Rhinoscleroma in a 5-year-old Portuguese Child

Rhinoscleroma is a chronic granulomatous infectious disease that is rare in Western Europe. We report the case of a 5-year-old Portuguese boy diagnosed with rhinoscleroma in the context of recurrent epistaxis. He had a 6-month course of antibiotic (amoxicillin plus clavulanate) therapy with full recovery.

Comparing the performance of the EQ-5D-3L and the EQ-5D-5L in young Portuguese adults

Background Some studies have reported a ceiling effect in EQ-5D-3L, especially in healthy and/or young individuals. Recently, two further levels have been included in its measurement model (EQ-5D-5L). The purposes of this study were (1) to assess the properties of the EQ-5D-5L in comparison with the standard EQ-5D-3L in a sample of young adults, (2) to foreground the importance of collecting qualitative data to confirm, validate or refine the EQ-5D questionnaire items and (3) to raise questions pertaining to the wording in these questionnaire items. Methods The data used came from a sample of respondents aged 30 or under (n = 624). They completed both versions of the EQ-5D, which were compared in terms of feasibility, level of inconsistency and ceiling effect. Agreement between the instruments was assessed using correlation coefficients and Bland-Altman plots. Known-groups validity of the EQ-5D-5L was also assessed using non-parametric tests. The discriminative properties were compared using receiver operating characteristic curves. Finally, four interviews were conducted for retrospective reports to elicit respondents’ understanding and perceptions of the format, instructions, items, and responses. Results Quantitative results show a ceiling effect reduction of 25.3 % and a high level agreement between both indices. Known-groups validity was confirmed for the EQ-5D-5L. Explorative interviews indicated ambiguity and low degree of certainty in regards to conceptualizing differences between levels moderate-slight across three dimensions. Conclusions The EQ-5D-5L performed better than the EQ-5D-3L. However, the explorative interviews demonstrated several limitations in the EQ-5D questionnaire wording and high context-dependent answers point to lack of illnesses’ experience amongst young adults.

Food consumption and risk of malnutrition in community-dwelling very old Spanish adults (≥ 80 years)

Introduction: There are few studies assessing overall diet and food patterns of the oldest population. Objectives: To examine food groups consumption (grams and servings) and their compliance with the dietary guidelines in community-dwelling very old Spanish adults. The relationship with the risk of malnutrition was also studied. Methods: Within the cross-sectional health study of elderly people of Villanueva de la Cañada (Madrid, Spain), in 98 non-institutionalized elders aged ≥ 80 years (66% women) food consumption was calculated from a 24-hour dietary recall and nutritional risk was assessed by Mini Nutritional Assessment (MNA). Statistical significance was evaluated at 95% confidence level (p < 0.05). Results: Men consumed significantly higher amounts of snacks/pickles and alcoholic beverages. The consumption of cereals/grain products (2 servings/day), vegetables (1.5 servings/day) and meat, fish, eggs (1.4 servings/day), was below desirable levels. As nutritional status got worse, fruit consumption was significantly smaller (p = 0.039). Relatively weak but highly significant correlations were found between MNA and oils/fats, fruits and alcoholic beverages. After adjustment for energy intake, oils and fats and fruits associations disappeared whereas a negative association between milk/dairy products and MNA was found. Conclusions: Dietary patterns of the elderly population of Villanueva are departing from the traditional Mediterranean diet and though adequate consumption of fruits, milk/dairy products, oils/fats and sugar/confectionery has been achieved, cereals/grain products, vegetables and the meat,fish,eggs group consumption was below the desirable levels. Deterioration of the nutritional status coincided with a reduction in the consumption of all food groups except for ready meals and milk/dairy products whose consumption increased. Further research on the influence of fruit, milk/dairy products, wine and olive oil consumption on nutritional status is required.

Validade estrutural e externa do Death Anxiety Questionnaire numa amostra de adultos idosos portuguesa

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção do grau de Mestre na especialidade de Psicologia Clínica.

Adolescent parents’ values: the role played by retrospective perceptions of the family-of-origin

Family-of-origin is an important system in individual’s lives, and its influence is extensive over the life cycle. The aim of this study was to investigate, in a sample of adolescents’ parents, whether their retrospective perceptions of parenting and relationship qualities within their families-of-origin during adolescence predicted their current collectivist and individualist values. Participants included 110 Portuguese adults with a mean age of 46.86 years old. The results of structural equation modeling supported that retrospective perceptions of parenting and relationship qualities in the family-of-origin predicted the adults’ collectivist values but not their individualist values. This study highlights the importance of retrospective perceptions of supporting and non-rejecting parenting for value acquisition. The results also suggest that values that preserve and protect family connections and collaborations are more likely to be socialized by families. Implications for practice and for the theories on parenting, values, family-of-origin influences and family intergenerational transmission are discussed.

