Subjective versus objective stress in noncritically ill hospitalized and outpatient adult men

A cross-sectional study of 120 subjects was performed with the purpose of evaluating stress hormones and emotional stress (anxiety) in outpatient and hospitalized subjects. The aims were to determine the degree of objective stress, as well as to correlate this finding with subjective findings, estimated using Beck's Anxiety Inventory.. METHOD: Three populations were investigated, namely outpatient clinical cases (Group I, n = 30), hospitalized clinical individuals (Group II, n = 30), and hospitalized surgical candidates (Group III, n = 30). Controls (Group IV, n = 30) were healthy volunteers who were health-care professionals and students. To avoid hormone interactions, only men were enrolled in all groups. All hospitalized subjects were tested on admission and before therapeutic interventions. Fasting epinephrine, norepinephrine, and cortisol were measured in the morning, and Beck's Anxiety Inventory was adminstered by a trained psychologist. RESULTS: The 3 patient groups displayed higher anxiety levels than the controls. Hormone concentrations did not present remarkable changes and did not correlate with subjective stress (anxiety). CONCLUSIONS: 1) Subjective disorders (as determined with Beck's Anxiety Inventory ) were a common finding in both outpatient and hospitalized populations, without differences between the various groups; 2) Objective stress (as determined by elevated hormone levels) was more difficult to confirm-findings rarely exceeded the reference range; 3) Correlation between the two variables could not be demonstrated; 4) Further studies are necessary to define stress quantification and interpretation in patient populations, especially in relationship with nutritional diagnosis and dietetic prescription.

The best infertility treatment for vasectomized men: assisted reproduction or vasectomy reversal?

In men with prior vasectomy, microsurgical reconstruction of the reproductive tract is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if the obstructive interval is less than 15 years and no female fertility risk factors are present. If epididymal obstruction is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment.

Perfil antropométrico de mulheres adultas da área urbana e rural no município de Barcelos, AM

De um total de 203 mulheres adultas entrevistadas, foram avaliadas 175 (entre 16 a 73 anos), por meio de medidas antropométricas: peso, altura, prega cutânea tricipital (PCT), circunferência braquial (CB), circunferência muscular (CMB) e Índice de Massa Corpórea (IMC). Das mulheres analisadas, 84,0% (n=147) residiam na zona urbana e 16,0% (n=28) na zona rural. Verificou-se que o peso médio das mulheres não nutrizes residentes na área urbana foi de 54,1 kg; altura de 149,0 cm e o IMC de 24,4 kg/m², enquanto que a PCT, CB e a CMB forneceram valores médios de 19,2 mm, 27,5 cm e 21,5 cm, respectivamente. Na área rural, as mulheres apresentaram um peso médio de 50,4 kg, altura de 148,6 cm, IMC de 23,0 kg/cm² e a PCT, CB e a CMB foram 13,8 mm, 26,4 cm e 22,1 cm, respectivamente. Houve diferença estatisticamente significativa apenas nos valores médios da PCT entre as mulheres procedentes da área urbana e rural (p<0,05). Nas mulheres da área urbana, a ocorrência de baixo peso foi de 6,5%, 28,2% de sobrepeso e 11,3% de obesidade. Nas mulheres da área rural, a prevalência de baixo peso e obesidade foi de 4% e de sobrepeso de 16%. A maioria da população estudada situou-se no limite máximo de normalidade do IMC, e os índices representantes das reservas adiposas (PCT) foram maiores nas mulheres residentes na área urbana.

Diversity of sand flies in domiciliary environment of Santarém, state of Pará, Brazil: species composition and abundance patterns in rural and urban areas

This paper aimed to evaluate the richness, abundance and frequency of sand fly occurrence in rural and urban areas American visceral Leishmaniasis -AVL is endemic in the study area of Santarém municipality, Pará state. Sand flies were collected during 1995-2000, using CDC light traps placed in neighborhoods and rural areas of the municipality. A total of 53.454 individuals and 26 species of sand flies were collected. The most abundant species in both urban and rural environments was Lutzomyia longipalpis, vector of AVL in the area. The highest species richness by capture was in rural area. In all years sampled, the largest number of species of sand fly collected was always in rural areas. The species of sand flies in urban and rural area were similar in 11 species. In the rural area other 11 species were found, a total of 22 species. Shannon-Wiener index ranged from 0.12 to 0.84 at rural areas and 0.08 to 0.34 at urban ones. In general, rural localities showed higher diversity (H') of phlebotomines than urban ones. Individual-based rarefaction curves for each area demonstrated that urban localities had the lowest expected number of phlebotomine species and the richest rural ones reach higher expected values with lower amount of individuals than urban sites. The most frequent species were Lutzomyia longipalpis, Evandromyia carmelinoi and Bichromomyia flaviscutellata.

