Sociodemographic and Behavioural Determinants of a Healthy Diet in Switzerland.

BACKGROUND/AIMS: The determinants of a healthy diet have not been studied in Switzerland. This study aimed at assessing the individual and behavioural factors associated with a healthy diet in a Swiss city. METHODS: Cross-sectional, population-based study conducted between 2009 and 2013 (n = 4,439, 2,383 women, mean age 57.5 ± 10.3 years) in Lausanne. Food consumption was assessed using a validated food frequency questionnaire. Two Mediterranean diet scores (classic score and specific for Switzerland) and the Harvard School of Public Health alternate healthy eating index were computed. RESULTS: For all three dietary scores considered, living in couple or having a high education were associated with a healthier diet. An unhealthy lifestyle (smoking, sedentary behaviour) or a high body mass index were associated with an unhealthier diet. Participants born in Italy, Portugal and Spain had healthier diets than participants born in France or Switzerland. Women and elderly participants had healthier diets than men and young participants according to 2 scores, while no differences were found for the Swiss-specific Mediterranean score. CONCLUSIONS: In Switzerland, healthy eating is associated with high education, a healthy lifestyle, marital status and country of origin. The associations with gender and age depend on the dietary score considered.

Le point sur la pratique infirmière avancée [Update on advanced practice nursing].

NlmCategory="UNASSIGNED">We report outcomes of a clinical audit examining criteria used in clinical practice to rationalize endotracheal tube (ETT) suction, and the extent these matched criteria in the Endotracheal Suction Assessment Tool(ESAT)©. A retrospective audit of patient notes (N = 292) and analyses of criteria documented by pediatric intensive care nurses to rationalize ETT suction were undertaken. The median number of documented respiratory and ventilation status criteria per ETT suction event that matched the ESAT© criteria was 2 [Interquartile Range (IQR) 1-6]. All criteria listed within the ESAT© were documented within the reviewed notes. A direct link was established between criteria used for current clinical practice of ETT suction and the ESAT©. The ESAT©, therefore, reflects documented clinical decision making and could be used as both a clinical and educational guide for inexperienced pediatric critical care nurses. Modification to the ESAT© requires "preparation for extubation" to be added.

Long-Term Anticoagulant Therapy of Patients with Venous Thromboembolism. What Are the Practices?

Current guidelines of antithrombotic therapy suggest early initiation of vitamin K antagonists (VKA) in non-cancer patients with venous thromboembolism (VTE), and long-term therapy with low-molecular weight heparin (LMWH) for those with cancer. We used data from RIETE (international registry of patients with VTE) to report the use of long-term anticoagulant therapy over time and to identify predictors of anticoagulant choice (regarding international guidelines) in patients with- and without cancer. Among 35,280 patients without cancer, 82% received long-term VKA (but 17% started after the first week). Among 4,378 patients with cancer, 66% received long term LMWH as monotherapy. In patients without cancer, recent bleeding (odds ratio [OR] 2.70, 95% CI 2.26-3.23), age >70 years (OR 1.15, 95% CI 1.06-1.24), immobility (OR 2.06, 95% CI 1.93-2.19), renal insufficiency (OR 2.42, 95% CI 2.15-2.71) and anemia (OR 1.75, 95% CI 1.65-1.87) predicted poor adherence to guidelines. In those with cancer, anemia (OR 1.83, 95% CI 1.64-2.06), immobility (OR 1.51, 95% CI 1.30-1.76) and metastases (OR 3.22, 95% CI 2.87-3.61) predicted long-term LMWH therapy. In conclusion, we report practices of VTE therapy in real life and found that a significant proportion of patients did not receive the recommended treatment. The perceived increased risk for bleeding has an impact on anticoagulant treatment decision.

Life span and reproductive cost explain interspecific variation in the optimal onset of reproduction.

Fitness can be profoundly influenced by the age at first reproduction (AFR), but to date the AFR-fitness relationship only has been investigated intraspecifically. Here, we investigated the relationship between AFR and average lifetime reproductive success (LRS) across 34 bird species. We assessed differences in the deviation of the Optimal AFR (i.e., the species-specific AFR associated with the highest LRS) from the age at sexual maturity, considering potential effects of life history as well as social and ecological factors. Most individuals adopted the species-specific Optimal AFR and both the mean and Optimal AFR of species correlated positively with life span. Interspecific deviations of the Optimal AFR were associated with indices reflecting a change in LRS or survival as a function of AFR: a delayed AFR was beneficial in species where early AFR was associated with a decrease in subsequent survival or reproductive output. Overall, our results suggest that a delayed onset of reproduction beyond maturity is an optimal strategy explained by a long life span and costs of early reproduction. By providing the first empirical confirmations of key predictions of life-history theory across species, this study contributes to a better understanding of life-history evolution.

