Prevalência de Síndrome Metabólica em Idosos e Concordância entre Quatro Critérios Diagnósticos

Fundamento: A Síndrome Metabólica (SM) é uma agregação de fatores de risco que aumenta a incidência de eventos cardiovasculares e Diabete Melito (DM). O envelhecimento da população vem acompanhado de maior prevalência de SM, que varia dependendo da população estudada e do critério diagnóstico utilizado. Objetivo: Determinar a prevalência de SM em idosos por quatro critérios diagnósticos e a concordância entre esses. Métodos: Estudo transversal realizado em 243 indivíduos acima de 60 anos (180 mulheres) em Niterói (RJ). Foram avaliados através de exame clínico glicemia jejum, insulinemia jejum, perfil lipídico e medidas antropométricas - peso, estatura, circunferência abdominal e relação cintura/quadril. A prevalência de SM foi estimada utilizando critérios diagnósticos da Organização Mundial da Saúde (OMS) modificado, National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATPIII), International Diabetes Federation (IDF) e Joint Interim Statement (JIS). Resultados: A prevalência foi elevada pelos quatro critérios, OMS (51,9%), NCEP-ATPIII (45,2%), IDF (64,1%) e JIS (69,1%), e a concordância entre os critérios diagnósticos pelo índice kappa foi moderada em quase todas as comparações OMS vs. IDF (k = 0,47; intervalo de confiança (IC) 95%, 0,35 - 0,58); OMS vs. NCEP-ATPIII (k = 0,51; IC 95%, 0,40 - 0,61); OMS vs. JIS (k = 0,45; IC 95%, 0,33 - 0,56); IDF vs. NCEP-ATPIII (k = 0,55, IC 95%, 0,45 - 0,65) e NCEP-ATPIII vs. JIS (k = 0,53; IC 95%, 0,43 - 0,64), exceto entre IDF vs. JIS (K= 0,89; IC 95%, 0,83 - 0,95), considerada boa. Conclusão: A prevalência de SM foi elevada pelos quatro critérios diagnósticos, principalmente pelo JIS. Houve uma boa concordância entre os critérios JIS e IDF e moderada entre os outros.

Blood Pressure Control in Hypertensive Patients in the "Hiperdia Program": A Territory-Based Study

Background:Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level.Objective:To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil).Methods:Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR) with 95% confidence interval, Wald's χ2 test, and simple and multiple Poisson regression were used in the statistical analysis.Results:The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM) was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled.Conclusion:Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control.

Education to a Healthy Lifestyle Improves Symptoms and Cardiovascular Risk Factors – AsuRiesgo Study

Background: Cardiovascular diseases are the current leading causes of death and disability globally. Objective: To assess the effects of a basic educational program for cardiovascular prevention in an unselected outpatient population. Methods: All participants received an educational program to change to a healthy lifestyle. Assessments were conducted at study enrollment and during follow-up. Symptoms, habits, ATP III parameters for metabolic syndrome, and American Heart Association’s 2020 parameters of cardiovascular health were assessed. Results: A total of 15,073 participants aged ≥ 18 years entered the study. Data analysis was conducted in 3,009 patients who completed a second assessment. An improvement in weight (from 76.6 ± 15.3 to 76.4 ± 15.3 kg, p = 0.002), dyspnea on exertion NYHA grade II (from 23.4% to 21.0%) and grade III (from 15.8% to 14.0%) and a decrease in the proportion of current active smokers (from 3.6% to 2.9%, p = 0.002) could be documented. The proportion of patients with levels of triglycerides > 150 mg/dL (from 46.3% to 42.4%, p < 0.001) and LDL cholesterol > 100 mg/dL (from 69.3% to 65.5%, p < 0.001) improved. A ≥ 20% improvement of AHA 2020 metrics at the level graded as poor was found for smoking (-21.1%), diet (-29.8%), and cholesterol level (-23.6%). A large dropout as a surrogate indicator for low patient adherence was documented throughout the first 5 visits, 80% between the first and second assessments, 55.6% between the second and third assessments, 43.6% between the third and fourth assessments, and 38% between the fourth and fifth assessments. Conclusion: A simple, basic educational program may improve symptoms and modifiable cardiovascular risk factors, but shows low patient adherence.

