Association between levels of pentraxin 3 and incidence of chronic kidney disease in the elderly

OBJECTIVE: Higher levels of the novel inflammatory marker pentraxin 3 (PTX3) predict cardiovascular mortality in patients with chronic kidney disease (CKD). Yet, whether PTX3 predicts worsening of kidney function has been less well studied. We therefore investigated the associations between PTX3 levels, kidney disease measures and CKD incidence. METHODS: Cross-sectional associations between serum PTX3 levels, urinary albumin/creatinine ratio (ACR) and cystatin C-estimated glomerular filtration rate (GFR) were assessed in two independent community-based cohorts of elderly subjects: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS, n = 768, 51% women, mean age 75 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 651, mean age 77 years). The longitudinal association between PTX3 level at baseline and incident CKD (GFR <60 mL( ) min(-1)  1.73 m(-) ²) was also analysed (number of events/number at risk: PIVUS 229/746, ULSAM 206/315). RESULTS: PTX3 levels were inversely associated with GFR [PIVUS: B-coefficient per 1 SD increase -0.16, 95% confidence interval (CI) -0.23 to -0.10, P < 0.001; ULSAM: B-coefficient per 1 SD increase -0.09, 95% CI -0.16 to -0.01, P < 0.05], but not ACR, after adjusting for age, gender, C-reactive protein and prevalent cardiovascular disease in cross-sectional analyses. In longitudinal analyses, PTX3 levels predicted incident CKD after 5 years in both cohorts [PIVUS: multivariable odds ratio (OR) 1.21, 95% CI 1.01-1.45, P < 0.05; ULSAM: multivariable OR 1.37, 95% CI 1.07-1.77, P < 0.05]. CONCLUSIONS: Higher PTX3 levels are associated with lower GFR and independently predict incident CKD in elderly men and women. Our data confirm and extend previous evidence suggesting that inflammatory processes are activated in the early stages of CKD and drive impairment of kidney function. Circulating PTX3 appears to be a promising biomarker of kidney disease.

Inflammation, oxidative stress, glomerular filtration rate, and albuminuria in elderly men : a cross-sectional study

BACKGROUND: The role of inflammation and oxidative stress in mild renal impairment in the elderly is not well studied. Accordingly, we aimed at investigating the associations between estimated glomerular filtration rate (eGFR), albumin/creatinine ratio (ACR), and markers of different inflammatory pathways and oxidative stress in a community based cohort of elderly men. FINDINGS: Cystatin C-based GFR, ACR, and biomarkers of cytokine-mediated inflammation (interleukin-6, high-sensitivity C-reactive protein[CRP], serum amyloid A[SAA]), cyclooxygenase-mediated inflammation (urinary prostaglandin F2alpha [PGF2alpha]), and oxidative stress (urinary F2 isoprostanes) were assessed in the Uppsala Longitudinal Study of Adult Men(n = 647, mean age 77 years). RESULTS: In linear regression models adjusting for age, BMI, smoking, blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides, and treatment with statins, ACE-inhibitors, ASA, and anti-inflammatory agents, eGFR was inversely associated with CRP, interleukin-6, and SAA (beta-coefficient -0.13 to -0.19, p < 0.001 for all), and positively associated with urinary F2-isoprostanes (beta-coefficient 0.09, p = 0.02). In line with this, ACR was positively associated with CRP, interleukin-6, and SAA (beta- coefficient 0.09-0.12, p < 0.02 for all), and negatively associated with urinary F2-isoprostanes (beta-coefficient -0.12, p = 0.002). The associations were similar but with lower regression coefficients in a sub-sample with normal eGFR (>60 ml/min/1.73 m2, n = 514), with the exception that F2-isoprostane and SAA were no longer associated with eGFR. CONCLUSION: Our data indicate that cytokine-mediated inflammation is involved in the early stages of impaired kidney function in the elderly, but that cyclooxygenase-mediated inflammation does not play a role at this stage. The unexpected association between higher eGFR/lower albuminuria and increased F2-isoprostanes in urine merits further studies.

