Should we debrief and counsel people who have had psychological shock?

Design: Randomised controlled trial of psychological debriefing. Setting: A British teaching hospital (the Radcliffe Hospital, Oxford). Patients: 66 men and 40 women, aged 17–69 years, admitted to hospital after a motor vehicle accident. Most had been the driver of a car. Median admission duration was four days for the 52 control patients and eight days for the 54 who underwent the intervention. Interventions: A debriefing of about one hour on Day 2 of admission, encouraging patients to describe the accident and express their emotions, followed by a cognitive appraisal which included describing common reactions to traumatic experiences and suggesting a range of people who might be able to assist in the future, including the patient's general practitioner. 91 patients were assessed at four months and 61 were assessed at three years. Control patients had no debriefing or counselling. Main outcome measures: Impact of Event Scale (IES, which focuses on intrusive thoughts and avoidance of similar situations to the event); Brief Symptom Inventory (BSI, a measure of 53 symptoms); and other questions related to physical pain and functional activities. Main results: At four months there was still considerable psychological morbidity among the patients who were followed up. There was a significant difference (P < 0.05) in changes of IES between the 42 who received the intervention, in whom it increased from 15 (standard deviation [SD], 15) to 16 (SD, 15), and the 49 controls, in whom it fell from 15 (SD, 12) to 13 (SD, 14). Similarly, two subscales of the BSI score changed significantly between the intervention group, among whom it deteriorated from 0.5 (SD, 0.5) to 0.6 (SD, 0.8), and the control s, in whom it hardly changed from 0.4 (SD, 0.3) to 0.4 (SD, 0.4). Among the 61 patients followed for three years, the 30 randomised to receive the intervention were significantly worse, by self-report, both psychologically and physically. Their mean IES score deteriorated from a baseline of 15 (SD, 14) to 16 (SD, 18). In comparison, scores for the 31 control patients improved from 16 (SD, 12) to 13 (SD, 17). The difference in change was significant (P < 0.05). Among all patients with high initial scores, these decreased among the controls but not among those receiving the intervention. Conclusion: Psychological counselling should only be used in the context of trials rather than routine care.

A case of myoepithelial carcinoma displaying biallelic inactivation of the tumour suppressor gene APC in a patient with familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is an autosomal dominant disorder caused by mutation of the APC gene. It is characterised by the appearance of hundreds to thousands of colorectal adenomas in adolescence and the subsequent development of colorectal cancer. Various extracolonic malignancies are associated with FAP, including desmoids and neoplasms of the stomach, duodenum, pancreas, liver, and brain. We present a family affected by FAP with an exon 14 APC mutation displaying two rare extracolonic lesions, a hepatoblastoma and a myoepithelial carcinoma. The hepatoblastoma was found in a male patient aged 2 years. The second lesion, a myoepithelial carcinoma of the right cheek, was found in a female patient aged 14 years. Inactivation of the normal APC allele was demonstrated in this lesion by loss of heterozygosity analysis, thus implicating APC in the initiation or progression of this neoplasm. This is the first reported case of this lesion in a family affected by FAP.

Knowledge of the national emergency telephone number and prevalence and characteristics of those trained in CPR in Queensland: baseline information for targeted training interventions

Members of the community contribute to survival from out-of-hospital cardiac arrest by contacting emergency medical services and performing cardiopulmonary resuscitation (CPR) prior to the arrival of an ambulance. In Australia there is a paucity of information of the extent that community members know the emergency telephone number and are trained in CPR. A survey of Queensland adults (n = 4490) was conducted to ascertain current knowledge and training levels and to target CPR training. Although most respondents (88.3%) could state the Australian emergency telephone number correctly, significant age differences were apparent (P < 0.001). One in five respondents aged 60 years and older could not state the emergency number correctly. While just over half the respondents (53.9%) had completed some form of CPR training, only 12.1% had recent training. Older people were more likely to have never had CPR training than young adults. Additional demographic and socio-economic differences were found between those never trained in CPR and those who were. The results emphasise the need to increase CPR training in those aged 40 and over, particularly females, and to increase the awareness of the emergency telephone number amongst older people. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Caveolae — from ultrastructure to molecular mechanisms

Almost 50 years after the first sighting of small pits that covered the surface of mammalian cells, investigators are now getting to grips with the detailed workings of these enigmatic structures that we now know as caveolae.

