Falls Among The Elderly: Risk Factors In A Population-based Study.

The aim of the present study was to identify factors associated with the occurrence of falls among elderly adults in a population-based study (ISACamp 2008). A population-based cross-sectional study was carried out with two-stage cluster sampling. The sample was composed of 1,520 elderly adults living in the urban area of the city of Campinas, São Paulo, Brazil. The occurrence of falls was analyzed based on reports of the main accident occurred in the previous 12 months. Data on socioeconomic/demographic factors and adverse health conditions were tested for possible associations with the outcome. Prevalence ratios (PR) were estimated and adjusted for gender and age using the Poisson multiple regression analysis. Falls were more frequent, after adjustment for gender and age, among female elderly participants (PR = 2.39; 95% confidence interval (95% CI) 1.47 - 3.87), elderly adults (80 years old and older) (PR = 2.50; 95% CI 1.61 - 3.88), widowed (PR = 1.74; 95% CI 1.04 - 2.89) and among elderly adults who had rheumatism/arthritis/arthrosis (PR = 1.58; 95% CI 1.00 - 2.48), osteoporosis (PR = 1.71; 95% CI 1.18 - 2.49), asthma/bronchitis/emphysema (PR = 1,73; 95% CI 1.09 - 2.74), headache (PR = 1.59; 95% CI 1.07 - 2.38), mental common disorder (PR = 1.72; 95% CI 1.12 - 2.64), dizziness (PR = 2.82; 95% CI 1.98 - 4.02), insomnia (PR = 1.75; 95% CI 1.16 - 2.65), use of multiple medications (five or more) (PR = 2.50; 95% CI 1.12 - 5.56) and use of cane/walker (PR = 2.16; 95% CI 1.19 - 3,93). The present study shows segments of the elderly population who are more prone to falls through the identification of factors associated with this outcome. The findings can contribute to the planning of public health policies and programs addressed to the prevention of falls.

Estudos dos desniveis e desvios posturais nas atletas que praticam a modalidade esportiva voleibol

Universidade Estadual de Campinas. Faculdade de Educação Física

Isolamento de Salmonella enterica em gambás (Didelphis aurita e Didelphis albiventris) do Estado de São Paulo, Brasil

No Brasil, não há relato de estudos de Salmonella em gambás, sendo assim, este trabalho tem por objetivo determinar a frequência de isolamento de Salmonella enterica em gambás (D. aurita e D. albiventris) no Estado de São Paulo. No período de janeiro de 2005 a dezembro de 2006, foram necropsiados 106 D. aurita e 40 D. albiventris e colhidos fragmentos de intestinos delgado, grosso e suabe da cloaca. As amostras foram plaqueadas diretamente em ágar Mac Conkey, paralelamente suspendidas nos caldos Rappaport-Vassiliadis e Tetrationato e posteriormente plaqueados em ágar XLT4. As colônias sugestivas de Salmonella foram confirmadas através de provas bioquímicas e sorotipagem. Encontrou-se Salmonella enterica em 17,0% (18/106) dos D. aurita. Destes, 50% apresentaram positividade no intestino delgado (ID), 88,9% no intestino grosso (IG) e 66,7% na cloaca. Da espécie S. enterica, as subespécies encontradas foram: diarizonae (11,1%) houtenae e enterica (5,5% cada um); enquanto da subespécie S. enterica enterica os sorotipos foram Newport (83,3%), Typhimurium e Cerro (5,5% cada um). Nos D. albiventris, 17,5% (7/40) eram positivos, sendo que se encontraram 42,8% no ID, 85,7% no IG e 71,4% na cloaca. O sorotipo mais prevalente também foi Newport (71,4%), seguido por Typhimurium, Bareilly e Thompson (14,3% cada um). Através dos resultados obtidos neste estudo pode-se comprovar a presença de Salmonella enterica no trato intestinal de gambás no Brasil.

