"You Need to Keep It Going, Mind, Body, and Spirit": Older Adults' Perspectives on Aging in Place in Subsidized Housing.

In the U.S., more than one million older adults with low incomes live in apartment buildings subsidized by the Low-Income Housing Tax Credit. Although this population experiences disproportionate rates of nursing home admission, little is known about residents' perspectives on factors that influence their ability to live independently in these settings. Fifty-eight residents aged 62 and older and eight study partners participated in qualitative interviews about their perspectives on living independently in subsidized housing, including barriers and facilitators. We analyzed transcripts using a hybrid inductive and deductive approach to qualitative thematic analysis. Barriers and facilitators for living independently in subsidized housing related to the influence of the social and physical environment on individuals' experiences of living independently, including factors unique to subsidized housing. Findings suggest how interventions to optimize functional status and promote independence among older adults living in subsidized housing can build on existing strengths of the subsidized housing environment to improve outcomes.

Caring for Patients with Functional Impairment in Middle Age: Perspectives from Primary Care Providers and Geriatricians.

BACKGROUND: The prevalence of functional impairment is increasing among middle-aged adults and is associated with adverse health outcomes. Primary care providers (PCPs) and geriatricians may have important insights about optimal approaches to caring for these patients, but little is known about their perspectives. OBJECTIVE: To examine PCPs' and geriatricians' perspectives on clinical needs and optimal approaches to care for middle-aged patients with functional impairment. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: PCPs and geriatricians from outpatient practices in the San Francisco Bay area. APPROACH: Interviews focused on characteristics and care needs of middle-aged patients with functional impairment and models of care to address these needs. We analyzed interviews using hybrid deductive-inductive qualitative thematic analysis. KEY RESULTS: Clinicians (14 PCPs, 15 geriatricians) described distinct characteristics of functional impairment in middle-aged versus older adults, such as different rates of onset, but similar clinical needs. Despite these similar needs, clinicians identified age-specific barriers to delivering optimal care to middle-aged patients. These included system-level challenges such as limited access to insurance and social services; practice- and clinician-level barriers including inadequate clinician training; and patient-level factors including less access to family caregivers and perceptions of stigma. To overcome these challenges, clinicians suggested clinical approaches including addressing health-related social needs within healthcare systems; implementing practice-based models that are multi-disciplinary, team-based, and coordinated; training clinicians to effectively manage functional impairment; and expanding community-based services and supports to help patients navigate the medical system. Identified needs, challenges, and solutions were generally similar across geriatricians and PCPs. CONCLUSIONS: Clinicians face challenges in delivering optimal care to middle-aged patients who have functional impairments similar to their older counterparts but lack access to services and supports available to older people. These findings suggest the importance of increasing access to care models that address functional impairment regardless of age.

"I'll fill in the gaps": perspectives of HHAs on promoting aging in place for older adults with low incomes.

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk of nursing home admission. Home health aides (HHAs) may have insight into how to optimize aging in place for this population, yet little is known about HHAs' perspectives on this topic. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs in Pennsylvania and New Jersey. Transcripts were analyzed using qualitative thematic analysis, and three themes emerged. First, HHAs described the uniqueness of their role within multidisciplinary care teams. Second, HHAs shared concrete interventions they employ to help their clients improve their function at home. Third, HHAs discussed barriers they face when helping clients age in place. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and that their perspectives should be incorporated into care planning and intervention delivery.

When Functional Impairment Develops Early: Perspectives from Middle-Aged Adults.