Peça por peça: sistematização de um programa de responsabilidade social

O objetivo da dissertação foi analisar o processo de desenvolvimento e a aplicação de ações sociais e trabalho voluntário, que demonstram a preocupação da empresa com o seu papel social, através de uma participação mais ativa, concreta e efetiva, influenciando na ocorrência das mudanças que a sociedade necessita. O foco do estudo foi analisar um dessas empresas, notadamente a Robert Bosch Limitada, de capital alemão, radicada no Brasil desde o início da década de 1950. Sendo considerada, mais especificamente, uma de suas unidades, localizada no Paraná desde 1975. A Bosch Curitiba, através da implementação de um programa de ação social baseado principalmente na educação e no desenvolvimento sustentável, pretendeu criar condições para que a comunidade de um bairro da periferia de Curitiba pudesse identificar oportunidades de desenvolvimento econômico e social. Esta dissertação é o resultado dessa discussão e se desenvolveu por meio de um programa de ação social que evidencia a importância da participação ativa da empresa na comunidade, baseada em projetos que evidenciam a educação como a essência para o desenvolvimento social. A Vila Verde, comunidade da periferia de Curitiba, foi escolhida pela empresa para implantar o programa de responsabilidade social (Peça por Peça). Nessa comunidade, o foco principal foram os membros da faixa etária de O a 18 anos. O programa, portanto, teve a participação de uma empresa, dos seus colaboradores, como voluntários, e das escolas da comunidade envolvida. A coleta dos dados deu-se por diferentes procedimentos: pesquisa bibliográfica, pesquisa documental, observação participante e entrevistas. Os dados qualitativos foram comparados, e foram apresentados em forma de relatório. Os dados quantitativos foram tabulados e avaliados, servindo de apoio e confirmação aos resultados apresentados pela análise dos dados quantitativos. A atuação do programa social, Peça por Peça, foi no sentido de sensibilizar, estimular e criar condições de conscientizar os envolvidos que as mudanças necessárias somente serão efetivas na medida em que aumentar o seu nível de comprometimento, ou seja, tomar-se uma população capaz de se organizar e de preservar e defender seus interesses e anseios, desenvolvendo seu papel natural do exercício da cidadania e de uma convivência social que assegure direitos básicos para qualquer processo e evolução de uma sociedade. Sistematizar um programa de responsabilidade social, mais do que pretender criar soluções inovadoras, busca consolidar um outro pressuposto, em que a maioria das atividades sociais implementadas, sejam elas de cunho filantrópico ou não, dificilmente conseguem se manter e alegando várias razões, mas de que alguma forma sempre se reflete na falta de uma sistemática de trabalho, com metas, monitoramento, resultados esperados, com um planejamento estratégico que projete as ações a curto, médio e longo prazo. Isso também é uma evidência de que um projeto social não direcionado para atividades assistencialistas, mas sim para a busca de exercer efetivamente a responsabilidade social, não deve ter no fator tempo a principal referência de sucesso do empreendimento, mas sim de pequenas ações de melhoria de forma continuada e planejada, auto-sustentada, efetiva, mensurável e compartilhada.

O enfoque comunitário: uma visão renovadora das abordagens tradicionais em psicologia e aconselhamento