Difference in the in-hospital mortality of unstable angina pectoris between men and women

PURPOSE: To assess differences in the in-hospital mortality (HM) rate between men and women with unstable angina pectoris (UA) according to age, depression of the ST segment, history of previous acute myocardial infarction (AMI), and risk factors for coronary heart disease. METHODS: From October 96 to March 98, 261 patients with UA were selected. Logistic regression models were developed to adjust the association between sex and HM for possible influence of covariables, such as hypertension, diabetes mellitus, dyslipidemia, sedentary lifestyle, smoking, and familial history of early coronary heart disease. RESULTS: HM due to UA was approximately three times higher in women (9.3%; 12/129) than in men (3.0%; 4/132) accounting for a relative risk of 3.07; 95% confidence interval (CI) =1.02-9.27. In logistic regression models, the association between sex and death was not significantly altered when the following parameters were considered: age, depression of the ST segment, history of previous AMI and risk factors for coronary heart disease. The nonadjusted and adjusted odds ratio (OR) for the distinct covariables were 3.28 (CI 95%=1.03-10.45) and 3.14 (CI = 95% = 0.88-11.20), respectively. CONCLUSION: Similarly to AMI, HM in UA is higher in women than in men. Age, risk factors for coronary heart disease, and depression of the ST segment in the electrocardiogram on patients' admission to the hospital did not significantly influence the association between sex and death.

Assessment of cardiovascular risk factors in a rural community in the Brazilian state of Bahia

OBJECTIVE: To assess the frequency of cardiovascular risk factors in the rural community of Cavunge, in the Brazilian state of Bahia. METHODS: A cross-sectional study was carried out with 160 individuals (age > 19 years) randomly drawn from those listed in the population census of the Cavunge Project. The following parameters were studied: arterial hypertension, dyslipidemia, diabetes, obesity, smoking, waist-hip ratio (WHR), physical activity, and overall cardiovascular risk classified according to the Framingham score. The assessing parameters used were those established by the III Brazilian Consensus on Hypertension and the II Brazilian Consensus on Dyslipidemia. RESULTS: Of the randomly drawn individuals, 126 with a mean age of 46.6 + 19.7 years were included in the study, 43.7% of whom were males. The frequency of arterial hypertension was 36.5%; 20.4% of the individuals had cholesterol levels >240 mg/dL; 31.1% of the individuals had LDL-C levels > 130 mg/dL; 4% were diabetic; and 39.7% had a high-risk Framingham score. Abdominal obesity was observed in 41.3% of the population and in 57.7% of the females. High caloric-expenditure (HCE) physical activities were performed by 56.5% of the individuals. The HCE group had a greater frequency of normal triglyceride levels (63% vs 44%; P=0.05), no diabetes, and WHR tending towards normal (46% vs 27%, P=0.08) as compared with those in the low caloric-expenditure group. CONCLUSION: Cardiovascular risk factors, such as hypertension and hypercholesterolemia, are frequently found in rural communities. The greatest frequency of normal triglyceride levels and normal WHR in the HCE group reinforces the association between greater caloric expenditure and a better risk profile.

Associação entre obesidade central, triglicerídeos e hipertensão arterial em uma área rural do Brasil

FUNDAMENTO: A hipertensão, importante problema de saúde pública, representa uma das principais causas de morbidade em todo o mundo. OBJETIVO: Estimar a prevalência da hipertensão arterial e seus fatores de risco em uma comunidade rural do nordeste do estado de Minas Gerais, Brasil. MÉTODOS: Estudo transversal realizado em 2004, em Virgem das Graças, comunidade rural localizada no Vale do Jequitinhonha. A amostra era composta por 287 indivíduos, com idades entre 18 e 88 anos. Hipertensão foi definida segundo os critérios da Joint National Committee (pressão arterial sistólica > 140 mmHg e/ou pressão arterial diastólica > 90 mmHg): indivíduos que já usavam medicamentos anti-hipertensivos também foram considerados hipertensos. Usou-se a análise bivariada para testar a relação entre as variáveis independentes e hipertensão, e a regressão logística para ajustar fatores de confusão e identificar interações. A força de associação foi mensurada usando-se odds ratio (OR) e seus intervalos de confiança de 95% [IC (95%)]. RESULTADOS: A prevalência bruta da hipertensão foi de 47,0% [IC (95%): 41,1 - 53,0], a prevalência ajustada por idade foi de 43,2% [IC (95%): 35,7 - 50,7], enquanto a prevalência ajustada por escolaridade foi de 44,1% [IC (95%): 43,9 - 44,3]. De acordo com a análise multivariada, observou-se que idade, triglicerídeos, circunferência da cintura e sexo eram fatores de risco independentes associados à hipertensão. CONCLUSÃO: Os achados fornecem evidências importantes de que a hipertensão é um problema de saúde pública associado à dislipidemia e à obesidade abdominal, na área rural de Minas Gerais.

Perfil clínico-demográfico e indicadores de qualidade da insuficiência cardíaca em uma área rural

FUNDAMENTOS: Os dados sobre insuficiência cardíaca (IC) no Brasil são provenientes de centros terciários. Esses dados não podem ser extrapolados para a população rural, pois refletem características socioeconômico-culturais distintas. OBJETIVO: Estabelecer o perfil clínico-demográfico e indicadores de qualidade da IC em área rural. MÉTODOS: Estudo de coorte transversal, incluindo 166 pacientes da área rural do município de Valença-RJ. Após avaliação dos dados clínicos, laboratoriais e ecocardiográficos e utilizados o teste do qui-quadrado e o exato de Fisher para a análise das proporções, assim como o teste t de Student para as variáveis numéricas, com o intuito de estabelecer as características da população. RESULTADOS: A idade média foi de 61±14 anos, sendo 85 (51%) homens; 88 (53%) afrobrasileiros e 85 (51%) com ICFER. Comorbidades prevalentes: HAS em 151 (91%) e síndrome metabólica (SM) em 103 (62%). Etiologias mais comuns: hipertensiva em 77 (46%), isquêmica em 62 (37%). Indicadores de qualidade na IC: 43 (26%) com ecocardiograma prévio; 102 (62%) utilizavam betabloqueador; 147 (88%) receberam IECA ou BRA; e 22% dos portadores de FA utilizavam anticoagulação oral. Na ICFEN, predominou o sexo feminino p=0,001 RC 0,32 CI (0,17-0,60); SM p=0,004 RC 0,28 CI (1,31-4,78); e etiologia hipertensiva p<0,0001 RC 6,83 CI (3,45-13,5). Na ICFER, predominou o sexo masculino p=0,001, RC 0,32 CI (0,170-0,605) e etiologia isquêmica p<0,0001 RC 0,16 CI (0,079-0,330). CONCLUSÃO: Na área rural, a IC mostra semelhanças em relação ao sexo, cor e classificação da IC. A etiologia mais comum foi a hipertensiva. A ICFEN foi mais prevalente em mulheres e na SM. A ICFER associou-se a homens e etiologia isquêmica.

Estudo da influência da locação de uma edificação rural na carga térmica solar recebida pelas paredes

O presente trabalho se propõe a verificar de que modo a orientação de uma edificação rural influe na carga térmica radiante (radiação solar) interceptada pela mesma. Duas situações freqüentemente encontradas na prática são examinadas: a orientação Norte-Sul e a Leste-Oeste. Para determinar a carga térmica radiante, de importância nos problemas deventilação e refrigeração, é adotado um modelo de construção a título de exemplo, sendo que as relações aqui propostas são aplicáveis a qualquer modelo de construção desejado. Os resultados mostraram quea carga térmica radiante da exposição Leste-Oeste chega a ser 74% da carga na exposição Norte-Sul.

Imaturos de mosquito (Diptera, Culicidae) de áreas urbana e rural no norte do Estado do Paraná, Brasil

The results of larval collections of mosquitoes from artificial containers and natural breeding at urban and rural areas carried out at Sertaneja, northern State Paraná, Brazil, from February to April, 1995, are presented. Among the 4534 immature forms collected, belonging to 21 species or species-groups, the species with higher density were Aedes aegypti (Linnaeus, 1762), Aedes albopictus (Skuse, 1894), Culex quinquefasciatus Say, 1823 and Limatus durhami Theobald, 1901.

Composição e diversidade de Scarabaeoidea (Coleoptera) atraídos por armadilha de luz em área rural no norte do Paraná, Brasil

No Estado do Paraná, as áreas mais devastadas são aquelas com potencial agrícola e as ações de inferência no meio raramente são precedidas do estudo faunístico que permitam avaliar a diversidade e abundância dos animais das áreas atingidas. Este trabalho objetivou catalogar a escarabeoideofauna atraída por armadilha de luz na área rural do município de Tamarana, Paraná e contribuir com o conhecimento ecológico de espécies deste grupo. As coletas foram realizadas em duas propriedades, utilizando armadilha de luz modelo Luiz de Queiroz modificada. Estas tiveram periodicidade quinzenal de março de 2002 a abril de 2001. Foram capturados 2.447 espécimens, distribuídos em 10 famílias, 24 gêneros e 67 espécies. As três espécies mais abundantes também foram as mais freqüentes: Aphodius lividus (Olivier, 1789), Melolonthidae sp. 1 e Ataenius sp. 5. A maior abundância de A. lividus ocorreu no outono, durante o mês de abril, enquanto que Melolonthidae sp. 1 e Ataeucus sp. 5 foram mais abundantes em outubro e novembro. A maioria das espécies foram representadas por poucos indivíduos (H'=1,74) e as espécies apareceram de maneira uniforme (J'=0,95; S=0,20). Ocorreu um maior número de famílias que estavam representadas por poucos indivíduos. Houve predominância das famílias que apresentam hábitos alimentares detritívoros - Aphodiidae, Scarabaeidae, Hybosoridae e fitófagos - Melolonthidae, Dynastidae e Rutelidae. Para os grupos de hábito detritívoro, foram coletados 25 espécies, num total de 1.422 espécimes.

Cutaneous allergic reactions to Triatoma infestans after xenodiagnosis

We determined the frequency of cutaneous allergic reactions to bites of Triatoma infestans during xenodiagnosis in a rural community where Panstrongylus megistrus is the only domestic vector of Trypanosoma cruzi. Localized urticaria or more intense cutaneous allergic reactions at 48 and 72 hours were observed in 86.7% and 82.1% respectively of the individuals in our study. Urticaria was more severe in children and older adults and in women than in men. The high frequency of reactions suggests either cutaneous reactivity to T. infestans without prior sensitization or cross reactivity between P. megistus and T. infestans. A single application of topical corticosteroid or antihistamine medication did not reduce the cutaneous reactions.

Outbreak of human toxoplasmosis in a rural area. A three year serologic follow-up study

Thirty-six persons living on a farm located in the state of Minas Gerais (Brazil) were studied. Nine of them had the glandular form of toxoplasmosis, between May and August, 1976. These nine cases of toxoplasmosis were confirmed serologically by immunefluorescence-IF-, presenting IgG antibody titres between 1:4096 and 1:32000 and IgM antibody titres between 1:16 and 1:8000. Twelve out of thirty-six persons studied were considered to be "dubious cases". They were defined either by presenting a clinical picture compatible with acquired toxoplasmosis, yet having low serologic titres, or inversely they did not have a clear clinical picture but had serologic evidence of recent Toxoplasma infection. Fifteen out of thirty-six persons studied showed neither serologic nor clinical evidence of recent Toxoplasma infection. The epidemiologic information suggests two possible modes of transmission: a) poorly cooked pork at a barbecue party; b) farm vegetables and soil contaminated with Toxoplasma gondii oocysts (rat-cat cycle). Serologic follow-up nine months later in the human farm population demonstrated still high IgG titres, yet they tended to decline and IgM titres became negative. Three years later most of the IgG titres continued to decline and were almost compatible with the titres obtained in Brazilian population surveys.

Epidemiological aspects of toxoplasmosis in schoolchildren residing in localities with urban or rural characteristics within the city of Rio de Janeiro, Brazil

Immunofluorescence tests (IF) for toxoplasmosis were performed on a total of 608 schoolchildren in elementary and junior high grades. 166 being in the Bonsucesso district (an urban region of Rio de Janeiro) and 442 children from locations within the lowlands of Jacarepaguá (with rural characteristics). All the IF-IgM were nonreactive, whilst 416 schoolchildren (68.4%) were IF-IgG serum-reactive ([greater than or equal to] 1:16). The percentages of serum-reactives in Jacarepaguá were significantly higher than in Bonsucesso, both as regards the total number of schoolchildren (p < 0.001), as also when subdivided according to the age-grades from six to eight years (p < 0.001) or from twelve to fourteen (p < 0.05). Both in Jacarepaguá and in Bonsucesso, the prevalence of reactions in the 12 to 14 year age-grade was significantly greater than in the 6 to 8 year age-grade (p < 0.001 in both cases). Expressively larger prevalences of serum reactions were found in Jacarepaguá among schoolchildren who preferred eating raw or undercooked meat, as well as among those having cats as pets; this occurred equally in the 6 to 8 year and in the 12 to 14 year age-grades. In Bonsucesso, the only significant difference was in the 6 to 8 year age-grades that had cats as pets. Thus, it has been verified that the risk of infection is greater and more precocious in localities with rural characteristics than in urban regions.