Prevalence of functional limitations in portuguese older adults and its association with high-protein foods: an EpiDoC database analysis

RESUMO: Introdução: O dramático aumento da esperança de vida é uma das maiores conquistas das sociedades modernas. No entanto, muitos desses últimos anos podem ser passados com incapacidade física e má qualidade de vida. A reduzida ingestão proteica associa-se à perda de massa muscular e de força nos idosos. Contudo, a evidência científica sobre a associação entre a ingestão proteica e limitação funcional em idosos é limitada. Assim, os objetivos deste estudo são: 1) determinar a prevalência de limitações funcionais na população idosa a viver na comunidade em Portugal; 2) estabelecer a associação entre a ingestão de alimentos com alto teor proteico e as limitações funcionais nesta população. Métodos: Para responder aos objetivos foi utilizado um estudo transversal em 2393 indivíduos ( 65 anos) da segunda onda de avaliação da coorte EpiDoC, um estudo de base populacional representativo da população portuguesa. Os participantes responderam a um questionário estruturado durante uma entrevista por telefone. Foram recolhidos dados sociodemográficos, de saúde, de estilos de vida, de ingestão alimentar, dados antropométricos e função física. A limitação funcional foi definida como uma pontuação superior a 0 no Health Assessment Questionnaire (HAQ). Utilizou-se regressão logística binária e regressão linear para avaliar a associação entre os alimentos com alto teor proteico e a prevalência de limitações funcionais. Resultados: A prevalência de limitação funcional entre os idosos portugueses foi de 81,0% (n = 2236). A prevalência aumentou com o grupo etário (76,9% para os indivíduos entre os 65 e os 75 anos vs. 93,1% nos indivíduos com mais de 85 anos) e foi mais elevada em indivíduos do sexo feminino (87,1%) e na região dos Açores (85,3%). Não houve associação entre o consumo de alimentos com alto teor proteico (carne, peixe e produtos lácteos) e as limitações funcionais [por exemplo, comer carne todos os dias vs. comer carne raramente ou nunca, em relação à presença de limitações funcionais (OR 0,75; IC a 95%: 0,32-1,78)]. Apesar deste resultado, verificou-se que a idade, o sexo, o índice de massa corporal, a multimorbilidade, a toma de medicação e o estado de saúde percebido estavam significativamente associados (p < 0,05) à existência de limitação funcional [por exemplo, índice de massa corporal (OR 1,08; IC a 95%: 1,03-1,12)], conforme já reportado na literatura científica. Conclusão: Existe uma elevada prevalência de limitações funcionais nos idosos portugueses e as intervenções nutricionais que previnam o seu desenvolvimento são de extrema importância. Não foi identificada associação entre o consumo de alimentos com alto teor proteico e a prevalência de limitações funcionais em idosos portugueses. Estes resultados carecem de replicação noutros estudos em diferentes contextos.ABSTRACT: Introduction: The dramatic increase in life expectancy ranks one of the greatest achievements of the modern societies. However, many of these later years may be spent with increasing disability and compromised quality. Reduced protein intake has been associated with loss of muscle mass and strength in older adults. However, evidence on the association between protein intake and functional limitations among older adults is limited. We aimed to: 1) determine the prevalence of functional limitations among community-dwelling Portuguese older adults and 2) establish the association between the consumption of high-protein foods and functional limitations among Portuguese older adults in these population. Methods: A cross-sectional analysis of 2393 adults( 65 years), of the second wave of follow-up of the EpiDoC cohort - a population-based study representative of the Portuguese population, was performed. Subjects completed a structured questionnaire during a telephone interview. Sociodemographic, health data, lifestyle behaviours, dietary intake, anthropometric data and physical function were collected. Functional limitation was defined as a score > 0 in the Health Assessment Questionnaire. Binary logistic regression and linear regression were used to assess the effect of high-protein foods on functional limitations. Results: Functional limitation prevalence among older adults was 81.0% (n = 2236), increased with age strata (76.9% for 65 – 75 years to 93.1% for > 85 years), and was highest in female individuals (87.1%) and in the Azores (85.3%). There was no association between the consumption of high-protein foods (meat, fish and dairy products) and functional limitation outcomes [e.g. the odds of having functional limitations (HAQ > 0) was similar for eating meat every day vs. eating meat rarely or never (OR 0.75; 95% CI: 0.32-1.78)]. Despite this result, we found that age, sex, body mass index, multimorbidity, medication use and perceived health status were significantly associated (p < 0.05) with functional limitation prevalence [e.g. body mass index (OR 1.08; 95% CI: 1.03-1.12)], as previously reported in scientific literature. Conclusion: Community-dwelling Portuguese older adults have a high prevalence of functional limitations, suggesting the urge to address this situation with nutritional interventions that prevent the development of functional limitations. There was no association between the consumption of high-protein foods and the prevalence of functional limitations in Portuguese older adults. These findings need to be replicated in other studies in different settings

