Increased epithelial cell proliferation in the ileal pouch mucosa of patients with familial adenomatous polyposis

To eliminate the risk of colorectal cancer in patients with familial adenomatous polyposis (FAP), reconstructive proctocolectomy is performed. Although most colonic mucosa is resected during the ileal pouch anal anastomosis, adenomas and carcinomas may develop in the pouch. This may be caused by altered cell kinetics due to intraluminal changes in the pouch. In 32 patients with FAP, biopsy specimens from the mucosa of the pouch and also of the afferent ileal loop were taken. Tissue sections were immunohistochemically processed with the monoclonal antibodies M30 and MIB-1 to assess apoptotic and proliferative indices, respectively. Cell proliferation was also assessed by a modified sign test. There were no significant differences in apoptotic rates between the mucosa of the pouch and the mucosa of the afferent ileal loop. However, cell proliferation was significantly higher in the mucosa of the pouch vs afferent ileal loop, both by using the quantitative (68.3% vs 61.6%, p = 0.001) and semiquantitative methods (p < 0.05). Our newly developed semiquantitative approach outperformed previously described methods. The higher cell proliferation in the pouch as compared to the afferent ileal loop may contribute to the increased risk for adenomas and carcinomas in the pouch of patients with FAP and emphasizes the need for regular endoscopic surveillance

Planning and Designing Walkable Cities: A Smart Approach

Walking may be considered one of the most sustainable and democratic ways of travelling within a city, thus providing benefits not only to pedestrians but also to the urban environment. Besides, walking is also one of the means of transport most likely subjected to factors outside an individual\u2019s control, like social or physical abilities to walk and the presence of comfortable and safe street infrastructures and services. Therefore, improving urban conditions provided to pedestrians has positive impacts on walkability. At the same time technological solutions and innovations have the power to encourage and support people to walk by overcoming immaterial barriers due to a lack of information or boring travel and they give to decision makers the possibility to gain data to understand how and where people travel. Merging these two dimensions into a unique approach can drastically improve accessibility, attractiveness, safety, comfort and security of urban spaces. In this context, this paper aims to draw a more multifaceted context for walkability, where new technologies assume a key role for introducing new approaches to pedestrian paths planning and design and thus for enhancing this mode of transport. Indeed, by combining more traditional spatial-based and perceptual analysis of the urban environment with technological applications and social media exploitation there will be room to better support the decision on and to enhance satisfaction of walking as well as to easier plan and design more walkable cities

The Correlates of Leisure Time Physical Activity among an Adults Population from Southern Taiwan

<p>Abstract</p> <p>Background</p> <p>Assessing the correlates of practicing physical activity during leisure time is important with regard to planning and designing public health strategies to increase beneficial behaviors among adult populations. Although the importance of leisure time physical activity (LTPA) is highlighted in many Western countries, there are not many publications on physical activity patterns, and even less on their correlates, in non-Western societies. The goal of this study was thus to explore the determinants influencing adults' leisure time physical activity (LTPA) in a city in southern Taiwan.</p> <p>Methods</p> <p>A cross-sectional population-based study was conducted in 2007, using a standardized questionnaire. Energy expenditure was dichotomized into two groups based on the recommended levels of moderate physical activity from LTPA: ≥10 or < 10 MET·hr·wk^-1. Logistic regression analyses were applied to the results.</p> <p>Results</p> <p>A total of 762 subjects with valid data took part in the study (mean age 53.8 ± 13.8 years). In multivariate logistic regression analysis, we found the following results: Age was positively associated with LTPA. Adults with stronger perceived convenience of exercise facilities (OR = 2.04; 95%CI = 1.28-3.24) and past exercise experience in school (OR = 1.86; 95%CI= 1.19-2.91) participated in more LTPA. Subjects with more general social support (OR = 1.66;95%CI = 1.13-2.44), greater knowledge about the health benefits of exercise (OR = 1.85;95%CI = 1.25-2.74), more sports media consumption (OR = 1.94;95%CI = 1.26-2.98), and higher self-efficacy (OR = 3.99;95%CI = 2.67-5.97) were more likely to engage in LTPA. Further analysis comparing different sources of social support showed only social support from friends had a significant positive association (OR = 1.73;95%CI = 1.14-2.63) with increased LTPA.</p> <p>Conclusions</p> <p>LTPA in southern city of Taiwan showed some unique associations with age, socioeconomic status and media consumption that are not commonly reported in the Western World and similar associations with regards to psychosocial correlates of LTPA participation. Further studies from developing countries are warranted to highlight culture-specific differences in physical activity participation.</p

