Body Mass Index: A Scientific Evidence-Based Inquiry

OBJECTVE: To objectively and critically assess body mass index and to propose alternatives for relating body weight and height that are evidence-based and that eliminate or reduce the limitations of the body mass index. METHODS: To analyze the relations involving weight and height, we used 2 databases as follows: 1) children and adolescents from Brazil, the United States, and Switzerland; and 2) 538 university students. We performed mathematical simulations with height data ranging from 115 to 190 cm and weight data ranging from 25 to 105 kg. We selected 3 methods to analyze the relation of weight and height as follows: body mass index - weight (kg)/height (m²); reciprocal of the ponderal index - height (cm)/weight1/3 (kg); and ectomorphy. Using the normal range from 20 to 25 kg/m² for the body mass index in the reference height of 170 cm, we identified the corresponding ranges of 41 to 44 cm/kg1/3 for the reciprocal of the ponderal index, and of 1.45 to 3.60 for ectomorphy. RESULTS: The mathematical simulations showed a strong association among the 3 methods with an absolute concordance to a height of 170 cm, but with a tendency towards discrepancy in the normal ranges, which had already been observed for the heights of 165 and 175 cm. This made the direct convertibility between the indices unfeasible. The reciprocal of the ponderal index and ectomorphy with their cut points comprised a larger age range in children and adolescents and a wider and more central range in the university students, both for the reported (current) and desired weights. CONCLUSION: The reciprocal of the ponderal index and ectomorphy are stronger and are more mathematically logical than body mass index; in addition, they may be applied with the same cut points for normal from the age of 5 ½ years on.

Tradução e validação para o português do Medication Regimen Complexity Index

FUNDAMENTO: A complexidade da farmacoterapia consiste de múltiplas características do regime prescrito, incluindo o número de diferentes medicações no esquema, o número de unidades de dosagem por dose, o número total de doses por dia e os cuidados na administração dos medicamentos. O Medication Regimen Complexity Index (MRCI) é um instrumento específico, validado e utilizado para medir a complexidade da farmacoterapia, desenvolvido originalmente em língua inglesa. OBJETIVO: Tradução transcultural e validação desse instrumento para o português do Brasil. MÉTODOS: Foi desenvolvido um estudo transversal envolvendo 95 pacientes com diabete do tipo 2 utilizando múltiplas medicações. O processo de validação teve início pela tradução, retrotradução e pré-teste do instrumento, gerando uma versão adaptada chamada Índice de Complexidade da Farmacoterapia (ICFT). Em seguida foram analisados parâmetros psicométricos, incluindo validade convergente, validade divergente, confiabilidade entre avaliadores e teste-reteste. RESULTADOS: A complexidade da farmacoterapia medida pelo ICFT obteve média de 15,7 pontos (desvio padrão = 8,36). O ICFT mostrou correlação significativa com o número de medicamentos em uso (r = 0,86; p < 0,001) e a idade dos pacientes (r = 0,28; p = 0,005). A confiabilidade entre avaliadores obteve correlação intraclasse igual a 0,99 (p < 0,001) e a confiabilidade teste-reteste obteve correlação de 0,997 (p < 0,001). CONCLUSÃO: Os resultados demonstraram que o ICFT apresenta bom desempenho de validade e confiabilidade, podendo ser utilizado como ferramenta útil na prática clínica e em pesquisas envolvendo análise da complexidade da terapia.

Duke Activity Status Index em Doenças Cardiovasculares: Validação de Tradução em Português

Fundamentos: O Duke Activity Status Index (DASI) avalia a capacidade funcional de pacientes com doença cardiovascular (DCV), mas não há versão validada em português para doenças cardiovasculares. Objetivos: Traduzir e adaptar culturalmente o DASI para o idioma português do Brasil, e verificar suas propriedades psicométricas na avaliação da capacidade funcional de pacientes com doenças cardiovasculares. Métodos: O DASI foi traduzido para o português, verificado pela retrotradução para o inglês e avaliado por um comitê de especialistas. A versão pré-teste foi avaliada pela primeira vez em 30 indivíduos. As propriedades psicométricas e a correlação com o teste de esforço foram verificadas em um segundo grupo de 67 indivíduos. Uma análise fatorial exploratória foi realizada em todos os 97 pacientes para verificar a validade de construto do DASI. Resultados: O coeficiente de correlação intraclasse para a confiabilidade teste-reteste foi de 0,87 e para a confiabilidade entre avaliadores foi de 0,84. O alfa de Cronbach para consistência interna foi de 0,93. A validade concorrente foi verificada por correlações positivas significativas de pontuações do DASI com o VO2 max (r = 0,51, p < 0,001). A análise fatorial mostrou dois fatores que explicaram 54% da variância total, com o fator 1 responsável por 40 % da variância. A aplicação do DASI requer entre um e três minutos e meio por paciente. Conclusão: A versão brasileira do DASI parece ser um instrumento válido, confiável, rápido e fácil de administrar para avaliar a capacidade funcional em pacientes com doenças cardiovasculares.

Left Atrial Volume Index and Prediction of Events in Acute Coronary Syndrome: Solar Registry

Background: According to some international studies, patients with acute coronary syndrome (ACS) and increased left atrial volume index (LAVI) have worse long-term prognosis. However, national Brazilian studies confirming this prediction are still lacking. Objective: To evaluate LAVI as a predictor of major cardiovascular events (MCE) in patients with ACS during a 365-day follow-up. Methods: Prospective cohort of 171 patients diagnosed with ACS whose LAVI was calculated within 48 hours after hospital admission. According to LAVI, two groups were categorized: normal LAVI (≤ 32 mL/m2) and increased LAVI (> 32 mL/m2). Both groups were compared regarding clinical and echocardiographic characteristics, in- and out-of-hospital outcomes, and occurrence of ECM in up to 365 days. Results: Increased LAVI was observed in 78 patients (45%), and was associated with older age, higher body mass index, hypertension, history of myocardial infarction and previous angioplasty, and lower creatinine clearance and ejection fraction. During hospitalization, acute pulmonary edema was more frequent in patients with increased LAVI (14.1% vs. 4.3%, p = 0.024). After discharge, the occurrence of combined outcome for MCE was higher (p = 0.001) in the group with increased LAVI (26%) as compared to the normal LAVI group (7%) [RR (95% CI) = 3.46 (1.54-7.73) vs. 0.80 (0.69-0.92)]. After Cox regression, increased LAVI increased the probability of MCE (HR = 3.08, 95% CI = 1.28-7.40, p = 0.012). Conclusion: Increased LAVI is an important predictor of MCE in a one-year follow-up.

Oviposition preference hierarchy in Ceratitis capitata (Diptera, Tephritidae): influence of female age and experience

The influence of two factors, age and previous experience, on the oviposition hierarchy preference of Ceratitis capitata (Wiedemann, 1824) females was studied. Two populations were analyzed: one reared in laboratory during 17 years and the other captured in nature. In the first experiment the oviposition preference for four fruits, papaya, orange, banana and apple was tested at the beginning of oviposition period and 20 days past. The results showed that the wild females as much the laboratory ones had an oviposition preference hierarchy at the beginning of peak period of oviposition. However this hierarchic preference disappeared in a later phase of life. In the second experiment the females were previously exposed to fruits of different hierarchic positions and afterwards their choice was tested in respect to the oviposition preference for those fruits. The results showed that there was an influence of the previous experience on the posterior choice of fruits to oviposition when the females were exposed to fruits of lower hierarchic position.

The interference of methods in the collection of teredinids (Mollusca, Bivalvia) in mangrove habitats

In the estuary of the Mamanguape River (Paraíba, Brazil), a new collection technique was developed and applied with virgin poles of mangrove trees Avicennia schaueriana (Verbenaceae), Rhizophora mangle (Rhizophoraceae), and Laguncularia racemosa (Combretaceae), taking into account wood preference, water salinity and depth influence during teredinid larval settlement. Sets of poles were vertically fixed in the riverbed at three sites along a decreasing salinity gradient, where they stayed for four months. The poles were collected and divided into upper, median, and lower segments, in agreement with different immersion regimes. An increase of 239% was obtained in the number of individuals when compared to a previous study in the same area using a different methodology. The species Teredo bartschi (Clapp, 1923), Nausitora fusticula (Jeffreys, 1860) and Bankia fimbriatula Moll & Roch, 1931 were registered in both studies, and the species Psiloteredo healdi (Bartsch, 1931) is here registered for the first time as occurring in that estuary. The species Neoteredo reynei (Bartsch, 1920), previously registered on tree branches of the mangrove habitat, was not found in the present work. Bankia fimbriatula, the most abundant species, did not show preference for any substratum but occurred significantly on the lower segment of the poles. N. fusticula, second in abundance, preferred to settle on poles of A. schaueriana and on any of the three segments. Aiming to assess the habitat variations, a more accurate study on teredinids diversity in mangrove ecosystems should be performed through a concomitant analysis from tree branches of the mangrove habitat, as well as from poles of mangrove trees or panels made of pine wood or mangrove trees wood. These collection devices should be maintained along a decreasing salinity gradient exposed to different tide levels.

Species richness, relative abundance, and habitat of reproduction of terrestrial frogs in the Triângulo Mineiro region, Cerrado biome, southeastern Brazil

Based on field observations and pitfall sampling, we determined the species richness, relative abundance, and reproductive habitat of terrestrial frogs in three municipalities in the Triângulo Mineiro region, south Cerrado biome, in southeastern Brazil. We found thirty-two species of terrestrial frogs, belonging to the families Brachycephalidae, Bufonidae, Cycloramphidae, Dendrobatidae, Leiuperidae, Leptodactylidae and Microhylidae. Most of the species were found in open areas and reproduced in human-generated environments, such as artificial lakes (10 species) and ponds (14 species). Dominance was high, with Physalaemus cuvieri Fitzinger, 1826 (Leiuperidae) representing 48% of sampled frogs. A larger number of individuals was captured in the wet season, when most of the species were reproducing. Compared to other areas of Cerrado biome, the Triângulo Mineiro sites presented a larger number of species, which may be attributed to the larger sampled area and greater sampling effort, lower altitude and presence of human generated habitats. The richness of terrestrial frogs was also larger than that in some forested localities in southeastern Brazil, indicating that the number of species cannot be explained only by precipitation and type of vegetation cover. The greater abundance of individuals during the wet season may be related to a greater movement of adults to breeding sites and to juvenile recruitment/dispersion. The heterogeneity of environments in the Cerrado biome, including its several isolated highlands, contributes to its high (local and regional) diversity of frogs.

Habitat use by a tree frog species of Scinax (Amphibia, Hylidae) at an urban forest fragment from south-eastern Brazil

We studied the pattern of habitat use by the tree frog Scinax aff. perereca. Fieldworks were performed from August 1996 to August 1997 at Parque das Mangabeiras, Belo Horizonte, State of Minas Gerais, southeastern Brazil. Calling males were observed in September, October and December 1996, February to April and June 1997. Females were found only in October 1996. Specimens were found perched on vegetation, on the ground or on stones near waterfall. At Parque das Mangabeiras, S. aff. perereca occupied nine types of substrata. The most frequently used substrata were shrubs, stones at the stream edges, and fallen trunks. The pattern of spatial occupation varied among months. Males were found calling in aggregations on the vegetation and spatial niche breadth was related to species abundance.

Feeding ecology of Ozotoceros bezoarticus: conservation implicationsin Uruguay

The pampas deer (Ozotoceros bezoarticus Linnaeus, 1758) was in the recent past one of the most characteristic species in the Uruguayan grasslands. However, today the species is very rare, with small relict populations inhabiting in few ranches. To improve our understanding of pampas deer habitat use in modified ecosystems and propose management guidelines we analyzed the pampas deer feeding ecology at Los Ajos ranch. We performed an annual vegetation survey with the purpose to identify the main components of pampas's deer diet and the spatial overlap with livestock. Vegetation offer was characterized by predominance of monocotyledon plants; in three of the four sample periods. The preference values for the crops were positive for ryegrass in winter (0.24) and spring (0.54), the moments of greatest productivity of this pasture; while the rice crops values were negative all year round. The spatial overlap indexes with sheep show a complete exclusion, whereas with cattle the indexes gave values of 0.95 in spring to 0.14 in summer. The niche amplitude was significantly correlated with the spatial overlap levels with cattle. Pampas deer foraging behaviour is opportunistic, typical of mixed feeders. Conservation efforts should focus on implementation of management guidelines of agriculture and cattle breeding activities.

Calliphorid fly (Diptera, Calliphoridae) attraction to different colored traps in the Tingua Biological Reserve, Rio de Janeiro, Brazil

The present study intended to analyze calliphorid attraction to traps painted in a variety of colors and the calliphorid constancy index in the Tingua Biological Reserve, Rio de Janeiro state, Brazil. The Diptera were collected monthly in the Reserve, between 2002 and 2005, totaling 24 samplings. Four traps containing sardines as bait were painted olive green, blood red, black, or white and exposed for 48 h at four equidistant points, 50 m from each other. To determine the calliphorid species constancy, the Bodenheirmer constancy index was used throughout the study. To analyze differences in the total abundance between species and in their color selection, an ANCOVA test with a significance level of 5 % and a Tukey post-test were used, considering the categories species and color as cofactors and climatic variables as co-variables (temperature, relative humidity and precipitation), since the samples were collected over two years. 10,444 insects were captured. Of these, 56 % belonged to the Calliphoridae family, totaling 13 species, with the most frequent species being Laneela nigripes (28.5 %), Hemilucilia semidiaphana (17 %), and Mesembrinella sp. (16.4 %). The other species had frequencies lower than 12 %. Nine species were considered constant, two accessories, and two accidental. The data indicated that the most frequent species presented significant differences between themselves concerning abundance over the captured months, however, the Tukey post-test indicated differences only between a few of them. The black trap presented the higher relative calliphorid frequency (27.34 %), followed by green (25 %), red (24.0 %), and white (23.7 %), although the species abundance in the different colored traps did not differ significantly among themselves. Therefore, there was no Calliphorid flies preference for any of the tested colors.

