Tube feeding with a diabetes-specific feed for 12 weeks improves glycaemic control in type 2 diabetes patients

Background and aims: Assess longer-term (12 weeks) effects of a diabetes-specific feed on postprandial glucose response, glycaemic control (HbA1c), lipid profile, (pre)-albumin, clinical course and tolerance in diabetic patients. Methods: In this randomized, controlled, double-blind, parallel group study 25 type 2 diabetic patients on tube feeding were included. Patients received a soy-protein based, multi-fibre diabetes-specific feed or isocaloric, fibre-containing standard feed for 12 weeks, while continuing on their anti-diabetic medication. At the beginning, after 6 and 12 weeks, several (glycaemic) parameters were assessed. Results: The postprandial glucose response (iAUC) to the diabetes-specific feed was lower at the 1st assessment compared with the standard feed (p = 0.008) and this difference did not change over time. HbA1c decreased over time in the diabetes-specific and not in the standard feed group (treatment*time:p = 0.034): 6.9 +/- 0.3% (mean +/- SEM) at baseline vs. 6.2 +/- 0.4% at 12 weeks in the diabetes-specific group compared to 7.9 +/- 0.3% to 8.7 +/- 0.4% in the standard feed group. No significant treatment*time effect was found for fasting glucose, insulin, (pre-) albumin or lipid profile, except for increase of HDL in the diabetes-specific group. Conclusions: The diabetes-specific feed studied significantly improved longer-term glycaemic control in diabetic patients. This was achieved in addition to on-going anti-diabetic medication and may affect clinical outcome. (C) 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Family history of cancer: Pooled analysis in the International Head and Neck Cancer Epidemiology consortium

Alcohol and tobacco consumption are well-recognized risk factors for head and neck cancer (HNC). Evidence suggests that genetic predisposition may also play a role. Only a few epidemiologic studies, however, have considered the relation between HNC risk and family history of HNC and other cancers. We pooled individual-level data across 12 case-control studies including 8,967 HNC cases and 13,627 controls. We obtained pooled odds ratios (OR) using fixed and random effect models and adjusting for potential confounding factors. All statistical tests were two-sided. A family history of HNC in first-degree relatives increased the risk of HNC (OR = 1.7, 95% confidence interval, CI, 1.2-2.3). The risk was higher when the affected relative was a sibling (OR = 2.2, 95% CI 1.6-3.1) rather than a parent (OR = 1.5, 95% CI 1.1-1.8) and for more distal HNC anatomic sites (hypopharynx and larynx). The risk was also higher, or limited to, in subjects exposed to tobacco. The OR rose to 7.2 (95% CI 5.5-9.5) among subjects with family history, who were alcohol and tobacco users. A weak but significant association (OR = 1.1, 95% CI 1.0-1.2) emerged for family history of other tobacco-related neoplasms, particularly with laryngeal cancer (OR = 1.3, 95% CI 1.1-1.5). No association was observed for family history of nontobacco-related neoplasms and the risk of HNC (OR = 1.0, 95% CI 0.9-1.1). Familial factors play a role in the etiology of HNC. In both subjects with and without family history of HNC, avoidance of tobacco and alcohol exposure may be the best way to avoid HNC. (C) 2008 Wiley-Liss, Inc,

Teaching Psychodynamics to Psychiatric Residents through Psychiatric Outpatient Interviews

Objective: This study evaluates whether a course that was designed for first-year psychiatric residents and that specifically addressed psychodynamic principles fostered residents` progress in knowledge, skills, and attitudes regarding these concepts. Methods: The course was given in the 2005 academic year to all residents (N = 18) in their first psychiatric postgraduate year at the Department and Institute of Psychiatry, University of Sao Paulo, Brazil. The residents were assessed in the first and last sessions of the course through a written test that was blindly rated by two independent judges. Residents were also interviewed to observe whether psychodynamic concepts had been integrated into actual practice. Their responses were subjected to content analysis. Significance was tested using analysis of variance or nonparametric tests when necessary. Agreement between the judges was tested using intraclass correlation coefficients. Results: The judges demonstrated a high level of agreement. The difference in mean scores before and after the course was such that the total score increased by a mean of 2.5 points (total test score was 10 points). Additionally, residents started to undergo personal psychotherapy after the course. They reported that this course had markedly improved their relationship with patients. They emphasized the opportunities for self-reflection and gaining insights into themselves and patient treatment issues. Conclusion: This initial study indicates that this educational method can effectively promote psychodynamic knowledge, skills, and appropriate attitudes for managing psychiatric outpatients among residents. The course was very well received by the residents, and a similar method can easily be instituted within other residency programs that pursue integrated teaching methods.