Differentation of the fat body cells in the precocius adults of Schistocerca gregaria: regulation of polyploidy by juvenile hormone

Precocious adults from 2nd and 3rd instar larvae of the desert locust Schistocerca gregaria were used to assess the competence of their fat body to synthesize DNA in response to a juvenile hormone analog (JHA), hydoprene. Autoradiographic studies show that JHA stimulates DNA synthesis since a significant proportion of the fat body nuclei are labelled after treatment with 100 or 200 µg of JHA. Maximum DNA synthesis occurs 24 h after treatment with 100 µg of JHA. The nuclear ploidy classes of the precocious adults from 3rd larvae are similar to those of 1-d-old normal adults, but treatemnt of these precociuos adults with µg of JHA doubles the DNA content resulting in enhanced ploidy classes which resemble those of 10-d-old normal females. In the precocious adults that emerged from 2nd instar larvae the ploidy classes are higher than those of 1-d-old normal adults, and treatment of these precocious adults with JHA results in a further increase in the DNA content of the fat body nuclei leading to the formation of high percentages of 16C and 32C nuclei. The results of these studies suggest that any model on the mode of action of JH should recognize this phenomenon of JH-induced polyploidization in the fat body nuclei.

Risk factors for head and neck cancer in young adults : a pooled analysis in the INHANCE consortium

BACKGROUND: Increasing incidence of head and neck cancer (HNC) in young adults has been reported. We aimed to compare the role of major risk factors and family history of cancer in HNC in young adults and older patients. METHODS: We pooled data from 25 case-control studies and conducted separate analyses for adults ≤45 years old ('young adults', 2010 cases and 4042 controls) and >45 years old ('older adults', 17 700 cases and 22 704 controls). Using logistic regression with studies treated as random effects, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The young group of cases had a higher proportion of oral tongue cancer (16.0% in women; 11.0% in men) and unspecified oral cavity / oropharynx cancer (16.2%; 11.1%) and a lower proportion of larynx cancer (12.1%; 16.6%) than older adult cases. The proportions of never smokers or never drinkers among female cases were higher than among male cases in both age groups. Positive associations with HNC and duration or pack-years of smoking and drinking were similar across age groups. However, the attributable fractions (AFs) for smoking and drinking were lower in young when compared with older adults (AFs for smoking in young women, older women, young men and older men, respectively, = 19.9% (95% CI = 9.8%, 27.9%), 48.9% (46.6%, 50.8%), 46.2% (38.5%, 52.5%), 64.3% (62.2%, 66.4%); AFs for drinking = 5.3% (-11.2%, 18.0%), 20.0% (14.5%, 25.0%), 21.5% (5.0%, 34.9%) and 50.4% (46.1%, 54.3%). A family history of early-onset cancer was associated with HNC risk in the young [OR = 2.27 (95% CI = 1.26, 4.10)], but not in the older adults [OR = 1.10 (0.91, 1.31)]. The attributable fraction for family history of early-onset cancer was 23.2% (8.60% to 31.4%) in young compared with 2.20% (-2.41%, 5.80%) in older adults. CONCLUSIONS: Differences in HNC aetiology according to age group may exist. The lower AF of cigarette smoking and alcohol drinking in young adults may be due to the reduced length of exposure due to the lower age. Other characteristics, such as those that are inherited, may play a more important role in HNC in young adults compared with older adults.

Risk factors for head and neck cancer in young adults: a pooled analysis in the INHANCE consortium.

BACKGROUND: Increasing incidence of head and neck cancer (HNC) in young adults has been reported. We aimed to compare the role of major risk factors and family history of cancer in HNC in young adults and older patients. METHODS: We pooled data from 25 case-control studies and conducted separate analyses for adults ≤45 years old ('young adults', 2010 cases and 4042 controls) and >45 years old ('older adults', 17 700 cases and 22 704 controls). Using logistic regression with studies treated as random effects, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The young group of cases had a higher proportion of oral tongue cancer (16.0% in women; 11.0% in men) and unspecified oral cavity / oropharynx cancer (16.2%; 11.1%) and a lower proportion of larynx cancer (12.1%; 16.6%) than older adult cases. The proportions of never smokers or never drinkers among female cases were higher than among male cases in both age groups. Positive associations with HNC and duration or pack-years of smoking and drinking were similar across age groups. However, the attributable fractions (AFs) for smoking and drinking were lower in young when compared with older adults (AFs for smoking in young women, older women, young men and older men, respectively, = 19.9% (95% CI = 9.8%, 27.9%), 48.9% (46.6%, 50.8%), 46.2% (38.5%, 52.5%), 64.3% (62.2%, 66.4%); AFs for drinking = 5.3% (-11.2%, 18.0%), 20.0% (14.5%, 25.0%), 21.5% (5.0%, 34.9%) and 50.4% (46.1%, 54.3%). A family history of early-onset cancer was associated with HNC risk in the young [OR = 2.27 (95% CI = 1.26, 4.10)], but not in the older adults [OR = 1.10 (0.91, 1.31)]. The attributable fraction for family history of early-onset cancer was 23.2% (8.60% to 31.4%) in young compared with 2.20% (-2.41%, 5.80%) in older adults. CONCLUSIONS: Differences in HNC aetiology according to age group may exist. The lower AF of cigarette smoking and alcohol drinking in young adults may be due to the reduced length of exposure due to the lower age. Other characteristics, such as those that are inherited, may play a more important role in HNC in young adults compared with older adults.