Prevalência e fatores associados ao tabagismo em escolares da Região Sul do Brasil

OBJETIVO: Estimar a prevalência do tabagismo em estudantes e os fatores associados.MÉTODOS: Foram utilizados dados secundários, provenientes do inquérito Vigescola realizado em Curitiba (PR), Florianópolis (SC) e Porto Alegre (RS) em 2002 e 2004. A amostra compreendeu 3.690 escolares de 13 a 15 anos, cursando as sétima e oitava séries do ensino fundamental e primeira do ensino médio, em escolas públicas e privadas. Para a análise dos resultados foram estimadas proporções ponderadas, odds ratio (OR), e utilizada a técnica de regressão logística múltipla.RESULTADOS: As taxas de prevalência de tabagismo corresponderam a 10,7 por cento (IC 95 por cento: 10,2;11,3) em Florianópolis, 12,6 por cento (IC 95 por cento: 12,4;12,9) em Curitiba e 17,7 por cento (IC 95 por cento: 17,4;18,0) em Porto Alegre. Os fatores associados ao tabagismo em escolares em Curitiba foram: sexo feminino (OR=1,49), pai fumante (OR=1,59), amigos fumantes (OR=3,46), exposição à fumaça do tabaco fora de casa (OR=3,26) e possuir algum objeto com logotipo de marca de cigarro (OR=3,29). Em Florianópolis, as variáveis associadas ao tabagismo foram escolares do sexo feminino (OR=1,26), ter amigos fumantes (OR=9,31), exposição à fumaça do tabaco em casa (OR=2,03) e fora de casa (OR=1,45) e ter visto propaganda em cartazes (OR=1,82). Em Porto Alegre, as variáveis que estiveram associadas com o uso de tabaco pelos escolares foram sexo feminino (OR=1,57), idade entre 14 anos (OR=1,77) e 15 anos (OR=2,89), amigos fumantes (OR=9,12), exposição à fumaça do tabaco em casa (OR=1,87) e fora de casa (OR=1,77) e possuir algo com logotipo de marca de cigarro (OR=2,83).CONCLUSÕES: Há elevada prevalência de tabagismo entre escolares de 13 a 15 anos, cujos fatores significativamente associados comuns às três capitais são: ter amigos fumantes e estar exposto à fumaça ambiental fora de casa

Gastroenterology training in Latin America

Latin America is characterized by ethnic, geographical, cultural, and economic diversity; therefore, training in gastroenterology in the region must be considered in this context. The continent's medical education is characterized by a lack of standards and the volume of research continues to be relatively small. There is a multiplicity of events in general gastroenterology and in sub-disciplines, both at regional and local levels, which ensure that many colleagues have access to information. Medical education programs must be based on a clinical vision and be considered in close contact with the patients. The programs should be properly supervised, appropriately defined, and evaluated on a regular basis. The disparity between the patients' needs, the scarce resources available, and the pressures exerted by the health systems on doctors are frequent cited by those complaining of poor professionalism. Teaching development can play a critical role in ensuring the quality of teaching and learning in universities. Continuing professional development programs activities must be planned on the basis of the doctors' needs, with clearly defined objectives and using proper learning methodologies designed for adults. They must be evaluated and accredited by a competent body, so that they may become the basis of a professional regulatory system. The specialty has made progress in the last decades, offering doctors various possibilities for professional development. The world gastroenterology organization has contributed to the speciality through three distinctive, but closely inter-related, programs: Training Centers, Train-the-Trainers, and Global Guidelines, in which Latin America is deeply involved. (C) 2011 Baishideng. All rights reserved.

Runoff sources and land cover change in the Amazon: an end-member mixing analysis from small watersheds

