Prevalence of sleep apnoea syndrome in the middle to old age general population.

On the basis of a large populationbased sample who underwent full polysomnography at home (HypnoLaus cohort), we recently reported that 49·7% of men and 23·4% of women aged 40 years or older had an apnoea-hypopnoea index of 15 events per h or more1 according to the American Academy of Sleep Medicine (AASM) 2013 scoring criteria. When excessive daytime sleepiness (ie, Epworth score >10 [maximum score 24]) was included in the definition with an apnoea-hypopnoea index of 5 events per h or more, the prevalence was 12·5% in men and 5·9% in women. This high prevalence of sleep disordered breathing reinforced the idea that the treatment decision should not only be based the apnoeahypopnoea index, but should also take into account associated symptoms and cardiovascular and metabolic comorbidities. After this Article was published, several readers contacted us to ask for the prevalence of sleep apnoea syndrome in our sample according to the International Classification of Sleep Disorders (ICSD-3) criteria. These criteria include either the presence of an apnoea-hypopnoea index of 5 events per h or more associated with obstructive sleep apnoearelated symptoms or cardiovascular and metabolic comorbidities, or an apnoea-hypopnoea index of 15 events per h or more (figure).

Sleep Characteristics in Early Stages of Chronic Kidney Disease in the HypnoLaus Cohort.

STUDY OBJECTIVES: To evaluate the association between early stages of chronic kidney disease (CKD) and sleep disordered breathing (SDB), restless legs syndrome (RLS), and subjective and objective sleep quality (SQ). METHODS: Cross-sectional analysis of a general population-based cohort (HypnoLaus). 1,760 adults (862 men, 898 women; age 59.3 (± 11.4) y) underwent complete polysomnography at home. RESULTS: 8.2% of participants had mild CKD (stage 1-2, estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m(2) with albuminuria) and 7.8% moderate CKD (stage 3, eGFR 30-60 mL/min/1.73 m(2)). 37.3% of our sample had moderate-to-severe SDB (apnea-hypopnea index [AHI] ≥ 15/h) and 15.3% had severe SDB (AHI ≥ 30/h). SDB prevalence was positively associated with CKD stages and negatively with eGFR. In multivariate analysis, age, male sex, and body mass index were independently associated with SDB (all P < 0.001), but kidney function was not. The prevalence of RLS was 17.5%, without difference between CKD stages. Periodic leg movements index (PLMI) was independently associated with CKD stages. Subjective and objective SQ decreased and the use of sleep medication was more frequent with declining kidney function. Older age, female sex, and the severity of SDB were the strongest predictors of poor SQ in multivariate regression analysis but CKD stage was also independently associated with reduced objective SQ. CONCLUSIONS: Patients with early stages of CKD have impaired SQ, use more hypnotic drugs, and have an increased prevalence of SDB and PLM. After controlling for confounders, objective SQ and PLMI were still independently associated with declining kidney function.

Characterization of Mechanically Alloyed Nanocrystalline Fe(Al): Crystallite Size and Dislocation Density

A nanostructured disordered Fe(Al) solid solution was obtained from elemental powders of Fe and Al using a high-energy ball mill. The transformations occurring in the material during milling were studied with the use of X-ray diffraction. In addition lattice microstrain, average crystallite size, dislocation density, and the lattice parameter were determined. Scanning electron microscopy (SEM) was employed to examine the morphology of the samples as a function of milling times. Thermal behaviour of the milled powders was examined by differential scanning calorimetry (DSC). The results, as well as dissimilarity between calorimetric curves of the powders after 2 and 20 h of milling, indicated the formation of a nanostructured Fe(Al) solid solution

Esfoliação e hidratação da caulinita após intercalação com uréia

Well-ordered Georgia kaolinite (Kga-1b) obtained from the source Clay Repository of the Clay Minerals Society (USA) was intercalated with urea using grinding procedures. To achieve complete intercalation 20% of urea (in weight) was used, producing Al2Si2O5(OH)4 (N2H4CO)0,86 with an interplanar basal spacing of 1,08nm. After washing with water under ultrasound stirring at 363K, urea was completely removed and kaolinite was partially exfoliated. After drying under air, the material was converted to hydrated kaolinite with the composition Al2Si2O5(OH)4 (H2O)0,64 and an interplanar basal spacing of 0,84nm. In this compound, water molecules positioned between the layers of the silicate can be removed after calcination at 573K, regenerating structurally disordered kaolinite.

