Caffeine Intake and its Association with Disease Progression, Sleep Quality and Anxiety Symptoms and Nutritional Alterations in People Living with HIV in the Miami Adult Studies on HIV Cohort

Miami-Dade County has approximately 27,000 people living with HIV (PLWH), and the highest HIV incidence in the nation. PLWH have reported several types of sleep disturbances. Caffeine is an anorexic and lipolytic stimulant that may adversely affect sleep patterns, dietary intakes and body composition. High caffeine consumption (>250 mg. per day or the equivalent of >4 cups of brewed coffee) may also affect general functionality, adherence to antiretroviral treatment (ART) and HIV care. This study assess the relationship of high caffeine intake with markers of disease progression, sleep quality, insomnia, anxiety, nutritional intakes and body composition. A convenience sample of 130 PLWH on stable ART were recruited from the Miami Adult Studies on HIV (MASH) cohort, and followed for three months. After consenting, questionnaires on Modified Caffeine Consumption (MCCQ), Pittsburg Insomnia Rating Scale (PIRS), Pittsburg Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), socio-demographics, drug and medication use were completed. CD4 count, HIV viral load, anthropometries, and body composition measures were obtained. Mean age was 47.89±6.37 years, 60.8% were male and 75.4% were African-Americans. Mean caffeine intake at baseline was 337.63 ± 304.97 mg/day (Range: 0-1498 mg/day) and did not change significantly at 3 months. In linear regression, high caffeine consumption was associated with higher CD4 cell count (β=1.532, P=0.049), lower HIV viral load (β=-1.067, P=0.048), higher global PIRS (β=1.776, P=0.046), global PSQI (β=2.587, P=0.038), and GAD-7 scores (β=1.674, P=0.027), and with lower fat mass (β=-0.994, P=0.042), energy intakes (β=-1.643, P=0.042) and fat consumption (β=-1.902, P=0.044), adjusting for relevant socioeconomic and disease progression variables. Over three months, these associations remained significant. The association of high caffeine with lower BMI weakened when excluding users of other anorexic and stimulant drugs such as cocaine and methamphetamine, suggesting that caffeine in combination, but not alone, may worsen their action. In summary, high caffeine consumption was associated with better measures of disease progression; but was also detrimental on sleep quality, nutritional intakes, BMI and body composition and associated with insomnia and anxiety. Large scale studies for longer time are needed to elucidate the contribution of caffeine to the well-being of PLWH.

The role of pharmacists in caring for young people with chronic illness

Purpose - To explore the perceived and potential roles of pharmacists in the care of young people aged 10-24 years with chronic illness, through the exemplar of juvenile arthritis, from the perspectives of UK community and hospital pharmacists, health service commissioners, rheumatology health professionals and lay advocates. Methods - A sequential mixed methods study design comprising: focus groups with community and hospital pharmacists; telephone interviews with pharmacy and rheumatology stakeholders and commissioners, and multidisciplinary group discussions to prioritize roles generated by the first two qualitative phases. Results - The high priority roles for pharmacists, identified by pharmacists and rheumatology staff, were: developing generic healthcare skills among young people; transferring information effectively across care interfaces; building trusting relationships with young people; helping young people to find credible online health information, and the need to develop specialist expertise. Participants identified associated challenges for pharmacists in supporting young people with chronic illness. These challenges included parents collecting prescription refills alone, thus reducing opportunities to engage, and pharmacist isolation from the wider healthcare team. Conclusions - This study has led to the identification of specific enhancements to pharmacy services for young people which have received the endorsement of a wide range of stakeholders. These suggestions could inform the next steps in developing the contribution of community and hospital pharmacy to support young people with chronic illness in the optimal use of their medication.

