Characteristics and Predictors of Obstructive Sleep Apnea in Patients With Systemic Hypertension

Obstructive sleep apnea (OSA) is a secondary cause of hypertension and independently associated with target-organ damage in hypertensive patients. However, OSA remains largely underdiagnosed and undertreated. The aim of the present study was to evaluate the characteristics and clinical predictors of OSA in a consecutive series of patients followed up in a hypertension unit. A total of 99 patients (age 46 +/- 11 years, body mass index 28.8 kg/m(2), range 25.1 to 32.9) underwent polysomnography. The clinical parameters included age, gender, obesity, daytime sleepiness, snoring, Berlin Questionnaire, resistant hypertension, and metabolic syndrome. Of the 99 patients, 55 (56%) had OSA (apnea-hypopnea index >5 events/hour). Patients with OSA were older and more obese, had greater levels of blood pressure, and presented with more diabetes, dyslipidemia, resistant hypenension, and metabolic syndrome than the patients without OSA. Of the patients with OSA, 51% had no excessive daytime sleepiness. The Berlin Questionnaire and patient age revealed a high sensitivity (0.93 and 0.91, respectively) but low specificity (0.59 and 0.48, respectively), and obesity and resistant hypertension revealed a low sensitivity (0.58 and 0.44, respectively) but high specificity (0.75 and 0.91, respectively) for OSA. Metabolic syndrome was associated with high sensitivity and specificity for OSA (0.86 and 0.85, respectively). Multiple regression analysis showed that age of 40 to 70 years (odds ratio 1.09, 95% confidence interval 1.03 to 1.16), a high risk of OSA on the Berlin Questionnaire (odds ratio 8.36, 95% confidence interval 1.67 to 41.85), and metabolic syndrome (odds ratio 19.04, 95% confidence interval 5.25 to 69.03) were independent variables associated with OSA. In conclusion, more important than the typical clinical features that characterize OSA, including snoring and excessive daytime sleepiness, the presence of the metabolic syndrome is as an important marker of OSA among patients with hypertension. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:1135-1139)

Relation between visceral fat and coronary artery disease evaluated by multidetector computed tomography

Visceral abdominal fat has been associated to cardiovascular risk factors and coronary artery disease (CAD). Computed tomography (CT) coronary angiography is an emerging technology allowing detection of both obstructive and nonobstructive CAD adding information to clinical risk strati. cation. The aim of this study was to evaluate the association between CAD and adiposity measurements assessed clinically and by CT. We prospectively evaluated 125 consecutive subjects (57% men, age 56.0 +/- 12 years) referred to perform CT angiography. Clinical and laboratory variables were determined and CT angiography and abdominal CT were performed in a 64-slice scanner. CAD was defined as any plaque calcified or not detected by CT angiography. Visceral and subcutaneous adiposity areas were determined at different intervertebral levels. CT angiography detected CAD in 70 (56%) subjects, and no association was found with usual anthropometric adiposity measurements (waist and hip circumferences and body mass index). Otherwise, CT visceral fat areas (VFA) were significantly related to CAD. VFA T12-L1 values >= 145 cm(2) had an odds ratio of 2.85 (95% CI 1.30-6.26) and VFA L4-L5 >= 150 cm(2) had a 2.87-fold (95% CI 1.31-6.30) CAD risk. The multivariate analysis determined age and VFA T12-L1 as the only independent variables associated to CAD. Visceral fat assessed by CT is an independent marker of CAD determined by CT angiography. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Two-step tuberculin skin test and booster phenomenon prevalence among Brazilian medical students

SETTING: Five medical schools in three cities in Rio de Janeiro State, Brazil, with different tuberculosis (TB) incidence rates. OBJECTIVE: To evaluate the prevalence of the booster phenomenon and its associated factors in a voting universally BCG-vaccinated TB-exposed population. DESIGN: A two-step tuberculin skin test (TST) was performed among undergraduate medical students. Boosting was defined as an induration >= 10 mm in the second TST (TST2), with an increase of at least 6 mm over the first TST (TST1). The association of boosting with independent variables was evaluated using multivariate analysis. RESULTS: Of the 764 participants (mean age 21.9 +/- 2.7 years), 672 (87.9%) had a BCG scar. The overall booster SUMMARY phenomenon prevalence was 8.4% (95%CI 6.5-10.6). Boosting was associated with TST1 reactions of 1-9 mm (aOR 2.5, 95%CI 1.04-5.9) and with BCG vaccination, mostly after infancy, i.e., after age two years (aOR 9.1, 95%,CI 1.2-70.7). CONCLUSION: The prevalence of the booster phenomenon was high. A two-step TST in young BCG-vaccinated populations, especially in those with TST1 reactions of 1-9 mm, can avoid misdiagnosis as a false conversion and potentially reduce unnecessary treatment for latent TB infection.

Conductive hearing loss in children with bronchopulmonary dysplasia: A longitudinal follow-up study in children aged between 6 and 24 months

Aims: To determine the occurrence of isolated and recurrent episodes of conductive hearing loss (CHL) during the first two years of life in very low birth weight (VLBW) infants with and without bronchopulmonary dysplasia (BPD). Study design, subjects and outcome measures: In a longitudinal clinical study. 187 children were evaluated at 6, 9, 12,15 18 and 24 months of age by visual reinforcement audiometry, tympanometry and auditory brain response system. Results: Of the children with BPD, 54.5% presented with episodes of CHL, as opposed to 34.7% of the children without BPD. This difference was found to be statistically significant. The recurrent or persistent episodes were more frequent among children with BPD (25.7%) than among those without BPD (8.3%). The independent variables that contributed to this finding were small for gestational age and a 5 min Apgar score. Conclusions: Recurrent CHL episodes are more frequent among VLBW infants with BPD than among VLBW infants without BPD. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Processing Speed and Working Memory Span: Their Differential Role in Superficial and Deep Memory Processes in Schizophrenia

Previous work has suggested that decrement in both processing speed and working memory span plays a role in the memory impairment observed in patients with schizophrenia. We undertook a study to examine simultaneously the effect of these two factors. A sample of 49 patients with schizophrenia and 43 healthy controls underwent a battery of verbal and visual memory tasks. Superficial and deep encoding memory measures were tallied. We conducted regression analyses on the various memory measures, using processing speed and working memory span as independent variables. In the patient group, processing speed was a significant predictor of superficial and deep memory measures in verbal and visual memory. Working memory span was an additional significant predictor of the deep memory measures only. Regression analyses involving all participants revealed that the effect of diagnosis on all the deep encoding memory measures was reduced to non-significance when processing speed was entered in the regression. Decreased processing speed is involved in verbal and visual memory deficit in patients, whether the task require superficial or deep encoding. Working memory is involved only insofar as the task requires a certain amount of effort. (JINS, 2011, 17, 485-493)

Prevalence of equine Piroplasmosis and its association with tick infestation in the State of Sao Paulo, Brazil

Serum samples were collected from 582 horses from 40 stud farms in the State of Sao Paulo and tick (Acari: Ixodidae) infestations were evaluated on them. Serum samples were subjected to the complement fixation test (CFT) and a competitive inhibition ELISA (cELISA) for Babesia caballi and Theileria equi. Logistic regression analyses were performed to construct multivariate models that could explain the dependent variable (horses positive for B. caballi or T equi) as a function of the independent variables (presence or abundance of each one of the rick species found on the farms). A higher overall prevalence of B. caballi (54.1%) than of T equi (21.6%) was found by the two tests. The ticks Dermacentor nitens Neumann, 1897, Amblyomma cajennense (Fabricius, 1787) and Rbipicephalus (Boopbilus) microplus (Canestrini, 1887) were present on horses on 38 (95%), 20 (50%), and 4 (10%) farms, respectively. Infestations by D. nitens were statistically associated with B. caballi-positive horses on the farms by either the CFT or cELISA. Infestations by A. cajennense were statistically associated with T equi-positive horses on the farms by either CFT or cELISA.