Comparison between open and laparoscopic elective cholecystectomy in elderly, in a teaching hospital

Objective: to analyze the differences in mortality rates, length of hospital stay, time of surgery and the conversion rate between elective open cholecystectomies (OC) and laparoscopic ones (LC) in elderly patients. Methods : we evaluated medical records of patients 65 years of age or older undergoing open or laparoscopic cholecystectomy at the Hospital Regional de Mato Grosso do Sul between January 2008 and December 2011. We excluded individuals operated in non-elective scenarios or who underwent intraoperative cholangiography. Results : we studied 113 patients, of whom 38.1% were submitted to the OC and 61.9%, to LC. Women accounted for 69% of patients and men, for 31%. The conversion rate was 2.9%. The mean age and duration of the procudure was 70.1 and 84 minutes, respectively, with no significant difference between OC and LC. Patients undergoing LC had shorter hospital stays (2.01 versus 2.95 days, p=0.0001). We identified operative complications in sixpatients (14%) after OC and in nine (12%) after LC, with no statistical difference. Conclusion : there was no difference in morbidity and mortality when comparing OC with LC. The laparoscopic approach led to shorter hospital stay. Operative time did not differ between the two access routes. The conversion rate was similar to other studies.

Effect of toxin-g from Tityus serrulatus scorpion venom on gastric emptying in rats

The effect of toxin-g from Tityus serrulatus scorpion venom on the gastric emptying of liquids was studied in 176 young adult male Wistar rats (2-3 months of age) divided into subgroups of 8 animals each. Toxin-g was injected iv at doses of 25, 37.5, 50 or 100 µg/kg and the effect on gastric emptying was assessed 30 min and 8 h later. A time-course study was also performed by injecting 50 µg of toxin-g /kg and measuring the effect on gastric emptying at times 0.25, 0.5, 1, 2, 4, 8, 24 and 48 h post-venom. Each envenomed animal was paired with its saline control and all received a saline test meal solution containing phenol red (60 µg/ml) as a marker. Ten minutes after administering the test meal by gavage the animals were sacrificed and gastric retention was determined by measuring the residual marker concentration of the test meal. A significant delay in gastric emptying, at 30 min and 8 h post-venom, was observed only after 50 and 100 µg of toxin-g /kg compared to control values. The responses to these two doses were significantly different after 8 h post-venom. Toxin-g (50 µg/kg) significantly delayed the gastric emptying of liquids at all times studied, with a peak response at 4 h after toxin administration compared to control values. These results indicate that the iv injection of toxin-g may induce a rapid, intense and sustained inhibition of gastric emptying 0.25 to 48 h after envenomation.

Nasopharyngeal colonization by pathogenic bacteria: effect of polymorphisms in innate immune genes of young children

Nasopharyngeal bacteria can asymptomatically colonize the nasopharynx of infants and young children but are also associated with the development of respiratory infections and diseases. Such nasopharyngeal bacteria include Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae and Staphylococcus aureus. The host defense against invading pathogens is largely relies germline-encoded pattern recognition receptors (PRR), which are expressed on the cells of innate immunity, and different cytokines. These include toll-like receptors (TLR), mannose-binding lectin (MBL) and different cytokines such as IL-17A. Single nucleotide polymorphisms (SNP) in these receptors and cytokines have been reported. The aim of this study was to investigate genetic polymorphisms in the genes for TLR2, 3 and 4, MBL as well as for IL-17A and their associations with nasopharyngeal pathogenic bacterial colonization during a two-year follow-up. The study revealed that polymorphisms in TLRs, MBL2 and IL17A are associated with the nasopharyngeal bacterial colonization in young children. Healthy young (2.6 months of age) children with variant types of MBL2, TLR2 R753Q or TLR4 D299G had an increased risk to be colonized by S. pneumonia, S. aureus or M. catarrhalis, respectively. Moreover, variant types of MBL2 in healthy children with might facilitate human rhinovirus (HRV)-induced S. pneumoniae colonization at 2.6 months of age. The polymorphism of TLR4 D299G was shown to be associated with M. catarrhalis colonization throughout the whole two-year follow-up (2.6, 13 and 24 months of age) and also with the bacterial load of this pathogen. Also, the polymorphism of IL17A G152A was shown to be associated with increased risk to be colonized by S. pneumoniae at 13 and 24 months of age. Furthermore, the results suggest that IL17A G152A has an effect on production of serum IL-17A already at young age. In conclusion, the results of this study indicate that polymorphisms in the key PRRs and IL17A seem to play an important role to colonization of S. pneumoniae, M. catarrhalis, and S. aureus in healthy young Finnish children. The nasopharyngeal colonization by these pathogenic bacteria may further promote the development of respiratory infections and may be related to development of asthma and allergy in the later life of children. These findings offer a possible explanation why some children have more respiratory infections than other children and provide a rational basis for future studies in this field.

