The monocyte/high-density lipoprotein ratio predicts coronary artery disease in heart failure

Background

The monocyte/high density lipoprotein ratio (MHR) is a combined inflammatory marker implicated in atherosclerosis. MHR predicts cerebrovascular disease (CVD) and chronic kidney disease (CKD); it correlates with coronary artery disease (CAD) severity and has been shown to be a prognostic predictor in patients with myocardial infarction. The role of MHR in chronic heart failure (HF) is largely unknown.

Purpose

Assess the ability of MHR to predict CAD in patients with HF

Methods

We conducted a retrospective cohort study in ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) that were followed in our HF clinic from January/2012 to May/2018. We selected all the patients that had performed a diagnostic/therapeutic coronary angiography. Patients with missing data concerning monocyte counts or high-density lipoprotein levels were excluded. The endpoint under analysis was the presence of CAD on coronary angiography. A ROC curve was used to study the ability of MHR to predict CAD. The association of MHR with CAD was assessed by a logistic-regression analysis. A multivariate model was built accounting for age, sex, comorbidities [hypertension, diabetes, peripheral artery disease (PAD), CVD, CKD and inflammatory/auto-immune disease], low-density lipoprotein value, haemoglobin, brain-type natriuretic peptide (BNP), severe LVSD and segmental contractility defects in the echocardiogram. MHR was analysed both as continuous and categorical variable; the cut-off of 16 was chosen based on the ROC curve.

Results

We studied 295 chronic HF patients with LSVD who underwent coronary angiography. Mean age was 67±12 years, 70.8% men and 55.9% with CAD. Patients with CAD were older (69 against 64 years), had significantly higher MHR (19±9 vs. 16±7), higher prevalence of hypertension, diabetes, PAD and CVD, and worse renal function. The area under the curve for the association between MHR and CAD was 0.68 (0.62–0.74), p<0.001. The best MHR cut-off for CAD prediction was 16 - sensitivity: 66.7%, specificity: 65.4%, positive predictive value: 71.0% and negative predictive value: 60.8%. This association was independent of potential confounders. Patients with MHR≥16 had a multivariate-adjusted OR of having CAD of 5.41 (95% CI: 2.40–12.20), p<0.001 when compared to those with lower MHR. When MHR was analysed as a continuous variable the association remained significant.

Conclusions

The MHR is an independent predictor of CAD in chronic HF. Patients with MHR ≥16 have a 71% probability of presenting CAD and a more than 5-fold higher risk compared with those with lower MHR. It is sometimes difficult to ascertain ischemic disease/aetiology in HF patients, particularly in the elderly, frail and/or with advanced CKD. This simple, inexpensive and harmless marker can help clinicians identify patients most likely to have CAD and decide treatment in accordance.

Funding Acknowledgement

Type of funding sources: None.

The prognostic value of monocyte/ high-density lipoprotein ratio in chronic heart failure

Background

The monocyte-high density lipoprotein ratio (MHR) is an inflammation marker that combines monocyte counts, increased in inflammatory states, and high-density lipoprotein (HDL) levels, that appear to have protective and anti-inflammatory properties. It has been studied in chronic kidney disease, primary hypertension, cerebrovascular disease and coronary artery disease (CAD), and has been shown to be positively correlated with disease severity and worse prognosis. Although inflammation is thought to be implicated in heart failure's (HF) pathophysiology, little is known about the role of MHR in the HF setting.

Purpose

To study the prognostic impact of MHR in chronic HF.

Methods

We conducted a retrospective cohort study in ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) that were followed in our HF clinic from January/2012 to May/2018. Patients with no data on monocyte counts or HDL levels in the first appointment were excluded. Endpoint under analysis: all-cause mortality. Patients were categorized according to MHR quartiles: 1st quartile <11, 2nd quartile ≥11 to <15, 3rd quartile ≥15 to <20 and 4th quartile ≥20. A Cox-regression analysis was used to assess association between MHR and all-cause mortality. A multivariate model was built adjusting for age, sex, hypertension, diabetes mellitus (DM), CAD, obstructive sleep apnea, inflammatory/autoimmune disease, atrial fibrillation, anaemia, renal dysfunction, brain-type-natriuretic peptide (BNP), New York Heart Association (NYHA) class, low-density lipoprotein value, prognostic modifying therapy and severe LVSD.

