Dysphagia Screening in Brazilian Older Adults with Dementia: Content Development and Validation of a Questionnaire for Caregivers - RaDID-QC.

This study aims to develop and validate the content and response processes of a questionnaire intended for caregivers to screen for dysphagia in Brazilian older adults with dementia due to Alzheimer's disease and/or vascular dementia. The instrument items were developed in Brazilian Portuguese language based on the theoretical framework. A committee of speech-language-hearing therapists analyzed the relevance, objectivity, clarity, and understandability of the items with the Delphi method. The content validity index cutoff agreement score for experts' answers to validate each item in the questionnaire was 0.78; in the intraclass correlation coefficient, it was 0.75 for all items. For response process validity evidence, the questionnaire was applied to 30 caregivers of older adults with dementia, who judged the clarity and understandability of the items. Each item was validated when understood by at least 95% of participants. The first version of the instrument had 29 items. After two expert assessments, the last version had 24 items. The intraclass correlation coefficient was 0.85. Only one item needed semantic adjustments in the pre-test. The dysphagia screening instrument applied to caregivers of older adults with dementia was developed with adequate content and response process validity evidence, enabling adjustments in its construct. Future studies will analyze the remaining evidence of validity and reliability.

Characterization and bioactivities of coffee husks extract encapsulated with polyvinylpyrrolidone.

Coffee processing generates large amounts of residues of which a portion still has bioactive properties due to their richness in phenolic compounds. This study aimed to obtain a coffee husks extract (CHE) and to encapsulate it (ECHE) with polyvinylpyrrolidone using a one-step procedure of solid dispersion. The extraction and encapsulation yields were 9.1% and 92%, respectively. Thermal analyses revealed that the encapsulation increased the thermal stability of CHE and dynamic light scattering analyses showed a bimodal distribution of size with 81% of the ECHE particles measuring approximately 711 nm. Trigonelline and caffeine were the main alkaloids and quercetin the main phenolic compound in CHE, and the encapsulation tripled quercetin extraction. The total phenolics content and the antioxidant activity of ECHE, assayed with three different procedures, were higher than those of CHE. The antioxidant activity and the bioaccessibility of the phenolic compounds of ECHE were also higher than those of CHE following simulated gastrointestinal digestion (SGID). Both CHE and ECHE were not toxic against Alliumcepa cells and showed similar capacities for inhibiting the pancreatic α-amylase in vitro. After SGID, however, ECHE became a 1.9-times stronger inhibitor of the α-amylase activity in vitro (IC50 = 8.5 mg/mL) when compared to CHE. Kinetic analysis revealed a non-competitive mechanism of inhibition and in silico docking simulation suggests that quercetin could be contributing significantly to the inhibitory action of both ECHE and CHE. In addition, ECHE (400 mg/kg) was able to delay by 50% the increases of blood glucose in vivo after oral administration of starch to rats. This finding shows that ECHE may be a candidate ingredient in dietary supplements used as an adjuvant for the treatment of diabetes.

Nanoparticles Loaded with a Carotenoid-Rich Extract from Cantaloupe Melon Improved Hepatic Retinol Levels in a Diet-Induced Obesity Preclinical Model.

The study evaluated the effect of the carotenoid-rich extract from cantaloupe melon (CE) nanoencapsulated in porcine gelatin (EPG) on hepatic retinol concentration and liver damage scores in Wistar rats with obesity induced by high glycemic index and high glycemic load diet (HGLI diet). For 17 days, animals were fed the HGLI diet. They were divided into three groups and treated for 10 days [HGLI diet + water, HGLI diet + CE (12.5 mg/kg), and HGLI diet + EPG (50 mg/kg)]. The groups were evaluated for dietary intake, retinol, weight variation, hematological parameters, fasting glucose, lipid profile, hepatic retinol concentration, AST/ALT ratio, FIB-4 (Fibrosis-4 Index for Liver Fibrosis), and APRI (AST to Platelet Ratio Index) scores to evaluate the effects on the liver. Animals treated with EPG showed a lower dietary intake (p < 0.05). No significant weight change was detected in the evaluated groups (p > 0.05). The EPG-treated group had significantly higher concentrations (p < 0.05) of hepatic retinol [266 (45) µg/g] than the untreated group [186 (23.8) µg/g] and the one treated with CE [175 (8.08) µg/g]. Liver damage assessment scores did not show significant differences, but the lowest means were observed in the group treated with EPG. The nanoencapsulation of the extract rich in beta-carotene promoted reduced food consumption and increased hepatic retinol without causing significant changes in liver damage scores. Thus, EPG is a candidate for future clinical studies to evaluate the beneficial effects of treating diseases involving vitamin A deficiencies.

