Prevalência e fatores associados à síndrome da fragilidade em idosos: inquérito populacional em Campina Grande-PB

The frailty syndrome is a geriatric medical condition of vulnerability resulting in the decline of physiological reserves, characterized by high-risk consequences as falls, disability, hospitalization, institutionalization and death. Although the presence of comorbidities is not always accompanied by fragility, this presence could also indicate an increased risk of adverse health events, taking the elderly to a greater likelihood of becoming brittle due to the physical limitations that may occur with emergence of diseases, which are strongly predictive of Fragility Syndrome. This study aimed to assess the prevalence of frailty syndrome in the elderly and associated factors. The specific objectives were to identify the prevalence of frailty syndrome in the elderly and their associations with demographic, economic, health, functional and psychological; identify the reasons for the prevalence of frailty syndrome with the demographic profile, health problems, use of legal drugs and problems with sleep of older people. The study was cross-sectional and composed of 385 elderly aged 65 or more. Multivariate Poisson regression models were used to check conditions associated with fragility and determine the prevalence ratio (α = 0.05). The prevalence of fragility was 8.7% and pre-fragility of 50.4%. Fragile and pre-frail elderly presented, bigger and increasing prevalence ratio for marital status, difficulty in performing instrumental activities of daily living, old age, involuntary loss of stool, depression and negative affect. Elderly people who do not work have a higher prevalence of fragility, as well as those who reported having had a stroke / stroke / ischemia, those who suffered falls in the last 12 months and those with sleep problems. It is considered that the results, together with other available in the literature, can contribute to the understanding of the fragility epidemiology and also in the implementation of specific programs aimed at reducing the prevalence of frailty, optimizing the quality of life. It is suggested that future programs have special attention to the profiles of elderly people who have not yet developed fragility, i.e., pre-fragile. This could prevent the elderly from becoming frail.

Enhanced Volatile Organic Compounds emissions and organic aerosol mass increase the oligomer content of atmospheric aerosols

Secondary organic aerosol (SOA) accounts for a dominant fraction of the submicron atmospheric particle mass, but knowledge of the formation, composition and climate effects of SOA is incomplete and limits our understanding of overall aerosol effects in the atmosphere. Organic oligomers were discovered as dominant components in SOA over a decade ago in laboratory experiments and have since been proposed to play a dominant role in many aerosol processes. However, it remains unclear whether oligomers are relevant under ambient atmospheric conditions because they are often not clearly observed in field samples. Here we resolve this long-standing discrepancy by showing that elevated SOA mass is one of the key drivers of oligomer formation in the ambient atmosphere and laboratory experiments. We show for the first time that a specific organic compound class in aerosols, oligomers, is strongly correlated with cloud condensation nuclei (CCN) activities of SOA particles. These findings might have important implications for future climate scenarios where increased temperatures cause higher biogenic volatile organic compound (VOC) emissions, which in turn lead to higher SOA mass formation and significant changes in SOA composition. Such processes would need to be considered in climate models for a realistic representation of future aerosol-climate-biosphere feedbacks.

Molecular composition of organic aerosols in central Amazonia: an ultra-high-resolution mass spectrometry study

The Amazon Basin plays key role in atmospheric chemistry, biodiversity and climate change. In this study we applied nanoelectrospray (nanoESI) ultra-high-resolution mass spectrometry (UHRMS) for the analysis of the organic fraction of PM2.5 aerosol samples collected during dry and wet seasons at a site in central Amazonia receiving background air masses, biomass burning and urban pollution. Comprehensive mass spectral data evaluation methods (e.g. Kendrick mass defect, Van Krevelen diagrams, carbon oxidation state and aromaticity equivalent) were used to identify compound classes and mass distributions of the detected species. Nitrogen- and/or sulfur-containing organic species contributed up to 60 % of the total identified number of formulae. A large number of molecular formulae in organic aerosol (OA) were attributed to later-generation nitrogen- and sulfur-containing oxidation products, suggesting that OA composition is affected by biomass burning and other, potentially anthropogenic, sources. Isoprene-derived organosulfate (IEPOX-OS) was found to be the most dominant ion in most of the analysed samples and strongly followed the concentration trends of the gas-phase anthropogenic tracers confirming its mixed anthropogenic–biogenic origin. The presence of oxidised aromatic and nitro-aromatic compounds in the samples suggested a strong influence from biomass burning especially during the dry period. Aerosol samples from the dry period and under enhanced biomass burning conditions contained a large number of molecules with high carbon oxidation state and an increased number of aromatic compounds compared to that from the wet period. The results of this work demonstrate that the studied site is influenced not only by biogenic emissions from the forest but also by biomass burning and potentially other anthropogenic emissions from the neighbouring urban environments.