Results

We studied 560 chronic HF patients with LVSD, mean age 70±12 years, 67.5% men, 37.1% in NYHA class I, 44.8% in NYHA class II and the remaining in higher classes. Patients with MHR≥20 (last quartile) were mostly men with higher prevalence of DM and CAD, they more often presented in higher NYHA classes and with worse renal function and higher BNP. No difference existed concerning doses of evidence based-drugs. During a median follow-up of 53 (32–88) months from the index medical appointment 256 patients (45.7%) died. Mortality was similar in the lower three MHR quartiles, being statistically higher in the last quartile. Considering only two groups - MHR <20 and MHR ≥20 - the all-cause mortality rate was of 41.6 vs. 57.6%, respectively, p=0,001. MHR was independently associated with poor survival. In patients presenting with MHR ≥20, the HR of long-term all-cause mortality was 1.42 (95% CI: 1.04–1.93), p=0.03 when compared with those with lower MHR.

Conclusions

Chronic HF patients with MHR ≥20 have a significant 42% increased risk of long-term all-cause death. We reinforce the role of inflammation in chronic HF. The MHR is a practical, inexpensive and widely available parameter that can help clinicians in the identification of chronic HF patients at higher risk of death.

Funding Acknowledgement

Type of funding sources: None.

Independent community walking after a short protocol of repetitive transcranial magnetic stimulation associated with body weight-support treadmill training in a patient with chronic spinal cord injury: a case report

PURPOSE

Our report describes the effect of repetitive transcranial magnetic stimulation (rTMS) combined with body weight-supported treadmill training (BWSTT) on independent gait recovery in a patient with incomplete spinal cord injury (iSCI).

CASE DESCRIPTION

The patient was a 31-year-old male, household ambulator (aid walker) and community wheelchair user who was 8.5 year post traumatic iSCI (T8 vertebra injury, AIS D).

INTERVENTION

The patient participated in 12 sessions (three times/week for four weeks) of rTMS (1800 pulses, 10 Hz, intensity of 90% resting motor threshold) followed by BWSTT (15-20 min, moderate intensity).

OUTCOMES

After treatment, the patient's score increased 3 points on the Walking Index for Spinal Cord Injury II (walking independence) and he became a community ambulator with crutches. His American Spinal Injury Association (ASIA) lower extremities motor score (motor function) increased from 33 to 45 points and the Spinal Cord Independence Measure III (functional independence) score increased from 23 to 29 for the mobility indoors/outdoors subscale. The patient's lower limb spasticity was reduced (Modified Ashworth Scale), and quality of life improved based on the Short-Form Health Survey - 36, and the Patient Global Impression of Change Scale showed considerable perception of improvement.

CONCLUSION

Our report suggests that a short protocol of rTMS combined with BWSTT improved walking independence, motor function, spasticity, functional mobility and quality of life in this patient with iSCI.

International consensus on natural orifice specimen extraction surgery (NOSES) for gastric cancer (2019)

At present, natural orifice specimen extraction surgery (NOSES) has attracted more and more attention worldwide, because of its great advantages including minimal cutaneous trauma and post-operative pain, fast post-operative recovery, short hospital stay, and positive psychological impact. However, NOSES for the treatment of gastric cancer (GC) is still in its infancy, and there is great potential to improve its theoretical system and clinical practice. Especially, several key points including oncological outcomes, bacteriological concerns, indication selection, and standardized surgical procedures are raised with this innovative technique. Therefore, it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES, which is of great significance for healthy and orderly development of NOSES worldwide.

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer

In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.

