Frequency and molecular characterisation of Entamoeba histolytica , Entamoeba dispar , Entamoeba moshkovskii , and Entamoeba hartmanni in the context of water scarcity in northeastern Brazil

This study aimed to estimate the frequency, associated factors, and molecular characterisation of Entamoeba histolytica , Entamoeba dispar, Entamoeba moshkovskii , and Entamoeba hartmanni infections. We performed a survey (n = 213 subjects) to obtain parasitological, sanitation, and sociodemographic data. Faecal samples were processed through flotation and centrifugation methods. E. histolytica, E. dispar, E. moshkovskii, and E. hartmanni were identified by nested-polymerase chain reaction (PCR). The overall prevalence of infection was 22/213 (10.3%). The infection rate among subjects who drink rainwater collected from roofs in tanks was higher than the rate in subjects who drink desalinated water pumped from wells; similarly, the infection rate among subjects who practice open defecation was significantly higher than that of subjects with latrines. Out of the 22 samples positive for morphologically indistinguishable Entamoeba species, the differentiation by PCR was successful for 21. The species distribution was as follows: 57.1% to E. dispar, 23.8% to E. histolytica, 14.3% to E. histolytica and E. dispar, and 4.8% E. dispar and E. hartmanni. These data suggest a high prevalence of asymptomatic infection by the group of morphologically indistinguishable Entamoeba histolytica/dispar/moshkovskii complex and E. hartmanni species. In this context of water scarcity, the sanitary and socioenvironmental characteristics of the region appear to favour transmission.

Business-IT Alignment in PSS Value Networks: A Capability-Based Framework

Part 8: Business Strategies Alignment

One-year follow-up of the nutritional status of patients undergoing liver transplantation

Background: Choosing the method of nutritional assessment is essential for proper follow-up of the nutritional status of patients undergoing liver transplantation. Objectives: Evaluate and compare the nutritional status of cirrhotic patients before and after liver transplantation over a year by different methods of nutritional assessment. Methods: Patients undergoing liver transplantation were assessed in five phases: pre-transplant, 1, 3, 6 and 12 months after transplantation at the hospital Santa Casa de Misericordia de Porto Alegre, RS, Brazil. The methods used for nutritional assessment were anthropometry, grip strength of the non-dominant hand (HGS) by dynamometry, thickness of the adductor pollicis muscle (APM) and phase angle (PA) by bioelectrical impedance analysis (BIA). In all evaluations, the same measurements were taken. Results: Evaluations were performed in 22 patients. Methods that showed a higher prevalence of malnourished patients before transplantation were PA by BIA (25%), arm muscle circumference (AMC) (21.9%) and arm circumference (AC) (18.8%). When comparing the nutritional status of patients during follow-up, there was a significant difference only in the evaluation methods AC, triceps skinfold thickness and PA by BIA. At the end, the methods of nutritional assessment were compared again. They showed a significant statistical difference, with HGS being the best method for detecting malnutrition. Conclusions: In conclusion, it is suggested that the method PA by BIA could be widely used with this population since the results are consistent with other findings in the literature and they are significant, reliable, and reproducible.

Influ��ncia do zinco suplementar na matura����o biol��gica e no crescimento de jovens atletas de futebol do sexo masculino

