel was determined from counts of their nocturnal calls in Santo Antão, São Vicente, Santa Luzia, Branco, Raso and São Nicolau. Cape Verde Petrel occurred only on mountainous islands (Santo Antão, São Nicolau, Santiago, and Fogo) from mid-to high elevations. Larger species such as the Cape Verde Shearwater and Boyd’s Shearwater exhibited a wider distribution in the archipelago, occurring close to the coastline but at lower densities on populated islands. Small procellariforms such as the Cape Verde Storm-petrel occurred at high densities only on rat-free islets and in steep areas of main islands where introduced cats and rats are unlikely to occur. The main threats to seabird populations in Cabo Verde range from predation by introduced predators, habitat alteration or destruction, and some residual human persecution.
The production of beef cattle in the Atlantic Forest biome mostly takes place in pastoral production systems. There are millions of hectares covered with pastures in this biome, including degraded pasture (DP), and only small area of the original Atlantic Forest has been preserved in tropics, implying that actions must be taken by the livestock sector to improve sustainability. Intensification makes it possible to produce the same amount, or more beef, in a smaller area; however, the environmental impacts must be assessed. Regarding climate change, the C dynamics is essential to define which beef cattle systems are sustainable. The objectives of this study were to investigate the C balance (t CO2e./ha per year), the intensity of C emission (kg CO2e./kg BW or carcass) and the C footprint (t CO2e./ha per year) of pasture-based beef cattle production systems, inside the farm gate and considering the inputs. The results were used to calculate the number of trees to be planted in beef cattle production systems to mitigate greenhouse gas (GHG) emissions. The GHG emission and C balance, for 2 years, were calculated based on the global warming potential (GWP) of AR4 and GWP of AR5. Forty-eight steers were allotted to four grazing systems: DP, irrigated high stocking rate pasture (IHS), rainfed high stocking rate pasture (RHS) and rainfed medium stocking rate pasture (RMS). The rainfed systems (RHS and RMS) presented the lowest C footprints (−1.22 and 0.45 t CO2e./ha per year, respectively), with C credits to RMS when using the GWP of AR4. The IHS system showed less favorable results for C footprint (−15.71 t CO2e./ha per year), but results were better when emissions were expressed in relation to the annual BW gain (−10.21 kg CO2e./kg BW) because of its higher yield. Although the DP system had an intermediate result for C footprint (−6.23 t CO2e./ha per year), the result was the worst (−30.21 CO2e./kg BW) when the index was expressed in relation to the annual BW gain, because in addition to GHG emissions from the animals in the system there were also losses in the annual rate of C sequestration. Notably, the intensification in pasture management had a land-saving effect (3.63 ha for IHS, 1.90 for RHS and 1.19 for RMS), contributing to the preservation of the tropical forest.
Accurate estimates of methane (CH4) production by cattle in different contexts are essential to developing mitigation strategies in different regions. We aimed to: (i) compile a database of CH4 emissions from Brazilian cattle studies, (ii) evaluate prediction precision and accuracy of extant proposed equations for cattle and (iii) develop specialized equations for predicting CH4 emissions from cattle in tropical conditions. Data of nutrient intake, diet composition and CH4 emissions were compiled from in vivo studies using open-circuit respiratory chambers, SF6 technique or the GreenFeed® system. A final dataset containing intake, diet composition, digestibility and CH4 emissions (677 individual animal observations, 40 treatment means) obtained from 38 studies conducted in Brazil was used. The dataset was divided into three groups: all animals (GEN), lactating dairy cows (LAC) and growing cattle and non-lactating dairy cows (GCNL). A total of 54 prediction equations available in the literature were evaluated. A total of 96 multiple linear models were developed for predicting CH4 production (MJ/day). The predictor variables were DM intake (DMI), gross energy (GE) intake, BW, DMI as proportion of BW, NDF concentration, ether extract (EE) concentration, dietary proportion of concentrate and GE digestibility. Model selection criteria were significance (P < 0.05) and variance inflation factor lower than three for all predictors. Each model performance was evaluated by leave-one-out cross-validation. The Intergovernmental Panel on Climate Change (2006) Tier 2 method performed better for GEN and GCNL than LAC and overpredicted CH4 production for all datasets. Increasing complexity of the newly developed models resulted in greater performance. The GCNL had a greater number of equations with expanded possibilities to correct for diet characteristics such as EE and NDF concentrations and dietary proportion of concentrate. For the LAC dataset, equations based on intake and animal characteristics were developed. The equations developed in the present study can be useful for accurate and precise estimation of CH4 emissions from cattle in tropical conditions. These equations could improve accuracy of greenhouse gas inventories for tropical countries. The results provide a better understanding of the dietary and animal characteristics that influence the production of enteric CH4 in tropical production systems.