Diet of Astyanax paranae (Characidae) in streams with different riparian land covers in the Passa-Cinco River basin, southeastern Brazil

An analysis of the diet of Astyanax paranae Eigenmann, 1914 in nine streams located in the Passa-Cinco River basin (upper Paraná River system) was performed to investigate the feeding habits of this species, check for possible spatial variations in diet and to investigate the influence of riparian vegetation in the composition of the diet. Stomach contents of 243 specimens were analyzed by the methods of relative frequency of occurrence and volume, and the diet was characterized by the alimentary index (AIi). The species showed insectivorous feeding habits, with a predominance of terrestrial and aquatic insects in the diet, varying by location. In most streams, resources of allochthonous origin were the most consumed. The participation of aquatic insects and terrestrial plants were high in most streams, while terrestrial insects and invertebrates were highest in streams with a greater presence of riparian forest. The two streams located draining pasture fields were the only places were A. paranae consumed algae and macrophyte fragments. These results were corroborated by the analysis of similarity (ANOSIM): the descriptor "percentage of riparian forest" was the highest environmental influence on the diet of A. paranae. The study shows that riparian forest percentage on the stream reach determines the species diet composition, but A. paranae is also able to gather enough food resources in a variety of severely degraded environments.

Variações ecomorfológicas e de uso de habitat em Piabina argentea (Characiformes, Characidae) da bacia do Rio das Velhas, Minas Gerais, Brasil

O presente estudo teve como objetivo investigar os padrões local e regional de uso de habitat de Piabina argentea Reinhardt, 1867 em quatro diferentes rios da bacia do rio das Velhas. Os habitat amostrados foram caracterizados quanto à velocidade da água, profundidade e tipo de substrato. Para a análise ecomorfológica, foram calculados 17 atributos ecomorfológicos de 40 exemplares de cada rio. Embora estas populações tenham se sobreposto no espaço ecomorfológico, a Análise Discriminante Canônica mostrou haver diferença significativa entre elas, principalmente da população do rio das Velhas em relação às demais. A separação se deu em termos do índice de compressão, altura relativa do corpo e índice de achatamento ventral. Os padrões locais de seleção de habitat não foram congruentes em todos os rios, mas em geral, houve predomínio do padrão regional: habitat lênticos, profundidade entre 20 e 40 cm e 60 e 80 cm e substrato areia, silte+argila e banco de folhas. Considerando as características físicas de cada rio e o padrão regional da espécie, a maior parte dos seus requerimentos de habitat é contemplada nos quatro rios. Entretanto, um corpo d'água assoreado como o trecho do rio das Velhas, tende a ter maiores velocidades da água, menores profundidades e substrato finos, o que atende em parte à seleção de habitat da espécie estudada.

Influence of seasonal changes in daily activity and annual life cycle of Geotrigona mombuca (Hymenoptera, Apidae) in a Cerrado habitat, São Paulo, Brazil

The foraging activity of Geotrigona mombuca Smith, 1863 was studied under natural conditions aiming to verify the influence of seasonal changes on daily flight activity and annual cycle of the colony. Daily flight activity was monitored for a year based on the observation and counting of foragers leaving and entering the hive, as well as the kind of material transported and meteorological factors such as day time, temperature and relative humidity. The influence of seasonal changes was evidenced by alterations on daily rhythm of flight activity and by differences on transportation of food resources, building material and garbage. These data indicate that forager behavior is related to daily microclimate conditions and it is synchronized with the requirements of colony annual cycle, which determines an intense pollen collection in the summer. Thus, the recomposition of the intranidal population in spring and summer can be ensured, which is characterized both for a higher intensity of flight activity and increase in garbage and resin transport, as well as the swarming process in the spring. In this way, an action targeting the preservation or management of the species in a natural environment should consider that survival and reproduction of the colony depends greatly on the amount of available pollen in late winter.