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

Vorapaxar in the secondary prevention of atherothrombotic events

Item does not contain fulltextBACKGROUND: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. METHODS: We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. RESULTS: At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). CONCLUSIONS: Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.)