BACKGROUND: Difficulty performing basic daily activities such as bathing and dressing ("functional impairment") affects more than 15% of middle-aged people, and this proportion is increasing. Little is known about the experiences and needs of individuals who develop functional impairment in middle age. OBJECTIVE: To examine the experiences and needs of adults who developed functional impairment in middle age. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: Forty patients aged 50-64 years who developed functional impairment in middle age, recruited from four primary care clinics in San Francisco. APPROACH: Interviews included open-ended questions about participants' daily life, ability to perform activities of daily living (ADLs), and needs related to functional impairment. We analyzed interviews using qualitative thematic analysis. KEY RESULTS: Interviews revealed several themes related to the psychosocial and physical impacts of developing functional impairment in middle age. Participants noted that losses associated with functional impairment, such as loss of independence, control, and social roles, caused conflict in their sense of identity. To cope with these losses, participants used strategies including acceptance, social comparison, adjusting standards, and engaging in valued life activities. Participants reflected on the intersection of their functional impairment with the aging process, noting that their impairments seemed premature compared to the more "natural" aging process in older adults. In terms of physical impacts, participants described how a lack of accommodations in the built environment exacerbated their impairments. While participants used behavioral strategies to overcome these challenges, unmet needs remained, resulting in downstream physical and psychological impacts including safety risks, falls, frustration, and fear. CONCLUSIONS: Unmet psychosocial and physical needs were common among middle-aged adults with functional impairment and led to negative downstream effects. Eliciting and addressing unmet needs may help mitigate downstream health consequences for this growing population, optimizing function and quality of life.

Effect of in vitro digestion on the bioaccessibility and bioactivity of phenolic compounds in fractions of Eugenia pyriformis fruit.

Uvaia is a Brazilian fruit species that has great economic and nutritional potential, in addition to being a good source of compounds of biological interest. In this study, we evaluated for the first time the influence of in vitro gastrointestinal digestion on the bioaccessibility and bioactivity of phenolic compounds from two fractions of uvaia (edible and seed). It was observed that the content of total phenolic compounds was about 3 times higher in the seed (undigested extract), but reduced significantly after intestinal digestion (-50.08%). In turn, the total flavonoid content was about 5 times higher in the undigested seed extract. After intestinal digestion, the flavonoid content increased in the edible fraction (+109.49%) and decreased in the uvaia seed (-70.20%). The heatmap analysis showed that after intestinal digestion, there was an increase in the relative intensity of the flavonoids, while phenolic acids reduced their intensity. The antioxidant capacity of the undigested extract was 4-7 times greater for the seed, but decreased after intestinal digestion (-8.04-27.23%), while the antioxidant capacity of the edible fraction increased by 72.12-107.89% in this same stage of digestion. Thus, the content of phenolic compounds and antioxidant capacity were higher in the uvaia seed, and the bioaccessibility of the bioactive compounds in this fruit were dependent on the fraction and digestive phase evaluated. These results can contribute to the establishment of uvaia as a novel ingredient for preparations with functional claims.

Underutilized plants of the Cactaceae family: Nutritional aspects and technological applications.

This review examines the nutritional and functional aspects of some representatives of the Cactaceae family, as well as its technological potential in the most diverse industrial fields. The studied species are good sources of nutrients and phytochemicals of biological interest, such as phenolic compounds, carotenoids, betalains, phytosterols, tocopherols, etc. They also have shown great potential in preventing some diseases, including diabetes, obesity, cancer, and others. As to technological applications, the Cactaceae family can be explored in the production of food (e.g., cakes, yogurts, bread, ice cream, and juices), as natural dyes, sources of pectins, water treatment and in animal feed. In addition, they have great potential for many technological domains, including food chemistry, pharmacy, biotechnology, and many others.

Antidiabetic potential of dietary polyphenols: A mechanistic review.

Diabetes is a metabolic disorder that has caused enormous harm to the public health worldwide. In this study, we evaluated the potential of phenolic compounds on diabetes management, addressing their mechanisms of action, in addition to discussing the digestion, absorption, metabolism, bioavailability, and toxic effects of these compounds. The intake of phenolic compounds can play a fundamental role on diabetes management, since they can reduce blood glucose levels, oxidative stress, protein glycation, inhibit the activity of dipeptidyl peptidase - IV and other key enzymes related to carbohydrate metabolism, activate various biochemical pathways to improve pancreatic ß-cell functions, increase insulin secretion, and improve insulin resistance. In this way, they can be considered a potential strategy in the development of pharmaceutical approaches that aim to reduce complications resulting from the progression of this metabolic pathology.

