Health improvement and prevention study (HIPS) - evaluation of an intervention to prevent vascular disease in general practice

Background

The Health Improvement and Prevention Study (HIPS) study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization.

Methods/Design

HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs) and practice nurses (PNs) are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange) and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1) a practice questionnaire, (2) GP and PN questionnaires to assess preventive care attitudes and practices, (3) patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4) physical assessment including weight, height, body mass index (BMI), waist circumference and blood pressure, (5) a fasting blood test for glucose and lipids, (6) a clinical record audit, and (7) qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the intervention is compared between intervention and control groups after adjusting for baseline differences and clustering at the level of the practice.

Discussion

This study will provide evidence of the effectiveness of a primary care intervention to reduce the risk of cardiovascular disease and diabetes in general practice patients. It will inform current policies and programs designed to prevent these conditions in Australian primary health care.

Use of social network analysis to indentify the coopetition in a commercial cluster plan

The cluster provides a greater commercial relationship between the companies that comprise it. This encourages companies to adopt competitive structures that allow solving problems that would hardly alone (Lubeck et. Al., 2011). With that this paper aims to describe the coopetition between companies operating on a commercial cluster planned, from the point of view of retailers, taking as a basis the theoretical models proposed by Bengtsson and Kock (1999) and Leon (2005) and operationalized by means of Social Network Analysis (SNA). Data collection consisted of two phases, the first exploratory aspect to identify the actors, and the second was characterized as descriptive as it aims to describe the coopetition among the enterprises. As a result we identified the companies that cooperate and compete simultaneously (coopetition), firms that only compete, companies just cooperate and businesses that do not compete and do not cooperate (coexistence)

Why is it important to correctly identify Haemonchus species?

Infecções por Haemonchus spp. são uma das principais causas de perda econômica nas criações de ruminantes devido à redução no ganho de peso e mortalidade de bovinos e pequenos ruminantes, especialmente em regiões com clima tropical e subtropical. A identificação precisa das diferentes espécies, bem como o conhecimento sobre a epidemiologia das gastroenterites parasitárias, são fundamentais para a elaboração de estratégias sustentáveis de profilaxia das parasitoses. Essa revisão tem por objetivo central, abordar os principais métodos parasitológicos utilizados na identificação morfológica das espécies, os quais se caracterizam pela facilidade e baixo custo. Na maioria dos estudos realizados no Brasil, a distinção entre as espécies Haemonchus contortus e Haemonchus placei não tem sido considerada. Vários relatos de H. contortus, particularmente em bovinos, podem se tratar na verdade da infecção dos animais por H. placei. A identificação correta das espécies é, portanto, fundamental. Além das medidas dos espículos dos exemplares machos, outros detalhes morfológicos, tais como a sínlofe, devem ser avaliados com o objetivo de auxiliar na diferenciação das espécies. Mensurações das larvas infectantes, obtidas em coproculturas, podem também indicar a espécie de Haemonchus presente. Esse procedimento pode ser útil especialmente em estudos que não envolvem a necropsia de animais, como é o caso de testes destinados a avaliar a resistência anti-helmíntica em rebanhos.

Fish community alterations due to pollution and damming in Tiete and Paranapanema rivers (Brazil)

The Tiete River crosses the metropolitan region of São Paulo (Brazil) and receives a large amount of pollution, in contrast to Paranapanema River which runs in a less populated area. In the inferior portions of the basins of these rivers, a series of reservoirs has been built for hydroelectric energy generation which improve the water quality due to the decantation of suspended soils and aeration in the water spills.Twenty-nine sampling sites were established along the two rivers and in each sampling site, two groups of eight gillnets were used with standardized sizes in two seasons: winter (dry season: June-September 1994) and summer (rainy season: December-March 1995). The fishes were measured and weighed.Twenty-five parameters related. to the water were recorded. PCA and cluster analysis helped to identify two groups of sampling sites. The first one corresponds to the rainy season samples, while the second corresponds to the dry season samples, so evidencing strong seasonal environmental variation. However, the dry season group is still divided into polluted and non-polluted sites, showing that during drought there are larger effects of pollutant concentration due to the decreased flow.A total of 415 kg of fish were caught, corresponding to 8324 individuals belonging to 64 different species, in 22 families and four orders of Teleostei. The largest catches occurred in the middle Tiete River. The catches in the reservoirs of the Tiete River, during the rainy season are superior to those of the dry season. on the other hand, sampling sites located in running water presented an inverse pattern with the largest catches in the dry-season. In river Paranapanema, catches are lower than in the Tiete River, except in Rosana Reservoir during the rainy season. Fish diversity was shown to be a good-indicator of environmental stress. In Tiete River an expressive fall in species richness was detected in the polluted stretches, with dominance of one or two species. In the intermediary stretches, the presence of rapids increases the amount of dissolved oxygen, allowing the development of the most abundant and diverse fish community of the river. Fish communities in the reservoirs of the inferior stretch of Tiete River are more diverse. on the other hand, the damming of the superior reaches of Paranapanema River provoked a decrease in diversity. 0 the whole, types of local fish communities detected, showing different compositions and specific abundances, revealed different ecological situations. A discriminant analysis revealed that the parameters of the water influencing the fish community were: dissolved oxygen, conductivity, nitrogen (nitrate, ammoniacal and albuminoid), phosphate, alkalinity, hardness and iron. Copyright (C) 2003 John Wiley Sons, Ltd.

