Síndrome de fragilidade relacionada à incapacidade funcional no idoso

OBJETIVOS: Caracterizar o perfil sociodemográfico de idosos, verificar os níveis de fragilidade segundo sexo, independência funcional e atividades instrumentais da vida diária e correlacionar as dimensões da Medida da Independência Funcional e Atividades Instrumentais da Vida Diária com idade, escolaridade, fragilidade e morbidades. MÉTODOS: Estudo de natureza observacional e transversal utilizando amostra de 240 idosos que residiam em Ribeirão Preto, São Paulo. O período de coleta foi de novembro/2010 e fevereiro/2011. Os questionários: perfil sociodemográfico, Escala de Fragilidade de Edmonton, Medida da Independência Funcional e Escala de Lawton e Brody foram utilizados. Para análise, foram empregados a estatística descritiva e o teste t-student e Pearson. RESULTADOS: A média de idade foi de 73,5 anos (±8,4), 57,5% eram casados, 39,1% apresentaram algum nível de fragilidade. Entre os idosos frágeis, 29,8% tinham dependência mínima/supervisão, e 81,9% dependência parcial para as atividades instrumentais da vida diária. CONCLUSÃO: Evidenciou-se maior dependência para as atividades nos idosos frágeis, sendo o sexo feminino com maior prevalência de fragilidade.

Sobrecarga de trabalho em cuidadores de idosos fragilizados que vivem no domicílio

OBJETIVOS: Avaliar a sobrecarga dos cuidadores de idosos fragilizados que residem no domicílio; caracterizar os idosos que são considerados frágeis e seus cuidadores; avaliar o grau de dependência dos idosos de acordo com o nível de fragilidade e correlacioná-lo com a sobrecarga de trabalho dos seus cuidadores. MÉTODOS: Estudo transversal com amostra de 60 cuidadores e de idosos frágeis, que viviam no domicílio. A coleta de dados realizada no domicílio com idosos frágeis e seus cuidadores. Utilizaram-se os instrumentos de perfil sociodemográfico do idoso e do cuidador, a Escala de Fragilidade de Edmonton, a Medida da Independência Funcional para os idosos e a Escala Zarit Burden Interview, para os cuidadores. Para a análise foram empregados a estatística descritiva e o teste de Pearson. RESULTADOS: A maioria dos cuidadores era do sexo feminino (75%), casados (58,3%) e, 45% eram filhos. Quanto à sobrecarga, 31,7% responderam que raramente se sentiam sobrecarregados. Mas, houve correlação entre a fragilidade e a sobrecarga, ou seja, quanto maior o nível de fragilidade, maior a sobrecarga do cuidador. CONCLUSÃO: Evidenciou-se a maioria dos cuidadores do sexo feminino e quanto maior o grau de dependência funcional, maior o grau de fragilidade o que eleva o nível de sobrecarga do cuidador.

Qualidade de vida em idosos que sofreram quedas: revisão integrativa da literatura

Foi realizada uma Revisão Integrativa da Literatura com o objetivo de avaliar o conhecimento científico produzido relacionado à qualidade de vida do idoso que sofreu quedas. Métodos: foram selecionados artigos publicados nas bases de dados Lilacs, CINAHL e Medline, com os seguintes descritores: qualidade de vida, idoso e acidentes por quedas, nos idiomas português, inglês e espanhol, entre 1999 e 2009. Resultados: nove artigos atenderam aos critérios de inclusão. Encontrou-se que as quedas são frequentes nos idosos, sendo que aqueles com mais fatores de risco intrínsecos e que já caíram apresentaram mais medo e possuem mais chance de caírem novamente; e também relataram déficits nas funções física, mental/emocional, dor corporal e relacionados ao meio ambiente e que programas de prevenção de quedas podem melhorar sua qualidade de vida com o tempo. Conclusão: evidenciou-se como lacunas no conhecimento: escassa produção científica nacional, principalmente de autores enfermeiros, e predomínio de estudos descritivos e com nível de evidência considerado fraco. Sugere-se a atuação dos profissionais de saúde em pesquisas de intervenções para prevenção de quedas as quais possam ser aplicadas na prática clínica e que possibilitem melhorar a qualidade de vida dos idosos.

