Doctor Versus Midwifery-led Care: A Commentary on a Task-shift, not Only Complex but Difficult to Accept

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Avaliação da circunferência da cintura como variável preditora de risco coronariano em estudo de base populacional

INTRODUÇÃO: A doença coronariana é uma das mais prevalentes no país e determina altos índices de morbi-mortalidade. Medidas simples e práticas que possam ser utilizadas pelos profissionais de saúde para detectar indivíduos com alta probabilidade de desenvolver esse tipo de doença podem ser importantes para a sua prevenção e seu diagnóstico precoce. Nos últimos anos é crescente a atenção dada ao papel da adiposidade abdominal no desenvolvimento de doenças crônicas, especialmente das cardiovasculares. Como na prática a avaliação direta da quantidade de gordura é de difícil obtenção, pode-se utilizar a circunferência da cintura como indicador antropométrico de adiposidade abdominal. OBJETIVOS: Avaliar a associação da circunferência da cintura com risco coronariano, analisar a capacidade dos pontos de corte existentes na literatura em predizer a existência dos fatores de risco e determinar os melhores pontos de corte da circunferência da cintura para predizer hipertensão, dislipidemia, diabetes e risco coronariano elevado na amostra. METODOLOGIA: Estudo transversal, de base populacional, realizado com 1.662 pessoas, na cidade de Vitória (ES). A coleta de dados envolveu questionário estruturado, coleta de dados antropométricos, de pressão arterial e de bioquímica sanguínea. O risco coronariano foi avaliado pelo escore de Framingham, considerado elevado quando acima de 20%. Utilizaram-se como pontos de corte para a circunferência da cintura àqueles sugeridos pela OMS. Foram realizadas análises de correlação, regressão linear e logística, além da construção da curva ROC com a circunferência da cintura como variável preditora dos fatores de risco coronariano. Também se procedeu a determinação dos pontos de corte ideais de acordo com o índice de Youden. RESULTADOS: foram avaliados 764 homens e 898 mulheres com idade entre 25 e 64 anos. As análises de correlação e regressão demonstraram associação positiva entre circunferência da cintura e hipertensão, diabetes, dislipidemia ou risco coronariano elevado. Nos homens, os pontos de corte da circunferência da cintura recomendados pela OMS apresentaram sensibilidade baixa ou moderada para detectar os fatores de risco estudados. Nas mulheres o desempenho do ponto correspondente a 80 cm foi de moderado a bom. A área sob a curva ROC foi maior que 0,5 para todas as condições estudadas, mostrando que a circunferência da cintura é capaz de identificar indivíduos hipertensos, dislipidêmicos, diabéticos ou com risco coronariano elevado. Os dados deste estudo sugerem valores de circunferência da cintura entre 85 e 95 cm para os homens e 76 e 90 cm para as mulheres, como pontos de corte para identificação de hipertensão, dislipidemia, diabetes ou risco coronariano elevado a serem usados em populações com características semelhantes a esta. CONCLUSÃO: a circunferência da cintura pode ser utilizada como preditor de hipertensão, dislipidemia, diabetes e risco coronariano elevado. Por ser uma medida simples, prática e de fácil interpretação, pode-se propor que a circunferência da cintura seja instrumento de vigilância epidemiológica para estes desfechos

Antenatal care policy in high-income countries with a universal health system: A scoping review