Introdu����o O zinco �� um importante elemento tra��o que auxilia na capacidade antioxidante, al��m de participar da matura����o biol��gica. Em atletas, a suplementa����o de zinco tem efeito positivo nos par��metros hematol��gicos e pode melhorar o rendimento esportivo. Sua defici��ncia �� comumente observada nesses grupo e pode estar associada �� diminui����o da for��a f��sica assim como da massa corporal, al��m de ter efeito significativo no crescimento. Assim os objetivos do presente estudo foram: comparar os m��todos de avalia����o da maturidade biol��gica e suas rela����es com vari��veis antropom��tricas e de rendimento f��sico de acordo com o estado de zinco em jovens jogadores de futebol; comparar diferentes m��todos de avalia����o da composi����o corporal em jovens jogadores de futebol esratificados de acordo com os n��veis plasm��ticos de zinco e investigar o efeito do zinco suplementar na matura����o biol��gica, no crescimento, na composi����o corporal e na for��a muscular de jogadores de futebol p��beres do sexo masculino. Materiais e m��todos Foram avaliados em dois momentos 48 jovens do sexo masculino (13��1 anos, massa corporal de 48��10kg, estatura de 160��10cm e zinco plasm��tico de 12,1��2,2 ��mol/L). Todos eram jogadores de futebol de um tradicional clube do Rio de Janeiro e foram divididos aleatoriamente em dois grupos. Durante 12 semanas o grupo placebo (n=28) recebeu c��psulas de amido de milho e o grupo suplementado (n=20) recebeu c��psulas de gluconato de Zn (22mg/dia). O valor de 11,0 ��mol/L foi considerado como ponto de corte para classifica����o dos jovens em normozinc��micos ou hipozinc��micos. No in��cio da manh��, ap��s jejum noturno, foram coletados sangue e urina para determina����o da concentra����o de zinco. A massa corporal, alturas (do v��rtex, acromial, dactiloidal, iliocristal, trocant��rica e sentado), composi����o corporal, for��a e maturidade esquel��tica (TW3) tamb��m foram determinadas por metodologias validadas. Resultados As compara����es entre as categorias maturacionais definidas por cada m��todo de avalia����o mostraram que a idade ��ssea foi o ��nico m��todo que permitiu a identifica����o de diferen��as entre as tr��s categorias, em ao menos duas vari��eis relacionadas ao rendimento (massa livre de gordura (MLG) e for��a na m��o dominante (FMD) ��� p<0,0001). O m��todo da pilosidade axilar foi capaz de discriminar apenas para a FMD (p<0,0001). Embora tenha fornecido quatro categorias maturacionais, o m��todo por dosagem da testosterona n��o possibilitou a identifica����o de diferen��as entre as categorias relativas a MLG, a FMD e as dobras cut��neas(DC). Quando observamos os m��todos de avalia����o da composi����o corporal n��o foram identificadas diferen��as sigificativas entre os grupos hipozinc��mico e normozinc��mico no percentagem de gordura(PG) nem na MLG obtidas atrav��s dos m��todos da absortometria de dupla energia (DXA) (p=0,06076 e p=0,5638 respectivamente), das DC (p=0,6840 and 0,5087) e atrav��s da bioimped��ncia el��trica (BIA) (p=0,3475 and p=0,3475). Entre os diferentes m��todos tamb��m n��o foi encontrada diferen��as significativas (PG: p=0,1272 e p=0,3231 - MLG: p=0,9229 and p=0,8933 para os grupos hipozinc��mico e normozinc��mico, respectivamente). As correla����es entre os m��todos foram significativas (PG: r= 0,3414 a 0,9765 e p<0,0001 a 0,0133 - MLG: r=0,9533 a 0,9998 e p<0,0001). Fortes coeficientes de determina����o foram obtidos nas regress��es m��ltiplas dos valores do DXA com a equa����o de Slaughter na estimativa da PG (r=0,86; r2=0,928 e SEE=2,37%) e ainda maiores para MLG (r=0,98; r2=0,990 e SEE=1,18kg). Valores menores foram encontrados para as outras equa����es com DC e para BIA. Ao analisar os efeitos da suplementa����o de zinco sobre o crescimento, a matura����o, a composi����o corporal e a for��a, observou-se que somente as altera����es ocorridas nos indicadores de crescimento foram significativas (p=0,0312), sendo que todas as demais n��o foram significativas - idade ��ssea (p=0,1391), massa livre de gordura (p=0,0593), percentual de massa gorda (p=0,2212) e for��a na m��o dominante (p=0,6569). Conclus��es Observando diferentes m��todos de avalia����o da maturidade biol��gica e as categorias por eles definidas, o m��todo da idade ��ssea (IO) mostrou ser melhor, visto que ele permitiu identificar diferen��as entre as tr��s categorias poss��veis, nas vari��veis MLG e FMD, ao contr��rio dos outros m��todos. Para a avalia����o da composi����o corporal, os m��todos baseados nas DC foram melhores que BIA, quando DXA n��o estiver dispon��vel. A compara����o entre os m��todos baseados nas DC mostrou que a melhor associa����o foi obtida com a equa����o de Slaughter, seguida pela equa����o de Lohman com a utiliza����o da IO ao inv��s da idade cronol��gica. Os n��veis de zinco plasm��tico parecem n��o serem influenciados pela composi����o corporal, o que certamente justifica mais estudos. Os resultados da an��lise dos efeitos da suplementa����o de zinco no crescimento, na matura����o, na composi����o corporal e na for��a, nos levam a concluir que o crescimento teve altera����o positiva significativa e que os valores das demais vari��veis estudadas (matura����o, composi����o corporal e for��a muscular) n��o sofreram altera����es significativas relacionadas �� suplementa����o de zinco nos jovens jogadores de futebol do sexo masculino, na faixa et��ria dos 12 aos 14 anos.