Body measurements and blood plasma lipid, PCB and OH-PCB content of polar bear (U. maritimus) mothers and cubs, Svalbard

The aim of this study was to examine the plasma concentrations and prevalence of polychlorinated biphenyls (PCBs) and hydroxylated PCB-metabolites (OH-PCBs) in polar bear (Ursus maritimus) mothers (n = 26) and their 4 months old cubs-of-the-year (n = 38) from Svalbard to gain insight into the mother-cub transfer, biotransformation and to evaluate the health risk associated with the exposure to these contaminants. As samplings were performed in 1997/1998 and 2008, we further investigated the differences in levels and pattern of PCBs between the two sampling years. The plasma concentrations of Sum(21)PCBs (1997/1998: 5710 ± 3090 ng/g lipid weight [lw], 2008: 2560±1500 ng/g lw) and Sum(6)OH-PCBs (1997/1998: 228 ± 60 ng/g wet weight [ww], 2008: 80 ± 38 ng/g ww) in mothers were significantly lower in 2008 compared to in 1997/1998. In cubs, the plasma concentrations of Sum(21)PCBs (1997/1998: 14680 ± 5350 ng/g lw, 2008: 6070 ± 2590 ng/g lw) and Sum(6)OH-PCBs (1997/1998: 98 ± 23 ng/g ww, 2008: 49 ± 21 ng/g ww) were also significantly lower in 2008 than in 1997/1998. Sum(21)PCBs in cubs was 2.7 ± 0.7 times higher than in their mothers. This is due to a significant maternal transfer of these contaminants. In contrast, Sum(6)OH-PCBs in cubs were approximately 0.53 ± 0.16 times the concentration in their mothers. This indicates a lower maternal transfer of OH-PCBs compared to PCBs. The majority of the metabolite/precursor-ratios were lower in cubs compared to mothers. This may indicate that cubs have a lower endogenous capacity to biotransform PCBs to OH-PCBs than polar bear mothers. Exposure to PCBs and OH-PCBs is a potential health risk for polar bears, and the levels of PCBs and OH-PCBs in cubs from 2008 were still above levels associated with health effects in humans and wildlife.

An exploration of men’s experiences of undergoing active surveillance for favourable-risk prostate cancer: A mixed methods study protocol

Background
Prostate cancer is one of the most common male cancers worldwide. Active Surveillance (AS) has been developed to allow men with lower risk disease to postpone or avoid the adverse side effects associated with curative treatments until the disease progresses. Despite the medical benefits of AS, it is reported that living with untreated cancer can create a significant emotional burden for patients.

Methods/design
The aim of this study is to gain insight into the experiences of men eligible to undergo AS for favourable-risk PCa.

This study has a mixed-methods sequential explanatory design consisting of two phases: quantitative followed by qualitative. Phase 1 has a multiple point, prospective, longitudinal exploratory design. Ninety men diagnosed with favourable-risk prostate cancer will be assessed immediately post-diagnosis (baseline) and followed over a period of 12 months, in intervals of 3 month. Ninety age-matched men with no cancer diagnosis will also be recruited using peer nomination and followed up in the same 3 month intervals. Following completion of Phase 1, 10–15 AS participants who have reported both the best and worst psychological functioning will be invited to participate in semi-structured qualitative interviews. Phase 2 will facilitate further exploration of the quantitative results and obtain a richer understanding of participants’ personal interpretations of their illness and psychological wellbeing.

Discussion
To our knowledge, this is the first study to utilise early baseline measures; include a healthy comparison group; calculate sample size through power calculations; and use a mixed methods approach to gain a deeper more holistic insight into the experiences of men diagnosed with favourable-risk prostate cancer.

