Prospective comparison of clinical prognostic scores in elderly patients with pulmonary embolism.

Background: The Geneva Prognostic Score (GPS), the Pulmonary Embolism Severity Index (PESI), and its simplified version (sPESI) are well known clinical prognostic scores for pulmonary embolism (PE).Objectives: To compare the prognostic performance of these scores in elderly patients with PE. Patients/Methods: In a multicenter Swiss cohort of elderly patients with venous thromboembolism, we prospectively studied 449 patients aged ≥65 years with symptomatic PE. The outcome was 30-day overall mortality. We dichotomized patients as low- vs. higher-risk in all three scores using the following thresholds: GPS scores ≤2 vs. >2, PESI risk classes I-II vs. III-V, and sPESI scores 0 vs. ≥1. We compared 30-day mortality in low- vs. higher-risk patients and the areas under the receiver operating characteristic curve (ROC). Results: Overall, 3.8% of patients (17/449) died within 30 days. The GPS classified a greater proportion of patients as low risk (92% [413/449]) than the PESI (36.3% [163/449]) and the sPESI (39.6% [178/449]) (P<0.001 for each comparison). Low-risk patients based on the sPESI had a mortality of 0% (95% confidence interval [CI] 0-2.1%) compared to 0.6% (95% CI 0-3.4%) for low-risk patients based on the PESI and 3.4% (95% CI 1.9-5.6%) for low-risk patients based on the GPS. The areas under the ROC curves were 0.77 (95%CI 0.72-0.81), 0.76 (95% CI 0.72-0.80), and 0.71 (95% CI 0.66-0.75), respectively (P=0.47). Conclusions: In this cohort of elderly patients with PE, the GPS identified a higher proportion of patients as low-risk but the PESI and sPESI were more accurate in predicting mortality.

Electric bicycles as a new active transportation modality to promote health.

GOJANOVIC, B., J. WELKER, K. IGLESIAS, C. DAUCOURT, and G. GREMION. Electric Bicycles as a New Active Transportation Modality to Promote Health. Med. Sci. Sports Exerc., Vol. 43, No. 11, pp. 2204-2210, 2011. Electrically assisted bicycles (EAB) are an emerging transportation modality favored for environmental reasons. Some physical effort is required to activate the supporting engine, making it a potential active commuting option. Purpose: We hypothesized that using an EAB in a hilly city allows sedentary subjects to commute comfortably, while providing a sufficient effort for health-enhancing purposes. Methods: Sedentary subjects performed four different trips at a self-selected pace: walking 1.7 km uphill from the train station to the hospital (WALK), biking 5.1 km from the lower part of town to the hospital with a regular bike (BIKE), or EAB at two different power assistance settings (EAB(high), EAB(std)). HR, oxygen consumption, and need to shower were recorded. Results: Eighteen sedentary subjects (12 female, 6 male) age 36 +/- 10 yr were included, with (V) over dotO(2max) of 39.4 +/- 5.4 mL.min(-1).kg(-1). Time to complete the course was 22 (WALK), 19 (EAB(high)), 21 (EAB(std)), and 30 (BIKE) min. Mean %(V) over dotO(2max) was 59.0%, 54.9%, 65.7%, and 72.8%. Mean%HR(max) was 71.5%, 74.5%, 80.3%, and 84.0%. There was no significant difference between WALK and EAB(high), but all other comparisons were different (P < 0.05). Two subjects needed to shower after EAB(high), 3 needed to shower after WALK, 8 needed to shower after EAB(std), and all 18 needed to shower after BIKE. WALK and EAB(high) elicited 6.5 and 6.1 METs (no difference), whereas it was 7.3 and 8.2 for EAB(std) and BIKE. Conclusions: EAB is a comfortable and ecological transportation modality, helping sedentary people commute to work and meet physical activity guidelines. Subjects appreciated ease of use and mild effort needed to activate the engine support climbing hills, without the need to shower at work. EAB can be promoted in a challenging urban environment to promote physical activity and mitigate pollution issues.

