Loneliness, ageism and mental wellbeing in nursing homes during the COVID-19 pandemic

16th European Public Health Conference 2023 Our Food, Our Health, Our Earth: A Sustainable Future for Humanity Dublin, Ireland 8-11 November 2023.Background: The measures imposed during the COVID-19 pandemic, especially social distancing, had important effects on feelings of loneliness. The objective of this work is to assess the perception of loneliness in older adults living in nursing homes during the pandemic, how it has changed during the pandemic and its explanatory factors. Methods: The data come from the cross-sectional project "Protective environments of the elderly in health crises", carried out in the Community of Madrid (Spain) in 2021. The variables used were the frequency of feelings of loneliness and its change during the pandemic, as well as socio-demographic, health, emotional and contextual characteristics. Descriptive statistics and logistic regression analysis were calculated. Results: The sample consisted of 447 people; mean age was 83.8; 63.1% were women; half of the sample were widowed; 40% had an educative level lower than primary. Almost 3 out of 10 residents stated that they often or always/almost always felt alone. In the regression model, loneliness was negatively associated with age, number of medications, emotional balance, coping ability, self-perception of aging, and engaging in rewarding activities; while having a low assessment of mobility in the residential environment was positively associated. In addition, 28% of the participants who declared loneliness, also felt lonelier than before the pandemic. The variables associated with change in feelings of loneliness were age, self-perception of aging and a low assessment of the residential environment. Conclusions: The restrictions on mobility and social relationships during the COVID-19 epidemic have affected older people who were living in residences, with an increase in the feeling of loneliness related to demographic, emotional and contextual variables. Interventions on the design of residential spaces can mitigate the effects of isolation and loneliness related to health crises such as COVID-19 pandemic.S

A voz dos bandos: colectivos de justiça e ritos da palavra portuguesa em Timor Leste colonial

Este artigo examina as relações entre o discurso da justiça e a prática do ritual nos bandos do governo colonial português em Timor Leste, entre a segunda metade do século XIX e as primeiras décadas do século XX. Os bandos consistiam em ordens e instruções de comando emanadas pelo governador português em Díli, e comunicadas de forma cerimonial por oficiais às populações dos diversos reinos timorenses dispersos pelo país. Bandos eram um instrumento por excelência de governação colonial dos assuntos indígenas, servindo para arbitrar conflitos, punir transgressões e, em geral, instituir realidades no mundo timorense. Contudo, esta instituição assumiu igualmente uma singular expressão nos usos timorenses, servindo bandos para comunicar também as ordens de autoridades tradicionais, os liurais. O artigo acompanha as variações coloniais e indígenas que os bandos adquiriram em Timor Leste, conceptualizando-os enquanto colectivos de justiça. Ao considerar assim os bandos como colectivos – formações heterogéneas em que elementos linguísticos e não linguísticos se combinam na produção de efeitos de poder sobre as populações – o artigo propõe uma via conceptual alternativa às perspectivas linguísticas e literárias de análise do discurso colonial

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems

Reproducibility of hemodynamic, cardiac autonomic modulation and blood flow assessments in patients with intermittent claudication

Objective: To identify, in patients with peripheral artery disease and intermittent claudication (IC), the reproducibility of heart rate (HR), blood pressure (BP), rate pressure product (RPP), heart rate variability (HRV), and forearm and calf blood flow (BF) and vasodilatory assessments. Methods: Twenty-nine patients with IC underwent test and retest sessions, 8-12 days apart. During each session, HR, BP, HRV, BF and vasodilatory responses were measured by electrocardiogram, auscultation, spectral analysis of HRV (low frequency, LFR-R; high frequency, HFR-R) and strain gauge plethysmography (baseline BF, post-occlusion BF, post-occlusion area under the curve, AUC). Reproducibility was determined by intraclass coefficient correlation (ICC), typical error, coefficient of variation (CV) and limits of agreement. Results: The ICC for HR and BP were > 0.8 with CV 0.9 while CV were 0.9 while CV were < 19%; variable ICC and CV for vasodilatory responses were exhibited for calf (0.653 – 0.770; 35.2 – 37.7%) and forearm (0.169 – 0.265; 46.2 – 55.5%). Conclusions: In male patients with IC, systemic hemodynamic (HR and BP), cardiac autonomic modulation (LFR-R and HFR-R) and forearm and calf baseline BF assessments exhibited excellent reproducibility, whereas the level of reproducibility for vasodilatory responses were moderate to poor. Assessment reproducibility has highlighted appropriate clinical tools for the regular monitoring of disease/intervention progression in patients with IC

