Effects of the Mediterranean diet and exercise in subjects with coronary artery disease

Introduction The association of the Mediterranean diet and exercise appears to have a protective role, reducing cardiovascular risk. This study investigated the effects of education sessions on the Mediterranean diet and an exercise program in modifying eating behaviors, body composition and abdominal fat. Methods An experimental study was performed on 20 subjects with known coronary heart disease randomly assigned to experimental (n=10) and control (n=10) groups. Both groups received education sessions on the Mediterranean diet, but the experimental group also followed an eight-week program of specific exercises. A semiquantitative food frequency questionnaire was administered to analyze food intake, bioimpedance was used to measure weight, fat mass and lean mass, and waist circumference was measured to calculate waist-to-height ratio. Results After eight weeks, protein (p<0.05) and cholesterol (p<0.05) intake in the experimental group had decreased significantly compared with the control group. Between the beginning and end of the study, there were significant decreases in the control group in carbohydrate (p<0.05) and saturated fat intake (p<0.05). In both groups the percentage of total fat (p<0.05) and fat mass (p<0.05) was significantly decreased. In the experimental group the waist-to-height ratio was significantly reduced (p<0.05). Conclusion The Mediterranean diet reduced carbohydrate and saturated fat intake, reflected in reduced fat mass. The association of the exercise program showed additional benefits in reduction of protein and cholesterol intake and abdominal fat.

Predição precoce de risco de Pré-eclâmpsia na doença hipertensiva e diabetes na gravidez: Papel de fatores angiogénicos

RESUMO: A pré-eclâmpsia tem elevada morbi-mortalidade materna e perinatal. A sua etiologia multi-fatorial tem sido objeto de investigação, não sendo ainda totalmente conhecida. Não se conhece também a razão da diferente suscetibilidade individual e das diferentes expressões da doença. A hipertensão crónica e a diabetes são fatores de risco reconhecidos, e o adiamento da maternidade contribui para que estas duas patologias sejam atualmente mais prevalentes entre as mulheres grávidas. Uma vez que o seu quadro fisiopatológico precede em meses o quadro clínico, tem-se investigado a possibilidade de serem encontrados marcadores precoces e indicadores de risco. Em Portugal, os estudos relativos à hipertensão na gravidez são escassos, bem como a investigação sobre fatores de risco e marcadores para a mesma. No sentido de avaliar possíveis marcadores de risco para o desenvolvimento de préeclâmpsia ou complicações hipertensivas foi colhida, para esta dissertação, uma amostra de 1215 mulheres que frequentaram a consulta de Hipertensão ou de Diabetes na gravidez de um centro terciário, entre 2004 e 2013. Optou-se pela realização de três estudos independentes, abrangendo os dois primeiros um leque temporal de 9 e de 2 anos respetivamente. O primeiro, centrado na hipertensão, pesquisou, em 521 mulheres com hipertensão na presente ou em anterior gravidez, fatores de risco capazes de influenciar a progressão para pré-eclâmpsia. O segundo, direcionado para a diabetes gestacional, considerou uma amostra de 334 grávidas, parte das quais tinha também hipertensão crónica e procurou identificar fatores que contribuíram para o aparecimento de complicações hipertensivas. O terceiro estudo, realizado em 2012 e 2013, em três coortes de grávidas com hipertensão crónica, com diabetes gestacional, e sem estas patologias - procurou avaliar no 1º trimestre o comportamento de dois marcadores placentares obtidos no 1º trimestre - proteína plasmática A associada à gravidez (PAPP-A) e o fator de crescimento placentar (PlGF) - e o seu papel, quer como bio-marcadores isolados, quer em associação aos fatores de risco encontrados nos anteriores estudos, na construção de um modelo preditivo de préeclâmpsia. No primeiro estudo, a nuliparidade, a hipertensão gestacional, a fluxometria das artérias uterinas com IP superiores ao P95 entre as 20-22 semanas e a existência de restrição de crescimento fetal, foram os fatores que contribuíram para a construção de um modelo preditivo de pré-eclâmpsia. No segundo estudo, a coexistência de diabetes e hipertensão crónica agravou o prognóstico, associando-se as complicações hipertensivas à multiparidade, obesidade, idade materna e etnia negra. No terceiro estudo verificou-se uma redução da PlGf e da PAPP-A no 1º trimestre nas duas primeiras coortes, comparativamente à coorte sem patologia; na análise separada de cada coorte, quando se verificaram complicações hipertensivas ou pré-eclâmpsia, as concentrações de PlGf e PAPP-A também foram inferiores. Contudo, na elaboração de um modelo preditivo de pré-eclâmpsia, em conjunto com marcadores encontrados, apenas a PlGf pode ser integrada no modelo preditivo, o que se verificou na coorte com hipertensão crónica. Os marcadores bioquímicos em estudo tiveram valores inferiores nas coortes com patologia hipertensiva, demonstrando uma deficiente produção destas proteínas placentares nestas situações, podendo ser importante a sua pesquisa. Contudo, neste estudo, apenas na coorte de hipertensão crónica a PlGf teve participação como fator de risco, na construção de um modelo preditivo de pré-eclâmpsia.--------------------------------------------------------------------------------------------------ABSTRACT: Preeclampsia is associated with a great maternal and perinatal morbimortality. Its multifactorial etiology has been under investigation and is still insufficiently understood. The reason why there are differences in individual susceptibility and differences in expressions of the disease is still unknown. Chronic hypertension and diabetes are known risk factors for preeclampsia and maternity delay contributes to the great prevalence of these pathologies among pregnant women. As the physiopathological signs antedate by months the clinical course of the disease, early risk factors and biological markers are object of clinical research. In Portugal, scarce clinical studies were devoted to hypertension in pregnancy and to risk factors and markers of this pathology. This dissertation inquires 1215 pregnant women who were treated for hypertension or diabetes in a tertiary care center between 2004 and 2013, in order to find risk markers for hypertensive complications or preeclampsia. We conducted three independent studies for this purpose. In the first one we investigated which risk factors could influence the progression to preeclampsia in 521 pregnant women with present or past history of hypertension. The second one was conducted to find what factors were associated to hypertensive complications, with a sample of 334 pregnant women with gestational diabetes, some also with chronic hypertension, addressing the identification of the factors contributing to hypertensive complications. The third study was conducted between 2012 and 2013 with three cohorts of pregnant women, with chronic hypertension, gestational diabetes, and in the third one, pregnant women had a low risk pregnancy. The objective of the study was to evaluate the behavior of two placental markers – PAPP-A and PlGf – obtained in the first trimester, and the role of these markers as isolated biomarkers or in association with other risk factors, in order to define a predictive model of early preeclampsia. In the first study, nuliparity, gestational hypertension, uterine arteries doppler with PI above P95 between 20-22 weeks of gestation and the presence of fetal growth restriction were the markers involved in a predictive model for preeclampsia. In the second study the cohort with the coexistence of diabetes and hypertension had registered worse result and hypertensive complications were associated to multiparity, obesity, maternal age and black ethnicity. In the third study there was a reduction of the PlGf and a PAPP-A concentration for the first trimester in the two first cohorts comparatively to the low risk cohort; the separate analysis of each cohort showed that plGf and PAPP-A concentrations were reduced when hypertensive complications appeared. However, when trying to find a preeclampsia predictive model, only plGf gave significant results for being considered in the model and this was only possible in the chronic hypertension cohort. The biochemical markers investigated in this study were reduced in the cohorts when high blood pressure complications occurred, showing a defective production of these placenta proteins, and suggesting that they should be investigated as first trimester biomarkers. Nevertheless, for this research, in the cohort of chronic hypertension only PlGf had a significant result, when multivariate analysis of all the risk factors was considered for the construction of a preeclampsia predictive model.