Comportamento térmico da caulinita hidratada

Well-ordered kaolinite from the Brazilian Amazon Region (State of Pará) was initially reacted at 60 °C with a water dimethylsulfoxide mixture. After washing and characterisation, the resulting material was washed several times with methanol and in the final step with water. The water molecules displace the previously dimethylsulfoxide intercalated molecules and two different hydrated kaolinites were obtained. An unstable phase characterized by an interplanar basal distance of 0,996 nm that after drying collapse to the stable 0,844 nm hydrated kaolinite. The dehydration of the sample to disordered kaolinite was accompanied by Powder X-ray Diffractometry, thermal analysis (simultaneous TG and DSC) and FTIR spectroscopy.

Jóvenes internados bajo la LO 5/2000 reguladora de la responsabilidad penal del menor. Estudio de casos

This research focuses on life trajectories and desistance from crime processes in a case-study qualitative sample of six offenders from 18 to 21 years old sentenced to penal custody in Barcelona, Spain.The theoretical framework comprises systemism (Mario Bunge, 2000, 2006), the life-course perspective (Elder, 1994, 2007), transition to adulthood (Casal et al., 2006) and desistance from crime as a process (Maruna, 2001; Sampson and Laub, 2003; Bottoms and Shapland, 2010; Cid and Martí, 2011).Information was collected through in-depth personal interviews and analysed through content analysis. Results show the importance of attachment to family and school institutions, as well as an effective professional training skill programme at the correctional facility to achieve a law-abiding lifestyle at adulthood.

Nocturnal Transcutaneous Carbon Dioxide and Early Changes in Atherosclerosis in Pre- and Postmenopausal Women

The risk of cardiovascular diseases and sleep-disordered breathing increases after menopause. This cross-sectional study focuses on overnight transcutaneous carbon dioxide (TcCO₂) measurements and their power to predict changes in the early markers of cardiovascular and metabolic diseases. The endothelial function of the brachial artery, the intima-media thickness of the carotid artery, blood pressure, glycosylated hemoglobin A1C and plasma levels of cholesterols and triglycerides were used as markers of cardiovascular and metabolic diseases. The study subjects consisted of healthy premenopausal women of 46 years of age and postmenopausal women of 56 years of age. From wakefulness to sleep, the TcCO₂ levels increased more in postmenopausal women than in premenopausal women. In estrogen-users the increase in TcCO₂ levels was even more pronounced than in other postmenopausal women. From the dynamic behaviour of the nocturnal TcCO₂ signal, several important features were detected. These TcCO₂ features had a remarkable role in the prediction of endothelial dysfunction and thickening of the carotid wall in healthy premenopausal women. In addition, these TcCO₂ features were linked with blood pressure, lipid profile and glucose balance in postmenopausal women. The nocturnal TcCO₂ profile seems to contain significant information, which is associated with early changes in cardiovascular diseases in middle-aged women. TcCO₂ might not only measure the tissue carbon dioxide levels, but the TcCO₂ signal variation may also reflect peripheral vasodynamic events caused by increased sympathetic activity during sleep.

A formação em Química discutida com base nos modelos proposto por estudantes de pós-graduação para o fenômeno de dissolução

Mental models play an important role in the evolution of an individual's so-called knowledge. Using such representations, students can explain, foresee, and attribute causality to observed phenomena. In the case of Chemistry, the ability to work mentally with models assumes great importance, due to the microscopic component that is characteristic of this science. With the objective of exploring students' ability to work with models, 27 students of the Chemistry Institute of UNESP were asked to describe the mechanisms of dissolution, in water, of NaCl, HCl and HCN, as well as the partial dissolution of I2. Due to difficulties of access to complex descriptors of these processes, each student was asked to explain the phenomena using words and drawings. The results of these investigations were analyzed, and enabled construction of a framework representing the Chemistry students' theoretical training, especially with respect to their most important transferred skill: an ability to model the physical world.

