Changes over time in self-efficacy to cope with cancer and well-being in women with breast cancer: a cross-cultural study.

OBJECTIVE: This study aimed to examine whether self-efficacy to cope with cancer changes over time in patients with breast cancer and whether these potential changes are similar across patients. It also aimed to examine whether these trajectories are related to patient psychological well-being and overall quality of life. METHODS: Participants (N = 404) from four countries (i.e. Finland, Israel, Italy, and Portugal) were enrolled in the study few weeks after breast surgery or biopsy. Self-efficacy to cope with cancer was assessed at baseline, six and 12 months later. Well-being indices were assessed at baseline, 12 and 18 months later. RESULTS: Using Latent Class Growth Analysis, two groups of patients were identified. The majority of patients reported high levels of self-efficacy to cope, which increased over time. For almost 15% of the patients, however, self-efficacy declined over time. Diminishing levels of self-efficacy to cope predicted worse levels of well-being. The pattern of self-efficacy changes and their relationships to well-being was consistent across countries. CONCLUSION: Monitoring self-efficacy to cope with cancer is probably important in order to detect alarming changes in its levels, as a declining self-efficacy to cope may serve as a signal of the need for intervention to prevent adaptation difficulties.

The Interplay Between Trait Resilience and Coping Self-efficacy in Patients with Breast Cancer: An International Study.

The role of self-efficacy to cope with breast cancer as a mediator and/or moderator in the relationship of trait resilience to quality of life and psychological symptoms was examined in this study. Data from the BOUNCE Project ( https://www.bounce-project.eu/ ) were used. Women diagnosed with and in treatment for breast cancer (N = 484), from four countries, participated in the study. Trait resilience and coping self-efficacy were assessed at baseline (soon after the beginning of systemic treatment), and outcomes (quality of life, psychological symptoms) 3 months later. Hierarchical regression, mediation, moderation, and conditional (moderated) mediation and moderation analyses were performed to examine the study hypotheses. Coping self-efficacy mediated the impact of trait resilience. In addition, higher levels of resilience in combination with higher levels of coping self-efficacy were associated with better outcomes. Country of origin had no impact on these results. Overall, it seems that coping self-efficacy is a key factor that should be taken into account for research and intervention efforts in cancer.

The mutual determination of self-efficacy to cope with cancer and cancer-related coping over time: a prospective study in women with breast cancer.

OBJECTIVE: The aim of this study was to examine the longitudinal impact of self-efficacy to cope with cancer on the cancer-related coping reactions of breast cancer patients and vice versa. DESIGN AND MAIN OUTCOMES MEASURES: Data from the BOUNCE Project (https://www.bounce-project.eu/) were used to address the hypotheses. Participants (N = 403) were enrolled in the study a few weeks after surgery or biopsy. Coping self-efficacy was assessed at baseline and six months later (M6). Cancer-related coping was assessed three (M3) and nine months (M9) after baseline. The analyses were performed using structural equation modeling with Mplus 8.6. RESULTS: Baseline coping self-efficacy predicted all M3 coping reactions, while M6 coping self-efficacy also predicted changes in all but one M9 coping reaction. Moreover, one of the M3 coping reactions, that is, hopelessness/helplessness, predicted the changes in M6 coping self-efficacy. The relation between coping self-efficacy and one coping reaction (i.e. cognitive avoidance) was rather weak. Stability paths from M3 to M9 coping reactions were moderate to high. CONCLUSION: The relationship between self-efficacy to cope with cancer and cancer-related coping is complex. New theoretical models are needed to more accurately describe the diverse aspects of this association.

Real-world evidence from a European cohort study of patients with treatment resistant depression: Healthcare resource utilization.

BACKGROUND: Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. METHODS: This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively. RESULTS: Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively. LIMITATIONS: Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems. CONCLUSION: Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs.

Real-world evidence from a European cohort study of patients with treatment resistant depression: Treatment patterns and clinical outcomes.