Spinal muscular atrophy (SMA) is a devastating rare disease that affects individuals regardless of ethnicity, gender, and age. The first-approved disease-modifying therapy for SMA, nusinursen, was approved by Health Canada, as well as by American and European regulatory agencies following positive clinical trial outcomes. The trials were conducted in a narrow pediatric population defined by age, severity, and genotype. Broad approval of therapy necessitates close follow-up of potential rare adverse events and effectiveness in the larger real-world population.
The Canadian Neuromuscular Disease Registry (CNDR) undertook an iterative multi-stakeholder process to expand the existing SMA dataset to capture items relevant to patient outcomes in a post-marketing environment. The CNDR SMA expanded registry is a longitudinal, prospective, observational study of patients with SMA in Canada designed to evaluate the safety and effectiveness of novel therapies and provide practical information unattainable in trials.
The consensus expanded dataset includes items that address therapy effectiveness and safety and is collected in a multicenter, prospective, observational study, including SMA patients regardless of therapeutic status. The expanded dataset is aligned with global datasets to facilitate collaboration. Additionally, consensus dataset development aimed to standardize appropriate outcome measures across the network and broader Canadian community. Prospective outcome studies, data use, and analyses are independent of the funding partner.
Prospective outcome data collected will provide results on safety and effectiveness in a post-therapy approval era. These data are essential to inform improvements in care and access to therapy for all SMA patients.
Constitutive heterochromatin typically exhibits low gene density and is commonly found adjacent or close to the nuclear periphery, in contrast to transcriptionally active genes concentrated in the innermost nuclear region. In Triatoma infestans cells, conspicuous constitutive heterochromatin forms deeply stained structures named chromocenters. However, to the best of our knowledge, no information exists regarding whether these chromocenters acquire a precise topology in the cell nuclei or whether their 18S rDNA, which is important for ribosome function, faces the nuclear center preferentially. In this work, the spatial distribution of fluorescent Feulgen-stained chromocenters and the distribution of their 18S rDNA was analyzed in Malpighian tubule cells of T. infestans using confocal microscopy. The chromocenters were shown to be spatially positioned relatively close to the nuclear periphery, though not adjacent to it. The variable distance between the chromocenters and the nuclear periphery suggests mobility of these bodies within the cell nuclei. The distribution of 18S rDNA at the edge of the chromocenters was not found to face the nuclear interior exclusively. Because the genome regions containing 18S rDNA in the chromocenters also face the nuclear periphery, the proximity of the chromocenters to this nuclear region is not assumed to be associated with overall gene silencing.
In 1880, the French neurologist Jules Cotard described a specific kind of nihilistic delusion which the patient believed that she no longer existed. Since then, this rare condition known as Cotard's Syndrome or Cotard's Delusion (CD) has intrigued clinicians and investigators.
To present CD's features, including historical, clinical, etiopathological, and treatment issues.
Case report of a 49-year-old woman with fully developed CD; review of the literature.
There is still a considerable debate concerning the nature of this phenomenon - whether it should be conceptualized as a psychiatric symptom or as a syndromatic entity.
CD may appear in different severity levels, and most authors accept the idea of a spectrum of clinical presentations, ranging from the belief of loosing intellectual capacities to the extreme belief of non-existence of life and the universe.
This manifestation has been identified in patients with distinct diagnosis, mostly in severe depression, but also in schizophrenia and psycho-organic syndromes.
Treatment should be chosen according to the underlying pathology.
Over the last few years, new contributions from neuropsychological and imaging studies have brought interesting approaches to understand CD's underlying mechanisms. At the moment, CD does not fit clearly into any category of the current systems of classification. Future investigations should address the pathophysiological nature of CD and its place in the new, etiopathologically-oriented, classification systems.
PPA is characterized by progressive language dissolution, with remarkable spare of other cognitive domains for at least two years, and should be considered in the differential diagnosis of dementia.