Contextuality in SME Ownership – Studies on Owner-managers’ Ownership Behavior

The purpose of this study is to deepen the understanding of the meaning of ownership in the context of small and medium sized businesses. The research on ownership has increased and widened during the last few years. Ownership is treated increasingly as a psychological phenomenon and it has been noticed that it is common for SME ownermanagers to be mentally linked to their firms. Previous research is suggesting that the central role of an owner-manager in an SME is specifying the concept of SMEs, and that ownership is creating a great heterogeneity within SMEs. This study suggests that there is a variation whitin ownership behaviour of small business owners, and the variation is not totally random or irrational, but following the general patterns of business ownership and of doing business on an SME level. This study is a concept analytical in nature and it builds on the theoretical clarification of the concept of ownership. The theoretical consideration concludes with proposing a definition of ownership: Ownership means a subject’s relatively sustaining position of control in regard to an object. The empirical part of this study consists of five articles, out of which one is conceptual and four are empirical in nature. The notion of contextuality of ownership and the notions of SME characteristics form the basic premise of this study and the theoretical basis for the publications. From the owner-managers point of view, ownership relates the owner also to his or her environment and therefore also to the valuations of the owner-managers. This means that all the dimensions are not equally valued, but certain dimensions in his or her ownership are more important. The presented empirical research is supporting the claim that there is a variation whitin ownership behaviour of small business owners. When bringing the definition of ownership onto a personal and psychological level and into the SME context, it was noticed that ownership is not only a closed system phenomenon occurring between the owner and object owned, but it is also elementarily connected to the environment. Ownership - along with the psychological side of it - is a contextual phenomenon where the fundamental factor is the relatively sustaining position of control with regard to an object. As a contribution of the study, this definition is bringing a new point of view to the discussion on SMEs, SME strategic behaviour and family businesses. The study concludes with pointing out directions for future research.

Airway surgery for obstructive sleep apnea and partial upper airway obstruction during sleep

This study analyzed the feasibility and efficacy of surgical therapies in patients with sleep-disordered breathing ranging from partial upper airway obstruction during sleep to severe obstructive sleep apnea syndrome. The surgical procedures evaluated were tracheostomy, laser-assisted uvulopalatoplasty (LUPP) and uvulopalatopharyngoplasty (UPPP) with laser or ultrasound scalpel. Obstructive sleep apnea and partial upper airway obstruction during sleep were measured with the static charge-sensitive bed (SCSB) and pulse oximeter. The patients with severe obstructive sleep apnea syndrome were treated with tracheostomy. Palatal surgery was performed only if the upper airway narrowing occurred exclusively at the soft palate level in patients with partial upper airway obstruction during sleep. The ultrasound scalpel technique was compared to laser-assisted UPPP. The efficacy of LUPP to reduce partial upper airway obstruction during sleep was assessed and histology of uvulopalatal specimen was compared to body fat distributional parameters and sleep study findings. Tracheostomy was effective therapy in severe obstructive sleep apnea. Partial upper airway obstruction and arterial oxyhemoglobin desaturation index during sleep decreased significantly after LUPP. The minimal retropalatal airway dimension increased and soft palate collapsibility decreased at the level where the velopharyngeal obstruction had occurred before the surgery. Ultrasound scalpel did not offer any significant benefits over the laser-assisted technique, except fewer postoperative haemorrhage events. The loose connective tissue as a manifestation of edema was the only histological finding showing correlation with partial upper airway obstruction parameters of SCSB. Tracheostomy remains a life-saving therapy and also long-term option when adherence to CPAP fails in patients with obstructive sleep apnea syndrome. LUPP effectively reduces partial upper airway obstruction during sleep provided that obstruction at the other levels than the soft palate and uvula were preoperatively excluded. Technically the ultrasound scalpel or laser surgeries are equal. In patients with partial upper airway obstruction the loose connective tissue is more important than fat accumulation in the soft palate. This supports the hypothesis that edema is a primary trigger for aggravation of upper airway narrowing during sleep at the soft palate level and evolution towards partial or complete upper airway obstruction during sleep.

Exploring the Impact of Mental Health Education on Adolescents’ Perceptions About Mental Health and Mental Illness. Improving community health

The purpose of this study was to explore perceptions of mental health and mental illness as well as the perceptions towards people with mental illness among adolescents, and further to examine the impact that a mental health educational intervention has on these perceptions. The review of the literature revealed a small number of publications on mental health educational interventions among adolescents which aimed at increasing knowledge and affecting attitudes towards mental illness with positive results. Fifty nine pupils (13-16 years old) from two randomly selected secondary schools around Athens, Greece, participated in this study. These schools were randomly selected as the experimental group (n=28) which participated in the mental health educational intervention, and the comparison group (n=31), which did not receive any intervention. Data were collected using individual interviews with open-ended questions, drawings and a questionnaire (Opinions about Mental Illness - O.M.I. scale). The participants described mental health and mental illness before and after the intervention, using the same expressions for both terms. Among the experimental group, changes were seen within the same expressions after the intervention, although some descriptions did not change. However, after the intervention, participants in the experimental group did not confuse mental health with mental illness and they also included specific diagnostic examples or stated that mental illness can happen to anyone and it can be managed. Moreover, they expressed positive attitudes towards mentally ill people, which they had not done before the intervention. The analysis of the drawings before the intervention showed that mentally ill persons were drawn similarly in both groups. After the intervention, the drawings of the participants in the experimental group changed, including fewer negative elements, while the drawings of the comparison group did not change. Regarding the results on the O.M.I. scale, it was found that the score on the Social Discrimination factor significantly decreased from pre-test to post-test in both study groups. The experimental group had higher levels on Social Discrimination at pre-test compared to the comparison group, but this difference was not significant at post-test. No significant changes were found for the Social Restriction factor for either study group. Scores of the Social Care and Social Integration factors increased significantly only in the intervention group. Overall, the results of this study indicate that the mental health educational intervention had a positive impact on the perceptions about mental health and mental illness among adolescents, and (mental) health professionals can use these results for implementing similar interventions and further research.