Psychosocial factors of resilience: two mixed methodological from four European countries

Building resilient societies in the face of health emergencies requires more than robust infrastructure. In this work, we introduce the psychosocial understanding of resilience: citizens need mental resources to cope with adversity, social cohesion, willingness to follow guidance, and engagement with preparedness behaviours. Next, we present findings from two studies based on the first wave of a longitudinal European survey on preparedness, conducted in the Netherlands, Spain, Slovenia, and Ireland, to explore what preparedness means to individuals at the individual, organisational, and governmental levels. Study 1 investigates how individual responsibility is linked to expectations of employers and governments. For example, if governments provide masks or ensure clean water, citizens may feel less need to prepare personally. We find that respondents in the Netherlands, Spain, and Ireland feel less prepared than those in Slovenia. Slovenians perceive their government as less prepared than themselves, while the reverse is true in the other countries. Analysis of free responses (n = 6740) shows that those who feel prepared cite past experiences and confidence in coping with uncertainty, while those who feel unprepared mention a lack of knowledge. Employer preparedness is often judged by the ability to work from home and the clarity of protocols. Country-specific concerns include financial stress in Ireland, corruption in Spain, and freedom in Slovenia. Study 2 (n = 4725) identifies clusters of individuals based on mental health, resilience, social support, trust in institutions, risk perception, preparedness perception and behaviours. These behavioural insights inform that policies to support mental health, social cohesion and trust in institutions must be tailored across groups and countries with responsibility across the socio-ecological ladder

Worldwide comparison of survival from childhood leukaemia for 1995–2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries

Background Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia. Methods Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0-14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995-99, 2000-04, and 2005-09), sex, and age at diagnosis (< 1, 1-4, 5-9, and 10-14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). Findings We analysed data from 89 828 children from 198 registries in 53 countries. During 1995-99, 5-year agestandardised net survival for all lymphoid leukaemias combined ranged from 10.6% (95% CI 3.1-18.2) in the Chinese registries to 86.8% (81.6-92.0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005-09, when age-standardised survival for lymphoid leukaemias ranged from 52.4% (95% CI 42.8-61.9) in Cali, Colombia, to 91.6% (89.5-93.6) in the German registries, and for AML ranged from 33.3% (18.9-47.7) in Bulgaria to 78.2% (72.0-84.3) in German registries. Survival from precursor-cell ALL was very close to that of all lymphoid leukaemias combined, with similar variation. In most countries, survival from AML improved more than survival from ALL between 2000-04 and 2005-09. Survival for each type of leukaemia varied markedly with age: survival was highest for children aged 1-4 and 5-9 years, and lowest for infants (younger than 1 year). There was no systematic difference in survival between boys and girls. Interpretation Global inequalities in survival from childhood leukaemia have narrowed with time but remain very wide for both ALL and AML. These results provide useful information for health policy makers on the effectiveness of health-care systems and for cancer policy makers to reduce inequalities in childhood survival

Walking training improves systemic and local pathophysiological processes in intermittent claudication

Objective: This study examined the impact of submaximal walking training (WT) on local and systemic nitric oxide (NO) bioavailability, inflammation, and oxidative stress in patients with intermittent claudication (IC). Methods: The study employed a randomised, controlled, parallel group design and was performed in a single centre. Thirty-two men with IC were randomly allocated to two groups: WT (n = 16, two sessions/week, 15 cycles of two minutes walking at an intensity corresponding to the heart rate obtained at the pain threshold interspersed by two minutes of upright rest) and control (CO, n = 16, two sessions/week, 30 minutes of stretching). NO bioavailability (blood NO and muscle nitric oxide synthase [eNOS]), redox homeostasis (catalase [CAT], superoxide dismutase [SOD], lipid peroxidation [LPO] measured in blood and muscle), and inflammation (interleukin-6 [IL-6], C-reactive protein [CRP], tumour necrosis factor α [TNF-α], intercellular adhesion molecules [ICAM], vascular adhesion molecules [VCAM] measured in blood and muscle) were assessed at baseline and after 12 weeks. Results: WT statistically significantly increased blood NO, muscle eNOS, blood SOD and CAT, and muscle SOD and abolished the increase in circulating and muscle LPO observed in the CO group. WT decreased blood CRP, ICAM, and VCAM and muscle IL-6 and CRP and eliminated the increase in blood TNF-α and muscle TNF-α, ICAM and VCAM observed in the CO group. Conclusion: WT at an intensity of pain threshold improved NO bioavailability and decreased systemic and local oxidative stress and inflammation in patients with IC. The proposed WT protocol provides physiological adaptations that may contribute to cardiovascular health in these patients

