Efeito do treinamento físico associado a um programa de perda de peso no controle clínico e nos fatores de saúde relacionados à qualidade de vida em asmáticos obesos

Introdução: O fenótipo asma-obeso caracteriza-se por uma asma mais grave, no qual o controle clínico é mais difícil de ser alcançado, mesmo sob terapia medicamentosa otimizada. A cirurgia bariátrica tem sido recomendada para perda de peso e melhora dos sintomas, porém os benefícios de intervenções não-cirúrgicas têm sido pouco estudados. Objetivo: Avaliar o efeito do treinamento físico associado a um programa de perda de peso no controle clínico da asma, qualidade de vida e sintomas psicossociais em asmáticos obesos. Métodos: 55 pacientes com asma moderada a grave e obesidade grau II (IMC >= 35 e < 39.9 kg/m2) foram alocados em 2 grupos: programa de perda de peso + placebo (PP+P) ou programa de perda de peso + exercícios (PP+E), sendo que o programa de perda de peso incluiu terapia nutricional e psicológica (12 sessões semanais de 60 minutos cada). O grupo PP+E associou exercícios aeróbios e resistidos programa de perda de peso, enquanto o grupo PP+P associou exercícios placebo (respiratórios e alongamentos), 2xvezes/semana, 60 minutos/sessão durante 3 meses. Antes e após as intervenções, foram avaliados o controle clínico da asma, os fatores de saúde relacionados a qualidade de vida (FSRQV), a capacidade física, a composição corporal, os sintomas de ansiedade e depressão, a qualidade do sono, a função pulmonar e as inflamações das vias aéreas e sistêmica. A comparação dos dados contínuos entre os grupos foi realizada por ANOVA de dois fatores com medidas repetidas e das variáveis categóricas pelo teste qui-quadrado. A correlação linear e a regressão linear múltipla foram utilizadas para avaliar associações entre as variáveis avaliadas. Resultados: Foram analisados os resultados de 51 pacientes que foram reavaliados. Comparado com o grupo PP+P, os pacientes que realizaram exercício apresentaram melhora no controle clínico da asma (- 0,7 [-1,3 - -0,3] vs. -0,3 [-0,9 - 0,4] escore ACQ; p=0,01) e nos FSRQV (0,8 [0,3 -2,0] vs. 0,4 [-0,3 - 0,9] escore AQLQ; p=0,02), respectivamente. Essa melhora parece ter sido consequência do aumento do condicionamento físico (3,0 [2,4-4,0] vs. 0,9 [-0,3-1,3] mL.O2/Kg/min; p < 0,001) e da perda de peso (6,8±3,5% vs. 3,1±2,6% do peso corpóreo; p < 0,001) nos pacientes do grupo PP+E, que também apresentaram uma melhora dos sintomas de depressão, da qualidade do sono (ronco, latência e eficiência) e dos níveis séricos de vitamina D. Houve também melhora da função pulmonar (capacidade vital forçada e volume de reserva expiratório) e das inflamações das vias aéreas (FeNO) e sistêmica (CCL2, CXCL9, IL-4, IL-6, TNF-alfa, IL-10 e leptina/adiponectina), que parecem ser possíveis mecanismos associados à melhora do controle clinico da asma nos pacientes do grupo PP+E (p < 0,05 para todas variáveis apresentadas). Conclusão: A inclusão do treinamento físico em um programa de perda de peso a curto prazo deve ser considerada como uma intervenção eficiente para associar à terapia medicamentosa da asma na melhora do controle clínico em asmáticos obesos

Renewable Energies and Community Associations: Providing Homeowners with Renewable Energy Options

As energy costs increase in Colorado more homeowners will need renewable energies to provide electricity, heating and cooling for their homes. Renewable energy technology and energy efficient measures have been available for decades but Homeowner Associations (HOA) has not permitted this technology into communities primarily because of aesthetics. In April 2008, House Bill 1270 was signed into law that gives homeowners the right to make their homes more energy efficient and install renewable energy generation devices. The purpose of this capstone is to enable HOAs with information on available technology and design guideline options that can be integrated into communities and thus encourage, instead of hinder, the use of renewable energy and energy efficient measures.

Prospective associations between meth/amphetamine (speed) and MDMA (ecstasy) use and depressive symptoms in secondary school students

Background Research has raised significant concern regarding the affective consequences of synthetic drug use. However, little evidence from well-controlled longitudinal studies exists on these consequences. The aim of this study was to determine whether use of meth/amphetamine (speed) and 63,4- methylenedioxymethamphetamine (MDMA, ecstasy) is independently predictive of subsequent depressive symptoms in adolescents. Methods A sample of 3880 adolescents from secondary schools in disadvantaged areas of Quebec, Canada, were followed over time (2003e2008). Logistic regression was used to test the association between meth/ amphetamine and MDMA use in grade 10 (ages 15e16 years) and elevated depressive symptoms on an abridged Center for Epidemiologic Studies-Depression scale in grade 11, controlling for pre-existing individual and contextual characteristics. Results After adjustment, both MDMA use (OR 1.7, 95% CI 1.1 to 2.6) and meth/amphetamine use (OR 1.6, 95% CI 1.1 to 2.3) in grade 10 significantly increased the odds of elevated depressive symptoms in grade 11. These relationships did not vary by gender or pre-existing depressive symptoms. Increased risk was particularly observed in concurrent usage (OR 1.9, 95% CI 1.2 to 2.9). Conclusions Adolescent use of meth/amphetamine and MDMA (particularly concurrent use) is independently associated with subsequent depressive symptoms. Further enquiry must determine whether these associations reflect drug-induced neurotoxicity and whether adolescence is a period of increased vulnerability to the hazards of synthetic drug exposure.