Skeletal maturity and socio-economic status in portuguese children and youths: the Madeira growth study

Skeletal maturity is used to evaluate biological maturity status. Information about the association between socio-economic status (SES) and skeletal maturity is limited in Portugal. Aims: The aim of this study is to document the skeletal maturity of youths in Madeira and to evaluate variation in maturity associated with SES. Subjects and methods: The study involved 507 subjects (256 boys and 251 girls) from the Madeira Growth Study, a mixed-longitudinal study of five cohorts (8, 10, 12, 14 and 16 years of age) followed at yearly intervals over 3 years (1996–1998). A total of 1493 observations were made. Skeletal age was estimated from radiographs of the hand and wrist using the Tanner–Whitehouse 2 method (TW2). Social class rankings were based on Graffar’s (1956) method. Five social rankings were subsequently grouped into three SES categories: high, average and low. Results: Median for the radius, ulna and short finger bones (RUS scores) in the total sample of boys and girls increased curvilinearly across age whereas median for the 7 (without pisiform) carpal bones (Carpal scores) increased almost linearly. The 20-bone maturity scores demonstrated distinctive trends by gender: the medians for boys increased almost linearly while the medians for girls increased curvilinearly. SES differences were minimal. Only among children aged 10–11 years were high SES boys and girls advanced in skeletal maturity. Madeira adolescents were advanced in skeletal maturity compared with Belgian reference values. Conclusion: The data suggests population variation in TW2 estimates of skeletal maturation. Skeletal maturity was not related to SES in youths from Madeira.

Participation of portuguese manufacturing industry in global value chains

Portugal’s manufacturing sector has a significant importance both in national income and employment. As has been pointed out by several researchers, the traditional methods of analysis fail to grasp all the dimensions of economic competitiveness. This dissertation is then, at its core, an analysis of Portugal’s manufacturing industry in terms of the latter’s value added to production and impact to employment under the framework of global value chains. The current dissertation seeks to study in which way the Portuguese manufacturing industry, and its respective sectors, has a direct and indirect impact on the creation of value added and employment and how this impact can be measured. For development of this work the input-output approach for calculation of multipliers and the new framework proposed by Timmer et al. (2013) for calculation of GVC income and GVC jobs indicators were used, elaborated on the basis of the WIOD project dataset. Moreover, to illustrate the application of the provided methodology the Portuguese textile industry was used as an example. It was found that the changes in final demand of such sectors as Pulp, Paper, Printing and Publishing; Machinery, Nec and Textiles and Textile Products would have a larger impact on generated value added than other manufacturing sectors. At the same time, employment created by the changes in final demand would be more impacted by such sectors as Food, Beverages and Tobacco; Wood and Products of Wood and Cork and Textiles and Textile Products. In this regard, the number of low-skilled workers in Portugal seems to be more effected by changes in final demand, than those occupied by higher -skilled individuals. Moreover, it was found that the distribution of GVC income and GVC jobs for the Portuguese manufacturing industry shares a similar outlook. However, upon closer inspection of GVC labour distribution by skill levels there seems to exist a general progression in which low-skilled jobs requirements are met by local resources, while the need for higher skilled jobs require a greater “off-shoring” of work The results obtained through calculations of presented multipliers provide a powerful tool for policy makers in strategic planning of development of national economy. Using the provided methodology and obtained results, a government and supranational organizations could define which industry would have the greatest impact for an additional unit of output generated through the economy, and thus define the sectors for further investments.