Experience with molecular and cytogenetic diagnosis of fragile X syndrome in Brazilian families

We report on the cytogenetic and DNA analysis of 55 families with the fragile X (FMR-1 locus) mutation (318 individuals and 15 chorionic villi samples). A total of 129 males were investigated, 54 mentally normal and 75 presenting mental retardation. Among the 54 normal males, 11 had the premutation, and none expressed the fragile site. The full mutation was detected in 73 retarded males, and 14 (18%) presented a premutation along with the full mutation (mosaics). All of them manifested the fragile site. The frequencies of fragile site expression correlated positively with the sizes of the expansion of the CGG repeats (D). Among 153 normal females, 85 were found to be heterozygous for the premutation and 15 had the full mutation. In the premutated females the fragile site was not observed or it occurred at frequencies that did not differ from those observed in 53 noncarriers. Cytogenetic analysis was thus ineffective for the diagnosis of premutated males or females. Among the 51 heterozygotes for the full mutation, 36 (70%) had some degree of mental impairment. As in males, a positive correlation was detected between the frequencies of fragile site manifestation and the size of the expansion. However, the cytogenetic test was less effective for the detection of fully mutated females, than in the case of males, since 14% false negative results were found among females. Segregation analysis confirmed that the risk of mental retardation in the offspring of heterozygotes increases with the length of D. The average observed frequency of mental retardation in the offspring of all heterozygotes was 30%. There was no indication of meiotic drive occurring in female carriers, since the number of individuals who inherited the mutation did not differ from the number of those inheriting the normal allele. No new mutations were detected in the 55 genealogies studied here.

Vammaisuus hyvinvointivaltiossa. Invalideiksi, vajaamielisiksi tai kehitysvammaisiksi määriteltyjen kansalaisasema suomalaisessa vammaispolitiikassa 1940-luvun taitteesta vuoteen 1987

Tutkimuksessa tarkastellaan vammaisiksi määriteltyjen ihmisten kansalaisasemaa suomalaisessa toisen maailmansodan jälkeisessä vammaispoliittisessa keskustelussa. Analyysissa huomioidaan suomalaisen vammaishuollon molemmista päälinjoista, eli invalidihuollosta sekä vajaamielis- ja kehitysvammahuollosta, käydyt keskustelut. Tutkimuksen aikarajauksena toimii niin kutsuttu invalihuollon kausi, joka ulottui lakisääteisen vammaishuollon tarpeesta 1940-luvun taitteessa virinneestä keskustelusta vuoteen 1987, jolloin säädettiin periaatteiltaan edeltävään lainsäädäntöön verrattuna uudenlainen laki vammaisuuden perusteella järjestettävistä palveluista ja tukitoimista. Vammaisuuden käsitettä lähestytään tutkimuksessa yhtenä modernin sosiaalipoliittisen lainsäädännön kategorioista, jotka ovat vapauttaneet kansalaisen velvollisuudesta itsensä ja perheensä elättämiseen ja oikeuttaneet hänet toimeentulossaan sosiaaliturvaan. Tutkimuksessa pyritään hahmottamaan millaiseksi tutkimuksen kohteena olevien vammaisten ryhmien kansalaisasema tutkimusajankohtana ymmärrettiin. Tarkastelussa keskitytään kansalaisuuden käsitteen niin kutsuttuun aineellisoikeudelliseen sisältöön analysoimalla tutkimuksen kohteena olevissa keskusteluissa esiintyneitä kansalaisuuden ideaaleja ja käsityksiä kansalaisen ja valtion suhteesta. Tutkimusaihetta lähestytään etsimällä vastausta kysymyksiin 1) Mihin yhteiskunnallisiin ongelmiin invalidihuollosta ja vajaamielis- tai 312 kehitysvammahuollosta käydyissä asiantuntijakeskusteluissa haettiin ratkaisuja? 2) Millaisia tavoitteita huollolle asetettiin? 3) Millaiseksi hahmotettiin huollon kohderyhmien asema ja tehtävät yhteiskunnassa? Analyysissa keskitytään huollosta käydyn asiantuntijakeskustelun tarkasteluun. Tutkimuksen keskeisin lähdeaineisto muodostuu tutkimusajankohdan vammaishuoltoa käsittelevästä lainsäädännöstä, sen valmistelun materiaaleista sekä vammaisjärjestöjen ja muiden alan asiantuntijoiden vammaishuollosta julkisuudessa käymästä keskustelusta. Tutkimuksessa esitetään, että suomalaisen vammaispolitiikan ja vammaisten kansalaisaseman kehityksessä on tutkimusajankohtana erotettavissa kolme vaihetta: 1) 1940–1950-lukujen yhteiskunnan rationalisointia ja sosiaalisten ongelmien vähentämistä painottaneella ennaltaehkäisevän huoltopolitiikan kaudella vammaiset ihmiset hahmotettiin yhteiskunnan reunamilla tai ulkopuolella olevaksi erityisryhmäksi, joka tuli pyrkiä huollon toimenpiteillä integroimaan omalle paikalleen yhteiskunnan kokonaisuuteen. 2) 1960-luvun kuntoutusideaalin laajenemisen kaudella vammaishuollon julkilausutuksi tavoitteeksi omaksuttiin yksilön edun ajaminen. 3) 1970–1980-lukujen normalisaation periaatetta painottaneessa vammaispolitiikassa tavoitteeksi otettiin vammaisille tarkoitettujen erityisjärjestelmien purkaminen sekä vammaisten tasa-arvoisen kansalaisaseman turvaaminen heidän osallistumismahdollisuuksiaan parantavilla tukitoimenpiteillä.