The flowpaths by which water moves from watersheds to streams has important consequences for the runoff dynamics and biogeochemistry of surface waters in the Amazon Basin. The clearing of Amazon forest to cattle pasture has the potential to change runoff sources to streams by shifting runoff to more surficial flow pathways. We applied end-member mixing analysis (EMMA) to 10 small watersheds throughout the Amazon in which solute composition of streamwater and groundwater, overland flow, soil solution, throughfall and rainwater were measured, largely as part of the Large-Scale Biosphere-Atmosphere Experiment in Amazonia. We found a range in the extent to which streamwater samples fell within the mixing space determined by potential flowpath end-members, suggesting that some water sources to streams were not sampled. The contribution of overland flow as a source of stream flow was greater in pasture watersheds than in forest watersheds of comparable size. Increases in overland flow contribution to pasture streams ranged in some cases from 0% in forest to 27-28% in pasture and were broadly consistent with results from hydrometric sampling of Amazon forest and pasture watersheds that indicate 17- to 18-fold increase in the overland flow contribution to stream flow in pastures. In forest, overland flow was an important contribution to stream flow (45-57%) in ephemeral streams where flows were dominated by stormflow. Overland flow contribution to stream flow decreased in importance with increasing watershed area, from 21 to 57% in forest and 60-89% in pasture watersheds of less than 10 ha to 0% in forest and 27-28% in pastures in watersheds greater than 100 ha. Soil solution contributions to stream flow were similar across watershed area and groundwater inputs generally increased in proportion to decreases in overland flow. Application of EMMA across multiple watersheds indicated patterns across gradients of stream size and land cover that were consistent with patterns determined by detailed hydrometric sampling.

Constipation in Australian women: Prevalence and associated factors

A postal health survey was completed by 14761 young women (aged 18-23 years), 14070 middle-aged women (45-50 years) and 12893 older women (70-75 years). The prevalence of constipation was 14.1% (CI 13.5-14.7) in young women, 26.6% (CI 25.9-27.4) in middle-aged women, and 27% (CI 26.9-28.5) in the older women. The prevalence of hemorrhoids was 3.2% (CI 2.9-3.4 young), 17.7% (CI 17.1-18.4 middle-aged) and 18.3% (CI 17.6-19.0 older). In the middle-aged and older women, those who reported previous gynecologic surgery were between 18% and 63% more likely to report constipation; in the younger cohort, women with one or two children were also more likely to report constipation (adjusted OR 1.43-1.46); One-third of the young women and half the middle-aged and older women had sought help for constipation; the majority indicated that they were satisfied with the help available to them.

Prevalence of Acne Vulgaris in Patients with Down Syndrome

Background/Objective: Acne vulgaris exhibits a worldwide prevalence of up to 95% among adolescents. On the other hand, Down syndrome is an autosomal chromosomal disorder with associated dermatoses and a tendency to obesity. There are no data on its association with acne. Our aim was to detect the prevalence of acne, its forms and associated factors in Down syndrome. Method: A cross-sectional study including 89 subjects aged 10-28 years from Associacao de Pais e Amigos dos Excepcionais-Sao Paulo to verify acne, metabolic and hormonal disorders by interview, clinical and laboratory examinations. Results: We evaluated 49 (55%) males and 40 (45%) females. A weak agreement between self-estimation for acne and examination result was detected. The overall prevalence of acne was 70.8%: 83.7% in males and 55% in females. The prevalence of acne in the age groups 10-17 and 18-28 was 62 and 78.7%, respectively. Facial comedonal acne was mostly detected. The prevalence of obesity was 40%, that of metabolic disorders 7% and that of hyperandrogenism (in females) 15%. Except for gender, no other factor evaluated correlated with acne. Conclusion: A low prevalence of acne in Down syndrome, a predominance in males aged 18-28 and a facial comedonal form were detected. An association with obesity, metabolic disorders or hyperandrogenemia was not assessed. Copyright (C) 2010 S. Karger AG, Basel

Evolutive physicochemical characterization of diabetic ketoacidosis in adult patients admitted to the intensive care unit

Purpose: The aim of this study was to characterize the first 48-hour evolution of metabolic acidosis of adult patients with diabetic ketoacidosis admitted to the intensive care unit. Materials and Methods: We studied 9 patients retrieved from our prospective collected database, using the physicochemical approach to acid-base disturbances. Results: Mean (SD) age was 34 (13) years; mean (SD) Acute Physiology and Chronic Health Evaluation II score was 16 (10); mean (SD) blood glucose level on admission was 480 (144) mg/dL; mean (SD) pH was 7.17 (0.18); and mean (SD) standard base excess was -16.8 (7.7) mEq/L. On admission, a great part of metabolic acidosis was attributed to unmeasured anions (strong ion gap [SIG], 20 +/- 10 mEq/L), with a wide range of strong ion difference (41 +/- 10 mEq/L). During the first 48 hours of treatment, 297 +/- 180 IU of insulin and 9240 +/- 6505 mL of fluids were used. Metabolic improvement was marked by the normalization of pH, partial correction of standard base excess, and a reduction of hyperglycemia. There was a significant improvement of SIG (7.6 +/- 6.2 mEq/L) and a worsening of strong ion difference acidosis (36 +/- 5 mEq/L) in the first 24 hours, with a trend toward recuperation between 24 and 48 hours (38 +/- 6 mEq/L). Conclusion: Initial metabolic acidosis was due to SIG, and the treatment was associated with a significant decrease of SIG with an elevation of serum chloride above the normal range. (C) 2011 Elsevier Inc. All rights reserved.

