Bone turnover markers for early detection of fracture healing disturbances: A review of the scientific literature

Imaging techniques are the standard method for assessment of fracture healing processes. However, these methods are perhaps not entirely reliable for early detection of complications, the most frequent of these being delayed union and non-union. A prompt diagnosis of such disorders could prevent prolonged patient distress and disability. Efforts should be directed towards the development of new technologies for improving accuracy in diagnosing complications following bone fractures. The variation in the levels of bone turnover markers (BTMs) have been assessed with regard to there ability to predict impaired fracture healing at an early stage, nevertheless the conclusions of some studies are not consensual. In this article the authors have revised the potential of BTMs as early predictors of prognosis in adult patients presenting traumatic bone fractures but who did not suffer from osteopenia or postmenopausal osteoporosis. The available information from the different studies performed in this field was systematized in order to highlight the most promising BTMs for the assessment of fracture healing outcome.As técnicas imagiológicas são o método convencional para a avaliação dos processos de cicatrização das fraturas. No entanto, estes métodos não são talvez totalmente confiáveis para a deteção precoce de complicações, as mais frequentes destas sendo o atraso da união e a não-união. Um diagnóstico eficaz destas desordens poderia prevenir a dor e a incapacidade prolongada do paciente. Esforços devem ser dirigidos no sentido do desenvolvimento de novas tecnologias para melhorar a exatidão no diagnóstico de complicações após fraturas ósseas. A variação nos níveis dos marcadores do turnover ósseo (BTMs) têm sido avaliados com vista à sua capacidade para prever o comprometimento da cicatrização das fraturas numa fase inicial, no entanto, as conclusões de alguns estudos não são consensuais. Neste artigo os autores fizeram uma revisão do potencial dos BTMs como fatores de previsibilidade precoce do prognóstico em doentes adultos que apresentavam fraturas ósseas traumáticas mas que não sofriam de osteopenia ou osteoporose pós-menopausa. A informação disponível nos diferentes estudos realizados neste campo foi sistematizada com vista a evidenciar-se os BTMs mais promissores para a avaliação da evolução da cicatrização das fraturas.SFRH/BD/45018/200

Ending intimate partner violence after pregnancy : findings from a community-based longitudinal study in Nicaragua

BACKGROUND: Although reducing intimate partner violence (IPV) is a pervasive public health problem, few longitudinal studies in developing countries have assessed ways to end such abuse. To this end, this paper aims to analyze individual, family, community and societal factors that facilitate reducing IPV. METHODS: A longitudinal population-based study was conducted in León, Nicaragua at a demographic surveillance site. Women (n = 478) who were pregnant between 2002 and 2003 were interviewed, and 398 were found at follow-up, 2007. Partner abuse was measured using the WHO Multi-country study on women's health and domestic violence questionnaire. Women's socio demographic variables, perceived emotional distress, partner control, social resources, women's norms and attitudes towards IPV and help-seeking behaviours were also assessed. Ending of abuse was defined as having experienced any abuse in a lifetime or during pregnancy but not at follow-up. Crude and adjusted odds ratios were applied. RESULTS: Of the women exposed to lifetime or pregnancy IPV, 59% reported that their abuse ended. This finding took place in a context of a substantial shift in women's normative attitudes towards not tolerating abuse. At the family level, no or diminishing partner control [ORadj 6.7 (95%CI 3.5-13)] was associated with ending of abuse. At the societal level, high or improved social resources [ORadj 2.0 (95%CI 1.1.-3.7)] were also associated with the end of abuse. CONCLUSION: A considerable proportion of women reported end of violence. This might be related to a favourable change in women's norms and attitudes toward gender roles and violence and a more positive attitude towards interventions from people outside their family to end abuse. Maintaining and improving social resources and decreasing partner control and isolation are key interventions to ending abuse. Abuse inquiring may also play an important role in this process and must include health care provider's training and a referral system to be more effective. Interventions at the community level are crucial to reducing partner violence

A review on macrobenthic trophic relationships along subtropical sandy shores in southernmost Brazil

Main trophic relationships that occur along the exposed sandy shores in southernmost Brazil (,336 S) are established taking into account several biological compartments operating at morphodynamically distinct environments. Beaches are predominantly of the intermediate type but some stretches of coastline are truly dissipative (Cassino Beach) or tending-to-reflective (Concheiros Beach), presenting thus diverse biological compartments and inhabitant macrobenthic assemblages. Dense concentrations of the surf-zone diatom Asterionellopsis glacialis are responsible - at least for the intermediate shorelines - for the most year-round primary production, sustaining several consumers up to tertiary level. Among them, bivalves Amarilladesma mactroides, Donax hanleyanus and the hippid crab Emerita brasiliensis can account for more than 95% of all the surf-zone secondary production, in addition to the elevated biomass of the suspension-feeder polychaete Spio gaucha and the scavenger isopod Excirolana armata. Crabs, whelks, carnivorous polychaetes, seabirds and surf-zone fishes may also be present and occupy superior trophic levels depending on the beach morphodynamics. Based on the high species richness, abundance and the role of macrobenthic fauna in transferring matter and energy to seabirds and the surf-zone fish assemblages, we address this important issue on the Southwestern Atlantic ecology. Conservation efforts should be implemented for the southernmost Brazilian sandy shores, at least for those non urbanized areas.As principais relac¸o˜ es tro´ ficas observadas ao longo da costa arenosa exposta do extremo sul do Brasil (,336 S) sa˜o estabelecidas levando-se em considerac¸a˜o os va´ rios compartimentos biolo´ gicos que operam em ambientes morfodinamicamente distintos. Estas praias sa˜o predominantemente do tipo intermedia´ rio, embora alguns trechos sejam dissipativos (Praia do Cassino) ou apresentem tendeˆncias reflectivas (Praia dos Concheiros), possuindo compartimentos biolo´ gicos diversificados e associac¸o˜es macrobentoˆnicas residentes. Densas concentrac¸o˜ es da diatoma´cea Asterionellopsis glacialis sa˜o responsa´ veis - pelo menos para as praias intermedia´ rias - por grande parte da produtividade prima´ ria anual, sustentando va´ rios consumidores ate´ o nı´vel tercia´ rio. Entre estes, os bivalves Amarilladesma mactroides, Donax hanleyanus e o crusta´ceo Emerita brasiliensis sa˜o responsa´ veis por mais de 95% de toda a produc¸a˜o secunda´ ria da zona de surfe, em adic¸a˜o a` elevada biomassa do poliqueta suspensı´voro Spio gaucha e do iso´pode necro´fago Excirolana armata. Caranguejos, gastro´ podes, poliquetas carnı´voros, aves marinhas e peixes da zona de surfe tambe´m podem estar presentes, ocupando nı´veis tro´ ficos superiores dependendo da morfodinaˆmica praial. Baseado na alta riqueza de espe´cies, na abundaˆncia e no papel da macrofauna bentoˆ nica em transferir mate´ria e energia para as aves marinhas e as assemble´ias de peixes da zona de surfe, esta importante questa˜o ecolo´ gica do Atlaˆntico Sudoeste foi investigada. Esforc¸os de conservac¸a˜o devem ser implementados nas praias arenosas do extremo sul do Brasil, pelo menos naquelas a´ reas na˜o urbanizadas