Mental rotation of anthropoid hands: a chronometric study

It has been shown that mental rotation of objects and human body parts is processed differently in the human brain. But what about body parts belonging to other primates? Does our brain process this information like any other object or does it instead maximize the structural similarities with our homologous body parts? We tried to answer this question by measuring the manual reaction time (MRT) of human participants discriminating the handedness of drawings representing the hands of four anthropoid primates (orangutan, chimpanzee, gorilla, and human). Twenty-four right-handed volunteers (13 males and 11 females) were instructed to judge the handedness of a hand drawing in palm view by pressing a left/right key. The orientation of hand drawings varied from 0º (fingers upwards) to 90º lateral (fingers pointing away from the midline), 180º (fingers downwards) and 90º medial (finger towards the midline). The results showed an effect of rotation angle (F(3, 69) = 19.57, P < 0.001), but not of hand identity, on MRTs. Moreover, for all hand drawings, a medial rotation elicited shorter MRTs than a lateral rotation (960 and 1169 ms, respectively, P < 0.05). This result has been previously observed for drawings of the human hand and related to biomechanical constraints of movement performance. Our findings indicate that anthropoid hands are essentially equivalent stimuli for handedness recognition. Since the task involves mentally simulating the posture and rotation of the hands, we wondered if "mirror neurons" could be involved in establishing the motor equivalence between the stimuli and the participants' own hands.

Breathing disorders in congestive heart failure: gender, etiology and mortality

We investigated the relationship between sleep-disordered breathing (SDB) and Cheyne-Stokes respiration (CSR) while awake as well as mortality. Eighty-nine consecutive outpatients (29 females) with congestive heart failure (CHF; left ventricular ejection fraction, LVEF <45%) were prospectively evaluated. The presence of SDB and of CSR while awake before sleep onset was investigated by polysomnography. SDB prevalence was 81 and 56%, using apnea-hypopnea index cutoffs >5 and >15, respectively. CHF etiologies were similar according to the prevalence of SDB and sleep pattern. Males and females were similar in age, body mass index, and LVEF. Males presented more SDB (P = 0.01), higher apnea-hypopnea index (P = 0.04), more light sleep (stages 1 and 2; P < 0.05), and less deep sleep (P < 0.001) than females. During follow-up (25 ± 10 months), 27% of the population died. Non-survivors had lower LVEF (P = 0.01), worse New York Heart Association (NYHA) functional classification (P = 0.03), and higher CSR while awake (P < 0.001) than survivors. As determined by Cox proportional model, NYHA class IV (RR = 3.95, 95%CI = 1.37-11.38, P = 0.011) and CSR while awake with a marginal significance (RR = 2.96, 95%CI = 0.94-9.33, P = 0.064) were associated with mortality. In conclusion, the prevalence of SDB and sleep pattern of patients with Chagas' disease were similar to that of patients with CHF due to other etiologies. Males presented more frequent and more severe SDB and worse sleep quality than females. The presence of CSR while awake, but not during sleep, may be associated with a poor prognosis in patients with CHF.