Actividade física e índice de massa corporal na população adulta portuguesa

Sabe-se pouco sobre a prevalência da prática de actividade física em Portugal, estratificada por categorias de índice de massa corporal. O objectivo do presente projecto foi verificar a associação da prática de actividade física como (a) características sociodemográficas e (b) índice de massa corporal. Trata-se de um estudo observacional e transversal. Dados recolhidos entre Janeiro/2003 e Janeiro/2005, por questionário estruturado (entrevista face-a-face) e avaliação antropométrica (peso, altura e perímetros da cintura e anca). Amostra representativa da população adulta em Portugal continental. Para avaliação da prática de actividade física, foi utilizado o Baecke Questionnaire of Habitual Physical Activity. Participaram 8116 pessoas. 27.9% referiu praticar algum tipo de actividade desportiva. A proporção dos que fazem desporto diminui com a idade. A proporção de homens que referiram níveis de actividade mais elevados é significativamente superior à encontrada para as mulheres. As pontuações obtidas para a prática de actividade física em qualquer dos contextos (lazer, desporto e trabalho) correlacionam-se significativamente com o nível educacional (principalmente em contextos de lazer). Nas actividades de lazer e de desporto, a pontuação de actividade física está negativamente correlacionada com o índice de massa corporal. Quanto à actividade física no trabalho, esta correlaciona-se positivamente com o índice de massa corporal. Concluímos que são necessárias estratégias de saúde pública que facilitem e promovam a actividade física em contexto de lazer, especialmente dirigidas aos idosos e aos grupos demográficos com níveis educacionais mais baixos.

Children and adults with thrombotic thrombocytopenic purpura associated with severe, acquired Adamts13 deficiency: comparison of incidence, demographic and clinical features

BACKGROUND Thrombotic thrombocytopenic purpura (TTP) associated with severe, acquired ADAMTS13 deficiency is uncommonly reported in children. The incidence, demographic, and clinical features of these children, compared to adults, have not been described. PROCEDURES This study focused on children (<18 years old) and adults with TTP associated with severe, acquired ADAMTS13 deficiency, defined as activity <10%. The incidence rates for TTP in children and adults were calculated from patients enrolled in the Oklahoma TTP-HUS (Hemolytic-Uremic syndrome) Registry, 1996-2012. To describe demographic and clinical features, children with TTP were also identified from a systematic review of published reports and from samples sent to a reference laboratory for analysis of ADAMTS13. RESULTS The standardized annual incidence rate of TTP in children was 0.09 × 10(6) children per year, 3% of the incidence rate among adults (2.88 × 10(6) adults per year). Among the 79 children who were identified (one from the Oklahoma Registry, 55 from published reports, 23 from the reference laboratory), TTP appeared to be more common among females, similar to the relative increased frequency of women among adults with TTP, and more common in older children. Clinical data were available on 52 children; the frequency of severe renal failure, relapse, treatment with rituximab, and systemic lupus erythematosus in these children was similar to adults with TTP. CONCLUSIONS TTP associated with severe, acquired ADAMTS13 deficiency is uncommon in children. The demographic and clinical features of these children are similar to the features of adults with TTP.

Social determinants of dental treatment needs in Brazilian adults

Background The chronic cumulative nature of caries makes treatment needs a severe problem in adults. Despite the fact that oral diseases occur in social contexts, there are few studies using multilevel analyses focusing on treatment needs. Thus, considering the importance of context in explaining oral health related inequalities, this study aims to evaluate the social determinants of dental treatment needs in 35–44 year old Brazilian adults, assessing whether inequalities in needs are expressed at individual and contextual levels. Methods The dependent variables were based on the prevalence of normative dental treatment needs in adults: (a) restorative treatment; (b) tooth extraction and (c) prosthetic treatment. The independent variables at first level were household income, formal education level, sex and race. At second level, income, sanitation, infrastructure and house conditions. The city-level variables were the Human Development Index (HDI) and indicators related to health services. Exploratory analysis was performed evaluating the effect of each level through calculating Prevalence Ratios (PR). In addition, a three-level multilevel modelling was constructed for all outcomes to verify the effect of individual characteristics and also the influence of context. Results In relation to the need for restorative treatment, the main factors implicated were related to individual socioeconomic position, however the city-level contextual effect should also be considered. Regarding need for tooth extraction, the contextual effect does not seem to be important and, in relation to the needs for prosthetic treatment, the final model showed effect of individual-level and city-level. Variables related to health services did not show significant effects. Conclusions Dental treatment needs related to primary care (restoration and tooth extraction) and secondary care (prosthesis) were strongly associated with individual socioeconomic position, mainly income and education, in Brazilian adults. In addition to this individual effect, a city-level contextual effect, represented by HDI, was also observed for need for restorations and prosthesis, but not for tooth extractions. These findings have important implications for the health policy especially for financing and planning, since the distribution of oral health resources must consider the inequalities in availability and affordability of dental care for all.

