Suplementos fluorados pós-natais: recomendações de pediatras, entidades profissionais e instituições públicas de saúde

OBJETIVOS: identificar a opinião de pediatras e conhecer as recomendações de entidades profissionais e instituições públicas de saúde quanto à prescrição de suplementos fluorados. MÉTODOS: um questionário foi enviado a médicos pediatras. Informações adicionais sobre recomendações de suplementos fluorados foram obtidas junto a sete entidades profissionais e quatro instituições públicas de saúde. RESULTADOS: aproximadamente um em cada dez pediatras declarou prescrever algum suplemento contendo flúor. Risco de fluorose dentária, porque a água é fluoretada, foi a principal razão para afirmar que isso não deve ser feito. Quanto às entidades profissionais, duas deram respostas apropriadas. As respostas das demais não foram satisfatórias quanto ao uso racional de flúor. As respostas das instituições públicas foram apropriadas, embora o Ministério da Saúde não tenha se posicionado a respeito. CONCLUSÕES: um em cada 10 pediatras declarou prescrever suplementos contendo flúor para crianças residentes em São Paulo, cidade com água fluoretada. Em consequência, é necessário que o poder público e as entidades odontológicas assumam suas responsabilidades quanto ao uso dos suplementos fluorados.

Insatisfação com a imagem corporal em universitárias brasileiras

A insatisfação com a imagem corporal é avaliada por meio da diferença entre a figura real e a idealizada e pode influenciar comportamentos alimentares. OBJETIVO: Avaliar a insatisfação corporal de universitárias do sexo feminino nas cinco regiões do país e possíveis associações e correlações com a idade, o estado nutricional, a renda e o grau de escolaridade do chefe da família. MÉTODOS: 2.402 universitárias responderam à Escala de Silhuetas de Stunkard. As regiões foram comparadas por meio da análise de variância; correlações entre as variáveis foram analisadas pelos coeficientes de Pearson e Spearman. RESULTADOS: 64,4 por cento gostariam de ser menores do que sua figura atual, e mesmo as estudantes eutróficas escolheram figuras saudável e ideal menores. Na região Norte foram apontados os mais magros padrões ideais e de saúde e na região Centro-Oeste, os maiores. CONCLUSÃO: A ocorrência de insatisfação corporal foi bastante expressiva, com algumas diferenças regionais e sociodemográficas que devem ser consideradas

Interethnic Differences in the Distribution of Clinically Relevant Vascular Endothelial Growth Factor Genetic Polymorphisms

Vascular endothelial growth factor (VEGF) is a homodimeric glycoprotein produced mostly in endothelial cells and its transcription is regulated by a variety of growth factors and cytokines. VEGF plays many relevant roles, and three functional polymorphisms in the promoter region of the VEGF gene (C-2578A, G-1154A, and G-634C) have been associated with disease conditions. Although some studies suggest that interethnic differences exist in the distribution of these variants, no previous study has examined this hypothesis in admixed populations. We examined the distribution of these three clinically relevant VEGF single-nucleotide polymorphisms in 175 white and 185 black subjects. We have also estimated the haplotype distribution and assessed associations between these variants. Although the A-2578 and A-1154 variants were more common in whites (39% and 29%, respectively) than in blacks (29% and 16%, respectively; both p < 0.05), no significant interethnic differences were found with regards to the G-634C polymorphism. While the haplotype including the C-2578, G-1154, and G-634 variants was the most common in both ethnic groups, it was more common in blacks than in whites (p < 0.05). The haplotype including the C-2578, A-1154, and G-634 alleles and the haplotype including the C-2578, A-1154, and C-634 alleles were more common in whites than in blacks (both p < 0.05). These results show marked interethnic differences in the distribution of genetic variants of VEGF that may explain, at least in part, interethnic disparities in the susceptibility to cardiovascular diseases.