Glaucoma and Keratoprosthesis Surgery Role of Adjunctive Cyclophotocoagulation

Purpose: To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation (DLTSC) to control intraocular pressure (IOP) in keratoprosthesis patients with uncontrolled glaucoma. Patients and Methods: Between 1993 and 2007, 18 eyes of 18 patients underwent DLTSC, either before (n = 3), during (n = I), or after (n = 14) keratoprosthesis surgery. Keratoprosthesis type 1 was used in 72%. All but one of these patients received an Ahmed Glaucoma Valve, either with or after the keratoprosthesis placement. Best-corrected visual acuity, IOP (assessed by digital palpation), number of medications, and complications were recorded preoperatively, at day 7, at 1, 3, and 6 months then every 6 months postoperatively. Results: Mean follow-tip was 26.6 +/- 19.6 months (mean +/- SD) and mean age was 50.1 +/- 15.6 years. Glaucoma was identified in 1 I eyes before keratoprosthesis surgery and in 7 eyes after. Mean postoperative IOP was significantly reduced at 6, 12, 24, 36, and 48 months after DLTSC. DLTSC was repeated in 6 eyes. At final visit, mean best-corrected visual acuity was not decreased and there were no statistically significant differences in the number of glaucoma medications. Two patients had complications after DLTSC: a conjunctival dehiscence and a fungal endophthalmitis. Conclusions: DLTSC has beneficial long-term effects in the control of IOP and can be considered in the management of keratoprosthesis patients with refractory glaucoma.

Predictors of word-level literacy amongst Grade 3 children in five diverse languages

Groups of Grade 3 children were tested on measures of word-level literacy and undertook tasks that required the ability to associate sounds with letter sequences and that involved visual, auditory and phonological-processing skills. These groups came from different language backgrounds in which the language of instruction was Arabic, Chinese, English, Hungarian or Portuguese. Similar measures were used across the groups, with tests being adapted to be appropriate for the language of the children. Findings indicated that measures of decoding and phonological-processing skills were good predictors of word reading and spelling among Arabic- and English-speaking children, but were less able to predict variability in these same early literacy skills among Chinese- and Hungarian-speaking children, and were better at predicting variability in Portuguese word reading than spelling. Results were discussed with reference to the relative transparency of the script and issues of dyslexia assessment across languages. Overall, the findings argue for the need to take account of features of the orthography used to represent a language when developing assessment procedures for a particular language and that assessment of word-level literacy skills and a phonological perspective of dyslexia may not be universally applicable across all language contexts. Copyright (C) 2008 John Wiley & Sons, Ltd.

Environmental factors associated with adults' participation in physical activity : A review

Background: Promoting physical activity is a public health priority, and changes in the environmental Contexts of adults' activity choices are believed to be crucial. However, of the factors associated with physical activity, environmental influences are among the least understood. Method: Using journal scans and computerized literature database searches, we identified 19 quantitative studies that assessed the relationships With physical activity behavior of perceived and objectively determined physical environment attributes. Findings were categorized into those examining five categories: accessibility of facilities, opportunities for activity, weather, safety, and aesthetic attributes. Results: Accessibility, opportunities, and aesthetic attributes had significant associations with physical activity, Weather and safety showed less-strong relationships. Where Studies pooled different categories to create composite variables, the associations were less likely to be statistically significant. Conclusions: Physical environment factors have consistent associations with physical activity behavior. Further development of ecologic and environmental models, together with behavior-specific and context-specific measurement strategies, should help in further understanding of these associations. Prospective Studies are required to identify possible causal relationships.

Cadherin-directed actin assembly: E-cadherin physically associates with the Arp2/3 complex to direct actin assembly in nascent adhesive contacts

Cadherin cell adhesion molecules are major determinants of tissue patterning which function in cooperation with the actin cytoskeleton [1-4]. In the context of stable adhesion [1], cadherin/catenin complexes are often envisaged to passively scaffold onto cortical actin filaments. However, cadherins also form dynamic adhesive contacts during wound healing and morphogenesis [2]. Here actin polymerization has been proposed to drive cell surfaces together [5], although F-actin reorganization also occurs as cell contacts mature [6]. The interaction between cadherins and actin is therefore likely to depend on the functional state of adhesion. We sought to analyze the relationship between cadherin homophilic binding and cytoskeletal activity during early cadherin adhesive contacts. Dissecting the specific effect of cadherin ligation alone on actin regulation is difficult in native cell-cell contacts, due to the range of juxtacrine signals that can arise when two cell surfaces adhere [7]. We therefore activated homophilic ligation using a specific functional recombinant protein. We report the first evidence that E-cadherin associates with the Arp2/3 complex actin nucleator and demonstrate that cadherin binding can exert an active, instructive influence on cells to mark sites for actin assembly at the cell surface.