Planning a One Health Case Study to Evaluate Methicillin Resistant Staphylococcus aureus and Its Economic Burden in Portugal

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important multidrug-resistant nosocomial pathogens worldwide with infections leading to high rates of morbidity and mortality, a significant burden to human and veterinary clinical practices. The ability of S. aureus colonies to form biofilms on biotic and abiotic surfaces contributes further to its high antimicrobial resistance (AMR) rates and persistence in both host and non-host environments, adding a major ecological dimension to the problem. While there is a lot of information on MRSA prevalence in humans, data about MRSA in animal populations is scarce, incomplete and dispersed. This project is an attempt to evaluate the current epidemiological status of MRSA in Portugal by making a single case study from a One Health perspective. We aim to determine the prevalence of MRSA in anthropogenic sources liable to contaminate different animal habitats. The results obtained will be compiled with existing data on antibiotic resistant staphylococci from Portugal in a user-friendly database, to generate a geographically detailed epidemiological output for surveillance of AMR in MRSA. To achieve this, we will first characterize AMR and genetic lineages of MRSA circulating in northern Portugal in hospital wastewaters, farms near hospitals, farm animals that contact with humans, and wild animals. This will indicate the extent of the AMR problem in the context of local and regional human-animal-environment interactions. MRSA strains will then be tested for their ability to form biofilms. The proteomes of the strains will be compared to better elucidate their AMR mechanisms. Proteomics data will be integrated with the genomic and transcriptomic data obtained. The vast amount of information expected from this omics approach will improve our understanding of AMR in MRSA biofilms, and help us identify new vaccine candidates and biomarkers for early diagnosis and innovative therapeutic strategies to tackle MRSA biofilm-associated infections and potentially other AMR superbugs.

Early Inflammatory Biomarkers as Predictive Factors for Freedom from Infection after Colorectal Cancer Surgery: A Prospective Cohort Study

PURPOSE

Different biomarkers are useful in diagnosing infections. The aim of this work was to clarify the relation between different inflammatory biomarkers (white blood cell [WBC] count, C-reactive protein [CRP], procalcitonin [PCT], and C-reactive protein-to-albumin ratio [CAR]) and early infectious complications after colorectal surgery.

METHODS

This prospective single-center cohort study included 130 patients undergoing elective colorectal surgery. The WBC count, CRP, and PCT were measured at post-operative day one (POD1) and POD3 and albumin on POD3.

RESULTS

Patients with surgical site infections (SSI) exhibited significantly higher CRP concentrations on POD1 and CRP and CAR on POD3 than did patients without SSI. According to receiver operating characteristic analysis, the CRP concentration on POD1 and the CRP and CAR on POD3 showed the highest area under the curve (AUC) for predicting SSI (AUC 0.639, 0.736, and 0.729, respectively). Multivariable logistic regression analysis showed that CRP on POD1 and CRP and CAR on POD3 were independent predictors of SSI (odds ratio 7.355, 7.605, and 8.337, respectively).

CONCLUSIONS

The CRP concentration on PO1 and CRP and CAR on POD3 can positively identify patients at low risk of SSI. They can be used as a prognostic tool to predict an uneventful post-operative period and therefore have been incorporate into our discharge criteria after elective colorectal resection, improving clinical decision-making.

The influence of metabolic syndrome in the outcomes of colorectal cancer patients

AIMS

Determine the influence of metabolic syndrome and its different components in the outcomes of colorectal cancer surgery at 30days.

MATERIALS AND METHODS

Prospective study that included all patients submitted to elective colorectal cancer surgery between August 2015 and August 2016 at Hospital de Braga. Clinical and laboratory parameters evaluated pre-operatively were: central obesity, blood pressure, fasting glucose, triglycerides levels and HDL cholesterol levels. Any complications during the first 30-days after surgery were recorded (readmission, reintervention, anastomotic dehiscence, morbimortality).