Elaboração e validação do questionário de rastreamento de disfagia aplicado aos cuidadores de idosos com demência (RaDID-QC) / Development and validation of the dysphagia screening questionnaire applied to caregivers of elderly people with dementia (RaDID-QC)

O rápido envelhecimento populacional e o aumento da expectativa de vida associam-se ao incremento da população de idosos em todo o mundo, o que contribui significativamente para a maior prevalência das síndromes demenciais. A demência é uma síndrome clínica caracterizada pela deterioração progressiva de múltiplos domínios da cognição, prejuízo da funcionalidade e alterações comportamentais. O cuidador possui relevância fundamental no cuidado do idoso com demência. Em relação à alimentação, os idosos com demência apresentam menor interesse pelos alimentos, maior dificuldade na coordenação do bolo alimentar e redução na ingesta de alimentos, determinando alteração no processo da deglutição. É de suma importância que o cuidador identifique os sinais e sintomas dos transtornos da deglutição, visto que a disfagia é um fator de risco para mortalidade. O presente estudo, tem como objetivo desenvolver e validar o questionário Rastreamento de Disfagia em Idosos com Demência ­ Questionário para cuidadores (RaDID-QC), aplicado ao cuidador de idoso com demência por doença de Alzheimer e/ou demência vascular de gravidade leve, moderada ou avançada. Construímos um questionário para rastreamento de disfagia. Foi realizado um estudo de validação observacional transversal com o objetivo de identificar a disfagia no idoso parcial ou totalmente dependente de cuidado de terceiros. Para evidência de validade baseada no conteúdo, foram realizados levantamento bibliográfico, elaboração da primeira versão do questionário e análise das questões pelo comitê de 23 especialistas em disfagia com experiência em atendimento a idosos. A concordância entre as análises dos especialistas foi aferida por meio do Índice de Validade de Conteúdo por item (IVC-I) e do Coeficiente de Correlação Intraclasse (CCI). Para evidência de validade baseada nos processos de resposta, uma fonoaudióloga aplicou o instrumento, por meio de entrevista, em 30 cuidadores de idosos com demência (binômio cuidador-idoso com demência) provenientes do Instituto Jenny Andrade Faria de atenção à saúde do idoso do Hospital das Clínicas da Universidade Federal de Minas Gerais. Em seguida, os cuidadores realizaram o julgamento das questões quanto à clareza e facilidade de compreensão. Após novo ajuste no questionário, seguiu-se para a obtenção das evidências de validade baseadas na estrutura interna. Nesta etapa participaram 170 cuidadores de idosos com demência que responderam o instrumento. Os dados desta fase foram analisados usando coeficiente Alfa de Cronbach, correlações item-total e análise fatorial exploratória. A primeira versão do RaDID-QC foi constituída de 29 questões. Após duas rodadas de avaliações dos especialistas, a última versão permaneceu com 24 questões. O coeficiente de correlação intraclasse foi de 0,85. Na evidência de validade baseada nos processos de resposta houve adequação semântica de apenas uma questão. Na validade baseada na estrutura interna, após a análise fatorial exploratória, o questionário permaneceu com 14 questões, cinco fatores conseguiram explicar 61,7% da variância total, o coeficiente de correlação item-total apresentou valores iguais ou acima de 0,50 para os fatores e o Alfa de Cronbach padronizado obteve índice de 0,688. O questionário de rastreamento de disfagia aplicado ao cuidador de idoso com demência ­ RaDID-QC apresentou evidências de validade baseadas na análise de conteúdo, processos de resposta e estrutura interna satisfatório, válido e confiáveis.

