Relationship between the morphologic alterations of vocal cords from adult autopsies and the cause of death

PURPOSE: The purpose of this study was to identify the possible alteration in the thickness of the epithelium basal membrane of the vocal cords and correlate it with the cause of death. METHOD: Larynxes collected from adult autopsies during the period of 1993 to 2001 were utilized. We used the hematoxylin-eosin and periodic acid-Schiff staining methods for the morphological and morphometric analysis. RESULTS: Sixty-six vocal cords were analysed; increased thickness was identified in 14 cases (21.2%), with equal proportions between the genders. Increased vocal-cord thickness was more frequent in patients of the white ethnicity (12 cases, 85.7%). Respiratory alterations were found in 10 (71.4%) of the cases with increased vocal-cord thickness. Of the patients that were maintained with mechanical ventilation before death, 7 (18.4%) had thickening of the basal membrane. Among the smokers, 9 (19.63%) had basal membrane thickening. CONCLUSION: No statistically significant differences were found between the cases in which the cause of death was related to respiratory diseases as compared to non-respiratory diseases and the thickening of the basal membrane of the vocal cords. However, new studies are needed in order to verify the etiopathogenesis of this thickening.

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

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

The burden of chronic low back pain in the adult Portuguese population : an epidemiological population-based study under the scope of Epireumapt