BACKGROUND: Treatment resistant depression (TRD) characterizes a subgroup of 10-30% of patients with major depressive disorder, and is associated with considerable morbidity and mortality. A consensus treatment for TRD does not exist, which often leads to wide variations in treatment strategies. Real-world studies on treatment patterns and outcomes in TRD patients in Europe are lacking and could help elucidate current treatment strategies and their efficacy. METHODS: This non-interventional cohort study of patients with TRD (defined as treatment failure on ≥2 oral antidepressants given at adequate dose and duration) with moderate to severe depression collected real-world data on treatment patterns and outcomes in several European countries. Patients were started on a new treatment for depression according to routine clinical practice. RESULTS: Among 411 patients enrolled, after 6 months, only 16.7% achieved remission and 73.5% showed no response. At Month 12, while 19.2% achieved remission and 69.2% showed no response, 33.3% of those in remission at Month 6 were no longer in remission. Pharmacological treatments employed were heterogenous; 54 different drugs were recorded at baseline, and the top 5 treatment types according to drug classes accounted for 40.0% of patients. Even though remission rates were very low, at Month 12, 60.0% of patients had not changed treatment since enrolment. CONCLUSIONS: The heterogeneity of treatments highlights a lack of consensus. Moreover, despite low response rates, patients often remained on treatments for substantial periods of time. These data further support existence of an unmet treatment need for TRD patients in Europe.

Real-world evidence from a European cohort study of patients with treatment resistant depression: Baseline patient characteristics.

BACKGROUND: Treatment resistant depression (TRD; failure to respond to ≥2 treatments) affects ~20% of patients with major depressive disorder (MDD). Real-world data could help describe patient characteristics and TRD disease burden, to assess the unmet needs of TRD patients in Europe. METHODS: This observational study collected data from adults with moderate to severe TRD initiating a new treatment for depression, according to local standards of care. At baseline, socio-demographic characteristics, medical history, prior and current treatments were recorded. Disease severity, health-related quality of life (HRQoL), functionality and productivity were assessed. RESULTS: Overall, 411 eligible patients were enrolled across seven European countries. Mean (standard deviation [SD]) patient age was 51.0 (10.8) years; 62.3% were female. Long-term sick leave was reported by 19.0% of patients; 30.2% were unemployed. The mean (SD) duration of the current episode was 2.6 (3.9) years. At baseline, mean (SD) HRQoL scores for EuroQoL 5-dimension 5-level (UK tariff) and EQ-Visual Analog Scale were 0.41 (0.25) and 41.1 (18.7), respectively. The Work Productivity and Activity Impairment questionnaire demonstrated mean (SD) absenteeism of 57.0% (44.9%) and presenteeism of 54.7% (29.5%); mean (SD) overall work impairment was 60.5% (29.9%). LIMITATIONS: Key limitations are small cohort size, absence of a control group and generalizability to countries with different healthcare models. CONCLUSIONS: TRD patients had a high disease burden, low HRQoL and reduced function and productivity, with a substantial proportion unable to work. This demonstrates an unmet treatment need in TRD patients that, if addressed, could reduce the heavy personal and societal burden.

Oxidative and nitrosative stress markers in obsessive-compulsive disorder: a systematic review and meta-analysis.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a chronic, prevalent, and highly impairing psychiatric illness. Although the pathophysiology of OCD remains unknown, pathways involved in oxidative and nitrosative stress (O&NS) have been implicated. The present study aims to systematically review the literature for quantitative evidence that patients with OCD have altered measures of blood O&NS markers. METHODS: Independent random-effects meta-analyses using standardized mean differences were conducted to assess each marker separately. Additionally, data from multiple markers were pooled together in a meta-analysis for measures of oxidant activity and another for measures of antioxidant activity. RESULTS: Thirteen studies met inclusion criteria, involving 433 OCD patients and 459 controls. Eleven blood O&NS markers were eligible for independent quantitative analyses. We found that, in OCD patients, the oxidant markers 8-hydroxydeoxyguanosine and malondialdehyde, and the antioxidants glutathione peroxidase and superoxide dismutase, were significantly increased while total antioxidant status, vitamin C, and vitamin E were significantly decreased, when comparing with controls. Regarding pooled meta-analyses, we found a statistically significant increase in oxidant markers, but non-significant results regarding antioxidant markers. CONCLUSIONS: Our meta-analysis suggests that OCD patients have a systemic oxidative imbalance that is not adequately buffered by the antioxidant system. Additional studies are needed in order to support this association.

