Advancing age and bleeding risk are the strongest barriers to anticoagulant prescription in atrial fibrillation

In clinical practice many patients with atrial fibrillation (AF) at high thromboembolic risk fail to receive adequate oral anticoagulation (OAC) [1]. The complex management of anticoagulant therapy [frequent international normalised ratio (INR) monitoring because of narrow therapeutic window, interaction with food and alcohol, concomitant medications and comorbities], the overestimation of bleeding risk and the underestimation of stroke risk, may partially explain physicians' reluctance to prescribe anticoagulation. In the current issue of Age and Ageing, Pugh and Mead [2] report a systematic review on physicians' attitudes concerning anticoagulant treatment among AF patients. Through surveys (questionnaire, clinical vignette and interview) on hypothetical case scenarios, they have identified the barriers to effective anticoagulant prescription, as follows: increasing age, bleeding risk or previous bleeding, fall risk, co-morbidities (e.g. chronic alcoholism or cognitive impairment) and lack of compliance. In particular, advanced age has been reported as the most striking reason for with-holding anticoagulation, while risk of falls and previous bleeding are also disproportionate barriers to warfarin prescription.

The effect of group counseling on the self-esteem, attendance, and counselor utilization of immigrant Hispanic secondary limited English proficient students

As the population of the United States becomes more diverse and the immigrant Hispanic, limited English proficient (LEP) school age population continues to grow, understanding and addressing the needs of these students becomes a pressing question. The purpose of this study was to investigate the effects of group counseling, by a bilingual counselor, on the self-esteem, attendance and counselor utilization of Hispanic LEP high school students. The design for this study was a quasi-experimental design. The experimental and control groups consisted of one class from each of the four levels of English for Speakers of Other Languages (ESOL), I-IV. The counseling intervention, the independent variable, was delivered by a bilingual counselor once a week, for fifteen weeks.^ A total of 112 immigrant Hispanic LEP students selected from the total ESOL student population participated in the study. The experimental and control groups were administered the Culture Free Self Esteem Inventory (CFSEI) Form AD as a pretest and posttest. The Background Information Questionnaire (BIQ) was utilized to gather information on counselor utilization and demographic data. Attendance data were obtained from the students' computer records. At the conclusion of the study the differences between the experimental and control groups on the three dependent variables were compared.^ Statistical analyses of the data were done using SPSS statistical software. A multivariate analysis of variance (MANOVA) was utilized to determine if there were significant differences in the self-esteem scores, attendance and counselor utilization. Correlational analyses was utilized to determine if there was a relationship between English language proficiency and self-esteem and between acculturation level and self-esteem.^ The study results indicate that there were no significant differences in the self-esteem scores and attendance of the subjects in the experimental group at the completion of the group counseling treatment. Counselor utilization was statistically significant for the targeted population. A relationship was found between English language proficiency level and self-esteem scores for students in ESOL levels II, III and IV. No significant correlation was found between acculturation and self-esteem.^ Research on the dropout rates of LEP coupled with the results of this study show that students at the intermediate and advanced levels of ESOL (III and IV) exhibit more positive self-esteem and achieve higher graduation rates that levels I and II. LEP students at levels I and II, once they became familiar with the role and function of school counselors through group counseling, utilized their services. ^

Late-career international migration and reproductive work. A comparison between Peruvian and Ukrainian women in the Southern Europe

Research on the relationship between reproductive work and women´s life trajectories including the experience of labour migration has mainly focused on the case of relatively young mothers who leave behind, or later re-join, their children. While it is true that most women migrate at a younger age, there are a significant number of cases of men and women who move abroad for labour purposes at a more advanced stage, undertaking a late-career migration. This is still an under-estimated and under-researched sub-field that uncovers a varied range of issues, including the global organization of reproductive work and the employment of migrant women as domestic workers late in their lives. By pooling the findings of two qualitative studies, this article focuses on Peruvian and Ukrainian women who seek employment in Spain and Italy when they are well into their forties, or older. A commonality the two groups of women share is that, independently of their level of education and professional experience, more often than not they end up as domestic and care workers. The article initially discusses the reasons for late-career female migration, taking into consideration the structural and personal determinants that have affected Peruvian and Ukrainian women’s careers in their countries of origin and settlement. After this, the focus is set on the characteristics of domestic employment at later life, on the impact on their current lives, including the transnational family organization, and on future labour and retirement prospects. Apart from an evaluation of objective working and living conditions, we discuss women’s personal impressions of being domestic workers in the context of their occupational experiences and family commitments. In this regard, women report varying levels of personal and professional satisfaction, as well as different patterns of continuity-discontinuity in their work and family lives, and of optimism towards the future. Divergences could be, to some extent, explained by the effect of migrants´ transnational social practices and policies of states.