A study of the abilities in oral language comprehension of the Boston Diagnostic Aphasia Examination - Portuguese version: a reference guide for the Brazilian population

We analyzed the performance of 162 normal subjects, subdivided into groups according to age and schooling, in the oral comprehension tasks of the Boston Diagnostic Aphasia Examination translated and adapted to Brazilian Portuguese to obtain a profile of performance for the Brazilian population, as well as cut-off scores for each task, and to determine the best combination of tasks that distinguish normal from aphasic subjects, as a guide for clinicians. The normal subjects were compared to 69 aphasics. Age alone influenced the performance in the designation of actions (subjects above 70 years showing the worst performance); schooling alone influenced the comprehension of forms, colors and numbers (subjects with less than four years of education showing a poorer performance). Both age and schooling influenced the performance in Body Part Identification (BPI) and Complex Ideational Material (CIM) with mean values of 70.5 ± 3.3 (Word Discrimination, WD), 18.9 ± 1.4 (BPI), 14.7 ± 0.9 (Commands), and 10.3 ± 1.7 (CIM) for the whole sample; the cut-off scores obtained were 65 (WD), 17.5 (BPI), 14 (Commands), and 9.5 (CIM) for the whole sample. Logistic regression showed that the combination of BPI + Commands + CIM was the most efficient in differentiating normal subjects from aphasics, with 72.5% sensitivity and 97.6% specificity. However, for low-education subjects, BPI and Commands were sufficient for this differentiation (75.7% sensitivity and 84.7% specificity). The main contribution of this study was to provide reference values that are far more representative of our population to be used by health professionals in Brazil, taking into account cultural differences.

Minor segmental wall motion abnormalities detected in patients with Chagas' disease have adverse prognostic implications

Recent data from our laboratory have shown that patients with the indeterminate form of Chagas' disease can have impairment of left ventricular contractility, as evaluated by the slope of the left ventricle end-systolic pressure-dimension relationship. We also showed that Chagas' disease patients with minimal baseline wall motion abnormalities detected by two-dimensional echocardiography have more intense contractility impairment when compared to patients with the indeterminate form of the disease without this abnormality. The prognostic implications of these findings have not been established. We evaluated 59 patients (37-76 years, mean = 55 years) with different clinical forms of Chagas' disease, who had normal left ventricular global systolic function at baseline (57.6 ± 6.9%) and who had at least one additional echo during clinical follow-up (0.4-17.6; mean 4.6 years). Group 1 consisted of 14 patients with minor baseline left ventricle wall motion abnormalities and group 2 consisted of 45 patients without these abnormalities. During follow-up, global left ventricle systolic function deterioration was observed in 10 group 1 patients (71.4%) and in only 10 group 2 patients (22.2%; P < 0.005). Age and duration of follow-up were not independent determinants of left ventricular function deterioration in these patients. The present data indicate that mild segmental left ventricular wall motion abnormalities are associated with worsening of systolic function in Chagas' disease patients who have normal baseline global systolic performance.

Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02)×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65)×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days) and had platelet counts of >20×109/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.

"Petit suisse" cheese from kefir: an alternative dessert with microorganisms of probiotic activity

"Petit Suisse" is a creamy cheese. Kefir is a symbiotic mixture of lactic acid bacteria and yeasts with probiotic activity including immunomodulation and balance of intestinal microflora. The present study aims to develop "Petit Suisse" cheese from kefir. Kefir grains were grown in pasteurized cow milk, and after the separation of kefir the serum was discarded and the "Petit Suisse" cheese was prepared using strawberry, mangaba, herbs, and dried tomatoes. The acceptance of the different preparations was evaluated using a nine-point hedonic scale followed by ANOVA. The sweet and salty products were compared by the Student's t-test. Purchase intent was evaluated by the means test and frequency distribution. All products were well accepted by the judges. The product was characterized by low yield, but it can be prepared at home at low cost. The nutritional composition analyses and the variety of flavors as well as the range of age of the judges are alternatives for further studies.