Fitting genetic models to twin data with binary and ordered categorical responses: A comparison of structural equation modelling and Bayesian hierarchical models

We compare Bayesian methodology utilizing free-ware BUGS (Bayesian Inference Using Gibbs Sampling) with the traditional structural equation modelling approach based on another free-ware package, Mx. Dichotomous and ordinal (three category) twin data were simulated according to different additive genetic and common environment models for phenotypic variation. Practical issues are discussed in using Gibbs sampling as implemented by BUGS to fit subject-specific Bayesian generalized linear models, where the components of variation may be estimated directly. The simulation study (based on 2000 twin pairs) indicated that there is a consistent advantage in using the Bayesian method to detect a correct model under certain specifications of additive genetics and common environmental effects. For binary data, both methods had difficulty in detecting the correct model when the additive genetic effect was low (between 10 and 20%) or of moderate range (between 20 and 40%). Furthermore, neither method could adequately detect a correct model that included a modest common environmental effect (20%) even when the additive genetic effect was large (50%). Power was significantly improved with ordinal data for most scenarios, except for the case of low heritability under a true ACE model. We illustrate and compare both methods using data from 1239 twin pairs over the age of 50 years, who were registered with the Australian National Health and Medical Research Council Twin Registry (ATR) and presented symptoms associated with osteoarthritis occurring in joints of the hand.

Lipid rafts and caveolae as portals for endocytosis: New insights and common mechanisms

Clathrin-coated pits and caveolae are two of the most recognizable features of the plasma membrane of mammalian cells. While our understanding of the machinery regulating and driving clathrin-coated pit-mediated endocytosis has progressed dramatically, including the elucidation of the structure of individual components and partial in vitro reconstitution, the role of caveolae as alternative endocytic carriers still remains elusive 50 years after their discovery. However, recent work has started to provide new insights into endocytosis by caveolae and into apparently related pathways involving lipid raft domains. These pathways, distinguished by their exquisite sensitivity to cholesterol-sequestering agents, can involve caveolae but also exist in cells devoid of caveolins and caveolae. This review examines the current evidence for the involvement of rafts and caveolae in endocytosis and the molecular players involved in their regulation.

Effectiveness of case management and post-acute services in older people after hospital discharge

Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.

The characteristics of six species of living hollow-bearing trees and their importance for arboreal marsupials in the dry sclerophyll forests of southeast Queensland, Australia

Six species of trees located in the dry sclerophyll forests of southeast Queensland were studied to ascertain which was most suitable to be retained as hollow-bearing trees for nesting and denning by arboreal marsupials. Generally for all tree species, the number of entrances to hollows was positively correlated with the diameter at breast height (DBH) and the growth stage, and entrance diameters also increased in trees with a larger DBH. However, there were differences between the species; Corymbia citriodora had few hollows until the individuals were very large while Eucalyptus crebra had low numbers of hollows throughout its entire size range. It was concluded that a mixture of tree species provided a range of hollow sizes and positions that would be suitable for nesting and denning by arboreal marsupials in those forests. There were large differences between tree species in the relationship between tree size and estimated age. Five of the tree species took between 186 and 230 years to begin to produce hollows while E. crebra took up to 324 years. This suggests that tree species other than E. crebra may be the most preferred for retention in areas where hollow-bearing tree densities are lower than the prescribed level. Other data also suggests there are likely to be enough trees in larger size classes that would begin to form hollows within the next 50 years to compensate for an expected loss of hollow-bearing stags during that same period. In terms of forest operation, the retention of six hollow-bearing trees/ha would represent an estimated loss of 7.3-15% wood production. (C) 2003 Elsevier Science B.V. All rights reserved.