Survenue des arythmies et troubles de conduction après un remplacement de la valve aortique par cathéter : incidence et impact

La sténose aortique est la cardiopathie valvulaire la plus fréquente retrouvée chez les patients agés. Suite à l’apparition des symptômes, la survie des patients diminue de façon drastique en l’absence d’un remplacement valvulaire aortique. Cependant, une proportion considérable de ces patients n’est pas opérée en raison d’un risque chirurgical élevé, l’âge étant l’une des principales raisons de refus d’un remplacement valvulaire aortique chirurgical. Ce défaut dans la prise en charge des ces patients a favorisé le développement du remplacement valvulaire aortique par cathéter où implantation valvulaire aortique par cathèter (TAVR ou TAVI), qui a représenté une révolution dans le traitement de la sténose aortique. Cette intervention est actuellement un traitement de routine chez les patients à haut risque chirurgical atteints d’une sténose aortique, même si la chirurgie cardiaque n’est pas contre-indiquée. Ces dernières années ont vu un changement de profil des candidats potentiels vers une population à plus faible risque. Cependant, plusieurs préoccupations demeurent. L’une des plus importantes est la survenue des arythmies et de troubles de conduction, notamment le bloc de branche gauche et le bloc auriculo-ventriculaire, qui sont des complications fréquemment associées au TAVR. Malgré l’évolution de la technologie et le développement de nouveaux dispositifs réduisant le taux global de complications, aucune amélioration n’a pas été intégrée pour prévenir l’apparition de telles complications. De plus, l’utilisation de certains dispositifs de nouvelle génération semble être associée à un risque accru de troubles de conduction, et par conséquent, l’incidence de ces complications pourrait augmenter dans le futur. Cependant, L’impact et l’évolution de ces complications sont inconnus. Ce travail de recherche évalue l’incidence et l’évolution des troubles de conduction suite au TAVR et l’impact des blocs de branche gauche de novo et de l’implantation d’un pacemaker sur les résultats cliniques et échocardiographiques.

Qualidade de vida em portadores crónicos do vírus da hepatite B

Dissertação de Mestrado realizada apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica em Clínica

De-escalação da antibioterapia na sépsis grave e choque séptico numa unidade de cuidados intensivos : estudo epidemiológico no serviço de medicina intensiva do Hospital de Santa Maria

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Population ageing and monetary policy

Mestrado em Economia Monetária e Financeira

Population’s knowledge about cerebrovascular accident (stroke) - passers of the square giraldo in Evora

Stroke is the leading cause of death in Portugal and the Alentejo region. Objective: Describe the population's knowledge about risk factors, signs and symptoms of stroke. Methodology: Quantitative and cross-sectional study. Convenience sample of 207 pedestrians with ages between 16 and 86 years old (M=38,85; SD = 18.93). Results: The pathology is known, the most frequently mentioned sources of information are television and friends. Hypercholesterolemia, heart disease and smoking are the risk factors more set out. The most well known signs are numbness and weakness in the hemisphere and dysarthria. Conclusion: It is necessary to strengthen the role of health services in education about stroke. Knowledge displays weaknesses in appreciation of advanced age and diabetes. Noteworthy is the recognition of the risk associated with tobacco consumption and persistence on it.

Predictors For Weight Loss Failure Following Roux-en-y Gastric Bypass.

Weight loss failure is a widely recognized occurrence following Roux-en-Y gastric bypass. This study aims to identify predictors associated with weight loss failure. It is a retrospective cohort which enrolled 187 subjects who underwent RYGB. Comparisons were made between patients' features at baseline and 24 months after surgery. A weight loss failure rate of 11.2% was found. Advanced age and diabetes were statistically associated with failure. The results found were close to previous reports. As weight loss failure represents an important concern, there is the possibility to perform revisional surgeries, which may emphasize the restrictive or malabsorptive characteristics of RYGB, leading to varied results. It is reinforced that weight loss cannot be used as the unique outcome to evaluate the success of surgery.

Relações entre aptidão fisica, sexo, idade, nivel de atividade fisica e supervisão dos exercicios em individuos fisicamente ativos de 50 a 79 anos de idade

Universidade Estadual de Campinas . Faculdade de Educação Física

Avaliação subjetiva da qualidade de vida em individuos de meia idade submetidos a treinamento fisico

Universidade Estadual de Campinas . Faculdade de Educação Física

Vidas arriscadas: uma reflexão sobre a relação entre o número de gestações e mortalidade materna

