Osteoporosis and Falls: Problems Overlooked by the Portuguese Medical Community

Introdução: A prevalência da osteoporose continua a aumentar, aumentando a morbimortalidade associada às fraturas osteoporóticas, na maioria resultantes de queda, sendo a fratura do fémur proximal a de maior impacto socioeconómico. O nosso objetivo foi caracterizar uma amostra da população hospitalar com fratura do fémur proximal quanto a medidas preventivas e terapêuticas da osteoporose e quedas. Material e Métodos: Realizámos um estudo transversal retrospetivo em mulheres com idade mínima de 65 anos e fratura recente do fémur proximal internadas num serviço de Ortopedia, durante um ano, através de questionário desenvolvido para o efeito e consulta do processo clínico. Resultados: Avaliámos 100 doentes, a maioria com fratura decorrente de queda, no domicílio, durante o dia e em piso regular; 76% das doentes tinha antecedentes de queda e 42% história prévia de fratura osteoporótica. Considerando os critérios para instituição terapêutica apenas 5,3% da amostra se encontrava medicada. Verificou-se a existência de uma associação estatisticamente significativa entre a ocorrência de quedas e as fraturas osteoporóticas bem como com a implementação de medidas de prevenção do risco de queda. Conclusão: os resultados corroboram a importância das quedas e das fraturas osteoporóticas na saúde. Tendo por base a literatura, os custos diretos estimados com esta amostra serão de 1,34 M€ no primeiro ano pós-fratura. Considerando a taxa mínima de cobertura terapêutica e o potencial de redução de risco fraturário estabelecido, conclui-se que um tratamento adequado poderia reduzir estes valores em, no mínimo, 40%-45%.info:eu-repo/semantics/publishedVersio

Risco de câncer de pulmão, laringe e esôfago atribuível ao fumo

OBJECTIVE:Lung, laryngeal and esophageal cancers have smoking as one of their main risk factors. The objective of this study was to evaluate the population attributed risk (PAR) of smoking for these forms of cancer. METHODS: The study was based in three case-control studies conducted in medium size cities in Brazil. Incident cases of lung cancer, laryngeal cancer and esophageal cancer seen at a hospital setting and diagnosed through biopsy were analyzed; controls were hospitalized patients with another diagnoses. Smoking was the exposure factor measured at three levels: non-smokers, former smokers and smokers, which were defined using a questionnaire applied by trained interviewers. For effect measure, odds ratio was used and the populational attributed risk for smoking was then calculated for a 95% CI. RESULTS: A total of 122 lung cancer cases and 244 controls, 50 cases of laryngeal cancer and 48 cases of esophageal cancer, and 96 controls for both of them were studied. The prevalence of smoking exposure was 34%, which is the overall prevalence of smoking in this city's adult population. Odds ratios (OR) for the PAR analysis were the adjusted OR for confounding variables from each study. Lung cancer PAR was 63% (95% IC, 0.58-0.68) for former smokers and 71% (95%IC, 0.65-0.77) for smokers. Larynx cancer PAR was 74% (95% IC, 0.70-0.78) and 86% (95%IC, 0.81-0.85) for former smokers and smokers, respectively. Esophageal cancer PAR was 54% (95%IC, 0.46-0.62) for smokers. CONCLUSION: Smoking is an avoidable risk factor and smoking cessation could be responsible for significant reductions in the incidence of these three forms of cancer.OBJETIVO: Os tipos de câncer de pulmão, laringe e esôfago têm como um de seus principais fatores de risco o fumo. O objetivo do estudo foi avaliar o risco populacional atribuível ao fumo nesses tipos de câncer. MÉTODOS: A pesquisa baseou-se em três estudos de caso-controle em cidade de médio porte do Brasil. Analisaram-se casos incidentes hospitalares de câncer de pulmão, de laringe e de esôfago diagnosticados por biópsias; os controles foram pacientes hospitalizados por outros motivos, sem ser câncer ou doenças altamente relacionadas ao fumo. O fator de exposição foi o tabagismo medido em três níveis: não-fumantes, ex-fumantes e fumantes atuais, definidos por meio de questionários aplicados por entrevistadores treinados. Para a medida de efeito, foi utilizado o odds ratio obtendo-se, dessa forma, o "risco populacional atribuível" ao fumo com IC de 95%. RESULTADOS: Foram estudados 122 casos e 244 controles de câncer de pulmão, 50 casos de câncer de laringe e 48 casos de câncer de esôfago, com um grupo de 96 controles comum a ambos. A prevalência da exposição ao fumo utilizada para a análise foi de 34%, que corresponde à prevalência de fumo na população adulta da cidade. Os odds ratios para o cálculo do risco populacional atribuível foram obtidos por análises ajustadas para os fatores de confusão de cada um dos estudos. Para ex-fumantes com câncer de pulmão, o risco populacional atribuível foi de 63% (IC95%, 0,58-0,68) e, para fumantes, de 71% (IC95%, 0,65-0,77). Para câncer de laringe, o RPA foi de 74% (IC95%, 0,70-0,78) para ex-fumantes e de 86% (IC95%, 0,81-0,85) para fumantes. O câncer de esôfago mostrou um risco de 54% (IC95%, 0,46-0,62) para fumantes. CONCLUSÃO: Conclui-se que o fumo é um importante fator de risco e que a cessação do mesmo contribuiria para reduções significativas na incidência de câncer nesses três sítios