Nos últimos anos, vem sendo desenvolvido um número significativo de abordagens dos problemas comportamentais e sociais. Todas elas fazem parte de um movimento mais amplo de mudança de funções, papéis, metodologias e programas tradicionais das profissões de ajuda. As novas direções vislumbradas em psicologia, ultrapassam os limites de uma postura profissional passiva e destacam que os modelos intrapessoais da psicologia nem sempre condizem com as realidades sociais. o objetivo deste estudo foi fornecer uma visão geral destas abordagens inovadoras, que refletem um posiconamento novo, não tradicional, nas profissões de ajuda, integrando-as em um conjunto coeso: a abordagem comunitária em psicologia e, mais especificamente, no aconselhamento psicológico. A abordagem comunitária enfatiza a necessidade de se desenvolver modelos preventivos e desenvolvimentistas de amplo alcance, em psicologia, bem como a necessidade de se reconhecer o contexto social no qual ela é praticada. Requer novas definições de muitas e papéis para as atividades de ajuda. Tratou-se, neste estudo, de apresentar definições e de estabelecer um fundamento histórico, ideológico e teórico para esta posição, bem como de ilustra-la através de programas de nível comunitário, que extrapolam a orientação tradicional de ajuda. Tratou-se também, dos muitos problemas enfrentados nestes programas e das perspectivas para o novo campo da psicologia e do aconselhamento comunitário. Concluiu-se que a descrição de tal posição poderá fornecer importantes subsídios para aqueles psicólogos interessados em desempenhar um papel profissional mais completo e em atualizar-se acerca das modalidades preventivas e desenvolvimentistas de prestação de serviços.

Motivação no trabalho voluntário: expectativas e motivos na Pastoral da Criança

The present study has proposed a structural model to identify the reasons why individuals become voluntary, keep and exit this type of work. The empirical space was the Pastoral da Criança - social action agency of the National Conference of Bishops of Brazil (CNBB) - community-based institution that has its work based on solidarity and the sharing of knowledge. The theoretical framework has the context in which are volunteering studies in Brazilian and world level. Then discuss the various concepts of volunteering and presented the theoretical models of volunteer motivation. Studies of Mostyn (1983) and studies conducted by the BEPEGE-Base for Studies and Research in Management Policies and Strategies - in their line of research GERQUAL - Human Resource Management and Organizational Quality - of the Federal University of Rio Grande do Norte as Carvalho e Souza(2006), Souza, Medeiros e Fernandes (2006), Souza et al (2009, 2010), Cavalcante et al (2011a, 2011b, 2011c, 2011d) were the main theoretical references for the construction of the model that was tested. Data collection was done through a survey with 71 indicators, in 2 visits to cities from the Diocese of Pesqueira, Pernambuco. The first data collection occurred in the period between May 30 and June 3, 2011, in Buique/PE and the second collection happened in Pesqueira/PE, in St. Joseph Seminary, in the period between July 6-8, 2011. 720 questionnaires were collected. The sample was divided into two parts. Exploratory Factor Analysis was applied in first part and Confirmatory Factor Analysis - structural equation modeling - in the second half. The examination of the results achieved by the expectations, reasons for entry, reasons for staying and exit reasons showed that all hypotheses were accepted. So the motivation of voluntary Pastoral da Criança can be explained by a set of interactions between these five constructs: Altruistic, Affectionate, Amiable, Adjusted and Astute

Aquaculture Research and Development as an Entry-Point and Contributor to Natural Resources and Coastal Management

Recent, fervent international dialogue concerning the existence and magnitude of impacts associated with aquaculture has had both positive and negative outcomes. Aquaculture stakeholders have become sensitized to requirements for improved environmental management of aquaculture. on the other hand, in some cases aquaculture development has been negatively affected by some of the unwarranted and unproved allegations to the detriment of the stakeholders most in need of aquaculture development (i.e., resource users, particularly the poor, who are dependent on natural resources). These resource users are targeted by, and directly influence biodiversity and conservation agendas; hence the need to understand how to gain their active participation. This discussion focuses on examples of how aquaculture research and development can be a useful tool or strategy for resource management initiatives and provide tangible positive including increased stakeholder participation and cooperation, offering alternatives to resource extraction and use in otherwise difficult or intransigent resource management conflicts.

