Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: A nationwide multicenter study in Brazil

Objective: To determine the prevalence of patients with type 1 diabetes mellitus who meet the glycemic and cardiovascular (CV) risk factors goals and the frequency of screening for diabetic complications in Brazil according to the American Diabetes Association guidelines. Research design and methods: This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 1774 adult patients (56.8% females, 57.2% Caucasians) aged 30.3 +/- 9.8 years with diabetes duration of 14.3 +/- 8.8 years. Results: Systolic blood pressure was at goal in 40.3% and diastolic blood pressure was at goal in 26.6% of hypertensive patients. LDL cholesterol and HbA1c were at the goal in 45.2% and 13.2% of the patients, respectively. Overweight was presented in 25.6% and obesity in 6.9%. Among those with more than 5 years of disease, screening for retinopathy was performed in the preceding year in 70.1%. Nephropathy and feet complications were screened in 63.1% and 65.1%, respectively. Conclusions: The majority of patients did not meet metabolic control goals and a substantial proportion was not screened for diabetic complications. These issues may increase the risk of chronic complications and negatively impact public health. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Risk factors for magnetic resonance imaging-detected patellofemoral and tibiofemoral cartilage loss during a six-month period: The Joints On Glucosamine study

Objective To assess several baseline risk factors that may predict patellofemoral and tibiofemoral cartilage loss during a 6-month period. Methods For 177 subjects with chronic knee pain, 3T magnetic resonance imaging (MRI) of both knees was performed at baseline and followup. Knees were semiquantitatively assessed, evaluating cartilage morphology, subchondral bone marrow lesions, meniscal morphology/extrusion, synovitis, and effusion. Age, sex, and body mass index (BMI), bone marrow lesions, meniscal damage/extrusion, synovitis, effusion, and prevalent cartilage damage in the same subregion were evaluated as possible risk factors for cartilage loss. Logistic regression models were applied to predict cartilage loss. Models were adjusted for age, sex, treatment, and BMI. Results Seventy-nine subregions (1.6%) showed incident or worsening cartilage damage at followup. None of the demographic risk factors was predictive of future cartilage loss. Predictors of patellofemoral cartilage loss were effusion, with an adjusted odds ratio (OR) of 3.5 (95% confidence interval [95% CI] 1.39.4), and prevalent cartilage damage in the same subregion with an adjusted OR of 4.3 (95% CI 1.314.1). Risk factors for tibiofemoral cartilage loss were baseline meniscal extrusion (adjusted OR 3.6 [95% CI 1.310.1]), prevalent bone marrow lesions (adjusted OR 4.7 [95% CI 1.119.5]), and prevalent cartilage damage (adjusted OR 15.3 [95% CI 4.947.4]). Conclusion Cartilage loss over 6 months is rare, but may be detected semiquantitatively by 3T MRI and is most commonly observed in knees with Kellgren/Lawrence grade 3. Predictors of patellofemoral cartilage loss were effusion and prevalent cartilage damage in the same subregion. Predictors of tibiofemoral cartilage loss were prevalent cartilage damage, bone marrow lesions, and meniscal extrusion.

The use of nasal dilator strips as a placebo for trials evaluating continuous positive airway pressure

OBJECTIVES: The aim of the current study was to compare the objective and subjective effects of continuous positive airway pressure to the use of nasal dilator strips in patients with acromegaly and moderate to severe obstructive sleep apnea. METHODS: We studied 12 patients with acromegaly and moderate to severe obstructive sleep apnea (male/females = 8/4, age = 52 +/- 8 ys, body mass index = 33.5 +/- 4.6 Kg/m(2), apnea-hypopnea index = 38 +/- 14 events/h) who had been included in a randomized, crossover study to receive three months of treatment with continuous positive airway pressure and nasal dilator strips. All patients were evaluated at study entry and at the end of each treatment by polysomnography, and Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and treatment satisfaction questionnaires. ClinicalTrials.gov: NCT01265121 RESULTS: The apnea-hypopnea index values decreased significantly with continuous positive airway pressure treatment but did not change with the use of nasal dilator strips. All of the subjective symptoms improved with both treatments, but these improvements were significantly greater with continuous positive airway pressure than with the nasal dilator strips. CONCLUSION: The use of nasal dilator strips had a much smaller effect on the severity of obstructive sleep apnea in patients with acromegaly and moderate to severe obstructive sleep apnea in comparison to the use of continuous positive airway pressure. Moreover, the improvement in several subjective parameters without any significant objective improvement in obstructive sleep apnea resulting from the use of nasal dilator strips is compatible with a placebo effect.