RESUMO: Nos pa��ses desenvolvidos a lombalgia �� a condi����o m��sculo-�����esquel��tica mais prevalente. Quando evolui para um quadro cr��nico �� respons��vel por um encargo econ��mico bastante consider��vel, n��o s�� em rela����o aos indiv��duos, mas tamb��m para a sociedade. A lombalgia cr��nica �� por isso uma das principais causas de perda de produtividade e de perda de independ��ncia econ��mica, nomeadamente atrav��s do absente��smo (aus��ncia do trabalho), do presente��smo (perda de produtividade no trabalho, devido �� capacidade diminu��da provocada pela lombalgia) e da incapacidade para trabalhar (invalidez permanente, total ou parcial). At�� �� data, em Portugal, a preval��ncia e carga social da lombalgia cr��nica eram desconhecidas. At�� agora n��o existiam estudos populacionais de grande dimens��o sobre este tema. O objetivo principal desta tese foi determinar a preval��ncia de lombalgia cr��nica, e tamb��m avaliar a carga social que esta tem na popula����o adulta Portuguesa. O trabalho de investiga����o foi desenvolvido no ��mbito do Estudo Epidemiol��gico de Doen��as Reum��ticas em Portugal (EpiReumaPt). Este foi o primeiro estudo de larga escala e de base populacional, que determinou a preval��ncia de doen��as reum��ticas e m��sculo-����� esquel��ticas na popula����o adulta portuguesa. Foi realizado numa amostra aleat��ria e representativa, de 10.661 indiv��duos do Continente, da Regi��o Aut��noma dos A��ores e da Regi��o Aut��noma da Madeira, entre Setembro de 2011 e Dezembro de 2013. Esta tese foi dividida em duas sec����es. A primeira sec����o incluiu o detalhe das quest��es relativas ao desenvolvimento e gest��o do EpiReumaPt, constituindo-�����se como um guia pr��tico sobre como realizar um estudo de base populacional de larga escala, em Portugal. A metodologia detalhada do EpiReumaPt foi tamb��m descrita nesta sec����o e incluiu os objectivos, o desenho do estudo, as caracter��sticas de recrutamento e a prepara����o de dados para an��lise. Nesta sec����o foram ainda descritos os principais resultados do EpiReumaPt. Estes evidenciaram que a lombalgia foi a condi����o m��sculo-�����esquel��tica com maior preval��ncia na popula����o adulta portuguesa.A segunda sec����o desta tese estimou a preval��ncia da lombalgia cr��nica ativa na popula����o adulta Portuguesa, e avaliou a carga social esta condi����o. A lombalgia ativa foi definida com base na dor auto-�����relatada no dia da entrevista e que persistia h�� pelo menos 90 dias (independentemente da causa). A lombalgia foi definida como dor na ��rea definida entre a margem inferior das d��cimas segundas costelas at�� ��s pregas gl��teas inferiores, com ou sem dor nos membros inferiores. A carga social foi medida tendo em conta os seguintes par��metros: qualidade de vida, fun����o, consumo de recursos de sa��de, consumo de analg��sicos e outros f��rmacos usados no al��vio da dor, sintomas de ansiedade e sintomas de depress��o. Os resultados mostraram que o consumo de recursos em sa��de e a carga social da lombalgia cr��nica na popula����o adulta Portugu��s �� significativa. Tamb��m a incapacidade causada pela lombalgia cr��nica,nos indiv��duos com idade ativa, �� respons��vel por elevadas taxas de absente��smo e m�� qualidade de vida, aos quais acresce o consequente ��nus socioecon��mico. Esta tese tamb��m concluiu que o consumo de analg��sicos e outros medicamentos para al��vio da dor, na popula����o adulta portuguesa com lombalgia cr��nica ativa, �� relativamente baixa. A maioria destes indiv��duos n��o tomava nenhum medicamento analg��sico, independentemente da intensidade da dor. Mesmo os indiv��duos que reportaram dor intensa, apenas 4.0% estavam no primeiro degrau da escada analg��sica da Organiza����o Mundial de Sa��de; 2.3% usavam opi��ides fracos e 0.03% usavam opi��ides fortes para controlar a dor (segundo e terceiro degrau da escada analg��sica da Organiza����o Mundial da Sa��de). O trabalho de investiga����o tamb��m confirmou que a preval��ncia de sintomas de ansiedade e depress��o entre os indiv��duos adultos portugueses com lombalgia cr��nica ativa �� elevada. Nestes indiv��duos, registou-�����se um consumo mais elevado de analg��sicos e outros medicamentos para al��vio da dor, quando comparados com os indiv��duos com lombalgia cr��nica activa sem esses sintomas psicol��gicos. Os grupos terap��uticos mais utilizados foram os ansiol��ticos, sedativos e hipn��ticos, os antidepressivos e os anti-�����inflamat��rios n��o ester��ides. A intensidade m��dia da dor reportada foi tamb��m maior entre os indiv��duos com lombalgia ativa e sintomas de ansiedade e/ou depress��o. Tamb��m nestes, foi reportada pior fun����o e pior estado de sa��de. Em rela����o ao consumo de recursos de sa��de foram encontradas diferen��as significativas entre as duas popula����es: os indiv��duos com lombalgia ativa e sintomas psicol��gicos concomitantes registaram maior n��mero de consultas de psiquiatria de outras especialidades m��dicas, assim como precisaram de mais apoio domicili��rio nos 12 meses pr��vios �� entrevista do EpiReumaPt. Foram tamb��m identificados os fatores associados a sintomas isolados de ansiedade, a sintomas isolados de depress��o e a sintomas de ansiedade e depress��o. Resumindo,esta tese permitiu concluir que a lombalgia cr��nica �� um problema de sa��de comum na popula����o adulta portuguesa, contribuindo para um elevado grau de incapacidade e que consequentemente afeta o desempenho laboral e o bem-�����estar dos indiv��duos. A lombalgia cr��nica �� tamb��m respons��vel por um consumo consider��vel de recursos de sa��de. Acresce ainda que os sintomas de ansiedade e depress��o s��o comuns, entre os indiv��duos com lombalgia cr��nica, contribuindo com uma carga social adicional.