A dieta mediterrânica nos provérbios portugueses

Title: «Mediterranean diet in Portuguese proverbs». Mediterranean diet has been considered Immaterial World Patrimony since December 2013. It is characteristic of basin Mediterranean people (Portugal, Spain, Morocco, Italy, Greece, Cyprus and Croatia) and includes their gastronomy with local products, their traditions, their culture and their healthy lifestyle. Mediterranean diet is passed on from one generation to another mostly orally and it is likewise present in phraseological units, especially in proverbs. This paper analyses Portuguese proverbs aiming to show their importance when transmitting cookingrelated knowledge and information, such as, local ingredients, cooking techniques and the social function, both daily or on holidays. Since the practice of physical exercise is so important for the Mediterranean diet, our study includes physical exercise and relaxation-related proverbs as well.

Entre o fazer e o dever

A compreensão da ocorrência das doenças em termos de risco e o estabelecimento de relações com os chamados estilos de vida, colocam na experiência de doença um acréscimo de conotações morais, um dever de autodisciplina e responsabilidade. Estes princípios têm sido inúmeras vezes sublinhados nos discursos e políticas da Saúde Pública, nomeadamente no que concerne às doenças cardiovasculares pela importância epidemiológica, económica e social de que se revestem e consequente necessidade de redução da sua grande incidência na população, como é o caso de Portugal. A hipertensão, como doença crónica e fator de risco cardiovascular sujeita os doentes a controlo médico periódico, terapêutica farmacológica e impele a um comprometimento com comportamentos alimentares e exercício físico adequado. Através das entrevistas realizadas a doentes hipertensos utentes da consulta específica em Cuidados de Saúde Primários, verifica-se a presença de modos diversos de agir perante a circunstância de se ter hipertensão arterial, mostrando a presença de várias racionalidades, apreciações e valorações práticas dos comportamentos de saúde e doença e do próprio corpo. Para os doentes hipertensos entrevistados, a hipertensão arterial não é encarada como uma “verdadeira doença”, sendo vista sobretudo como resultado do envelhecimento e dos excessos que se acumularam no corpo, consequentes da própria vida. Nas narrativas de experiência de doença, os conceitos de moderação e equilíbrio, “ter cuidado”, parecem servir de mecanismo de operacionalização entre aquilo que são as recomendações médicas e as práticas individuais. Constatam-se as capacidades dos doentes hipertensos construírem para si formas de gestão da doença e do medo, sendo que os seus comportamentos podem passar por assumir o controlo dos fatores de risco ou ignorá-los. Em qualquer dos casos, as representações e ações relativas à hipertensão e às recomendações médicas a ela associadas integram-se nas práticas quotidianas dos doentes, ajustando-se a hábitos e representações instaladas, constituindo-se em modos distintos de agir dos doentes hipertensos.

A doença pulmonar obstrutiva crónica e o exercício: impacto da doença no declínio funcional e importância do treino de exercício nos benefícios para a saúde