Plants from the genus Eugenia as promising therapeutic agents for the management of diabetes mellitus: A review.

This review combined scientific data regarding the use of genus Eugenia plants for the management of diabetes. Diabetes mellitus is a chronic metabolic disease mainly characterized by hyperglycaemia, which can lead to serious health complications. Scientists have been seeking therapeutic compounds in plants, reporting the species of the genus Eugenia as a potential source of phytochemicals with antidiabetic properties. In vitro and in vivo studies have proved that the bioactive compounds in the genus Eugenia can positively affect the biomarkers of diabetes. We discussed the phytochemical profile of the genus Eugenia and its mechanism of action on diabetes, which could modulate carbohydrate metabolism, glucose homeostasis, and insulin secretion, inhibit carbohydrases and reduce oxidative stress, suppressing the formation of advanced glycation end-products and protecting/regenerating pancreatic ß-cells. Therefore, plants of the genus Eugenia showed therapeutic potential to be used in the treatment of diabetes and its comorbidities.

Chemical characterization of Eugenia stipitata: A native fruit from the Amazon rich in nutrients and source of bioactive compounds.

Eugenia stipitata is a fruit native to the Brazilian Amazonian region, belonging to the Myrtaceae family whose chemical composition has been little evidenced. In this study, we evaluated for the first time the nutritional composition, bioactive compounds and antioxidant properties of two fractions of this fruit. It was observed that the edible fraction had a higher content of minerals such as K, Ca and Mg (827.66 ± 14.51; 107.16 ± 1.54; and 75.65 ± 1.28 mg 100 g-1 dw, respectively), sucrose (38.01 ± 2.94 mg g-1 dw), fructose (17.58 ± 0.80 mg g-1 dw), and maltotetraose (1.63 ± 0.09 mg g-1 dw). In this same fraction, about 30 volatile compounds were found, mainly biciclo(3.2.1)octan-3-one, 6 (2-hydroxyethyl)-, endo-; butanoic acid, 2-methyl-, hexyl ester and p-ocimene. In turn, the seed had the highest number of compounds identified by ESI-LTQ-MS/MS (including vanillic acid, gallic acid hexoside, catechin hexoside, luteolin hexoside, among others), higher content of phenolics (142.43 ± 0.82 mg GAE g-1 dw), flavonoids (43.73 ± 0.23 mg CE g-1 dw), and antioxidant capacity (139.59 ± 2.47; 447.94 ± 2.70; and 100.07 ± 10.50 µM TE g-1 dw for DPPH, ABTS, and ORAC, respectively). These results suggest that Eugenia stipitata has excellent nutritional value and great functional potential, and may contribute to a greater commercial exploitation of this fruit, not only in food, but also in the pharmaceutical and cosmetic industries.

Influence of high-intensity ultrasound on color, chemical composition and antioxidant properties of araçá-boi pulp.

In this study, we evaluated the influence of the ultrasound application on five levels of energy density (1000; 3000; 5000 and 7000 J g-1) compared to two pasteurization techniques (70 °C/5 min and 94 °C/0.5 min) on color parameters, polyphenoloxidase activity, chemical composition, and antioxidant properties of araçá-boi pulp. Ultrasound caused changes in the parameters brightness/darkness, hue angle, and total color difference, but did not change chroma, yellowness/blueness, color index, and yellow index. Moreover, this technique was efficient for inactivating polyphenoloxidase. Ultrasound at 7000 J g-1 was responsible for an increase in soluble solids (16%), vitamin C (46.5%), phenolics (15.65%), flavonoids (50%) and antioxidant capacity in relation to untreated pulp, while ultrasound at 5000 J g-1 increased the relative intensity of compounds of biological interest. Thus, ultrasound can be considered as a promising technique to maintain the shelf life, without drastically affecting the nutritional and functional qualities of this fruit.