Fatores associados a atividade fisica, comportamento sedentario e participacao na Educacao Fisica em estudantes do Ensino Medio em Santa Catarina, Brasil

Abstract published in English and Portuguese English title: Factors associated with physical activity, sedentary behavior, and participation in physical education among high school students in Santa Catarina State, BrazilThe objectives of this study were to estimate the prevalence of insufficient physical activity, sedentary behavior, and absence from physical education and associated factors. The Santa Catarina State Adolescents' Questionnaire (COMPAC, in Portuguese) was applied to a sample of 5,028 adolescents (15-19 years of age) attending public high schools in the State of Santa Catarina, Brazil. Information included demographic and socioeconomic indicators. Poisson regression analyses were used to test associations. The proportion of students with insufficient physical activity was 28.5%, associated with low consumption of fruits and vegetables (PR = 1.27; 95%CI: 1.15; 1.40) and enrollment in night classes (PR = 1.44; 95%CI: 1.34; 1.54). Absence from physical education was reported by 48.6%; employment and older age were negatively associated with absence from physical education. Sedentary behavior was reported by 38.4%, but was less frequent in rural areas (PR = 0.52; 95%CI: 0.31; 0.83) and among those enrolled in absence from physical education (RP = 0.73; 95%CI: 0.56; 0.95). The results suggest interventions with specific strategies aimed at ameliorating each contributing factor. = O objetivo deste estudo foi analisar as prevalências e fatores associados à atividade física insuficiente, comportamento sedentário e ausência nas aulas de Educação Física em escolares do Ensino Médio. O questionário COMPAC (Comportamento do Adolescente Catarinense) foi respondido por 5.028 estudantes (15 a 19 anos), de escolas públicas de Santa Catarina, Sul do Brasil. Foram analisados comportamentos de risco, informações demográficas e sócio-econômicas. Utilizou-se regressão de Poisson para análises das associações. A prevalência de atividade física insuficiente foi de 28,5% e associou-se a um menor consumo de frutas/verduras (RP = 1,27; IC95%: 1,15-1,40) e estudo noturno (RP = 1,44; IC95%: 1,34-1,54). A prevalência de ausência nas aulas de Educação Física foi de 48,6% e associou-se negativamente à idade e com estar trabalhando (RP = 1,52; IC95%: 1,18-2,19). A prevalência de comportamento sedentário foi de 38,4%, atingindo menos os residentes de áreas rurais (RP = 0,52; IC95%: 0,31-0,83) e que participavam de uma ausência nas aulas de Educação Física semanal (RP = 0,73; IC95%: 0,56-0,95). Os resultados sugerem intervenções com estratégias específicas para cada comportamento analisado.Kelly Samara da Silva, Markus Vinícius Nahas, Karen Glazer Peres, Adair da Silva Lope