Avaliação nutricional dos idosos institucionalizados no concelho de Viseu

O envelhecimento da população, bem como a alteração da dinâmica da família, têm contribuído diretamente para o aumento do número de idosos institucionalizados. A incidência da desnutrição alcança níveis elevados nestes idosos, sendo essencial o seu diagnóstico precoce para a melhoria da sua qualidade de vida. Constitui objetivo primordial do estudo a avaliação do estado nutricional de idosos institucionalizados no concelho de Viseu, Portugal. A amostra (n=120) é constituída por idosos de ambos os sexos, institucionalizados, com idade igual ou superior a 65 anos, com capacidade para se colocar de pé, sem demência e que não sejam portadores de patologia passível de afetar a digestão, absorção ou utilização dos nutrientes. A avaliação do estado nutricional é determinada tendo em conta parâmetros antropométricos, a aplicação do e Mini Nutricional Assessment (MNA) e dietéticos, através da avaliação da ingestão alimentar (registo de 3 dias). Os questionários aplicados estão validados para a população portuguesa idosa e foram aplicados após consentimento informado. Foram realizadas estatísticas descritivas e inferenciais às diferentes variáveis, de acordo com o género e estratos etários. Considerou-se um nível de confiança de 95%. Dos 120 indivíduos estudados 30% eram do sexo masculino e 70% eram do sexo feminino. As médias das idades eram de 82,36 ± 6,34 anos. A determinação do IMC mostrou que 12,5% dos idosos avaliados exibem baixo peso (IMC 19,6±2,1); 46,7% são eutróficos (IMC 25,7±1,3); 11,7% apresentam excesso de peso (IMC 29,0±0,6), sendo 29,2% classificados como obesos (IMC 33,8±2,9).A avaliação da população pelo MNA evidenciou uma percentagem de desnutrição de 1,7% com uma prevalência de risco de desnutrição (33,3%) mas identifica 65% da amostra como bem nutrida. Os 2 instrumentos utilizados para avaliação do estado nutricional, antropometria (IMC) e MNA mostraram uma correlação estatística entre si positiva. Independentemente do género e do grupo etário verificou-se que o Valor Calórico Total (VCT) ingerido diariamente apresentava valores abaixo do recomendado. Já a ingestão diária de hidratos de carbono e de proteínas apresentou valores médios superiores às recomendações nutricionais enquanto os teores de lípidos ingeridos se situava dentro dos limites recomendados estando porém os valores da ingesta média de fibra total (18g/dia) abaixo dos indicados para a população idosa (25g/dia). Quanto aos micronutrientes encontraram-se deficits de ingestão média diária de minerais e oligoelementos como o cálcio, ferro, magnésio selénio, zinco e iodo e também de algumas vitaminas (D, E, ácido fólico). Conclui-se então que no geral a população estudada apresenta um estado de nutrição normal avaliado através de IMC e do MNA dois instrumentos que estão correlacionados entre si e se complementam. Que a ingestão alimentar apresentada pelos idosos desta amostra é apenas ligeiramente inferior ao recomendado, não colocando em risco o aparecimento de desnutrição. Porém é importante a intervenção dietética no sentido de corrigir determinadas carências (vitaminas, minerais) e prevenir o risco de desnutrição detetado assim como a obesidade.

Parental Adjustment to Disability, Stress Indicators and the Influence of Social Support

Research into families of children and young people with disability maintain that parents or caregivers seem to experience higher levels of global stress than parents of children without disabilities, thereby presenting a high risk of developing disorders in their health and quality of life. The aim of this study is to understand the differences in parental stress and social support among groups of parents whose children have different disabilities in the context of parental adjustment to disability. Considering that adjustment is related to the effectiveness with which the family uses its resources and the support of their social network, we intend to analyse the differences of stress and social support among groups of parents of children with different problems and to clarify the relationships between the variables under study in order to adapt family intervention strategies. For this purpose a comparative, descriptive-correlational study was undertaken. The convenience sample included 152 parents of children with different disabilities (82 with intellectual disability, 37 with motor problems and 33 with autism) supported by schools and institutions in Viseu. The instruments used were: a Portuguese version of the Parenting Stress Index (Abidin, 1995), the Social Support Questionnaire – short version (Pinheiro & Ferreira, 2001) and a Parental Questionnaire (demographic and family data). Data were collected in schools and institutions that support people with disabilities, located in the Municipality of Viseu (Portugal). The results revealed significant differences between groups of parents in the partial results of parental stress, specifically in the Hyperactivity/Distract (DI), Acceptability (AC) and Adaptability (AD), dimensions of the Child Domain subscale (CD stress) and the Role Restriction (RO), dimension of Parent Domain subscale (PD stress). With regard to social support dimensions, we found significant differences between parents in the extent and availability of the social support network (SSQN).