Rapid population aging and increased life expectancy are associated with the increase in the elderly population worldwide, which significantly contributes to the higher prevalence of dementia syndromes. Dementia is a clinical syndrome characterized by the progressive deterioration of multiple domains of cognition, impairment of functionality and behavioral changes. The caregiver has fundamental relevance in the care of the elderly with dementia. Regarding food, elderly people with dementia have less interest in food, greater difficulty in coordinating the food bolus and reduced food intake, determining changes in the swallowing process. It is extremely important for the caregiver to identify the signs and symptoms of swallowing disorders, as dysphagia is a risk factor for mortality. The present study aims to develop and validate the questionnaire Dysphagia Screening in older adults with Dementia - Questionnaire for caregivers (RaDID-QC), applied to caregivers of older adults with dementia due to Alzheimer's disease and/or mild vascular dementia, moderate or advanced. We built a dysphagia screening questionnaire. A cross-sectional observational validation study was carried out with the aim of identifying dysphagia in the elderly partially or totally dependent on third-party care. For evidence of content-based validity, a bibliographic survey was carried out, the first version of the questionnaire was created, and the questions were analyzed by a committee of 23 experts in dysphagia with experience in caring for the elderly. The agreement between the experts' analyzes was checked using the Content Validity Index per item (IVC-I) and the Intraclass Correlation Coefficient (ICC). For evidence of validity based on the response processes, a speechlanguage applied the instrument, through interviews, to 30 caregivers of older adults with dementia (caregiver-elderly binomial with dementia) from the Jenny Andrade Faria Institute of health care for the elderly in the Clinical Hospital of the Federal University of Minas Gerais. Then, the caregivers judged the questions regarding clarity and ease of understanding. After a new adjustment in the questionnaire, we proceeded to obtain evidence of validity based on the internal structure. In this step, 170 caregivers of elderly people with dementia answered the instrument. Data from this phase were analyzed using Cronbach's alpha coefficient, item-total correlations and exploratory factor analysis. The first version of the RaDID-QC consisted of 29 questions. After two rounds of expert evaluations, the last version remained with 24 questions. The intraclass correlation coefficient was 0.85. In the evidence of validity based on response processes, there was semantic adequacy of only one question. In the validity based on the internal structure, after the exploratory factor analysis, the questionnaire remained with 14 questions, five factors were able to explain 61.7% of the total variance, the item-total correlation coefficient presented values equal to or above 0.50 for the factors and standardized Cronbach's alpha obtained an index of 0.688. The dysphagia screening questionnaire applied to caregivers of elderly people with dementia - RaDID-QC presented evidence of validity based on content analysis, response processes and internal structure that was satisfactory, valid and reliable.

Aquatic exercise associated or not with grape juice consumption-modulated oxidative parameters in Parkinson disease patients: A randomized intervention study.

Parkinson's disease (PD) is a neurodegenerative disorder with significant motor disabilities and cognitive decline. Importantly, the imbalance of oxidative stress is related to PD physiopathology and progression. This study aimed to evaluate the impact of grape juice consumption associated with an aquatic exercise protocol on oxidative stress parameters and cognitive function in individuals with PD. The participants were randomized into two groups: grape juice group (GJG) and control group (CG) and were submitted to 4 weeks of an aquatic intervention (twice a week, approximately 60 minutes/session). The GJG also consumed 400 ml of grape juice per day (integral and conventional) during this period. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCa) questionnaire. For the analysis of oxidative stress markers, specifically lipid oxidative damage (TBARS), proteins (Carbonil), acid uric and the activity of antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase), blood collection were done before and after intervention. No changes were observed in cognitive function after intervention in both groups. Regarding biomarkers, a reduction of antioxidant enzymes, thiobarbituric acid reactive substances (TBARS) and uric acid was observed in both groups. However, only the GJG showed a significant reduction on protein oxidation levels after intervention. In conclusion, the consumption of grape juice associated with an aquatic exercise protocol might be consider an effective alternative to reduce the oxidative damage in PD, reinforcing the importance of this intervention in promoting beneficial impact in this population.

Antioxidant stability enhancement of carotenoid rich-extract from Cantaloupe melon (Cucumis melo L.) nanoencapsulated in gelatin under different storage conditions.