The dynamical state of galaxy groups and their luminosity content

We analyse the dependence of the luminosity function (LF) of galaxies in groups on group dynamical state. We use the Gaussianity of the velocity distribution of galaxy members as a measurement of the dynamical equilibrium of groups identified in the Sloan Digital Sky Survey Data Release 7 by Zandivarez & Martinez. We apply the Anderson-Darling goodness-of-fit test to distinguish between groups according to whether they have Gaussian or non-Gaussian velocity distributions, i.e. whether they are relaxed or not. For these two subsamples, we compute the (0.1)r-band LF as a function of group virial mass and group total luminosity. For massive groups, , we find statistically significant differences between the LF of the two subsamples: the LFs of groups that have Gaussian velocity distributions have a brighter characteristic absolute magnitude (similar to 0.3 mag) and a steeper faint-end slope (similar to 0.25). We detect a similar effect when comparing the LF of bright [M-0.1r(group) - 5log(h) < -23.5] Gaussian and non-Gaussian groups. Our results indicate that, for massive/luminous groups, the dynamical state of the system is directly related to the luminosity of its galaxy members.

STATE INSTITUTIONS, POWER, AND SOCIAL NETWORKS IN BRAZILIAN URBAN POLICIES

A large historiographic tradition has studied the Brazilian state, yet we know relatively little about its internal dynamics and particularities. The role of informal, personal, and unintentional ties has remained underexplored in most policy network studies, mainly because of the pluralist origin of that tradition. It is possible to use network analysis to expand this knowledge by developing mesolevel analysis of those processes. This article proposes an analytical framework for studying networks inside policy communities. This framework considers the stable and resilient patterns that characterize state institutions, especially in contexts of low institutionalization, particularly those found in Latin America and Brazil. The article builds on research on urban policies in Brazil to suggest that networks made of institutional and personal ties structure state organizations internally and insert them,into broader political scenarios. These networks, which I call state fabric, frame politics, influence public policies, and introduce more stability and predictability than the majority of the literature usually considers. They also form a specific power resource-positional power, associated with the positions that political actors occupy-that influences politics inside and around the state.

The perception of sleep quality in kidney transplant patients during the first year of transplantation

OBJECTIVE: Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant recipients and analyze the variables affecting sleep quality in the first years after renal transplantation. METHODS: Kidney transplant recipients were evaluated at two time points after a successful transplantation: between three and six months (Phase 1) and between 12 and 15 months (Phase 2). The following tools were used for assessment: the Pittsburgh Sleep Quality Index; the quality of life questionnaire Short-Form-36; the Hospital Anxiety and Depression scale; the Karnofsky scale; and assessments of social and demographic data. The prevalence of poor sleep was 36.7% in Phase 1 and 38.3% in Phase 2 of the study. RESULTS: There were no significant differences between patients with and without changes in sleep quality between the two phases. We found no changes in sleep patterns throughout the study. Both the physical and mental health scores worsened from Phase 1 to Phase 2. CONCLUSION: Sleep quality in kidney transplant recipients did not change during the first year after a successful renal transplantation.

SLEEP QUALITY OF OBESE WORKERS OF A TEACHING HOSPITAL: ACUPUNCTURE AS A COMPLEMENTARY THERAPY

The objective of this study was to verify the effect of acupuncture on the sleep quality of obese workers in a teaching hospital. Data were collected from July to October 2009, focusing on 37 workers who attended eight weekly acupuncture sessions. The Pittsburgh Sleep Quality Index was used to assess their sleep quality before and after the intervention. Results show that before the intervention, five (13.5%) people experienced good quality of sleep whereas at the end of the study 14 (37.8%) showed this condition. Statistic significance (p=0.0001) was found in comparing the mean scores obtained before and after acupuncture. Acupuncture had effects on the quality of sleep in the studied sample, presenting itself as a complementary technique for treating sleep disorders and consequently improving the quality of life in this population.

New molecular targets for PET and SPECT imaging in neurodegenerative diseases

The pathophysiology of neurodegenerative diseases (ND) such as Alzheimer's disease (AD) and Parkinson's disease (PD) has not yet been completely elucidated. However, in the past few years, there have been great knowledge advances about intra-and extracellular proteins that may display impaired function or expression in AD, PD and other ND, such as amyloid beta (AB), alpha-synuclein, tau protein and neuroinfiammatory markers. Recent developments in the imaging techniques of positron emission tomography (PET) and single photon emission computed tomography (SPECT) now allow the non-invasive tracking of such molecular targets of known relevance to ND in vivo. This article summarizes recent findings of PET and SPECT studies using these novel methods, and discusses their potential role in the field of drug development for ND as well as future clinical applications in regard to differential diagnosis of ND and monitoring of disease progression.