RESULTS

One hundred and thirty-four patients were included. Metabolic syndrome was diagnostic in 40.7% of patients with the ATPIII definition, 67.5% with the AHA definition and 67.0% with the IDF definition. At 30days after colorectal cancer surgery, 73.1% patients don't have any complication, 15.7% have minor complications (grade I/II of Clavien-Dindo classification), 11.1% have major complications (grade III/IV/V of Clavien-Dindo classification) and 1.5% have died from surgical complications (grade V of Clavien-Dindo classification). The statistic analysis didn't reveal any association between MS, or it's different components, and surgical outcomes.

CONCLUSION

This study seems to indicate that metabolic syndrome don't have any influence in surgical outcomes of colorectal cancer surgery.

Efficacy of Noninvasive Brain Stimulation on Pain Control in Migraine Patients: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the efficacy of noninvasive brain stimulation (NIBS) on pain control in migraine patients.

BACKGROUND

Recent studies have used NIBS as an abortive and prophylactic treatment for migraine; however, its efficacy regarding meaningful clinical effects remains to be critically analyzed.

DESIGN

Systematic review of controlled clinical trials.

METHODS

Searches were conducted in six databases: MEDLINE (via PubMed), LILACS (via BIREME), CINAHL (via EBSCO), Scopus (via EBSCO), Web of Science, and CENTRAL. Two independent authors searched for randomized controlled clinical trials published through until January 2016 that involved the use of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in migraineurs. Studies which met the eligibility criteria were assessed and methodological quality was examined using the Cochrane tool for assessing risk of bias. Information about pain intensity (primary outcome), migraine attacks, painkiller intake, and adverse effects were extracted.

RESULTS

Eight studies were included in the quantitative analysis with 153 migraine patients that received NIBS and 143 sham NIBS. In overall meta-analysis, we did not find significant results for pain intensity (SMD: -0.61; CI: -1.35 to 0.13; P = .11), for migraine attacks (SMD: -0.44; 95%; CI: -1.15 to 0.26; P = .22), and for painkiller intake (SMD: -0.57; 95% CI: -1.21 to 0.07; P = .08). However, subgroup analysis considering only tDCS effects have demonstrated a decrease for pain intensity (SMD: -0.91; 95% CI: -1.79 to -0.03; P = .04), migraine attacks (SMD: -0.75; 95% CI: -1.25 to -0.24; P = .004), and painkiller intake (SMD: -0.64; 95% CI: -1.21 to -0.07; P = .03). Subgroup analysis for TMS did not reveal significant effects for any outcome.

CONCLUSION

Low or very low quality of evidence suggests that our primary outcome evaluation failed to find support for the superiority of NIBS over sham treatment. Although, subgroup analysis reveals that tDCS have moderate to high effects and could be a promising nonpharmacological alternative to pain control, mainly for painkiller intake reduction. However, there is a need for larger controlled trials with methodological rigor, which could increase the power of result inference.

Antiphospholipid Syndrome On Cloud (APSOnCloud): web-based monitoring of oral anticoagulation

Antiphospholipid Syndrome (APS) is an autoimmune disease characterized by recurrent thromboses and fetal losses with the presence of antiphospholipid antibodies. The main treatment to prevent recurrent thrombotic events is oral anticoagulation with vitamin K antagonist (VKA), which requires frequent monitoring and dosage adjustments. Outpatient anticoagulation monitoring has its limitations, such as patients spending long hours between the testing procedure and waiting for the results to be adjusted. To optimize this adjustment and to improve APS patients-doctors relationship, we developed a website to help monitor APS patients, called Antiphospholipid Syndrome On Cloud or APSOnCloud. To test it, since March 2014 to March 2016, we registered 20 patients with APS that have inserted 132 international normalized ratio (INR) values. Sixty two percent were out of range and it took on average 7 hours for the doctor in charge to adjust these values. The mean time in therapeutic range was 58.1%. Our preliminary experience in monitoring VKA oral anticoagulation on APSOnCloud suggests that patients with APS might benefit from this web-based monitoring.