COOP/WONCA Charts as a Screen for Mental Disorders in Primary Care

PURPOSE most people with mental disorders receive treatment in primary care. The charts developed by the Dartmouth Primary Care Cooperative Research Network (COOP) and the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA) have not yet been evaluated as a screen for these disorders, using a structured psychiatric interview by an expert or considering diagnoses other than depression. We evaluated the validity and feasibility of the COOP/WONCA Charts as a mental disorders screen by comparing them both with other questionnaires previously validated and with the assessment of a mental health specialist using a structured diagnostic interview. METHODS We trained community health workers and nurse assistants working in a collaborative mental health care model to administer the COOP/WONCA Charts, the 20-item Self-Reporting Questionnaire (SRQ-20), and the World Health Organization Five Well-Being Index (WHO-5) to 120 primary care patients. A psychiatrist blinded to the patients' results on these questionnaires administered the SCID, or Structured Clinical Interview for the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS The area under the receiver operating characteristic curve was at least 0.80 for single items, a 3-item combination, and the total score of the COOP/WONCA Charts, as well as for the SRQ-20 and the WHO-5, for screening both for all mental disorders and for depressive disorders. The accuracy, sensitivity, specificity, and positive and negative predictive values of these measures ranged between 0.77 and 0.92. Community health workers and nurse assistants rated the understandability, ease of use, and clinical relevance of all 3 questionnaires as satisfactory. CONCLUSIONS One-time assessment of patients with the COOP/WONCA Charts is a valid and feasible option for screening for mental disorders by primary care teams.

Screening for abdominal aortic aneurysm: lessons from a population-based study

Objectives: To test the acceptability of screening and to identify modifiable risk factors for abdominal aortic aneurysm (AAA) in men. Design: A trial of ultrasound screening for AAA in a population-based random sample of men aged 65-83 years, and a cross-sectional case-control comparison of men in the same sample. Participants: 12203 men who had an ultrasound examination of their abdominal aorta, and completed a questionnaire covering demographic, behavioural and medical factors. Main outcome measures: Prevalence of AAA, and independent associations of AAA with demographic, medical and lifestyle factors. Results: Invitations to screening produced a corrected response of 70.5%. The prevalence of AAAs (> 30 mm) rose from 4.8% in men aged 65-69 years to 10.8% in those aged 80-83 years. The overall prevalence of large (> 50 mm) aneurysms was 0.69%. In a multivariate logistic model Mediterranean-born men had a 40% lower risk of AAA (> 30 mm) compared with men born in Australia (odds ratio [OR], 0.6; 95% CI, 0.4-0.8), while ex-smokers had a significantly increased risk of AAA (OR, 2.3; 95% CI, 1.9-2.8), and current smokers had even higher risks. AAA was significantly associated with established coronary and peripheral arterial disease and a waist:hip ratio greater than 0.9; men who regularly undertook vigorous exercise had a lower risk (OR, 0.8; 95% CI, 0.7-1.0). Conclusion: Ultrasound screening for AAA is acceptable to men in the likely target population. AAA shares some but not all of the risk factors for occlusive vascular disease, but the scope for primary prevention of AAA in later life is limited.

Bioimpedance Analysis: Should it be Used in Morbid Obesity?

Objectives: Questions about reliability of bioimpedance analysis (BIA) in morbidly obese subjects have curtailed its use in this setting, but metabolic implications might reignite the debate. In a prospective study, it was aimed to analyze anthropometric and clinical associations. Methods: Bariatric candidates (n = 94) with or without metabolic syndrome were consecutively investigated. Age was 34.9 +/- 10.4 years (68.1% females), and BMI was 40.8 +/- 4.6 kg m(-2). Methods included single-frequency BIA, anthropometrics, inflammatory indices, and general biochemical profile. Results: Body composition results (water, fat) in females, but not in males, were entirely consistent with the literature. In both genders good association was observed with anthropometrics (BMI, waist circumference), inflammatory indices (ferritin, C-reactive protein) and general biochemical variables. Anthropometric measurements also displayed comparable associations. Multivariate tests including the two sets of measurements indicated no predominance of one method over the other, one complementing the other as metabolic marker. Conclusions: BIA limitations were mostly relevant for males, not females. Despite such discrepancies, good associations with anthropometry were demonstrated for both genders. Correlations with liver enzymes, and indices of protein, carbohydrate, and lipid metabolism could be demonstrated. BIA deserves more investigations concerning liver steatosis and ongoing inflammation, and it could contribute as well, synergistically with anthropometry, to monitor weight loss, body fat shifts, and metabolic risk. Am. J. Hum. Biol. 23: 420-422, 2011. (c) 2011 Wiley-Liss, Inc.