Bullying as a social process : factors influencing bystander behaviour

Bullying was approached as a social phenomenon in the present study. The central aim of this thesis was to uncover some of the factors that contribute to the attitudes and behavioural choices of bystanders during bullying situations. With this type of information, interventions can be tailored to change the behaviour of bystanders during bullying situations, and thus the ethos of the larger group. Thus, acting to alter the available sources of reinforcement for bullying behaviour and peer intervention attempts. Six hundred and twenty-six students participated. Students were sampled from grades 4 (n=140), 5 (n=l 13), 7 (n=205), and 8 (n=168). Students were measured for their involvement in bullying and victimization, as well as for involvement in the following bystander behaviours: encouraging, onlooking, defending, and seeking adult support. In addition, students were measured for tolerance of deviance, pro-victim attitudes, social anxiety and fear, and self-efficacy for peer intervention. Last, students were asked to complete a series of qualitative measures, including a series of hypothetical vignettes and open-ended questions. Analyses centered on the following areas: 1) rates of bullying, victimization, and bystander behaviour; 2) the influence of age and gender on bystander behaviour; 3) the characteristics associated with students who predominantly report involvement with defending, seeking adult assistance, encouraging, and onlooking behaviour; and 4) the influence of past involvement with bullying and victimization on bystander behaviour. b .--' -i . k Rates of bullying, victimization, and bystander behaviour were comparable to findings in the existing literature, where male students were more likely than female students to report involvement in both bullying and victimization. Boys were more likely than girls to report participation in encouraging and onlooking behaviours, while being less likely to report involvement in defending and seeking adult assistance. Partly consistent with existing findings, older students were more likely to report involvement in bullying, encouraging, and onlooking behaviour than younger students, who were more likely to report victimization, defending, and seeking adult assistance. Self-identified encouragers and onlookers reported a similar array of characteristics, in that they tended express high levels of tolerance of deviance, while expressing low levels of pro-victim attitudes and self-efficacy for peer intervention. Likewise, self-identified defenders and seekers of adult assistance tended to report a similar array of characteristics to each other, in that they tended to report low levels of tolerance of deviance, while expressing high levels of pro-victim attitudes and self efficacy for peer intervention. Additionally, self-identified bullies and self-identified bully-victims tended to report increased involvement in encouraging and onlooking, whereas self-identified victims tended to report increased involvement in defending behaviour and seeking adult assistance. Results are discussed in terms of implications for bullying prevention and intervention. Specifically, evidence from the present study suggests that as bystanders, students predominantly act to either support bullying acts or to support the victims of these acts, or alternatively, to actively remain outside bullying situations. Thus, encouraging students to make small changes in the way they express these sentiments during bullying situations would act to alter the culture of the larger peer group and the sources of reinforcement available for bullying acts as well as peer intervention attempts.

Evaluation of a stage II screening protocol for prostate cancer

In 2003, prostate cancer (PCa) is estimated to be the most commonly diagnosed cancer and third leading cause of cancer death in Canada. During PCa population screening, approximately 25% of patients with a normal digital rectal examination (DRE) and intermediate serum prostate specific antigen (PSA) level have PCa. Since all patients typically undergo biopsy, it is expected that approximately 75% of these procedures are unnecessary. The purpose of this study was to compare the degree of efficacy of clinical tests and algorithms in stage II screening for PCa while preventing unnecessary biopsies from occurring. The sample consisted of 201 consecutive men who were suspected of PCa based on the results of a DRE and serum PSA. These men were referred for venipuncture and transrectal ultrasound (TRUS). Clinical tests included TRUS, agespecific reference range PSA (Age-PSA), prostate specific antigen density (PSAD), and free-to-total prostate specific antigen ratio (%fPSA). Clinical results were evaluated individually and within algorithms. Cutoffs of 0.12 and 0.15 ng/ml/cc were employed for PSAD. Cutoffs that would provide a minimum sensitivity of 0.90 and 0.95, respectively were utilized for %fPSA. Statistical analysis included ROC curve analysis, calculated sensitivity (Sens), specificity (Spec), and positive likelihood ratio (LR), with corresponding confidence intervals (Cl). The %fPSA, at a 23% cutoff ({ Sens=0.92; CI, 0.06}, {Spec=0.4l; CI, 0.09}, {LR=1.56; CI, O.ll}), proved to be the most efficacious independent clinical test. The combination of PSAD (cutoff 0.15 ng/ml/cc) and %fPSA (cutoff 23%) ({Sens=0.93; CI, 0.06}, {Spec=0.38; CI, 0.08}, {LR=1.50; CI, 0.10}) was the most efficacious clinical algorithm. This study advocates the use of %fPSA at a cutoff of 23% when screening patients with an intermediate serum PSA and benign DRE.

Niagara Symphony Orchestra fonds, 1926, 1948-1998, n.d.