Criatividade, psycap e liderança: a visão dos profissionais das organizações de saúde

Nas organizações do sector de saúde, a pesquisa sobre liderança e o seu impacto no capital psicológico e na criatividade, em qualquer tipo de contexto organizacional, é quase inexistente. Para reduzir essa lacuna, o objetivo deste texto foi identificar em que medida a percepção de uma liderança autêntica e o capital psicológico influenciam a criatividade dos profissionais de um Centro Hospitalar Português. Os dados relacionados com os conceitos de liderança, capital psicológico e criatividade foram obtidos por meio de um questionário constituído por três partes: capital psicológico positivo; liderança autêntica, e dados demográficos e funcionais, numa amostra de 61 líderes das chefias intermédias dos diversos serviços dos 22 departamentos de Centro Hospitalar, bem como de 183 colaboradores selecionados aleatoriamente pelos líderes. As respostas foram analisadas através da utilização das análises fatoriais e das equações estruturais. Os resultados obtidos confirmaram duas das três hipóteses consideradas no estudo, sugerindo a existência de uma forte relação entre a liderança autêntica e o capital psicológico, e entre este e a criatividade, não sendo explicada diretamente a criatividade pela liderança. Concluiu-se ainda que a liderança e ocapital psicológico têm, nas organizações de saúde, uma forte relação com a criatividade dos seus profissionais

Gestão de saúde familiar e pobreza em período de recessão económica em Portugal

Este artigo assumiu como objetivo principal investigar sobre gestão e saúde, verificando a contribuição da saúde familiar e o seu papel no desenvolvimento local em contexto de recessão económica e agravamento da pobreza em Portugal. Na metodologia inquiriram-se 1021 indivíduos em Portugal Continental, com tratamento estatístico através de análise inferencial, fatorial e também de regressão. Salientam-se como resultados que o facto de um indivíduo se considerar uma pessoa saudável não é independente da atividade profissional, condições de habitação, ou outros determinantes relacionados com as condições de vida. Através de uma análise fatorial consistente foram identificados um conjunto de fatores com importância sobre a gestão de saúde familiar. Como conclusão resulta que as condições de trabalho e em que vivem os cidadãos estão relacionadas com o seu nível de saúde. Identificámos os determinantes mais importantes para explicar a esperança média de vida e que se refletem em período de recessão económica.

Serum level changes of long chain-polyunsaturated fatty acids in patients undergoing periodontal therapy combined with one year of omega-3 supplementation: a pilot randomized clinical trial

Purpose

We aimed to investigate the impact of nonsurgical periodontal treatment combined with one-year dietary supplementation with omega (ω)-3 on the serum levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and arachidonic acid (AA).

Methods

Fifteen patients with chronic generalized periodontitis were treated with scaling and root planing. The test group consisted of seven patients (43.1±6.0 years) supplemented with ω-3, consisting of EPA plus DHA, three capsules, each of 300 mg of ω-3 (180-mg EPA/120-mg DHA), for 12 months. The control group was composed of eight patients (46.1±11.6 years) that took a placebo capsule for 12 months. The periodontal examination and the serum levels of DPA, EPA, DHA, and AA were performed at baseline (T0), and 4 (T1), and 12 (T2) months after therapy.

Results

In the test group, AA and DPA levels had been reduced significantly at T1 (P<0.05). AA and EPA levels had been increased significantly at T2 (P<0.05). The ΔEPA was significantly higher in the test compared to the placebo group at T2-T0 (P=0.02). The AA/EPA had decreased significantly at T1 and T2 relative to baseline (P<0.05).

Conclusions

Nonsurgical periodontal treatment combined with ω-3 supplementation significantly increased the EPA levels and decreased the AA/EPA ratio in serum after one year follow-up. However, no effect on the clinical outcome of periodontal therapy was observed.