THE SLOAN DIGITAL SKY SURVEY CO-ADD: A GALAXY PHOTOMETRIC REDSHIFT CATALOG

We present and describe a catalog of galaxy photometric redshifts (photo-z) for the Sloan Digital Sky Survey (SDSS) Co-add Data. We use the artificial neural network (ANN) technique to calculate the photo-z and the nearest neighbor error method to estimate photo-z errors for similar to 13 million objects classified as galaxies in the co-add with r < 24.5. The photo-z and photo-z error estimators are trained and validated on a sample of similar to 83,000 galaxies that have SDSS photometry and spectroscopic redshifts measured by the SDSS Data Release 7 (DR7), the Canadian Network for Observational Cosmology Field Galaxy Survey, the Deep Extragalactic Evolutionary Probe Data Release 3, the VIsible imaging Multi-Object Spectrograph-Very Large Telescope Deep Survey, and the WiggleZ Dark Energy Survey. For the best ANN methods we have tried, we find that 68% of the galaxies in the validation set have a photo-z error smaller than sigma(68) = 0.031. After presenting our results and quality tests, we provide a short guide for users accessing the public data.

Sleep in patients with large pleural effusion: impact of thoracentesis

This study aimed to evaluate the sleep quality and impact of thoracentesis on sleep in patients with a large pleural effusion. Patients with large unilateral pleural effusion were evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire and dyspnea Borg scale. Full polysomnography (PSG) was performed on the night before and 36 h after thoracentesis. We studied 19 patients, 11 males and 8 females, age 55 +/- 18 years and body mass index of 26 +/- 5 kg/m(2). The baseline sleep quality was poor (PSQI = 9.1 +/- 3.5). Thoracentesis removed 1.624 +/- 796 mL of pleural fluid and resulted in a significant decrease in dyspnea Borg scale (2.3 +/- 2.1 vs. 0.8 +/- 0.9, p < 0.001). The PSG before and after thoracentesis showed no significant change in apnea-hypopnea index and sleep time with oxygen saturation < 90%. There was a significant improvement in sleep efficiency (76% vs. 81%, p = 0.006), decrease percent sleep stage 1 (16% vs. 14%, p = 0.002), and a trend improvement in total sleep time (344 +/- 92 vs. 380 +/- 69 min, p = 0.056) and percentage of rapid eye movement sleep (15% vs. 20%, p = 0.053). No significant changes occurred in six patients that performed two consecutive PSG before thoracentesis. The improvement in sleep quality was not associated with the volume of pleural fluid withdrawn or changes in dyspnea. Patients with large pleural effusion have poor subjective and objective sleep quality that improves after thoracentesis.

Women's Poorer Satisfaction With Their Sex Lives Following Gynecologic Cancer Treatment

Gynecologic cancer treatment can lead to anatomical changes in the genitalia that may impair sexual response. As a result, the authors aimed to assess women's self-perceptions of their sex lives following gynecologic cancer treatment and the impact of such treatment on sexual function. Thirty sexually active women were examined. At the first meeting with a physician sex therapist, women were asked about their satisfaction with their sexual activities prior to and after gynecologic cancer treatment, either with a partner or alone, and how many times per month they had sexual intercourse prior to the cancer diagnosis and after treatment. Women reported significantly worse sex lives and a significantly lower frequency of sexual relations following cancer treatment. All participants reported pain on vaginal penetration and feeling uncomfortable in discussing their sexual difficulties with the oncologist. The findings show that women experienced impaired sexual function, as well as poorer quality of sexual function, following gynecologic cancer treatment. Nurses should provide basic guidelines about sexual function to all patients who undergo treatment for gynecologic cancer.

Qualidade de sono de trabalhadores obesos de um hospital universitário: acupuntura como terapia complementar

O objetivo do estudo foi verificar o efeito da acupuntura na qualidade de sono de trabalhadores obesos em um hospital universitário. Os dados foram coletados no período de julho a outubro de 2009, junto a 37 funcionários, submetidos a oito aplicações semanais de acupuntura. O Índice de Qualidade de Sono de Pittsburgh foi utilizado para identificar a qualidade de sono dos sujeitos antes e após a intervenção. Os resultados mostram que antes da intervenção cinco (13,5%) pessoas apresentaram boa qualidade de sono e, ao final da intervenção, 14 (37,8%) relataram este quadro. A diferença obtida na comparação das médias dos escores obtidos antes e após a acupuntura foi significativa (p=0,0001). Concluiu-se que a acupuntura produziu um efeito positivo sobre a qualidade do sono na amostra estudada, apresentando-se como uma técnica adjuvante no tratamento dos distúrbios do sono e consequentemente na melhoria da qualidade de vida desta população.

