Chronic obstructive pulmonary disease is underdiagnosed and undertreated in São Paulo (Brazil): results of the PLATINO study

Chronic obstructive pulmonary disease (COPD) is a common disease in adults over 40 years of age and has a great social and economic impact. It remains little recognized and undertreated even in developed countries. However, there are no data about its diagnosis and treatment in Brazil. The objectives of the present study were to evaluate the proportion of COPD patients who had never been diagnosed and to determine if the COPD patients who had been identified were receiving appropriate treatment. The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was a randomized epidemiological study of adults over 40 years living in five metropolitan areas, including São Paulo. The studied sample was randomly selected from the population after a division of the metropolitan area of São Paulo in clusters according to social characteristics. All subjects answered a standardized questionnaire on respiratory symptoms, history of smoking, previous diagnosis of lung disease, and treatments. All subjects performed spirometry. The criterion for the diagnosis of COPD was defined by a post-bronchodilator FEV1/FVC ratio lower than 0.7. A total of 918 subjects were evaluated and 144 (15.8%) met the diagnostic criterion for COPD. However, 126 individuals (87.5%) had never been diagnosed. This undiagnosed group of COPD patients had a lower proportion of subjects with respiratory symptoms than the previously diagnosed patients (88.9 vs 54.8%) and showed better lung function with greater FEV1 (86.8 ± 20.8 vs 68.5 ± 23.6% predicted) and FVC (106.6 ± 22.4 vs 92.0 ± 24.1% predicted). Among the COPD patients, only 57.3% were advised to stop smoking and 30.6% received the influenza vaccine. In addition, 82.3% did not receive any pharmacological treatment. In conclusion, COPD is underdiagnosed and a large number of COPD patients are not treated appropriately.

The northern provinces of Sweden and Norway with part I, of Russia / published under the superintendence of the Society for the Diffusion of Useful Knowledge.

[N. 1:4400000].

Charta öfwer Finland år 1747 / sammandragen och förfärdigad wid Kongl. lantmäteri contoiret til General gouvernearens och Riksrådets högwälborne herr baron von Rosens tienst at förwaras wid gouvernaments residencet ; Suomen maantieteellisen seuran julkaisema jäljennös = Kopian publicerad av Geografiska sällskapet i Finland = Reprint published by the Geographical society of Finland.

Kartta ilmestynyt teoksen A map of Finland from 1747 / description by Sakari Härö liitteenä sarjassa Fennia. Supplementum. 1.

Genetic, prenatal and postnatal determinants of weight gain and obesity in young children – The STEPS Study

Genetic, Prenatal and Postnatal Determinants of Weight Gain and Obesity in Young Children – The STEPS Study University of Turku, Faculty of Medicine, Department of Paediatrics, University of Turku Doctoral Program of Clinical Investigation (CLIPD), Turku Institute for Child and Youth Research. Conditions of being overweight and obese in childhood are common health problems with longlasting effects into adulthood. Currently 22% of Finnish boys and 12% of Finnish girls are overweight and 4% of Finnish boys and 2% of Finnish girls are obese. The foundation for later health is formed early, even before birth, and the importance of prenatal growth on later health outcomes is widely acknowledged. When the mother is overweight, had high gestational weight gain and disturbances in glucose metabolism during pregnancy, an increased risk of obesity in children is present. On the other hand, breastfeeding and later introduction of complementary foods are associated with a decreased obesity risk. In addition to these, many genetic and environmental factors have an effect on obesity risk, but the clustering of these factors is not extensively studied. The main objective of this thesis was to provide comprehensive information on prenatal and early postnatal factors associated with weight gain and obesity in infancy up to two years of age. The study was part of the STEPS Study (Steps to Healthy Development), which is a follow-up study consisting of 1797 families. This thesis focused on children up to 24 months of age. Altogether 26% of boys and 17% of girls were overweight and 5% of boys and 4% of girls were obese at 24 months of age according to New Finnish Growth references for Children BMI-for-age criteria. Compared to children who remained normal weight, the children who became overweight or obese showed different growth trajectories already at 13 months of age. The mother being overweight had an impact on children’s birth weight and early growth from birth to 24 months of age. The mean duration of breastfeeding was almost 2 months shorter in overweight women in comparison to normal weight women. A longer duration of breastfeeding was protective against excessive weight gain, high BMI, high body weight and high weight-for-length SDS during the first 24 months of life. Breast milk fatty acid composition differed between overweight and normal weight mothers, and overweight women had more saturated fatty acids and less n-3 fatty acids in breast milk. Overweight women also introduced complementary foods to their infants earlier than normal weight mothers. Genetic risk score calculated from 83 obesogenic- and adiposity-related single nucleotide polymorphisms (SNPs) showed that infants with a high genetic risk for being overweight and obese were heavier at 13 months and 24 months of age than infants with a low genetic risk, thus possibly predisposing to later obesity in obesogenic environment. Obesity Risk Score showed that children with highest number of risk factors had almost 6-fold risk of being overweight and obese at 24 months compared to children with lowest number of risk factors. The accuracy of the Obesity Risk Score in predicting overweight and obesity at 24 months was 82%. This study showed that many of the obesogenic risk factors tend to cluster within children and families and that children who later became overweight or obese show different growth trajectories already at a young age. These results highlight the importance of early detection of children with higher obesity risk as well as the importance of prevention measures focused on parents. Keywords: Breastfeeding, Child, Complementary Feeding, Genes, Glucose metabolism, Growth, Infant Nutrition Physiology, Nutrition, Obesity, Overweight, Programming