Blood Pressure and Hemodynamic Adaptations after a Training Program in Young Individuals with Down Syndrome

Background:Cardiovascular diseases affect people worldwide. Individuals with Down Syndrome (DS) have an up to sixteen-time greater risk of mortality from cardiovascular diseases.Objective:To evaluate the effects of aerobic and resistance exercises on blood pressure and hemodynamic variables of young individuals with DS.Methods:A total of 29 young individuals with DS participated in the study. They were divided into two groups: aerobic training (AT) (n = 14), and resistance training (TR) (n = 15). Their mean age was 15.7 ± 2.82 years. The training program lasted 12 weeks, and had a frequency of three times a week for AT and twice a week for RT. AT was performed in treadmill/ bicycle ergometer, at an intensity between 50%-70% of the HR reserve. RT comprised nine exercises with three sets of 12 repetition-maximum. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) and hemodynamic variables were assessed beat-to-beat using the Finometer device before/after the training program. Descriptive analysis, the Shapiro-Wilk test to check the normality of data, and the two-way ANOVA for repeated measures were used to compare pre- and post-training variables. The Pearson’s correlation coefficient was calculated to correlate hemodynamic variables. The SPSS version 18.0 was used with the significance level set at p < 0.05.Results:After twelve weeks of aerobic and/or resistance training, significant reductions in variables SBP, DBP and MBP were observed.Conclusion:This study suggests a chronic hypotensive effect of moderate aerobic and resistance exercises on young individuals with DS.

Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care

Abstract Background: Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective: To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied. Methods: Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05). Results: Of the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion: BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS.

Tratamento de mandioca pela colquicina: III análise comparativa entre clones diplóides e tetraplóides

1) Um estudo sobre o modo de crescimento de alones tetraplóides de mandioca Vassourinha Paulista, obtido experimentalmente por meio da colquicina, foi feito em comparação ao crescimento de clones diplóides da mesma variedade. Três outros clones da mandiosa amargosa foram também incluidos na análise para comparação. As observações foram feitas nas hastes da primeira ramificação de cada planta e podem ser resumidas como segue: (Quadros n.°s 1 e 2). a) comprimento: Dos 6 clones tetraplóides analisados, 5 (n.°s 1, 3, 6, 5 e 7) tiveram um comprimento bem menor que o dos clones controles diplóides, mostrando assim serem plantas menores. Um único clone tetraplóide (n.° 15) teve um comprimento menor, porém com a média não estatisticamente diferente da média do clone diplóide. b) peso: Os seis clones tetraplóides formaram dois grupos, com relação ao peso das hastes: um grupo de 3 clones (n.°s 1, 3 e 6) com o peso médio diferente do peso médio dos controles e um grupo de 3 clones (n.°s 5, 7 e 15) com peso médio não diferindo dos controles. Estes resultados estão confirmados pelo valor do índice pêso/n.° de folhas. c) n.° de folhas: O número de folhas por unidade de comprimento foi praticamente o mesmo para os clones diplóides e tetraplóides, conforme se pode verificar pelos valores do índice comprimento/n.° de folhas. Pode-se concluir que os clones tetraplóides têm um hábito de crescimento diferente daquele dos clones diplóides; as plantas tetraplóides são menores que as diplóides e, entre os clones tetraplóides, houve também diferença, alguns clones tendo plantas mais finas que outros. As estacas da variedade Vassourinha Paulista, de onde partimos para a obtenção das formas poliplóides, não foram obtidas de uma única planta e assim não podemos garantir se a diferença verificada entre os clones tetraplóides seja devida a clones iniciais diferentes ou se produzida ainda pela colquicina. 2) A produção de raizes e ramas numa experiência de um ciclo vegetativo, em blocos ao acaso e cem 3 repetições, foi analisada e mostrou que a produção dos clones diplóides é maior que aquela dos clones tetraplóides (Quadro n.° 10). A produção dos clones tetraplóides não foi uniforme. Eles formaram uma seqüência de produção e pelo menos um clone, o de n.° 6, ficou significativamente fora do conjunto, quando a sua média foi comparada à média de raiz e rama obtidas do total de clones tetraplóides. Este clone foi o único tetraplóide do grupo de 3 com estacas mais finas, indicados na análise de crescimento, que entrou na experiência; êle confirma assim aquela separação. O índice rama/raiz foi menor para os clones diplóides que para os tetraplóides, indicando que a produção de raiz em relação à rama é menor nos clones tetraplóides, no primeiro ciclo, provavelmente devido ao retardamento de crescimento nos primeiros meses de vegetação, pois as plantas tetraplóides cresceram mais vagarosamente que as plantas diplóides. 3) Uma experiência com 2 ciclos vegetativos e 3 repetições, mostrou que o clone tetraplóide n.° 6 (Quadro n.° 20) é de fato diferente dos demais, tendo plantas muito pequenas e produção muito pequena no campo. Esta experiência mostrou também que o clone n.° 2, que foi o tetraplóide mais produtivo na experiência com um ciclo vegetativo, parece formar um outro grupo tetraplóide com relação a produção de raizes e ramas. Esta experiência de dois ciclos foi realizada com um espaçamento bastante grande, de modo a eliminar toda possível competição entre plantas; os valores médios de produção por planta, contidos no quadro n.° 20, servem para identificar um clone do outro mas não representam produção comercial. Com 2 ciclos vegetativos o índice rama/raiz torna-se igual para todos os clones, mostrando que, após o primeiro ciclo, a produção de raiz em relação à rama torna-se idêntica para todos os clones. A correlação positiva entre produção de rama e raiz é significante e grande, tanto com um como com 2 ciclos vegetativos. 4) Mais uma experiência com um ciclo vegetativo, feita sistematicamente e com os clones n.° 8 (controle) e clones tetraplóides n.°s 2 e 6, confirmou os resultados anteriores, isto é, que a produção por planta dos clones tetraplóides é menor que a produção dos clones diplóides e que existe diferença entre os clones tetraplóides obtidos (quadro n.° 26). O aproveitamento comercial dos melhores clones tetraplóides só poderá ser avaliado depois da realização de experiências de espaçamento, pois é possível que, com um maior número de plantas, possa se obter a mesma ou melhor produção que os clones diplóides, numa mesma área. O clone tetraplóide n.° 6 não suporta as condições de campo (Fig. 32) e é possível que, pelo pequeno tamanho de suas plantas, seja útil para condições hortícolas, uma questão já discutida em outra publicação (6). 5) Uma análise de estacas para plantação, medindo 20 cms. cada uma, mostrou que há diferença de peso entre estacas dos clones tetraplóides. O clone n.° 6 teve um valor médio menor e diferindo estatisticamente dos demais clones tetraplóides, confirmando assim outros resultados anteriores. 6) Um estudo detalhado sobre a percentagem de amido dos diferentes clones mostrou que os tetraplóides não diferem dos diplóides quanto ao teor amido e que eles não são também diferentes de 3 outros clones de mandioca amargosa incluidos na análise para comparação.