Reciprocal Prospective Associations Between Depressive Symptoms and Perceived Relationship With Parents in Early Adolescence

Objective: Adolescent depressive symptoms are associated with difficult family relationships. Family systems and interpersonal theories of depression suggest that this association could reflect a circular process in which symptoms and family functioning affect each other over time. Few longitudinal studies have tested this hypothesis, and the results of these studies have been equivocal. In this study, we examine reciprocal prospective associations in early adolescence between depressive symptoms and 2 important aspects of parent–child relationships: communication and conflict. Methods: Participants were 3862 students who annually filled out self-reports. Path analysis was used to examine prospective associations between depressive symptoms and perceived communication and conflict with parents from the age of 12 to 13 and 14 to 15 years. Independence of these associations was assessed by controlling for family context (parental separation and family socioeconomic status) and adolescent behaviour problems (delinquent behaviours and substance use). Sex differences were evaluated with multiple group analysis. Results: Reciprocal prospective associations were found between depressive symptoms and perceived conflict with parents, but not between depressive symptoms and communication with parents. Depressive symptoms were found to predict poorer communication with parents over time, but communication was not predictive of lower depressive symptoms in subsequent years. All paths were sex-invariant and independent from family context and behaviour problems. Conclusion: This study highlights the importance of considering the potential impact of adolescent symptomatology on parent–child relationships and suggests that reciprocity may characterize the association between depressive symptoms and negative aspects of parent–child relationships. The role of adolescent perceptions in the interplay between depressive symptoms and family relationships remains to be clarified.

The Judicial Dimension of the European Neighbourhood Policy. EU Diplomacy Paper 08/2013, November 2013

In this paper, the expression “neighbourhood policy” of the European Union (EU) is understood in a broad way which includes the members of the European Free Trade Association (EFTA) contracting parties to the European Economic Area (EEA), the EFTA State Switzerland, candidate states, the countries of the European Neighbour-hood Policy (ENP), and Russia. The European Court of Justice (ECJ) is the centre of gravity in the judicial dimension of this policy. The innermost circle of integration after the EU itself comprises the EFTA States who are party to the European Economic Area. With the EFTA Court, they have their own common court. The existence of two courts – the ECJ and the EFTA Court – raises the question of homogeneity of the case law. The EEA homogeneity rules resemble the ones of the Lugano Convention. The EFTA Court is basically obliged to follow or take into account relevant ECJ case law. But even if the ECJ has gone first, there may be constellations where the EFTA Court comes to the conclusion that it must go its own way. Such constellations may be given if there is new scientific evidence, if the ECJ has left certain questions open, where there is relevant case law of the European Court of Human Rights or where, in light of the specific circumstances of the case, there is room for “creative homogeneity”. However, in the majority of its cases the EFTA Court is faced with novel legal questions. In such cases, the ECJ, its Advocates General and the Court of First Instance make reference to the EFTA Court’s case law. The question may be posed whether the EEA could serve as a model for other regional associations. For the ENP states, candidate States and Russia this is hard to imagine. Their courts will to varying degrees look to the ECJ when giving interpretation to the relevant agreements. The Swiss Government is – at least for the time being – unwilling to make a second attempt to join the EEA. The European Commission has therefore proposed to the Swiss to dock their sectoral agreements with the EU to the institutions of the EFTA pillar, the EFTA Surveillance Authority (ESA) and the EFTA Court. Switzerland would then negotiate the right to nominate a member of the ESA College and of the EFTA Court. The Swiss Government has, however, opted for another model. Swiss courts would continue to look to the ECJ, as they did in the past, and conflicts should also in the future be resolved by diplomatic means. But the ECJ would play a decisive role in dispute settlement. It would, upon unilateral request of one side, give an “authoritative” interpretation of EU law as incorporated into the relevant bilateral agreement. In a “Non-Paper” which was drafted by the chief negotiators, the interpretations of the ECJ are even characterised as binding. The decision-making power would, however, remain with the Joint Committees where Switzerland could say no. The Swiss Government assumes that after a negative decision by the ECJ it would be able to negotiate a compromise solution with the Commission without the ECJ being able to express itself on the outcome. The Government has therefore not tried to emphasise that the ECJ would not be a foreign court. Whether the ECJ would accept its intended role, is an open question. And if it would, the Swiss Government would have to explain to its voters that Switzerland retains the freedom to disregard such a binding decision and that for this reason the ECJ is not only no foreign court, but no adjudicating court at all.

Why Are German Employers Associations Declining? A Challenge to the Conventional Wisdom. CES Germany & Europe Working Papers, No. 05.3, 2005

This paper challenges the conventional explanation for declining density of German employers associations. The dominant account asserts that German trade unions have taken advantage of increased globalization since the 1980s which has made internationally active enterprises more vulnerable to production disruptions to extract additional monopoly rents from multinational employers via aggressive collective bargaining. Small firms have responded to the increased union pressures by avoiding membership employers associations, which has produced the density declines. Data, however, disconfirm the conventional explanation; compensation increases have actually become increasingly smaller over the decades. This paper presents an alternative explanation that is consistent with the data. We argue that it is the large product manufacturers rather than the trade unions that have greatly increased price pressures on parts suppliers, which has led to a disproportionate number of suppliers to quit employers associations. The paper also discusses these findings in light of the "varieties of capitalism" literature. It points out that this literature has depicted national models as too homogeneous. The decision of several German employers associations to offer different classes of membership represents an accentuation of variety within national varieties of capitalism.