Estimates of genetic parameters, and cluster and principal components analyses of breeding values related to egg production traits in a White Leghorn population

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Physiological and Stroke Parameters to Assess Aerobic Capacity in Swimming

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

ECLAC: thirty years of contributing to transport infrastructure institutionbuilding in Latin America and the Caribbean

This edition of the FAL Bulletin summarizes the principal contributions by ECLAC and its Infrastructure Services Unit to creating and strengthening transport service infrastructure institutions in Latin America and the Caribbean. The examination is based on a bibliography of key documents issued by ECLAC since it was founded, on studies conducted by the Infrastructure Services Unit and on FAL Bulletins from the past 15 years.

Stress responses to chemical alarm cues in Nile tilapia

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Using the Hard, Randy, and Rittler Test to Evaluate Color Vision in Capuchins (Cebus libidinosus)

The identification of color vision types in primates is fundamental to understanding the evolution and biological function of color perception. The Hard, Randy, and Rittler (HRR) pseudoisochromatic test categorizes human color vision types successfully. Here we provide an experimental setup to employ HRR in a nonhuman primate, the capuchin (Cebus libidinosus), a platyrrhine with polymorphic color vision. The HRR test consists of plates with a matrix composed of gray circles that vary in size and brightness. Differently colored circles form a geometric shape (X, O, or Delta) that is discriminated visually from the gray background pattern. The ability to identify these shapes determines the type of dyschromatopsy (deficiency in color vision). We tested six capuchins in their own cages under natural sunlight. The subjects chose between two HRR plates in each trial: one with the gray pattern only and the other with a colored shape, presented on the left or right side at random. We presented the test 40 times and calculated the 95 % confidence limits for chance performance based on the binomial test. We also genotyped all subjects for exons 3 and 5 of the X-linked opsin genes. The HRR test diagnosed two subjects as protan dichromats (missing or defective L-cone), three as deutan dichromats (missing or defective M-cone), and one female as trichromat. Genetic analysis supported the behavioral data for all subjects. These findings show that the HRR test can be applied to diagnose color vision in nonhuman primates.

Oral health and access to dental care services in relation to the Health Necessities Index. Sao Paulo, Brazil, 2008

The Health Department of Sao Paulo, Brazil, has developed a Health Necessities Index (HNI) to identify priority areas for providing health assistance. In 2008, a survey of the status of oral health was conducted. The objective of this ecological study was to analyze the status of oral health in relation to the HNI. The variables, stratified by the age of 5, 12 and 15 years old were: percentage of individuals with difficulty of access to dental care services; DMFT and DMFS; prevalence of the need for tooth extraction and treatment of dental caries. Data were analyzed for the 25 Health Technical Supervision Units (HTS). The Statistical Covariance Test was used as well as the Pearson correlation coefficient and linear regression model. A positive correlation was observed between high scores of the HNI and difficulty of access to services. In the HTS with high scores of HNI a higher incidence of dental caries was observed, a greater need for tooth extractions and low caries-free incidence. In order to improve health conditions of the population it is mandatory to prioritize actions in areas of social deprivation.

