Sociocultural considerations in aging men's health: implications and recommendations for the clinician

http://dx.doi.org/10.1016/j.jomh.2009.07.00

Crustacea decapoda da praia rochosa da Ilha do Farol, Matinhos, Paraná: II. Distribuição espacial de densidade das populações

<abstract language="eng">Decapod crustaceans from rocky shore at Farol Isle, Matinhos, Paraná, Brazil. II. Spatial distribution of population densities. A study of the spatial distribution of the decapod populations from a rocky shore at Farol Isle, Matinhos, State of Paraná, Brazil (25º51'S, 48º32'W) was canied out. In the supralittoral the rocky surface is covered partially by a layer of litter coming from the terrestrial habitats; in the midlittoral boulders and pebbles cover the rocky basin and in the infralittoral, there is a belt of seaweeds. A total of 8 samples were taken by hand, two from each of the following levels: supralittoral (emersion time 8-12 hours), upper midlittoral (4-8), lower midlittoral (0-4) and limit between midlittoral and infralittoral, monthly, from May/1990 to April/1991. The number of species increased from supralittoral (5) to infralittoral (22) and a clear vertical zonation on density was observed according to the emersion time gradient. The supralittoral is characterized by grapsids Armases angustipes (Dana, (1852), Cyclograpsus integer H. Milne Edwards, 1837 and Metasesarma rubripes (Rathbun, 1897) which have terrestrial habits and aerial respiration as a main way in obtaining the oxygen. In the midlittoral, the decapods show three basic types of adaptation against emersion desiccation and thermal stresses: (1) by digging into wet mud among the stones such as Panopeus americanus Saussure, 1857, Panopeus occidentalis Saussure, 1857 and Eurypanopeus abbreviatus Stimpson, 1860, (2) by resting in shady and wet space between the boulders and pebbles or underside of them, like Pachygrapsus transversus (Gibbes, 1850), Petrolisthes armatus (Gibbes, 1850) and adults of Menippe nodifrons Stimpson, 1859 and (3) by clinging over the soaked filamentous algae layer on the pebbles or bouders surfaces, a strategy observed in small species such as Pilumnus dasypodus Kingsley, 1879, Podochela sp., Petrolisthes galathinus (Bosc, 1801 ), Alpheus bouvieri A. Milne Edwards, 1878 and juveniles of Menippe nodifrons. In the infralittoral, small species which are vulnerable to desiccation stresses share space by diversification of their diet and adaptation strategies such as camouflage, body color change according to the substratum, flattened body for tight adhesion on hard surface and rapid movements. The main species of this zone are Petrolisthes armatus, Petrolisthes galathinus, juveniles of Menippe nodifrons, Epialtus brasiliensis Dana, 1852, P. dasypodus, Synalpheus fritzmuelleri Coutière, 1909, Megalobrachium roseum (Rathbun, 1900) and species of Palaemonidae. The rocky shore at Farol Isle is a complex architectural environment due to the conjunction of diversified habitats such as litter over a hard surface, spaces and crevices among boulders and pebbles, muddy substratum and phytal

Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE):an international observational study

Background: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. Methods: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. Findings: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p&lt;0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14–1·44; all p&lt;0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12–1·72) irrespective of other patient and service characteristics. Interpretation: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes

A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee

Many clinical trials have evaluated the benefit of long-term use of antiplatelet drugs in reducing the risk of clinical thrombotic events. Aspirin and ticlopidine have been shown to be effective, but both have potentially serious adverse effects. Clopidogrel, a new thienopyridine derivative similar to ticlopidine, is an inhibitor of platelet aggregation induced by adenosine diphosphate. METHODS: CAPRIE was a randomised, blinded, international trial designed to assess the relative efficacy of clopidogrel (75 mg once daily) and aspirin (325 mg once daily) in reducing the risk of a composite outcome cluster of ischaemic stroke, myocardial infarction, or vascular death; their relative safety was also assessed. The population studied comprised subgroups of patients with atherosclerotic vascular disease manifested as either recent ischaemic stroke, recent myocardial infarction, or symptomatic peripheral arterial disease. Patients were followed for 1 to 3 years. FINDINGS: 19,185 patients, with more than 6300 in each of the clinical subgroups, were recruited over 3 years, with a mean follow-up of 1.91 years. There were 1960 first events included in the outcome cluster on which an intention-to-treat analysis showed that patients treated with clopidogrel had an annual 5.32% risk of ischaemic stroke, myocardial infarction, or vascular death compared with 5.83% with aspirin. These rates reflect a statistically significant (p = 0.043) relative-risk reduction of 8.7% in favour of clopidogrel (95% Cl 0.3-16.5). Corresponding on-treatment analysis yielded a relative-risk reduction of 9.4%. There were no major differences in terms of safety. Reported adverse experiences in the clopidogrel and aspirin groups judged to be severe included rash (0.26% vs 0.10%), diarrhoea (0.23% vs 0.11%), upper gastrointestinal discomfort (0.97% vs 1.22%), intracranial haemorrhage (0.33% vs 0.47%), and gastrointestinal haemorrhage (0.52% vs 0.72%), respectively. There were ten (0.10%) patients in the clopidogrel group with significant reductions in neutrophils (< 1.2 x 10(9)/L) and 16 (0.17%) in the aspirin group. INTERPRETATION: Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death. The overall safety profile of clopidogrel is at least as good as that of medium-dose aspirin

Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage

BackgroundThe kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain.Study DesignSecondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP<140mmHg) or contemporaneous guideline-based (target SBP<180mmHg) BP management.Setting & Participants2,823 patients from 144 clinical hospitals in 21 countries.PredictorsAdmission estimated glomerular filtration rates (eGFRs) of patients were categorized into 3 groups based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation: normal or high, mildly decreased, and moderately to severely decreased (>90, 60-90, and <60mL/min/1.73m2, respectively).OutcomesThe effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms.ResultsOf 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P=0.5 for homogeneity).LimitationsGeneralizability issues arising from a clinical trial population.ConclusionsDecreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs