Perinatal stroke and the risk of developing childhood epilepsy

Objectives—To describe the prevalence of epilepsy after 6 months-of-age in children with perinatal stroke and examine whether perinatal data predict epilepsy onset and resolution. Study design—A retrospective review of 64 children with perinatal stroke. In children with at least 6 months of follow-up data, Kaplan-Meier curves, univariate log-rank tests, and Cox proportional hazards models were used to examine predictors of time to development of seizures, and time to resolution of seizures in children with epilepsy. The association of risk factors with the presence of epilepsy at any time after 6 months-of-age was examined using Fisher’s exact test. Results—Forty-one of the 61 children with at least 6 months of follow-up data (67%) had epilepsy between 6 months-of-age and last follow-up, but in 13 of 41 seizures eventually resolved and anticonvulsants were discontinued. Infarct on prenatal ultrasound (p=0.0065) and family history of epilepsy (p=0.0093) were significantly associated with time to development of seizures after 6 months-of-age in the univariate analysis. No assessed variables were associated with time to resolution of epilepsy or with the presence of epilepsy after 6 months-of-age. Conclusions—Childhood epilepsy is frequent after perinatal stroke. Evidence of infarction on prenatal ultrasound and a family history of epilepsy predict earlier onset of active seizures

A taxonomic revision of the Neotropical termite genera Labiotermes Holmgren and Paracornitermes Emerson (Isoptera: Termitidae: Nasutitermitinae)

The taxonomy of the South American termite genus Labiotermes Holmgren (sensu novo) is revised,including identification keys to soldiers and workers, and distribution maps for all 10 species.Paracornitermes Emerson is treated as a new synonym of Labiotermes. Two new species aredescribed: L. guasu, from the Amazon rain forest and L. oreadicus, from the Cerrado of centralBrazil. Paracornitermes caapora Bandeira & Cancello and P. hirsutus Araujo are placed under thesynonymy of L. orthocephalus. The imagos of L. emersoni and L. orthocephalus are described forthe first time. The workers of all species are described and illustrated, including the enteric valve armature and the mixed segment. The soldiers of the species previously included inParacornitermes are redescribed.Fil: Constantino, Reginaldo. Universidade de Brasília; BrasilFil: Acioli, Agmo N. S.. PPG Entomologia; BrasilFil: Smith, Karen. Universidade de Brasília; BrasilFil: Cuezzo, Adriana Carolina. Fundación Miguel Lillo. Dirección de Zoología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán; ArgentinaFil: Carvalho, Sergio H. C. Universidade de Brasília; BrasilFil: Vasconcellos, Alexandre. Universidade Federal do Rio Grande do Norte; Brasi

Sources Of Medicines For Hypertension And Diabetes In Brazil: Telephone Survey Results From Brazilian State Capitals And The Federal District, 2011

This study aimed to analyze differences between patients with diabetes and hypertension in drug treatment and their sources for obtaining medication. This was a cross-sectional study with data from the VIGITEL telephone survey in 2011 in Brazil's state capitals and Federal District. Some 72% of the 15,027 hypertensive patients and 78.2% of the 4,083 diabetics were on medication; 45.8% of the hypertensive patients obtained their medications from public health units, 15.9% from the Popular Pharmacy program, and 38.3% from drugstores, pharmacies, and other sources. The rates among diabetics were 54.4%, 16.2%, and 29.4%, respectively. In the public health units the percentages were highest among individuals with less schooling, black or brown skin, and without private health plans, while the percentages in the Popular Pharmacy program and drugstores/pharmacies and other sources were higher among individuals with more schooling, white skin, and private health plans. Access to different sources of medicines showed disparities between Brazil's regions and state capitals and between social segments of the population.32

Wheezing in infants: frequency, clinical characteristics and treatment

OBJECTIVE: To estimate the frequency and describe the clinical characteristics and respective treatments of previous history of wheezing. METHODS: Infants aged 6-23 months with upper respiratory tract complaints and reporting previous wheezing were followed-up retrospectively. Data were registered on a validated standardized form. RESULTS: Out of 451 infants, 164 (36.4%; 95%CI: 31.9-41.0) had a report of prior history of wheezing, 148 (32.8%; 95%CI: 28.5-37.4) during the first year of life. The mean age at the first episode of wheezing was 5.3±3.9 months. Among those who had had their first episode before 12 months of age, 38.5% reported 3 to 6 episodes and 14.2% > 6 episodes. Mean age at first episode was lower for those with > 3 episodes in comparison with those with seis episódios. A média da idade no primeiro episódio foi menor para os que apresentaram > três episódios em comparação aos que apresentaram até dois episódios (3,2±2,7 versus 5,7±2,5 meses, p < 0,001). CONCLUSÃO: Um terço dos lactentes apresentou chiado no primeiro ano de vida. Quanto mais cedo ocorre o primeiro episódio, mais frequente é a recorrência do chiado.Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal da Bahia Faculdade de Medicina da Bahia Programa de Pós-Graduação em Ciências da SaúdeUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUniversidade de São Paulo Faculdade de Saúde Pública Departamento de EpidemiologiaEscola Bahiana de Medicina e Saúde PúblicaUFBAUFBA Faculdade de Medicina da Bahia Departamento de Anatomia Patológica e Medicina LegalUFBA Faculdade de Medicina da Bahia Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