Graphical Abstract

Epidemiological surveillance of colonising group B Streptococcus epidemiology in the Lisbon and Tagus Valley regions, Portugal (2005 to 2012): emergence of a new epidemic type IV/clonal complex 17 clone

Binary file ES_Abstracts_Final_ECDC.txt matches

[Epidemiological study of lung cancer in Portugal (2000/2002)]

Lung cancer is the most common form of cancer death in the world. Five-year survival is about 15%, without any change to this picture envisaged. It is the 3rd most prevalent type of cancer in Portugal and the primary cause of cancer death. 85% of lung cancer cases are attributable to smoking. One study performed in Portugal for 3 years (2000/2002) by the Lung Oncology Work Committee of the Portuguese Society of Pulmonology in 22 Hospitals showed that of a total of 4396 patients with lung cancer, 81.8% were male and 18.2% were female, with a mean age of 64.49 +/- 11.28 years. About 70% of patients were smokers or former smokers, with 50.3% of patients presenting with performance status (Zubrod) 1. Histologically, 37.5% were adenocarcinoma, followed by squamous carcinoma in 30.5% of cases, and small cell lung cancer in 12.5%; neuroendocrine carcinoma presented in 1.4% of cases; non small cell lung cancer in 10.5%; mixed carcinoma in 0.7%; large cell carcinoma in 2.3%; and others/not specified in 4.6% of cases. Staging (known in 4097 patients), showed 113 patients in stage IA (2.8%)and 250 patients in stage IB (6.1%); only 0.8% in stage IIA and 4.5% in stage IIB; 9.1% in stage IIIA and 29.9% in stage IIIB; 46.9% were already in stage IV by the time of diagnosis. The first therapeutic option was known in 3855 patients. Surgery was performed in 8.2% and 21.8% of cases were treated with combined therapies (surgery and chemotherapy or radiotherapy, or combination of chemotherapy and radiotherapy); chemotherapy alone was first choice in 43.7% of patients and in 20.3% only best support therapy was chosen.

A novel system for large-scale gene expression analysis: bacterial colonies array

In the present work, we report the use of bacterial colonies to optimize macroarray technique. The devised system is significantly cheaper than other methods available to detect large-scale differential gene expression. Recombinant Escherichia coli clones containing plasmid-encoded copies of 4,608 individual expressed sequence tag (ESTs) were robotically spotted onto nylon membranes that were incubated for 6 and 12 h to allow the bacteria to grow and, consequently, amplify the cloned ESTs. The membranes were then hybridized with a beta-lactamase gene specific probe from the recombinant plasmid and, subsequently, phosphorimaged to quantify the microbial cells. Variance analysis demonstrated that the spot hybridization signal intensity was similar for 3,954 ESTs (85.8%) after 6 h of bacterial growth. Membranes spotted with bacteria colonies grown for 12 h had 4,017 ESTs (87.2%) with comparable signal intensity but the signal to noise ratio was fivefold higher. Taken together, the results of this study indicate that it is possible to investigate large-scale gene expression using macroarrays based on bacterial colonies grown for 6 h onto membranes.

Flooded native pastures of the northern region of the Pantanal of Mato Grosso: biomass and primary productivity variations

The Pantanal comprises a number of landscape units, submitted to a flood pulse with variable intensity or regularity. One of these units, the flooded plains, is important in cattle raising. This study was carried out in the northern portion of the Pantanal and presents data related to the productive dynamics of the flooded native pastures both protected from and exposed to cattle. The greatest total biomass values were for the protected pasture due to accumulated dead biomass. Net primary production presented smaller values at the flood-season start and increasing gradually beginning in the subsequent rainy season. However, consumption by cattle was also more intense during the months of greater precipitation. The effect of cattle in pastures is of fundamental importance to management since it prevents the dead biomass excess that increases fire risks.