Financial impact of introducing the Swiss-DRG reimbursement system on potentially avoidable readmissions at a university hospital.

QUESTION UNDER STUDY: Thirty-day readmissions can be classified as potentially avoidable (PARs) or not avoidable (NARs) by following a specific algorithm (SQLape®). We wanted to assess the financial impact of the Swiss-DRG system, which regroups some readmissions occurring within 18 days after discharge within the initial hospital stay, on PARs at our hospital. METHODS: First, PARs were identified from all hospitalisations recorded in 2011 at our university hospital. Second, 2012 Swiss-DRG readmission rules were applied, regrouped readmissions (RR) were identified, and their financial impact computed. Third, RRs were classified as potentially avoidable (PARRs), not avoidable (NARRs), and others causes (OCRRs). Characteristics of PARR patients and stays were retrieved, and the financial impact of PARRS was computed. RESULTS: A total of 36,777 hospitalisations were recorded in 2011, of which 3,140 were considered as readmissions (8.5%): 1,470 PARs (46.8%) and 1,733 NARs (53.2%). The 2012 Swiss-DRG rules would have resulted in 910 RRs (2.5% of hospitalisations, 29% of readmissions): 395 PARRs (43% of RR), 181 NARRs (20%), and 334 OCRRs (37%). Loss in reimbursement would have amounted to CHF 3.157 million (0.6% of total reimbursement). As many as 95% of the 395 PARR patients lived at home. In total, 28% of PARRs occurred within 3 days after discharge, and 58% lasted less than 5 days; 79% of the patients were discharged home again. Loss in reimbursement would amount to CHF 1.771 million. CONCLUSION: PARs represent a sizeable number of 30-day readmissions, as do PARRs of 18-day RRs in the 2012 Swiss DRG system. They should be the focus of attention, as the PARRs represent an avoidable loss in reimbursement.

Estructura del subsistema demersal durante el verano 2004.Crucero BIC Olaya 0401-02.