Meningoencephalitis associated with Mycoplasma pneumoniae

We report a case of a child with meningoencephalitis of atypical etiology. The patient developed the disease after an infection in the upper airways with unfavorable evolution. The clinical recovery was only possible after the administration of adequate antibiotic therapy for the etiological agent. This case report describes a child with meningoencephalitis of atypical etiology. The patient developed the disease after an infection in the superior airways with negative evolution. The clinical recovery was possible only after the introduction of adequate antibiotic therapy for the etiological agent.

Maduración y obtención de puestas de Seriola rivoliana en Canarias

The almaco jack Seriola rivoliana belongs to the Carangidae family of fishes. These species are an important resource for recreational and commercial fisheries worldwide. Among other attributes, almaco jack has being identified as potentially aquaculture species due to their fast growth, excellent flesh quality and significant market opportunities internationally. The present work describes the establishment of broodstock of Seriola rivoliana in the Instituto Canario de Ciencias Marinas from year 2006 to 2009 and subsequent maturation and spawning. Twenty sub adults were captured by local fisherman in the South coast of Gran Canaria in may 2006. Adaptation to culture conditions in tanks and inert food was successfully carried out just after one moth of capture. Initial fish weight (1,76± 0,25kg), was increased to 6,0±1,1kg in july 2009. Every year fish were sampled to determine individual growth in weight and size. In addition, the evolution of its sexual maturity state was established by gonadal biopsy. In July 2009, the use of hormonal injection (LHRH) results in two successful spawns with 42% of viable eggs.

Desarrollo embrionario y estudio morfométrico de la fase lecitotrófica de larvas de medregal negro (Seriola rivoliana Valenciennes, 1883)

[EN]The present study describes the main embryonic stages and larval development, in culture conditions, of the almaco jack until the fifth day of life. Also a morphometric study of the eggs and larvae from induced spawning was realized. Larval hatching occurred at 36 hours from fertilization. At 60 hours after hatching, 100% of the larvae had their mouths open. At 72 hours all the larvae had a swimming bladder and a digestive tract sufficiently formed to start exogenous feeding.

Tecniche regionali di stima della portata di progetto: Impatto della correlazione spaziale tra le serie di osservazioni

La stima degli indici idrometrici in bacini non strumentati rappresenta un problema che la ricerca internazionale ha affrontato attraverso il cosiddetto PUB (Predictions on Ungauged Basins – IAHS, 2002-2013). Attraverso l’analisi di un’area di studio che comprende 61 bacini del Sud-Est americano, si descrivono e applicano due tecniche di stima molto diverse fra loro: il metodo regressivo ai Minimi Quadrati Generalizzati (GLS) e il Topological kriging (TK). Il primo considera una serie di fattori geomorfoclimatici relativi ai bacini oggetto di studio, e ne estrae i pesi per un modello di regressione lineare dei quantili; il secondo è un metodo di tipo geostatistico che considera il quantile come una variabile regionalizzata su supporto areale (l’area del bacino), tenendo conto della dislocazione geografica e l’eventuale struttura annidata dei bacini d’interesse. L’applicazione di questi due metodi ha riguardato una serie di quantili empirici associati ai tempi di ritorno di 10, 50, 100 e 500 anni, con lo scopo di valutare le prestazioni di un loro possibile accoppiamento, attraverso l’interpolazione via TK dei residui GLS in cross-validazione jack-knife e con differenti vicinaggi. La procedura risulta essere performante, con un indice di efficienza di Nash-Sutcliffe pari a 0,9 per tempi di ritorno bassi ma stazionario su 0,8 per gli altri valori, con un trend peggiorativo all’aumentare di TR e prestazioni pressoché invariate al variare del vicinaggio. L’applicazione ha mostrato che i risultati possono migliorare le prestazioni del metodo GLS ed essere paragonabili ai risultati del TK puro, confermando l’affidabilità del metodo geostatistico ad applicazioni idrologiche.