A 56-year-old previously healthy man was seen for speech difficulties. He studied Portuguese for 4 years, and then went to live in France, where he learned French for 3 years. He returned definitely to Portugal when he was 42. Since early adolescence he was fluent on speaking, reading and writing in both languages. In the last 12 years he spoke French mainly when visiting his family. Three years ago he started showing disintegration of his second language preceding that of his native one. Upon examination he had laborious, effortful, nonfluent and agrammatic speech, with severe anomia and some repetition and complex-command comprehension difficulties. He could not name, understand or write any French word. The remaining neurological examination was near-normal to age and education level (MMSE - 25/30). Brain MRI showed left-side predominant frontotemporal cortical atrophy. PET scan revealed hypometabolism in the same area and the temporal lobe, anterior cynguli and dorsolateral frontal cortex.
Our patient has nonfluent variant of PPA. Cases like this can give further insight into the neural network subserving language acquisition and dissolution. In proficient bilinguals, the main point on language dissolution in PPA seems to be the recency of use. The best way to confirm this would be to systematically characterize PPA patients on secondary language usage, attained proficiency and disintegration sequence.
Bipolar disorder is a chronic, recurrent and debilitating mood disorder with a major impact on several aspects of everyday life. Although pharmacotherapy plays a central role in bipolar disorder treatment, psychosocial interventions are essential to a more complete and successful treatment.
To present a psychoeducation program for bipolar patients runned in a Portuguese psychiatric hospital - Hospital de Magalhães Lemos, Oporto. To review the impact of psychoeducative measures on bipolar patients.
A psychoeducative program for bipolar patients was developed and adapted, based on the Barcelona Bipolar Disorders Program"s experience. The psychoeducative program was applied to bipolar patients as an adjuvant of maintenance treatment.
Fifteen sessions were runned during 15 weeks. Twelve patients were recruited to integrate the psychoeducative group. The sessions addressed several topics including information about the illness, early detection of prodromal symptoms and symptoms management, stress management and the importance of maintaining routines.
The best treatment available for patients with bipolar disorder includes, along with the pharmacological treatment, psychosocial interventions aimed to target issues as early identification of prodromal symptoms, coping skills, medication adherence and understanding of the disorder. This broader approach of bipolar disorder treatment has proved to be efficient in reducing relapse rates, and improving patients’ feelings of self-efficacy and quality of life.
Verbal fluency (VF) involves complex processes and has been a good marker of cognitive decline. However, the literature is inconsistent concerning to witch factors are associated with VF.
Our aims are to analyze the relationship between both phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) and sociodemographic and psychopathological variables, and explore which emerge as significant predictors.
A subsample of 429 of healthy institutionalized elderly from the Aging Trajectories at Coimbra Council Project were surveyed (60 to 100 years; mean age = 80.38 ± 7.24), the majority was women (76.9%), without a partner (82.2%), without education or with less than four years of education (85.7%), manual occupation (90.1%), and attending day care centers. We evaluated VF phonetically (letters P, M, R) and semantically (animals and food), anxiety symptoms through the Geriatric Anxiety Inventory (GAI), depressive symptoms through Geriatric Depression Scale (GDS), and feelings of loneliness through Loneliness Scale (UCLA).
PVF was significantly related with education, occupation, GAI, and GDS. SVF was significantly associated with age, education, occupation, and GDS. Furthermore, SVF scores were worse in elderly men and in those living in night care center, and PVF scores were lower in those with high levels of anxiety symptomatology. In logistic regression analysis none of the variables accounted for the variance in PVF. The only predictor of SVF was sex. In conclusion, this study allowed us to elucidate the only key factor underlying verbal fluency. Being a man may affect SVF performance in institutionalized elderly.
The changing epidemiological profile of population in recent decades is related to the socio-economic conditions of contemporaneity. Diabetes mellitus (DM) is positioned in the chronic non-communicable diseases spectrum as one of the most prevalent being responsible for high rates of morbidity and mortality. Therapeutic adhere is of crucial importance because there are high risks associated with non-adherence and it impacts on quality of life.
Identifying therapeutic adherence predictors in type 2 diabetes (DM2).
188 patients attending diabetology consultations at the Department of Endocrinology, Diabetes and Metabolism, at Centro Hospitalar e Universitário de Coimbra and at Associação Protetora dos Diabéticos de Portugal participated in the study. Participants completed the following set of self-report instruments: Beck Depression Inventory (BDI), the Diabetes Health Profile (DHP), the Rosenberg Self-Esteem (RSE), and the social relations dimension of the World Health Organization Quality of Life (WHOQOL). Therapeutic adherence was established base on HbA1C clinical criteria.