Infectious and immunogenetic factors in bipolar disorder.

OBJECTIVE: Despite the evidence supporting the association between infection and bipolar disorder (BD), the genetic vulnerability that mediates its effects has yet to be clarified. A genetic origin for the immune imbalance observed in BD, possibly involved in the mechanisms of pathogen escape, has, however, been suggested in recent studies. METHOD: Here, we present a critical review based on a systematic literature search of articles published until December 2016 on the association between BD and infectious/immunogenetic factors. RESULTS: We provide evidence suggesting that infectious insults could act as triggers of maladaptive immune responses in BD and that immunogenetic vulnerability may amplify the effects of such environmental risk factors, increasing susceptibility to subsequent environmental encounters. Quality of evidence was generally impaired by scarce attempt of replication, small sample sizes and lack of high-quality environmental measures. CONCLUSION: Infection has emerged as a potential preventable cause of morbidity in BD, urging the need to better investigate components of the host-pathogen interaction in patients and at-risk subjects, and thus opening the way to novel therapeutic opportunities.

Influência de diferentes extratos aquosos de plantas medicinais no desenvolvimento de Colletotrichum gloeosporioides e de Fusarium moniliforme / Influence of different aqueous extracts of medicinal plants in the development of Colletotrichum gloeosporioides and Fusarium moniliforme

O objetivo deste trabalho foi avaliar a influência dos extratos aquosos das plantas medicinais alecrim, alho, cravo-da-índia, sálvia, capim-limão, orégano ou pimenta-do-reino no desenvolvimento in vitro de Colletotrichum gloeosporioides e de Fusarium moniliforme. Os extratos foram obtidos pela infusão de 60 g de cada planta medicinal em 200 mL de água fervente. Cada extrato aquoso foi fracionado em concentrações de 0, 5, 10 e 20% (p:v) e incorporado ao meio de cultivo BDA (batata-dextrose-ágar) antes da esterilização em autoclave. Posteriormente, um disco de 8 mm de diâmetro de micélio fúngico de cada patógeno foi transferido para o centro de placas de Petri. Após 24, 48 e 96 horas de incubação em câmara de crescimento a 22 ± 2 ºC e fotoperíodo de 12 horas avaliou-se o crescimento micelial de F. moniliforme e de C. gloesporioides. No último período de incubação, também se quantificou o número de conídios de cada fungo. Para o teste de germinação adicionou-se nas cavidades de placas de teste Elisa, uma alíquota de 40 µL de cada extrato nas concentrações de 0, 5, 10 e 20%, e outra alíquota, da suspensão de conídios de cada patógeno. Após 24 horas a 22 ± 2 ºC, no escuro, a germinação dos conídios foi paralisada com a adição de 20 µL de lactofenol; avaliou-se então a porcentagem de germinação de conídios. Os experimentos foram conduzidos no delineamento inteiramente casualizado em esquema fatorial 7 x 4 (extratos de plantas medicinais x concentrações) com quatro repetições. Para ambos os patógenos o extrato aquoso de alho e cravo-da-índia apresentaram maior ou total inibição do crescimento micelial, respectivamente, quando comparado com os demais extratos. Para C. gloeosporioides, o extrato de cravo-da-índia apresentou menor número de conídios em todas as concentrações testadas, e para o extrato de alho a 20%, também não foi observada a germinação de conídios. O extrato de alho foi eficiente em reduzir o número e a germinação dos conídios de F. moniliforme na concentração de 20%. Os extratos de alecrim, cravo-da-índia, orégano e pimenta-do-reino, nas maiores concentrações, tiveram efeito positivo na redução da produção de conídios deste mesmo fungo.