Molecular biology of prolactin and prolactin receptor in a marine teleost: the sea bream(Sparus aurata)

Tese de dout. em Biologia, especialidade de Biologia Molecular, Unidade de Ci��ncias e Tecnologias dos Recursos Aqu��ticos, Univ. do Algarve

Successional dynamics in inland dune shrub communities drive changes in functional diversity

Communities can be defined as assemblages of species coexisting under particular environments. The relationship between environment and species are regulated by both environmental requirements ���which ultimately determine the species capacity to establish and survive in a particular environment��� and the ecological interactions occurring during assembly processes ���which also determine community composition by conditioning species coexistence. In this context, plant functional traits are attributes that represent ecological strategies and determine how plants respond to environmental factors and interact with other species. Therefore, the analysis of how traits vary through the dynamics of communities, such as along successions, can give insights about how environmental requirements and species interactions may determine the composition and functional structure of these communities. The xerophytic shrub communities inhabiting inland sand dunes in SW Portugal are characterized by successional processes that are mainly driven by local (edaphic gradients and human disturbance) and regional (climate) processes. Therefore, they constitute an appropriate system for studying species interactions and environmentcommunity co-variations based on functional terms. Using these communities as a model, we evaluate the hypothesis that successional community changes in species composition of xerophytic shrub communities can result in concurrent changes in functional diversity

Bia���s smile: an health education instrument on cleft lip and palate

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.

Bioelectric Impedance Analysis in the Diagnosis of Vesicoureteral Reflux

Background: Vesicoureteral reflux (VUR) is a common abnormality of the urinary tract in childhood. Objectives: As urine enters the ureters and renal pelvis during voiding in vesicoureteral reflux (VUR), we hypothesized that change in body water composition before and after voiding may be less different in children with VUR. Patients and Methods: Patients were grouped as those with VUR (Group 1) and without VUR (Group 2). Bioelectric impedance analysis was performed before and after voiding, and third space fluid (TSF) (L), percent of total body fluid (TBF%), extracellular fluid (ECF%), and intracellular fluid (ICF%) were recorded. After change of TSF, TBF, ECF, ICF (��TSF, ��TBF%, ��ECF%, ��ICF%), urine volume (mL), and urine volume/body weight (mL/kg) were calculated. Groups 1 and 2 were compared for these parameters. In addition, pre- and post-voiding body fluid values were compared in each group. Results: TBF%, ECF%, ICF%, and TSF in both pre- and post-voiding states and ��TBF%, ��ECF%, ��ICF%, and ��TSF after voiding were not different between groups. However, while post-voiding TBF%, ECF% was significantly decreased in Group 1 (64.5 �� 8.1 vs 63.7 �� 7.2, P = 0.013 for TBF%), there was not post-voiding change in TSF in the same group. On the other hand, there was also a significant TSF decrease in Group 2. Conclusions: Bladder and ureter can be considered as the third space. Thus, we think that BIA has been useful in discriminating children with VUR as there was no decreased in patients with VUR, although there was decreased TSF in patients without VUR. However, further studies are needed to increase the accuracy of this hypothesis.