RESUMO: A reabilitação respiratória (RR) é uma intervenção abrangente e interdisciplinar dirigida aos doentes respiratórios crónicos e inclui o treino de exercício, programas de educação e de modificação comportamental, entre outros, desenhados individualmente para melhorar o desempenho físico e psicossocial e promover a adesão a longo prazo a comportamentos promotores de saúde. A doença pulmonar obstrutiva crónica (DPOC) é uma doença comum, afetando cerca de 210 milhões de pessoas em todo o mundo, com elevada mortalidade e com custos económicos significativos decorrentes do agravamento progressivo da doença, das hospitalizações e de reinternamentos frequentes. Apesar do crescente conhecimento da DPOC e do papel da RR nos benefícios para a saúde, existem aspetos ainda não esclarecidos que têm impacto na prática clínica e de investigação e nas decisões das autoridades de saúde. A primeira parte desta tese focou a DPOC e o seu impacto negativo e incluiu: o estudo da prevalência da DPOC em Portugal; os fatores clínicos e funcionais que se associam à mortalidade em doentes com DPOC avançada; a morbilidade, impacto funcional e risco dos doentes se tornarem dependentes para as atividades diárias e a influência da inflamação sistémica. A prevalência estimada da DPOC de 14,2% indica que esta é uma doença comum em Portugal e alerta para a necessidade de uma maior sensibilização da população, dos profissionais de saúde e autoridades de saúde com vista a um diagnóstico precoce e à alocação dos recursos terapêuticos adequados. A elevada taxa de mortalidade em doentes com DPOC avançada - 36,6% em 3 anos - associou-se a insuficiência respiratória, a elevado número de exacerbações, ao cancro do pulmão e a reduzida capacidade funcional para a marcha, salientando a importância da referenciação precoce para RR, a identificação e o tratamento das comorbilidades e a prevenção das exacerbações. A aplicação de um questionário que avaliou as atividades da vida diária básicas e instrumentais, permitiu identificar um marcador clínico do risco de dependência, complementando as avaliações funcionais e associando-se a outros marcadores de mau prognóstico, como as exacerbações. Em doentes com DPOC, com FEV1 médio de 46,76% (desvio padrão: 20,90%), 67% da categoria D do GOLD, verificou-se uma associação positiva entre a expressão de genes inflamatórios avaliada pela reação em cadeia da polimerase (ARN mensageiro de IFNg, IL1b, IL6, IL8, TNFa, TGFb1, iNOS) e o índice de massa corporal em repouso, acentuando-se após o exercício. Este estudo aponta a inflamação como o potencial elo de ligação entre a obesidade e a inflamação sistémica em doentes com DPOC. A segunda parte da tese focou a RR, nomeadamente os seus efeitos em doentes das categorias GOLD A, B, C e D; o impacto das comorbilidades nos resultados da RR e os resultados de diferentes intensidades de treino aeróbio. Após o programa de RR, verificaram-se melhorias significativas na capacidade de exercício funcional e de endurance e no estado geral de saúde dos doentes de todas as categorias GOLD. Esta classificação não distingue os doentes que melhor poderão beneficiar desta intervenção, indicando que devem ser referenciados para RR, os doentes sintomáticos ou com repercussão na qualidade de vida, independentemente da categoria da DPOC a que pertençam. A prevalência das comorbilidades no grupo de doentes com DPOC que é referenciado para RR, é elevada, sendo as mais frequentes, as cardiovasculares, as respiratórias e as psicológicas. Apesar de poderem diminuir o impacto da RR, os resultados desta foram semelhantes independentemente do número de comorbilidades. A identificação e o tratamento sistemáticos das comorbilidades conferem maior segurança clínica a esta intervenção terapêutica a qual, por apresentar bons resultados, não deve limitar a referenciação dos doentes. Com o programa de RR, verificou-se melhoria significativa em todos os resultados centrados no doente para ambas as intensidades de treino aeróbio, a 60% e a 80% da potência aeróbica máxima (Wmax), com melhoria do estado geral de saúde, nos sintomas e na capacidade para o exercício, o que questiona a indicação sistemática de elevadas intensidades de treino em doentes com DPOC para a obtenção de benefícios a curto prazo. Na terceira e última parte da tese foi estudado o papel da atividade física na DPOC, focando os fatores que influenciam a atividade física diária; a evolução da capacidade funcional e o estado de saúde 2 anos após um programa de RR e o papel da telemonitorização na quantificação e monitorização da atividade física. Confirmámos que os doentes com DPOC são marcadamente sedentários e os fatores que se associaram ao sedentarismo nestes doentes foram a dispneia e a distância percorrida na prova de marcha de seis minutos. Este estudo sublinha a importância do controlo sintomático, nomeadamente da dispneia, bem como, mais uma vez, o potencial papel da reabilitação respiratória no aumento da capacidade funcional para o exercício e na aquisição de hábitos de vida fisicamente ativa. Verificámos que, apesar de os doentes com DPOC apresentarem benefícios clinicamente significativos na capacidade funcional para o exercício e no estado geral de saúde com o programa de RR, apenas os que se mantêm ativos, podem, no final dos dois anos de seguimento, manter os efeitos benéficos desse programa. O sistema de telemonitorização que combina a oximetria e a quantificação da atividade física provou ser clinicamente útil na avaliação da necessidade de oxigenoterapia de longa duração (OLD) e na aferição do débito de oxigénio em repouso, no esforço e no sono, podendo contribuir para uma melhor adequação da prescrição da OLD. A monitorização dos níveis de atividade física regular é um importante instrumento de avaliação dos programas de RR e o seu uso potencial na telereabilitação permitirá prolongar a eficácia dos programas e reduzir os custos associados aos cuidados de saúde.---------------------------------------------------------------------------------------------------ABSTRACT: Pulmonary rehabilitation (PR) is a comprehensive interdisciplinary intervention that includes, but is not limited to, exercise training, education, and behavior change, individually designed to improve physical and psychological conditions of people with chronic respiratory disease and to promote long-term adherence to health-enhancing behaviors. Chronic obstructive pulmonary disease (COPD) is a common disease, affecting about 210 million people worldwide, with high mortality and significant health-related costs due to disease progression, hospitalizations and frequent hospital readmissions. Although the increasing knowledge about COPD and benefitial outcomes of PR, some aspects with impact in clinical practice, research and health authorities’ decisions, remain to be clarified. The first part of this thesis focused on COPD and its negative impact, including the study of COPD prevalence in Portugal; clinical and functional factors associated with mortality in advanced COPD patients; morbidity, functional impact and risk of others’ dependance to perform activities of daily living; and the role of systemic inflammation. The evidence of 14.2% estimated COPD prevalence as a common disease in Portugal raises the need of an increasing awareness of population, health care professionals and health authorities towards an earlier diagnosis and apropriate treatment resources allocation. High mortality in patients with advanced COPD – 36.6% in 3 years - was associated with respiratory failure, high frequency of exacerbations, lung cancer and a low functional capacity in walking. This highlightens the importance of an earlier referral to PR, comorbidity identification and treatment, and prevention of exacerbations. A questionnaire evaluated basic and instrumental activities of daily living, and identified a clinical marker of the risk of becoming dependent. This clinical marker complemented other functional evaluations and was associated with prognosis markers such as the number of exacerbations. In COPD patients with a mean FEV1 46.76% (SD 20.90%), 67% belonging to GOLD grade D, we found a positive association between inflammatory gene expression evaluated by polymerase chain reaction (IFNg, IL1b, IL6, IL8, TNFa, TGFb1, iNOS RNA messenger) and body mass index at rest, and a further increase with exercise. This study evidenced obesity as one potential link between COPD and systemic inflammation. The second part of this thesis focused PR, namely its outcomes in patients of GOLD categories A, B, C and D; comorbidities impact in PR outcomes, and the impact of different exercise training intensities in patient related outcomes. xviii With PR intervention, we found significant improvement in functional exercise capacity, endurance exercise capacity and health status in patients of all GOLD categories. This classification did not differentiate which patients would benefit more from PR, hence all symptomatic patients with a negative impact in health status should be referred to PR, regardless of the GOLD category they belong to. There is a high prevalence of comorbidities in COPD patients referred to PR, being cardiovascular, respiratory and psychological, the most prevalent. Although some comorbidities might reduce PR impact, the results were similar regardless of the number of comorbidities. Systematic comorbidities identification and treatment provides safety to PR intervention, and its good results should not preclude patients referral. With PR intervention we found a significant improvement in all patient reported outcomes for exercise training intensities at 60% and 80% maximum work rate (Wmax), namely in health status, symptoms and exercise capacity. These findings challenge the current systematic indication of high exercise training intensities to achieve PR short-term benefits. In the third and last part of the thesis, the role of physical activity in COPD was studied, focusing factors that may influence daily physical activity; the evolution of functional capacity and health status two years after a PR program, and the role of a telemonitoring system in physical activity quantification and monitoring. We confirmed that COPD patients are markedly inactive and factors associated with a sedentary lifestyle are dyspnea and 6 minute walking distance. This study emphasized the importance of symptom control, namely of dyspnea, as well as, once again, the potential role of PR in functional exercise improvement and in integrating physically active habits in daily life. We verified that, although COPD patients improve functional exercise capacity and health status after a PR program, only those who kept physical activity habits were able to maintain those effects after 2 years of follow-up. A telemonitoring system that combines oximetry and physical activity quantification proved to be clinically useful in the evaluation of long-term oxygen therapy (LTOT) indication, as well as in the titration of oxygen levels at rest, exertion, and sleeping, which might contribute to a more adequate LTOT prescription. Monitoring of daily physical activity levels is an important PR evaluation instrument and its potential use in telerehabilitation might allow lengthening programs efficacy, while reducing health-care costs.

Qualidade de vida após um ano da cirurgia bariátrica

Dissertação de mestrado integrado em Psicologia

Escolhas e preferências alimentares: um estudo com estudantes universitários

Dissertação de mestrado em Psicologia Aplicada

Atividade física sistematizada e sintomas de depressão na demência de Alzheimer: uma revisão sistemática

OBJETIVO: Realizar uma revisão sistemática de artigos científicos que analisaram os efeitos da atividade física sistematizada nos sintomas de depressão de pacientes com demência de Alzheimer. MÉTODOS: Foi realizada uma busca nas seguintes bases de dados: Web of Science, PubMed, PsycINFO, MedLine e Biological Abstracts, utilizando-se as seguintes palavras-chave: "Alzheimer dementia" , "Alzheimer disease" , "Alzheimer, physical activity", "physical exercise", "motor intervention" , "physical therapy" , "exercise" , "aerobic" , "strength" , "fitness" , "depression" , "dysphoria" , "depressive symptoms" e "depressive episodes". Além da busca nas bases de dados, foi realizada também uma busca manual nas listas de referências dos artigos selecionados. RESULTADOS: Foram encontrados quatro estudos que preencheram todos os critérios de inclusão adotados para o presente trabalho. Dois estudos apresentaram reduções dos sintomas depressivos, e outros dois não encontraram redução desses sintomas. CONCLUSÃO: Com a realização desta revisão sistemática, observou-se que não há consenso em relação aos benefícios da atividade física aos sintomas depressivos em pacientes com demência de Alzheimer.

Hormonal and cardiovascular reflex assessment in a female patient with pure autonomic failure

We report the case of a 72-year-old female with pure autonomic failure, a rare entity, whose diagnosis of autonomic dysfunction was determined with a series of complementary tests. For approximately 2 years, the patient has been experiencing dizziness and a tendency to fall, a significant weight loss, generalized weakness, dysphagia, intestinal constipation, blurred vision, dry mouth, and changes in her voice. She underwent clinical assessment and laboratory tests (biochemical tests, chest X-ray, digestive endoscopy, colonoscopy, chest computed tomography, abdomen and pelvis computed tomography, abdominal ultrasound, and ambulatory blood pressure monitoring). Measurements of catecholamine and plasmatic renin activity were performed at rest and after physical exercise. Finally the patient underwent physiological and pharmacological autonomic tests that better diagnosed dysautonomia.

Atendimento no Ambulatório de Nutrição Renal da Faculdade de Nutrição da Universidade Federal Fluminense e Hospital Universitário Antônio Pedro : efeitos de um programa de treino de força intradialítica em pacientes renais crónicos

Relatório de estágio de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2015

Exercice physique et athérosclérose : quels sont les mécanismes physiologiques et moléculaires de l'exercice qui préviennent et protègent de l'athérosclérose? : approche chez un modèle expérimental d'athérosclérose : la souris génétiquement dépourvue en apolipoprotéine E (apoE-/-)