---------------------------------- ABSTRACT:Low Back Pain(LBP) is the most prevalent of musculoskeletal condition in developed countries.When it becomes chronic, LBP causesan enormous economic burden on individuals and society -����� it is one of the leading causes of loss of productivity and economic independence through absenteeism (time off work), presenteeism (lost productivity because of diminished capacity while at work) and work disability (permanent, partial or complete disablement for work purposes). In Portugal the prevalence and burden of LBP and chronic LBP (CLBP) were poorly defined. Until now no large population-�����based studies have focused on this. The main aim of this thesis was to determine the prevalence of LBP and CLBP, and also to assess the burden of CLBP in the adult rtuguese population. The research work was developed under the scope of EpiReumaPt (the Portuguese Epidemiologic Study of Rheumatic Diseases). EpiReumaPt was the first national large population-�����based and prevalence study of rheumatic and musculoskeletal diseases (RMD). It was performed among a randomized and representative sample of 10,661 adult Portuguese subjects recruited in Mainland, Azores and Madeira Islands, from September 2011 to December 2013. The first section of this thesis included detailed issues regarding the development and management of EpiReumaPt, and provided a practical guide on how to set-�����up a large population-�����based study in Portugal. The detailed methodology of EpiReumaPt, including its objectives,study design,recruitment features,and data preparation for analyses were also described. The main results from EpiReumaPt study were provided in this section and showed that LBP was the musculoskeletal condition with highest prevalence among Portuguese population. The second section of this thesis estimated the prevalence of active CLBP among adult Portuguese population, and assessed the social burden of this condition. Active CLBP was defined based on self-�����reported pain on the day of the interview, and for most of the time for at least 90 days (independently from cause). LBP was defined as pain in the back area from the lower margin of the twelfth ribs to he lower gluteal folds, with or without pain referred to the lower limbs. Social burden was measured taking into account the following outcomes: quality of life, function, healthcare resources consumption, analgesic and other pain relief drugs intake, anxiety and depression symptoms. Results showed that the healthcare consumption and social burden of CLBP among adult Portuguese population were enormous, and the disability caused by CLBP among subjects in a working age provides high rates of absenteeism (work loss) and poor quality of life, with a consequent socioeconomic burden. This thesis also concluded that analgesic and other pain relief drugs untake among adult Portuguese population with active CLBP was very low. Most of the subjects with active CLBP did not take any analgesic drug regardless pain severity. Even when subjects self-�����reported severe pain, only 24.0% were in the 1st step of the analgesic ladder,2.3% used weak analgesic opioids and 0.03% used strong opioids (2nd and 3rd step of WHO analgesic ladder, respectively) to control pain . The research work also confirmed that the prevalence of anxiety and depression symptoms among adult Portuguese subjects with active CLBP was high. Regarding pharmacological therapy, the intake of analgesic and other pain relief drugs was higher among subjects with anxiety and/or depression symptoms, when compared with subjects without these psychological symptoms. Anxiolytics, sedatives and hypnotics, antidepressants and NSAIDs intake had higher usage rates among these subjects. The pain severity mean was also higher among this subjects and function and health status was worse. Regarding healthcare resources consumption,significant differences between the two populations were found. Subjects with ctive CLBP and concomitant psychological symptoms had a higher number of psychiatrist and other physician visits. They also needed more home care in the previous 12 months. Factors associated with isolated symptoms of anxiety, depression,and concomitant anxiety and depression symptoms were also identified. Summarizing, we concluded that CLBP is a common health problem among adult Portuguese population contributing to disability and affecting labor performance, and the well being of subjects. it is also responsible for considerable healthcare resource consumption. Anxiety and depression symptoms are common among subjects with CLBP and provided an additional burden among them.