A influência da idade, do género e da saúde funcional subjectiva na ansiedade face à morte em adultos idosos

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

Corpo-sujeito Kadiweu : jogo e esporte

Universidade Estadual de Campinas . Faculdade de Educação Física

Effect of growth hormone on in vitro osteogenesis and gene expression of human osteoblastic cells is donor-age-dependent

it has been demonstrated that the effect of GH on bone tissue is reduced with aging. In this study we tested the hypothesis that the action of GH on osteoblastic cells is donor-age-dependent by investigating the effect of GH on the development of osteoblastic phenotype in cultures of cells from adolescents (13-16 years old), young adults (18-35 years old), and adults (36-49 years old). Osteoblastic cells derived from human alveolar bone were cultured with or without GH for periods of up to 21 days, and parameters of in vitro osteogenesis and gene expression of osteoblastic markers were evaluated. GH increased culture growth, collagen content and alkaline phosphatase (ALP) activity in cultures from adolescents and young adults, whereas non-significant effect was observed in cultures from adults. While GH significantly increased the bone-like formation in cultures from adolescents, a slightly effect was observed in cultures from young adults and no alteration was detected in cultures from adults. Results from real-time PCR demonstrated that GH upregulated ALP, osteocalcin, type I collagen, and Cbfa1 mRNA levels in cultures from adolescents. In addition, cultures from young adults showed higher ALP mRNA expression and the expression of all evaluated genes was not affected by GH in cultures from adults. These results indicate that the GH effect on both in vitro osteogenesis and gene expression of osteoblastic markers is donor-age-dependent, being more pronounced on cultures from adolescents.

Prevalência da doença pulmonar obstrutiva crónica em Lisboa, Portugal: estudo burden of obstructive lung disease

Introdução - A prevalência da doença pulmonar obstrutiva crónica (DPOC) apresenta valores muito heterogéneos em todo o mundo. A iniciativa Burden of Obstructive Lung Disease (BOLD) foi desenvolvida para que a prevalência da DPOC possa ser avaliada com metodologia uniformizada. O objetivo deste estudo foi estimar a prevalência da DPOC em adultos com 40 ou mais anos numa população alvo de 2 700 000 habitantes na região de Lisboa, de acordo com o protocolo BOLD. Métodos - A amostra foi estratificada de forma aleatória multifaseada selecionando-se 12 freguesias. O inquérito compreendia um questionário com informação sobre fatores de risco para a DPOC e doença respiratória autoreportada; adicionalmente, foi efetuada espirometria com prova de broncodilatação. Resultados - Foram incluídos 710 participantes com questionário e espirometria aceitáveis. A prevalência estimada da DPOC na população no estadio GOLD I+ foi de 14,2% (IC 95%: 11,1; 18,1) e de 7,3% no estadio ii+ (IC 95%: 4,7; 11,3). A prevalência não ajustada foi de 20,2% (IC 95%: 17,4; 23,3) no estadio i+ e de 9,5% (IC 95%: 7,6; 11,9) no estadio ii+. A prevalência da DPOC no estadio GOLD II+ aumentou com a idade, sendo mais elevada no sexo masculino. A prevalência estimada da DPOC no estadio GOLD I+ foi de 9,2% (IC 95%: 5,9; 14,0) nos não fumadores versus 27,4% (IC 95%: 18,5; 38,5) nos fumadores com carga tabágica de ≥ 20 Unidades Maço Ano. Detetou-se uma fraca concordância entre a referência a diagnóstico médico prévio e o diagnóstico espirométrico, com 86,8% de subdiagnósticos. Conclusões - O achado de uma prevalência estimada da DPOC de 14,2% sugere que esta é uma doença comum na região de Lisboa, contudo com uma elevada proporção de subdiagnósticos. Estes dados apontam para a necessidade de aumentar o grau de conhecimento dos profissionais de saúde sobre a DPOC, bem como a necessidade de maior utilização da espirometria nos cuidados de saúde primários.