Níveis de calcidiol e manutenção da função muscular, capacidade funcional e densidade mineral óssea em uma população espanhola não selecionada.

Introduction: Vitamin D has beneficial effects that supposedly contribute to the maintenance of musculoskeletal function. Objective: To analyze in an unselected population the effect of calcidiol levels on the muscular function of both hands, on the activities of daily living and on changes in bone mineral density (BMD). Material and methods: The cohort of the EVOS study was used, which performed, among others, measurements of muscle strength of grasping both hands, questions related to the difficulty in performing daily activities, densitometric study of the lumbar and hip spine and biochemistry for determination calcidiol levels. Results: Calcidiol values ​​≥20 ng / mL were associated with increased grip muscle strength in both hands. After adjusting for age, sex, BMI and seasonality, calcidiol levels <20 ng / mL were independently associated with decreased muscle grip strength only in the left hand (OR = 2.35, 95% CI 1.03 -5, 38) Likewise, the inability or difficulty in "picking up a book or object on a high shelf" and "getting out of bed" was significantly associated with calcidiol levels <20 ng / mL. Calcidiol levels <20 ng / mL were associated with greater losses of BMD in the femoral neck and in the total hip. These associations were maintained in the multivariate analysis. Conclusions: The maintenance of calcidiol levels ≥20 ng / mL was associated with greater muscle grip strength in the hands, maintenance of daily activities and less loss of BMD in the hip. This study corroborates the usefulness of maintaining adequate levels of vitamin D to maintain musculoskeletal function.Introdução: A vitamina D tem efeitos benéficos que supostamente contribuem para a manutenção da função músculo-esquelética. Objetivo: Analisar em uma população não selecionada o efeito dos níveis de calcidiol na função muscular de ambas as mãos, nas atividades da vida diária e nas alterações na densidade mineral óssea (DMO). Material e métodos: Utilizou-se a coorte do estudo EVOS, que realizou, entre outras, medidas de força muscular de preensão nas duas mãos, questões relacionadas à dificuldade na realização das atividades diárias, estudo densitométrico da coluna lombar e quadril e bioquímica para determinação dos níveis de calcidiol. Resultados: Valores de calcidiol ≥20 ng / mL foram associados ao aumento da força muscular de preensão em ambas as mãos. Após o ajuste para idade, sexo, IMC e sazonalidade, os níveis de calcidiol <20 ng / mL foram associados de forma independente à diminuição da força de preensão muscular apenas na mão esquerda (OR = 2,35, IC 95% 1,03-5, 38) Da mesma forma, a incapacidade ou dificuldade em "pegar um livro ou objeto em uma prateleira alta" e "sair da cama" foi significativamente associada a níveis de calcidiol <20 ng / mL. Níveis de calcidiol <20 ng / mL foram associados a maiores perdas de DMO no colo do fêmur e no quadril total. Essas associações foram mantidas na análise multivariada. Conclusões: A manutenção de níveis de calcidiol ≥20 ng / mL foi associada a maior força de preensão muscular nas mãos, manutenção das atividades diárias e menor perda de DMO no quadril. Este estudo corrobora a utilidade de manter níveis adequados de vitamina D para manter a função músculo-esquelética

Impact of a multifaceted intervention to improve the clinical management of osteoporosis. The ESOSVAL-F study

<p>Abstract</p> <p>Background</p> <p>A study to evaluate the impact of a combined intervention (in-class and on-line training courses, a practicum and economic incentives) to improve anti-osteoporosis treatment and to improve recordkeeping for specific information about osteoporosis.</p> <p>Methods/design</p> <p>A before/after study with a non-equivalent control group to evaluate the impact of the interventions associated with participation in the ESOSVAL-R cohort study (intervention group) compared to a group receiving no intervention (control group). The units of analysis are medical practices identified by a Healthcare Position Code (HPC) referring to a specific medical position in primary care general medicine in a Healthcare Department of the Region of Valencia, Spain. The subjects of the study are the 400 participating "practices" (population assigned to health care professionals, doctors and/or nurses) selected by the Healthcare Departments of the Valencia Healthcare Agency for participation as associate researchers in the ESOSVAL-R study (intervention group), compared to 400 participating "practices" assigned to primary care professionals NOT selected for participation as associate researchers in the ESOSVAL-R study, who are selected on the basis of their working in the same Healthcare Centers as the practices receiving the interventions (control group). The study's primary endpoint is the appropriateness of treatment according by the Spanish National Health System guide (2010) and the National Osteoporosis Foundation (NOF, 2008) and International Osteoporosis Foundation guidance (IOF, 2008).</p> <p>The study will also evaluate a series of secondary and tertiary endpoints. The former are the suitability of treatment and evaluation of the risk of fracture; and the latter are the volume of information registered in the electronic clinical records, and the evaluation of risks and the suitability of treatment.</p

"Bomba hormonal": os riscos da contracepção de emergência na perspectiva dos balconistas de farmácias no Rio de Janeiro, Brasil

Resumo: A pesquisa objetivou conhecer a perspectiva dos balconistas de farmácias sobre a contracepção de emergência na Região Metropolitana do Rio de Janeiro, Brasil. O material empírico advém de pesquisa socioantropológica com vinte entrevistas semiestruturadas com balconistas dos sexos feminino (8) e masculino (12). Os entrevistados apresentam concepções negativas sobre a contracepção de emergência, enfatizando os riscos que ela pode provocar à saúde. O medicamento é considerado uma "bomba hormonal" que pode causar danos aos órgãos reprodutivos femininos e outros sistemas do corpo. Eles destacam os riscos do uso "descontrolado" ou "indiscriminado", especialmente por adolescentes e mulheres jovens. Por ser considerado "perigoso" aos corpos femininos, eles atribuem a responsabilidade de orientação e aconselhamento sobre o uso do método aos médicos ginecologistas e não aos farmacêuticos. Discute-se a necessidade de ampliação do debate público sobre contracepção de emergência no Brasil, incluindo-se os farmacêuticos e balconistas de farmácia, além dos profissionais de saúde e educadores

TOI-1759 b: A transiting sub-Neptune around a low mass star characterized with SPIRou and TESS

Stars and planetary system

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden