LEISURE AND MENTAL HEALTH IN PEOPLE WITH HYPERTENSION: CONVERGENCE IN HEALTH EDUCATION

People with hypertension constantly deal with issues related to mental health due to the psychosocial determinants of this illness, and leisure is an important control strategy. The objective of this study was to promote health education to a group of hypertensive patients, through research-action, based on critical-social pedagogy, and taking into consideration the participants' perception of leisure. Educational activities were conducted and, following, an evaluation was performed regarding the subjects' opinion about the impact of leisure on their lives and mental health. The group perceived leisure as a coping strategy for loneliness and also as a late development of independence; it was also regarded as a means of socialization and as a promotion of mental health. These perceptions revealed two themes: aging, leisure, and chronic disease; and knowledge and leisure experiences. Educational actions, such as group dynamics and discussions, were planned considering these themes with the purpose of providing the necessary conditions for socializing and exchanging experiences.

Second-trimester soft markers: relation to first-trimester nuchal translucency in unaffected pregnancies

Objective Genetic sonography following first-trimester combined screening appears to increase substantially detection rates for Down syndrome but it relies on the unproved assumption of independence between these tests. In this study we aimed to investigate the relationship between first-trimester nuchal translucency (NT) and a series of second-trimester soft markers and structural defects in unaffected pregnancies. Methods NT measurement in the first trimester was followed by second-trimester scan (18 to 23 + 6 weeks) including examination for three categorical markers (intracardiac echogenic foci, hyperechogenic bowel and structural defects) and measurement of nasal bone length, nuchal-fold thickness, femur length, humerus length, renal pelvis diameter and prenasal thickness. All continuous variables were expressed in multiples of the median (MoM) for gestation and correlation coefficients between log-transformed NT and second-trimester variables were calculated. In addition, frequencies of soft markers and structural defects in cases with increased NT were compared to those with normal NT, using MoM cut-offs. Results In a dataset of 1970 cases, NT was significantly correlated (P < 0.05) with all second-trimester continuous variables, the correlation being strongest for nuchal-fold thickness (r = 0.10). There was a higher frequency of cases with second-trimester nuchal-fold thickness above the 97.5th centile (10.7 vs. 2.2%) and hyperechogenic bowel (2.4 vs. 0.1%) in cases with increased NT. Conclusions Straightforward reassessment of risk using likelihood ratios derived from the second-trimester genetic sonogram might lead to inaccurate estimates. Multivariate models using continuous second-trimester variables might be preferable in sequential screening strategies. Copyright. 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Medical adverse events in elderly hospitalized patients: A prospective study

OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e. g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score II). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events, the patients with medical adverse events had a significantly longer hospital stay (21.41 +/- 15.08 days versus 10.91 +/- 7.21 days) and a higher mortality rate (39 deaths [41.5%] versus 17 deaths [22.1%]). Mortality was significantly predicted by the Simplified Acute Physiology Score II score (odds ratio [OR] = 1.13, confidence interval [CI] 95%, 1.07 to 1.20), the Katz score (OR = 1.47, CI 95%, 1.18 to 1.83), and medical adverse events (OR = 3.59, CI 95%, 1.55 to 8.30). CONCLUSION: Medical adverse events should be monitored in every elderly hospitalized patient because there is no risk profile for susceptible patients, and the consequences of adverse events are serious, sometimes leading to longer hospital stays or even death.

Indicatori di correlazione e di disordine basati sul concetto di entropia

The aim of this work is to carry out an applicative, comparative and exhaustive study between several entropy based indicators of independence and correlation. We considered some indicators characterized by a wide and consolidate literature, like mutual information, joint entropy, relative entropy or Kullback Leibler distance, and others, more recently introduced, like Granger, Maasoumi and racine entropy, also called Sρ, or utilized in more restricted domains, like Pincus approximate entropy or ApEn. We studied the behaviour of such indicators applying them to binary series. The series was designed to simulate a wide range of situations in order to characterize indicators limit and capability and to identify, case by case, the more useful and trustworthy ones. Our target was not only to study if such indicators were able to discriminate between dependence and independence because, especially for mutual information and Granger, Maasoumi and Racine, that was already demonstrated and reported in literature, but also to verify if and how they were able to provide information about structure, complexity and disorder of the series they were applied to. Special attention was paid on Pincus approximate entropy, that is said by the author to be able to provide information regarding the level of randomness, regularity and complexity of a series. By means of a focused and extensive research, we furthermore tried to clear the meaning of ApEn applied to a couple of different series. In such situation the indicator is named in literature as cross-ApEn. The cross-ApEn meaning and the interpretation of its results is often not simple nor univocal and the matter is scarcely delved into by literature, thereby users can easily leaded up to a misleading conclusion, especially if the indicator is employed, as often unfortunately it happens, in uncritical manner. In order to plug some cross-ApEn gaps and limits clearly brought out during the experimentation, we developed and applied to the already considered cases a further indicator we called “correspondence index”. The correspondence index is perfectly integrated into the cross-ApEn computational algorithm and it is able to provide, at least for binary data, accurate information about the intensity and the direction of an eventual correlation, even not linear, existing between two different series allowing, in the meanwhile, to detect an eventual condition of independence between the series themselves.

Negoziazioni intergenerazionali dell'autonomia abitativa in contesti di working class

Nell’ambito della riflessione sui processi di riproduzione e trasmissione intergenerazionale delle disuguaglianze sociali, la presente tesi dottorale propone un’analisi in prospettiva intersezionale dei percorsi verso l’indipendenza abitativa dei giovani bolognesi di origine popolare, e il ruolo svolto dalle loro famiglie in questi percorsi. Nell’approfondimento teorico si offre una ricostruzione del dibattito sociologico nazionale e internazionale sul tema delle disuguaglianze sociali e abitative delle giovani generazioni, nonché dello studio della classe sociale e i principali approcci presenti in letteratura. La ricerca sul campo si concentra, in particolare, sui modi in cui le famiglie appartenenti ad una determinata classe sociale, intesa nel senso conferito al termine da Bourdieu, negoziano e sostengono la transizione all’indipendenza abitativa dei loro figli. L’approfondimento empirico consiste in una ricerca qualitativa longitudinale retrospettiva, condotta nel bolognese nel 2013-2014 su un campione di famiglie working class. Ai giovani-adulti coinvolti e ai loro genitori è stato chiesto di ricostruire le loro biografie attraverso lo strumento delle life histories. La ricerca evidenzia il delinearsi di “micro sistemi economici” familiari specifici e creativi. Le molteplici forme di sostegno genitoriale nei percorsi di autonomizzazione dei figli, individuate nel corso dell’analisi del materiale raccolto, si innestano quindi all’interno di un più ampio sistema di supporto intergenerazionale, che continua anche dopo l’uscita dalla famiglia di origine, a conferma dello stretto legame che caratterizza le famiglie italiane. Nello studio una particolare attenzione viene rivolta alle logiche di legittimazione del sostegno genitoriale, adottate dalle famiglie per orientare i propri interventi di aiuto. Infine, mettendo a confronto la concezione di indipendenza dei giovani adulti con quella dei loro genitori, l’indagine rileva l’esistenza di una apparente contraddizione tra le rappresentazioni dell’indipendenza e dell’autonomia abitativa e i comportamenti attuati nella vita quotidiana, contraddizione che trova una risoluzione nella negoziazione, tra le due diverse generazioni, del concetto stesso di indipendenza.