Multiple regression analyses revealed that the full model was statistically significant [c 2 (4, n = 188) = 20.79, p >0.001] explaining between 20% and 29.6% of total variance and 76.3% of the cases were correctly classified. The four variables significantly contributed to the model, especially the BDI and the RSE, registering an odds ratio of 1.104 and 1.203, respectively.
In DM2 predictors of non-adherence were depression and diabetes patient health profile while self-esteem and quality of life in social relations, emerged as predictors of adherence.
Mental health literacy is an emergent research area in the fields of health promotion and mental illness prevention in communitarian environment, considered one relevant variable in the professional help-seeking behavior.
Evaluate the mental health literacy of Portuguese adolescents and youth concerning depression and schizophrenia; - Identify the contribute of the social demographic variables in mental health literacy.
Characterize the mental health literacy of adolescents and youth with the aim of create health promotion and mental illness prevention programs.
Descriptive-correlational study. Sample of 671 students, randomly selected of Portuguese schools. 294 of male gender and 323 of female gender, with an average age of 15,20 (sd = 1,84 years). The data were collected with the Mental Health Literacy Evaluate Questionnaire (Loureiro, Pedreiro and Correia, 2011). The data were analyzed using the IBM-SPSS 20.
Only 47,81% correctly identifies depression and 22,04% schizophrenia. Besides gender (p = 0,002), the familiarity with the mental illness and the socio demographic variables weren?t related to the recognition of the disorders.
The low levels of mental health literacy are a problem and a challenge, since they are associated with prejudiced and stigmatizing visions of the diseases and the ill with implications in the professional help-seeking behavior. The planning of programs should be alert since the adolescents and youth are the group with less interaction with the health system.
The aim of this study was to understand the universe of a group of Muslim women, focusing their experiences in a western society, their perception of cultural differences and the repercussion of these factors mental health. for such, we applied the qualitative method using the semidirected interview in eight Muslim women who live in Brazil. the sample was constructed using the snow-ball technique, closed according to the criterion of saturation of data. the emergent categories starting from the statements were analyzed and explained in the light of psychosocial theories. the interviewers showed great interest in bringing up visibility to the religious questions which permeate the life of the Muslim people, emphasizing the lack of knowledge of the Western world concerning these issues. They say they are discriminated in several aspects, especially in relation to their clothes; they questioned the Western idea of the subdued woman, introducing as counterpoint the submission to the rigid patterns of beauty and health which permeate the female western universe. General aspects of Islam were also dealt with, including sexuality, marriage, raising children and the relations with the people of a country with habits and traditions different from their own. the impact of September 11th on the lives of these women was evident, promoting fear and social exclusion. as these issues are closely related to mental health, the study of the religious and ethnic minorities aiming the comprehension of mental disease through a culturally sensitive medicine is urgent.
Donepezil, a centrally acting acetylcholinesterase inhibitor (AChEI), is approved for symptomatic relief of cognitive impairment in patients with Alzheimer's disease and Vascular Dementia (VD). Several adverse effects were reported and the most common are gastrointestinal disturbances. Others include bradycardia, agitation and confusion. Although epileptic seizures are listed as a side effect, there are few reports.
To present a case-report of donepezil-induced epileptic seizures and a review study regarding the theme available in Medline.
Brief literature review.
A case report is presented and literature of this theme shortly reviewed.
The case involves a 62-year-old female diagnosed with VD 6 months previously. Her medical history included a cerebrovascular accident 24 months earlier. She started the treatment with donepezil 5 mg and 48 hours later she was admitted in the Emergency with convulsions. She was unconscious for 20 minutes with urinary incontinence and bitten tongue. Normal blood analyses. A contrast brain CT showed a mild degree of cortical atrophy without new structural lesions. EEG showed mild and diffuse neuronal dysfunction with no grafoelements indicative of epilepsy. Donepezil was discontinued, no therapy was instituted and the patient has been convulsion free.
The mechanism of convulsive action of AChEIs isn’t clear. There are reports about centrally acting AChEIs inducing convulsions in patients with Dementia without any underlying neurological condition. Further research is needed to delineate the frequency of this effect and to extend our knowledge of the underlying pathophysiological mechanism in order to determinate the safety profile of AChEIs.