Da Barra do Rio aos parrachos: duas realidades sociorganizacionais no litoral Norteriograndense

Observing that social capital is considered crucial for the consolidation of an association, this paper analyzes how different groups associative absorb the concept of membership and how to manage routing in their actions to the social interest. The research aimed to evaluate two central forms of association, based on the concept of Pierre Bourdieu (1980) on social capital, stressing that its distribution and perception are uneven and depends on the ability of ownership of different social groups. Accordingly, took up two organizations community based one in - Barra do Rio and another in Maracajaú - whose main activity is the exploitation in the coastal tourist norteriograndense. Once processed the data, it became clear that, despite the purpose for the association has been motivated by exploration in both organizations, each differently appropriates its capital. While one maintains a feelings of togetherness, trust and satisfaction of group work, the other one, feelings are stifled by individualism, mistrust among their members that although they see the association as something important for the growth and strengthening of the group, working individually

Dificuldades e/ou facilidades vivenciadas pelos profissionais que compõem a Estratégia de Saúde da Família

Descriptive and quantitative study, with the objective of review the positive and negative aspects experienced by professionals working in the Family Health Strategy (ESF) of Ceará-Mirim town, at Rio Grande do Norte state. The population included 190 healthcare professionals that integrate the family healthcare staff and the data-collection occurred in a meeting at their workplace, with the implementation of a questionnaire. Results were organized in Microsoft Excel spreadsheet software, with descriptive statistical analysis in tables, graphs and tables through frequencies, averages values and standard deviations. There is a predominance of females (n = 137) and higher rates in almost all professions, and higher average age (38.9%, SD = 7.8) and income wage (average = 10) in the medical category. Regarding the more developed activities, for physicians and nurses are the healthcare actions in the Unit, the oral hygiene for dentists, the immunization for auxiliary nurses (Aux-N), educational meeting for the dental office assistants (ACD), and home visitations to community-based health workers (ACS). About the easiness of work, 93.2% said to be presence of professionals with a personal profile in public healthcare; about the difficulties, 86.8% of professionals cited the unavailability of material, followed by salary range reported by nurses (80.9% ), dentists (80.0%), physicians (73.3%), ACS (83.1%), and Aux-N (90.5%). In relation to working conditions, the unavailability of materials was the most mentioned, with the exception of dentists who reported improvement in wages. We still identify among these difficulties: the drugs availability regarded as first grade obstacle by ACS and physicians, the type of contracts in second grade cited by the ACD and dentists and, in third grade, the salary range cited by dentists and auxiliary nurses. It is concluded that the difficulties and easiness faced by ESF professionals are divergent among themselves. For physicians and nurses, whose healthcare actions become directed to specific groups, the individual and the family, their difficulties relate to the unavailability of materials. For dentists, whose actions more quoted were topical application of fluoride and supervised toothbrush, their greatest difficulty is the salary range. As to the Aux-N, ACD and ACS, for all of them the unavailability of materials has hindered the implementation of their activities in ESF

Conhecimento dos adolescentes sobre métodos contraceptivos: pesquisa-ação em uma unidade do programa saúde da família de Natal

It is a descriptive study with a qualitative approach, and an action-research type, which aimed to analyze the changes of knowledge about contraceptive methods invested to a teenager group attended in Igapó Family Healthcare Unit, in the city of Natal/RN, after consent and institutional assent of Ethics Committee of Rio Grande do Norte Federal University (Protocol No. 131/07). It were researched 16 teenagers of both sexes, with age ranging from 11 to 16 years. We used two structured questionnaires, one in the initial diagnosis and another during the seven meetings of the focus group, in addition to the field notes and the meetings discussions transcriptions. The data-collection was performed in the period of two months by a team composed by a nurse the research coordinator, a dentist, a nursing assistant, a community-based healthcare worker and a nursing academic. The quantitative and qualitative data were organized, tagged and categorized into spreadsheet in Microsoft Excel, being held a thematic analysis of speeches performed by the study participants. The results were presented as tables, graphics, photos, drawings and word clippings. The educational strategy developed in focus group allowed adolescents to discuss, exchange ideas and opinions on several contraceptive methods, providing expansion in knowledge of all contraceptives discussed, especially those natural and surgical, which were less mentioned at the beginning of the study. Among the advantages of the contraceptive methods listed by teenagers, was highlighted avoiding pregnancy and STDs in use of the barrier method of condom. As for the disadvantages more frequently noted by the survey with the misuse of barrier methods, was highlighted get pregnant, acquire STD's and do not prevent STD's in hormonal, natural and surgical methods. Adolescents showed consistency between the advantages and disadvantages and types of contraceptive methods, showing a widening in knowledge among them. It may be said that, in general, those surveyed had a good understanding about the use of the various contraceptive methods. Thus, the study participants had positively evaluated all the criteria used to qualify the meetings in the focus group. The action strategy of the focus group should be encouraged by professionals who work with teenagers, since they prefer to live in groups, one characteristic of adolescence.