Impaired IFN-alpha secretion by plasmacytoid dendritic cells induced by TLR9 activation in chronic idiopathic urticaria

P>Background The evolution and therapeutic outcome of American tegumentary leishmaniasis (ATL) depend upon many factors, including the balance between Th1 and Th2 cytokines to control parasite multiplication and lesion extension. Other cytokines known for their role in inflammatory processes such as interleukin IL-17 or IL-18 as well as factors controlling keratinocyte differentiation and the inflammatory process in the skin, like the Notch system, could also be involved in the disease outcome. Notch receptors are a group of transmembrane proteins that regulate cell fate decisions during development and adulthood in many tissues, including keratinocyte differentiation and T-cell lineage commitment, depending on their activation by specific groups of ligands (Delta-like or Jagged). Objectives To compare the in situ expression of Notch system proteins (receptors, ligands and transcriptional factors) and cytokines possibly involved in the disease outcome (IL-17, IL-18, IL-23 and transforming growth factor-beta) in ATL cutaneous and mucosal lesions, according to the response to therapy with N-methyl glucamine. Methods Cutaneous and mucosal biopsies obtained from patients prior to therapy with N-methyl glucamine were analysed by immunohistochemistry and real-time polymerase chain reaction. Results Notch receptors and Delta-like ligands were found increased in patients with ATL, particularly those with poor response to therapy or with mucosal lesions. Conclusions The increase of Notch receptors and Delta-like ligands in patients with a poor response to treatment suggests that these patients would require a more aggressive therapeutic approach or at least a more thorough and rigorous follow-up.

The Ideal Timing for Experimental Cleft Lip Creation

Cleft lip and palate (CLP) is the most common congenital defect of the face. Many animal models have been utilized to study embryogenesis and pathogenesis of CLP, including the development of secondary anomalies and consequent deformities. However, the ideal gestational age for surgical creation of lip or palate defects in rat models has never been determined. The aim of the present study is to improve the experimental model utilizing rat fetuses, defining the most appropriate timing for creation of the lip defect model. The study was composed of three groups of fetuses undergoing surgical creation of a lip defect at the left side of the superior lip at 17.5, 18.5, and 19.5 days of gestation. Fetuses were harvested at 21.5 days of gestation (term = 22 days) and underwent macroscopic and microscopic analyses. We found that the most appropriate moment for lip defect creation was at 19.5 days, given the presence of lip depression at the site of the defect and asymmetry and retraction associated with interruption of the lip and complete reepithelialization of the borders of the defect.

New recurrent deletions in the PPAR gamma and TP53 genes are associated with childhood myelodysplastic syndrome

Myelodysplastic syndrome (MDS) is a rare hematological malignancy in children. It was performed FISH analysis in 19 pediatric MDS patients to investigate deletions involving the PPAR gamma and TP53 genes. Significant losses in the PPAR gamma gene and deletions in the tumor suppressor gene TP53 were observed in 17 and 18 cases, respectively. Using quantitative RT-PCR, it was detected PPAR gamma transcript downexpression in a subset of these cases. G-banding analysis revealed 17p deletions in a small number of these cases. One MDS therapy-related patient had neither a loss of PPAR gamma nor TP53. These data suggest that the PPAR gamma and TP53 genes may be candidates for molecular markers in pediatric MDS, and that these potentially recurrent deletions could contribute to the identification of therapeutic approaches in primary pediatric MDS. (C) 2008 Elsevier Ltd. All fights reserved.