Sjuksköterskans stöd till personer med psykiska funktionsnedsättningar i utövandet av fysisk aktivitet och dess hälsoeffekter Litteraturstudie

Det har forskats mycket om fysisk aktivitets positiva effekter på människokroppen rent fysiskt. Tidigare har det inte varit en naturlig del av behandlingen inom psykiatrin vilket gjorde författarna nyfikna på hur det kan lyftas fram i vården av personer med psykiska funktionsnedsättningar. Syfte: Syftet med litteraturstudien var att beskriva hälsoeffekterna av fysisk aktivitet för personer med psykiska funktionsnedsättningar och sjuksköterskans stöd genom handledning. Metod: Litteraturstudie. Resultat: Under sammanställningen av resultatet framkom att sjuksköterskor kan ge stöd genom Motiverande samtal (MI) som var av central betydelse. Då patienten själv hörsammas och bygger upp sina mål som ska vara mätbara tillsammans med utbildad vårdpersonal, men även genom stöd i patienternas egen utbildning och kunskap av den fysiska aktivitetens positiva inverkan på psykisk ohälsa. Slutsats: Sjuksköterskans metod att stödja och motivera personer med psykiska funktionsnedsättningar till att utöva fysisk aktivitet visade sig vara flera. Då det var viktigt med personcentrarad metod, var viktigt att de behärskade och kände till olika vägar att kunna motivera personer med psykiska funktionsnedsättningar. Andra betydelsefulla tillvägagångssätt var god vårdrelation, individualiserade träningsprogram, samt stöd och utbildning i de positiva hälsoeffekterna som fysisk aktivitet gav.

The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review

This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l'ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.

Outcome of the Public Consultation on the Draft Opinion of the Scientific Panel on Dietetic Products, Nutrition, and Allergies (NDA) on Dietary Reference Values for Fats, Including Saturated Fatty Acids, Polyunsaturated Fatty Acids, Monounsaturated Fatty Acids, Trans Fatty Acids, and Cholesterol

On 2 July 2009, the EFSA Panel on Dietetic products, Nutrition and Allergies (NDA) endorsed a draft Opinion on Dietary Reference Values for fats to be released for public consultation. This Scientific Report summarises the comments received through the public consultation and outlines how these were taken into account in the final opinion. EFSA had received contributions from 40 interested parties (individuals, non-governmental organisations, industry organisations, academia and national assessment bodies). The main comments which were received during the public consultation related to: the availability of more recent data, the nomenclature used, the use of a non-European food composition data base, the impact of genetic factors in modulating the absorption, metabolism and health effects of different fatty acids, the definition of “nutritionally adequate diet”, the use of Dietary Reference Values in the labelling of foods, the translation of advice into food-based dietary guidelines, nutrient goals and recommendations, certain risk management issues, and to Dietary Reference Values of fats, individual fatty acids, and cholesterol. All the public comments received that related to the remit of EFSA were assessed and the Opinion on Dietary Reference Values for fats has been revised taking relevant comments into consideration.

Mobilisation des dépôts ectopiques de tissu adipeux : ses implications dans la résolution des comorbidités associées à l'obésité sévère suivant une chirurgie bariatrique

