Normal aging and decision-making: a systematic review of the literature of the last 10 years

Objective Conduct a systematic review to investigate whether healthy elderly have deficits in the decision-making process when compared to the young. Methods We performed a systematic search on SciELO, Lilacs, PsycINFO, Scopus and PubMed database with keywords decision making and aging (according to the description of Mesh terms) at least 10 years. Results We found nine studies from different countries, who investigated 441 young and 377 elderly. All studies used the IOWA Gambling Task as a way of benchmarking the process of decision making. The analysis showed that 78% of the articles did not have significant differences between groups. However, 100% of the studies that assessed learning did find relevant differences. Furthermore, studies that observed the behavior of individuals in the face of losses and gains, 60% of articles showed that the elderly has more disadvantageous choices throughout the task. Conclusion: The consulted literature showed no consensus on the existence of differences in performance of the decision-making process between old and young, but it is observed that the elderly has deficits in learning and a tendency to fewer advantageous choices.

Comparison of immediate results and follow-up of patients with single-vessel and multivessel coronary artery disease younger than 50 years of age undergoing coronary stent implantation

OBJECTIVE: To assess the in-hospital results and clinical follow-up of young patients (< 50 years) with multivessel coronary artery disease undergoing stent implantation in native coronary arteries and to compare their results with those of patients with single-vessel coronary artery disease. METHODS: We retrospectively studied 462 patients undergoing coronary stent implantation. Patients were divided into 2 groups: group I (G-I) - 388 (84%) patients with single-vessel coronary artery disease; and group II (G-II) - 74 (16%) patients with multivessel coronary artery disease. RESULTS: The mean age of the patients was 45±4.9 years, and the clinical findings at presentation and demographic data were similar in both groups. The rate of clinical success was 95% in G-I and 95.8% in G-II (P=0.96), with no difference in regard to in-hospital evolution between the groups. Death, acute myocardial infarction, and the need for myocardial revascularization during clinical follow-up occurred in 10.1% and 11.2% (P=0.92) in G-I and G-II, respectively. By the end of 24 months, the actuarial analysis showed an event-free survival of 84.6 % in G-I and 81.1% in G-II (P=0.57). CONCLUSION: Percutaneous treatment with coronary stent implantation in young patients with multivessel disease may be safe with a high rate of clinical success, a low incidence of in-hospital complications, and a favorable evolution in clinical follow-up.

Análisis crítico de la formación y capacitación del profesional de la seguridad en la Provincia de Córdoba en los últimos diez años. A critical analysis of the formation and training of the professional in the area of security in the province of Córdoba in the last 10 years.

El problema que abordaremos es la transformación y la toma de decisiones en los procesos de formación y capacitación de las instituciones de seguridad, específicamente, los motivos y fundamentos de los cambios en los planes de estudios, en relación a los contenidos curriculares de los institutos de formación de los profesionales en seguridad. Esto sobre la hipótesis de que las organizaciones educativas policiales y penitenciarias han llevado a cabo transformaciones en su organización y gestión curricular para adecuarse a las nuevas demandas sociales y políticas. El objetivo del presente proyecto es analizar críticamente los contenidos curriculares de los institutos de formación y capacitación de la Policía y Servicio Penitenciario de la Provincia de Córdoba. Abordaremos el análisis de los planes de dichas instituciones en los últimos 10 años, sus modificaciones y criterios utilizados para responder a los nuevos escenarios sociales. Se hará una exploración de la información y la documentación existente en los ámbitos oficiales. Asimismo, la investigación contará con la realización de entrevistas y encuestas a directivos, docentes, alumnos y demás actores claves, con la finalidad de recabar la opinión de los mismos respecto de las transformaciones en la educación policial y penitenciaria. A partir del proyecto de investigación se pretende construir conocimiento acerca de las políticas educativas en el área de seguridad especialmente sobre la formación y capacitación de recursos profesionales específicos, dentro del ámbito local. De tal modo, se pretende aportar elementos teóricos de análisis al modo en que se han instituido la oferta educativa y las transformaciones en los planes de estudios en las instituciones de formación profesional de la seguridad y cómo éstos han sido implementados a la luz de los nuevos escenarios políticos y sociales. Esto nos permitirá aportar al incipiente campo de los estudios sobre la seguridad, específicamente sobre la formación de los profesionales en seguridad, poniendo a diposición de los responsables gubernamentales e institucionales un estudio que explora y sistematiza las transformaciones y fundamentos de la politica de educación en el campo de la seguridad provincial. Este desarrollo investigativo nos permitirá inagurar la actividad de producción de conocimiento dentro del ámbito académico de la Licenciatura en Seguridad de la Universidad Nacional de Villa María a través del presente proyecto que describirá el proceso de formación y capacitación policial y penitenciaria y los cambios que con el transcurso del tiempo se han verificado.