Polyphenols and their applications: An approach in food chemistry and innovation potential.

Polyphenols are compounds naturally present in fruits and vegetables that are gaining more and more attention due to their therapeutic effects and their potential technological applications. In this review, we intend to demonstrate the importance of some phenolic compounds, addressing their biological effects and potential for applications in various industrial fields. The intake of these compounds in appropriate concentrations can present promising effects in the prevention of diseases such as diabetes, obesity, Parkinson's, Alzheimer's, and others. They can also be used to improve the physicochemical properties of starch, in the preservation of foods, as natural dyes, prebiotic ingredients, hydrogels and nanocomplexes. In addition, these compounds have potential for innovation in the most diverse technological fields, including organic fine chemistry, basic materials chemistry, pharmaceuticals, food chemistry, chemical engineering, etc.

Brazilian fruits of Arecaceae family: An overview of some representatives with promising food, therapeutic and industrial applications.

The Arecaceae family is widely distributed and comprises about 2600 species, in which 48 of them are native to Brazil and occurs in transition biomes between the Amazon, Cerrado and Caatinga. In addition to being used as a source of food and subsistence, they are also rich in lipophilic bioactive compounds, mainly carotenoids, polyunsaturated fatty acids, tocopherols and vitamin A. Moreover, they have considerable content of phenolic compounds, fibers and minerals. Therefore, the objective of this review is to present the physical-chemical and nutritional aspects, the main bioactive compounds, the biological properties and the innovative potential of four Brazilian palm-tree fruits of the Arecaceae family. Due to the presence of bioactive compounds, these fruits have the potential to promote health and can be used to prevent chronic non-communicable diseases, such as obesity, type 2 diabetes and others. Furthermore, these raw materials and their by-products can be used in the development of new food, chemical, pharmaceutical and cosmetic products. To ensure better use of these crops, promote their commercial value, benefit family farming and contribute to the country's sustainable development, it is necessary to implement new cultivation, post-harvest and processing techniques. Investing in research to publicize their potential is equally important, mainly of the ones still little explored, such as the buritirana.

Distribution of nutrients and functional potential in fractions of Eugenia pyriformis: An underutilized native Brazilian fruit.

Uvaia is a Brazilian native species whose fruit has few studies on the nutritional composition and antioxidant properties. In this study, we evaluated for the first time the proximate composition, mineral content, carbohydrate profile, identification of organic compounds, and determination of antioxidant properties in two fractions of this fruit (edible fraction and seed). Edible fraction showed the highest content of ash, lipids, proteins, total fibers, minerals mainly K and Mg (1557.61 and 124.40 mg 100 g-1, respectively), and carbohydrates such as fructose, sucrose, glucose (123.08; 64.40; and 42.39 mg g-1, respectively), and maltotetraose (G4). From the ESI-LTQ-XL-MS/MS analysis, it was possible to identify 22 compounds in the edible fraction and 16 compounds in the uvaia seed, including organic acids, phenolic acids and flavonoids. On the other hand, uvaia seed had the highest content of total phenolics, flavonoids and antioxidant capacity. These results suggest that this fruit has great potential to be used in industry, with emphasis on making food with functional claims.

Will COVID-19 affect food supply in distribution centers of Brazilian regions affected by the pandemic?

BACKGROUND: Currently, there is great concern about the consequences of COVID-19 on health and also on food supply globally. Ceasas are important food distribution centers in Brazil that have great economic importance in Brazilian agribusiness. SCOPE AND APPROACH: In this work, the price of fruits and vegetables sold in four Ceasas in different regions affected by COVID-19 in the first quarter of 2020 were evaluated, with the aim of verifying the possible effects of the pandemic on food supply chains. Data were collected from the institutions' websites and subjected to analysis of variance and Tukey's test (p ≤ 0.05), principal component analysis and Cluster analysis (Euclidean distance). KEY FINDINGS AND CONCLUSIONS: The regions affected by COVID-19 showed great variations in the prices of products sold in the studied Ceasas. Statistical analysis showed that food prices were dependent on the regions and the period in which they were traded. In general, the month of March proved to have the greatest impact on the consumer's pocket. The strengthening of Ceasas as platforms for supplying food from short supply chains is essential to guarantee internal food security during crises such as that caused by the new coronavirus.