Este estudo teve por objetivo identificar o risco e os fatores associados à mortalidade materna de multigestas (cinco ou mais gestações). Descreve a tendência da Taxa de Fecundidade Total (TFT) e da Razão de Mortalidade Materna (RMM) de 1998 a 2004 no Paraná. Apresenta uma análise dos 822 óbitos maternos deste período, o cálculo da Razão de Mortalidade Materna Específica, o Risco Relativo, a freqüência e o Odds Ratio para algumas variáveis segundo número de gestações. Analisa também as causas e a evitabilidade dos óbitos maternos. Os resultados apontaram TFT baixa (1,8 filhos por mulher) e a RMM elevada (69,7/100.000 nascidos vivos) no Paraná em 2004. Um quarto dos 822 óbitos maternos (206) era de multigestas (cinco ou mais gestações), o risco relativo de morte materna foi seis vezes superior do que para as mulheres com até duas gestações, e os perfis sociodemográfico e o reprodutivo foram mais desfavoráveis para aquele grupo de mulheres. A baixa escolaridade, a idade igual ou acima de 30 anos e o pré-natal com menos de quatro consultas apresentaram associação com o maior número de gestações. A proporção de mortes por causas obstétricas indiretas, hemorragias e aborto, foi maior entre as multigestas, e cerca de 90% dos óbitos deste grupo foi considerado evitável. Concluiu-se que o monitoramento das multigestas com idade avançada e em desvantagem social, bem como ações efetivas de planejamento familiar, e serviços obstétricos qualificados para gestação de alto risco são medidas que podem contribuir para a redução da mortalidade materna

MEMORY TRAINING FOR OLDER ADULTS WITH LOW EDUCATION: MENTAL IMAGES VERSUS CATEGORIZATION

This study aimed to describe the benefits of memory training for older adults with low education. Twenty-nine healthy older adults with zero to two years of formal education participated. Sixteen participants received training based on categorization (categorization group = CATG) and 13 received training based on mental images (imagery group = IMG). One group served as control for the other because they trained with different strategies. Training was offered in eight sessions of 90 minutes. The participants were evaluated pre- and posttraining. IMG improved performance in episodic memory tests and had reduced depressive symptoms. CATG increased the use of categorization but did not increase performance in episodic memory tests. Results suggest that the strategy based on the creation of mental images was more effective for older adults with low formal education.

Nosocomial outbreak by imipenem-resistant metallo-beta-lactamase-producing Pseudomonas aeruginosa in an adult intensive care unit in a Brazilian teaching hospital

Objective: To describe an outbreak of imipenem-resistant metallo-beta-lactamase-producing Pseudomonas aeruginosa, enzyme type bla, by horizontal transmission in patients admitted to a mixed adult ICU. Methods: A case-control study was carried out, including 47 patients (cases) and 122 patients (control) admitted to the mixed ICU of a university hospital in Minas Gerais. Brazil from November 2003 to July 2005. The infection site, risk factors, mortality, antibiotic susceptibility, metallo-beta-lactamase (MBL) production, enzyme type, and clonal diversity were analyzed, Results: A temporal/spatial relationship was detected in most patients (94%), overall mortality was 55.3%, and pneumonia was the predominant infection (85%). The majority of isolates (95%) were resistant to imipenem and other antibiotics, except for polymyxin, and showed MBL production (76.7%). Only bla SPM-1 (33%) was identified in the 15 specimens analyzed. In addition, 4 clones were identified, with a predominance of clone A (61.5%) and B (23.1%). On multivariate analysis, advanced age, mechanical ventilation, tracheostomy, and previous imipenem use were significant risk factors for imipenem-resistant P. aeruginosa infection. Conclusions: Clonal dissemination of MBL-producing P. aeruginosa strains with a spatial/temporal relationship disclosed problems in the practice of hospital infection control, low adherence to hand hygiene, and empirical antibiotic use. (C) 2008 Elsevier Espana, S.L. All rights reserved.

Parafoveal letter recognition at reduced contrast in normal aging and in patients with risk factors for AMD

Background Patients with early age-related maculopathy ( ARM) do not necessarily show obvious morphological signs or functional impairment. Many have good visual acuity, yet complain of decreased visual performance. The aim of this study was to investigate the aging effects on performance of parafoveal letter recognition at reduced contrast, and defects caused by early ARM and normal fellow eyes of patients with unilateral age-related macular degeneration (nfAMD). Methods Testing of the central visual field (8 radius) was performed by the Macular Mapping Test (MMT) using recognition of letters in 40 parafoveal target locations at four contrast levels (5, 10, 25 and 100%). Effects of aging were investigated in 64 healthy subjects aged 23 to 76 years (CTRL). In addition, 39 eyes (minimum visual acuity of 0.63; 20/30) from 39 patients with either no visible signs of ARM, while the fellow eye had advanced age-related macular degeneration (nfAMD; n=12), or early signs of ARM (eARM; n=27) were examined. Performance was expressed summarily as a ""field score"" (FS). Results Performance in the MMT begins to decline linearly with age in normal subjects from the age of 50 and 54 years on, at 5% and 10% contrast respectively. The differentiation between patients and CTRLs was enhanced if FS at 5% was analyzed along with FS at 10% contrast. In 8/12 patients from group nfAMD and in 18/27 from group eARM, the FS was statistically significantly lower than in the CTRL group in at least one of the lower contrast levels. Conclusion Using parafoveal test locations, a recognition task and diminished contrast increases the chance of early detection of functional defects due to eARM or nfAMD and can differentiate them from those due to aging alone.