The objective of this study was to evaluate the influence of aqueous extracts of the medicinal plants rosemary, garlic, clove, sage, lemongrass, oregano and black pepper in the in vitro development of Colletotrichum gloeosporioides and Fusarium moniliforme. The extracts were obtained by infusing 60 g of each medicinal plant in 200 mL of boiling water. Each aqueous extract was fractionated in the concentrations of 0, 5, 10 and 20% (w:v) and incorporated into the PDA (potato dextrose agar) culture medium before sterilization by autoclaving. Later, an 8 mm diameter disc of each pathogen mycelium was transferred to the center of the Petri dishes. After 24, 48 and 96 hours of incubation in a growth chamber at 22 ± 2 ºC and a photoperiod of 12 hours, we evaluated the mycelial growth of F. moniliforme, and C. gloesporioides. In the last period of incubation, we quantified the production of conidia of each fungus. For the germination test, we added, into the wells of an ELISA test plates, a 40 µL aliquot of each extract at the concentrations of 0, 5, 10 and 20% and another aliquot of a suspension of conidia of each pathogen. After 24 hours at 22 ± 2 ºC in the dark, the germination of the fungi was stopped with the addition of 20 µL of lactophenol. Then, we evaluated the germination of conidia. The experiments followed a completely randomized 7 x 4 factorial design (medicinal plants x concentrations) with four replications. For both pathogens, the aqueous extract of garlic and clove showed a greater or total inhibition of the mycelial growth, when compared to the other extracts. For the C. gloeosporioides, the clove extract showed a lower number of conidia at all concentrations tested, and the garlic extract at 20% showed not conidial germination. The garlic extract was efficient to reduce the conidial number and germination of F. moniliforme at 20%. Extracts of rosemary, clove, oregano and black pepper, in the highest concentrations, had positive effect in reducing the production of spores of the same fungus.

Extrato de alho no controle in vitro e in vivo da antracnose da videira / Garlic extract in the in vitro and in vivo control of anthracnose of grapevine

O objetivo deste trabalho foi avaliar a eficiência in vitro e in vivo do extrato bruto de alho no controle da antracnose da videira (Elsinoe ampelina). No primeiro experimento in vitro, adicionaram-se doses de 0, 5, 10, 15, 20, 25 ou 30 mL L-1 de extrato bruto de alho em meio batata-dextrose-ágar (BDA) antes da esterilização em autoclave e em meio fundente. Após 3, 5, 7 e 9 dias de incubação a 24 ± 2ºC e fotoperíodo de 16 horas, mensurou-se o crescimento micelial de E. ampelina. No segundo experimento in vitro, repetiu-se a metodologia de adição de extrato em meio fundente acrescentando 2,5 mL L-1 de óleo vegetal e uma testemunha absoluta somente com BDA. Avaliação da germinação de E. ampelina foi realizada após duas horas e após quatro horas de incubação a 24ºC e luz constante. O delineamento experimental utilizado para os experimentos in vitro foi inteiramente casualizado, com quatro repetições e parcela experimental constituída por uma placa de Petri. No experimento a campo, logo após a poda da videira cv. Isabel pulverizou-se semanalmente, sobre as folhas da planta, as doses de extrato bruto de alho acrescida do óleo, exceto na testemunha absoluta (sem tratamento). A partir dos primeiros sintomas da antracnose da videira, avaliou-se a severidade que foi expressa em área abaixo da curva do progresso da doença (AACPD). O delineamento foi em blocos ao acaso com cinco repetições. Constatou-se que o extrato bruto de alho reduziu o crescimento micelial do patógeno, principalmente ao adicioná-lo em meio de cultura, antes da esterilização, quando expressou o máximo potencial antifúngico. Ao adicionar o óleo vegetal às doses de extrato, constatou-se inibição total nas doses de 25 ou 30 mL L-1. Este efeito aditivo entre esses compostos também foi constato no teste de germinação de E. ampelina. Em condições de campo, o extrato bruto de alho reduziu a AACPD em 83,59% na dose de 25 mL L-1.