Valoraci��n m��dico deportiva y an��lisis de la pruebas de aptitud en estudiantes de danza

Para el acceso a los estudios oficiales de danza, se realizan pruebas de aptitud en los Conservatorios Profesionales de Danza de Espa��a. Estas son realizadas por profesores de danza que eval��an aptitudes r��tmicas, expresivas y psicomotrices y por m��dicos que realizan una evaluaci��n de las caracter��sticas f��sica. Objetivos: En primer lugar: a) evaluar los ��tems de calificaci��n de la Prueba de Aptitud por parte del profesorado de danza; b) comprobar si se correlacionan con los rangos adjudicados por la Administraci��n; c) proponer una adaptaci��n de las calificaciones de los ��tems de la evaluaci��n de la Prueba de Aptitud. En segundo lugar y relativo a los ��tems de la valoraci��n m��dica del alumnado, nuestros objetivos fueron: a) determinar si existe mayor riesgo de padecer trastornos de la conducta alimentaria (TCA) en nuestra poblaci��n; b) valorar cuales son las variables de composici��n corporal m��s sensibles y espec��ficas para el cribaje de TCA; c) describir cuales son las mediciones de flexibilidad de la Prueba de Aptitud m��s entrenables al aplicar un plan de entrenamiento; d) discernir qu�� tipo de entrenamiento de flexibilidad alcanza mejores resultados. M��todos: Se plantearon 3 estudios. Para la valoraci��n de los ��tems y para el estudio de la composici��n corporal y los TCA se realizaron estudios de tipo transversal. En el estudio del entrenamiento de la flexibilidad se practic�� un estudio longitudinal experimental con pre evaluaci��n y 4 evaluaciones post intervenci��n, de grupos aleatorizados a 3 tipos de entrenamiento: estiramiento activo (EA), estiramiento pasivo (EP) y estiramiento bal��stico (BAL), con un grupo control (CT). Sujetos: 216 sujetos fueron seleccionados para los diferentes estudios, profesorado (n=27) y alumnos (n=189). Para obtener la informaci��n y realizar el estudio de la valoraci��n de los ��tems se aplic�� un cuestionario ad hoc en dos p��ginas. En el estudio de la composici��n corporal las variables antropom��tricas, componentes del somatotipo y bioimpedancia el��ctrica (BIA) fueron relacionadas con el test EAT-26 para la discriminaci��n de los TCA. Se obtuvieron medidas antropom��tricas mediante las t��cnicas estandarizadas de la ISAK y se calcul�� el ��ndice de masa corporal (IMC) de forma cl��sica, la masa grasa mediante la ecuaci��n de Slaughter y la masa muscular esquel��tica (MME) mediante ecuaci��n de Poortmans. La BIA de cuerpo entero se realiz�� con protocolo estandarizado. La aleatorizaci��n a grupos de entrenamiento se realiz�� mediante asignaci��n num��rica aleatoria a doble ciego de los grupos. Resultados: El profesorado de danza cl��sica (CL) prioriza calificaciones en los ��tems peso/talla, morfolog��a del pie y extensi��n de piernas, los docentes de danza espa��ola (ES) y flamenco (FL) conceden mayor importancia a la evaluaci��n de la morfolog��a de las piernas y aspectos de ritmo y expresi��n, mientras que en danza contempor��nea (CO) se destaca la calificaci��n de la morfolog��a de la columna y pelvis, existen diferencias estad��sticamente significativas en la distribuci��n de las calificaciones de determinados ��tems de evaluaci��n, siendo los rangos de calificaci��n aportados por el profesorado diferente al aportado por la Administraci��n. En el cuestionario EAT-26, se comprueba que existen diferencias en nuestra poblaci��n entre los puntos de corte de 10 y 20, y por especialidades se muestra la danza espa��ola y la danza contempor��nea con mayor prevalencia que la danza cl��sica y el baile flamenco. Mediante un an��lisis con curvas ROC, la MME expresada en kilogramos demuestra ser la m��s sensible y espec��fica para la discriminaci��n de los TCA y de las variables de la BIA son la reactancia (Xc) y el ��ngulo de fase (Af) las que destacan como mejores predictoras de los TCA. Con respecto al entrenamiento de la flexibilidad se observaron diferencias estad��sticamente significativas de las tres medidas estudiadas abducci��n de cadera (ABD), distancia dedos-suelo (DDS) y flexi��n plantar (FP), de los tres grupos de entrenamiento a estudio EP, EA, BAL, con respecto al CO a la semana decimosegunda (P<0,001), la m��xima mejor��a fue en DDS, en el grupo BAL. En los grupos de entrenamiento no hubo descenso del rango de movimiento (ROM) tras el cese del entrenamiento. Conclusiones: Todos estos resultados deber��an ser tenidos en cuenta en el dise��o futuro de las prueba de aptitud y selecci��n de futuros bailarines. La inclusi��n en las pruebas de elementos de valoraci��n de la composici��n corporal con mayor sensibilidad para la discriminaci��n de TCA nos puede aportar informaci��n para la prevenci��n y diagn��stico. Unas calificaciones basadas en los criterios unificados del profesorado, en elementos m��s entrenables y en las aptitudes m��s innatas facilitar��an el proceso evaluador y de selecci��n.