Distinct placental malaria pathology caused by different Plasmodium berghei lines that fail to induce cerebral malaria in the C57BL/6 mouse

Background: Placental malaria (PM) is one major feature of malaria during pregnancy. A murine model of experimental PM using BALB/c mice infected with Plasmodium berghei ANKA was recently established, but there is need for additional PM models with different parasite/host combinations that allow to interrogate the involvement of specific host genetic factors in the placental inflammatory response to Plasmodium infection. Methods: A mid-term infection protocol was used to test PM induction by three P. berghei parasite lines, derived from the K173, NK65 and ANKA strains of P. berghei that fail to induce experimental cerebral malaria (ECM) in the susceptible C57BL/6 mice. Parasitaemia course, pregnancy outcome and placenta pathology induced by the three parasite lines were compared. Results: The three P. berghei lines were able to evoke severe PM pathology and poor pregnancy outcome features. The results indicate that parasite components required to induce PM are distinct from ECM. Nevertheless, infection with parasites of the ANKA Delta pm4 line, which lack expression of plasmepsin 4, displayed milder disease phenotypes associated with a strong innate immune response as compared to infections with NK65 and K173 parasites. Conclusions: Infection of pregnant C57BL/6 females with K173, NK65 and ANKA Delta pm4 P. berghei parasites provide experimental systems to identify host molecular components involved in PM pathogenesis mechanisms.

Are we able to correctly identify prostate cancer patients who could be adequately treated by focal therapy?

Introduction and Objective: Because of the improvements on detection of early stage prostate cancer over the last decade, focal therapy for localized prostate cancer (PC) has been proposed for patients with low-risk disease. Such treatment would allow the control of cancer, thereby diminishing side effects, such as urinary incontinence and sexual dysfunction, which have an enormous impact on quality of life. The critical issue is whether it is possible to preoperatively predict clinically significant unifocal or unilateral prostate cancer with sufficient accuracy. Our aim is to determine whether there is any preoperative feature that can help select the ideal patient for focal therapy. Material and methods: A total of 599 patients who underwent transrectal ultrasound, (TRUS)-guided prostate biopsy followed by radical prostatectomy to treat PC were examined in our laboratory between 2001 and 2009. We established very restricted criteria to select patients with very-low-risk disease for whom focal therapy would be suitable (only I biopsy core positive, tumor no larger than 80% of a single core, no perineural invasion, PSA serum level < 10 ng/ml, Gleason score < 7 and clinical stage T1c, T2a-b). We defined 2 groups of patients who would be either adequately treated or not treated by focal therapy. The primary endpoint was the evaluation of preoperative features in order to identify which parameters should be considered when choosing good candidates for focal therapy. Results: Fifty-six out of 599 patients met our criteria. The mean age was 59 years, and the mean number of biopsy cores was 14.4. Forty-seven (83.9%) were staged T1c, and 9 (16.1%) were staged T2a-b. Forty-four (78.6%) patients could be considered to have been adequately treated by focal therapy, and 12 (21.4%) could not. There was no statistical difference between the 2 groups considering age, clinical stage, PSA levels, Gleason score, and tumor volume in the biopsy. All 12 patients who could be considered inadequately treated had a bilateral, significant secondary tumor, 58.3% had Gleason >= 7, and 25% were staged pT3. Conclusion: Although focal therapy might be a good option for patients with localized prostate cancer, we are so far unable to select which of them would benefit from it based on preoperative data, even using very restricted criteria, and a considerable proportion of men would still be left undertreated. (c) 2012 Elsevier Inc. All rights reserved.

Metabolic and thermodynamic responses to dehydration-induced reductions in muscle blood flow in exercising humans