EFEITO DE INJÚRIAS MECÂNICAS NO PROCESSO RESPIRATÓRIO E NOS PARÂMETROS QUÍMICOS DE GOIABAS 'PALUMA' E 'PEDRO SATO'

O objetivo deste trabalho foi avaliar o efeito das injúrias mecânicas por impacto, compressão ou corte na atividade respiratória e na composição química de goiabas 'Paluma' e 'Pedro Sato' colhidas no estádio de maturação "de vez" e armazenadas a 23,4±1 °C e 62±6 % UR (condições de ambiente). Na injúria por impacto, os frutos foram deixados cair, por duas vezes e em queda livre, de uma altura de 1,20 m, sofrendo os impactos em lados opostos de sua porção equatorial. Na injúria por compressão, os frutos foram submetidos a um peso de 3 kg, por 15 minutos. Para a injúria por corte foram efetuados 2 cortes no sentido longitudinal dos frutos, de 30 mm de comprimento por 2 mm de profundidade. Os frutos injuriados foram colocados em bandejas de isopor e armazenados sob as condições de ambiente, com a atividade respiratória avaliada diariamente e seus conteúdos de sólidos solúveis totais, açúcares redutores, acidez total titulável e ácido ascórbico, determinados a cada 2 dias. Houve um incremento na evolução da atividade respiratória dos frutos em todos os tratamentos durante o armazenamento, com os injuriados produzindo maior quantidade de CO2 (184,12 mg de CO2.kg-1.h-1) que os do controle (164,23 mg de CO2.kg-1.h-1). Os frutos da 'Paluma' apresentaram essa atividade mais intensa (178,39 mg de CO2.kg-1.h-1) que os da 'Pedro Sato' (169,35 mg de CO2.kg-1.h-1), e não se detectou durante o período de armazenamento a ocorrência de pico respiratório. Os teores de sólidos solúveis totais (9,39 °Brix), açúcares redutores (2,24 g de glicose.100 g-1), acidez total titulável (706,25 mg de ácido cítrico.100 g-1) e ácido ascórbico (65,33 mg.100 g-1) dos frutos injuriados apresentaram-se com valores menores que os do controle, ao longo do período de armazenamento.

Prevalencia de la discapacidad en España por comunidades autónomas: el papel de los factores individuales y del entorno geográfico en su variabilidad

Fundamento: La prevalencia de discapacidad en la población general presenta una gran variabilidad geográfica, de manera que identificar aquellos factores que pudieran explicarla será importante para la planificación de políticas sociales. En este trabajo se analiza la variabilidad de la discapacidad por comunidades autónomas desde una doble vertiente, los factores individuales y del entorno. Métodos: Los datos proceden principalmente de la Encuesta de Discapacidad, Deficiencias y Estado de Salud de 1999 y del Inebase, ambas del Instituto Nacional de Estadística (INE). Se calculó la prevalencia de discapacidad simple y ajustada por edad de las CCAA. Se analizan los factores individuales asociados a la discapacidad mediante una regresión logística y los factores individuales y de la comunidad autónoma conjuntamente con una regresión logística de dos niveles. Resultados: La prevalencia de discapacidad muestra una diferencia máxima de 5,75 puntos entre las comunidades autónomas. En la regresión logística la comunidad de residencia fue estadísticamente significativa (OR: 3,35 en la de mayor prevalencia respecto a la de menor) junto con otras variables individuales: edad (OR de 40-64= 1,78 OR de 65-79= 1,87 y OR de >79= 3,34), sexo (OR mujer= 0,66), situación laboral (OR sin trabajo=2,25 OR amas casa/estudiante=1,39 y OR otros=2,03), estado de salud (OR regular= 1,69 OR malo/muy malo= 2,05) y enfermedades crónicas (OR 1-3=1,56 OR4-6=1,82 OR>6=2,59). En la regresión de dos niveles las variables individuales explican poca varianza (s=0,261) y ninguna de las variables relativas a las CCAA mejora el modelo. Conclusiones: Las características individuales no explican suficientemente la variabilidad de la discapacidad entre CCAA y no se han identificado variables del entorno que sean significativas.