Building bridges for innovation in ageing:synergies between action groups of the EIP on AHA

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups��� new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

Vaccins �� base de plante comme alternatives aux antibiotiques : ��valuation du potentiel d'un extrait de tabac contenant rFaeGntd/dsc d���Escherichia coli ent��rotoxig��nique (ETEC) �� induire une r��ponse immunitaire chez le procelet sevr��.

La diarrh��e post-sevrage caus��e par Escherichia coli ent��rotoxig��nique pr��sentant le fimbriae F4 (ETEC F4+) cause actuellement des pertes ��conomiques importantes dans l���industrie porcine canadienne. Afin de mieux contr��ler cette maladie, et afin d���offrir une alternative �� l���utilisation excessive d���antibiotiques, le projet d��crit dans ce m��moire ��value la capacit�� de la sous-unit�� majeure du fimbriae F4, FaeG, �� prot��ger les porcelets contre ETEC F4+. Trois phases animales ont ��t�� r��alis��es afin de tester s��par��ment et de fa��on combin��e l���effet de FaeG sous forme d�����mulsion orale et sous forme d���injection intramusculaire (IM). Les analyses de dosages d���anticorps sp��cifiques et de prolif��rations lymphocytaires effectu��es sur les ��chantillons recueillis �� chaque phase animale permirent d�����valuer la r��ponse immunitaire mucosale et syst��mique. Les r��sultats finaux obtenus ont d��montr�� un effet des injections IM sur l���activation de la production d���anticorps sanguins ainsi que sur la prolif��ration de cellules mononucl����es sanguines (CMS). L�����valuation de l���expression de diff��rents g��nes dans les ganglions m��sent��riques et dans la muqueuse il��ale a permis d���observer une modulation de l���expression de certains g��nes (TLR4, NF��BIA, IFNg, CCL20, CXCL2, IL4 et IL17), mais ��galement l���absence de modulation sur plusieurs g��nes attendus. Au final, certains effets secondaires observ��s lors des immunisations de la derni��re phase animale, tels que la diarrh��e, la difficult�� �� respirer et la faiblesse, ont n��cessit�� des analyses suppl��mentaires. Il a ainsi ��t�� d��termin�� que plusieurs porcelets ont subi une r��action de type anaphylactique aux immunisations re��ues �� la derni��re phase animale, bien que la composante exacte causant cette r��action soit inconnue. En conclusion, bien qu���une r��ponse immunitaire puisse ��tre d��clench��e par FaeG, d���autres ��tudes seront n��cessaires afin de d��velopper un vaccin oral contre ETEC F4+

Discrepancies in HLA Typing by PCR-SSOP and SBT Techniques: a case study

Six hundred twenty-one samples from Portugal, the Cabo Verde archipelago, and Guinea-Bissau were typed for HLA-A, HLA-B, and HLADRB1usingthepolymerasechainreaction���sequence-speci���coligonucleotide probe (PCR-SSOP) method and the sequence-based typing (SBT) method to characterizeandcomparediscrepanciesbetweenthetwomethods.Fifty-three alleles (4.27% of 1,242 chromosomes typed) identi���ed by the PCR-SSOP method were not concordant with the results obtained using the SBT method. Thirty-four (2.74% of total chromosomes typed) PCR-SSOP mistyping results were discrepancies inside the same allele group and 19 others (1.53% of total chromosomes typed) were relative to nonconcordant results between different groups. PCR-SSOP allele mistyping is the result of interpretation dif���culties resulting from less intense, absent, or dubious hybridization patterns. Noncommercial PCR-SSOP procedures are highly exigent on the technicians��� experience and the availability of properly calibrated high-precision equipment.