The study evaluated the potential and antioxidant stability of nanoencapsulated carotenoid-rich extract (CE) from Cantaloupe melon (EPG). DPPH and ABTS radical scavenging assays were used to investigate the nanoencapsulation effect on antioxidant potential. CE and EPG stability were evaluated at 25 °C and 5 °C, with and without light (1600 lx) for 60 days, determining the ß-carotene concentration by UHPLC and antioxidant potential by ABTS. The antioxidant potential of carotenoids increased after nanoencapsulation (57-59%). After 60 days, there was low retention of ß-carotene (0-43.6%) in the CE, mainly at 25 °C light (0.00%) and dark (10.0%), and total loss of activity in the four conditions. EPG preserved the ß-carotene concentration in the dark at 25 °C (99.0%) and in the light (83.1%) and dark (99.0%) at 5 °C, maintaining the antioxidant potential (68.7-48.3%). Therefore, EPG enhanced and stabilized the antioxidant potential of carotenoids, beneficial to human health.

Safety and bioactive potential of nanoparticles containing Cantaloupe melon (Cucumis melo L.) carotenoids in an experimental model of chronic inflammation.

The safety and bioactive potential of crude carotenoid extract from Cantaloupe melon nanoencapsulated in porcine gelatin (EPG) were evaluated in a chronic inflammatory experimental model. Animals were fed a high glycemic index and high glycemic load (HGLI) diet for 17 weeks and treated for ten days with 1) HGLI diet, 2) standard diet, 3) HGLI diet + crude carotenoid extract (CE) (12.5 mg/kg), and 4) HGLI diet + EPG (50 mg/kg). General toxicity signals were investigated, considering body weight, food intake, hematological, biochemical parameters, relative weight, morphology, and histopathology of organs. The biochemical parameters indicated the low toxicity of EPG. Acute hepatitis was observed in animals' livers, but CE and EPG groups presented improved tissue appearance. Chronic enteritis was observed in animals, with villi and intestinal glands preservation in the EPG group. The results suggest the safety and the bioactive effect of EPG, possibly related to its anti-inflammatory potential.

Effect of exercise and grape juice on epigenetic modulation and functional outcomes in PD: A randomized clinical trial.

OBJECTIVE: This study aimed to investigate the impact of an aquatic physical training program associated with grape juice (Vitis labrusca) consumption on functional outcomes, Brain-Derived Neurotrophic Factor (BDNF) and global histone H4 acetylation levels in peripheral blood from individuals with Parkinson's disease. METHODS: Nineteen participants were randomized to Aquatic Exercise (AQ, n = 9) and Aquatic Exercise + Grape Juice (AQ+GJ, n = 10) groups and performed to 4 weeks of an aquatic intervention (twice a week, approximately 60 min/session). The AQ+GJ groups also consumed 400 mL of grape juice per day during this period. Functional capacity (six-min walk test, 6MWT), mobility (The Timed Up and Go, TUG) and the risk of falls (Berg Balance Scale, BBS) were evaluated before and after intervention. In addition, blood collections were carried out for biomarker analysis (e.g. BDNF and global histone H4). RESULTS: The aquatic exercise program induced functional improvement in individuals with Parkinson's disease, specifically ameliorating their mobility and functional capacity. In addition, enhanced levels of BDNF and histone H4 acetylation were found after the intervention. Grape juice consumption did not potentiate these effects, since any significant differences between the AQ and AQ+GJ groups were not found in all analysed variables. CONCLUSIONS: The present study provides important insights about aquatic exercise-modulated BDNF levels in individuals with Parkinson's disease in combination with functional improvements, suggesting that histone acetylation status may interact to dictate the molecular mechanisms involved in this response. Parkinson disease, aquatic exercise, BDNF, epigenetic, grape juice.