III - A ocorrência das células anexas dos estômatos na família Rubiaceae

As minhas primeiras observações sobre a ocorrência das cédulas anexas dos estômatos na família Rubiaceae foram feitas na epiderme foliar de Coffea arabica L.. Em seguida, examinei a epiderme de 20 espécies, pertencentes a 9 gêneros e cultivadas no Parque da E. S. A. "Luiz de Queiroz". Em virtude da constância das células anexas, analisei, a princípio, as espécies e variedades de Coffea (ao todo 28 indivíduos) existentes na coleção de cafés do Instituto Agronômico de Campinas e, depois, o maior número de gêneros e espécies da família. Para a realização desse trabalho, solicitei de várias instituições material botânico, tanto vivo como herborizado, constante de folhas; consegui reunir, assim, copiosa quantidade de espécies. Feita a separação das duplicatas e das fôlhas de epiderme de difícil extração, as espécies se reduziram a 553. Do exposto neste e nos trabalhos que publiquei (1,2), posso concluir que as duas células anexas dos estômatos, na família Rubiaceae, constituem um caráter anatômico de família, muito embora me faltem alguns gêneros para seu estudo completo. Minha conclusão se apoia nos três pontos básicos seguintes: 1 - Que as duas células anexas dos estômatos, com as ca- racterísticas descritas, ocorrem entre as Rubiales sómente na família Rubiaceae. 2 - Que as espécies estudadas até agora revelaram, sem exceção, as duas células anexas nos estômatos. 3 - Que as células anexas poderão constituir, no caso de sua inconstância, um caráter diferencial de espécie ou de gênero.

Alimentação dos marrecos: III sôro de leite (Líquido)

The author studied in this paper the influence of liquid whey in feeding Pekin ducklings. Wet mash, either by liquid whey or water, was given to the ducklings during the whole day. Green feed was added to the ration just once a day. The statistical analysis did not show significant differences between the use of water and liquid whey but the results obtained with wet mash proved to be statistically better than the results obtained with dry mash.

Raça de galinha "P P P P" (Pescoço Pelado Preta Piracicaba) III - Efeitos da consanguinidade

Four years of inbreeding and its effects on fertility, hatchability, viability and egg production in the new bred "PPPP" (Pescoço Pelado Preta Piracicaba) (naked neck and black plumage, Piracicaba) were reported in this paper. It was observed a decrease in fertility, hatchability, viability and egg production as the inbreeding increases. The black plumage naked neck homozygozous chickens are now submitted to a system of uncontrolled mating in the hope that the natural selection will reduce some of the undesirable factors providing abundant material for pedigree control.