O adolescente em conflito com a lei e a escola: criminalização e inclusão perversa

This study aims to identify the relation between adolescents in conflict with the penal law, who were convicted to assisted freedom (a socio-educative measure applied by the Juvenile Justice system as a sanction to adolescent offenders), and the school. The research was developed in the Community-based Assisted Freedom Program of Pastoral do Menor , in Fortaleza (capital city of Ceará State, Brazil). The study has engaged 21 adolescents, eight program professionals, three members of the Center for Defense of Child Rights in Ceará, five teachers and eight school principals and education managers from the schools attended by the adolescents in the neighborhoods of Pirambu, Tancredo Neves, Jardim Iracema e Bom Jardim. It intends, based on dialectical and historical method, to define the investigated adolescents as persons with a very singular insertion into the social structures of neoliberal capitalism. Their adolescence is subject to consumerism appeals, to the limits imposed by these appeals and to perverse ways of insertion in the system, such as criminalization, segregation and marginalization. It reveals that the school attended by the adolescents reproduces such conditions of insertion. At the same time, these conditions are elements of identity, by which the adolescents are characterized.

Cartografia de uma intervenção comunitária para prevenção de DST/HIV/AIDS

Community-based interventions have been presented as a proposal of operationalization of the concept of vulnerability to STD/Aids prevention. This study aimed to analyze the Community intervention developed through the project Strengthening of Community action networks for STD/Aids prevention: know and intervenein, at Mãe Luiza neighborhood, in the city of Natal, State of Rio Grande do Norte, Brazil. The study was conducted in the same location where intervention occurs and took as time reference the first 30 months of construction and deployment process, from April 2010 until December 2012. This is research with qualitative approach, participatory character, developed from the immersion of the researcher in the field, being this community intervention itself. In this perspective, the study approximates to the Cartographic method in which the researcher-researched is engendered in the acts and effects research. The data-generating sources were the memories of the researcher from the field notes, written narratives of subjects involved in the intervention and documents pertaining to the project. In the methodological path of cartography, the image of the rhizome by Deleuze and Guattari (1995) has accompanied the immersion in the field given the nature of research-intervention which approach to the concept of object-Rhizome. The presentation of results was composed for the attempted rhizomatic and a hypertext representation, based on the descriptive narrative taken from the documentary analysis and the multi-faceted narratives with the voices, the looks and the affections narrated by the subject involved, respectively. On the path taken, three lanes were drawn as synthesis of learning produced by experience-that can contribute to understanding the process under study, in his singular character, and reflections on other experiences of community intervention: track 1- Community intervention as active-reflective space and a cause; track 2 Inclusion as power and challenge of community involvement; track 3 Sustainability as A challenge of Community intervention. The study indicates that community intervention is presented as a potential producer of health as also produces practical and creative skills, subjects and inventive in the daily life of the community with a view to reinventing knowledge and practices for the prevention of STD/HIV/Aids