Medicolegal issues in labor analgesia

Within surgical disciplines, obstetrics and anesthesia carry a greater risk of medicolegal liability although with improved monitoring and practice standards issued by national scientific societies such as the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Anesthesiologists (ASA). Pain relief is becoming an area of concern. Analgesia refers to the relief of pain without the loss of consciousness. Modalities of analgesia during childbirth include regional analgesia, systemic opioid analgesia, continuous labor support, pudendal blocks, immersion in water during the first stage of labor, sterile water injections in the lumbosacral spine, hypnosis, and acupuncture [1]. Even though there are multiple options for labor pain management, women often experience pain during childbirth in accordance with their expectations. The ASA Closed Claims database [2] has shown that since the1990s the proportion of claims associated with general anesthesia has progressively declined while the proportion associated with regional analgesia has steadily increased although the majority of maternal injuries are minor (e.g., headache, back pain, pain during analgesia, neuropsychological consequences). In addition, [3] it reported that postnatal depression may be more common when analgesia is not used and pain during labor has been correlated with the development of posttraumatic stress disorder. Furthermore, men are also affected by severe labor pain. A survey of first-time fathers showed that the men whose partners received an epidural felt three times as helpful and involved during labor and delivery and had less anxiety and stress, as compared with men whose partners did not receive an epidural [3]. All these situations may reflect unrealistic expectations and dissatisfaction with parturient care, and litigation serves the purpose not only of reparation of injury and deterrence of standard of care but also of emotional vindication. This is especially true in Italy where labor analgesia is becoming an important public health issue with its introduction free of charge in SSN as LEA (Essential Levels of Assistance) (DPCM April 23, 2008, art. 37) but, at the same time, it is not performed in all hospitals [4] due to lack of funding. The problem is clear. Labor analgesia has to be considered an important aspect of the obstetric anesthesia practice, and the provision of adequate pain relief and management has foundation in the law of negligence. The law of medical negligence emphasizes taking reasonable care in all aspects of patient management and, with respect to this particular issue, doctors (the anesthetist as well as the obstetrician, midwife, neonatologist, and labor and delivery nurses) may breach their standard of care by failing to exchange information with the parturient and also with other members of the woman’s family as well as with the obstetric team; by failing to provide appropriate prenatal education and to acquire informed consent; by treating the pain inadequately or by failing to counteract adverse reaction and eventually perform acute resuscitation. © Springer International Publishing Switzerland 2015. © Springer International Publishing Switzerland 2015

A Method for Observing Physical Activity on Residential Sidewalks and Streets

Assessment of physical activity needs to improve in order to gain a more comprehensive understanding of the relationship between characteristics of the environment and physical activity. Our study evaluated a method [Block Walk Method (BWM)] for observing physical activity along residential sidewalks and streets. The BWM was utilized in 12 U.S. Census block groups over a three-month period. Examination transportation routes (ETRs), 1,524 m in length, were constructed and examined in each block group. On 6 days, ETRs were traversed by a trained observer for 50 min. Physical activities, street names, and geographical locations (e.g., addresses) were recorded. We found encouraging results for the BWM. The level of agreement between independent observers was >98% for activity type. The number of individuals seen walking, running, or biking did not differ significantly between the days of the week or observation times. The number of individuals observed was correlated with block group characteristics (e.g., percent walking/biking to work) and weather (e.g., temperature). The BWM is an easy to use, economically viable observational approach to obtaining reliable information concerning physical activities performed on residential streets and sidewalks. Its use could help advance our understanding about the environment–physical activity relationship

Disparities in urban neighborhood conditions: Evidence from GIS measures and field observation in New York city

Although many low-income urban areas are highly walkable by conventional measures such as population density or land use mix, chronic diseases related to lack of physical activity are more common among residents of these areas. Disparities in neighborhood conditions may make poor areas less attractive environments for walking, offsetting the advantages of density and land use mix. This study compared poor and nonpoor neighborhoods in New York City, using geographic information systems measures constructed from public data for US census tracts within New York City (N2,172) as well as field observation of a matched-pair sample of 76 block faces on commercial streets in poor and nonpoor neighborhoods. Poor census tracts had significantly fewer street trees, landmarked buildings, clean streets, and sidewalk cafes, and higher rates of felony complaints, narcotics arrests, and vehicular crashes. The field observation showed similar results. Improving aesthetic and safety conditions in poor neighborhoods may help reduce disparities in physical activity among urban residents. © 2009 Palgrave Macmillan Ltd