Prevention of contrast induced nephropathy with sodium bicarbonate (the PROMEC study)

Introduction: Contrast-induced nephropathy is a common complication of radiographic procedures. Different measures have been used to avoid this damage, but the evidence is controversial. New investigations are required to clarify it. We investigated the efficacy and safety of sodium bicarbonate solution compared with sodium chloride solution to prevent contrast induced nephropathy in patients with or at risk of renal dysfunction. Methods: A prospective, single-center, randomized clinical trial conducted from May 1, 2007 to February 8, 2008. Inpatients in a tertiary center, scheduled to undergo a procedure with the nonionic radiographic contrast agent iohexol. There were 220 patients with serum creatinine levels of at least 1.2 mg/dL (106.1 µmol/L) and/or type 2 diabetics, who were randomized to receive an infusion of sodium chloride (n = 113) or sodium bicarbonate (n = 107) before and after contrast dye administration. The intervention were "A" group received 1 ml/kg/hour of normal saline solution, starting 12 hours before and continuing 12 hours after iohexol contrast. "B" group received 3 ml/kg of sodium bicarbonate solution (150 mEq/L) one hour prior to procedure and then drip rate was decreased to 1 ml/kg/hour until 6 hours post procedure. Our main outcome measure was change in serum creatinine. Results: The mean creatinine value after the procedure was 1.26 mg/dL in the saline group and 1.22 mg/dL in the bicarbonate group (mean difference: 0.036; CI 95%: -0.16 to 0.23, p = 0.865). The diagnosis of contrast-induced nephropathy, defined by increase in serum creatinine on 25% or more within 2 days after administration of radiographic contrast, was done in twelve patients (12%) in the bicarbonate group and eighth patients (7.1%) in the saline group (RR: 1.68, CI 95%: 0.72 to 3.94). Conclusion: Our investigation showed that there were no differences between normal saline solution (extended infusion) vs. bicarbonate solution for nephroprotection.

Ventricular rate during acute atrial fibrillation and outcome of electrical cardioversion: The FinCV Study