The influence of genetic and environmental factors in estimations of current body size, desired body size, and body dissatisfaction

The objective was to investigate the genetic epidemiology of figural stimuli. Standard figural stimuli were available from 5,325 complete twin pairs: 1,751 (32.9%) were monozygotic females, 1,068 (20.1%) were dizygotic females, 752 (14.1%) were monozygotic males, 495 (9.3%) were dizygotic males, and 1,259 (23.6%) were dizygotic male-female pairs. Univariate twin analyses were used to examine the influences on the individual variation in current body size and ideal body size. These data were analysed separately for men and women in each of five age groups. A factorial analysis of variance, with polychoric correlations between twin pairs as the dependent variable, and age, sex, zygosity, and the three interaction terms (age x sex, age x zygosity, sex x zygosity) as independent variables, was used to examine trends across the whole data set. Results showed genetic influences had the largest impact on the individual variation in current body size measures, whereas non-shared environmental influences were associated with the majority of individual variation in ideal body size. There was a significant main effect of zygosity (heritability) in predicting polychoric correlations for current body size and body dissatisfaction. There was a significant main effect of gender and zygosity in predicting ideal body size, with a gender x zygosity interaction. In common with BMI, heritability is important in influencing the estimation of current body size. Selection of desired body size for both men and women is more strongly influenced by environmental factors.

Corporate stadium sponsorships, signaling theory, agency conflicts, and shareholder wealth

Contrary to the plethora of critical articles recently appearing in both the popular and business press, this carefully controlled investigation of 49 stadium- and arena-naming-rights agreement announcements provides striking evidence that such sponsorships can significantly enhance the stock prices of sponsoring companies. Indeed, the results of the study show that the average stadium sponsor's stock prices increased by 1.65 percent at the time of announcement of the programs-a result considerably in excess of the returns associated with other major marketing programs such as the signing of Olympic sponsorships and celebrity endorsers. A multiple regression analysis employing firm-specific changes in stock prices as the dependent variable and quantifiable corporate and sponsorship-related attributes as independent variables is also presented. Variables positively and significantly correlated with perceived sponsorship success include team-winning percentages, contract length, and high technology and locally based companies. Overall, the findings of the study are consistent with the novel hypothesis that, for some firms, the real value-added of a stadium sponsorship may lie in its ability to serve as an effective or honest signal of managerial confidence in the future of the company.

Segmenting the market of West Australian senior tourists using an artificial neural network

Measuring perceptions of customers can be a major problem for marketers of tourism and travel services. Much of the problem is to determine which attributes carry most weight in the purchasing decision. Older travellers weigh many travel features before making their travel decisions. This paper presents a descriptive analysis of neural network methodology and provides a research technique that assesses the weighting of different attributes and uses an unsupervised neural network model to describe a consumer-product relationship. The development of this rich class of models was inspired by the neural architecture of the human brain. These models mathematically emulate the neurophysical structure and decision making of the human brain, and, from a statistical perspective, are closely related to generalised linear models. Artificial neural networks or neural networks are, however, nonlinear and do not require the same restrictive assumptions about the relationship between the independent variables and dependent variables. Using neural networks is one way to determine what trade-offs older travellers make as they decide their travel plans. The sample of this study is from a syndicated data source of 200 valid cases from Western Australia. From senior groups, active learner, relaxed family body, careful participants and elementary vacation were identified and discussed. (C) 2003 Published by Elsevier Science Ltd.

Prevalência e fatores associados à infecção pelo M. tuberculosis entre agentes comunitários de saúde