Caracterização fenotípica de três seleções de maracujazeiro-roxo (Passiflora edulis Sims)

O interesse pelo cultivo do maracujazeiro-roxo vem crescendo no centro-sul do País, visando à exportação. Observa-se um número significativo de formas selvagens, nativas, compatíveis entre si, propagadas por sementes de polinização aberta, ampliando a variabilidade natural da fruteira. Com o objetivo de identificar cruzamentos com características comerciais desejáveis e disponibilizar sementes de matrizes selecionadas aos produtores, foram realizados estudos de caracterização agronômica, morfológica e citogenética, envolvendo seleções do Banco de Germoplasma de Passifloras do IAC, denominadas 'Roxinho-Miúdo', 'Paulista' e 'Maracujá-Maçã'. Durante duas safras consecutivas, foram analisados cerca de 350 flores e 150 frutos de cada seleção. A maior amplitude de variação ocorreu na massa e no tamanho dos frutos (de 21 a 193 g por fruto), seguidos pelo teor de sólidos solúveis (de 15,2 a 21,4º Brix), produção por planta (11,5 a 30,8 kg) e número de sementes por fruto (de 39 a 261 sementes). A viabilidade polínica variou de 77 a 94,5%, enquanto o teste de germinação do pólen em ágar apresentou índices de 65,5 a 86%, contribuindo para o diferencial em produtividade observado. Todas as seleções apresentaram características comerciais desejáveis. 'Roxinho-Miúdo' possui fruto redondo, pequeno, com 4 cm de diâmetro, doce e de coloração roxo-intensa, adequando-se à preferência internacional. A seleção 'Paulista' apresentou frutos ovais, destacando-se pela dupla finalidade, podendo atender também à agroindústria. O 'Maracujá-Maçã' distinguiu-se pelo maior tamanho, formato arredondado e casca rosada, apto para um segmento diferenciado de mercado, que comercializa frutas por unidade e privilegia a qualidade.

Caracterização química de frutos de jenipapeiros nativos do Recôncavo Baiano visando ao consumo natural e industrialização

O objetivo deste trabalho foi identificar a variabilidade química de frutos de jenipapeiro com potencial econômico para o Recôncavo Baiano. Foram identificadas 100 árvores de jenipapeiro distribuídas em seis municípios do Recôncavo Baiano, onde se coletaram 10 frutos por planta para realização das análises químicas. As variáveis estudadas foram: pH, teor de sólidos solúveis (SS), ácido ascórbico (AA), acidez titulável (AT), relação entre sólidos solúveis e acidez titulável (SS/AT), açúcares redutores (AR), não-redutores (ANR) e totais (AST). Para a interpretação dos resultados, utilizaram-se análise descritiva e coeficiente de Correlação de Pearson. As análises dos frutos nas safras de 2004/2005 apresentaram valores médios iguais a 3,44 e 3,39 para o pH; 1,40% e 1,42% de AT; 17,18 ºBrix e 16,8 ºBrix para SS; 2,76 mg.100g-1 e 2,65 mg.100g-1 de ácido ascórbico; 9,26% e 8,95% de AR; 3,39% e 3,31% de ANR; 12,61% e 12,28% de AST; 12,37 e 12,00 para SS/AT. Os resultados permitiram concluir que existe variabilidade para os caracteres analisados, possibilitando a exploração econômica dos frutos para o consumo in natura e industrialização; que o SS contribui para a maioria dos caracteres, com exceção da vitamina C, e os genótipos JP12, JP39, JP41, JP59, JP73, JP79, JP80, JP83, JP89, JP90 e JP99 podem ser recomendados para utilização nas condições agroecológicas do Recôncavo Baiano.

Comportamiento de los cultivares de papaya Sunset, Sunrise y de los genotipos Baixinho de Santa Amalia y BH - 65 en la zona sur de la isla de Tenerife

Los antecedentes de la papaya (Carica papaya, L.) en Canarias vienen a poner de manifiesto, la viabilidad de este cultivo en invernadero y la posibilidad de su mayor expansión a corto plazo, debido a la introducción a lo largo de los últimos años de cultivares comerciales y de gran calidad, procedentes de Hawaii ('Sunrise') y de Brasil 'Baixinho de Santa Amalia' (BSA). En este trabajo se ha estudiado el crecimiento, desarrollo y productividad de los cultivares Sunset, Sunrise, y de los genotipos BH-65 y 'Baixinho de Santa Amalia' y las características morfológicas y organolépticas de sus frutos, con el fin de continuar con la selección de aquellos cultivares que mejor se adapten y cumplan con las exigencias mínimas de mercado, que mantengan una buena productividad en aquellas zonas marginales para la platanera y que sirvan de base para futuros programas de mejora. Los resultados ponen de manifiesto que los mayores porcentajes de floración se obtienen en el mes de Mayo (6 meses después de la plantación) en las plantas hermafroditas de todos los cultivares, correspondiendo los mayores porcentajes a 'Sunset' y 'Sunrise' (80 y 90,4%, respectivamente). El número de hojas emitidas mensualmente es semejante en todos los cultivares, entre 7,5 y 7,8. Las plantas femeninas de 'Sunrise' así como las hermafroditas de 'Sunset' tienen mayor diámetro, y además, este último cultivar es más precoz en florecer y sus frutos son de mayor peso y tamaño. Hay que destacar también que en el punto de consumo los frutos del cultivar Sunrise son los que poseen mayor contenido en sólidos solubles totales (10,33 ºBrix). Además, los frutos hermafroditas de 'Sunrise' son los primeros en ser recolectados (422 días desde la plantación). Finalmente, señalar que el cultivar Sunset destaca por ser el más productivo (59,5 kg/pl) y por tener mayores rendimientos por hectárea (158,627 kg/ha). No obstante, los genotipos BH-65 y BSA poseen un comportamiento muy semejante, si bien tienen menor porte en el primer año de cultivo (142,9 y 138,8cm) menor altura a la primera flor (40,6 y 42,2 cm) y menor longitud de entrenudos (1,4 y 1,3 cm).Las características descriptivas de los frutos son muy parecidas sin existir diferencias significativas entre ellas. Los frutos tienen buen tamaño (13,74 x 7,81 cm y (12,68 x 7,98 cm) y peso (392,92 y 418,8 g.) y una producción excelente, cualidades de gran interés para el cultivo de la papaya bajo invernadero.

Handwriting and pre-frailty in the Lausanne cohort 65+ (Lc65+) study

BACKGROUND: Frailty is detected by weight loss, weakness, slow walking velocity, reduced physical activity or poor endurance/exhaustion. Handwriting has not been examined in the context of frailty, despite its functional importance. OBJECTIVE: Our goal was to examine quantitative handwriting measures in people meeting 0, 1, and 2 or more (2+) frailty criteria. We also examined if handwriting parameters were associated with gait performance, weakness, poor endurance/exhaustion and cognitive impairment. METHODS: From the population-based Lc65+, 72 subjects meeting 2+ frailty criteria with complete handwriting samples were identified. Gender-matched controls meeting 1 criterion or no criteria were identified. Cognitive impairment was defined by a Mini-Mental State Examination score of 25 or less or the lowest 20th percentile of Trail Making Test Part B. Handwriting was recorded using a writing tablet and measures of velocity, pauses, and pressure were extracted. RESULTS: Subjects with 2+ criteria were older, had more health problems and need for assistance but had higher education. No handwriting parameter differed between frailty groups (age and education adjusted). Writing velocity was not significantly slower among participants from the slowest 20th percentile of gait velocity but writing pressure was significantly lower among those from the lowest 20th percentile of grip strength. Poor endurance/exhaustion was not associated with handwriting measures. Low cognitive performance was related to longer pauses. CONCLUSIONS: Handwriting parameters might be associated with specific aspects of the frailty phenotype, but not reliably with global definitions of frailty at its earliest stages among subjects able to perform handwriting tests.

Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults between 1992 and 2007

PURPOSE: to assess the trends of prevalence of self-reported cardiovascular risk factors (CV RFs: hypertension, hypercholesterolemia, diabetes) and their management for the period of 1992 to 2007 in Switzerland. METHODS: four health interview surveys conducted between 1992 and 2007 in representative samples of the Swiss population (63,782 subjects overall). Self-reported CV RFs prevalence, treatment and control levels were computed after weighting. Weights were calculated by raking ratio such that the marginal distribution of the weighted totals conforms to the marginal distribution of the target population. Multivariate analysis was conducted using logistic regression. RESULTS: prevalence of all CV RFs increased between 1992 and 2007. Also, the prevalence of self-reported treatment among subjects with CV RFs increased, as confirmed by multivariate analysis: OR for hypolipidemic treatment relative to 1992: 0.64 [0.52-0.78]; 1.39 [1.18-1.65] and 2.00 [1.69-2.36] for 1997, 2002 and 2007, respectively. Still, in 2007, circa 40% of hypertensive, 60% of hypercholesterolemic and 50% of diabetic subjects weren't treated. On the other hand, there is an increase of the prevalence of controlled RFs as reported by treated subjects. This was confirmed by multivariate analysis 12.1 [12.0 - 12.2]; 4.16 [4.1 - 4.23] and 2.85 [2.79 - 2.90] for hypertension, hypercholesterolemia and diabetes, respectively, in 2007, relative to 1992. CONCLUSION: the prevalence of self-reported hypertension, hypercholesterolemia and diabetes increased between 1992 and 2007 in the Swiss population. Despite a good control of treated subjects, still a significant percentage of subjects with CV RFs are not treated.

Survival after surgical drainage of malignant pericardial effusion.

OBJECTIVES: Management of malignant pericardial effusion (PE) is complex. Cardiac surgeons are not necessarily familiar with or are challenged by the many underlying etiologies. Analyzing risk factors for mortality may help to estimate the benefit of surgery in high-risk patients. METHODS: Patients undergoing a surgical pericardiotomy for malignant PE, between 2001 and 2011, were included. The influence of tumor type, disease extension, intra-pericardial tumor infiltration on early mortality and long-term survival as well as freedom from symptoms after drainage, and the use of sclerosing agents on PE recurrence rates was analyzed. RESULTS: PE drainage was performed on 46 patients 12 ± 30 months after tumor diagnosis. Malignant diseases were lung cancers (50 %), breast cancers (15 %), lymphoma and leukemia (13 %), cancers of the digestive tract (13 %), and others (9 %). 80 % of patients were symptomatic and symptom relief was achieved in 65 %. Nobody died during surgery. Recurrence rate was 4 %. Early in-hospital mortality was 22 %. After 1 year, 29 % of patients were alive. Eleven patients (24 %) had a complete tumor regression. Metastatic spread (p < 0.001), pericardial infiltration (p = 0.02), and intra-pericardial Bleomycin (p = 0.01) injection were associated with increased mortality. Hematological malignancies had a better prognosis for survival. CONCLUSION: Surgical pericardiotomy is safe, associated with a low recurrence rate and symptom relief in the majority of dyspneic patients. Intra-pericardial Bleomycin may reduce recurrent effusion but does not ameliorate survival. Long-term survival rate was low with an increased mortality in cases of metastatic spreading, pericardial infiltration, and as the tumor of origin: breast cancers. Leukemic and lymphatic tumors have better prognosis.