Nitrate retention under sugarcane in wet tropical Queensland deep soil profiles

Nitrate leaching below the crop root-zone in variable charge soils may be adsorbed at anion exchange sites, thereby temporarily reducing the risk of contamination of water bodies. The objectives of this study were (i) to investigate whether nitrate adsorption, accumulation, and retention in the Johnstone River Catchment of Far North Queensland wet tropics is widespread; (ii) to assess the capacity of soil in the Johnstone River Catchment to retain nitrate; and (iii) to deduce the consequences of nitrate adsorption/desorption on contamination of water bodies. Soil cores ranging from 8 to 12.5 m depth were taken from 28 sites across the catchment, representing 9 Ferrosol soil types under sugarcane (Saccharum officinarum-S) cultivation for at least 50 years and from rainforest. The cores were segmented at 0.5-m depth increments and subsamples were analysed for nitrate-N, cation and anion exchange capacities, pH, exchangeable cations (Ca, Mg, K, Na), soil organic C, electrical conductivity, sulfate-S, and chloride. Nitrate-N concentration under sugarcane ranged from 0 to 72.5 mg/kg, compared with 0 to 0.31 mg/kg under rainforest, both Pin Gin soils. The average N load in 1-12 m depth across 19 highly oxidic profiles of the Pin Gin soil series was 1550 kg/ha, compared with 185 kg/ha under 8 non-Pin Gin soils and 11 kg/ha in rainforest on a Pin Gin soil. Most of the nitrate retention was observed at depth of 2-12 m, particularly at 4-10 m, indicating that the accumulation was well below the crop root-zone. The average maximum potential nitrate retention capacity was 10.8 t/ha for the Pin Gin and 4.7 t/ha for the non-Pin Gin soil. Compared with the current N load, the soils still possess a large capacity to adsorb and retain nitrate in profiles. Retention of large quantities of the leached nitrate deep in most of the profiles has reduced the risk of contamination of water bodies. However, computations show that substantial quantities of the nitrate leached below the root-zone were not adsorbed and remain unaccounted for. This unaccounted nitrate might have entered both on- and off-site water bodies and/or have been denitrified.

Ensino primário e matemática dos imigrantes e descendentes germânicos em Santa Leopoldina (1857-1907)

O objetivo da pesquisa é descrever o cenário da imigração germânica no século XIX, tratando também, de trilhar o caminho da educação por meio de educadores e das comunidades na Colônia de Santa Leopoldina, criada em 1857, na Província do Espírito Santo, considerando 50 anos a partir do início da imigração (1857-1907). A pesquisa histórica ancorou-se em consultas a documentos oficiais do Império, documentos e relatórios oficiais dos Presidentes da Província do Espírito Santo, jornais de circulação da época, fotografias, mapas geográficos, mapas estatísticos, livros didáticos antigos e livros de autores que abordaram o processo imigratório do Espírito Santo. O diálogo com Marc Bloch ajudou a entender essa multiplicidade de documentos, na complexa relação entre o passado e o presente da educação do Espírito Santo. O trabalho apresenta uma trajetória do imigrante germânico vindo da Europa até a ex-colônia e como a administração da província tratou a imigração e a educação. O ensino primário iniciou-se a partir de iniciativas públicas e particulares. Foram identificados as primeiras escolas e os nomes de muitos professores que atuaram no período estudado. Os livros utilizados nas escolas das comunidades teuto-brasileiras eram oriundos da Alemanha e posteriormente foram produzidos no sul do Brasil. Entre os livros escritos em alemão encontrados destacam-se o livro texto de alfabetização „Lese – Schule I für Deutsche Kinder in Brasilien‟, editado na Alemanha no final do século XIX, de autoria do diretor de uma escola particular em Santa Leopoldina, Albert Richard Dietze, e o primeiro volume do livro de matemática „Rechenbuch für Deutsch-Brasilianische Volksschulen‟, de Ferdinand Hackbart, Konrad Glaus e Hermann Lange. Foi feita uma análise sob os aspectos físicos e formais, o processo de ensino e os conteúdos do livro de matemática. A análise evidenciou que a proposta de ensino apoia-se no “cálculo mental” e o escrito, com a repetição dos conteúdos, envolvendo o treino intensivo. Os conceitos de matemática são apresentados partindo de problemas com situações concretas do aluno para a aquisição de competências necessárias para inserir o aluno em sua comunidade. Levando-se em conta que o livro foi editado em 1906, conclui-se que se trata de uma obra relevante com uma proposta de ensino que se manteve presente nos livros didáticos de matemática até os dias atuais.