La prévalence de l’obésité sévère ne cesse d’augmenter. La problématique associée à l’obésité sévère est la présence possible de nombreuses comorbidités qui peuvent coexister et altérer le système cardiovasculaire, pulmonaire, endocrinien, articulaire et même favoriser le développement de certains cancers. L’excès de poids, plus particulièrement l’excès de tissu adipeux, sont tous deux liés au développement de ces comorbidités. Aucune donnée n’est disponible quant au rôle de la déposition ectopique du tissu adipeux. Considérant le caractère morbide de l’obésité sévère, la mortalité de toute cause augmentée et l’espérance de vie réduite, à ce jour le seul traitement dit efficace à long terme pour le traitement de l’obésité sévère est la chirurgie bariatrique. L’efficacité est définie par la perte de poids, le maintien à long terme de cette perte de poids ainsi que par l’amélioration ou la résolution des comorbidités. L’intérêt clinique et scientifique pour la chirurgie bariatrique est grandissant. Un nombre important d’études s’intéresse aux mécanismes sous-jacents de la résolution des comorbidités. Le diabète de type 2 est la comorbidité la plus étudiée et peu d’études se sont intéressées aux déterm meil.inants de la résolution de l’hypertension artérielle et de l’apnée obstructive du som Comme premier objectif, cette thèse visait à caractériser les différences de la composition corporelle et de la distribution du tissu adipeux de patients obèses sévères avec ou sans diagnostic de diabète de type 2, d’hypertension artérielle et d’apnée obstructive du sommeil. Le deuxième objectif de cette thèse visait à comparer l’évolution postopératoire suite à une chirurgie bariatrique sur les changements de la composition corporelle et de la distribution du tissu adipeux selon le statut de résolution du diabète de type 2, de l’hypertension artérielle et de l’apnée obstructive du sommeil. De plus, considérant le peu d’évidences dans la littérature au sujet des déterminants de la résolution de l’hypertension artérielle et de l’apnée obstructive du sommeil, l’évaluation du profil inflammatoire, des adipokines et de l’activité du système nerveux autonome ont aussi été caractérisés. Premièrement, nous avons documenté qu’en présence d’obésité sévère, la déposition ectopique du tissu adipeux était plus importante chez les patients avec un diabète de type 2, une hypertension artérielle et une apnée obstructive du sommeil comparativement à ceux n’ayant pas ces comorbidités. Nous avons par la suite montré que la résolution du diabète de type 2 et de l’hypertension artérielle était caractérisée par une réduction plus importante du tissu adipeux viscéral. Au contraire, la résolution de l’apnée obstructive du sommeil était plutôt caractérisée par une réduction plus importante du tissu adipeux sous-cutané à la mi-cuisse et par une tendance à une perte de poids plus élevée. De plus, nous avons observé que chez les patients qui n’avaient pas résolu leur diabète de type 2, leur hypertension artérielle et leur apnée obstructive du sommeil, la quantité de tissu adipeux viscéral, à 12 mois suivant la chirurgie bariatrique, était plus importante comparativement à celle mesurée chez les patients n’ayant pas résolu ces comorbidités. Spécifiquement à l’évaluation du profil inflammatoire et des adipokines, nous avons observé que chez les patients obèses sévères, la présence de l’hypertension artérielle et de l’apnée obstructive du sommeil n’était pas caractérisée par un profil altéré au niveau des marqueurs inflammatoires et des adipokines. Également, nous n’avons pas observé de changements majeurs qui pouvaient expliquer, en partie, la résolution de l’hypertension artérielle et de l’apnée obstructive du sommeil. Quant à l’activité du système nerveux autonome, nous avons observé une faible activité du système nerveux parasympathique chez les patients obèses sévères avec hypertension artérielle et apnée obstructive du sommeil. Nous avons également documenté que la résolution de l’hypertension artérielle et de l’apnée obstructive du sommeil était associée à une tendance à une augmentation plus importante de l’activité parasympathique du système nerveux autonome. Les résultats obtenus au cours de ce doctorat supportent l’importance de la déposition ectopique du tissu adipeux en situation d’obésité sévère, particulièrement le rôle du tissu adipeux viscéral, dans le développement du diabète de type 2, de l’hypertension artérielle et de l’apnée obstructive du sommeil ainsi que dans la résolution de ces comorbidités suivant une chirurgie bariatrique. D’autres recherches devront davantage s’intéresser à la mobilisation des dépôts ectopiques de tissu adipeux comme un déterminant important dans la résolution à plus long terme de ces comorbidités.

Objective Methods for Characterizing Physical Exposures which may contribute to Work-related Musculoskeletal Disorders in Agricultural Workers

Thesis (Ph.D.)--University of Washington, 2016-08

Occupational exposure to fungi and particles in animal feed industry

Background: Very few studies regarding fungal and particulate matter (PM) exposure in feed industry have been reported, although such contaminants are likely to be a significant contributing factor to several symptoms reported among workers. The purpose of this study has been to characterize fungal and dust exposure in one Portuguese feed industry. Material and Methods: Air and surface samples were collected and subject to further macro- and microscopic observations. In addition we collected other air samples in order to perform real-time quantitative polymerase chain reaction (PCR) amplification of genes from Aspergillus fumigatus and Aspergillus flavus complexes as well as Stachybotrys chartarum. Additionally, two exposure metrics were considered – particle mass concentration (PMC), measured in 5 different sizes (PM0.5, PM1, PM2.5, PM5, PM10), and particle number concentration (PNC) based on results given in 6 different sizes in terms of diameter (0.3 μm, 0.5 μm, 1 μm, 2.5 μm, 5 μm and 10 μm). Results: Species from the Aspergillus fumigatus complex were the most abundant in air (46.6%) and in surfaces, Penicillium genus was the most frequently found (32%). The only DNA was detected from A. fumigatus complex. The most prevalent in dust samples were smaller particles which may reach deep into the respiratory system and trigger not only local effects but also the systemic ones. Conclusions: Future research work must be developed aiming at assessing the real health effects of these co-exposures.