Análisis de una iniciativa estudiantil de investigación surgida en Criptogamia, una asignatura optativa de segundo ciclo de Biología = Analysis of a students’ research initiative originating in Cryptogamy, an elective course in the last two years of the Biology degree

Presentamos una experiencia exitosa de aprendizaje que partió de Criptogamia (asignatura optativa de segundo ciclo de Biología), que dio lugar a un proyecto de investigación gestionado por los propios alumnos. La iniciativa se consolidó estableciendo una Asociación de Estudiantes centrada en investigación y divulgación. En poco tiempo, los participantes han presentado comunicaciones científicas, y organizado actividades dirigidas a diversos públicos, dentro y fuera de la comunidad universitaria. Actualmente se plantea una colaboración multidisciplinar con otros organismos de investigación y la extensión de su ámbito de estudio. Abordamos su incidencia en el aprendizaje en varios aspectos: científico (técnicas específicas, rigor, búsqueda de información e interpretación de resultados), comunicativo (estructuración y presentación de la información obtenida, para diversos públicos), y organizativo, incluyendo el trabajo en equipo. Aunque de carácter espontáneo, esta experiencia muestra rasgos evaluables en cuanto a sus posibilidades para otras asignaturas. Analizamos las características y planteamiento de esta optativa, el perfil de sus alumnos, y el contexto universitario que la acoge. Detectamos como factores principales los aspectos participativos de la asignatura, la cohesión del grupo, el carácter voluntario de la implicación, los beneficios percibidos por los estudiantes, y la disponibilidad de recursos humanos (supervisión) y materiales (equipamiento y subvenciones).

Conflict, Peace and Security in Africa: an Assessment and New Questions After 50 Years of African Independence

Since the independence processes in the African continent, armed conflicts, peace and security have raised concern and attention both at the domestic level and at the international scale. In recent years, all aspects have undergone significant changes which have given rise to intense debate. The end of some historical conflicts has taken place in a context of slight decrease in the number of armed conflicts and the consolidation of post-conflict reconstruction processes. Moreover, African regional organizations have staged an increasingly more active internal shift in matters related to peace and security, encouraged by the idea of promoting “African solutions to African problems”. This new scenario, has been accompanied by new uncertainties at the security level and major challenges at the operational level, especially for the African Union. This article aims to ascertain the state of affairs on all these issues and raise some key questions to consider.

The Last Fifteen Years of Schistosomiasis in Venezuela: Features and Evolution

Control of schistosomiasis in Venezuela has been a topic of major interest and controversy among the metaxenic parasitosis. A small area of transmission of approximately 15,000 km2 was thought to be eradicated some years ago. However, some epidemiological characteristics of our transmission area have limited the success on the way toward eradication. Since 1945, when the Schistosomiasis Control Program started, the prevalence in the endemic area has decreased from 14% in 1943 to 1.4% in 1996. Until 1982, the surveillance of active cases was based on massive stool examination. Since then, the Schistosomiasis Research Group (SRG) recommended the additional use of serologic tests in the Control Program and the selective or massive chemotherapy depending on serological and parasitological prevalence of each community. At present, the real prevalence is underestimated due to the fact that approximately 80% of the individuals eliminate less than 100 eggs/g of feces. Those persons could be responsible for the maintenance of the foci going on and therefore limiting the impact of the control measures. Efforts of the SRG are being oriented toward improvement of immunodiagnostic tests by using defined antigens (enzymes) and chemically synthesized peptides, derived from relevant molecules of the parasite, either for antibodies or antigens search. On the other hand, introduction of snail competitors has been a biological weapon in the control of the intermediate host in certain areas. However, the recent reinfestation of water courses by Biomphalaria glabrata, the increased prevalence in some areas, together with important administrative changes at the Control Program of the Minister of Health, have arisen new questions and doubts, challenging the eradication strategy proposed during the last decade.

Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years.

BACKGROUND/AIMS: Alveolar echinococcosis (AE) is a serious liver disease. The aim of this study was to explore the long-term prognosis of AE patients, the burden of this disease in Switzerland and the cost-effectiveness of treatment. METHODS: Relative survival analysis was undertaken using a national database with 329 patient records. 155 representative cases had sufficient details regarding treatment costs and patient outcome to estimate the financial implications and treatment costs of AE. RESULTS: For an average 54-year-old patient diagnosed with AE in 1970 the life expectancy was estimated to be reduced by 18.2 and 21.3 years for men and women, respectively. By 2005 this was reduced to approximately 3.5 and 2.6 years, respectively. Patients undergoing radical surgery had a better outcome, whereas the older patients had a poorer prognosis than the younger patients. Costs amount to approximately Euro108,762 per patient. Assuming the improved life expectancy of AE patients is due to modern treatment the cost per disability-adjusted life years (DALY) saved is approximately Euro6,032. CONCLUSIONS: Current treatments have substantially improved the prognosis of AE patients compared to the 1970s. The cost per DALY saved is low compared to the average national annual income. Hence, AE treatment is highly cost-effective in Switzerland.

A Better Future - 50 Years of Child Care in Northern Ireland

A Better Future - 50 Years of Child Care in Northern Ireland 1950 to 2000

Case-control study of factors associated with chronic Chagas heart disease in patients over 50 years of age

A case-control study on chronic Chagas heart disease (CCHD) was carried out between 1997 and 2005. Ninety patients over 50 years of age were examined for factors related to (CCHD). Fourty-six patients (51.1%) with Chagas heart disease (anomalous ECG) were assigned to the case group and 44 (48.9%) were included in the control group as carriers of undetermined forms of chronic disease. Social, demographic (age, gender, skin color, area of origin), epidemiological (permanence within an endemic zone, family history of Chagas heart disease or sudden death, physical strain, alcoholism, and smoking), and clinical (systemic hypertension) variables were analyzed. The data set was assessed through single-variable and multivariate analysis. The two factors independently associated with heart disease were age - presence of heart disease being three times higher in patients over 60 years of age (odds ratio, OR: 2.89; confidence interval of 95%: 1.09-7.61) - and family history of Chagas heart disease (OR: 2.833, CI 95%: 1.11-7.23). Systemic hypertension and gender did not prove to hold any association with heart disease, as neither did skin color, but this variable showed low statistical power due to reduced sample size.

Le taux de détresse respiratoire du nouveau-né augmente, celui des césariennes aussi: et si ce n'était pas un hasard? [Respiratory distress of the neonate and the rate of caesarean section have increased over the last 30 years. Is there a link?]

Ces trente dernières années, on note en Suisse une augmentation significative de l'incidence du syndrome de détresse respiratoire (SDR) chez le nouveau-né (NN), touchant particulièrement les enfants avec un poids de naissance >2500 g. En même temps, le taux des césariennes (CS) s'est aussi accru. Une explication pour une éventuelle corrélation entre les deux évolutions est une augmentation en particulier des CS électives qui ont tendance à être planifiées à un terme précoce pour éviter la mise en travail spontanée. Suite à cela, le foetus est privé de différents mécanismes qui favorisent l'adaptation pulmonaire périnatale. Les bénéfices réels de la CS sur la morbidité tant foetale que maternelle ne doivent pas faire oublier que la CS est un facteur de risque pour le SDR du NN. Ce risque peut être diminué efficacement en planifiant une CS élective après 39 semaines révolues. In Switzerland, the rate of respiratory distress in neonates needing hospitalization has doubled over the last thirty years, concerning in particular babies weighing more than 2500 g. In the same time, the rate of Caesarean section (CS) has also multiplied. We suppose that a link between the two evolutions might be the increase of elective CS. They tend to be planned early at term to avoid the onset of spontaneous labour As a consequence, the foetus is deprived of different mechanisms helping pulmonary transition around birth. The potential benefits of CS regarding morbidity of foetus and mother should not overshadow that CS is a significant risk factor for respiratory problems of the neonate. This risk could be dramatically decreased by planning elective CS only after completed 39 weeks of gestation