Mast cell-associated alveolar inflammation in patients with atopic uncontrolled asthma

Background: A significant proportion of patients with asthma have persistent symptoms despite treatment with inhaled glucocorticosteroids. Objective: We hypothesized that in these patients, the alveolar parenchyma is subjected to mast cell-associated alterations. Methods: Bronchial and transbronchial biopsies from healthy controls (n = 8), patients with allergic rhinitis (n = 8), and patients with atopic uncontrolled asthma (symptoms despite treatment with inhaled glucocorticosteroids; mean dose, 743 mu g/d; n = 14) were processed for immunohistochemical identification of mast cell subtypes and mast cell expression of Fc epsilon RI and surface-bound IgE. Results: Whereas no difference in density of total bronchial mast cells was observed between patients with asthma and healthy controls, the total alveolar mast cell density was increased in the patients with asthma (P < .01). Division into mast cell subtypes revealed that in bronchi of patients with asthma, tryptase positive mast cells (MC(T)) numbers decreased compared with controls (P <= .05), whereas tryptase and chymase positive mast cells (MC(TC)) increased (P <= .05). In the alveolar parenchyma from patients with asthma, an increased density was found for both MC(T) (P <= .05) and MC(TC) (P <= .05). The increased alveolar mast cell densities were paralleled by an increased mast cell expression of FceRI (P < .001) compared with the controls. The patients with asthma also had increased numbers (P < .001) and proportions (P < .001) of alveolar mast cells with surface-bound IgE. Similar increases in densities, FceRI expression, and surface-bound IgE were not seen in separate explorations of alveolar mast cells in patients with allergic rhinitis. Conclusion: Our data suggest that patients with atopic uncontrolled asthma have an increased parenchymal infiltration of MCT and MCTC populations with increased expression of FceRI and surface-bound IgE compared with atopic and nonatopic controls. (J Allergy Clin Immunol 2011;127:905-12.)

Valproic acid has temporal variability in urinary clearance of metabolites

The reasons for the intra- and interindividual variability in the clearance of valproic acid (VPA) have not been completely characterized. The aim of this study was to examine day-night changes in the clearance of 3-oxo-valproate (3-oxo-VPA), 4-hydroxy-valproate (4-OH-VPA), and valproic acid glucuronides under steady state. Six diurnally active healthy male volunteers ingested 200 mg sodium valproate 12 hourly, at 0800 and 2000, for 28 days. On the last study day, two sequential 12-h urine samples were collected commencing at 2000 the evening before. Plasma samples were obtained at the end of each collection. Following alkaline hydrolysis, urine was analyzed for concentrations of VPA, 3-oxo-VPA, and 4-OH-VPA. A separate aliquot was assayed for creatinine (CR). The plasma concentrations of VPA, 3-oxo-VPA, 2-en-VPA, and CR were determined. The analysis of VPA and its metabolites was performed by CC-MS. There was an increase in plasma 3-oxo-VPA concentration at 0800, sampling as compared to 2000 sampling (p < .05). The urinary excretion of 3-oxo-VPA and VPA glucuronides were decreased between 2000 and 0800, compared to between 0800, and 2000, by 30% and 50% respectively (p < .05). These results indicate a nocturnal decrease in renal clearance of 3-oxo-VPA rather than a decrease in the beta -oxidation of VPA at night. These differences were not explained by differences between the sampling periods in CR excretion. These results indicate the importance of collecting samples of 24-h duration when studying metabolic profiles of VPA.