RESUME : L'athérosclérose, pathologie inflammatoire artérielle chronique, est à l'origine de la plupart des maladies cardiovasculaires qui constituent l'une des premières causes de morbidité et mortalité en France. Les études observationnelles et expérimentales montrent que l'exercice physique prévient la mortalité cardiovasculaire. Cependant, les mécanismes précisant les bénéfices cliniques de l'exercice sur l'athérosclérose sont encore largement inconnus. Le but général de ce travail a donc été d'explorer, en utilisant un modèle expérimental d'athérosclérose, la souris hypercholestérolémique génétiquement dépourvue en apolipoprotéine E (apoE-/-), les mécanismes athéroprotecteurs de l'exercice. La dysfonction endothéliale, généralement associée aux facteurs de risque cardiovasculaire, serait l'une des étapes précoces majeures de l'athérogenèse. Elle est caractérisée par une diminution de la biodisponibilité en monoxyde d'azote (NO) avec la perte de ses propriétés vasculo-protectrices, ce qui favorise un climat pro-athérogène (stress oxydatif, adhésion et infiltration des cellules inflammatoires dans la paroi artérielle...) conduisant à la formation de la plaque athéromateuse. L'objectif de notre premier travail a donc été d'explorer les effets de l'exercice d'une part, sur le développement des plaques athéromateuses et d'autre part, sur la fonction endothéliale de la souris apoE-/-. Nos résultats montrent que l'exercice réduit significativement l'extension de l'athérosclérose et prévient la dysfonction endothéliale. L'explication pharmacologique montre que l'exercice stimule la fonction endothéliale via, notamment, une plus grande sensibilité des récepteurs endothéliaux muscariniques, ce qui active les événements signalétiques cellulaires récepteurs-dépendants à l'origine d'une bioactivité accrue de NO. Les complications cliniques graves de l'athérosclérose sont induites par la rupture de la plaque instable provoquant la formation d'un thrombus occlusif et l'ischémie du territoire tissulaire en aval. L'objectif de notre deuxième travail a été d'examiner l'effet de l'exercice sur la qualité/stabilité de la plaque. Nos résultats indiquent que l'exercice de longue durée stabilise la plaque en augmentant le nombre de cellules musculaires lisses et en diminuant le nombre de macrophages intra-plaques. Nos résultats montrent aussi que la phosphorylation de la eNOS (NO Synthase endothéliale) Akt-dépendante n'est pas le mécanisme moléculaire majeur à l'origine de ce bénéfice. Enfin, dans notre troisième travail, nous avons investigué l'effet de l'exercice sur le développement de la plaque vulnérable. Nos résultats montrent, chez un modèle murin de plaque instable (modèle d'hypertension rénovasculaire à rénine et angiotensine II élevés) que l'exercice prévient l'apparition de la plaque vulnérable indépendamment d'un effet hémodynamique. Ce bénéfice serait associé à une diminution de l'expression vasculaire des récepteurs AT1 de l'Angiotensine II. Nos résultats justifient l'importance de l'exercice comme outil préventif des maladies cardiovasculaires. ABSTRACT : Atherosclerosis, a chronic inflammatory disease, is one of the main causes of morbidity and mortality in France. Observational and experimental data indicate that regular physical exercise has a positive impact on cardiovascular mortality. However, the mechanisms by which exercise exerts clinical benefits on atherosclerosis are still unknown. The general aim of this work was to elucidate the anti-atherosclerotic effects of exercise, using a mouse model of atherosclerosis: the apolipoprotein E-deficient mice (apoE-/- mice). Endothelial dysfunction, generally associated with cardiovascular risk factors, has been recognized to be a major and early step in atherogenesis. Endothelial dysfunction is characterized by Nitric Oxide (NO) biodisponibility reduction with loss of NO-mediated vasculoprotective actions. This leads to vascular effects such as increased oxidative stress and increased adhesion of inflammatory cells into arterial wall thus playing a role in atherosclerotic plaque development. Therefore, one of the objective of our study was to explore the effects of exercise on atherosclerotic plaque extension and on endothelial function in apoE-/- mice. Results show that exercise significantly reduces plaque progression and prevents endothelial dysfunction. Pharmacological explanation indicates that exercise stimulates endothelial function by increasing muscarinic receptors sensitivity which in turn activates intracellular signalling receptor-dependent events leading to increased NO bioactivity. The clinical manifestations of atherosclerosis are the consequences of unstable plaque rupture with thrombus formation leading to tissue ischemia. The second aim of our work was to determine the effect of exercise on plaque stability. We demonstrate that long-term exercise stabilizes atherosclerotic plaques as shown by decreased macrophage and increased Smooth Muscle Cells plaque content. Our results also suggest that the Akt-dependent eNOS phosphorylation pathway is not the primary molecular mechanism mediating these beneficial effects. Finally, we assessed a putative beneficial effect of exercise on vulnerable plaque development. In a mouse model of Angiotensine II (Ang II)-mediated vulnerable atherosclerotic plaques, we provide fist evidence that exercise prevents atherosclerosis progression and plaque vulnerability. The beneficial effect of swimming was associated with decreased aortic Ang II AT1 receptor expression independently from any hemodynamic change. These findings suggest clinical benefit of exercise in terms of cardiovascular event protection.