"Unser Volk ist vereint, unser Land unabhängig" - zum Umgang mit nationalen Identitätsmodellen im postsowjetischen Kasachstan

Für alle fünf zentralasiatischen Teilrepubliken kam der Zusammenbruch der Sowjetunion im Jahr 1991 relativ plötzlich und eher unerwartet. Der Prozess der „Transformation“ beinhaltete für die neu entstandenen Staaten nun nicht nur die Umstellung politischer und wirtschaftlicher Systeme, sondern ebenso die Organisation von Erinnerung und die Konstruktion von Identität, bei der die staatliche Nationalisierungspolitik oft Paradebeispiele von invented traditions her-vorbrachte. rnIn Kasachstan, dem Land, das während der Sowjetzeit am stärksten russifiziert wurde und heute offiziell 120 Minderheiten zählt, stellt sich dabei die Frage, wie nationale Identitätsmus-ter konstruiert werden und wie Politik. Medien und Bevölkerung damit umgehen. Zwanzig Jahre nach der Unabhängigkeitserklärung des Landes und einer Phase, in der die Regierung mit einer Vielzahl von Maßnahmen versucht, den Identitätsfindungsprozess zu steuern, wurde im Rahmen dieser Arbeit erstmals eine empirische Studie zu der Frage durchgeführt, welche Bedeutungen bestimmte Identitätskonzepte für die lokale Bevölkerung haben. Während meh-rerer Forschungsaufenthalte von insgesamt vier Monaten in den Jahren 2010 und 2011 wurden in Hinblick auf die Fragestellung leitfadenorientierte Interviews und informelle Gespräche mit Teilen der kasachstanischen Bevölkerung geführt, teilnehmende Beobachtung, zwei Fragebo-genaktionen und eine Zeitungsanalyse durchgeführt sowie wissenschaftliche Studien und poli-tische Dokumente analysiert.rnDie Arbeit kommt zu dem Ergebnis, dass die Mehrheit der Befragten sich mehr oder weniger stark entweder über die Staatsbürgerschaft oder die ethnische Zugehörigkeit zur Titularnation mit dem Staat identifiziert. Auffällig ist die Bedeutung regionaler Identitäten für die Befrag-ten, die weder in der nationalen Identitätspolitik noch in der wissenschaftlichen Literatur von Wichtigkeit sind. Ethnische und religiöse Nivellierungen scheinen im Alltagsleben belanglos zu sein, aber in bestimmten anderen Kontexten eine entscheidende Rolle zu spielen. Starke Unterschiede in der Bedeutung verschiedener Identitätsmodelle lassen sich zwischen Stadt- und Landbevölkerung beziehungsweise zwischen sowjetisierten und nach der Wende repatri-ierten Kasachen ausmachen.rnEs ist anzunehmen, dass die Regierung der entscheidende Agent in der Identitätsfindung des Landes ist. Unter den Befragten zeigte sich, dass Identitätspolitik auf der pragmatischen Ebe-ne, beispielsweise in der Anerkennung von Russisch und Kasachisch als Staatssprachen, er-folgreicher ist als auf der emotionalen. rn

