Daniela Brandão

β-Adrenergic modulation of cancer cell proliferation: available evidence and clinical perspectives

PurposeIn this review, we aimed to present and discuss the available preclinical and epidemiological evidences regarding the modulation of cancer cell proliferation by β-adrenoceptors (β-AR), with a specific focus on the putative effects of β-blockers according to their pharmacological properties.MethodsA comprehensive review of the published literature was conducted, and the evidences concerning the involvement of β-AR in cancer as well as the possible role of β-blockers were selected and discussed.ResultsThe majority of reviewed studies show that: (1) All the cancer types express both β1- and β2-AR, with the exception of neuroblastoma only seeming to express β2-AR; (2) adrenergic agonists are able to increase proliferation of several types of cancers; (3) the proliferative effect seems to be mediated by both β1- and β2-AR; (4) binding to β-AR results in a cAMP transient flux which activates two major downstream effector systems: protein kinase A and EPAC and (5) β-blockers might be putative adjuvants for cancer treatment.ConclusionsOverall, the reviewed studies show strong evidences that β-AR activation, through several intracellular mechanisms, modulate tumor cell proliferation suggesting β-blockers can be a feasible therapeutic approach to antagonize β-adrenergic response or have a protective effect per se. This review highlight the need for intensifying the research not only on the molecular mechanisms underlying the β-adrenergic influence in cancer, but also on the implications of biased agonism of β-blockers as potential antitumor agents.

Health Status, Living Arrangements, and Service Use at 100: Findings From the Oporto Centenarian Study.

ABSTRACT This paper describes the sociodemographic characteristics, health status, and service use of centenarians living in the community and centenarians residing in an elder care facility/nursing home and examines their main differences. Participants were 140 centenarians from the population-based Oporto Centenarian Study (Mage = 101.2; SD = 1.6). Main findings revealed that the majority of the centenarians lived at home with their family members (57.9%). Increased health care needs, living alone, and family caregiving constraints were the most common reasons for entering a nursing home. Community-dwelling centenarians were cared for mostly by their children and were less dependent and in better cognitive health than those who resided in a nursing home. Differences were found in the pattern of health service use according to the centenarians’ residence, ability to pay medical expenses, and dependency level. Findings highlight the need for an accurate assessment of caregiving support systems, particularly family intergenerational duties, and of the factors constraining the access and use of health and social services. Policy makers may be guided by the insights gained from this research and work toward improvement of support options and removal of barriers to service access.

Underuse and Unawareness of Residential Respite Care Services in Dementia Caregiving: Constraining the Need for Relief

This article describes an analysis of the use of residential respite care services and the factors that influence the use of such services among informal caregivers of people with dementia. The authors studied a sample of 223 caregivers participating in a community-based intervention project in northern Portugal. Participants provided information on their overall caregiving situation and on their use or willingness to use respite care services. Results showed that fewer than 6 percent of caregivers accessed the services and that although most caregivers were not familiar with these services, they recognized their importance and strongly considered the possibility of using them. Part-time care, lower levels of gratification, higher burden, and the care receivers attendance of day center supported the willingness to use residential respite services. The limited offer, not knowing about the services, and cultural issues related to the family duties within the caregiving role can explain the low use of these services. Social work professionals have an important role in promoting residential respite care services, and thereby helping to reduce caregiving overload.

Hospital admissions by the oldest old: Past trends in one of the most ageing countries in the world

To examine discharges of octogenarians, nonagenarians and centenarians from Portuguese public hospitals, namely admission type, principal diagnoses, comorbidities and length of stay.

Hospital bronchoscopy-related pseudo-outbreak caused by a circulating Mycobacterium abscessus subsp. massiliense

Adolfo Lutz Institute in Sao Paolo State performs mycobacterial identification for many healthcare units, and in 2008 identified a possible outbreak involving patients submitted to bronchoscopy at the same hospital. This study aimed to analyse the clonality of isolates. Mycobacterium abscessus subsp. massiliense isolated from 28 patients, water from one bronchoscope and water from four automated endoscope reprocessing machines presented high similarity by pulsed-field gel electrophoresis. This strain was not found in the water supply, and it was hypothesized that an infected patient contaminated the bronchoscope, with further false-positive cultures from subsequent patients.

Pathways after inpatient admission in very advanced age: A Portuguese nationwide study

INTRODUCTION Oldest old patients often have complex and multiple medical conditions, which are associated with higher rates of use of healthcare services, and a higher risk of experiencing adverse outcomes, such as mortality. This study investigated (a) the in-hospital mortality rate and predictors in patients aged 80+; (b) the destination patients have after hospital discharge. METHODS Nationwide study. All inpatient admissions by individuals aged 80 years and older between 2011 and 2014 in Portugal were considered. Exploratory descriptive analyses of data regarding in-hospital mortality and destination after discharge were performed; multivariate logistic regression analyses were conducted to identify predictors of in-hospital mortality. RESULTS A total of 614,807 episodes of hospital admissions were analysed. A mortality rate of 15.4% was observed. In the majority of episodes, patients returned home (78.6%). Increased age, male gender, increased length of stay, unplanned attendance, medical DRG type, increased severity of illness and mortality risk, and comorbidities were significant predictors of in-hospital mortality. DISCUSSION This study strengthens the importance of implementing health policies specifically to the oldest old, namely with the promotion of the use of primary care services. That would expectably concur to a better management of the most common medical conditions in this population, and a decrease in hospital unplanned attendances.