The availability, effectiveness, and access to antenatal care are directly linked with good maternal and neonatal outcomes, making antenatal care an important determinant in health. But to be effective, care must always be appropriate, not excessive, not insufficient. Perinatal outcomes vary within and between countries, raising questions about practices, the use of best evidence in clinical decisions and the existence of clear and updated guidance. Through a scoping review methodology, this study aimed to map the available antenatal care policies for lowrisk pregnant women in high-income countries with a universal health system, financed by the government through tax payments. Following searches on the main databases and grey literature, the authors identified and analysed ten antenatal care policies using a previously piloted datachart: Australia, Denmark, Finland, Iceland, Italy, Norway, Portugal, Spain, Sweden and the United Kingdom. Some policies were over 10 years old, some recommendations did not present a rationale or context, others were outdated, or were simply different approaches in the absence of strong evidence. Whilst some recommendations were ubiquitous, others differed either in the recommendation provided, the timing, or the frequency. Similarly, we found wide variation in the methods/strategy used to support the recommendations provided. These results confirm that best evidence is not always assimilated into policies and clinical guidance. Further research crossing these differences with perinatal outcomes and evaluation of cost could be valuable to optimise guidance on antenatal care. Similarly, some aspects of care need further rigorous studies to obtain evidence of higher quality to inform recommendations.info:eu-repo/semantics/publishedVersio

The strange and charm quark contributions to the anomalous magnetic moment of the muon from lattice QCD

AbstractWe describe a new technique (published in [1]) to determine the contribution to the anomalous magnetic moment of the muon coming from the hadronic vacuum polarisation using lattice QCD. Our method uses Padé approximants to reconstruct the Adler function from its derivatives at q2=0. These are obtained simply and accurately from time-moments of the vector current-current correlator at zero spatial momentum. We test the method using strange quark correlators calculated on MILC Collaboration's nf=2+1+1 HISQ ensembles at multiple values of the lattice spacing, multiple volumes and multiple light sea quark masses (including physical pion mass configurations). We find the (connected) contribution to the anomalous moment from the strange quark vacuum polarisation to be aμs=53.41(59)×10−10, and the contribution from charm quarks to be aμc=14.42(39)×10−10−1% accuracy is achieved for the strange quark contribution. The extension of our method to the light quark contribution and to that from the quark-line disconnected diagram is straightforward

Synthesis of new cellulose ethers using Suzuki–Miyaura reactions

Cellulose ethers are functionalized biopolymers that are industrially produced through drastic conditions employing gaseous reactants with a high risk of industrial accident. The cellulose ethers that are commercially available generally bear short carbon-chains. In this work, an alternative method using non-gaseous chemicals is proposed. It relies on the use of the Suzuki–Miyaura reaction employing mild, moisture- and air-stable conditions. Relatively innocuous reagents are used for this step, which allows the formation of a wide range of cellulose ethers bearing various functional groups with different chain-length

Differential frequency of NKG2C/KLRC2 deletion in distinct African populations and susceptibility to Trachoma: a new method for imputation of KLRC2 genotypes from SNP genotyping data.

NKG2C is an activating receptor that is preferentially expressed on natural killer (NK) cells. The gene encoding NKG2C (killer cell lectin-like receptor C2, KLRC2) is present at different copy numbers in the genomes of different individuals. Deletion at the NKG2C locus was investigated in a case-control study of 1522 individuals indigenous to East- and West-Africa and the association with the ocular Chlamydia trachomatis infection and its sequelae was explored. The frequency of homozygous KLRC2 deletion was 13.7 % in Gambians and 4.7 % in Tanzanians. A significantly higher frequency of the deletion allele was found in West-Africans from the Gambia and Guinea-Bissau (36.2 % p = 2.105 × 10(-8), 26.8 % p = 0.050; respectively) in comparison to East-African Tanzanians where the frequency of the deletion is comparable to other human populations (20.9 %). We found no evidence for an association between the numbers of KLRC2 gene copies and the clinical manifestations of trachoma (follicular trachoma or conjunctival scarring). A new method for imputation of KLRC2 genotypes from single nucleotide polymorphism (SNP) data in 2621 individuals from the Gambia further confirmed these results. Our data suggest that NKG2C does not play a major role in trachomatous disease. We found that the deletion allele is present at different frequencies in different populations but the reason behind these differences is currently not understood. The new method offers the potential to use SNP arrays from genome wide association studies to study the frequency of KLRC2 deletion in other populations and its association with other diseases

Beyond aggression: Androgen-receptor blockade modulates social interaction in wild meerkats