Co-exposure to mycotoxins: the case of waste management workers

Introduction - Occupational exposures are characterized by being complex and associated to co-exposure to several contaminants by different exposure routes. Even if exposure occurs to only a chemical agent, it can have different exposure routes and can result in different health effects. The waste management setting is recognized by the presence of several chemical and biologic agents in the workplaces. Recently, it was reported occupational exposure to Aflatoxin B1 (AFB1) in one Portuguese waste management industry. However, data regarding to fungal burden showed that exposure to other mycotoxins should be expected. Aim of the study - The aim of the present work was to know if workers from this waste management industry were exposed to other mycotoxins besides AFB1.

Importance of size-selective particle measuring for assessing occupational exposures: a case study “from field to fork”

Sampling the total air concentration of particulate matter (PM) only provides a basic estimate of exposure that normally not allows correlating with the observed health effects. Therefore is of great importance to recognize the particles size distribution and, particularly, the exposure to fine particles (≤ 2.5 μm). This particles dimension corresponds to the respirable fraction, the one that can implicate local and systemic effects due to particle deposition and clearance from the lungs and transport within the organism. This study intended to describe occupational exposure to PM2.5 in three units related with swine production and consumption, namely: feed production, swine production and swine slaughterhouse. A size-selective particle measuring in five to six workplaces of each unit was performed. Measurements of PM were done using a portable direct-reading hand-held equipment (Lighthouse, model 3016 IAQ). Data showed slaughterhouse unit with higher values, with values ranging from 0.030 to 0.142 mg/m3 (0.073 + 0.043), being the cutting room the workplace with higher values. In feed production unit, values were between 0.026 and 0.033 mg/m3 (0.028 + 0.003) with the warehouse of pharmacy products as the workplace with higher values. Finally, in swine unit values ranged from 0.006 to 0.048 mg/m3 (0.023 + 0.017) with the batteries area presenting the higher values. PM can be rich in fungi and bacteria and their metabolites, such as endotoxins and mycotoxins. Previous publications already showed high contamination in these occupational settings and particles can have an important role in exposure since can easily act as carrier of these agents. Data acquired allow not only a better prediction of particle penetration into respiratory regions of the respiratory tract, but also a better estimation of PM health effects. Moreover, data permit to identify the workplaces where investment should be made to prevent and reduce exposure.

BPA occupational exposure assessment in Europe: a scientific gap

Bisphenol A (BPA), 2,2-bis(4-hydroxyphenyl) propane one is of the greatest volume industrial chemicals utilized in the world with increased production every year. Environmental exposure to this xenoestrogen is considered a generalized phenomenon with a Tolerable Daily Intake (TDI) of4 µg/kg body weight/day established by the European Food Safety Authority. Several studies have focused in estimate human daily intake and potential associated health effects of environmental exposures, however despite of the massive BPA production and consumption in European countries, with policarbonate and epoxy resins as the major applications, occupational exposure to BPA have been overlooked and considered safe by the European authorities.

Climate changes influence in occupational exposure to fungi and mycotoxins

Climate changes and their effects on fungal distribution and activity are aspects of concern regarding the human exposure to mycotoxins. An exhaustive search was made for papers available in scientific databases reposrting the influence that climate cchange has on fungi and mycotoxins. Also a review regarding fungal burden, collected between 2010 and 2015 in different settings, was done to support the discussion about future fungi and mycotoxins ocuupational exposure. A. flavus complex, E. graminerarum complex and F. verticilliodes were the most reported to be influenced by climate changes. We noted also that the analyzed Portuguese settings presented already an occupational problem due to their fungal burden. It will be important to know future climate changes to select what complexes/species and strains, and consequently the mycotoxins, we should consider as indicators of an occupational problem. In addition, epidemiologic studies are needed to increase knowledge about potential health effects related with the exposure to both risk factors.