Rigorous results in Spin Glasses and Monomer-Dimer systems

In this work I reported recent results in the field of Statistical Mechanics of Equilibrium, and in particular in Spin Glass models and Monomer Dimer models . We start giving the mathematical background and the general formalism for Spin (Disordered) Models with some of their applications to physical and mathematical problems. Next we move on general aspects of the theory of spin glasses, in particular to the Sherrington-Kirkpatrick model which is of fundamental interest for the work. In Chapter 3, we introduce the Multi-species Sherrington-Kirkpatrick model (MSK), we prove the existence of the thermodynamical limit and the Guerra's Bound for the quenched pressure together with a detailed analysis of the annealed and the replica symmetric regime. The result is a multidimensional generalization of the Parisi's theory. Finally we brie y illustrate the strategy of the Panchenko's proof of the lower bound. In Chapter 4 we discuss the Aizenmann-Contucci and the Ghirlanda-Guerra identities for a wide class of Spin Glass models. As an example of application, we discuss the role of these identities in the proof of the lower bound. In Chapter 5 we introduce the basic mathematical formalism of Monomer Dimer models. We introduce a Gaussian representation of the partition function that will be fundamental in the rest of the work. In Chapter 6, we introduce an interacting Monomer-Dimer model. Its exact solution is derived and a detailed study of its analytical properties and related physical quantities is performed. In Chapter 7, we introduce a quenched randomness in the Monomer Dimer model and show that, under suitable conditions the pressure is a self averaging quantity. The main result is that, if we consider randomness only in the monomer activity, the model is exactly solvable.

When Beauty Goes to Sleep: an analysis of the symbolism behind the sleeping beauty tale

Approaching the world of the fairy tale as an adult, one soon realizes that things are not what they once seemed during story time in bed. Something that once appeared so innocent and simple can become rather complex when digging into its origin. A kiss, for example, can mean something else entirely. I can clearly remember my sister, who is ten years older than I am, telling me that the fairy tales I was told had a mysterious hidden meaning I could not understand. I was probably 9 or 10 when she told me that the story of Sleeping Beauty, which I used to love so much in Disney’s rendering, was nothing more than the story of an adolescent girl, with all the necessary steps needed to become a woman, the bleeding of menstruation and the sexual awakening - even though she did not really put it in these terms. This shocking news troubled me for a while, so much so that I haven’t watched that movie since. But in reality it was not fear that my sister had implanted in me: it was curiosity, the feeling that I was missing something terribly important behind the words and images. But it was not until last year during my semester abroad in Germany, where I had the chance to take a very interesting English literature seminar, that I fully understood what I had been looking for all these years. Thanks to what I learned from the work of Bruno Bettelheim, Jack Zipes, Vladimir Propp, and many other authors that wrote extensively about the subject, I feel I finally have the right tools to really get to know this fairy tale. But what I also know now is that the message behind fairy tales is not to be searched for behind only one version: on the contrary, since they come from oral traditions and their form was slowly shaped by centuries of recountals and retellings, the more one digs, the more complete the understanding of the tale will be. I will therefore look for Sleeping Beauty’s hidden meaning by looking for the reason why it did stick so consistently throughout time. To achieve this goal, I have organized my analysis in three chapters: in the first chapter, I will analyze the first known literary version of the tale, the French Perceforest, and then compare it with the following Italian version, Basile’s Sun, Moon, and Talia; in the second chapter, I will focus on the most famous and by now classical literary versions of Sleeping Beauty, La Belle Au Bois Dormant, written by the Frenchman, Perrault, and the German Dornröschen, recorded by the Brothers Grimm’s; finally, in the last chapter, I will analyze Almodovar’s film Talk to Her as a modern rewriting of this tale, which after a closer look, appears closely related to the earliest version of the story, Perceforest.

Metodi per la stima spaziale della temperatura in territori ad orografia complessa e parametrizzazione di un modello idrologico semi-distribuito su alcuni bacini appenninici