Tendências temporais de mortalidade por câncer de próstata no estado do Espírito Santo

Introdução: O câncer de próstata é o segundo tipo de câncer mais incidente em homens em todas as regiões do Brasil. Aproximadamente 62% dos casos diagnosticados no mundo ocorrem em homens com 65 anos ou mais, caracterizando o único fator de risco estabelecido. Objetivos: Estudar a tendência da completude do Sistema de Informação de Mortalidade (SIM), segundo as variáveis idade, raça/cor, escolaridade e estado civil no período de 2000 a 2010, no Espírito Santo, Região Sudeste e Brasil. Analisar a tendência de mortalidade por câncer de próstata na série histórica no estado do Espírito Santo (ES), no período de 1980 a 2010. Metodologia: Realizou-se um estudo descritivo baseado em dados secundários de todos os óbitos por câncer de próstata obtidos do SIM e dados do Instituto Brasileiro de Geografia e Estatística (IBGE) disponíveis no DATASUS departamento de informática do SUS (Sistema Único de Saúde), no ES, Região Sudeste e Brasil, no período de 1980 a 2010. Considerou-se as variáveis (idade, raça/cor, escolaridade e estado civil). Analisou-se o número absoluto e calculou-se o percentual de não preenchimento das informações das declarações de óbitos (DOs), que são a base de informação do SIM, nas localidades selecionadas (ES, Região Sudeste e Brasil). Analisou-se através do Pacote Estatístico para Ciências Sociais (SPSS), versão 18.0. Realizou-se uma análise inferencial com ajustes de curvas para os percentuais de dados faltantes das variáveis demográficas disponíveis no sistema do DATASUS (estado civil, escolaridade, raça/cor). E para a análise de tendência, foi realizado o cálculo do coeficiente de mortalidade por óbitos. As equações do melhor modelo e as estatísticas de ajuste (valor de R2 e o p-valor do teste F de adequação do modelo) foram obtidas do programa SPSS, versão 18.0. Resultados: No período de 2000 a 2010 a variável raça/cor, escolaridade, mostrou-se decrescente para o Brasil. A variável estado civil destacou-se por caracterizar uma tendência crescente no ES, Região Sudeste e Brasil. No período de 1980 a 2010 observou-se 3.561 óbitos no ES. Observa-se na série história que há tendência crescente de mortalidade por câncer de próstata. Conclusão: O trabalho é de grande importância para o estudo de câncer de próstata no Brasil. Identificou-se a crescente não completude dos campos de Estado Civil, enquanto a variável raça/cor foi considerada decrescente, porém com qualidade dos dados ruim. É preciso ações para que o processo de coleta dos dados seja aprimorado pela capacitação dos registradores. Nos resultados observou-se a tendência de crescimento da mortalidade, sendo necessárias ações, estratégias e políticas governamentais voltadas para a integralidade à saúde masculina.

Thermal skin reference values in healthy late pregnancy

Digital thermal imaging has been employed in medicine for over 50 years. However, its use has been focused on vascular, musculoskeletal and neurological conditions, while other potential applications,such as obstetrics, have been much less explored. This paper presents a study conducted during 2011 at the Hospital of Braga on a group of healthy pregnant women in the last third of gestation. The analysis focused on characterizing typical pregnant women steady temperature profiles in specific defined regions of interest (ROI), and determining if the thermal symmetry values for late pregnant healthy women are in line with the values for non-pregnant healthy women. A temperature distribution pattern was found in the defined ROI. The obtained thermal symmetry value had a maximum of 0.370.2 1C, and there was no evidence for the influence of age (p40.05) in the observed group. The influence of the BMI requires further investigation since one ROI (P2 right) presented a p¼0.059, close to the threshold of statistical evidence in the influence of BMI. The study group presented symmetry values in line with non-pregnant reference values, but the profiles in temperature distribution are different. Assumptions can therefore now be used with higher confidence when assessing abnormalities in specific pathologic states during pregnancy using the defined ROI. This work represents a first contribution towards establishing guidelines for future research in this specific field of study.

An ecosystem of products and systems for ambient intelligence – the AAL4ALL users perspective

Developed societies are currently facing severe demographic changes: the world is getting older at an unprecedented rate. In 2000, about 420 million people, or approximately 7 percent of the world population, were aged 65 or older. By 2050, that number will be nearly 1.5 billion people, about 16 percent of the world population. This demographic trend will be also followed by an increase of people with physical limitations. New challenges will be raised to the traditional health care systems, not only in Portugal, but also in all other European states. There is an urgent need to find solutions that allow extending the time people can live in their preferred environment by increasing their autonomy, self-confidence and mobility. AAL4ALL presents an idea for an answer through the development of an ecosystem of products and services for Ambient Assisted Living (AAL) associated to a business model and validated through large scale trial. This paper presents the results of the first survey developed within the AAL4ALL project: the users’ survey targeted at the Portuguese seniors and pre-seniors. This paper is, thus, about the lives of the Portuguese population aged 50 and over.

