Comment on Bress et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017;40:1401-1408.

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Uso do Implante de Etonogestrel Além da Duração Aprovada – Um Caso Clínico

The contraceptive implant is the most effective method of reversible contraception. Observational and trial data indicate that this method remains effective beyond the initially approved duration of use. We report a case of etonogestrel serum levels above the supposed threshold value for ovulation suppression nine years after implant insertion.info:eu-repo/semantics/publishedVersio

Interictal Spike Quantification in Continuous Spike-Wave of Sleep (CSWS): Clinical Usefulness of a Wearable EEG Device

Continuous spike-wave of sleep (CSWS) syndrome is one of the most common epileptic encephalopathies of childhood. Because the associated cognitive/behavioral disturbances relate more to the amount of spike activity than of seizures, methods of spike quantification gained relevance in diagnosis and monitoring treatment. The conventional methodology for quantification of spike index (SI) relies on repeated full 10-20 long-term ambulatory electroencephalography (aEEG), which is both expensive and poorly tolerated.info:eu-repo/semantics/publishedVersio

Atypical presentation of erythema multiforme

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Adolescent Pregnancy: A Case-Series Study of 112 Adolescent Mothers and Their Newborns

Background Although declining, adolescent pregnancy remains an important health concern and is associated with adverse maternal and fetal outcomes. We aimed to characterize adolescent pregnancy in a level II hospital and the observed maternal, fetal, and perinatal complications. Methods We conducted a case-series study of five-years duration with adolescent mothers and their newborns. We collected sociodemographic, obstetric, and neonatal data through chart review and conducted a comparison analysis between newborns who needed hospitalization and those who did not. Results We identified 112 newborns with adolescent mothers. Most pregnancies were unplanned (89.3%) and the start of pregnancy surveillance was late. The most frequent complications were intrauterine growth restriction, oligohydramnios, and threatened preterm labor. Prematurity was found in 9.8% of the newborns and 0.9% had less than 32 weeks at the time of birth. Thirteen newborns (11.6%) needed hospitalization in the neonatal intensive care unit, with three (23%) needing invasive ventilation. The main diagnoses of admission were prematurity, social risk, low birth weight, feeding difficulties, and newborn respiratory distress syndrome. Hospitalization seemed associated with less frequent breastfeeding. Among the hospitalized newborns, there was a high rate of discharge at the care of a relative or an institution (30.8%). Surprisingly, surveillance during pregnancy did not seem to differ between newborns that needed hospitalization and those that did not. Discussion Adolescent pregnancy is associated with poor surveillance as well as obstetric and neonatal complications. Newborns of adolescent mothers have a high hospitalization rate, but further investigations are needed to fully understand the contributing factors. The creation of multidisciplinary teams is fundamental for reducing complications, and appropriate reproductive health programs should focus on reducing adolescent pregnancy through better access to education and contraception.info:eu-repo/semantics/publishedVersio

Does community deprivation determine longevity after the age of 75? A cross-national analysis

Objectives: Analyze the association between socioeconomic deprivation and old-age survival in Europe, and investigate whether it varies by country and gender. Methods: Our study incorporated five countries (Portugal, Spain, France, Italy, and England). A 10-year survival rate expressing the proportion of population aged 75–84 years who reached 85–94 years old was calculated at area-level for 2001–11. To estimate associations, we used Bayesian spatial models and a transnational measure of deprivation. Attributable/prevention fractions were calculated. Results: Overall, there was a significant association between deprivation and survival in both genders. In England that association was stronger, following a dose–response relation. Although lesser in magnitude, significant associations were observed in Spain and Italy, whereas in France and Portugal these were even weaker. The elimination of socioeconomic differences between areas would increase survival by 7.1%, and even a small reduction in socioeconomic differences would lead to a 1.6% increase. Conclusions: Socioeconomic deprivation was associated with survival among older adults at ecological-level, although with varying magnitude across countries. Reasons for such cross-country differences should be sought. Our results emphasize the importance of reducing socioeconomic differences between areas.This work was supported by Portuguese funds through FCT—Fundação para a Ciência e a Tecnologia in the framework of project UID/BIM/04293/2013. AIR and MFP would also like to thank to FC—Fundação para a Ciência e a Tecnologia for the Grants PTDC/SAU-EPI/113424/2009 and SFRH/BD/82529/2011. MSC was supported by CNpQ (309692/2013-0) and FAPERJ (E-26/203.557/2014).We are very grateful to the National Statistic Offices for sending us the required data and to all the members of the European Deprivation Index (EDI) team. The authors would like to thank Rogério Ribeiro for the help in preparing visual supports, Alexandra Guttentag for her work as language editor, and the anonymous reviewers for their highly valuable corrections and suggestions

Distance to parks and non-residential destinations influences physical activity of older people, but crime doesn’t: a cross-sectional study in a southern European city

Background: Physical activity (PA) has numerous health benefits, but older adults live mostly sedentary lifestyles. The physical and social neighborhood environment may encourage/dissuade PA. In particular, neighborhood crime may lead to feeling unsafe and affect older adults’ willingness to be physically active. Yet, research on this topic is still inconclusive. Older population, probably the age group most influenced by the neighborhood environment, has been understudied, especially in Southern Europe. In this study, we aimed to analyze the association between leisure-time physical activity (LTPA) in older adults and objective crime, alongside other neighborhood characteristics. Methods: We obtained data from a population-based cohort from Porto (2005–2008) to assess LTPA. Only adults aged 65 years or more were included (n = 532). A Geographic Information System was used to measure neighborhood characteristics. Neighborhood crime was expressed as crime rates by category (incivilities, criminal offenses with and without violence and traffic crime). Neighborhood characteristics such as socioeconomic deprivation, land gradient, street density, transportation network, distance to parks, non-residential destinations and sport spaces were also included. Generalized Additive Models were fitted to estimate the association between neighborhood characteristics and the participation (being active vs. inactive) and frequency (min/day) of LTPA. Results: Forty-six percent of the men and 61 % of the women did not engage in any kind of LTPA. Among the active participants, men spent on average 50.5 (35.2 Standard Deviation, SD) min/day in LTPA, whereas the average among women was 36.9 (35.1 SD) min/day (p < 0.001). Neighborhood crime was unrelated to the participation in, or frequency of, LTPA. On the other hand, two neighborhood characteristics – distance to the nearest park (β = −0.0262, p = 0.029) and to the nearest non-residential destination (β = −0.0735, p = 0.019) – were associated with time spent on LTPA, but only among active older women. No neighborhood characteristic was related to participation in LTPA. Conclusions: From a public health point of view, the provision of parks and non-residential destinations (shops, schools, cultural and worship places) might contribute to elevate PA levels of already active older women. On the other hand, in this setting, crime was not a big issue