Comparison of catheter-related infection risk in two different long-term venous devices in adult hematology-oncology patients

PURPOSE: Infection is the leading complication of long-term central venous catheters, and its incidence may vary according to catheter type. The objective of this study was to compare the frequency and probability of infection between two types of long-term intravenous devices. METHODS: Retrospective study in 96 onco-hematology patients with partially implanted catheters (n = 55) or completely implanted ones (n = 42). Demographic data and catheter care were similar in both groups. Infection incidence and infection-free survival were used for the comparison of the two devices. RESULTS: In a median follow-up time of 210 days, the catheter-related infection incidence was 0.2102/100 catheter-days for the partially implanted devices and 0.0045/100 catheter-days for the completely implanted devices; the infection incidence rate was 46.7 (CI 95% = 6.2 to 348.8). The 1-year first infection-free survival ratio was 45% versus 97%, and the 1-year removal due to infection-free survival ratio was 42% versus 97% for partially and totally implanted catheters, respectively (P <.001 for both comparisons). CONCLUSION: In the present study, the infection risk was lower in completely implanted devices than in partially implanted ones.

Young adult Brazilian beauty consumers perception of Lanc��me and the effectiveness of social media relationhips with local celebrities on their purchase intention

The aim of this research is to evaluate if a premium beauty brand, in this case, Lanc��me, can influence positively the purchase intention from Brazilian young adults, between 18 and 29 years old, consumers of beauty products, by initiating a relationship with a local celebrity or ���it��� girl on social media. This hypothesis has not been tested, and this research is a first attempt of evaluating it. Additionally, the consumer behavior, brand preferences and social media activeness of this age segment in Brazil are further studied as important insights for beauty brands to conquer these consumers. Results did not confirm the positive influence of local celebrities on this age segment���s purchase intention but several suggestions are made for future research to revisit this topic. Furthermore, there is a significant brand love for M.A.C., an international Lanc��me competitor, amongst this target, as well as a probable price sensitivity facing premium beauty brands.

On occurrence, habitat specificity and natural history of adult tiger beetles (Coleoptera: Carabidae: Cicindelinae) near Manaus, Central Amazonia, and key to the larvae of tiger beetle genera

Over a seven year period from 1991 to 1997, 22 species of tiger beetles, representing nine genera, were recorded near Manaus, Brazil. In the Whitewaterfloodplains along the Rio Solim&#245;es-Amazonas (Ilha de Marchantaria), three diurnal species inhabit inundation forests and six species (two diurnal, four nocturnal) live in open areas. Data on their natural history and adaptation to living conditions in floodplains are presented. Fifteen species were located on non-flooded uplands (Reserva Florestal A. Ducke). Five diurnal species inhabit the forest floor, two species are canopy dwellers, and eight species (seven diurnal, one nocturnal) live in open areas on whitesand or laterite. Only one species, Pentacomia lacordairei, was found in both floodplain and upland forests. A key to the larvae of tiger beetle genera located near Manaus is presented.

Adult learning and education policies in Germany, Portugal and Sweden: An analysis of national reports to CONFINTEA VI

The chapter presents a theoretical proposal of three analytical models of Adult Learning and Education (ALE) policies. Some analytical categories and the corresponding dimensions are organised according to the ALE rationale which is typical of each social policy model. Historical, cultural and educational features are mentioned in connexion with the different policy models and its interpretative capacity to making sense of policies and practices implemented in Germany, Portugal and Sweden. !e analysis includes the states of the art and the official representations of ALE produced by the respective national authorities through national reports which were presented to CONFINTEA VI (2009).

Literacy practices in adult learning biographies: possibilities and constraints

[Extrat] The answer to the social and economic challenges that it is assumed literacy (or its lack) puts to developed countries deeply concerns public policies of governments namely those of the OECD area. In the last decades, these concerns gave origin to several and diverse monitoring devices, initiatives and programmes for reading (mainly) development, putting a strong stress on education. UNESCO (2006, p. 6), for instance, assumes that the literacy challenge can only be met raising the quality of primary and secondary education and intensifying programmes explicitly oriented towards youth and adult literacy. (...)

Stabilization in early adult-onset myopia with corneal refractive therapy

Purpose: To describe the stabilization of early adult-onset myopia in three university students after initiating orthokeratology treatment with corneal refractive therapy contact lenses. Methods: Three Caucasian early adult-onset progressing myopic subjects (1 male, 2 females) were fitted with corneal refractive therapy lenses to correct myopia between ?1.50 and ?2.50 D of sphere using Paragon CRT (Paragon Vision Sciences, Mesa, AZ)lenses for overnight orthokeratology. The pre-treatment refractive history from 2005 as well as refraction and axial length after treatment onset are reported over a period of 3 years between December 2009 and January 2013 with an additional year of follow-up after treatment discontinuation (January���December 2013). The peripheral refractive patterns and topographic changes are also reported individually. Results: Treatment was successful in all three subjects achieving uncorrected visual acuity of 20/20 or better monocularly. During a period of 3 years of follow-up the subjects did not experience progression in their refractive error, nor in their axial length (measured during the last 2 years of treatment and 1 year after discontinuation). Furthermore, the subjects recovered to their baseline refraction and did not progressed further over the following year after lens wear discontinuation. Conclusions: We cannot attribute a causative effect to the orthokeratology treatment alone as underlying mechanism for myopia stabilization in this 3 patients. However, the present report points to the possibility of stabilization of early adult-onset myopia progression in young adults using corneal refractive therapy treatment.