Brazil in the Era of Fascism: The “New State” of Getúlio Vargas

The New State established in Brazil by Getúlio Vargas (1937–1945) is the most important case of the institutionalisation of a dictatorship of the fascism era in Latin America. During this time, an impressive spectrum of authoritarian regimes was established, some of which were very instable and poorly institutionalised, while others were more consolidated. Roger Griffin coined the concept of para-fascism for some of them, and the “New State” of Getúlio Vargas in Brazil is a paradigmatic case. In this essay, we analyse the processes of institutional reform in 1930s Brazil paying particular attention to how domestic political actors look at institutional models of fascism and corporatism.info:eu-repo/semantics/publishedVersio

A comparative analysis of the chemical compositions of Gaia-Enceladus/Sausage and Milky Way satellites using APOGEE

We use data from the 17th data release of the Apache Point Observatory Galactic Evolution Experiment (APOGEE 2) to contrast the chemical composition of the recently discovered Gaia Enceladus/Sausage system (GE/S) to those of ten Milky Way (MW) dwarf satellite galaxies: LMC, SMC, Boötes I, Carina, Draco, Fornax, Sagittarius, Sculptor, Sextans and Ursa Minor. Our main focus is on the distributions of the stellar populations of those systems in the [Mg/Fe]-[Fe/H] and [Mg/Mn]-[Al/Fe] planes, which are commonly employed in the literature for chemical diagnosis and where dwarf galaxies can be distinguished from in situ populations. We show that, unlike MW satellites, a GE/S sample defined purely on the basis of orbital parameters falls almost entirely within the locus of ‘accreted’ stellar populations in chemical space, which is likely caused by an early quenching of star formation in GE/S. Due to a more protracted history of star formation, stars in the metal-rich end of the MW satellite populations are characterized by lower [Mg/Mn] than those of their GE/S counterparts. The chemical compositions of GE/S stars are consistent with a higher early star formation rate than MW satellites of comparable and even higher mass, suggesting that star formation in the early universe was strongly influenced by other parameters in addition to mass. We find that the direction of the metallicity gradient in the [Mg/Mn]–[Al/Fe] plane of dwarf galaxies is an indicator of the early star formation rate of the system

Development and validation of the Multi-dimensional University Research Workplace Inventory (MDURWI)

WOS:000454839600005This study describes the development and validation of an instrument aimed toward measuring organizational features of an academic research workplace. The question pool was developed based on data from a pilot study (N = 43). The survey was deployed to academic researchers in the field of higher education research worldwide (N = 850). An exploratory factor analysis conducted on 36 questions, followed by confirmatory factor analysis, which lead to a final pool of 27 questions in five subscales, one of which divided into three lower-order factors. The final model exhibited very good fit (X2/df = 2.561; CFI = 0.972; PCFI = 0.784; RMSEA = 0.043; P[rmsea ? 0.05] < 0.001; AIC = 891.018; BCC = 987.839) and psychometric properties, in the form of factorial, convergent, and discriminant validity, as well as reliability and sensitivity. Implications of this instrument for research and policymaking are discussed, as well as future research directions.info:eu-repo/semantics/acceptedVersio

An enquiry on the origins of N-rich stars in the inner Galaxy based on APOGEE chemical compositions

Recent evidence based on APOGEE data for stars within a few kpc of the Galactic Centre suggests that dissolved globular clusters (GCs) contribute significantly to the stellar mass budget of the inner halo. In this paper, we enquire into the origins of tracers of GC dissolution, N-rich stars, that are located in the inner 4 kpc of the Milky Way. From an analysis of the chemical compositions of these stars, we establish that about 30 per cent of the N-rich stars previously identified in the inner Galaxy may have an accreted origin. This result is confirmed by an analysis of the kinematic properties of our sample. The specific frequency of N-rich stars is quite large in the accreted population, exceeding that of its in situ counterparts by near an order of magnitude, in disagreement with predictions from numerical simulations. We hope that our numbers provide a useful test to models of GC formation and destruction

Evidence from APOGEE for the presence of a major building block of the halo buried in the inner Galaxy

We report evidence from APOGEE for the presence of a new metal-poor stellar structure located within ∼4 kpc of the Galactic Centre. Characterized by a chemical composition resembling those of low-mass satellites of the Milky Way, this new inner Galaxy structure (IGS) seems to be chemically and dynamically detached from more metal-rich populations in the inner Galaxy. We conjecture that this structure is associated with an accretion event that likely occurred in the early life of the Milky Way. Comparing the mean elemental abundances of this structure with predictions from cosmological numerical simulations, we estimate that the progenitor system had a stellar mass of ∼5 × 108 M⊙, or approximately twice the mass of the recently discovered Gaia-Enceladus/Sausage system. We find that the accreted:in situ ratio within our metal-poor ([Fe/H] < –0.8) bulge sample is somewhere between 1:3 and 1:2, confirming predictions of cosmological numerical simulations by various groups