Interaction of temperature and vegetative flush maturity influences shoot structure and development of lychee (Litchi chinensis Sonn.)

Potted lychee trees (cv. Tai so) of varying vegetative flush maturity were grown under a range of temperature regimes and monitored for subsequent shoot structure and development. A combination of low temperature (15/17 or 18/13 degreesC day/night) and high vegetative flush maturity was necessary for floral initiation to occur, Exposure to high temperatures (28/23 degreesC) invariably resulted in the production of vegetative shoots, irrespective of flush maturity. Strong floral initiation was marked by the emergence of terminal particles and accompanying axillary particles. A decrea,;e in vegetative flush maturity or increase in temperature (e.g. 23/18 degreesC) resulted in a decrease in axillary shoot formation and the production of several intermediate shoot structures. These included leafy particles, stunted particles, partially emerged buds and non-emergent swollen buds, often produced on the same tree. At 23/18 degreesC, closer synchronisation of initial flush maturity was required for the production of a consistent shoot-type. Trees with synchronised mature flushes (I-2) at 23/18 degreesC resulted in the production of swollen terminal buds. Healthy trees were maintained in this state for at least 11 months. These results indicate that both temperature and flush maturity can influence subsequent shoot structure of lychee. In the absence of either a strong floral temperature (18/13 degreesC) or strong vegetative temperature (28/23 degreesC), slight differences in initial flush maturity have gteater impact on the type of emerging shoot formed. (C) 2002 Elsevier Science B.V. All rights reserved.

O aluno com deficiência motora e a acessibilidade arquitectónica no Ensino Básico : um estudo de caso : o concelho de Guimarães

RESUMO:Para que o sucesso educativo se verifique, a escola tem de ajustar a sua prática educativa a todos os alunos, incluindo os que apresentam necessidades educativas especiais (NEE). Portugal dispõe de legislação que assegura o direito à educação e à igualdade de oportunidades, consignados na Constituição da República Portuguesa (artigos 71º, 73º e 74º), em consonância com a Declaração Universal dos Direitos do Homem e na Lei de Bases do Sistema Educativo (artigos 2º, 7º, 17º e 18º). O nosso país subscreveu também a Declaração de Salamanca, a qual reuniu, em 1994, o consenso de noventa e dois governos e de vinte e cinco organizações internacionais, reafirmando o direito à educação para todos. A construção da escola inclusiva passa pela responsabilização da escola por todos os alunos, na perspectiva de educação para todos, exigindo a sua concretização novas estratégias e resposta a novos desafios. Há que alterar práticas para atender à diversidade. Assim, as escolas precisam de estar arquitectonicamente adaptadas às necessidades dos alunos que utilizam a cadeira de rodas como forma de mobilidade, respeitando o direito à diferença e possibilitando, em igualdade de oportunidades, o sucesso escolar e educativo. Levar à prática as medidas previstas na lei portuguesa e implementar, em cada escola, a inclusão do aluno com mobilidade condicionada, implica equipar as escolas com adaptações, meios e recursos educativos facilitadores do seu processo ensino/aprendizagem. A constatação do que efectivamente acontece no terreno educativo no que concerne aos alunos com deficiência motora que usam a cadeira de rodas para se movimentarem assume toda a centralidade da nossa investigação, que tem o cariz de um estudo de caso. Incide sobre a compreensão mais aprofundada de como se processa o acesso arquitectónico nas escolas do Ensino Básico da Zona Norte e mais concretamente do Concelho de Guimarães. Recolhemos dados através de questionários dirigidos aos professores de apoio educativo e coordenadores de escola; ouvimos os alunos com deficiência motora pronunciar-se sobre as dificuldades que sentiam; observámos o seu quotidiano escolar e, finalmente, escutámos as entidades locais, através de uma entrevista realizada à Vereadora da Cultura do Concelho de Guimarães. Os resultados obtidos serão, como foi acordado, divulgados aos intervenientes com responsabilidades directas no campo da educação que se prontificaram a partilhar connosco a sua informação e saber, no sentido de os sensibilizar para a necessidade de rever o aspecto das acessibilidades arquitectónicas nas instituições educativas que servem o seu concelho, pois, como verificámos, muito há ainda a fazer para que o Ensino Básico, universal e obrigatório, se traduza numa igualdade de oportunidades de acesso e sucesso educativo para os alunos que utilizam a cadeira de rodas para se movimentarem no espaço escolar. ABSTRACT: For the educational success of a school it has to adjust its educational practice so that it includes those with special needs. According to the Portuguese law, disabled people have the right to education and equal opportunities, well expressed in the Constitution of the Portuguese Republic (articles 71st, 73rd, and 74th), in consonance with the Universal Declaration of Human Rights, and in the main law the educational system (articles 2nd, 7th, 17th and 18th). Our country has also subscribed the Declaration of Salamanca, which was written in 1994 with the agreement of Representatives from ninety-two governments and twenty-five International Organizations, where was reaffirmed the right of education for all. It is necessary that school increases its responsibility in what concerns the education of all its students. Educating all and every student demands new strategies to face new challenges and so some practices have to be changed to respond to diversity. Schools must be architecturally adapted to give the disabled students, who use a wheel chair, equal opportunities to achieve educational success. Taking the measures foreseen in Portuguese law into practice, and implementing in each school the inclusion of students with conditioned mobility, involves equipping schools with adaptations, equipment and educational resources that facilitate the teaching / learning process. The observation of what actually happens on educative ground, regarding to pupils with motor disabilities who use a wheelchair to move, assumes the centrality of our research, which is a case study. It focuses on the deeper understanding of the way the architectonic access in primary schools of the North, and more specifically the Municipality of Guimarães, is processed. We collected data through questionnaires addressed to educational support teachers and school coordinators; heard students with motor disabilities to comment on the difficulties they felt; observed their daily school life, and finally heard the local authorities, through an interview the Councillor of Culture of the Municipality of Guimarães. As agreed, the results will be communicated to intervenients with direct responsibilities in the field of education who were willing to share with us their information and knowledge in order to raise awareness of the need of looking over the aspect of architectural accessibility in educational institutions that serve their county, because, as noted, much remains to be done so that the basic education, universal and compulsory, will result in equality of educational opportunities in access and success for students who use a wheelchair to move in school space.