[EN] 1. The present study examined whether reductions in muscle blood flow with exercise-induced dehydration would reduce substrate delivery and metabolite and heat removal to and from active skeletal muscles during prolonged exercise in the heat. A second aim was to examine the effects of dehydration on fuel utilisation across the exercising leg and identify factors related to fatigue. 2. Seven cyclists performed two cycle ergometer exercise trials in the heat (35 C; 61 +/- 2 % of maximal oxygen consumption rate, VO2,max), separated by 1 week. During the first trial (dehydration, DE), they cycled until volitional exhaustion (135 +/- 4 min, mean +/- s.e.m.), while developing progressive DE and hyperthermia (3.9 +/- 0.3 % body weight loss and 39.7 +/- 0.2 C oesophageal temperature, Toes). On the second trial (control), they cycled for the same period of time maintaining euhydration by ingesting fluids and stabilising Toes at 38.2 +/- 0.1 degrees C. 3. After 20 min of exercise in both trials, leg blood flow (LBF) and leg exchange of lactate, glucose, free fatty acids (FFA) and glycerol were similar. During the 20 to 135 +/- 4 min period of exercise, LBF declined significantly in DE but tended to increase in control. Therefore, after 120 and 135 +/- 4 min of DE, LBF was 0.6 +/- 0.2 and 1.0 +/- 0.3 l min-1 lower (P < 0.05), respectively, compared with control. 4. The lower LBF after 2 h in DE did not alter glucose or FFA delivery compared with control. However, DE resulted in lower (P < 0.05) net FFA uptake and higher (P < 0.05) muscle glycogen utilisation (45 %), muscle lactate accumulation (4.6-fold) and net lactate release (52 %), without altering net glycerol release or net glucose uptake. 5. In both trials, the mean convective heat transfer from the exercising legs to the body core ranged from 6.3 +/- 1.7 to 7.2 +/- 1.3 kJ min-1, thereby accounting for 35-40 % of the estimated rate of heat production ( approximately 18 kJ min-1). 6. At exhaustion in DE, blood lactate values were low whereas blood glucose and muscle glycogen levels were still high. Exhaustion coincided with high body temperature ( approximately 40 C). 7. In conclusion, the present results demonstrate that reductions in exercising muscle blood flow with dehydration do not impair either the delivery of glucose and FFA or the removal of lactate during moderately intense prolonged exercise in the heat. However, dehydration during exercise in the heat elevates carbohydrate oxidation and lactate production. A major finding is that more than one-half of the metabolic heat liberated in the contracting leg muscles is dissipated directly to the surrounding environment. The present results indicate that hyperthermia, rather than altered metabolism, is the main factor underlying the early fatigue with dehydration during prolonged exercise in the heat.

Use of behavioural patterns to analyze transport stress in piglets and young bulls. The influence of individual coping characteristics in stress response.

In modern farm systems the economic interests make reducing the risks related to transport practice an important goal. An increasing attention is directed to the welfare of animals in transit, also considering the new existing facilities. In recent years the results coming from the study of animal farm behaviour were used as tool to assess the welfare. In this thesis were analyzed behavioural patterns, jointly with blood variables, to evaluate the stress response of piglets and young bulls during transport. Since the animal behaviour could be different between individuals and these differences can affect animal responses to aversive situations, the individual behavioural characteristics were taken in account. Regarding young bulls, selected to genetic evaluation, the individual behaviour was investigated before, during and after transport, while for piglets was adopted a tested methodology classification and behavioural tests to observe their coping characteristics. The aim of this thesis was to analyse the behavioural and physiological response of young bulls and piglets to transport practice and to investigate if coping characteristics may affect how piglets cope with aversive situations. The thesis is composed by four experimental studies. The first one aims to identify the best existent methodology classification of piglets coping style between those that were credited in literature. The second one investigated the differences in response to novel situations of piglets with different coping styles. The last studies evaluated the stress response of piglets and young bulls to road transportation. The results obtained show that transport did not affect the behaviour and homeostasis of young animals which respond in a different way from adults. However the understanding of individual behavioural characteristic and the use of behavioural patterns, in addition to blood analyses, need to be more investigated in order to be useful tools to assess the animal response in aversive situation.

Computational strategies to include protein flexibility in Ligand Docking and Virtual Screening

The dynamic character of proteins strongly influences biomolecular recognition mechanisms. With the development of the main models of ligand recognition (lock-and-key, induced fit, conformational selection theories), the role of protein plasticity has become increasingly relevant. In particular, major structural changes concerning large deviations of protein backbones, and slight movements such as side chain rotations are now carefully considered in drug discovery and development. It is of great interest to identify multiple protein conformations as preliminary step in a screening campaign. Protein flexibility has been widely investigated, in terms of both local and global motions, in two diverse biological systems. On one side, Replica Exchange Molecular Dynamics has been exploited as enhanced sampling method to collect multiple conformations of Lactate Dehydrogenase A (LDHA), an emerging anticancer target. The aim of this project was the development of an Ensemble-based Virtual Screening protocol, in order to find novel potent inhibitors. On the other side, a preliminary study concerning the local flexibility of Opioid Receptors has been carried out through ALiBERO approach, an iterative method based on Elastic Network-Normal Mode Analysis and Monte Carlo sampling. Comparison of the Virtual Screening performances by using single or multiple conformations confirmed that the inclusion of protein flexibility in screening protocols has a positive effect on the probability to early recognize novel or known active compounds.