Introdução: A tuberculose é uma doença milenar e que, ainda hoje, constitui grave problema de saúde pública em todo o mundo. Objetivo: Estimar a prevalência e os fatores associados à infecção latente pelo MTB entre Agentes Comunitários de Saúde atuantes na rede básica de saúde de Municípios prioritários para o controle de TB – Cuiabá/MT, Manaus/AM, Salvador/BA e Vitória/ES. Métodos: Estudo de corte transversal no qual os dados foram coletados através de questionário, composto de questões abertas e fechadas sobre características pessoais; informações a respeito da tuberculose; utilização de medidas preventivas, etc. Aplicou-se prova tuberculínica, com leitura após 48-72h por enfermeiros treinados, considerando como ponte de corte positivo 5 e 10 mm de enduração. A análise múltipla foi feita por meio de regressão logística hierarquica. Foram incluídas no modelo as variáveis que mostraram associação com desfecho com p<0,1. Permaneceram no modelo as variáveis independentes que mantiveram associação com desfecho após ajuste (p<0,05). Este estudo obteve aprovação do Comitê de Ética em Pesquisa com seres humanos do Centro de Ciências da Saúde da Universidade Federal do Espírito Santo, n° de registro CEP-07/2010 e das Secretarias Municipais de Saúde, por meio de uma Carta de Apresentação. Resultados: 322 Agentes Comunitários de Saúde (ACS) aceitaram participar voluntariamente do estudo por meio da assinatura do Termo de Consentimento Livre e Esclarecido. Destes, 10 não compareceram para leitura, sendo estes considerados como perdas, além do que um indivíduo foi excluído pelo fato do teste rápido para HIV ter resultado positivo, perfazendo uma amostra final de 311 participantes. Ainda em relação aos ACS triados, a positividade a Prova Tuberculínica, levando-se em consideração o ponto de corte ao teste de 10 mm e de 5 mm de enduração, foi de 37,30% (IC95%: 0,31-0,42) e de 57,88% (IC95%: 0,52-0,63), respectivamente.Conclusões: Faz-se necessário um programa de realização de Prova Tuberculínica, de rotina, combinado com intervenções para reduzir o risco de transmissão nosocomial, bem como a realização de outros estudos para avaliar a eficácia de novos testes para detecção de tuberculose latente.

Remuneração executiva e desempenho: evidências empíricas no mercado de capitais brasileiro

O objetivo desta dissertação é analisar a relação existente entre remuneração executiva e desempenho em companhias brasileiras de capital aberto listadas na BM&FBOVESPA. A linha teórica parte do pressuposto que o contrato de incentivos corrobora com o alinhamento de interesses entre acionistas e executivos e atua como um mecanismo de governança corporativa a fim de direcionar os esforços dos executivos para maximização de valor da companhia. A amostra foi composta pelas 100 companhias mais líquidas listadas em quantidade de negociações de ações na BM&FBOVESPA durante o período 2010-2012, totalizando 296 observações. Os dados foram extraídos dos Formulários de Referência disponibilizados pela CVM e a partir dos softwares Economática® e Thomson Reuters ®. Foram estabelecidas oito hipóteses de pesquisa e estimados modelos de regressão linear múltipla com a técnica de dados em painel desbalanceado, empregando como variável dependente a remuneração total e a remuneração média individual e como regressores variáveis concernentes ao desempenho operacional, valor de mercado, tamanho, estrutura de propriedade, governança corporativa, além de variáveis de controle. Para verificar os fatores que explicam a utilização de stock options, programa de bônus e maior percentual de remuneração variável foram estimados modelos de regressão logit. Os resultados demonstram que, na amostra selecionada, existe relação positiva entre remuneração executiva e valor de mercado. Verificou-se também que os setores de mineração, química, petróleo e gás exercem influência positiva na remuneração executiva. Não obstante, exerce relação inversa com a remuneração total à concentração acionária, o controle acionário público e o fato da companhia pertencer ao nível 2 ou novo mercado conforme classificação da BMF&BOVESPA. O maior valor de mercado influencia na utilização de stock options, assim como no emprego de bônus, sendo que este também é impactado pelo maior desempenho contábil. Foram empregados também testes de robustez com estimações por efeitos aleatórios, regressões com erros-padrão robustos clusterizados, modelos dinâmicos e os resultados foram similares. Conclui-se que a remuneração executiva está relacionada com o valor corporativo gerando riqueza aos acionistas, mas que a ausência de relação com o desempenho operacional sugere falhas no sistema remuneratório que ainda depende de maior transparência e outros mecanismos de governança para alinhar os interesses entre executivos e acionistas.

