Characterization and evolution of the novel gene family FAM90A in primates originated by multiple duplication and rearrangement events

Genomic plasticity of human chromosome 8p23.1 region is highly influenced by two groups of complex segmental duplications (SDs), termed REPD and REPP, that mediate different kinds of rearrangements. Part of the difficulty to explain the wide range of phenotypes associated with 8p23.1 rearrangements is that REPP and REPD are not yet well characterized, probably due to their polymorphic status. Here, we describe a novel primate-specific gene family, named FAM90A (family with sequence similarity 90), found within these SDs. According to the current human reference sequence assembly, the FAM90A family includes 24 members along 8p23.1 region plus a single member on chromosome 12p13.31, showing copy number variation (CNV) between individuals. These genes can be classified into subfamilies I and II, which differ in their upstream and 5′-untranslated region sequences, but both share the same open reading frame and are ubiquitously expressed. Sequence analysis and comparative fluorescence in situ hybridization studies showed that FAM90A subfamily II suffered a big expansion in the hominoid lineage, whereas subfamily I members were likely generated sometime around the divergence of orangutan and African great apes by a fusion process. In addition, the analysis of the Ka/Ks ratios provides evidence of functional constraint of some FAM90A genes in all species. The characterization of the FAM90A gene family contributes to a better understanding of the structural polymorphism of the human 8p23.1 region and constitutes a good example of how SDs, CNVs and rearrangements within themselves can promote the formation of new gene sequences with potential functional consequences.

Missale ad usum ecclesiae Parisiensis .

Cf. notice du ms. par Leroquais, Sacramentaires, II, 180-183 n° 366. Les incipit des proses ont été relevés dans la table des incipit. F. 1-6v Calendrier de Paris : 3 janv., en rouge, «Genovefe virg. IX lc.» (1); 22 avr., «Inventio corporis s. Dyonisii sociorumque ejus. Oportune virg. semid.» (2v); 28 mai, en rouge, «Germani ep. Parisiensis semid. Carauni mart. memoria» (3); 25juin, en violet, «Translatio s. Eligii ep.» (3v); en violet, «In prima dominica hujus mensis [augusti] fit d. de cruce» [réception à Notre-Dame d'un fragment de la vraie Croix] (4v); 9 oct., en rouge, «Dyonisii sociorumque ejus duplex» (5v); 28 oct., «Germani ep. Translatio s. Genovefe virg. mart. memoria» (5v); 3 nov. «Marcelli ep. Parisiensis dupl.»; 13 nov., «Gendulphi ep. et conf. [Parisiensis] dupl.»; 26 nov., en violet, «Genovefe virg. de miraculo [ardentium] IX lc.» (6); 4 déc., «Susceptio capillorum b. Marie et capitis b. Dyonisii in ecclesia Parisiensi» (6v). Le calendrier ne contient pas la fête de s. Louis au 25 août (établie en 1298) ni au 17 mai la translation du chef de s. Louis à la Sainte-Chapelle (en 1306); — Ajout du XIVe s. au 30 avr., «Eutropii mart. et conf.» [culte établi à Paris en 1296] (2v); cf. Leroquais, Bréviaires, I, CXII-CXIII, Tableau chronologique des fêtes parisiennes. — Au début de chaque mois, vers sur les jours égyptiaques (éd. Hennig, Traditio, XI (1955), 84 III), sauf celui de janvier (1) qui correspond au premier vers de la série éd. par Riese (Anthol. lat., I2 (1906), 680a); — À la fin de février, vers sur l'année bissextile : «Byssextum sexte martis tenuere kalende...»; cf. ms. Latin 3162, f. 102 (1v); — À la fin de mars, vers sur la date de Pâques : «Post martis nonas ubi sit nova luna requiras...» (2); — Notations astrologiques et de comput, passim. F. 7-353v Temporal, avec parties chantées notées. Incomplet du début par la perte du premier f., il commence dans la prose du premier dimanche de l'Avent : «... [eterna indefici]ens mundi vita...» (7). À remarquer : «dominica IIIa [in Adventu] more ecclesie Parisiensis» (24v); — Cérémonie des Cendres avec rubriques liturgiques (62v-66v); — Dimanche des Rameaux, «congregatis processionibus conventualibus in ecclesia B. Marie, capiceriis portantibus capsam et tribus clericis in albis paratis tres textus, exitur de ecclesia nichil cantando et sic eundum est ad ecclesiam Sancte Genovefe de Monte...» (147); cf. Leroquais, 181; — Dans l'évangile des Rameaux, le Christ est désigné par la lettre L, le narrateur par la lettre C et les autres par la lettre S (153-158); dans les autres évangiles de la Passion (162-186 passim), ces lettres suscrites ont été effacées et remplacées à la mine de plomb de façon sporadique, le Christ étant alors désigné par une croix; — «Oremus pro papa nostro N...» (186v); «... pro christianissimo rege nostro N...» (187); — Parmi les litanies, «s.Stephane... s. Dyonisi...» (191v)..., « s. Lucane... s. Justine... s. Gendulphe... s. Germane...» (199)..., « s. Genovefa...» (201v). — «Incipit ordo misse. Sacerdos primo induat se rocheto dicens : Actiones nostras...» (203v-206); pour les rubriques liturgiques, cf. Leroquais, 181; — Préfaces notées : «Incipiunt prefationes...» (206-210); — Canon de la messe (210-213); pour les rubriques liturgiques, cf. Leroquais, 182; — «In die Re[sur]rectionis» (214); — «In die sancto [Pentecostes]» (262v); — [De sancta Trinitate] (280v); — «Dominica XXVa» (348v); — «In dedicatione ecclesie» (350-353v). La fête du Saint-Sacrement ne figure pas. F. 354-496v Sanctoral, avec parties chantées notées. À noter parmi les saints parisiens : 3 janv., «S. Genovefe virg.» (373v); 22 avr., «Inventio corporis s. Dyonisii, Rustici et Eleuterii» (398v); — 28 mai, «S. Germani ep. Parisiensis» (407v); — 10 juin, «S. Landerici Parisiensis ep.» (410); — 26 juill., «In translatione s. Marcelli» (432); — 11août, «De receptione s. corone...» (443v); —, 4 oct., «Auree virg. [abb. Parisiis]» (480); 9 oct., «In die [s. Dyonisii]», avec octave (481v); — 28oct., «In translatione s. Genovefe» (487); — 3nov., «S. Marcelli Parisiensis ep.», avec octave (489v); — 26 nov., «S. Genovefe de miraculo ardentium» (495); — «De s. Gendulpho. Prosa» (495). F. 497-541 Commun des saints, avec pièces chantées notées. F. 541-559 Messes votives, sans parties notées à l'exception de la messe des morts (551v-556). Aux ff. 546v-547, en marge de la messe «pro amico», deux additions d'une écriture cursive de la fin du XIVe s. précisent : «ducem nostrum et duxissem ejusque prolem». — Prières diverses (556-559). F. 559-563 Rituel de mariage. «Incipit ordo ad sponsam benedicendam. Cum venerint ante valvas ecclesie sponsus et sponsa, accinctus sacerdos alba et stola... auxilium et argentum super scutum positum benedicat dicens : Manda Deus... Tunc aspergatur aqua benedicta et thurificetur et sponsus et sponsa; quo facto sacerdos dicat : Bones genz nos avons faiz les bans III foiz de ces II genz et encore les faison nous, que se il i a nul ne nule qui sache enpeschement par quoi l'un ne puisse avoir l'autre par loi de mariage, si le die. Et re[spon]dent assistentes : Nous ni savons se bien non. Quo audito, accipiat sacerdos manum dexteram sponse et ponat in dextera manu sponsi et dicat... nominandos eos : Vos Marie et vos Jeham vous prometez, fianciez et jurez l'un à l'autre à garder la foi et la loiauté du mariage... Tunc sacerdos tradat anulum sponso et sponsus autem per manum sacerdotis primo in police sponse... dicens... : Marie de cest annel t'espous et de mon cors t'ennor et de douaire qui est devisiez entre mes amis et les tiens. In nomine... Secundo in indice dicens... Tercio in medio dicens : Et Spiritus sancti. Amen... Postea sacerdos extensa manu super illos dicat orationes... Tunc sacerdos centus [sic] sponsum per manum dexteram et sponsam et introducat eos in ecclesiam...» (559-559bis); — Messe de mariage, comportant deux préfaces notées : «Deinde celebratur missa...» (559bis-562v); pour les rubriques liturgiques, cf. Leroquais, 183. — «Missa celebrata, recedant sponsus et sponsa et, ipsis stantibus ante hostium domus illorum presentibus pane et vinum [sic], faciat sacerdos benedictionem super panem dicens : Benedic Domine creaturam... Tunc sponsus mordet in pane, postea sponsa. Item benedictio super vinum... Tunc sponsus bibat, postea sponsa. Quo facto introducit eos sacerdos per manum in domum... Item in sero benedictio thalami... Tunc turificet thalamum, postea sponsum et sponsam sedentes vel jacentes in lecto suo benedicat dicens : Benedic Domine adulescentulos...» (562v-563) (éd. avec variantes par E. Martène, De antiquis Ecclesiae ritibus, II, 374-376, d'après le ms. Latin 859A); même ordo dans le ms. NAL 2649, f. 333-336. F. 563-565v Exorcisme de l'eau et du sel (563-564v). — «Pro Terra sancta» (564v-565). — «Pro rege nostro» (565). — «Benedictio pere et baculi peregrinorum» (565-565v). — «Benedictio crucis... Benedictio novorum fructuum... Benedictio panis» (565v).

Nicolaus Vercellensis, Sermones de sanctis.

Ce ms. a appartenu à la bibliothèque du chapitre de Notre-Dame de Paris. Claude Joly, chantre de Notre-Dame de Paris, y a inscrit sa signature suivie de la date "maio 1654" au contreplat sup. Sur le f. A figure l'ex-libris "A la bibliotheque de l'Eglise de Paris", suivi de la cote C9 (XVIIe s.). Notre-Dame.

Health risk behavior pattern among students from Cartagena, Colombia: prevalence and associated variables

The aim of the study was to determine the prevalence and variables associated with the pattern of risky health behavior (PRHB) among adolescent students in Cartagena, Colombia. A cross-sectional study was designed to investigate PRHB in a random cluster sample of students from middle and high schools. The associations were adjusted by logistic regression. A total of 2,625 students participated in this research, with ages from 10 to 20 years, mean=13.8 years (SD=2.0), and 54.3% were women. A total of 332 students reported PRHB (12.7%, 95%CI 11.4–14.0). Age over 15 years (OR=2.19, 95%CI 1.72–2.79), not being heterosexual (OR=1.98, 95%CI 1.36-2.87), poor/mediocre academic performance (OR=1.87, 95%CI 1.47–2.38), family dysfunction (OR=1.78, 95%CI 1.40–2.28) and male gender (OR=1.58, 95%CI 1.24–2.01) were associated with PRHB. One in every eight students presented a PRHB. It is important to pay greater attention to students who are over 15 years of age, male, not heterosexual, with a poor/mediocre academic performance and a dysfunctional family.

Measures of fit in multiple correspondence analysis of crisp and fuzzy coded data

When continuous data are coded to categorical variables, two types of coding are possible: crisp coding in the form of indicator, or dummy, variables with values either 0 or 1; or fuzzy coding where each observation is transformed to a set of "degrees of membership" between 0 and 1, using co-called membership functions. It is well known that the correspondence analysis of crisp coded data, namely multiple correspondence analysis, yields principal inertias (eigenvalues) that considerably underestimate the quality of the solution in a low-dimensional space. Since the crisp data only code the categories to which each individual case belongs, an alternative measure of fit is simply to count how well these categories are predicted by the solution. Another approach is to consider multiple correspondence analysis equivalently as the analysis of the Burt matrix (i.e., the matrix of all two-way cross-tabulations of the categorical variables), and then perform a joint correspondence analysis to fit just the off-diagonal tables of the Burt matrix - the measure of fit is then computed as the quality of explaining these tables only. The correspondence analysis of fuzzy coded data, called "fuzzy multiple correspondence analysis", suffers from the same problem, albeit attenuated. Again, one can count how many correct predictions are made of the categories which have highest degree of membership. But here one can also defuzzify the results of the analysis to obtain estimated values of the original data, and then calculate a measure of fit in the familiar percentage form, thanks to the resultant orthogonal decomposition of variance. Furthermore, if one thinks of fuzzy multiple correspondence analysis as explaining the two-way associations between variables, a fuzzy Burt matrix can be computed and the same strategy as in the crisp case can be applied to analyse the off-diagonal part of this matrix. In this paper these alternative measures of fit are defined and applied to a data set of continuous meteorological variables, which are coded crisply and fuzzily into three categories. Measuring the fit is further discussed when the data set consists of a mixture of discrete and continuous variables.

The relation of body mass index and abdominal adiposity with dyslipidemia in 27 general populations of the WHO MONICA Project.

The association between adiposity measures and dyslipidemia has seldom been assessed in a multipopulational setting. 27 populations from Europe, Australia, New Zealand and Canada (WHO MONICA project) using health surveys conducted between 1990 and 1997 in adults aged 35-64 years (n = 40,480). Dyslipidemia was defined as the total/HDL cholesterol ratio >6 (men) and >5 (women). Overall prevalence of dyslipidemia was 25% in men and 23% in women. Logistic regression showed that dyslipidemia was strongly associated with body mass index (BMI) in men and with waist circumference (WC) in women, after adjusting for region, age and smoking. Among normal-weight men and women (BMI<25 kg/m(2)), an increase in the odds for being dyslipidemic was observed between lowest and highest WC quartiles (OR = 3.6, p < 0.001). Among obese men (BMI ≥ 30), the corresponding increase was smaller (OR = 1.2, p = 0.036). A similar weakening was observed among women. Classification tree analysis was performed to assign subjects into classes of risk for dyslipidemia. BMI thresholds (25.4 and 29.2 kg/m(2)) in men and WC thresholds (81.7 and 92.6 cm) in women came out at first stages. High WC (>84.8 cm) in normal-weight men, menopause in women and regular smoking further defined subgroups at increased risk. standard categories of BMI and WC, or their combinations, do not lead to optimal risk stratification for dyslipidemia in middle-age adults. Sex-specific adaptations are necessary, in particular by taking into account abdominal obesity in normal-weight men, post-menopausal age in women and regular smoking in both sexes.

Eficacia da limpeza ou desinfecao do meato urinario antes da cateterizacao urinaria: revisao sistematica

As infeções do trato urinário associadas à cateterização são muito frequentes no contexto comunitário e hospitalar. Existem atualmente várias recomendações para sua prevenção, contudo, quando abordado o soluto a utilizar no meato urinário previamente à algaliação continuam a persistir dúvidas. Assim, este estudo procurou determinar a eficácia da limpeza do meato urinário com água ou soro fisiológico comparativamente à sua assepsia por meio de uma revisão sistemática com metanálise. Para isso foram seguidos os princípios propostos pelo Cochrane Handbook , a análise crítica realizada por dois investigadores e a análise estatística com recurso ao programa STATA 11.1. Podemos concluir que a limpeza ou desinfeção do meato urinário previamente à cateterização vesical não é estatisticamente significativa (OR=1,07, IC 95%=0,68-1,68, p=0,779), existindo alguma evidência de que a utilização de água/soro fisiológico reduz as taxas de ITU.

Predictors of asthma control in everyday clinical practice in Switzerland.