Protected areas and the neglected contribution of Indigenous Peoples and local communities: Struggles for environmental justice in the Caatinga dry forest

Despite evidence about the contribution of Indigenous Peoples and local communities (IPLCs) to conservation, prevailing strategies still seek their separation from nature, often triggering conflicts. Current pledges to expand global protected area coverage suggest a need for the critical analysis of governance quality and the way conservation interacts with the well-being of IPLCs. We present the case of Catimbau National Park in the Caatinga dry forest of northeast Brazil, where we explored connections between the well-being of IPLCs and landscape through different values, practices and institutions, and perceptions of how environmentally just the park's governance has been. The well-being of IPLCs is inextricably connected with the Caatinga landscape, through multiple place-based relational values that, although differing between Indigenous and non-indigenous inhabitants, have in both cases developed over generations. Although often framed as degraders, IPLCs exhibit a strong motivation to conserve, reflected through local institutions including forest gardens, sustainable use regulations, restoration activities and prevention of external encroachment. The strict form of protected area implemented at Catimbau, instead of a locally led or sustainable use reserve, explicitly targeted the resettlement of IPLCs and livelihood reorientation. These imposed objectives have clashed with a way of life in this peopled landscape and precluded local stewardship on a larger scale. Long-term conflict arose through governance deficiencies which sparked multidimensional injustices. These include not only the misrecognition of local values and customary institutions but also the lack of procedures for consent or decision-making influence, plus distributional harms including tenure insecurity and denied development assistance. Development and conservation strategies must reject narratives about poor, resource-dependent rural communities and embrace the opportunities that local knowledge and institutions bring for effective conservation. As conservation efforts are expanded post-2020, the people of the Caatinga and beyond must be recognised as embedded and a key part of any solution. In strict protected areas like Catimbau, where social conflict constrains their ability to function, seeking legal changes in governance type can be onerous. However, we describe other local-level actions to build relationships and agency that may foster transitions towards better governance, and just treatment of IPLCs. A free Plain Language Summary can be found within the Supporting Information of this article

Sources of medicines for hypertension and diabetes in Brazil: telephone survey results from brazilian state capitals and the Federal District, 2011

Analisar as diferenças entre diabéticos e hipertensos em relação ao tratamento medicamentoso e suas fontes de obtenção. Trata-se de estudo transversal com dados do VIGITEL, realizado em 2011 nas capitais brasileiras. Cerca de 72% dos 15.027 hipertensos e 78,2% dos 4.083 diabéticos estavam em tratamento medicamentoso; 45,8% dos hipertensos obtiveram medicamento nas unidades de saúde públicas, 15,9% no Farmácia Popular e 38,3% em drogarias/farmácias e outras fontes. Entre os diabéticos, encontrou-se 54,4%; 16,2%; e 29,4%, respectivamente. Nas unidades de saúde os percentuais foram mais elevados entre os menos escolarizados, cor de pele preta ou parda e sem plano privado de saúde, e as prevalências de obtenção na Farmácia Popular, drogarias/farmácias e outras fontes foram mais elevadas entre os mais escolarizados, cor de pele branca e com plano privado. O acesso às diferentes fontes de medicamentos apresentou disparidades entre as regiões e capitais brasileiras e entre os segmentos sociais da população322113This study aimed to analyze differences between patients with diabetes and hypertension in drug treatment and their sources for obtaining medication. This was a cross-sectional study with data from the VIGITEL telephone survey in 2011 in Brazil’s state capitals and Federal District. Some 72% of the 15,027 hypertensive patients and 78.2% of the 4,083 diabetics were on medication; 45.8% of the hypertensive patients obtained their medications from public health units, 15.9% from the Popular Pharmacy program, and 38.3% from drugstores, pharmacies, and other sources. The rates among diabetics were 54.4%, 16.2%, and 29.4%, respectively. In the public health units the percentages were highest among individuals with less schooling, black or brown skin, and without private health plans, while the percentages in the Popular Pharmacy program and drugstores/pharmacies and other sources were higher among individuals with more schooling, white skin, and private health plans. Access to different sources of medicines showed disparities between Brazil’s regions and state capitals and between social segments of the populatio

Outcomes of TB Treatment by HIV Status in National Recording Systems in Brazil, 2003–2008

