Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability

OBJECTIVE: to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy.METHOD: observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale.RESULTS: the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators.CONCLUSION: the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process

Panorama da ginástica artística feminina brasileira de alto rendimento esportivo: progressão, realidade e necessidades

The Brazilian Women's Artistic Gymnastics results in international championships are refl ecting the high level of the athletes in the modality and expressing the evolution of this sport in Brazil in the last 10 years. Therefore, this article has the goal to present data about such evolution since the fi rst participation of the Brazilian gymnasts in the Olympic Games (1980), and to refl ect the development of the modality in Brazil. The data have been collected through a bibliographic and documental research. The data analysis showed a unstructured and immature process of the development of this sport in Brazil, revealing a very different reality from what has been exposed in the media.Os resultados das atletas brasileiras da Ginástica Artística feminina nos últimos 10 anos, refletidos principalmente nas competições de nível internacional, apontam para uma expressiva evolução do esporte no país. Assim, este artigo tem o propósito de apresentar dados acerca desta transformação, principalmente a partir da participação das ginastas em Jogos Olímpicos (desde 1980), e estabelecer reflexões em relação ao desenvolvimento da modalidade no país. A partir de uma pesquisa bibliográfica e documental, estes dados foram obtidos, reunidos e contextualizados com outras informações já disponíveis na literatura. Ao analisá-los foi possível não só apontar com especificidade como se deu esta evolução, como também apresentar uma realidade deflagradora de um processo ainda imaturo de desenvolvimento do esporte no país, que não condiz em grande parte com o que é posto pela mídia (de que a modalidade está em pleno avanço e de forma estruturada)

Utilizing associational resistance for biocontrol: impacted by temperature, supported by indirect defence

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Validation of the adherence evaluation of osteoporosis treatment (ADEOS) questionnaire for osteoporotic post-menopausal women

SUMMARY: We developed and validated a specific 12-item questionnaire to evaluate adherence to oral antiresorptive medication by post-menopausal osteoporotic women in everyday practice. Over the following 9 months, an index of ≤16 was associated with an increase in the risk of treatment discontinuation of 1.69 and of 2.10 for new patients who had started treatment within the previous year. INTRODUCTION: Adherence to medication in osteoporosis is poor. The goal of this study was to develop and validate a disease-specific questionnaire to evaluate adherence to treatment of women with post-menopausal osteoporosis taking oral antiresorptive medication. METHODS: A prototype adherence questionnaire with 45 items developed from patient interview, literature review, and physician opinion was evaluated in a sample of 350 post-menopausal women with osteoporosis treated in primary care. Item responses were matched against scores on the Morisky Medication Adherence Scale (MMAS). The most discriminant items were retained in the final questionnaire. Concurrent and predictive validity were assessed. RESULTS: Twelve items were associated with MMAS score at a probability level of 0.05. These were retained in the final questionnaire which provided an adherence index ranging from 0 to 22. An index of ≥20 was associated with a high probability of persistence and an index ≤ 16 with a high probability of treatment discontinuation in the following 9 months. CONCLUSIONS: The ADEOS-12 is a simple patient-reported measure to determine adherence to osteoporosis treatments with good concurrent and discriminant validity. This is the first disease-specific adherence measure to have been developed for osteoporosis

HIF-driven SF3B1 induces KHK-C to enforce fructolysis and heart disease.

Fructose is a major component of dietary sugar and its overconsumption exacerbates key pathological features of metabolic syndrome. The central fructose-metabolising enzyme is ketohexokinase (KHK), which exists in two isoforms: KHK-A and KHK-C, generated through mutually exclusive alternative splicing of KHK pre-mRNAs. KHK-C displays superior affinity for fructose compared with KHK-A and is produced primarily in the liver, thus restricting fructose metabolism almost exclusively to this organ. Here we show that myocardial hypoxia actuates fructose metabolism in human and mouse models of pathological cardiac hypertrophy through hypoxia-inducible factor 1α (HIF1α) activation of SF3B1 and SF3B1-mediated splice switching of KHK-A to KHK-C. Heart-specific depletion of SF3B1 or genetic ablation of Khk, but not Khk-A alone, in mice, suppresses pathological stress-induced fructose metabolism, growth and contractile dysfunction, thus defining signalling components and molecular underpinnings of a fructose metabolism regulatory system crucial for pathological growth