OBJECTIVE: To identify predictors of improved asthma control under conditions of everyday practice in Switzerland. RESEARCH DESIGN AND METHODS: A subgroup of 1380 patients with initially inadequately controlled asthma was defined from a cohort of 1893 asthmatic patients (mean age 45.3 + or - 19.2 years) recruited by 281 office-based physicians who participated in a previously-conducted asthma control survey in Switzerland. Multiple regression techniques were used to identify predictors of improved asthma control, defined as an absolute decrease of 0.5 points or more in the Asthma Control Questionnaire between the baseline (V1) and follow-up visit (V2). RESULTS: Asthma control between V1 and V2 improved in 85.7%. Add-on treatment with montelukast was reported in 82.9% of the patients. Patients with worse asthma control at V1 and patients with good self-reported adherence to therapy had significantly higher chances of improved asthma control (OR = 1.24 and 1.73, 95% CI 1.18-1.29 and 1.20-2.50, respectively). Compared to adding montelukast and continuing the same inhaled corticosteroid/fixed combination (ICS/FC) dose, the addition of montelukast to an increased ICS/FC dose yielded a 4 times higher chance of improved asthma control (OR = 3.84, 95% CI 1.58-9.29). Significantly, withholding montelukast halved the probability of achieving improved asthma control (OR = 0.51, 95% CI = 0.33-078). The probability of improved asthma control was almost 5 times lower among patients in whom FEV(1) was measured compared to those in whom it was not (OR = 0.23, 95% CI = 0.09-0.55). Patients with severe persistent asthma also had a significantly lower probability of improved control (OR = 0.15, 95% CI = 0.07-0.32), as did older patients (OR = 0.98, 95% CI = 0.97-0.99). Subgroup analyses which excluded patients whose asthma may have been misdiagnosed and might in reality have been chronic obstructive pulmonary disease (COPD) showed comparable results. CONCLUSIONS: Under conditions of everyday clinical practice, the addition of montelukast to ICS/FC and good adherence to therapy increased the likelihood of achieving better asthma control at the follow-up visit, while older age and more severe asthma significantly decreased it.

Family functioning of elderly with depressive symptoms

Objective: To classify families of elderly with depressive symptoms regarding their functioning and to ascertain the presence of an association between these symptoms, family functioning and the characteristics of the elderly. Method: This was an observational, analytical, cross-sectional study performed with 33 teams of the Family Health Strategy in Dourados, MS. The sample consisted of 374 elderly divided into two groups (with and without depressive symptoms). The instruments for data collection were a sociodemographic instrument, the GeriatricDepression Scale (15 items) and the Family Apgar. Results: An association was observed between depressive symptoms and family dysfunction, female gender, four or more people living together, and physical inactivity. Conclusion: The functional family may represent effective support for the elderly with depressive symptoms, because it offers a comfortable environment that ensures the well-being of its members. The dysfunctional family can barely provide necessary care for the elderly, which can exacerbate depressive symptoms.


Prevalence of comedications and effect of potential drug-drug interactions in the Swiss HIV Cohort Study.

BACKGROUND: Potential drug-drug interactions (PDDIs) might expand with new combination antiretroviral therapies (ART) and polypharmacy related to increasing age and comorbidities. We investigated the prevalence of comedications and PDDIs within a large HIV cohort, and their effect on ART efficacy and tolerability. METHODS: All medications were prospectively recorded in 1,497 ART-treated patients and screened for PDDIs using a customized version of the Liverpool drug interactions database. RESULTS: Overall, 68% (1,013/1,497) of patients had a comedication and 40% (599/1,497) had > or = 1 PDDI. Among patients with comedication, 2% (21/1,013) had red-flag interactions (contraindicated) and 59% (597/1,013) had orange-flag interactions (potential dose adjustment and/or close monitoring required). The latter involved mainly central nervous system drugs (49%), cardiovascular drugs (34%) and methadone (19%). In the multivariate analysis, factors associated with having a comedication were advanced age, female gender, obesity and HCV infection. Independent risk factors for PDDIs were regimens combining protease inhibitors and non-nucleoside reverse transcriptase inhibitors (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.44-6.48), > or = 2 comedications (OR 1.89, 95% CI 1.32-2.70), current illicit drug use (OR 2.00, 95% CI 1.29-3.10) and patients with HCV infection (OR 1.74, 95% CI 1.19-2.56). Viral response was similar in patients with and without PDDIs (84.5% versus 86.4%; P=0.386). During follow-up, ART was modified in 134 patients with comedication regardless of the presence of PDDIs (P=0.524). CONCLUSIONS: PDDIs increase with complex ART and comorbidities. No adverse effect was noted on ART efficacy or tolerability; however, most PDDIs affected comedication but were manageable through dose adjustment or monitoring.

Increased therapeutic window for the R91W mutant form of Rpe65 compared to Rpe65 null backgroud

Purpose:Given the advances of gene therapy studies to cure RPE65-derived Leber Congenital Amaurosis (LCA) (clinical trials phase I) and the heterogeneity of the targeted patients both genetically and phenotypically, it is of prime importance to examine the rescue efficiency of gene transfer in different mutant contexts. Indeed, half of these mutations are missense mutations, leading to potential residual RPE65 activity. Consequently, we wanted to evaluate the effect on retinal activity and cone survival of lentivirus-mediated gene therapy in the R91W knock-in mouse model expressing the mutant Rpe65R91W gene (Samardzija et al. 2008), a mutation found in LCA patients. Notably we investigated whether if the therapeutic window is prolonged in comparison to null mutations. Methods:An HIV-1-derived lentiviral vector (LV) expressing either the GFP or the mouse Rpe65 cDNA under the control of a 0.8 kb fragment of the human Rpe65 promoter (R0.8) was produced by transient transfection of 293T cells. LV-R0.8-RPE65 or GFP was injected into 5-days-old (P5) or 1 month-old R91W mice. Functional rescue was assessed by ERG (1 and 4 months post-injection) and pupillary light response (PLR) recordings and cone survival by histological analysis. Results:Increased light sensitivity was detected by scotopic ERG in animals injected with LV-R0.8-RPE65 at both P5 and 1 month compared to GFP-treated animals or untreated mice. PLR was also improved in some eyes and histological analysis of cone markers showed that the density of cones reached the wild type level in the region of wt RPE65 delivery after treatment at P5. However, the rescue effect of the injection at 1 month was limited and attained 60% of the wild type level, but still more cones were observed in the treated area than in 1 month-old untreated Rpe65R91W mice. Conclusions:We were able to show that lentivirus-mediated Rpe65 gene transfer not only increases retinal activity of the Rpe65R91W mouse and survival of cones after treatment at P5 but also after treatment at 1 month. However even if the treatment at 1 month is more limited (60% of the wild type level) than treatment at P5, the amount of cone markers is increased compared to the proportion found at 1 month of age in untreated animals. This results contrast with the lack of cone rescue by treatment at 1 month of age in Rpe65-/- (Bemelmans et al, 2006). Thus patient suffering from R91W mutation might benefit from a prolonged therapeutic window.

La planification de sortie des personnes âgées hospitalisées dans un service de médecine

Contexte: la planification infirmière de sortie des personnes âgées est une composante importante des soins pour assurer une transition optimale entre l'hôpital et la maison. Beaucoup d'événements indésirables peuvent survenir après la sortie de l'hôpital. Dans une perspective de système de santé, les facteurs qui augmentent ce risque incluent un nombre croissant de patients âgés, l'augmentation de la complexité des soins nécessitant une meilleure coordination des soins après la sortie, ainsi qu'une augmentation de la pression financière. Objectif: évaluer si les interventions infirmières liées à la planification de sortie chez les personnes âgées et leurs proches aidants sont prédictives de leur perception d'être prêts pour le départ, du niveau d'anxiété du patient le jour de la sortie de l'hôpital et du nombre de recours non programmé aux services de santé durant les trente jours après la sortie. Méthode: le devis est prédictif corrélationnel avec un échantillon de convenance de 235 patients. Les patients âgés de 65 ans de quatre unités d'hôpitaux dans le canton de Vaud en Suisse ont été recrutés entre novembre 2011 et octobre 2012. Les types et les niveaux d'interventions infirmières ont été extraits des dossiers de soins et analysés selon les composantes du modèle de Naylor. La perception d'être prêt pour la sortie et l'anxiété ont été mesurées un jour avant la sortie en utilisant l'échelle de perception d'être prêt pour la sortie et l'échelle Hospital Anxiety and Depression. Un mois après la sortie, un entretien téléphonique a été mené pour évaluer le recours non programmé aux services de santé durant cette période. Des analyses descriptives et un modèle randomisé à deux niveaux ont été utilisés pour analyser les données. Résultats: peu de patients ont reçu une planification globale de sortie. L'intervention la plus fréquente était la coordination (M = 55,0/100). et la moins fréquente était la participation du patient à la planification de sortie (M = 16,1/100). Contrairement aux hypothèses formulées, les patients ayant bénéficié d'un plus grand nombre d'interventions infirmières de préparation à la sortie ont un niveau moins élevé de perception d'être prêt pour le départ (B = -0,3, p < 0,05, IC 95% [-0,57, -0,11]); le niveau d'anxiété n'est pas associé à la planification de sortie (r = -0,21, p <0,01) et la présence de troubles cognitifs est le seul facteur prédictif d'une réhospitalisation dans les 30 jours après la sortie de l'hôpital ( OR = 1,50, p = 0,04, IC 95% [1,02, 2,22]). Discussion: en se focalisant sur chaque intervention de la planification de sortie, cette étude permet une meilleure compréhension du processus de soins infirmiers actuellement en cours dans les hôpitaux vaudois. Elle met en lumière les lacunes entre les pratiques actuelles et celles de pratiques exemplaires donnant ainsi une orientation pour des changements dans la pratique clinique et des recherches ultérieures. - Background: Nursing discharge planning in elderly patients is an important component of care to ensure optimal transition from hospital to home. Many adverse events may occur after hospital discharge. From a health care system perspective, contributing factors that increase the risk of these adverse events include a growing number of elderly patients, increased complexity of care requiring better care coordination after discharge, as well as increased financial pressure. Aim: To investigate whether older medical inpatients who receive comprehensive discharge planning interventions a) feel more ready for hospital discharge, b) have reduced anxiety at the time of discharge, c) have lower health care utilization after discharge compared to those who receive less comprehensive interventions. Methods: Using a predictive correlational design, a convenience sample of 235 patients was recruited. Patients aged 65 and older from 4 units of hospitals in the canton of Vaud in Switzerland were enrolled between November 2011 and October 2012. Types and level of interventions were extracted from the medical charts and analyzed according to the components of Naylor's model. Discharge readiness and anxiety were measured one day before discharge using the Readiness for Hospital Discharge Scale and the Hospital Anxiety and Depression scale. A telephone interview was conducted one month after hospital discharge to asses unplanned health services utilization during this follow-up period. Descriptive analyses and a two- level random model were used for statistical analyses. Results: Few patients received comprehensive discharge planning interventions. The most frequent intervention was Coordination (M = 55,0/100) and the least common was Patient participation in the discharge planning (M = 16,1/100). Contrary to our hypotheses, patients who received more nursing discharge interventions were significantly less ready to go home (B = -0,3, p < 0,05, IC 95% [-0,57, -0,11]); their anxiety level was not associated with their readiness for hospital discharge (r = -0,21, p <0,01) and cognitive impairment was the only factor that predicted rehospitalization within 30 days after discharge ( OR = 1,50, p = 0,04, IC 95% [1,02, 2,22]). Discussion: By focusing on each component of the discharge planning, this study provides a greater and more detailed insight on the usual nursing process currently performed in medical inpatients units. Results identified several gaps between current and Best practices, providing guidance to changes in clinical practice and further research.

Adherence to nutritional recommendations and sociodemographic variables in patients with diabetes mellitus

OBJECTIVETo determine if there is a relationship between adherence to nutritional recommendations and sociodemographic variables in Brazilian patients with type 2 diabetes mellitus.METHODSCross-sectional observational study using a stratified random sample of 423 individuals. The Food Frequency Questionnaire (FFQ) was used, and the Fisher's exact test was applied with 95% confidence interval (p<0.05).RESULTSOf the 423 subjects, 66.7% were women, mean age of 62.4 years (SD = 11.8), 4.3 years of schooling on average (SD = 3.6) and family income of less than two minimum wages. There was association between the female gender and adherence to diet with adequate cholesterol content (OR: 2.03; CI: 1.23; 3.34), between four and more years of education and adherence to fractionation of meals (OR: 1 92 CI: 1.19; 3.10), and income of less than two minimum wages and adherence to diet with adequate cholesterol content (OR: 1.74; CI: 1.03, 2.95).CONCLUSIONAdherence to nutritional recommendations was associated with the female gender, more than four years of education and family income of less than two minimum wages.

Genetic Loci Associated with C-reactive Protein Levels and Risk of Coronary Heart Disease.

CONTEXT: Plasma levels of C-reactive protein (CRP) are independently associated with risk of coronary heart disease, but whether CRP is causally associated with coronary heart disease or merely a marker of underlying atherosclerosis is uncertain. OBJECTIVE: To investigate association of genetic loci with CRP levels and risk of coronary heart disease. DESIGN, SETTING, AND PARTICIPANTS: We first carried out a genome-wide association (n = 17,967) and replication study (n = 13,615) to identify genetic loci associated with plasma CRP concentrations. Data collection took place between 1989 and 2008 and genotyping between 2003 and 2008. We carried out a mendelian randomization study of the most closely associated single-nucleotide polymorphism (SNP) in the CRP locus and published data on other CRP variants involving a total of 28,112 cases and 100,823 controls, to investigate the association of CRP variants with coronary heart disease. We compared our finding with that predicted from meta-analysis of observational studies of CRP levels and risk of coronary heart disease. For the other loci associated with CRP levels, we selected the most closely associated SNP for testing against coronary heart disease among 14,365 cases and 32,069 controls. MAIN OUTCOME MEASURE: Risk of coronary heart disease. RESULTS: Polymorphisms in 5 genetic loci were strongly associated with CRP levels (% difference per minor allele): SNP rs6700896 in LEPR (-14.8%; 95% confidence interval [CI], -17.6% to -12.0%; P = 6.2 x 10(-22)), rs4537545 in IL6R (-11.5%; 95% CI, -14.4% to -8.5%; P = 1.3 x 10(-12)), rs7553007 in the CRP locus (-20.7%; 95% CI, -23.4% to -17.9%; P = 1.3 x 10(-38)), rs1183910 in HNF1A (-13.8%; 95% CI, -16.6% to -10.9%; P = 1.9 x 10(-18)), and rs4420638 in APOE-CI-CII (-21.8%; 95% CI, -25.3% to -18.1%; P = 8.1 x 10(-26)). Association of SNP rs7553007 in the CRP locus with coronary heart disease gave an odds ratio (OR) of 0.98 (95% CI, 0.94 to 1.01) per 20% lower CRP level. Our mendelian randomization study of variants in the CRP locus showed no association with coronary heart disease: OR, 1.00; 95% CI, 0.97 to 1.02; per 20% lower CRP level, compared with OR, 0.94; 95% CI, 0.94 to 0.95; predicted from meta-analysis of the observational studies of CRP levels and coronary heart disease (z score, -3.45; P &lt; .001). SNPs rs6700896 in LEPR (OR, 1.06; 95% CI, 1.02 to 1.09; per minor allele), rs4537545 in IL6R (OR, 0.94; 95% CI, 0.91 to 0.97), and rs4420638 in the APOE-CI-CII cluster (OR, 1.16; 95% CI, 1.12 to 1.21) were all associated with risk of coronary heart disease. CONCLUSION: The lack of concordance between the effect on coronary heart disease risk of CRP genotypes and CRP levels argues against a causal association of CRP with coronary heart disease.