III - Contribuição para o estudo biológico e ecológico das Podostemaceae do salto do Piracicaba

1 - The Author, in this 3 thd. contribution, concludes the study of the biology and ecology of the species Tristicha trifaria (Willd.) Spreng. and Mourera aspera (Bong.) Tul., both of the Piracicaba Fall. 2 - According to the results of Dr. Peter van Royen (State Herbarium of Leiden, Holland), who made a complete revision of Podostemaceae of the Piracicaba Fall, the species Tristicha hypnoides (St. Hil.) Spreng. var. Hilarii Tul. and Mnioppsis Glazioviana Warm, correspond, respectively, to theTristicha trifaria (Willd.) Spreng. and Mniopsis weddelliana Tul. Apinagia Accorsii Toledo was transferred by Royen to the genus Wettsteiniola. So, its new name is Wettsteiniola accorsii (Toledo) v. Royen. 3 - Propagation by seeds may occur in the following places: a) placenta of partially open fruits; b) external and internal walls of the open capsules; c) pedicels of the fruits; d) remains of rhizomes, branches, etc. e) organic residues accumulated in water holes in the fall; f) clean rocks, in which the little groups of seedlings seems to be a colony of algae. Seeds adhere to the substrata above by means, of a mucilage produced by the transformation of the external integuments in contact with water. 4 - In the growth of the four species below it was found in Piracicaba Fall conspicuous zoning so scattered: a) Wettsteiniola accorsii (Toledo) v. Royen, in rocks situated just within the water fall, where velocity of the current and aeration of the water are very high. b) Tristicha trifaria (Willd.) Spreng. and Mniopsis weddelliana Tul., in rocks at some distance (100 m more or less) upstream until near the bridge across the river. c) Mourera aspera (Bong.) Tul., 300 m upwards the bridge. 5- During 1949, the ecological conditions of the Piracicaba Fall were changed due to the following factors: a) dry season very long, begining from last period of June until 30 november; b) stopping, during four months, of water from the Atibaia river (one of the components of Piracicaba river) near to the city of Americana, in the place where a new station of the Companhia Paulista de Força e Luz was build. In consequence, most of the Podostemaceae died. On the dry rocks there were only fruits and dried plants. 6 - Tristicha trifaria has the same biological and ecological behavior as the Mniopsis weddelliana,. 7 - The vegetative propagation of Tristicha trifaria is made by increasing of its branches, production of stolons with vegetatives buds and regeneration of old parts in especial conditions of water and aeration. 8 - Mourera aspera has the same vegetative propagation as the Wettsteiniola accorsii; it produces stolons (in very little percentage) with vegetative buds, branches of the rhizomes and regeneration of active old parts. 9 - Frequently, there is, on the plants an accumulation of sand, silt, loam, organic substances, and so on. The quantity of material stored depends of the purity of the water, of the morphology of the plants and of the situation on the fall. 10 - In extrem conditions of dry heat, the surviving of the species in its habitat depends exclusively from germination of seeds in the mentioned substrata. Exceptionally, some plants survive in a few water pockets full with the weak remaining current.

Estudos sobre o «vermelhão» do algodoeiro (III)

In several cotton crops areas of the State of S. Paulo it was observed, during the years of 1948, 1949, and 1951, the appearance of a purple color of the leaves; the color appears in the opening of the bolls and was correlated with a decrease of production. The opinions concerning the cause of such abnormality were very different and sometimes contradictory; certain investigators attributed the disease to insect attack, others to bad climatic conditions whereas others to a potassium deficiency now called "fome de potássio" (potash hunger); our ideas on the subject is another one. We think that the disease is caused by lack of a suitable supply of magnesium. This opinion is largely based on the syntomatology found in the literature. To study the problem, several experiments were carried out, namely: 1. pot experiments using soil collected in areas where the disorder had appeared; 2. pot experiments controlling the water supply; 3. sand culture experiments omitting either potassium or magnesium; 4. leaf analysis of plant matrial collected troughout the Piracicaba County; 5. plot experiments with the varieties Texas, Express, and I.A. 817 Campinas. The first four experiments were discussed elsewhere. To study the point 5 an experiment was carried out, with the following treatments : 1 - NPKCaMg (no K added) - Mg supplied as MgSO4 (a soluble form); 2 -NPKCa (no Mg added); 3 -NPKCaMg (complete) - Mg supplied as MgSO4; 4 - NPKCaMg (complete) - Mg supplied as dolomitic limestone (a slightly soluble form) as a rate 2.5 higher than in the treatment 1 and 3. Organic matter as cottonseed meal was applied in the proportion of 500 kg per hectare. The experimental design was randomized blocks with 4 replications and the results can be summarized as follows: 1 the I.A 817 variety was the most strongly affected by the physiological disorder, with severe decrease in yield; 2. the disease occurred more frequently in the minus magnesium treatment; 3. dolomitic limestone is so effective as magnesium sulfate in the control of the disease as well in the raising of the yield; 4. in the minus K treatment it was observed a marked occurrence of the typical symptoms of potassium deficiency (cotton rust); 5. magnesium was actually, in the experimental conditions the responsible for the purple color (vermelhão) of the cotton leaves.