Cardiac abnormalities in the acquired immunodeficiency syndrome. A prospective study with a clinical-pathological correlation in twenty-one adult patients

OBJECTIVE - To evaluate the cardiac abnormalities and their evolution during the course of the acquired immunodeficiency syndrome, as well as to correlate clinical and pathological data. METHODS - Twenty-one patients, admitted to the hospital with the diagnosis of acquired immunodeficiency syndrome, were prospectively studied and followed until their death. Age ranged from 19 to 42 years (17 males). ECG and echocardiogram were also obtained every six months. After death, macro- and microscopic examinations were also performed. RESULTS - The most frequent causes of referral to the hospital were: diarrhea or repeated pneumonias, tuberculosis, toxoplasmosis or Kaposi sarcoma. The most frequent findings were acute or chronic pericarditis (42%) and dilated cardiomyopathy (19%). Four patients died of cardiac problems: infective endocarditis, pericarditis with pericardial effusion, bacterial myocarditis and infection by Toxoplasma gondii. CONCLUSION - Severe cardiac abnormalities were the cause of death in some patients. In the majority of the patients, a good correlation existed between clinical and anatomical-pathological data. Cardiac evaluation was important to detect early manifestations and treat them accordingly, even in asymptomatic patients.

Cantrell Syndrome. Case report of an adult

Cantrell syndrome is characterized by defects that involve the diaphragm, abdominal wall, pericardium, heart, and lower region of the sternum. It is a rare entity, usually diagnosed at birth and accompanied by high mortality due to the complexity and gravity of the anomalies. In this report, we present a 32-year-old male patient, who was diagnosed in infancy but who reached adult age asymptomatic.

Maternal adjustment and maternal attitudes in adolescent and adult pregnant women

Study Objective: This study analyzes differences between adolescent and adult pregnant women and the contribution of maternal age to maternal adjustment and maternal attitudes during pregnancy. Design, Setting, and Participants: A sample of 398 Portuguese pregnant women (111 younger than 19 years) was recruited in a Portuguese Maternity Hospital and completed the Maternal Adjustment and Maternal Attitudes Questionnaire between the 24th and 36th weeks of gestation. Main Outcome Measures: Maternal Adjustment and Maternal Attitudes Questionnaire. Results: Adolescent pregnant women show lower maternal adjustment (poorer body image and worse marital relationship) and poorer maternal attitudes (more negative attitudes to sex) than adult pregnant women. When controlling for socio-demographics, age at pregnancy predicts poorer body image and more negative attitudes to sex, but not a worse marital relationship, more somatic symptoms or negative attitudes to pregnancy and the baby. A worse marital relationship was better predicted by living without the partner, and more somatic symptoms and negative attitudes to pregnancy and the baby was predicted by higher education. Conclusion: Adolescent pregnant women show lower maternal adjustment and poorer maternal attitudes than adult pregnant women according to socio-demographics and unfavorable developmental circumstances.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Report of an Adult Case

We report the clinical findings, pathophysiology, diagnostic characteristics, and surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in a 26-year-old female patient with a clinical diagnosis of coronary heart disease.

Ultrasound Blocks for the Anterior Abdominal Wall - Adult and Pediatric Surgery

Somatic post-surgical pain is invalidating and distressing to patients and carries the risk of important complications. The anterior abdominal wall is involved in most surgical procedures in general, gynecologic, obstetric, urological, vascular and pediatric surgery. Combined multimodal strategies involving nerve blocks, opiates, and non-steroidal anti-inflammatory drugs for systemic analgesia are necessary for optimal pain modulation. Anterior abdominal wall blocks, transverse abdominal plexus block, iliohypogastric and ilioinguinal nerveblock, genitofemoral nerve block and rectus sheath block have an important role as components of multimodal analgesia for somatic intraoperative and postoperative pain control. Ultrasound visualization has improved the efficacy and safety of abdominal blocks and implemented the application in the clinical setting. For this reason, they are a very important tool for all anesthesiologists who aim to treat effectively patients��� pain. This guide provides an evidence based comprehensive and necessary overview of anatomical, anesthesiological and technical information needed to safely perform these blocks.