Loneliness in Middle and Old Age

Purpose of the research: (a) To identify the degree of much loneliness reported in the Portuguese population over 50 years of age and (b) test whether loneliness can be predicted by socio-demographic, health related or social characteristic of the sample other than age. Materials and methods: 1174 late middle age and older adults were interviewed face to face by different interviewers across the country; after the informed consent was signed, we asked the participants several socio-demographic and health-related questions; finally we asked ‘‘How often do you feel lonely?’’ and participants responded according to a five point Likert scale. Principal results: The results showed that 12% of participants reporting feeling lonely often or always, whereas 40% reporting never feeling lonely. The remaining 48% self-reported they felt lonely seldom or sometimes. Additionally, results show that, when taken together, variables such as marital status, type of housing, residence settings, health conditions, social satisfaction, social isolation, lack of interest, transportation, and age were predictors of loneliness. Major conclusions: (1) The association of loneliness with advanced age has been greatly exaggerated by mass media and common sense; (2) But although our findings did not confirm the most alarmist views, the 12% of older adults reporting that they are feeling lonely always or often should be cause for attention and concern. It is necessary to understand the meaning, reasons and level of suffering implied on those feelings of loneliness. (3) Our findings suggest that it makes no sense to construe age as a singular feature or cause for feelings of loneliness. Instead, age and also a number of other features combine to predict feelings of loneliness. But even with our predictor variables there was a substantial of variance left unexplained. Therefore it is necessary to continue exploring how feelings of loneliness arise from the experience of living and how they can be changed.

Emoções mistas: integração social e académica dos alunos provenientes dos PALOP

RESUMO: A presente investigação teve como objectivo, conhecer as experiências emocionais que caracterizam os estudantes dos PALOP ao saberem que vão entrar no Ensino Superior em Portugal e durante o primeiro semestre; verificar se as emoções sentidas durante a frequência do primeiro semestre estão relacionadas com a sua integração social e académica. Participaram 100 alunos oriundos dos PALOP no primeiro ano do ensino superior português, de diferentes estabelecimentos de Ensino Superior, com idades entre os 20 e os 50 anos. Nesta investigação foram utilizados como instrumentos de medidas, as seguintes medidas: um Questionário sócio-demográfico, um questionário de experiências emocionais (Russell & Carroll); Escala de Emoções Mistas (AES, Carrera & Oceja, 2007); Teste de Positividade (Fredrickson, 2009); Escala de Integração Social e Académica (ISA, Silva; Abrantes, & Duarte (2009) e a Escala de Integração Social no Ensino Superior (EISES, Diniz & Almeida 2005). Concluímos assim que as emoções mistas mais sentidas são alegria e medo, assim como alegria e tristeza. Foi ainda possível concluir que o processo de integração está relacionado com um maior rácio da positividade na frequência do primeiro semestre. ABSTRACT: The objective of the present investigation is to know the emotional experiences that characterize the students of the African Countries with Portuguese as the Official Language while knowing that they are going to enter in the Superior Teaching in Portugal and during the first semester; to check if the emotions felt during the frequency of the first semester are connected with his social and academic integration. The participants were 100 pupils originating from the African Countries with Portuguese as the Official Language in the first year of the superior Portuguese teaching, of different establishments of Superior Teaching, with ages between the 20 and 50 years. In this investigation we used the following measures: a Questionnaire demographic-partner, a questionnaire of emotional experiences (Russell & Carroll); Analogical Emotional Scale (AES, Carrera & Oceja, 2007); Positivity Self-Test (Fredrickson, 2009); Scale of Social and Academic Integration (ISA, Silva, Abrantes, & Duarte, 2009) and the Scale of Social Integration in the Superior Teaching (EISES, Diniz & Almeida 2005). We concluded that the most felt mixed emotions are joy and fear, as well as joy and sadness. It was also possible to conclude that the process of integration is connected with a bigger ratio of the positivity during the frequency of the first semester.