A critical review of some fruit trees from the Myrtaceae family as promising sources for food applications with functional claims.

The Myrtaceae family is one of the world's leading commercial fruit tree families. Among the 121 genera belonging to this family, the Syzygium, Eugenia and Campomanesia genera are constituted by a wide variety of fruit species with great potential to be explored economically, besides presenting excellent nutritional value and being considered sources of phytochemicals such as phenolic compounds, carotenoids and volatile compounds. Many of these phytochemicals have been linked to the prevention and management of several chronic and degenerative diseases including cancer, cardiovascular diseases, type 2 diabetes mellitus, obesity, amnesia among other disorders. In this context, this review discusses about the importance of four fruits species representative of Myrtaceae family such as Syzygium cumini, Syzygium malaccense, Eugenia pyriformis and Campomanesia xanthocarpa, focusing on the nutrients and phytochemical constituents as well as demonstrating their biological effects in order to stimulate the cultivation and consumption of these fruits.

Phytochemicals and biological activities of mutamba (Guazuma ulmifolia Lam.): A review.

Guazuma ulmifolia Lam. (Malvaceae), popularly known as mutamba and guácimo, is a tree found in the Latina America, especially in Brazil and Mexico. Mutamba tree has been used as traditional medicine to treat several pathological conditions, such as diarrhoea, coughs, and gastrointestinal and cardiovascular disorders. Phytochemical studies on this plant have resulted in the discovery of secondary metabolites that have shown bioactivities, including antimicrobial, antiprotozoal, antioxidant, and antidiarrheal activities, and cardioprotective effect. The traditional uses of G. ulmifolia have been experimentally proved by in vitro and in vivo studies, in which its bioactivities were associated to its phytochemical composition, mainly proanthocyanidins dimer B and trimer C (condensed tannins). The current review assesses and summarizes the progress about the phytochemical and healthy properties of G. ulmifolia published until 2019. This review intends to present the current knowledge and perspectives about G. ulmifolia and its potential use as food and therapeutic plant.

Bond strengths of various resin cements to different ceramics.

This study evaluates the shear bond strength (SBS) of various resin cements to different ceramics. Composite resin cylinders of Z100 were fabricated and cemented to disks of feldspathic ceramic (Creation), leucite-reinforced feldspathic ceramic (Empress I), and densely sintered aluminum oxide ceramic (Procera AllCeram) using five resin cements: Panavia F (PAN), RelyX ARC (ARC), RelyX Unicem (RXU), RelyX Veneer, and Variolink II. SBS was measured after three days of water storage (baseline) and after artificial aging (180 days of water storage along with 12,000 thermal cycles). Failure mode of fractured specimens also was evaluated. Data were analyzed with Kruskal-Wallis and Mann-Whitney tests (α=0.05). RXU showed 1) the lowest baseline median SBS to feldspathic ceramic, which was not statistically different from PAN; 2) the lowest median baseline SBS to leucite-reinforced feldspathic and densely sintered aluminum-oxide ceramics. All cements performed similarly after aging, except for ARC (median 0.0 MPa) and PAN (median 16.2 MPa) in the densely sintered aluminum-oxide ceramic group. Resin cements perform differently when bonded to different ceramic substrates. While all test resin cements worked similarly in the long-term to feldspathic and leucite-reinforced feldspathic ceramics, only the MDP-containing resin cement provided durable bonds to densely sintered aluminum-oxide ceramic.