Effects of spin on high-energy radiation from accreting black holes

Observations of jets in X-ray binaries show a correlation between radio power and black hole spin. This correlation, if confirmed, points toward the idea that relativistic jets may be powered by the rotational energy of black holes. In order to examine this further, we perform general relativistic radiative transport calculations on magnetically arrested accretion flows, which are known to produce powerful jets via the Blandfordâ Znajek (BZ) mechanism. We find that the X-ray and γ-ray emission strongly depend on spin and inclination angle. Surprisingly, the high-energy power does not show the same dependence on spin as the BZ jet power, but instead can be understood as a redshift effect. In particular, photons observed perpendicular to the spin axis suffer little net redshift until originating from close to the horizon. Such observers see deeper into the hot, dense, highly magnetized inner disk region. This effect is largest for rapidly rotating black holes due to a combination of frame dragging and decreasing horizon radius. While the X-ray emission is dominated by the near horizon region, the near-infrared (NIR) radiation originates at larger radii. Therefore, the ratio of X-ray to NIR power is an observational signature of black hole spin.

Moral reasoning in sport: validation of the Portuguese version of the RSBH value-judgement inventory in adolescents

The purpose of this study was to examine the validity and reliability of the Portuguese version of the Rudd Stoll Beller Hahm Value-judgement Inventory (RSBHVI) in a sample of adolescents. The RSBHVI, which measures moral and social reasoning, was translated using a back translation method. A sample of 238 10th to 12th grade high school students (age mean value 16.93 years, s = 1.34) completed the Portuguese versions of RSBH, and the Task and Ego-orientation Questionnaire. Partial support for the original structure of the moral reasoning scale, but not the social reasoning scale, was found. Females, and non-athletes and individual sport athletes scored significantly higher than males and team sport athletes in moral reasoning, respectively. Moral reasoning was negatively correlated with ego-orientation (r = −30; p <. 001) and uncorrelated with task-orientation (r = .10, p > .05). Participants who were low-ego scored higher in moral reasoning than those who were high-ego. It is suggested that decreasing levels of ego-orientation may be necessary to improve athletes’ moral reasoning.

The quality of the physical environment and its association with activities and well-being among older people in residential care facilities

The physical environment can influence older people’s health and well-being, and is often mentioned as being an important factor for person-centred care. Due to high levels of frail health, many older people spend a majority of their time within care facilities and depend on the physical environment for support in their daily life. However, the quality of the physical environment is rarely evaluated, and knowledge is sparse in terms of how well the environment meets the needs of older people. This is partly due to the lack of valid and reliable instruments that could provide important information on environmental quality. Aim: The aim of this thesis was to study the quality of the physical environment in Swedish care facilities for older people, and how it relates to residents’ activities and well-being. Methods: The thesis comprises four papers where both qualitative and quantitative methods were used. Study I involved the translation and adaptation of the Sheffield Care Environment Assessment Matrix (SCEAM) into a Swedish version (S-SCEAM). Several methods were used including forward and backward translation, test of validity via expert consultation and reliability tests. In Study II, S-SCEAM was used to assess the quality of the environment, and descriptive data were collected from 20 purposively sampled residential care facilities (RCFs). Study III was a comparative case study conducted at two RCFs using observations, interviews and S-SCEAM to examine how the physical environment relates to older people’s activities and interactions. In study IV, multilevel modeling was used to determine the association between the quality of the physical environment and the psychological and social well-being of older people living in RCFs. The data in the thesis were analysed using qualitative content analysis, and descriptive, bivariate and multilevel statistics. Results: A specific result was the production of the Swedish version of SCEAM. The instrument contains 210 items structured into eight domains reflecting the needs of older people. When using S-SCEAM, the results showed a substantial variation in the quality of the physical environment between and within RCFs. In general, private apartments and dining areas had high quality, whereas overall building layout and outdoor areas had lower quality. Also, older people’s safety was supported in the majority of facilities, whereas cognitive support and privacy had lower quality. Further, the results showed that environmental quality in terms of cognitive support was associated with residents’ social well-being. Specific environmental features, such as building design and space size, were also noted, through observation, as influencing residents’ activities, and several barriers were found that seemed to restrict residents’ full use of the environment. Conclusions: This thesis contributes to the growing evidence-based design field. The S-SCEAM can be used in future research on the association between the environment and people’s health and well-being. The instrument could also serve as a guide in the planning and design process of new RCFs.