Fatores associados ao uso de drogas entre adolescentes escolares

OBJETIVO: Investigar fatores associados ao uso de drogas entre adolescentes de escolas com ensino médio. MÉTODOS: Realizou-se um estudo transversal, em 1998, em Pelotas, RS. Um questionário anônimo, auto-aplicado em sala de aula, foi respondido por uma amostra proporcional de estudantes com idade entre 10 e 19 anos, matriculados no ensino fundamental (a partir da quinta série) e no ensino médio, em todas as escolas públicas e particulares na zona urbana do município que tinham ensino médio. Realizaram-se até três revisitas para aplicação aos alunos ausentes. Os resultados foram expressos como razão de prevalências (RP). RESULTADOS: Foram entrevistados 2.410 estudantes e o índice de perdas foi de 8%. A prevalência do uso de drogas (exceto álcool e tabaco) no último ano foi 17,1%. Após controle para fatores de confusão, permaneceu a associação entre uso de drogas e separação dos pais (RP=1,46; IC 95%: 1,18-1,80), relacionamento ruim ou péssimo com o pai (RP=1,67; IC 95%: 1,17-2,38), relacionamento ruim ou péssimo com a mãe (RP=2,71; IC 95%: 1,64-4,48), ter pai liberal (RP=1,36; IC 95%: 1,08-1,72), presença em casa de familiar usuário de drogas (RP=1,61; IC 95%: 1,17-2,18), ter sofrido maus tratos (RP=1,62; IC 95%: 1,27-2,07), ter sido assaltado ou roubado no ano anterior (RP=1,38; IC 95%: 1,09-1,76) e ausência de prática religiosa (RP=1,31; IC 95%: 1,07-1,59). CONCLUSÕES: O estudo indica que diversas características familiares estão associadas ao uso de drogas pelos adolescentes, fornecendo informações úteis para a compreensão integral desse problema em nosso País.