The pathogenesis of oral lichen planus

Both antigen-specific and non-specific mechanisms may be involved in the pathogenesis of oral lichen planus (OLP). Antigen-specific mechanisms in OLP include antigen presentation by basal keratinocytes and antigen-specific keratinocyte killing by CD8(+) cytotoxic T-cells. Non-specific mechanisms include mast cell degranulation and matrix metalloproteinase (MMP) activation in OLP lesions. These mechanisms may combine to cause T-cell accumulation in the superficial lamina propria, basement membrane disruption, intra-epithelial T-cell migration, and keratinocyte apoptosis in OLP. OLP chronicity may be due, in part, to deficient antigen-specific TGF-beta1-mediated immunosuppression. The normal oral mucosa may be an immune privileged site (similar to the eye, testis, and placenta), and breakdown of immune privilege could result in OLP and possibly other autoimmune oral mucosal diseases. Recent findings in mucocutaneous graft-versus-host disease, a clinical and histological correlate of lichen planus, suggest the involvement of TNF-alpha, CD40, Fas, MMPs, and mast cell degranulation in disease pathogenesis. Potential roles for oral Langerhans cells and the regional lymphatics in OLP lesion formation and chronicity are discussed. Carcinogenesis in OLP may be regulated by the integrated signal from various tumor inhibitors (TGF-beta1, TNF-alpha, IFN-gamma, IL-12) and promoters (MIF, MMP-9). We present our recent data implicating antigen-specific and non-specific mechanisms in the pathogenesis of OLP and propose a unifying hypothesis suggesting that both may be involved in lesion development. The initial event in OLP lesion formation and the factors that determine OLP susceptibility are unknown.

Myelin proteolipid protein - the first 50 years

Myelin proteolipid protein (PLP), the most abundant protein of central nervous system (CNS) myelin, is a hydrophobic integral membrane protein. Because of its physical properties, which make it difficult to work with, progress towards determining the exact function(s) and disease associations of myelin PLP has been slow. However, recent molecular biology advances have given new life to investigations of PLP, and suggest that it has multiple functions within myelin and is of importance in several neurological disorders. (C) 2002 Elsevier Science Ltd. All rights reserved.

Avaliação da qualidade de vida em crianças e adolescentes com câncer

Trata-se de um estudo sobre avaliação da qualidade de vida de crianças e adolescentes com câncer que objetivou-se a produção de duas propostas de artigo. A primeira proposta de artigo teve como objetivo conhecer as médias dos escores geral ou por dimensões encontrados nos estudos realizados os quais utilizaram o Pediatric Quality of Life Inventory 3.0 Cancer Module. Aplicou-se a estratégia de busca nas bases Scopus, Web of Science, Bireme, PsycoInfo e a EBSCO host. Encontrou-se 210 resumos e títulos, excluiu-se 189 por duplicidade e por não atender aos critérios de inclusão. Analisou-se e elegeu-se 21 para compor o estudo. Todos os artigos publicados na língua inglesa, em sua maioria na América (47,6%) e no período de 2011 a 2013 (61,9%), utilizaram-se do questionário para a coleta de dados tanto para criança e adolescentes quanto para seus pais na maioria dos artigos (61,9%). A variação dos escores por dimensões e geral provavelmente esteve relacionada com a seleção dos grupos de comparação pois, pode-se perceber a diversidade dos critérios de inclusão e das variáveis para a análise em cada estudo. Concluiu-se que as médias dos escores por dimensões e geral não alcançaram valores abaixo de 30 e os maiores escores por dimensões estão acima de 80. Sugere-se que a dimensão ansiedade frente ao tratamento, no relato das crianças, pode ter obtido os maiores escores dentro de cada estudo. A segunda proposta de artigo objetivou-se avaliar a qualidade de vida de crianças e adolescentes com câncer em tratamento ou em acompanhamento e verificar associações com as variáveis socioeconômicas e clínicas. Realizou-se um estudo transversal com 98 crianças e adolescentes com diagnóstico de câncer de uma unidade de referência em oncologia pediátrica no estado do Espírito Santo - Brasil. Aplicou-se o questionário PedsQLTM e coletou-se informações sociodemográficas e clínicas. A amostra caracterizou-se com predominância do sexo masculino, de faixa etária de 08 a 12 anos, de classe econômica C e com diagnóstico de leucemia. Houve associação entre a faixa etária nas médias escores de 5 das 8 dimensões da avaliação da qualidade de vida. Não houveram diferenças estatisticamente significante em nenhuma das dimensões nem no escore total da qualidade de vida com as variáveis sexo da criança e adolescente, tipo de tumor, classe econômica e a escolaridade da mãe. Concluiu-se que faixa etária, o status do tratamento e frequentar a escola são fatores que modificam a avaliação qualidade de vida no relato das crianças e adolescentes, aumentando ou diminuindo as dificuldades frente ao tratamento e a doença.

