The importance of optimal 25-hydroxyvitamin D levels in the glycemic control of older adults with type 2 Diabetes Mellitus: Data from the study on aging and longevity EELO

Introduction: Optimal serum levels of vitamin D are of great importance, especially in populations with comorbidities such as Diabetes Mellitus (DM). Objective: The study evaluated the relationship between hypovitaminosis D and glycemic control in older adults with type 2 DM. Methods: Cross-sectional and prospective study, part of the EELO project (Study on Aging and Longevity), conducted in Southern Brazil. Glycated hemoglobin (diabetes ≥6.5%) and serum levels of vitamin D (25(OH)D) were evaluated. Hypovitaminosis D was determined using cutoff points <20 and <30 ng/mL). Multivariate logistic regression was used to assess the risk of having uncontrolled DM. Results: Of the 120 older adults included in the study, aged between 60 and 87 years, 74.2% were women, 66.7% used hypoglycemic medications and 75.8% exhibited uncontrolled diabetes. An inverse correlation was observed between the levels of 25(OH)D and glycated hemoglobin (rS=-0.19, p=0.037), suggesting that low levels of vitamin D are associated with poor glycemic control in diabetic individuals. The prevalence of hypovitaminosis D when using the cutoff points of <20 and <30 ng/mL were 34.2% and 75.0%, respectively. The odds ratio (OR) analysis showed that individuals with 25(OH)D<20ng/mL have almost 4 times more risk of having uncontrolled DM (OR:3.94; CI95%:1.25-12.46, p=0.02) when compared to the older adults with sufficient levels of vitamin D. Conclusion: The results indicate that the optimal serum levels currently recommended for 25(OH)D should preferably be 30 ng/mL or higher to contribute to better glycemic control in older adults with type 2 DM.

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Le planning familial au Mexique. Processus de formation d'une politique publique

Viviane Brachet-Marquez: Family planning in Mexico. Methods for the formation of public policy. What were the conditions which made it possible to establish a policy of family planning in Mexico? The author shows that the adoption of such a policy, far from being the result of public discussion of a social question, is the result of the existing compatibility beween the action of a group of professionals and academies and the personal projects of the president of Mexico. The relatively peaceful character of the application of the family planning programs stems from the fact that it involved merely bringing new elements into the health sector without affecting the established structures. Finally, the author insists on the importance of reinterpreting the impetus from abroad; indeed, one may speak of processes of exchange and negociation, since the groups which influenced the adoption of this policy did not simply convey information.Vivane Brachet-Marquez : Le planning familial au Mexique. Processus de formation d'une politique publique. Quelles sont les conditions qui ont permis la mise en œuvre de la politique de planning familial au Mexique ? L'auteur montre que l'adoption de cette politique, loin de résulter de la discussion publique d'une question sociale, est le fait de la compatibilité existant entre l'action d'un groupe de professionnels et d'universitaires et les projets personnels du président du Mexique. Le caractère relativement paisible de la mise en application des programmes de planning familial provient du fait qu'il était uniquement question d'apporter des éléments nouveaux au secteur de la santé sans affecter les structures déjà établies. Enfin, l'auteur insiste sur l'importance de la réinterprétation des impulsions provenant de l'étranger, les groupes qui ont influé sur l'adoption de cette politique n'ayant pas joué simplement le rôle de courroie de transmission, de telle façon qu'on peut parler de processus d'échange et de négociation.Brachet-Marquez Vivian. Le planning familial au Mexique. Processus de formation d'une politique publique. In: Sciences sociales et santé. Volume 3, n°1, 1985. pp. 9-34

Prevalence of risk factors for the occurrence of strokes in the elderly

Introduction: Stroke (CVA) is a multifactorial disease, where the combination of risk factors may be associated with and contribute to its development. Objectives: The objective of this study was to evaluate the prevalence of risk factors for stroke in the physically independent elderly in the city of Londrina, Brazil. Materials and methods: This study was composed of the elderly individuals participating in the EELO project (Age and Ageing Study, Londrina, State of Paraná, Brazil). In order to identify the risk factors for stroke, one used a structured questionnaire with information about socio-demographic and anthropometric data as well as lifestyle variables, such as physical inactivity and smoking, presence of comorbidities, and laboratory tests for diagnosis of diabetes and dyslipidemia. Results: The study included 454 elderly with mean age of 69.7 years. There was a significant relationship between the number of risk factors and gender (p = 0.01), with higher prevalence among women. In separate analysis, the elderly between 60 and 69 years had a higher incidence of obesity (p = 0.03) and dyslipidemia (p = 0.04). Regarding gender, obesity (p = 0.01), smoking (p = 0.0001), vascular disease (p = 0.0001) and heart disease in the family (p = 0.01) higher incidence was shown in females, according to Chi Squares test. Conclusions: It is concluded that elderly people aged less than 70 years and older women were those with the highest number of risk factors for CVA. Therefore, it may be suggested the development of primary care programs in order to promote information on the prevention of these risk factors and thus reduce the occurrence of stroke

Prevalence of risk factors for the occurrence of strokes in the elderly

Introduction Stroke (CVA) is a multifactorial disease, where the combination of risk factors may be associated with and contribute to its development. Objectives The objective of this study was to evaluate the prevalence of risk factors for stroke in the physically independent elderly in the city of Londrina, Brazil. Materials and methods This study was composed of the elderly individuals participating in the EELO project (Age and Ageing Study, Londrina, State of Paraná, Brazil). In order to identify the risk factors for stroke, one used a structured questionnaire with information about socio-demographic and anthropometric data as well as lifestyle variables, such as physical inactivity and smoking, presence of comorbidities, and laboratory tests for diagnosis of diabetes and dyslipidemia. Results The study included 454 elderly with mean age of 69.7 years. There was a significant relationship between the number of risk factors and gender (p = 0.01), with higher prevalence among women. In separate analysis, the elderly between 60 and 69 years had a higher incidence of obesity (p = 0.03) and dyslipidemia (p = 0.04). Regarding gender, obesity (p = 0.01), smoking (p = 0.0001), vascular disease (p = 0.0001) and heart disease in the family (p = 0.01) higher incidence was shown in females, according toChi Square’s test. Conclusions It is concluded that elderly people aged less than 70 years and older women were those with the highest number of risk factors for CVA. Therefore, it may be suggested the development of primary care programs in order to promote information on the prevention of these risk factors and thus reduce the occurrence of stroke

Improvement of heart rate variability after exercise training and its predictors in COPD

SummaryBackgroundCurrent literature lacks solid evidence on the improvement of heart rate variability (HRV) after exercise training in patients with COPD.ObjectivesWe aimed to investigate changes in HRV after two exercise training programs in patients with COPD and to investigate the determinants of these eventual changes.MethodsForty patients with COPD (FEV1 39±13%pred) were randomized into high (n=20) or low (n=20) intensity exercise training (3-month duration), and had their HRV assessed by the head-up tilt test before and after either protocols. Baseline spirometry, level of daily physical activity, exercise capacity, body composition, functional status, health-related quality of life and muscle force were also assessed to investigate the determinants of improvement in HRV after the training program.ResultsThere was a significant improvement in HRV only after the high-intensity protocol (pre versus post; SDNN 29±15ms versus 36±19ms; rMSSD 22±14ms versus 28±22ms; p<0.05 for both). Higher values of biceps brachialis strength, time spent walking in daily life and SDNN at baseline were determinants of improvement in HRV after the training program.ConclusionsHigh-intensity exercise training improves HRV at rest and during orthostatic stimulus in patients with COPD. Better baseline total HRV, muscle force and daily physical activity level are predictors of HRV improvements after the training program