E-cadherin homophilic ligation directly signals through Rac and phosphatidylinositol 3-kinase to regulate adhesive contacts

Classical cadherins mediate cell recognition and cohesion in many tissues of the body. It is increasingly apparent that dynamic cadherin contacts play key roles during morphogenesis and that a range of cell signals are activated as cells form contacts with one another. It has been difficult, however, to determine whether these signals represent direct downstream consequences of cadherin ligation or are juxtacrine signals that are activated when cadherin adhesion brings cell surfaces together but are not direct downstream targets of cadherin signaling. In this study, we used a functional cadherin ligand (hE/Fc) to directly test whether E-cadherin ligation regulates phosphatidylinositol 3-kinase (PI 3-kinase) and Rac signaling. We report that homophilic cadherin ligation recruits Rae to nascent adhesive contacts and specifically stimulates Rae signaling. Adhesion to hE/Fc also recruits PI 3-kinase to the cadherin complex, leading to the production of phosphatidylinositol 3,4,5-trisphosphate in nascent cadherin contacts. Rae activation involved an early phase, which was PI 3-kinase-independent, and a later amplification phase, which was inhibited by wortmannin. PI 3-kinase and Rae activity were necessary for productive adhesive contacts to form following initial homophilic ligation. We conclude that E-cadherin is a cellular receptor that is activated upon homophilic ligation to signal through PI 3-kinase and Rae. We propose that a key function of these cadherin-activated signals is to control adhesive contacts, probably via regulation of the actin cytoskeleton, which ultimately serves to mediate adhesive cell-cell recognition.

Evaluation of an internet-based physical activity intervention: A preliminary investigation

The Internet has the potential for delivering innovative, interactive physical activity (PA) interventions to large numbers of people. This study was designed to test the efficacy. of ant Internet intervention that consisted of a Web site plus 12 weekly e-mail tip sheets, compared with a waiting list control group. The Internet intervention was theory based and emphasized clear, graphical presentation of PA information. Sixty-five (30 intervention and 35 control) sedentary adult employees of several large hospitals (9 men and 56 women) were randomly assigned to 1 of the 2 study arms. Of the 65 participants, 57 completed the 1-month follow-up, and 52 completed the 3-month follow-up. At both 1 and 3 months, those in the intervention group were significantly more likely to have progressed, in stage of motivational readiness for PA than participants in the control group: 1 month, chi(2)(1, N = 52) = 4.05, p

O sentido de ser professor de Educação Física pelos “modos de ser sendo junto ao outro no mundo” perverso- fascista e democrático: a vivência real & no filme “Má Educação”

Quais são os “modos de ser sendo junto ao outro no mundo” professores de Educação Física da Prefeitura Municipal da Serra, ES, situados no que se denomina “real” e do professor de Educação Física padre José no filme “Má Educação” de Pedro Almodóvar situado no que se denomina “ficcional”? Que contribuições reflexivas podem trazer tais dados (analisados hermeneuticamente) para a Formação Continuada de professores de Educação Física [3]? OBJETIVO: Descrever os “modos de ser sendo junto ao outro no mundo” de [1] professores de Educação Física que trabalham em escolas públicas da Prefeitura Municipal da Serra, ES & do [2] padre José, personagem ficcional, professor de Educação Física no filme espanhol de 2004 “Má Educação” fazendo-o primeiramente através de uma pesquisa clássica (descritiva e hermenêutica) e depois uma literaturalizada e artística (hermenêutica). MARCO TEÓRICO: Trata-se de uma proposta discursiva (teórica) fenomenológica existencial de tendência marxista criada por Pinel; METODOLOGIA: Tratou-se de uma pesquisa fenomenológica existencial seguindo recomendações de Forghieri (2001) e Pinel (2006; 2012) - dentre outros. Os 29 professores de Educação Física foram provocados a mostrarem os seus “modos de ser sendo junto ao outro no mundo” do ofício professor de Educação Física. Depois essa mesma provocação foi feita ao personagem do filme. RESULTADOS & DISCUSSÃO: Descreveram-se [1] os “modos de ser sendo junto ao outro no mundo” dos professores de Educação Física na dimensão do real e do ficcional (cinema), e não se objetivou comparação por mais que isso tenha ficado evidente. Esses professores, em 2011/2012, experienciando uma democracia (im)perfeita brasileira [que tem até tendências neofascistas], mais ainda assim democracia - foram compreendidos sempre tomando um norte/ rumo/ direção em subjetivação pelos Guias de Sentido (GS – Pinel) democráticos reconhecimento [demanda do grupo em ser valorizado, reconhecido], em (im) potência [impotência e potencia possível de vir a lume sempre; a força e seu outro lado, a fragilidade de ser], afetando [o que se pratica e pensa/sente afeta a si mesmo, o outro e o mundo; o afetar produz mais subjetivações], sonhando [há demanda sempre de realizar projetos de vida; o projeto de ser sempre devir, em construção sempre; é uma precisão imprecisa], saudavelmente insano [o quão perto pode estar a experienciar a sanidade e a loucura e o quanto uma loucura é sã, pois criativa, inventiva, produtiva, opositora ao estabelecido] – eles mesmos junto ao outro no mundo tornando-se sujeitos. [2] Já o professor de Educação Física padre José da película almodovariana é um professor que de imediato pode ser apreendido como sólido e fixo na sua perversão fascista, ele como parte legitimadora do Estado espanhol de Franco, na década de 60, provavelmente em 1964, que é, na ficção, o espaço-tempo de José e suas ações pedagógicas e psicológicas (e de Educação Física). Mas não é apenas o fascismo que torna o fascista um criador de um cotidiano fascista, pois afinal, paralelamente a ele, no concreto e na ficção, haviam pessoas generosas, resistentes e resilientes que atuavam contra essas pressões quase na maioria das vezes advindas do todo (Estado) – eram pessoas democráticas individualmente e em pequenos e grandes grupos; eram exemplo de resistência contra o estabelecido pela ideologia dominante de então. José numa instituição fascista não conseguiu refletir e agir diferentemente, isto é, com mais saúde mental, escolhendo (na liberdade) ser fascista, ser menor (pouco) – optou não ser-mais. Finalmente os mesmos dados são apresentados em outra estética possível e sempre aberta, inconclusa, devir... As artes e a poesia (bem como a literatura) procuram cuidadosamente desvelar os “modos de ser junto ao outro no mundo” professor de Educação Física do mundo real e do imaginário (fílmico) desvelando muitas vezes indissociados. PÓSCRITO: O autor descreve as possíveis implicações do seu estudo para educação física pautado sempre em uma proposta de criar um discursso insubmisso focando na ideia de que uma pesquisa demanda narrar a vida, e literaturalizar a ciência.