Diversified applications of supplemental LED light for greenhouse tomato production in the Mediterranean context

Among the various aspects to be investigated for a technological and productive upgrade of tomato greenhouse production in the Mediterranean area, the application of supplementary LED interlighting still shows limited interest. However, high-density tomato cultivation with intensive high-wire systems could lead to mutual shading and consequent reduction in photosynthesis and yield, even in case of appreciable amounts of external solar radiation, as in Southern Europe. Applications of interest could also involve off-season production or Building-Integrated Agriculture (BIA) such as rooftop greenhouses, where municipal regulations for structure and fire safety could limit the incoming radiation in the growing area. The aim of this research was to investigate diversified applications of supplemental LED interlighting for greenhouse tomato production (Solanum lycopersicum) in the Mediterranean countries. The diversified applications included: effects on post-harvest quality, shading reduction in BIA, tailored seedlings production, and off-season cultivation. The results showed that the application of supplemental LED light on greenhouse-grown tomato in Mediterranean countries (Italy and Spain) has potential to foster diverse applications. In particular, it can increase production in case of the limited solar radiation in rooftop greenhouses, maintain quality and reduce losses during post-harvest, help producing high quality and tailored seedlings, and increase yield during wintertime. Despite the positive results obtained, some aspects of the application of additional LED light in Southern Europe countries still need to be deepened and improved. In particular, given the current increase of electricity cost, future research should focus on more economically valuable methods of managing supplemental lighting, such as the application of shorter photoperiods or lower intensities, or techniques that can provide energy savings such as the pulsed light.

Uso indiscriminado de benzodiazep��nicos pelos usu��rios de uma equipe da Estrat��gia de sa��de da Fam��lia: neessidade de interven����o

Os Benzodiazep��nicos s��o drogas com atividade ansiol��tica que agem diretamente no sistema nervoso central, podendo alterar aspectos cognitivos e psicomotores. As nomenclaturas utilizadas para denomin��-los incluem: ansiol��ticos, sedativo-hipn��ticos, "calmantes". Dentre seus principais efeitos terap��uticos, tem-se: seda����o, hipnose e relaxamento muscular. O objetivo deste trabalho foi propor um Plano de Interven����o com vistas a reduzir o uso indiscriminado de benzodiazep��nicos pelos usu��rios da Estrat��gia de Sa��de da Fam��lia I, no munic��pio de S��o Pedro dos Ferros - MG. Trata-se de uma pesquisa de revis��o integrativa realizada na Biblioteca Virtual de Sa��de por meio de artigos cient��ficos completos, publicados na literatura nacional nos anos de 2004 a 2014, utilizando os seguintes descritores: Ansiol��ticos; Uso indevido de subst��ncias e Benzodiazep��nicos. Para operacionaliza����o do Plano de Interven����o foram utilizados o M��todo do Planejamento Estrat��gico Situacional e uma Revis��o de Literatura sobre o tema. Dentre os principais resultados encontrados nos artigos pesquisados tem-se: os entrevistados referiram que as orienta����es aos medicamentos Benzodiazep��nicos s��o de um modo geral insuficientes, inclusive grande parte n��o s��o alertados sobre o tempo total do tratamento. Alguns entrevistados relataram que em algumas das vezes, n��o era necess��rio passar por uma consulta m��dica para obten����o da prescri����o dos medicamentos e maioria dos entrevistados dos artigos pesquisados n��o percebiam ser dependentes de Benzodiazep��nicos. Como considera����es finais podemos dizer que o controle deste problema n��o acontece de forma r��pida e depende da cultura e da experi��ncia das pessoas. No entanto, deve haver um esfor��o por parte dos profissionais de sa��de, uma vez que h�� possibilidade de mudan��a e enfrentamento desta situa����o. Como recomenda����es, consideramos que �� de fundamental import��ncia verificar e analisar a utiliza����o dessa classe medicamentosa principalmente em indiv��duos idosos, para assegurar a assist��ncia e a seguran��a necess��rias para esta popula����o.