Estudos sôbre o quiabeiro II: efeitos da autofecundação e do cruzamento

The present work deals with the study of the effects of selfing and crossing in pures lines of okra inbred for five generations and the methods of breeding in this plant. This work is party of a large program of this Dept. to study heterosis in plants naturally self pollinated. The technic of selfing consists of tying with a string the floral bud before anthesis. To make controlled crosses, it is necessary to emasculate the flowers removing the anthers with small forceps, and to cover the flowers with a bag and wait for 1 or 2 days until the blooming. Also, the male parents are covered with paper bags prior to flowering. Finally, the pollen is brushed lightly over the stigma of the emasculated flowers and the females unit rebagged. The authors have tried without sucess the technic of soda fountain straw used for cotton. The treatments were: I) Fl of the cross pure-line x foreign variety (not improved by breeding). II) Fl of the cross pure-line x parental variety and III) pure-line 5 generations inbred. In order to compare the production of these three treatments, a randomized blocks with 4 replications was designed; since we had 6 families in each treatment, the total number was: 4 replications x 3 treatments x 6 families: = 72. Each familiy was planted in lines of 10 plants. Owing to the design devised, the present experiment corresponds to a split-plot. The analysis of variance of the number and the weight of the pods is given in tables 2 and 4, and shows the following: 1) The production expressed in both numbers and weights of the cross, - pure lines x foreign variety - was statistically smaller than the others treatments, i, e., the cross of pure-lines x parental variety and the pure-lines; 2) The production of the treatments pure-lines x parental variety and selfed purelines was the same. It was proved that the selfing do not produce harmful effects in okra, it was benefical, since after 5 inbred generations the production was the same when compared with Fl of the parental variety. Also, the methods of pure-lines are indicated to improve varieties of okra.

Sombreamento dos cafezais: III - Resultados do 5º biênio (1961/1962)

This paper deals with data obtained in 1961 and 1962 in shaded and unshaded coffee plots at Piracicaba, São Paulo, Brazil. The results can be summarized as follows: a - the production, in shaded and unshaded plots, did not show differences statistically significant; b - the percentage of coffee berry borer infestation was higher in shaded plots as compared with unshaded ones; c - coffee fruits brought from the field in the harvest time yielding up in sunshaded plots as compared with shaded ones.

Influência do desponte sôbre a composição do colmo e do caldo da cana-de-açúcar: III. Var. CB 41-76

I. This paper deals with an experiment carried out to evaluate the effect of sugar cane upper end on the composition of the stalks and juice of sugar cane harvest as a raw material for the sugar industry. The variety studied was CB 41-76. The data were collected from plant cane at intervals of a two weeks, always from the same field, from a small central area of 3.000 square meters approximately, 60 stalks were cut in each occasion, randomly chosen from the whole area. They were afterwards separated into three groups of 20 stalks one for each of the treatments, namely: a) Complete stalk, with no leaves or sheaths. b) Stalks harvested by the technique of REYNOSO, that is, as usually done in practice. c) Stalks with the tops completely cut out, that is, cut by the techinique of REYNOSO and then with 3 other top internodes eliminated. The treatments caused significant differences on the weight of cane and coefficient of purity of juice, but the percentual differences between the average treatments a and c is 13% and 2%, respectively. II. Treatment differences for cane pol, cane fibre, brix, juice pol, reducing sugars, juice ashes, glucose coefficient, saline coefficient and available sucrose (pol) per cent were not significant. III. Time of harvest was an important factor affecting the composition of the cane and the juice. This paper shows that there is no sound basis for the heavy fines applied some sugar mills to planters who do not cut low enough the tops of the cane stalks.