Detection of atovaquone and Malarone resistance conferring mutations in Plasmodium falciparum cytochrome b gene (cytb)

Clinical treatment failures of the hydroxynaphthoquinone atovaquone or its combination with proguanil (Malarone) in Plasmodium falciparum malaria has been recently documented. These events have been associated to single nucleotide polymorphisms (SNPs) in the parasite cytochrome b gene (cytb). In this report we describe a set of nest PCR-RFLP methods developed for the fast detection of all known cytb mutations associated to resistance to these drugs. The methods were successfully applied for the analysis of phenol-chloroform extracted DNA samples from patients not cured by Malarone, and from an established parasite clone. Further, the protocol for the detection of the A803C mutation was applied to 164 DNA field samples extracted through crude methanol-based protocols, originated from several malaria settings. The PCR-RFLP methods here presented can be used as a valuable for the clinical detection and study of Malarone and atovaquone P. falciparum resistance.

Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation

OBJECTIVES

To evaluate: (1) the associations between maternal psychological stress, distress and low birth weight (LBW), prematurity and intrauterine growth retardation (IUGR); (2) the interactions between maternal stress, distress and smoking, alcohol and coffee intake; (3) the prevalences of stress and distress in pregnancy.

DESIGN

Longitudinal cohort study.

SETTING

Jundiaí city, São Paulo state, Brazil.

SUBJECTS

A total of 865 pregnant women who attended antenatal care between September 1997 and August 2000.

METHODS

Measures of stress and distress were obtained, by interview, three times in pregnancy: at a gestational age (GA) lower than 16 weeks, from 20 to 26 weeks and from 30 to 36 weeks. Stress was investigated by the perceived stress scale, PSS, and distress by both the general health questionnaire, GHQ, and the State Trait Anxiety inventories, STAI. The outcomes were: LBW (birth weight <2500 g), prematurity (gestational age (GA) at birth <37 weeks) and IUGR (birth weight for GA <or=10th percentile of William's curve). The associations between the outcomes and the psychological measures were assessed in multiple logistic regression models.

RESULTS

Maternal distress was associated with LBW (RR=1.97, P=0.019) and prematurity (RR=2.32, P=0.015), respectively. There was an interaction between distress and smoking in the second interview (P=0.05). The prevalences of stress and distress in the different interviews of pregnancy varied from 22.1 to 52.9%.

CONCLUSIONS

The present study has confirmed that distress is associated with both birthweight and GA. Further research is needed to evaluate the effectiveness of psychological interventions that can improve maternal and foetal well-being.

Geostatistics as a tool to improve sampling and statistical analysis in wetlands: a case study on dynamics of organic matter distribution in the Pantanal of Mato Grosso, Brazil

The Pantanal of Mato Grosso presents distinct landscape units: permanently, occasionally and periodically flooded areas. In the last ones, sampling is especially difficult due to the high heterogeneity occurring inter and intrastratas. This paper presents a comparison of different methodological approaches showing that they can influence decisively the knowledge of distribution organic matter dynamics. In such an area in order to understand the role of the flood pulse in the distribution dynamics of organic matter in a wetland at the Pantanal, we considered that there is spatial dependence between points. This consideration contradicts the classical statistic principle that focuses on the aleatority, and allowed the obtainment of a larger volume of information from a minor sampling effort, which means better performance, with time and money economy.

Promotores públicos e privados no Leader II: o caso das NUTS Douro e das Regiões Autónomas da Madeira e dos Açores

A abordagem territorializada e integrada da implementação de políticas de desenvolvimento rural constitui a principal inovação introduzida na actual concepção da reformulação da política agrícola comum, agora com um cari, cada vez mais rural e menos agrícola. A iniciativa comunitária LEADER é disso exemplo e tem sido apontada, embora com algumas limitações, como um êxito na mudança do status quo de muitas áreas rurais. O objectivo deste Trabalho será o de analisar o que se passou até ao fim de 1999 nas zonas de intervenção do LEADER II que coincidem com as NUTS Douro, uma região periférica do continente português, e das Regiões Autónomas da Madeira e dos Açores que, dada a sua característica insular, detém um estatuto de ultra- -perifericidade, prestando especial atenção ao papel assumido pelo investimento público e privado no processo de mudança para estes territórios.