A percepção dos moradores da comunidade do Passo da Pátria em Natal-RN

This essay: The perception environmental of the Passo da Pátria dwellers in Natal-RN has as its goal, investigate the perception of the dwellers in an degraded environment in ways of urbanizing, at the Potengi River riverine. This is an area in zone environmental risk, which year after year was even forgotten by the municipality, but which attracted a huge estranger public because of its facility in access urbanized areas in Natal at the same rate of its natural riches from the mangue and the sea. Front to problems of economical nature as scarce job offers, its habitants build their dwellings without any kind order or social protection, occupying an inadequate space for the well keeping of the urban environmental equilibrium. The analyzed community is exposed to water floods, tropical diseases, and to criminal problems like gangsters and drug dealers. We propose in such essay observe the connivance of the dwellers with the natural environment and their expectations o citizen transformations. This essay has as its bases the studies of Tuan (1983), Nunes (2000) and principally in Wilhem Reich (1998) in who we found our concept of perception, that here plays like an important analytical category to confront our corpus. Our first chapter debates the concept of place, not in an historical materialistic vision, but within an phenomenological survey; the second chapter presents the impacts of the urbanization in the community perception, and in the third one is analyzed the perception of the Passo da Pátria community. Based in this analyzes we confirmed that the conditions of living of the dwellers are extremely dangerous; but, the most of them do not see such dangers, even saying that are well living in its community

Avaliação da qualidade da atenção básica em 37 municípios do centro-oeste paulista: características da organização da assistência

No Estado de São Paulo, existe uma rede extensiva de serviços de Atenção Básica (AB) com perfil organizacional heterogêneo e pouco conhecido. Este estudo objetiva caracterizar a organização dos serviços de AB em 37 municípios do Centro-oeste paulista, como primeira etapa de um projeto de avaliação da qualidade desses serviços. Trata-se de um estudo transversal conduzido mediante questionário estruturado, autorrespondido pelos gerentes e equipes locais, com questões que abordam características institucionais e de organização e gerência do trabalho. Esses questionários foram enviados para 131 UBS, distribuídas em 37 municípios. Obteve-se resposta de 113 unidades (87%) localizadas em 32 municípios (86,4%). do total de unidades, 57 (50%) são UBS tradicionais, 26 (22,8%), Unidades de Saúde da Família, e 31, (27,2%) organizadas segundo formas mistas. A maioria dos serviços (62%, 70/113) não trabalha com área de abrangência delimitada de modo planejado. Os serviços se polarizam entre aqueles que realizam entre 70 e 100% de consultas médicas agendadas (37,6%, 41/109), e aqueles que realizam entre 70 e 100% de não agendadas (39,4%, 43/109). Não possuem conselhos locais organizados 65 unidades (63,7%, 65/102). Os dados coletados permitem discutir as características dos principais programas, procedimentos e ações realizados pelos serviços. Os perfis organizacionais predominantes apontam a presença de deficiências de estrutura e processo em relação às diretrizes do SUS. O desenvolvimento de instrumentos de autoavaliação permite que as equipes se apropriem, de forma crítica, de seu trabalho, e possam elaborar novos arranjos tecnológicos para melhoria da qualidade.

Predação de ninhos artificiais em uma ilha na Mata Atlântica: testando o local e o tipo de ovo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Inequalities in access to education and healthcare

The burden of disease is borne by those who suffer as patients but also by society at large, including health service providers. That burden is felt most severely in parts of the world where there is no infrastructure, or foreseeable prospects of any, to change the status quo without external support. Poverty, disease and inequality pervade all the activities of daily living in low-income regions and are inextricably linked. External interventions may not be the most appropriate way to impact on this positively in all circumstances, but targeted programmes to build social capital, within and by countries, are more likely to be sustainable. By these means, basic oral healthcare, underpinned by the primary healthcare approach, can be delivered to more equitably address needs and demands. Education is fundamental to building knowledge-based economies but is often lacking in such regions even at primary and secondary level. Provision of private education at tertiary level may also introduce its own inequities. Access to distance learning and community-based practice opens opportunities and is more likely to encourage graduates to work in similar areas. Recruitment of faculty from minority groups provides role models for students from similar backgrounds but all faculty staff must be involved in supporting and mentoring students from marginalized groups to ensure their retention. The developed world has to act responsibly in two crucial areas: first, not to exacerbate the shortage of skilled educators and healthcare workers in emerging economies by recruiting their staff; second, they must offer educational opportunities at an economic rate. Governments need to lead on developing initiatives to attract, support and retain a competent workforce.