In 1948, The St. Catharines Civic Orchestra was founded by Jan Wolanek who was also the first conductor. Initially, this was a community orchestra and in 1963 its governing body assumed the name St. Catharines Symphony Association. In 1978 the name was again changed to The Niagara Symphony Association to reflect regional responsibilities. Wally Laughton was named Assistant Conductor in 1952/53. R.C. Clarke took over the orchestra for an interim period after Wolanek left in 1957. In 1958 Leonard Pearlman became the Music Director. It was under his direction that the Niagara Symphony Chorus came into existence in 1963. Milton Barnes succeeded Pearlman in 1964 and he was responsible for directing the symphony’s first opera production. He also made a concerted effort to attract younger people to symphonic music. In 1972 Leonard Atherton became the Music Director. He started the Cantata Choir and the Madrigal Singers. It was under his tenure that the orchestra became professional. When Atherton left in 1980, there were three seasons of guest conductors, the most notable of these conductors was Uri Mayer. In 1981 James Vincent Fusco was appointed as composer in residence and in 1983 Ermanno Florio became the Music Director. He retained this position until 1995 when Michael Reason took over. Daniel Swift was appointed as Music Director and Conductor in 1999 and the Niagara Symphony Orchestra became the orchestr in residence at Brock University. Laura Thomas was appointed as Associate Conductor 1n 2004. Daniel Swift’s resignation in 2008 began a search for a new Music Director. Bradley Thachuck was appointed as Music Director Designate and Principal Conductor in 2010. The orchestra is a fully professional, charitable institution with 52 members.The orchestra has also been led by Victor Feldbrill and Howard Cable. A junior symphony was first formed under Leonard Pearlman in 1960/61, but it wasn’t until 1965 that The St. Catharines Youth Orchestra was founded. The orchestra has consistently been an award winner in music festivals. The musicians range in age from 12 to 18 years. The highlight of the 1973-74 season was the orchestra’s participation in the first Canadian Festival of Youth Orchestras at The Banff School of Fine Arts. The St. Catharines Youth Orchestra has evolved from the St. Catharines School String and Brass Ensembles to a full scale symphony under the direction of conductor Paul van Dongen. In 1974 the Symphony House music program came into existence. It was 1976 when Richard Grymonpre was hired as the principal violinist of the St. Catharines Symphony Orchestra and conductor of the St. Catharines Youth Orchestra. Tak Ng Lai took over the position as conductor in 1978. Laura Thomas is currently the Music Director of The Niagara Youth Orchestra. Source: Niagara Symphony, Orchestra in Residence, Brock University website and notes from Niagara Symphony files

Estimation histologique de l’âge à la mort à partir du deuxième métacarpe chez l’humain

Cette étude teste l’hypothèse que le remodelage osseux dans le deuxième métacarpe peut être utilisé pour estimer l’âge à la mort. Les métacarpes utilisés dans cette analyse proviennent d’un cimetière d’Ontario, incluant des individus d’origine européenne (n=63; 34 hommes; 29 femmes). Leur âge varie de 19 à 61 ans (moyenne: 41,1±11,6). L’âge était connu ou a été estimé indépendamment à partir de la morphologie générale du squelette. À partir de lames minces coupées à la mi-diaphyse, la densité de population des ostéons (OPD; ostéons/mm2 intacts et fragmentaires) a été calculée pour huit colonnes du périoste à l’endoste, deux par quadrant anatomique. Les régressions par calibration classique ont produit une série d’équation pour les estimations de l’âge pour chaque sexe, sexes combinés, et en fonction de la latéralité. La méthode utilisée diminue l’efficacité des estimations mais elle a l’avantage de réduire les biais. Quand les sexes sont combinés, l’OPD est corrélé modérément mais significativement avec l’âge (droit r2= 0,35; gauche r2=0,28). Cependant, quand les hommes et les femmes sont analysés séparément, la corrélation entre l’OPD et l’âge dans l’échantillon féminin est meilleure (droit r2=0,48; gauche r2=0,39) alors que celle des hommes est réduite (droit r2=0,29; gauche r2=0,22). Ce résultat a déjà été observé dans d’autres études, mais n’est pas expliqué. Les résultats démontrent aussi une meilleure corrélation entre l’OPD et l’âge du côté droit que du côté gauche. Tous les résultats présentés ici supportent l’hypothèse que l’OPD du métacarpe est corrélé avec l’âge effectif (c’est-à-dire connu ou estimé), les régressions de l’OPD sur l’âge (droit-gauche combinés ou séparés, sexes combinés ou séparés) étant toutes significatives.