[Malignant localized fibrous tumor of the pleura]

The authors report a case of a localized fibrous tumour of the pleura with huge proportions of 26 x 14 x 12 cm and 1.25 Kgr of weight, in a 56 year old female patient. The tumour occupied practically the inferior 2/3 of the right pulmonary field and had an unusual insertion in the diaphragmatic parietal pleura. It was non pediculous and had histological features of malignancy. The diagnosis of localized fibrous tumour of the pleura was achieved through observation of the sample obtained by fine needle aspiration. The immunohistochemical study subsequently done on the surgical specimen, confirmed the previous diagnosis. The evaluation of malignancy was based ou the following histological criteria: high cellularity, cellular pleomorphism, mitotic activity (more than four mitotic figures per 10 high power fields), hemorrhagic areas and necrosis.

The value of the Ecological Station of Jataí's ecosystem services and natural capital

The capacity of a given natural ecosystem to provide certain goods and services that satisfy human needs depends on its environmental characteristics (natural processes and components). It was described the availability of these goods and services (environmental functions) controlled and sustained by ecological processes operating in Ecological Station of Jataí (Luiz Antônio, SP). The environmental functions identified were grouped in four main categories. To make environmental values an integrated factor in planning and decision making it was assessed their socio-economic importance in qualitative terms and, if possible their monetary value. The combined potential annual return from identified functions of Ecological Station of Jataí is at least US$ 708.83/ha/year. In comparison to calculations made for other natural ecosystems this is a rather moderate estimate. The Ecological Station of Jataí is poorly protected and managed, it too is still threatened by human activity (agriculture) and many development plans. Although present day market economics do not recognize the monetary value of most environmental functions, such calculations do provide a revealing insight into the great socio-economic importance of Ecological Station of Jataí. More awareness of these values may provide an important incentive for their preservation and sustainable use.

Entre a inovação e o planeamento. Novos modelos de gestão das compras hospitalares

Quando se analisam novas propostas de dinâmicas para a gestão pública, uma das principais constatações é que a normatividade das mesmas constitui como que um labirinto, para o qual dificilmente se encontrará uma saída no campo da inovação. No entanto, face à rápida mudança da sociedade, da tecnologia e da economia actuais, as Instituições Públicas terão de dar os primeiros passos, abandonando, de alguma forma, a gestão beneficente, paternalista e burocrática que têm vindo a desenvolver, em busca de uma outra planeada em função da procura e da inovação. Este artigo reflecte algumas destas preocupações, enunciando os princípios teóricos fundamentais a considerar na criação de uma Central de Compras para as Unidades Hospitalares e Sub-Regiões de Saúde da Zona de Intervenção da Administração Regional de Saúde do Norte, sem descurar os interesses dos principais destinatários (doentes, equipes técnicas, etc.). Mais especificamente, os autores apontam algumas das implicações administrativas e de gestão decorrentes da reestruturação da cadeia de valor explícita na centralização da aquisições.

A diversificação e inovação do investimento em PME’s no âmbito do programa Leader I em Portugal

Pensar em desenvolvimento rural é, também, pensar na emergência, consolidação e diversificação do tecido empresarial, qualquer que seja a fileira de produção onde se enquadrem as PME' s (Pequenas e Médias Empresas). Foi neste sentido que seleccionámos para análise de estudo as PME' s criadas e apoiadas no âmbito do programa comunitário LEADER l (Ligações Entre Acções de Desenvolvimento da Economia Rural), visto tratar-se de um programa destinado à revitalização de economias rurais. Neste sentido, e com todas as. limitações que, por certo, se nos deparam, gostaríamos de ver respondidas algumas, se não todas, das seguintes questões: Quem foram os promotores destas PME' s? Quais as regiões e sectores de actividade mais abrangidos por estes investimentos? Será que as PME' s criadas e apoiadas contribuíram significativamente para a diversificação do tecido empresarial das respectivas economias locais? Em termos sociais, qual a sua contribuição para o emprego? Serão estas PME's inovadoras ao ponto de contribuírem para a melhoria da qualidade de vida das populações locais?