I bacini idrografici appenninici romagnoli rappresentano una fonte idropotabile di essenziale importanza per la Romagna, grazie alla regolazione stagionale svolta dall’invaso artificiale di Ridracoli. Nel presente elaborato si è implementato un modello per lo studio e la valutazione del regime idrologico dei bacini idrografici allacciati all’invaso, affrontando sia gli aspetti relativi alla miglior spazializzazione dei dati metereologici in ingresso al modello (in particolare in relazione alla stima della temperatura, fondamentale per la rappresentazione dei processi di evapotraspirazione e dei fenomeni di accumulo e scioglimento nevoso), sia gli aspetti di calibrazione dei parametri, confrontando le simulazioni ottenute a partire da diverse configurazioni del modello in termini di rappresentazione spaziale e temporale dei fenomeni. Inoltre si è eseguita una regionalizzazione del modello su due sezioni fluviali che sono al momento oggetto di indagini idrologiche, fornendo supporto alla valutazione della possibilità di realizzazione di una nuova opera di presa. A partire dai dati puntuali dei sensori termometrici disponibili si è ricercata la migliore tecnica di interpolazione della temperatura sull’area di studio, ottenendo una discreta precisione, con un errore in procedura di ricampionamento jack-knife raramente superiore al grado centigrado. La calibrazione del modello TUWien in approccio semi-distribuito, sia quando applicato a scala oraria sia quando applicato a scala giornaliera, ha portato a buoni risultati. La complessità del modello, dovuta in gran parte alla presenza di uno specifico modulo per la gestione di accumulo e scioglimento nivale, è stata ripagata dalle buone prestazioni delle simulazioni ottenute, sia sul periodo di calibrazione sia su quello di validazione. Tuttavia si è osservato che l’approccio semi-distribuito non ha portato benefici sostanziali rispetto a quello concentrato, soprattutto in relazione al forte aumento di costo computazionale.

Successful treatment of childhood high-risk hepatoblastoma with dose-intensive multiagent chemotherapy and surgery: final results of the SIOPEL-3HR study

The primary objective was to determine the efficacy of a newly designed preoperative chemotherapy regimen in an attempt to improve the cure rate of children with high-risk hepatoblastoma.

Genome-wide meta-analysis increases to 71 the number of confirmed Crohn's disease susceptibility loci

We undertook a meta-analysis of six Crohn's disease genome-wide association studies (GWAS) comprising 6,333 affected individuals (cases) and 15,056 controls and followed up the top association signals in 15,694 cases, 14,026 controls and 414 parent-offspring trios. We identified 30 new susceptibility loci meeting genome-wide significance (P < 5 × 10 ? ? ). A series of in silico analyses highlighted particular genes within these loci and, together with manual curation, implicated functionally interesting candidate genes including SMAD3, ERAP2, IL10, IL2RA, TYK2, FUT2, DNMT3A, DENND1B, BACH2 and TAGAP. Combined with previously confirmed loci, these results identify 71 distinct loci with genome-wide significant evidence for association with Crohn's disease.

Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: executive summary

With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. They have distinctive forms of heart failure, and their cardiac disease can be associated with pulmonary hypertension, thromboemboli, complex arrhythmias and sudden death.Medical aspects that need to be considered relate to the long-term and multisystemic effects of single-ventricle physiology, cyanosis, systemic right ventricles, complex intracardiac baffles and failing subpulmonary right ventricles. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the understanding of the late outcomes, genetics, medical therapy and interventional approaches in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. The present executive summary is a brief overview of the new guidelines and includes the recommendations for interventions. The complete document consists of four manuscripts that are published online in the present issue of The Canadian Journal of Cardiology, including sections on genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy and contraception risks, and follow-up requirements. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.

Urinary soluble HLA-DR is a potential biomarker for acute renal transplant rejection

BACKGROUND.: Urine is a potentially rich source of biomarkers for monitoring kidney dysfunction. In this study, we have investigated the potential of soluble human leukocyte antigen (sHLA)-DR in the urine for noninvasive monitoring of renal transplant patients. METHODS.: Urinary soluble HLA-DR levels were measured by sandwich enzyme-linked immunosorbent assay in 103 patients with renal diseases or after renal transplantation. sHLA-DR in urine was characterized by Western blotting and mass spectrometry. RESULTS.: Acute graft rejection was associated with a significantly elevated level of urinary sHLA-DR (P<0.0001), compared with recipients with stable graft function or healthy individuals. A receiver operating characteristic curve analysis showed the area under the curve to be 0.88 (P<0.001). At a selected threshold, the sensitivity was 80% and specificity was 98% for detection of acute renal transplant rejection. sHLA-DR was not exosomally associated and was of lower molecular weight compared with the HLA-DR expressed as heterodimer on the plasma membrane of antigen-presenting cells. CONCLUSIONS.: sHLA-DR excreted into urine is a promising indicator of renal transplant rejection.