Fatores determinantes da política de distribuição de dividendos: Evidência empírica para as empresas não financeiras da Euronext Lisbon

Dividends and their distribution decisions, being a component of the compensation of investors are a constant financial worry within companies, thus revealing one of the themes highlighted in the context of the financial literature. Study will address the factors determining the dividend policy practiced by companies listed in the Portuguese stock market. The latter will be 47 non-financial companies listed on the Euronext Lisbon during 2009 until 2011. The two samples that have been investigated include the representative of the majority of non-financial companies listed on Euronext Lisbon and the other financial companies members of the PSI 20. The methodology adopted is one of the ordinary least squares regression and the amount of dividends per share distributed was used in determining the dependent variable. In relation to the independent variables, six explanatory factors were chosen. These include profitability, stability of dividend policy, size, growth, risk and investment opportunities. The conclusion suggests that the most important factors to explain the amount of dividends distributed are profitability and stability of dividend policy. There after, growth and risk factors, as well as factors that explain the amount of dividends distributed are also relevant. The remaining variables obtained were insufficient evidence pointing to a significant effect in explaining the dividend policy of Portuguese companies in the sample. The conclusion also states that differences exist in the importance of the explanatory factors to the amount of dividends distributed between the study samples, given the differentiation of dividend policies, followed by companies from each group analyzed.

Factores explicativos da divulgação de informação sobre instrumentos derivados: evidência empírica no mercado de capitais português, em 2008

This study analyses the determinants of the derivative instruments disclosure level by Portuguese listed companies. It is built a disclosure index to measure the disclosure level using the Consolidated Annual Reports for 2008. The hypotheses have been tested through a linear regression model using the disclosure index as the dependent variable and companies’ characteristics as independent variables. Multivariate results suggest that firm size, quality of the external auditor, belonging to PSI 20, the market to book value ratio and the percentage of capital hold by the board of directors are associated with the disclosure level.

DETERMINANTS OF THE SUCCESS OF GLOBAL AND LOCAL BRANDS IN LATIN AMERICA

ABSTRACTThe purpose of this paper is to address the issue of the implementation of global and local brands in Latin America by drawing on contingency theory to develop and test hypotheses relating to how product category characteristics affect the success of global and local brands in the region. Hypotheses are tested using data obtained from top brands rankings reported in five Latin American markets (Argentina, Brazil, the Caribbean and Central America, Chile and Mexico). The study design considers estimating a logistic regression on a binomial dependent variable measuring whether 475 top brands are global or local brands, with product category characteristics as independent variables. Results reveal that product categories related to subscriptions, local tastes, high-tech, and global citizenship do have an impact on the success of global and local brands in Latin America.

Geographical patterns of proportionate mortality for the most common causes of death in Brazil

Mortality due to chronic diseases has been increasing in all regions of Brazil with corresponding decreases in mortality from infectious diseases. The geographical variation in proportionate mortality for chronic diseases for 17 Brazilian state capitals for the year 1985 and their association with socio-economic variables and infectious disease was studied. Calculations were made of correlation coefficients of proportionate mortality for adults of 30 years or above due to ischaemic heart disease, stroke and cancer of the lung, the breast and stomach with 3 socio-economic variables, race, and mortality due to infectious disease. Linear regression analysis included as independent variables the % of illiteracy, % of whites, % of houses with piped water, mean income, age group, sex, and % of deaths caused by infectious disease. The dependent variables were the % of deaths due to each one of the chronic diseases studied by age-sex group. Chronic diseases were an important cause of death in all regions of Brazil. Ischaemic heart diseases, stroke and malignant neoplasms accounted for more than 34% of the mortality in each of the 17 capitals studied. Proportionate cause-specific mortality varied markedly among state capitals. Ranges were 6.3-19.5% for ischaemic heart diseases, 8.3-25.4% for stroke, 2.3-10.4% for infections and 12.2-21.5% for malignant neoplasm. Infectious disease mortality had the highest (p < 0.001) correlation with all the four socio-economic variables studied and ischaemic heart disease showed the second highest correlation (p < 0.05). Higher socio-economic level was related to a lower % of infectious diseases and a higher % of ischaemic heart diseases. Mortality due to breast cancer and stroke was not associated with socio-economic variables. Multivariate linear regression models explained 59% of the variance among state capitals for mortality due to ischaemic heart disease, 50% for stroke, 28% for lung cancer, 24% for breast cancer and 40% for stomach cancer. There were major differences in the proportionate mortality due to chronic diseases among the capitals which could not be accounted for by the social and environmental factors and by the mortality due to infectious disease.