O uso da acupuntura para alívio imediato do zumbido

O zumbido, definido como percepção consciente de um som originado nas orelhas ou no sistema nervoso do paciente, representa até os dias atuais um grande desafio no que concerne seu tratamento, baseia-se na estimulação com agulhas de pontos específicos definidos sobre a anatomia humana. A utilização da Acupuntura (ACP) em sintomas como o zumbido assemelha-se ao modelo aplicado nos quadros álgicos, já que ambos estão relacionados como experiência sensorial e emocional subjetiva e desagradável. OBJETIVO: Estudar a eficácia da acupuntura no alívio sintomático de forma aguda no zumbido. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Foi realizado um estudo prospectivo, randomizado e duplo-cego em 76 pacientes atendidos no Ambulatório de Zumbido do Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da UNIFESP-EPM no período compreendido entre abril e junho de 2005. Todos os pacientes tinham queixa de zumbido e foram submetidos a anamnese clínica, exame físico e exames subsidiários a fim de se investigar sua etiologia. Os pacientes eram então encaminhados a um primeiro pesquisador que determinou um valor numérico subjetivo inicial do zumbido através de Escala Visual Analógica (EVA), variando de 0 a 10 pontos. Após isto, foram encaminhados para outra sala na qual um médico acupunturista, que não tinha acesso à avaliação inicial, separou os pacientes em Grupo Controle e Grupo Estudo de acordo com a ordem de atendimento, de maneira alternada. O ponto de ACP utilizado nos pacientes do Grupo Estudo situa-se a 6,5cm acima do ápice do pavilhão auditivo na região têmporo-parietal. O ponto utilizado no Grupo Controle situa-se 3cm acima do ponto anterior, na mesma linha vertical. Foram então encaminhados à sala inicial para uma nova avaliação pelo primeiro pesquisador, onde foram orientados a redefinir o escore subjetivo do zumbido. RESULTADOS: Dos 76 pacientes estudados, 29 eram do sexo masculino (38,2%) e 47 do sexo feminino (61,8%), com idade média 56,9 + 12,0 anos. Os Grupos Estudo e Controle contaram com 38 pacientes cada. Através do teste Anova foi constatado que houve diferença significante (p<0,001) entre os momentos pré e pós-agulhamento e que no grupo Estudo essa melhora é bem maior (p = 0,0127). O teste t-independente mostrou que houve uma diferença significante (p=0,017) entre os escores pré e pós-agulhamento nos grupos Estudo e Controle. CONCLUSÃO: Concluímos que houve redução significante da contagem dos momentos pré e pós-agulhamento em ambos os grupos (controle e estudo), sendo que no grupo estudo a redução é maior que no grupo controle.