Peripheral arterial disease in HIV patients older than 50 years of age

Our objective was to analyze the prevalence of peripheral arterial disease (PAD) in HIV patients at risk and to compare them with the general population. All HIV patients older than 50 years who attended our unit from October 2005-July 2006 and all persons attending for an annual medical checkup at an employees' insurance association during the same period were invited to participate in the study. Of the latter (n = 407), a person of the same sex and age (+/-5 years) was included for each HIV patient. PAD was assessed by the ankle-brachial index (ABI) in all subjects, and all completed the Edinburgh questionnaire. Ninety-nine HIV patients and 99 persons from the general population of the same age and sex were included in the study. The HIV patients had a greater prevalence of dyslipidemia, diabetes, and PAD, which was symptomatic in five of them and in one subject from the general population. Patients with HIV infection older than 50 had a high prevalence of PAD, and as it was asymptomatic in half the cases, an ABI may be performed in this population to actively look for PAD. Control of cardiovascular risk factors and the use of such drugs as platelet antiaggregation agents should therefore be optimized in this population.

Health correlates of overweight and obesity in adults aged 50 years and over: results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

QUESTIONS UNDER STUDY: To examine the association between overweight/obesity and several self-reported chronic diseases, symptoms and disability measures. METHODS: Data from eleven European countries participating in the Survey of Health, Ageing and Retirement in Europe were used. 18,584 non-institutionalised individuals aged 50 years and over with BMI > or = 18.5 (kg/m2) were included. BMI was categorized into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9) and obesity (BMI > or = 30). Dependent variables were 13 diagnosed chronic conditions, 11 health complaints, subjective health and physical disability measures. For both genders, multiple logistic regressions were performed adjusting for age, socioeconomic status and behaviour risks. RESULTS: The odds ratios for high blood pressure, high cholesterol, diabetes, arthritis, joint pain and swollen legs were significantly increased for overweight and obese adults. Compared to normal-weight individuals, the odds ratio (OR) for reporting > or = 2 chronic diseases was 2.4 (95% CI 1.9-2.9) for obese men and 2.7 (95% CI 2.2-3.1) for obese women. Overweight and obese women were more likely to report health symptoms. Obesity in men (OR 0.5, 95% CI 0.4-0.6), and overweight (OR 0.5, 95% CI 0.4-0.6) and obesity (OR 0.4, 95% CI 0.3-0.5) in women, were associated with poorer subjective health (i.e. a decreased risk of reporting excellent, very good or good subjective health). Disability outcomes were those showing the greatest differences in strength of association across BMI categories, and between genders. For example, the OR for any difficulty in walking 100 metres was non-significant at 0.8 for overweight men, at 1.9 (95% CI 1.3-2.7) for obese men, at 1.4 (95% CI 1.1-1.8) for overweight women, and at 3.5 (95% CI 2.6-4.7) for obese women. CONCLUSIONS: These results highlight the impact of increased BMI on morbidity and disability. Healthcare stakeholders of the participating countries should be aware of the substantial burden that obesity places on the general health and autonomy of adults aged over 50.

Evolució de la vegetació de l’antic estany de Sils (la Selva) en els darrers 50 anys

The historical evolution of vegetation in the former Sils Pond (la Selva) during the second half of the 20th century is described through the study of past(Bolòs, 1954; Vilar, 1981) and present-day (Mercadal, 2002) vegetation cartography, the first aerial photographs (1956 and 1980) and current orthophotos (2000). This inland pool was finally drained in 1851 and most of its area was converted into meadows (Gaudinio fragilis-Arrhenatheretum elatioris Br.-Bl. in Br.-Bl., Roussine & Nègre 1952), a semi cultural community which was very distinct florally, for the Mediterranean region. The results demonstrate that in the last 50 years changes in land use have transformed the former landscape, which was prominently meadow-like and grain-producing, into woodlands, wet grasslands, developed areas and sub-Mediterranean forests, with the consequent loss of meadow areas and floristic diversity. In response, based on historical cartography, we propose spaces to prioritize for recovery and management such as meadow areas