Walking Training Increases microRNA-126 Expression and Muscle Capillarization in Patients with Peripheral Artery Disease

Patients with peripheral artery disease (PAD) have reduced muscle capillary density. Walking training (WT) is recommended for PAD patients. The goal of the study was to verify whether WT promotes angiogenesis in PAD-affected muscle and to investigate the possible role of miRNA-126 and the vascular endothelium growth factor (VEGF) angiogenic pathways on this adaptation. Thirty-two men with PAD were randomly allocated to two groups: WT (n = 16, 2 sessions/week) and control (CO, n = 16). Maximal treadmill tests and gastrocnemius biopsies were performed at baseline and after 12 weeks. Histological and molecular analyses were performed by blinded researchers. Maximal walking capacity increased by 65% with WT. WT increased the gastrocnemius capillary-fiber ratio (WT = 109 ± 13 vs. 164 ± 21 and CO = 100 ± 8 vs. 106 ± 6%, p < 0.001). Muscular expression of miRNA-126 and VEGF increased with WT (WT = 101 ± 13 vs. 130 ± 5 and CO = 100 ± 14 vs. 77 ± 20%, p < 0.001; WT = 103 ± 28 vs. 153 ± 59 and CO = 100 ± 36 vs. 84 ± 41%, p = 0.001, respectively), while expression of PI3KR2 decreased (WT = 97 ± 23 vs. 75 ± 21 and CO = 100 ± 29 vs. 105 ± 39%, p = 0.021). WT promoted angiogenesis in the muscle affected by PAD, and miRNA-126 may have a role in this adaptation by inhibiting PI3KR2, enabling the progression of the VEGF signaling pathway

Low-intensity resistance exercise does not affect cardiac autonomic modulation in patients with peripheral artery disease

OBJECTIVE: To analyze the effect of a single bout of resistance exercise on cardiac autonomic modulation in patients with peripheral artery disease. METHODS: Fifteen patients with peripheral artery disease (age: 58.3±4.0 years) underwent the following sessions in a random order: resistance exercise (three sets of 10 repetitions of the six resistance exercises with a workload of 5-7 in the OMNI-RES scale) and control (similar to the resistance session; however, the resistance exercises were performed with no load). The frequency domain (low frequency, high frequency and sympathovagal balance) and symbolic analysis (0V, 1V and 2V patterns) of heart rate variability were obtained before and until one hour after the interventions. RESULTS: After the resistance exercise and control sessions, similar increases were observed in the consecutive heartbeat intervals (control: 720.8±28.6 vs. 790.9±34.4 ms; resistance exercise: 712.9±30.1 vs. 756.8±37.9 ms;

Corrida em esteira e exercícios de força: efeitos agudos da ordem de realização sobre a hipotensão pós-exercício

Este estudo analisou as respostas de pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD) após duas sessões de exercício concorrente realizado em diferentes ordens [aeróbio-força (AF), e força-aeróbio (FA)]. Quinze indivíduos normotensos foram submetidos a duas sessões de exercício realizadas em dias distintos na seguinte sequência AF e FA. A PAS e PAD foram medidas antes e a cada 15 min durante 60 min de recuperação pós-exercício. Houve hipotensão pós-exercício (HPE) para PAS, aos 30 min (-7,4 mmHg), 45 min (-12,14 mmHg) e 60 min (-15,14 mmHg) de recuperação na sessão AF. Já na FA houve HPE apenas aos 60 min (-8,34 mmHg) de recuperação. A variação da PAS e PAD entre as sessões revelou HPE maior aos 15 min, 45 min e 60 min na PAS; e aos 45 min na PAD comparando-se AF a FA. A realização de exercício aeróbio antes do de força resultou em maior HPE para adultos jovens