Increased 24-hour energy expenditure in cigarette smokers.

We studied the effect of smoking on energy expenditure in eight healthy cigarette smokers who spent 24 hours in a metabolic chamber on two occasions, once without smoking and once while smoking 24 cigarettes per day. Diet and physical exercise (30 minutes of treadmill walking) were standardized on both occasions. Physical activity in the chamber was measured by use of a radar system. Smoking caused an increase in total 24-hour energy expenditure (from a mean value [+/- SEM] of 2230 +/- 115 to 2445 +/- 120 kcal per 24 hours; P less than 0.001), although no changes were observed in physical activity or mean basal metabolic rate (1545 +/- 80 vs. 1570 +/- 70 kcal per 24 hours). During the smoking period, the mean diurnal urinary excretion of norepinephrine (+/- SEM) increased from 1.25 +/- 0.14 to 1.82 +/- 0.28 micrograms per hour (P less than 0.025), and mean nocturnal excretion increased from 0.73 +/- 0.07 to 0.91 +/- 0.08 micrograms per hour (P less than 0.001). These short-term observations demonstrate that cigarette smoking increases 24-hour energy expenditure by approximately 10 percent, and that this effect may be mediated in part by the sympathetic nervous system. The findings also indicate that energy expenditure can be expected to decrease when people stop smoking, thereby favoring the gain in body weight that often accompanies the cessation of smoking.

Assessment of total energy expenditure in free-living patients with cystic fibrosis.

The increase in resting energy expenditure (REE) reported in patients with cystic fibrosis (CF) does not necessarily imply an increase in total energy expenditure (TEE). In this study REE was assessed with open-circuit indirect calorimetry, and free-living 24-hour TEE with the heart rate method. Thirteen patients with CF, aged 8 to 24 years, with adequate nutritional status and moderately decreased pulmonary function, were studied. They were compared with 13 healthy control subjects matched for gender, age, height, and nutritional status. Resting energy expenditure was higher in patients with CF (1512 +/- 88 kcal/day) than in control subjects (1339 +/- 76 kcal/day; p less than 0.01), whereas free-living 24-hour TEE (2345 +/- 127 kcal/day and 2358 +/- 256 kcal/day, respectively) and net mechanical work efficiency of walking on a treadmill (20.4 +/- 0.7% and 19.8 +/- 0.6%, respectively) were similar. Respiratory quotient was higher in patients with CF than in control subjects at rest (0.834 +/- 0.009 vs 0.797 +/- 0.008; p less than 0.05), and tended to remain so during physical exercise, indicating a higher contribution of carbohydrate oxidation to energy expenditure. We conclude that in free living conditions, patients with CF can compensate for their increase in REE by a reduction in spontaneous physical activities or other yet undefined mechanisms.