El Crucero BIC Olaya 0401-02 se efectuó del 14 enero al 7 febrero 2004, de Puerto Pizarro (3°29’S) a Punta Pacasmayo (7°23’S). Se utilizó la red de arrastre Granton 300/160. Se efectuaron 87 arrastres de fondo, la captura total fue 42.015,8 kg, constituida por 169 especies: peces (102), crustáceos (32), moluscos (21), equinodermos (9), cnidarios (4) y anélidos (1). Las especies más importantes fueron: merluza peruana, Merluccius gayi peruanus (31.429,42 kg; 75% del total); bereche con barbo, Ctenosciaena peruviana (2815,67 kg; 6,7%); pota, Dosidicus gigas (1.777,27 kg; 4,2%); lenguado ojón, Hippoglossina macrops (611,82 kg; 1,5%); chiri Peprilus medius (543,67 kg; 1,3%); y el pampanito, Peprilus snyderi (497,54 kg; 1,2%). En conjunto, estas seis especies, representaron el 90% del monto total. Esta diversidad es similar al verano 2003 y también la distribución de los peces, cuya mayor diversidad específica se encontró al norte de Punta Aguja (6°S), indicando condiciones de normalidad.

Hematopoietic stem cell transplantation in Switzerland: a comprehensive quality control report on centre effect.

Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.

Helsingin ja Espoon rannikkoalueen tulvariskien hallintasuunnitelma vuosille 2016 - 2021

Suomen vesistöjen varsilla ja merenrannikolla on 21 tunnistettua merkittävää tulvariskialuetta. Kullekin merkittävälle alueelle on laadittu tulvariskien hallintasuunnitelmat. Tämä Helsingin ja Espoon rannikkoalueen tulvariskien hallintasuunnitelma sisältää tavoitteet ja toimenpiteet pääkaupunkiseudun ranta-alueiden sekä lähisaariston tulvariskien minimoimiseksi. Suunnitelman laatimista varten nimetyssä ryhmässä ovat olleet edustettuna Uudenmaan liitto, Helsingin ja Espoon kaupungit, Helsingin ja Länsi-Uudenmaan pelastuslaitokset sekä Uudenmaan ELY-keskus. Lisäksi työssä on ollut mukana asiantuntijaroolissa Helsingin Seudun Ympäristöpalvelut –kuntayhtymä HSY. Keskeisiä sidosryhmiä on kuultu tarpeen mukaan. Helsingin ja Espoon ranta-alueet ovat monimuotoisia vaihdellen jyrkistä kalliorannoista aina ruovikkoisiin ja mataliin merenlahtiin. Osa alavista mereen laskevista puroista ulottuu pitkälle sisämaahan laajentaen meritulvan vaikutusaluetta jopa useita kilometrejä rannikosta. Pääkaupunkiseudulle tyypillisesti ranta-alueita peittää yhä tihenevä asutus. Rannikon läheisyydessä sijaitsee asutuksen lisäksi mm. useita teollisuuden ja yhdyskuntatekniikan kohteita, alavia teitä sekä satamia. Helsingin erityispiirteenä ovat lisäksi maanalaiset tilat ja tunnelit. Tulvariskien hallinnan tavoitteena on mm. asuinrakennusten, vaikeasti evakuoitavien kohteiden, yhdyskuntatekniikan rakenteiden, merkittävien liikenneyhteyksien, satamien, ympäristölle vahingollisten kohteiden, kulttuuriperintökohteiden sekä muun rakennuskannan turvaaminen merenpinnan noustessa. Lisäksi tavoitteena ovat mm. omaisuusvahinkojen minimoiminen sekä ilmastonmuutoksen huomioon ottaminen tulvaturvallisessa rakentamisessa. Tavoitteisiin pyritään varautumisen lisäksi sekä tulvan aikana että tulvan jälkeen tehtävillä toimenpiteillä. Toimenpiteet eivät ole ristiriidassa vesienhoidon tavoitteiden kanssa. Helsingin ja Espoon rannikkoalueella eräs keskeisimmistä tulvariskiä vähentävistä toimenpiteistä on tulva-alueiden ja ilmastonmuutoksen huomioiminen maankäytön suunnittelussa. Tulvavaara-alueille rakentamista tulee lähtökohtaisesti välttää, ja toimintojen sijoittamisessa tulee ottaa huomioon suositukset alimmista rakentamiskorkeuksista. Olemassa olevien riskikohteiden osalta tulee varmistua ajantasaisista ja toimivista varautumissuunnitelmista. Asukkaiden omatoimisen varautumisen edellytyksiä tulee parantaa mm. tulvatietoisuutta lisäämällä. Suunnitelmassa on tunnistettu myös useita alueellisia ja paikallisia suojaustarpeita.

Le Roman de Tristan [de LUCE DE GAST], première partie.

Commençant par : « Apres ce que je ai leu et releu... » et finissant par : «... Si bien leur estoit avenu de la force de Sassoigne, que il orrent emprisonnée » . Cette partie va jusqu'à la destruction de la flotte saxonne par les habitants de Cornouailles.

L'Écho de Paris

1885/02/08 (Numéro 334).

Résistance : bulletin officiel du Comité national de salut public

1940/12/15 (N1).

Résistance : bulletin officiel du Comité national de salut public

1941/01/31 (N3).

Résistance : bulletin officiel du Comité national de salut public

1940/12/30 (N2).

Résistance : bulletin officiel du Comité national de salut public

1941/03/01.