Ecological quality assessment of transitional waters based on fish assemblages in Portuguese estuaries: The Estuarine Fish Assessment Index (EFAI)

The assessment of water quality has changed markedly worldwide over the last years, especially in Europe due to the implementation of the Water Framework Directive. Fish was considered a key-element in this context and several fish-based multi-metric indices have been proposed. In this study, we propose a multi-metric index, the Estuarine Fish Assessment Index (EFAI), developed for Portuguese estuaries, designed for the overall assessment of transitional waters, which could also be applied at the water body level within an estuary. The EFAI integrates seven metrics: species richness, percentage of marine migrants, number of species and abundance of estuarine resident species, number of species and abundance of piscivorous species, status of diadromous species, status of introduced species and status of disturbance sensitive species. Fish sampling surveys were conducted in 2006, 2009 and 2010, using beam trawl, in 13 estuarine systems along the Portuguese coast. Most of the metrics presented a high variability among the transitional systems surveyed. According to the EFAI values, Portuguese estuaries presented a "Good" water quality status (except the Douro in a particular year). The assessments in different years were generally concordant, with a few exceptions. The relationship between the EFAI and the Anthropogenic Pressure Index (API) was not significant, but a negative and significant correlation was registered between the EFAI and the expert judgement pressure index, at both estuary and water body level. The ordination analysis performed to evaluate similarities among North-East Atlantic Geographical Intercalibration Group (NEAGIG) fish-based indices put in evidence four main groups: the French index, since it is substantially different from all the other indices (uses only four metrics based on densities); indices from Ireland, United Kingdom and Spain (Asturias and Cantabria); the Dutch and German indices; and the indices of Belgium. Portugal and Spain (Basque country). The need for detailed studies, including comparative approaches, on several aspects of these assessment tools, especially in what regards their response to anthropogenic pressures was stressed. (C) 2011 Elsevier Ltd. All rights reserved.

Insights into population structure of Diplodus vulgaris along the SW Portuguese coast from otolith elemental signatures

The common two-banded sea bream (Diplodus vulgaris) is an important fish in the marine ecosystems of the NW Atlantic and Mediterranean. In southern Portugal it is a major fishery resource being targeted mainly by the artisanal fleets. Although there is some knowledge of the age, growth and reproductive biology of the species, information about its population structure is scarce and somewhat limited to the Mediterranean Sea. In this study the otolith elemental signatures of 90 specimens of D. vulgaris of the same age group (2+ years) and cohort collected from the important fishery regions of SW Portugal (Sesimbra, Sagres and Faro) have been analysed by inductively coupled plasma mass spectrometry (ICP-MS). Two different methodologies have been applied: solution based analysis of the whole otoliths; representative of the entire life-history prior to capture, and laser ablation analysis of otolith cores; representative of the larval and early post-settlement phase. Whole otolith comparisons utilised Sr/Ca, Ba/Ca, Mn/Ca, Li/Ca and Ni/Ca to demonstrate regional population structure. Classification accuracy rates from linear discriminant function analyses (LDFA) of whole otolith chemistry data were high for each region; Faro - 93%, Sagres - 90% and Sesimbra - 80%. Comparison of the otolith core chemistry utilised Sr/Ca, Ba/Ca, Mn/Ca and Mg/Ca and Zn/Ca. LDFA for the otolith core chemistry also achieved accurate classification for samples from Sesimbra (73%), but there was high overlap of otolith chemistry between samples from Faro and Sagres (47 and 43% classification accuracy respectively). The whole otolith results suggest that D. vulgaris are resident in the regional fishing areas during the juvenile phase. Both the core and whole otolith chemistry data supported separation of the Sesimbra fishery region from the more southern and closely associated Faro and Sagres regions for management purposes. However, while the whole otolith data indicated that the populations at Faro and Sagres likely remained separated in the juvenile stage, the otolith core chemistry data was inconclusive as to whether recruitment to these two areas was derived, or not, from different spawning areas.

EUNIS habitat's thresholds for the Western coast of the Iberian Peninsula — A Portuguese case study

The European Nature Information System (EUNIS) has been implemented for the establishment of a marine European habitats inventory. Its hierarchical classification is defined and relies on environmental variables which primarily constrain biological communities (e.g. substrate types, sea energy level, depth and light penetration). The EUNIS habitat classification scheme relies on thresholds (e.g. fraction of light and energy) which are based on expert judgment or on the empirical analysis of the above environmental data. The present paper proposes to establish and validate an appropriate threshold for energy classes (high, moderate and low) and for subtidal biological zonation (infralittoral and circalittoral) suitable for EUNIS habitat classification of the Western Iberian coast. Kineticwave-induced energy and the fraction of photosynthetically available light exerted on the marine bottom were respectively assigned to the presence of kelp (Saccorhiza polyschides, Laminaria hyperborea and Laminaria ochroleuca) and seaweed species in general. Both data were statistically described, ordered fromthe largest to the smallest and percentile analyseswere independently performed. The threshold between infralittoral and circalittoral was based on the first quartile while the ‘moderate energy’ class was established between the 12.5 and 87.5 percentiles. To avoid data dependence on sampling locations and assess the confidence interval a bootstrap technique was applied. According to this analysis,more than 75% of seaweeds are present at locations where more than 3.65% of the surface light reaches the sea bottom. The range of energy levels estimated using S. polyschides data, indicate that on the IberianWest coast the ‘moderate energy’ areas are between 0.00303 and 0.04385 N/m2 of wave-induced energy. The lack of agreement between different studies in different regions of Europe suggests the need for more standardization in the future. However, the obtained thresholds in the present study will be very useful in the near future to implement and establish the Iberian EUNIS habitats inventory.

An exploration of treatment burden and patient capacity in people with stroke

Background and aims: Advances in modern medicine have led to improved outcomes after stroke, yet an increased treatment burden has been placed on patients. Treatment burden is the workload of health care for people with chronic illness and the impact that this has on functioning and well-being. Those with comorbidities are likely to be particularly burdened. Excessive treatment burden can negatively affect outcomes. Individuals are likely to differ in their ability to manage health problems and follow treatments, defined as patient capacity. The aim of this thesis was to explore the experience of treatment burden for people who have had a stroke and the factors that influence patient capacity. Methods: There were four phases of research. 1) A systematic review of the qualitative literature that explored the experience of treatment burden for those with stroke. Data were analysed using framework synthesis, underpinned by Normalisation Process Theory (NPT). 2) A cross-sectional study of 1,424,378 participants >18 years, demographically representative of the Scottish population. Binary logistic regression was used to analyse the relationship between stroke and the presence of comorbidities and prescribed medications. 3) Interviews with twenty-nine individuals with stroke, fifteen analysed by framework analysis underpinned by NPT and fourteen by thematic analysis. The experience of treatment burden was explored in depth along with factors that influence patient capacity. 4) Integration of findings in order to create a conceptual model of treatment burden and patient capacity in stroke. Results: Phase 1) A taxonomy of treatment burden in stroke was created. The following broad areas of treatment burden were identified: making sense of stroke management and planning care; interacting with others including health professionals, family and other stroke patients; enacting management strategies; and reflecting on management. Phase 2) 35,690 people (2.5%) had a diagnosis of stroke and of the 39 co-morbidities examined, 35 were significantly more common in those with stroke. The proportion of those with stroke that had >1 additional morbidities present (94.2%) was almost twice that of controls (48%) (odds ratio (OR) adjusted for age, gender and socioeconomic deprivation; 95% confidence interval: 5.18; 4.95-5.43) and 34.5% had 4-6 comorbidities compared to 7.2% of controls (8.59; 8.17-9.04). In the stroke group, 12.6% of people had a record of >11 repeat prescriptions compared to only 1.5% of the control group (OR adjusted for age, gender, deprivation and morbidity count: 15.84; 14.86-16.88). Phase 3) The taxonomy of treatment burden from Phase 1 was verified and expanded. Additionally, treatment burdens were identified as arising from either: the workload of healthcare; or the endurance of care deficiencies. A taxonomy of patient capacity was created. Six factors were identified that influence patient capacity: personal attributes and skills; physical and cognitive abilities; support network; financial status; life workload, and environment. A conceptual model of treatment burden was created. Healthcare workload and the presence of care deficiencies can influence and be influenced by patient capacity. The quality and configuration of health and social care services influences healthcare workload, care deficiencies and patient capacity. Conclusions: This thesis provides important insights into the considerable treatment burden experienced by people who have had a stroke and the factors that affect their capacity to manage health. Multimorbidity and polypharmacy are common in those with stroke and levels of these are high. Findings have important implications for the design of clinical guidelines and healthcare delivery, for example co-ordination of care should be improved, shared decision-making enhanced, and patients better supported following discharge from hospital.