Building Evidence for Dementia Prevention

As was the case in 2010 when the National Institutes of Health issued a consensus statement on the prevention of Alzheimer’s and other dementias, there remains a lack of firm evidence for dementia prevention. Because of the difficulties in studying this phenomenon, no modifiable risk factors for dementia have been definitively established, and no pharmaceutical or nutritional supplements been proven to prevent Alzheimer’s disease or cognitive decline. However, longitudinal observational studies have identified several factors associated with dementia. A recent review article summarizes the current epidemiological evidence about Alzheimer’s and other dementias, and presents three ongoing large scale randomized control trials (RCTs) that focus on preventing dementia. The review argues that there is substantial evidence for many factors that, in combination, might reduce the risk of, or delay the onset of, dementia. Although no specific cure for dementia exists, and no specific pathway between risk factor and disease onset has been identified, several cardiovascular, stress, toxicity, and psychosocial variables have been repeatedly associated with dementia. Protective factors, such as high education, physical exercise, and not smoking cigarettes, have been identified as well. Intervention studies that account for these multiple factors may well identify strategies for preventing or delaying dementia. However, the protective effects and risk factors suggested by observational data have yet to be assessed in RCT research. The role of such factors in reducing or increasing the risk for dementia needs to be more specifically defined. Three ongoing RCT studies in Europe show promise in this area, as they target multiple risk and protective factors by promoting healthy lifestyle changes and medical treatment of vascular diseases. These are: FINGER, a Finnish trial involving 1,200 older adults at risk for dementia. This intervention features nutritional guidance, physical activity, cognitive and social engagement, and medical management of risk factors. Participants were involved in previous, intensive observational studies of vascular health and health behavior, so FINGER will provide a level of relevant information about its research subjects that is normally impossible for clinical RCTs to attain;MAPT, a multicenter study of 1,680 frail older adults in France. This study will compare the efficacy of omega-3 dietary supplementation with a multidomain training intervention that involves physical and cognitive training. The study will include follow-up assessments after five years;PreDIVA, a Dutch study of 3,534 community dwelling participants between 70 and 78 years old, recruited from primary care clinics. This study will compare standard medical care with a multicomponent vascular health intervention. The study will last for six years and measure both dementia and disability outcomes. These studies are an important step in dementia research, using earlier observational studies as the basis for rigorously assessed interventions. Although a cure for dementia has not been identified, this new research may identify preventive strategies against dementia. �� Source: Mangialasche F, Kivipelto M, et al. (2012). Dementia prevention: current epidemiological evidence and future perspective. Alzheimer’s Research and Therapy 4:6.

Influencia de sobrepeso y obesidad sobre la infertilidad: Plan de cuidados y programa educacional

The scientific evidence, demonstrates that the obesity reduces the possibility that a woman, conceive naturally and diminishes the success of the treatment for the fertility. Nurses of the Unit of Attended Reproduction and of the Units of Nutrition and Dietary, they consider necessary to design an educational program of Formation and Information, to change attitudes related with the overweight and the obesity, in even not fertile. The strategy of this Program is based in the control and reduction of the weight, assuring the adhesion to the treatment of fertility, with interactive works shops for the change of alimentary habits, giving emotional support and indications to practice adapted physical exercise. This Nursing Intervention is applied like one tool that develops abilities for the learning and training; never using diets or products of the denominated miracle. The narrow collaboration and investigating participation among the nurses of these Units, bear the design of a methodology channeled to the obtaining of some prospective results that can be evaluated regarding the obtained results.

Efectos de los factores dietéticos sobre la conducta agresiva y otras patologías del comportamiento del perro

Studies show that feeding patterns, environmental conditions, and pet management mainly affect animal health, behavior and welfare. However, little epidemiologic data exist about pet dog feeding habits and management and canine behavior, especially aggression. Moreover, it is well known that serotonin is involved in aggression: a diet low in tryptophan (serotonin precursor) with high levels of neutral amino-acids could decrease the central levels of serotonin and increase the expression of aggression and impulsiveness in several domestic animals. oreover, brain levels of serotonin in humans and other species can be increased by physical activity. In this study we alysed the effects of diet management, supplementation and regular physical activity on oncentration of serotonin in a population of non aggressive dogs. The general aim of the study is to determine the effect of environmental factors on the dogs’ feeding habits as well as the relationship between the type of food provided and management and behavioral problems in dogs. The specific objectives were: characterization and comparison of different physiological and blood parameters between dogs with and without behavior pathologies. Observation of the impact of the diet and managment factors (exercise, education) on those parameters and on dog’s behavior, with particular attention to aggression. This study is divided into three phases, according with the objectives. Firstly, characterization of the dogs’ characteristics and serics profiles on the basis of the blood tests. Comparison between the values noticed on animals without any behavior pathology and animals with behavior disorder to point out the difference between the biochemical parameters of the two groups. Secondly, the purpose of the second phase is to verify whether a type of food is able to affect the biochemical paramenters of a population of non-aggressive dogs. Thirdly, the goal is to evaluate the effects of different diet factors, management and physical exercise on the canine aggression.