In male vertebrates, androgens are inextricably linked to reproduction, social dominance, and aggression, often at the cost of paternal investment or prosociality. Testosterone is invoked to explain rank-related reproductive differences, but its role within a status class, particularly among subordinates, is underappreciated. Recent evidence, especially for monogamous and cooperatively breeding species, suggests broader androgenic mediation of adult social interaction. We explored the actions of androgens in subordinate, male members of a cooperatively breeding species, the meerkat (Suricata suricatta). Although male meerkats show no rank-related testosterone differences, subordinate helpers rarely reproduce. We blocked androgen receptors, in the field, by treating subordinate males with the antiandrogen, flutamide. We monitored androgen concentrations (via baseline serum and time-sequential fecal sampling) and recorded behavior within their groups (via focal observation). Relative to controls, flutamide-treated animals initiated less and received more high-intensity aggression (biting, threatening, feeding competition), engaged in more prosocial behavior (social sniffing, grooming, huddling), and less frequently initiated play or assumed a ‘dominant’ role during play, revealing significant androgenic effects across a broad range of social behavior. By contrast, guarding or vigilance and measures of olfactory and vocal communication in subordinate males appeared unaffected by flutamide treatment. Thus, androgens in male meerkat helpers are aligned with the traditional trade-off between promoting reproductive and aggressive behavior at a cost to affiliation. Our findings, based on rare endocrine manipulation in wild mammals, show a more pervasive role for androgens in adult social behavior than is often recognized, with possible relevance for understanding tradeoffs in cooperative systems

The evaluation of undergraduate nurses’ attitudes, perspectives and perceptions toward older people

This literature review was undertaken to evaluate undergraduate nurses' attitudes and perspectives toward older people and perceptions of working with older people. The objectives were to (1) identify if undergraduate nurses hold positive or negative attitudes and perspectives toward older people and perceptions of working with older people, and (2) determine if positive attitudes, perspectives and perceptions can be established, maintained and improved with curriculum activities.Literature review.For the period 2008-2013, the literature search included an electronic database search (Medline, CINAHL, Healthsource/Academic Edition, PsycINFO and PubMed) and a hand search of reference lists of the papers included.The analysis of 32 studies revealed that undergraduate nurses' attitudes, perspectives and perceptions are positive and it is recommended that this be the starting point for the development of curriculum activities and future research to maintain and improve this result. Finally, the limitations of recent studies are identified and a research agenda for future studies is proposed

Postoperative serum proteomic profiles may predict recurrence-free survival in high-risk primary breast cancer

Item does not contain fulltextPURPOSE: Better breast cancer prognostication may improve selection of patients for adjuvant therapy. We conducted a retrospective longitudinal study in which we investigated sera of high-risk primary breast cancer patients, to search for proteins predictive of recurrence-free survival. METHODS: Sera of 82 breast cancer patients obtained after surgery, but prior to the administration of adjuvant therapy, were fractionated using anion-exchange chromatography, to facilitate the detection of the low-abundant serum peptides. Selected fractions were subsequently analysed by surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI-TOF MS), and the resulting protein profiles were searched for prognostic markers by appropriate bioinformatics tools. RESULTS: Four peak clusters (i.e. m/z 3073, m/z 3274, m/z 4405 and m/z 7973) were found to bear significant prognostic value (P </= 0.01). The m/z 3274 candidate marker was structurally identified as inter-alpha-trypsin inhibitor heavy chain 4 fragment(658-688) in serum. Except for the m/z 7973 peak cluster, these peaks remained independently associated with recurrence-free survival upon multivariate Cox regression analysis, including clinical parameters of known prognostic value in this study population. CONCLUSION: Investigation of the postoperative serum proteome by, e.g., anion-exchange fractionation followed by SELDI-TOF MS analysis is promising for the detection of novel prognostic factors. However, regarding the rather limited study population, validation of these results by analysis of independent study populations is warranted to assess the true clinical applicability of discovered prognostic markers. In addition, structural identification of the other markers will aid in elucidation of their role in breast cancer prognosis, as well as enable development of absolute quantitative assays