The aim of this study was to evaluate the in vitro and in vivo efficacy of the crude extract of garlic in controlling anthracnose of grapevine (Elsinoe ampelina). In the first experiment in vitro, 0, 5, 10, 15, 20, 25 or 30 mL L-1 crude extract of garlic were added to potato-dextrose-agar medium (PDA) before autoclaving for sterilization and to melting media. After 3, 5, 7 and 9 days of incubation at 24 ± 2ºC and photoperiod of 16 hours, the mycelial growth of E. ampelina was measured. In the second experiment in vitro, we repeated the methodology of adding the extract to the melting medium plus 2.5 mL-1 of vegetable oil and an absolute control with PDA only. After two and four hours of incubation at 24ºC and constant light, germination of E. ampelina was assessed. The experimental design for in vitro experiments was completely randomized with four replicates and the experimental plot consisted of a Petri dish. In the field experiment, after pruning of the grapevine cv. Isabel, the levels of crude extract of garlic plus oil were weekly sprayed on the leaves of the plant, except on the absolute control (no treatment). From the first symptoms of anthracnose of grapevine, the severity that was expressed as area under the disease progress curve (AUDPC) was evaluated. The design was in randomized blocks with five replicates. The crude extract of garlic reduced the mycelial growth of the pathogen, especially when added to the culture medium prior to sterilization, when it expressed its maximal antifungal potential. When the vegetable oil was added to the extract levels, there was complete inhibition at the levels 25 or 30 mL L-1. This additive effect of these compounds was also noted for the germination test of E. ampelina. Under field conditions, the crude extract of garlic reduced the AUDPC by 83.59% at 25 mL L-1.

Gustatory and reward brain circuits in the control of food intake.

Gustation is a multisensory process allowing for the selection of nutrients and the rejection of irritating and/or toxic compounds. Since obesity is a highly prevalent condition that is critically dependent on food intake and energy expenditure, a deeper understanding of gustatory processing is an important objective in biomedical research. Recent findings have provided evidence that central gustatory processes are distributed across several cortical and subcortical brain areas. Furthermore, these gustatory sensory circuits are closely related to the circuits that process reward. Here, we present an overview of the activation and connectivity between central gustatory and reward areas. Moreover, and given the limitations in number and effectiveness of treatments currently available for overweight patients, we discuss the possibility of modulating neuronal activity in these circuits as an alternative in the treatment of obesity.

Somatic growth of a school-aged population from Mozambique: trend and biosocial meaning.

A cross-sectional study of children and adolescents from Maputo, Mozambique, was carried out in order to (1) describe the current growth status of children and adolescents from Maputo, (2) evaluate the relative status of the growth and development of youth from Maputo compared to WHO international standards, (3) assess the relationship between socioeconomic status and growth and development, and (4) assess the impact that the civil war (1980-1992) had on the health status of children and adolescents living in Maputo. The sample is composed of 2,271 subjects (1,098 boys and 1,173 girls), age 6 to 17 years. Somatic measures included height, weight, and skinfold thicknesses from which nutritional indicators were calculated and plotted against WHO norms. Subjects were divided into three groups according to their socioeconomic status. Data from a cross-sectional study done in the same areas in 1992 was used to analyze the impact of war. Beginning at 11 years, Maputo students are always shorter and weigh less than the WHO standards. BMI in boys from 11 years and in girls from 12 years is somewhat lower than the WHO norms. A social gradient is evident, favoring those students with higher socioeconomic status. Height, weight, BMI, fat mass, and lean body mass are always higher in the 1999 sample than in the 1992 study. We conclude that (1) there is a substantial difference in height and weight values of Maputo children and adolescents compared to WHO standards; (2) there is a clear advantage of being of higher socioeconomic status; (3) socioeconomic status, hygiene, and sanitation are the main factors responsible for the greater values of the 1999 sample; and (4) differences between the stature of students with higher socioeconomic status and the WHO norms are almost irrelevant. This last aspect reveals the importance of socioeconomic factors in determining the growth process, implying its importance in facilitating the "expression" of the genotypes available in the population.

A fatal case of human babesiosis in Portugal: molecular and phylogenetic analysis.

We report the first case of human babesiosis in Portugal. A 66-year-old splenectomized man was admitted to a Lisbon hospital after 1 week of fever, abdominal pain, anorexia and nausea. A high parasitaemia (30%) of Babesia parasites was found in Giemsa-stained blood smears and, despite treatment, the patient died several weeks later of renal failure. Ethylenediaminetetraacetic acid blood samples were processed for polymerase chain reaction (PCR) and reverse line blot hybridization to confirm and characterize the Babesia infection. The amplified PCR product was cloned and subsequently sequenced. Molecular analysis showed that the infection was caused by Babesia divergens and that other blood parasites were not involved. Phylogenetic analysis showed that the 18 S ribosomal RNA gene sequence was similar to three other European isolates of B. divergens. In view of the high risk for splenectomized individuals, strict measures should be taken to avoid tick bites.