BACKGROUND: Although the Brazilian national reporting system for tuberculosis cases (SINAN) has enormous potential to generate data for policy makers, formal assessments of treatment outcomes and other aspects of TB morbidity and mortality are not produced with enough depth and rigor. In particular, the effect of HIV status on these outcomes has not been fully explored, partly due to incomplete recording in the national database. METHODOLOGY/PRINCIPAL FINDINGS: In a retrospective cohort study, we assessed TB treatment outcomes, including rates of cure, default, mortality, transfer and multidrug resistant TB (MDR-TB) among a purposively chosen sample of 161,481 new cases reported in SINAN between 2003 and 2008. The study population included all new cases reported in the six States with the highest level of completeness of the HIV status field in the system. These cases were mostly male (67%), white (62%), had pulmonary TB (79%) and a suspect chest X ray (83%). Treatment outcomes were best for those HIV negative cases and worst for those known HIV positive patients (cure rate of 85.7% and 55.7% respectively). In multivariate modeling, the risk of having an unfavorable outcome (all outcomes except cure) was 3.09 times higher for those HIV positive compared with those HIV negative (95% CI 3.02-3.16). The risk of death and default also increased with HIV positivity. The group without a known HIV status showed intermediate outcomes between the groups above, suggesting that this group includes some with HIV infection. CONCLUSIONS: HIV status played an important role in TB treatment outcomes in the study period. The outcomes observed in those with known HIV were poor and need to be improved. Those in the group with unknown HIV status indicate the need for wider HIV testing among new TB cases

Investigating associations between the built environment and physical activity among older people in 20 UK towns.

BACKGROUND: Policy initiatives such as WHO Age Friendly Cities recognise the importance of the urban environment for improving health of older people, who have both low physical activity (PA) levels and greater dependence on local neighbourhoods. Previous research in this age group is limited and rarely uses objective measures of either PA or the environment. METHODS: We investigated the association between objectively measured PA (Actigraph GT3x accelerometers) and multiple dimensions of the built environment, using a cross-sectional multilevel linear regression analysis. Exposures were captured by a novel foot-based audit tool that recorded fine-detail neighbourhood features relevant to PA in older adults, and routine data. RESULTS: 795 men and 638 women aged 69-92 years from two national cohorts, covering 20 British towns, were included in the analysis. Median time in moderate to vigorous PA (MVPA) was 27.9 (lower quartile: 13.8, upper quartile: 50.4) minutes per day. There was little evidence of associations between any of the physical environmental domains (eg, road and path quality defined by latent class analysis; number of bus stops; area aesthetics; density of shops and services; amount of green space) and MVPA. However, analysis of area-level income deprivation suggests that the social environment may be associated with PA in this age group. CONCLUSIONS: Although small effect sizes cannot be discounted, this study suggests that older individuals are less affected by their local physical environment and more by social environmental factors, reflecting both the functional heterogeneity of this age group and the varying nature of their activity spaces

An Evaluation of Prediction Equations for the 6 Minute Walk Test in Healthy European Adults Aged 50-85 Years

This study compared actual 6 minute walk test (6MWT) performance with predicted 6MWT using previously validated equations and then determined whether allometric modelling offers a sounder alternative to estimating 6MWT in adults aged 50-80 years.We compared actual 6MWT performance against predicted 6MWT in 125 adults aged 50-85 years (62 male, 63 female). In a second sample of 246 adults aged 50-85 years (74 male, 172 female), a new prediction equation for 6MWT performance was developed using allometric modelling. This equation was then cross validated using the same sample that the other prediction equations were compared with.Significant relationships were evident between 6MWT actual and 6MWT predicted using all of the commonly available prediction equations (all P<0.05 or better) with the exception of the Alameri et al prediction equation (P>0.05). A series of paired t-tests indicated significant differences between 6MWT actual and 6MWT predicted for all available prediction equations (all P<0.05 or better) with the exception of the Iwama et al equation (P = .540). The Iwama et al equation also had similar bias (79.8m) and a coefficient of variation of over 15%. Using sample 2, a log-linear model significantly predicted 6MWT from the log of body mass and height and age (P = 0.001, adjusted R2 = .526), predicting 52.6% of the variance in actual 6MWT. When this allometric equation was applied to the original sample, the relationship between 6MWT actual and 6MWT predicted was in excess of values reported for the other previously validated prediction equations (r = .706, P = 0.001). There was a significant difference between actual 6MWT and 6MWT predicted using this new equation (P = 0.001) but the bias, standard deviation of differences and coefficient of variation were all less than for the other equations.Where actual assessment of the 6MWT is not possible, the allometrically derived equation presented in the current study, offers a viable alternative which has been cross validated and has the least SD of differences and smallest coefficient of variation compared to any of the previously validated equations for the 6MWT