Tolerance and Critical Thinking

Post-soviet countries are in the process of transformation from a totalitarian order to a democratic one, a transformation which is impossible without a profound shift in people's way of thinking. The group set themselves the task of determining the essence of this shift. Using a multidisciplinary approach, they looked at concrete ways of overcoming the totalitarian mentality and forming that necessary for an open democratic society. They studied the contemporary conceptions of tolerance and critical thinking and looked for new foundations of criticism, especially in hermeneutics. They then sought to substantiate the complementary relation between tolerance and criticism in the democratic way of thinking and to prepare a a syllabus for teaching on the subject in Ukrainian higher education. In a philosophical exploration of tolerance they began with relgious tolerance as its first and most important form. Political and social interests often lay at the foundations of religious intolerance and this implicitly comprised the transition to religious tolerance when conditions changed. Early polytheism was more or less indifferent to dogmatic deviations but monotheism is intolerant of heresies. The damage wrought by the religious wars of the Reformations transformed tolerance into a value. They did not create religious tolerance but forced its recognition as a positive phenomenon. With the weakening of religious institutions in the modern era, the purely political nature of many conflicts became evident and this stimulated the extrapolation of tolerance into secular life. Each historical era has certain acts and operations which may be interpreted as tolerant and these can be classified as to whether or not they are based on the conscious following of the principle of tolerance. This criterion requires the separation of the phenomenon of tolerance from its concept and from tolerance as a value. Only the conjunction of a concept of tolerance with a recognition of its value can transform it into a principle dictating a norm of conscious behaviour. The analysis of the contemporary conception of tolerance focused on the diversity of the concept and concluded that the notions used cannot be combined in the framework of a single more or less simple classification, as the distinctions between them are stimulated by the complexity of the realty considered and the variety of its manifestations. Notions considered in relation to tolerance included pluralism, respect and particular-universal. The rationale of tolerance was also investigated and the group felt that any substantiation of the principle of tolerance must take into account human beings' desire for knowledge. Before respecting or being tolerant of another person different from myself, I should first know where the difference lies, so knowledge is a necessary condition of tolerance.The traditional division of truth into scientific (objective and unique) and religious, moral, political (subjective and so multiple) intensifies the problem of the relationship between truth and tolerance. Science was long seen as a field of "natural" intolerance whereas the validity of tolerance was accepted in other intellectual fields. As tolerance eemrges when there is difference and opposition, it is essentially linked with rivaly and there is a a growing recognition today that unlimited rivalry is neither able to direct the process of development nor to act as creative matter. Social and economic reality has led to rivalry being regulated by the state and a natural requirement of this is to associate tolerance with a special "purified" form of rivalry, an acceptance of the actiivity of different subjects and a specification of the norms of their competition. Tolerance and rivalry should therefore be subordinate to a degree of discipline and the group point out that discipline, including self-discipline, is a regulator of the balance between them. Two problematic aspects of tolerance were identified: why something traditionally supposed to have no positive content has become a human activity today, and whether tolerance has full-scale cultural significance. The resolution of these questions requires a revision of the phenomenon and conception of tolerance to clarify its immanent positive content. This involved an investigation of the contemporary concept of tolerance and of the epistemological foundations of a negative solution of tolerance in Greek thought. An original soution to the problem of the extrapolation of tolerance to scientific knowledge was proposed based on the Duhem-Quine theses and conceptiion of background knowledge. In this way tolerance as a principle of mutual relations between different scientific positions gains an essential epistemological rationale and so an important argument for its own universal status. The group then went on to consider the ontological foundations for a positive solution of this problem, beginning with the work of Poincare and Reichenbach. The next aspect considered was the conceptual foundations of critical thinking, looking at the ideas of Karl Popper and St. Augustine and at the problem of the demarcation line between reasonable criticism and apologetic reasoning. Dogmatic and critical thinking in a political context were also considered, before an investigation of critical thinking's foundations. As logic is essential to critical thinking, the state of this discipline in Ukrainian and Russian higher education was assessed, together with the limits of formal-logical grounds for criticism, the role of informal logical as a basis for critical thinking today, dialectical logic as a foundation for critical thinking and the universality of the contemporary demand for criticism. The search for new foundations of critical thinking covered deconstructivism and critical hermeneutics, including the problem of the author. The relationship between tolerance and criticism was traced from the ancient world, both eastern and Greek, through the transitional community of the Renaissance to the industrial community (Locke and Mill) and the evolution of this relationship today when these are viewed not as moral virtues but as ordinary norms. Tolerance and criticism were discussed as complementary manifestations of human freedom. If the completeness of freedom were accepted it would be impossible to avoid recognition of the natural and legal nature of these manifestations and the group argue that critical tolerance is able to avoid dismissing such negative phenomena as the degradation of taste and manner, pornography, etc. On the basis of their work, the group drew up the syllabus of a course in "Logic with Elements of Critical Thinking, and of a special course on the "Problem of Tolerance".

ESPEN Guidelines on Parenteral Nutrition: geriatrics

Older subjects are at increased risk of partial or complete loss of independence due to acute and/or chronic disease and often of concomitant protein caloric malnutrition. Nutritional care and support should be an indispensable part of their management. Enteral nutrition is always the first choice for nutrition support. However, when patients cannot meet their nutritional requirements adequately via the enteral route, parenteral nutrition (PN) is indicated. PN is a safe and effective therapeutic procedure and age per se is not a reason to exclude patients from this treatment. The use of PN should always be balanced against a realistic chance of improvement in the general condition of the patient. Lower glucose tolerance, electrolyte and micronutrient deficiencies and lower fluid tolerance should be assumed in older patients treated by PN. Parenteral nutrition can be administered either via peripheral or central veins. Subcutaneous administration is also a possible solution for basic hydration of moderately dehydrated subjects. In the terminal, demented or dying patient the use of PN or hydration should only be given in accordance with other palliative treatments.

Ethnic Minority Children’s Active Commuting to School and Association with Physical Activity and Pedestrian Safety Behaviors

Background: Children's active commuting to school, i.e. walking or cycling to school, was associated with greater moderate-to-vigorous physical activity, although studies among ethnic minorities are sparse. Objectives: Among a low-income, ethnic minority sample of fourth grade students from eight public schools, we examined (1) correlates of active commuting to school and (2) the relationship between active commuting to school and moderate-to-vigorous physical activity. Methods: We conducted a cross-sectional analysis of baseline measurements from a sample of participants (n=149) aged 9-12 years from a walk to school intervention study in Houston, Texas. The primary outcome was the weekly rate of active commuting to school. Daily moderate-to-vigorous physical activity, measured by accelerometers, was a secondary outcome. Child self-efficacy (alpha=0.75), parent self-efficacy (alpha=0.88), and parent outcome expectations (alpha=0.78) were independent variables. Participant characteristics (age, gender, race/ethnicity, distance from home to school, acculturation, and BMI percentile) were independent sociodemographic variables. We used mixed-model regression analyses to account for clustering by school and a stepwise procedure with backward elimination of non-significant interactions and covariates to identify significant moderators and predictors. School-level observations of student pedestrians were assessed and compared using chi-square tests of independence. Results: Among our sample, which was 61.7% Latino, the overall rate of active commuting to school was 43%. In the mixed model for active commuting to school, parent self-efficacy (std. beta = 0.18, p=0.018) and age (std. beta = 0.18, p=0.018) were positively related. Latino students had lower rates of active commuting to school than non-Latinos ( 16.5%, p=0.040). Distance from home to school was inversely related to active commuting to school (std. beta = 0.29, p<0.001). In the mixed model for moderate-to-vigorous physical activity, active commuting to school was positively associated (std. beta = 0.31, p <0.001). Among the Latino subsample, child acculturation was negatively associated with active commuting to school (std. beta = -0.23, p=0.01). With regard to school-level pedestrian safety observations, 37% of students stopped at the curb and 2.6% looked left-right-left before crossing the street. Conclusion: Although still below national goals, the rate of active commuting was relatively high, while the rate of some pedestrian safety behaviors was low among this low-income, ethnic minority population. Programs and policies to encourage safe active commuting to school are warranted and should consider the influence of parents, acculturation, and ethnicity.

Controversy Total War

Total war is a controversial term used in the past by politicians, publicists and military officers as well as by computer specialists and academics in the present. Since its conception by French politicians during the First World War in a time of severe crisis (1916/17), it has become a term used by historians and other academics to cover a wide array of elements when looking at wars of the past. A real total war was and is impossible. Elements of total war – total war aims, total methods of warfare, total mobilization and total control – can, however, be identified and can serve as a useful tool for further transnational research on war.