Fatores associados à pressão de língua em pacientes pós-acidente vascular cerebral / Factors associated with tongue pressure in post-stroke patients

RESUMO Introdução A prática clínica fonoaudiológica no ambiente hospitalar mostra que existe alta prevalência de disfagia em pacientes pós-acidente vascular cerebral. Objetivo Verificar se o tempo de ocorrência e o tipo do acidente vascular cerebral, o hemicorpo acometido por hemiplegia, a gravidade do deficit neurológico, a presença e o grau de disfagia interferem na pressão de língua de pacientes internados pós-acidente vascular cerebral. Métodos Estudo realizado com 31 pacientes. Foi aplicado protocolo da avaliação da disfagia, prova de mobilidade lingual e mediu-se a pressão de língua com o Iowa Oral Performance Instrument (IOPI). Foram realizadas três medidas da pressão anterior e três da pressão posterior. Os dados foram analisados por meio de estatística apropriada, com nível de significância de 5%. Resultados Apenas a presença de disfagia se mostrou associada estatisticamente à pressão de língua, sendo que os pacientes pós-acidente vascular cerebral disfágicos apresentaram pressão anterior e posterior média e máxima da língua menor que aqueles sem a presença de disfagia. O tempo de ocorrência do acidente vascular cerebral, o tipo e o hemicorpo acometido e a gravidade do deficit neurológico não apresentaram associação com a pressão lingual. Dentre os 15 participantes que apresentaram a dificuldade de deglutição, 14 (93,3%) foram classificados com disfagia leve e um (6,7%) com disfagia moderada. Conclusão Verificou-se que a disfagia, ainda que de grau leve, foi o fator preponderante para diminuição da pressão de língua em pacientes que sofreram acidente vascular cerebral.

ABSTRACT Introduction: The clinical practice of speech pathology in hospitals shows that there is a high prevalence of dysphagia in post-stroke patients. Purpose: To verify whether the time of occurrence, type of stroke, affected hemisphere, severity of neurological deficit, presence or absence of dysphagia, and degree of dysphagia interfere with tongue pressure in post-stroke patients. Methods: This study was conducted in 31 stroke patients. Three evaluations were performed, one of tongue mobility, another of dysphagia, and another of tongue pressure using the Iowa Oral Performance Instrument. Three measurements were performed of anterior and three of posterior tongue pressure. Data were analyzed using appropriate statistics, considering a significance level of 5%. Results: Only the presence of dysphagia was associated with tongue pressure. Post-stroke patients with dysphagia had lower anterior and posterior tongue pressure (mean and maximum) than those without dysphagia. The time of occurrence, type, and affected hemisphere of the stroke and severity of the neurological deficit were not associated with tongue pressure. Regarding the degree of dysphagia, of the 15 participants who had swallowing difficulties, 14 were classified with mild and one with moderate dysphagia. Conclusion: Dysphagia was the most important factor in the decrease of tongue pressure in post-stroke patients.

Dificuldades enfrentadas pelos pais de crianças com doença do refluxo gastroesofágico / Difficulties faced by parents of children with gastroesophageal reflux disease

Objetivo Identificar as dificuldades enfrentadas pelos pais de crianças com doença do refluxo gastroesofágico.Métodos Pesquisa qualitativa realizada com 16 familiares de crianças com doença do refluxo gastroesofágico. Foi utilizada uma questão norteadora, as entrevistas foram gravadas e transcritas. Utilizou-se a técnica de análise de conteúdo.Resultados Emergiram oito categorias relacionadas às dificuldades enfrentadas pelos pais: vômitos frequentes, pneumonia, custo com tratamento, convívio social prejudicado, perda de peso, padrão de sono prejudicado, gerando dificuldade na adesão ao tratamento com orientações insuficientes.Conclusão As dificuldades enfrentadas pelos pais de crianças com refluxo gastroesofágico foram representadas por categorias que podem servir de indicadores para a qualidade do cuidado prestado.

Objective Identifying the difficulties faced by parents of children with gastroesophageal reflux disease.Methods Qualitative study carried out with 16 parents of children with gastroesophageal reflux disease. A guiding question was used and the interviews were recorded and transcribed.Results Eight categories related to the difficulties faced by parents emerged, as follows: frequent vomiting, pneumonia, cost of treatment, impaired social interaction, weight loss and disturbed sleep pattern, causing difficulty in adhering to treatment with insufficient guidance.Conclusion The difficulties faced by parents of children with gastroesophageal reflux were represented by categories that can serve as indicators for the quality of provided care.