The impact of ventricular rate (VR) on the outcome of electrical cardioversion (ECV) of acute atrial fibrillation (AF) is currently unknown. We aimed to determine the effect of VR during acute AF on the success of ECV, recurrence of AF and occurrence of post-cardioversion complications in 30 days follow-up. All ECVs performed in patients with acute atrial fibrillation lasting <48 hours in 2 Finnish university hospitals during 2003-2010 and 1 central hospital during 2010 were retrospectively identified. A total of 6,624 ECVs were performed in 2,821 consecutive patients. VR≤60 BPM was defined low and VR≥160 BPM high. The median VR before ECV was 109 BPM. The success rate of ECV was 94.2%. Bradycardia occurred in 62 (0.9%) and thromboembolic complications in 39 (0.6%) ECVs. Low VR was observed before 75 (1.1%) ECVs and male sex was its only independent predictor. High VR was observed in 165 (2.5%) ECVs. The independent predictors of high VR were younger age, <12 h episode duration, no previous history of AF and alcohol abuse. Low or high VR were not related to the success of ECV, incidence of thromboembolic or bradycardic complications, or recurrence of AF, although VR was significantly (p<0.001) lower in the patients in whom AF recurred. In conclusion, ECV of acute AF is an effective procedure and VR during AF does not affect its efficacy, the maintenance of sinus rhythm or the incidence of bradycardic, thromboembolic or other complications during 30 days follow-up after ECV. Low VR is predominately observed in male patients, while high VR was a feature related to a shorter history of AF and high alcohol-intake.

Forsaking all others: towards a new model of nationalism utilizing the case study of former Yugoslavia

Many people would like to believe that nationalism is a thing of the past, a dinosaur belonging to some bygone, uncivilized era. Such a belief is not borne out by recent history, however. Nationalism occupies the political forum with as much force as ever. Yet, in many ways, it remains a mystery to us. The purpose of this study is to explore individual motivations involved in the rise of nationalism, in addition to the role of structural factors. The linkage employed in this exploration is the psychosocial phenomenon of self-identity, including emotions and self-esteem. We demonstrate how individual, socially-constructed self-identity accounts for why some people embrace nationalism while others eschew it. The methodology employed was theoretical and historical analyses of secondary sources and indepth interviews with subjects who had some connection with former Yugoslavia, the country utilized to test the new model. Our analyses yielded the result that current conceptualizations of nationalism from an exclusively macro or micro perspective are unsatisfactory; we require a more comprehensive approach wherein the two perspectives are integrated. Such an integration necessitates a bridge: hence, our new model, which rests on the psychosocial premise, offers a more useful conceptual tool for the understanding of nationalism. We conclude that nationalism is first and foremost a matter relating to individual social self-identity which takes place within a particular context where oppositional forces emerge from structural factors and our membership in a particular group becomes paramount.

The report of the Loyal and Patriotic Society of Upper Canada, with an appendix and a list of subscribers and benefactors (1817)

Minutes, accounts and other records, 1812-1816, of an association formed at York, to alleviate distress in Upper Canada resulting from war with United States.

The Conceptualization and Exploration of Place Allegiance: Towards a Unified Model of Person-Place Relationships within Outdoor Recreation

The academic study of place has been generally defined by two distinct and highly refined discourses within outdoor recreation research: place attachment and sense of place. Place attachment generally describes the intensity of the place relationship, whereas sense of place approaches place from a more holistic and intimate orientation. This study bridges these two methodological and theoretical separate areas of place research together by re-conceptualizing the way in which place relationships are viewed within outdoor recreation research. The Psychological Continuum Model is used to extend the language of place attachment to incorporate more of the philosophy of sense of place while attending to the empirical strength and utility of place attachment. This extension results in the term place allegiance being coined to depict the strong and profound relationships outdoor recreationists build with their places of outdoor recreation. Using a concurrent mixed methods research design, this study explored place allegiance via an online survey (n = 437) and thirteen in-depth qualitative interviews with outdoor recreationists. Results indicate that place allegiance can be measured through a multi-dimensional model of place allegiance that incorporates behaviours, importance, resistance, knowledge and symbolic value. In addition, place allegiance was found to be related to an individual's influence on life course and his/her willingness to exhibit preservation and protection tendencies. Place allegiance plays an important role in acknowledging the importance of authentic place relationships in an effort to confront placelessness. Wilderness recreation is an important avenue for outdoor recreationists to build strong place relationships.

The law of psychic phenomena : working hypothesis for the systematic study of hypnotism. spiritism, mental therapeutic, etc.

UANL

A Memoir of Mary Capper, Late of Birmingham, a Minister of the Society of Friends.

UANL

The history of modern Europe: with a view of the progress of society from the rise of the modern kingdom to the peace of Paris, in 1763

UANL