Particle concentration and size distribution in the NGRIP ice core

A novel laser microparticle detector used in conjunction with continuous sample melting has provided a more than 1500 m long record of particle concentration and size distribution of the NGRIP ice core, covering continuously the period approximately from 9.5-100 kyr before present; measurements were at 1.65 m depth resolution, corresponding to approximately 35-200 yr. Particle concentration increased by a factor of 100 in the Last Glacial Maximum (LGM) compared to the Preboreal, and sharp variations of concentration occurred synchronously with rapid changes in the delta18O temperature proxy. The lognormal mode µ of the volume distribution shows clear systematic variations with smaller modes during warmer climates and coarser modes during colder periods. We find µ ~ 1.7 µm diameter during LGM and µ ~ 1.3 µm during the Preboreal. On timescales below several 100 years µ and the particle concentration exhibit a certain degree of independence present especially during warm periods, when µ generally is more variable. Using highly simplifying considerations for atmospheric transport and deposition of particles we infer that (1) the observed changes of µ in the ice largely reflect changes in the size of airborne particles above the ice sheet and (2) changes of µ are indicative of changes in long range atmospheric transport time. From the observed size changes we estimate shorter transit times by roughly 25% during LGM compared to the Preboreal. The associated particle concentration increase from more efficient long range transport is estimated to less than one order of magnitude.

Conflicto político, demografía y modo de producción en la Antigua Roma, siglos II-I a.C

Este trabajo se propone analizar críticamente algunas teorías recientes sobre las consecuencias sociales de la Segunda Guerra Púnica (218-201 a. C.) en la antigua sociedadáromana. Mientras que laáinterpretación clásica había subrayado el efecto dañino que las guerras de expansión supusieronápara el campesinado romano, los nuevos enfoques en boga se caracterizan por dejar de lado las contradicciones del proceso histórico, adoptando una interpretación malthusiana en la cual laápoblación simplementeáhabría crecido mucho más que los recursos para sostenerla. Considerando que la demografía no es una variable independiente sino que se encuentra enmarcada en un modo de producción específico, se propone estudiar algunasálimitaciones de los enfoques mencionados paraáluego abordar el problema desde una óptica que enfatice en la dinámica contradictoria de la sociedad romana

Comerciantes en conflicto. La Independencia en el Perú y la transformación de la elite mercantil 1780-1830

Durante la época colonial, los grandes comerciantes en el Perú se comportaron como un grupo muy dinámico que desarrollaron importantes negocios en el área de la comercialización y se dedicaron, además, a prestar dinero al gobierno de turno. El presente trabajo tiene por objetivo, identificar los conflictos que se suscitaron por la guerra de Independencia y cómo la elite mercantil fue transformándose con la llegada de comerciantes extranjeros, que se instalaron en Lima al ver esta plaza interesante para la expansión de sus actividades. Veremos también algunos estudios de casos, especialmente comerciantes extranjeros que nos permitirán analizar la dinámica empresarial de los mismos

"De celebración perpetua" : Fechas, héroes y fiestas para la Nación

Concluida la guerra de independencia y disuelta la unidad colombiana, desde el incipiente estado venezolano se pone especial empeño en fijar un conjunto de referentes históricos que contribuyan a afianzar el proceso de construcción de la Nación. El establecimiento de las fechas patrias, el culto al héroe y la celebración de fiestas cívicas, son parte fundamental de este esfuerzo de integración territorial y de cohesión política cuya finalidad es crear un ideario nacional único para todos los venezolanos. El propósito del artículo es identificar los mecanismos mediante los cuales se establecen estas referencias simbólicas, analizar sus contenidos y estudiar de qué manera se sostienen y se formalizan hasta constituirse en motivo "de celebración perpetua" para el conjunto de la sociedad venezolana.

Conflicto político, demografía y modo de producción en la Antigua Roma, siglos II-I a.C

Este trabajo se propone analizar críticamente algunas teorías recientes sobre las consecuencias sociales de la Segunda Guerra Púnica (218-201 a. C.) en la antigua sociedadáromana. Mientras que laáinterpretación clásica había subrayado el efecto dañino que las guerras de expansión supusieronápara el campesinado romano, los nuevos enfoques en boga se caracterizan por dejar de lado las contradicciones del proceso histórico, adoptando una interpretación malthusiana en la cual laápoblación simplementeáhabría crecido mucho más que los recursos para sostenerla. Considerando que la demografía no es una variable independiente sino que se encuentra enmarcada en un modo de producción específico, se propone estudiar algunasálimitaciones de los enfoques mencionados paraáluego abordar el problema desde una óptica que enfatice en la dinámica contradictoria de la sociedad romana