Análise epidemiológica da morbidade hospitalar por fratura de crânio e dos ossos da face em idosos brasileiros em 5 anos

&nbsp; Trauma, due to increased violence and accidents, is an emerging public health problem, with head and facial trauma being common. Traumatic Brain Injury (TBI) causes various injuries and is a silent epidemic, especially in underdeveloped countries. Globally, TBI is one of the leading causes of death among young adults, with a high incidence in the USA. This work is an ecological, quantitative and retrospective study, based on data from SIH/SUS and DATASUS. The variables analyzed include region, type of service, sex and color/race. Of the hospitalizations for skull and facial fractures in the elderly, 78.72% were urgent, 14.17% were elective and 7.09% were due to other accidents. The majority of patients (71.30%) were male. In terms of color/race, 41.84% were white, 38.56% mixed race, and 4.04% black.O trauma, devido ao aumento da violência e acidentes, é um problema emergente de saúde pública, com traumas na cabeça e face sendo comuns. O Traumatismo Crânio-Encefálico (TCE) causa lesões diversas e é uma epidemia silenciosa, especialmente em países subdesenvolvidos. Globalmente, o TCE é uma das principais causas de morte entre jovens adultos, com alta incidência nos EUA. Este trabalho é um estudo ecológico, quantitativo e retrospectivo, baseado em dados do SIH/SUS e DATASUS. As variáveis analisadas incluem região, tipo de atendimento, sexo e cor/raça. Das internações por fratura de crânio e face em idosos, 78,72% foram por urgência, 14,17% eletivas e 7,09% por outros acidentes. A maioria dos pacientes (71,30%) era masculina. Em termos de cor/raça, 41,84% eram brancos, 38,56% pardos, e 4,04% pretos.&nbsp;&nbsp; &nbsp

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Síndrome de Cockayne: Cockayne syndrome

INTRODUÇÃO: A Síndrome de Cocayne (SC) é um distúrbio raro, hereditário, autossômico recessivo que está associado a mutações em dois genes envolvidos no reparo do DNA. Ela é caracterizada por alterações, como nanismo, atraso no desenvolvimento neuropsicomotor, deficiência intelectual, marcha deficiente, anomalias oculares, microcefalia e surdez. Existem 3 tipos de apresentações dessa síndrome que podem ser do tipo I (clássica) , do tipo II (congênita) ou do tipo III ( de início tardio). APRESENTAÇÃO DO CASO: Paciente com 4 anos e 2 meses, feminina, procedente de Januária-MG, foi encaminhada ao HC de São Paulo por deficiência global do desenvolvimento. Apresentava&nbsp; microcefalia, atraso motor, face triangular, cáries nos dentes e pavilhões auriculares aumentados. Aos 3 anos foi diagnosticada surdez neurossensorial bilateral. DISCUSSÃO: A SC apresenta uma falha de crescimento somático e cerebral no período pós-natal, acompanhado de degeneração de múltiplos tecidos A patologia possui um reparo deficiente do DNA o que aumenta sua vulnerabilidade ao estresse oxidativo e envelhecimento. A síndrome não possui tratamento curativo, tendo como objetivo melhorar a qualidade de vida do paciente, tratando possíveis complicações e retardando a sua progressão. CONCLUSÃO: A avaliação do paciente com suspeita de SC deve incluir história clínica completa e um exame físico detalhado devido ao seu difícil diagnóstico, com um enfoque no&nbsp; sistema neurológico, oftalmológico, dermatológico&nbsp; e odontológico. Além disso, a medicina oferece tratamentos sintomáticos e, também, para suas possíveis complicações

Osteíte tuberculosa: Tuberculous osteitis

Introdução: A osteíte tuberculosa é uma condição rara e de difícil diagnóstico, causada por lesões ósseas associadas ao agente etiológico Mycobacterium tuberculosis. Os locais mais acometidos são joelhos, tornozelos, quadris e vértebras. Apresentação do caso: XXX, sexo feminino, 2 anos de idade,&nbsp; admitida com dor em membro inferior direito com edema em joelho associada a deambulação prejudicada há 15 dias. Ao quadro, associavam-se picos de febre baixa, principalmente noturna.&nbsp; Realizada radiografia que discriminou lesão osteolítica na epífise distal do fêmur. Discussão: O tratamento inicial com antibioticoterapia é muito comum devido à dificuldade em diagnosticar essa condição precocemente. Atualmente, o tratamento tem como base antibacilares por tempo variado, com média de um ano. Além disso, um cuidado abrangente, com pilares ortopédicos e fisioterápicos deve ser ofertado visando alívio da dor e evitar sequelas. Conclusão: A principal causa de falha do tratamento é a demora diagnóstica. Sendo assim, devido ao grande potencial benéfico da vacina e à boa resposta terapêutica da osteíte tuberculosa, a vacina não deve ser descontinuada mas se faz de suma importância a disseminação de informações claras e pertinentes a respeito dessa patologia desconhecida

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good