Skeletal maturity and socio-economic status in portuguese children and youths: the Madeira growth study

Skeletal maturity is used to evaluate biological maturity status. Information about the association between socio-economic status (SES) and skeletal maturity is limited in Portugal. Aims: The aim of this study is to document the skeletal maturity of youths in Madeira and to evaluate variation in maturity associated with SES. Subjects and methods: The study involved 507 subjects (256 boys and 251 girls) from the Madeira Growth Study, a mixed-longitudinal study of five cohorts (8, 10, 12, 14 and 16 years of age) followed at yearly intervals over 3 years (1996–1998). A total of 1493 observations were made. Skeletal age was estimated from radiographs of the hand and wrist using the Tanner–Whitehouse 2 method (TW2). Social class rankings were based on Graffar’s (1956) method. Five social rankings were subsequently grouped into three SES categories: high, average and low. Results: Median for the radius, ulna and short finger bones (RUS scores) in the total sample of boys and girls increased curvilinearly across age whereas median for the 7 (without pisiform) carpal bones (Carpal scores) increased almost linearly. The 20-bone maturity scores demonstrated distinctive trends by gender: the medians for boys increased almost linearly while the medians for girls increased curvilinearly. SES differences were minimal. Only among children aged 10–11 years were high SES boys and girls advanced in skeletal maturity. Madeira adolescents were advanced in skeletal maturity compared with Belgian reference values. Conclusion: The data suggests population variation in TW2 estimates of skeletal maturation. Skeletal maturity was not related to SES in youths from Madeira.

Conceptos y prácticas de la actividad física que se reproducen en las clases sociales: aproximación desde el enfoque determinantes/ determinación social de la salud

El concepto de actividad física es concebido de diferentes formas. Mostrando que existen varios factores que afectan de manera directa e indirecta la percepción que los sujetos construyen entorno a él, generando así una aproximación a diferentes definiciones de la actividad física desde varias perspectivas y dimensiones, donde predomina una noción netamente biológica. Este estudio pretende analizar, como desde las clases sociales se concibe la actividad física en sus conceptos y prácticas considerando los modelos de determinantes y determinación social para la salud. Con fin de comprender como los autores de la literatura científica conciben la actividad física y la relación con las clases sociales, desde una perspectiva teórica de los determinantes sociales de la salud y la teoría de la determinación social, se realizó una revisión documental y análisis de contenido de los conceptos y prácticas de la actividad física que se han considerado en los últimos 10 años. Para ello se seleccionaron las bases de datos PubMed y BVS (Biblioteca Virtual de Salud) por sus énfasis en publicaciones de salud mundialmente. Mostrando que la actividad física es concebida dominantemente desde una perspectiva biológica que ejerce una mirada reduccionista. Las relaciones entre actividad física y las clases sociales están claramente establecidas, sin embargo, estas relaciones pueden discrepar teniendo en cuenta el concepto de clase social, el contexto y la orientación de los autores y las poblaciones objetos de estudio. Obteniendo como resultado que los estudios documentados, revisados y analizados muestran una clara tendencia al modelo de determinantes; no obstante, algunos estudios en sus análisis se orientan hacia el modelo de determinación social. En cuanto al concepto de clases sociales los autores consideran una combinación de factores culturales y económicos sin atreverse a adoptar un concepto específico.