Ex-ante evaluation by the media of the Guimarães 2012 European Capital of Culture

The nomination of Guimarães to host the 2012 European Capital of Culture (ECC) has put on the agenda of the city the need of measuring the effects that the implementation of this mega event could have in it and in the municipality a whole. The balance of the benefits and costs and an extended community involvement tend to reduce negative impacts and enhance positive ones. This chapter analyzes the involvement of population and local associations in the planning and organization of the 2012 Guimarães European Capital of Culture, using the coverage made during 2011 by local and national press of the mega event. A content analysis of the news published covering the period between January and December 2011 and using three newspapers was conducted. From those, two were local and weekly newspapers and one was a national daily one. Looking to data results, it can be concluded that it was poor the community involvement and, also, the one of the cultural associations in the organizations of the 2012 ECC. A strong negative reaction to the model choose to plan the mega event conducted by official organizers was found, which has cast doubts on the desirable participation of the residents and, consequently, on the success of the mega event, especially in a perspective of a medium and long term effects.

BRAND EQUITY OF LAHORE FORT AS A TOURISM DESTINATION BRAND

ABSTRACTStudies that measure the brand equity of destination brands by using the Customer-Based Brand Equity (CBBE) model in a developing country context are scarce. The present study investigates the destination brand equity of the Lahore Fort by employing the CBBE model in a developing country context of Pakistan. Following the positivist tradition, we adopted a survey-based approach to collect data from 237 tourists visiting the Lahore Fort. Data were collected through a questionnaire developed to explain the relationship of brand awareness, brand image, brand association, and brand loyalty with Lahore Fort’s overall brand equity. We used various robust statistical techniques such as correlation, regression and confirmatory factor analysis (using PLS method) to reach meaningful conclusions and found that brand image and brand associations positively contribute to brand loyalty. Furthermore, brand loyalty significantly contributes towards overall brand equity. Pragmatically, this study measures the customer based brand equity of the Lahore Fort, a destination brand. The results are useful as they suggest a few strategies that can help policy makers to enhance Lahore Fort’s brand performance.

Educational characteristics of adult students in portuguese technological schools

Despite a massive expansion of education in Portugal, since the 1970’s, educational attainment of the adult population in the country remains low. The numbers of working-age people in some form of continuing education are among the lowest, according to the OECD and EU-27 statistics. Technological Schools(TS), initially created in the 1990’s, under the umbrella of the Ministry of Economy in partnership with industry and industrial associations, aimed to prepare qualified staff for industries and services in the country, particularly in the engineering sector, through the provision of post secondary non-university programmes of studies, the CET (Technological Specialization Courses). Successful CET students are awarded a DET(Diploma of Technological Specialization), which corresponds to Vocational Qualification level IV of the EU, according to the latest alteration (2005) of the Education Systems Act (introduced in 1986). In this, CET’s are also clearly defined as one of the routes for access to Higher Education (HE), in Portugal. The PRILHE (Promoting Reflective and Independent Learning in Higher Education) multinational project, funded by the European Socrates Grundtvig Programme, aimed to identify the learning processes which enable adult students in higher education to become autonomous reflective learners and search best practices to support these learning processes. During this research, both quantitative and qualitative methods were used to determine how students organise their studies and develop their learning skills. The Portuguese partner in the project’ consortium used a two case studies approach, one with students of Higher Education Institutions and other with students of TS. This paper only applies to students of TS, as these have a predominant bias towards engineering. Results show that student motivation and professional teaching support contribute equally to the development of an autonomous and reflective approach to learning in adult students; this is essential for success in a knowledge economy, where lifelong learning is the key to continuous employment.

Avaliação da aptidão física funcional em idosos hipertensos da Cidade da Praia - Cabo Verde

Mestrado em Fisioterapia.