Melhora da dor, do cansaço e da qualidade subjetiva do sono por meio de orientações de higiene do sono em pacientes com fibromialgia

OBJETIVO: Avaliar a efetividade das orientações para higiene do sono em mulheres portadoras de fibromialgia. MATERIAIS E MÉTODOS: Setenta mulheres completaram o estudo. Na avaliação foram aplicados o Questionário de Impacto da Fibromialgia(FIQ), o Índice de Qualidade do Sono de Pittsburgh (PSQI) e um questionário geral, com dados pessoais e informações de hábitos de vida. Todas as pacientes receberam informações quanto à doença, além de um diário do sono, e apenas o grupo-experimental recebeu orientações para higiene do sono. Foi solicitado às pacientes que realizassem a higiene do sono, e as mesmas foram reavaliadas após três meses. RESULTADOS: A idade média das pacientes do grupo-controle foi 55,2 ± 7,12 anos, e a do grupo-experimental foi 53,5 ± 8,89 anos (P = 0,392). Nessas pacientes foram observadas diminuições da medida de Escala Visual Analógica de dor (P = 0,028), de cansaço (P = 0,021) e do componente 1 do PSQI (P = 0,030). O grupo que recebeu orientações para higiene do sono mostrou redução significativa na dificuldade de retorno ao sono quando acordava de madrugada (P = 0,031). O grupo-experimental apresentou aumento na porcentagem de relatos de "ambiente sem ruído" (variando de 42,9% para 68,6%), diminuição da porcentagem de relatos de "ambiente com pouco ruído" (variando de 40% para 22,9%) e diminuição na porcentagem de relatos de "ambiente com muito ruído" (variando de 17,1% para 8,6%). As alterações facilitaram o retorno ao sono quando as pacientes acordavam durante a madrugada. CONCLUSÃO: Uma cartilha com orientações de higiene do sono permitiu a alteração do comportamento das pacientes, que obtiveram melhora da dor e do cansaço, aumento da qualidade subjetiva do sono, além de facilitação do retorno ao sono após despertar durante a madrugada.

Mastopexia após perda ponderal maciça: suspensão dérmica, remodelação do parênquima e aumento com tecido autógeno

INTRODUÇÃO: Pacientes com perda ponderal significativa podem apresentar mamas com ptose acentuada, perda de projeção do polo superior e excesso de tecido na porção toracolateral. Rubin & Khachi descreveram técnica de mastopexia com suspensão dérmica e remodelação do parênquima associada a aumento com tecido autógeno, tratando a deformidade mamária e o excesso toracolateral em um só estágio. Neste trabalho, é ilustrada essa técnica cirúrgica e demonstradas sua reprodutibilidade e suas complicações. MÉTODO: Foram operadas 14 pacientes com deformidade graus 2 e 3 pela Escala de Pittsburgh, no Hospital Estadual de Sapopemba (São Paulo, SP, Brasil), no período de dezembro de 2008 a dezembro de 2009, utilizando a técnica referida. Foram analisados os seguintes dados: tipos de deformidade das mamas, translocação do complexo areolopapilar (CAP), dimensões dos retalhos, tempo cirúrgico, tempo de permanência do dreno e incidência de complicações. RESULTADOS: A média de idade das pacientes foi de 41,21 + 7,67 anos e o índice de massa corporal médio foi de 29,30 + 2,77. O tempo de seguimento das pacientes variou de 3 meses a 18 meses, com média de 8 meses. Dentre as 14 pacientes operadas, 4 (28,6%) apresentavam deformidade grau 3 e 10 (71,4%), grau 2. A média de translocação do CAP foi de 6,38 cm. As dimensões médias do retalho foram de 25,21 cm x 6,92 cm. O tempo cirúrgico médio foi de 188,57 minutos. Os drenos permaneceram, em média, por 6,21 dias. Foram observadas as seguintes complicações: epiteliose de CAP, deiscência na junção do T, hematoma pequeno e linfedema toracolateral. CONCLUSÕES: A mastopexia com suspensão dérmica, remodelação do parênquima e aumento com tecido autólogo é uma técnica reprodutível, rápida e com baixo índice de complicações.