Depression is very common among institutionalized elders. Because of the increased risk of cognitive impairment/dementia, and mortality we want to describe the evolution of depression and analyze predictive factors.
In the Aging Trajectories Study (Instituto Superior Miguel Torga - Coimbra), we followed up a sample of 83 nondemented persons (M ± SD baseline age = 79.51 ± 6.58; men: 17; women: 66). In a 2-year prospective cohort analysis (2010-2011, and 2013), we assessed depression using the Geriatric Depressive Scale/GDS as screening tool and the Mini International Neuropsychiatric Interview to diagnose depression. We also used the UCLA Loneliness Scale, the Geriatric Anxiety Inventory/GAI, the Positive and Negative Affect Scale/PANAS. Sociodemographics, and health were control variables. We performed a multinomial logistic regression to identify predicitive factors.
Fifty participants had depression at baseline, nine developed, 49 maintained, nine remitted, and 16 maintained without depression.
Having depression was associated with worse scores in UCLA, GAI, and PANAS. Not having depression was correlated with higher positive affect.
Baseline higher GAI and UCLA, and lower positive affect and satisfaction predicted recurrent depression.
Improvement in GDS, GAI, and positive affect predicted depression remission.
Results show that depression is a concern issue for professionals working with institutionalized elderly. Anxiety, loneliness, low positive affect and satisfaction constitute a risk factor for maintaing depression in institutionalized elderly and low anxiety and depressive symptoms are a protective factors for depression. These results could be used in depression prevention programs.
Affectivity is related to cognitive impairment, but it is not known whether positive affect and negative affect increase/decrease the risk of cognitive impairment. In this study, we sought to examine the prevalence of cognitive impairment, and the potential role of positive and negative affectivity on cognitive functioning in institutionalized portuguese elderly, controlling the potential role of demographic and emotional factors.
A cross sectional investigation has been conducted with a portuguese institutionalized sample at Coimbra’s Council. We inquired 412 healthy elderly with a mean age of 80.38 years (SD = 7.24) using the Positive and Negative Affect Schedule (PANAS), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI). Demographic (76.9% women, 14.3% > 4 years of education, 99.1% manual occupation, 82.2% without partner) and other self-reported related factors were taken into consideration (GDS mean 14.30 ± 6.31; GAI mean = 12.49 ± 5.93).
The prevalence of cognitive impairment was 66.6% (youngest-old: 1.4%; young-old: 24.7%, old-old: 36.5%, oldest-old: 3.9%). We found that only the positive affect was significantly related with the MMSE (r = 0.22). Multiple logistic regression analysis showed that positive affect predicted impairment in cognitive performance (OR = 0.96, CI 95% = 0.93-0.98; p < 0.001). These relationships were significant even after controlling for depression and anxiety status, age, education, and occupation.
These findings suggest that positive affect is a variable to attend to when evaluating cognitive functioning in institutionalized elderly.
Cognitive rehabilitation techniques, reminiscence therapy, and reality orientation therapy, have shown an impact on cognition, life satisfaction, mood, and on the progression of cognitive decline in elderly.
To test the effectiveness of a NRGP on the cognitive and emotional functioning of institutionalized elderly.
single blind randomized controlled study with paired groups.
Coimbra institutionalized elderly, aged between 64-92 (N = 88) with cognitive impairment no dementia, mostly women (75.0%).
randomization of participants to the rehabilitation group/RG (n = 41) and to the comparison/waiting-list group/CG (n = 23). NRGP involved groups of five elders, and took 90 min. per day, once a week, for 10 weeks.
Mini-Mental State Examination/MMSE, Frontal Evaluation Battery/FAB, Geriatric Depression Scale/GDS.
We used general linear model with repeated measures analysis of variance.
RG improved significantly on cognitive, and executive function (p < 0.001), and CG worsened on cognitive, executive function, and mood (p < 0.01). There was a significant effect on the MMSE, FAB, and GDS scores, after excluding pre-rehabilitation scores as covariates [F (1, 81) = 43.98, p < 0.001; η2 = 0.35; F(1, 80) = 28.37, p < 0.001; η2 = 0.26; F(1, 79) = 19.66, p < 0.001; η2 = 0.20].
A NRGP including cognitive rehabilitation, reminiscence therapy, and reality orientation proved to be effective on cognitive and executive functioning, and on depressive symptoms of institutionalized elders with cognitive impairment no dementia.